[pt] Apresenta-se uma visão gerencial para o procedimento de projeto de suspensões de veículos terrestres. São descritos, em linhas gerais, os principais aspectos técnicos relativos ao projeto deste sub-sistema veicular, e tratados, com detalhes, os tópicos fundamentais para a sua administração. Discute-se, entre outras, as etapas de especificação do projeto, quesitos necessários, normas a serem aplicadas, e as etapas a cumprir, segundo a visão do gerente administrativo do projeto, responsável pela organização do grupo de técnicos que irá desenvolvê-lo. / [en] It is shown a managerial vision of the ground vehicles suspension design procedure. Are described, in general lines, the main technical aspects related to the design of this vehicular sub-system, and treats, with details, the fundamental topics for its administration. It is discussed, beside others, the design specification stages, necessary requirements, norms to be applied, and the stages to accomplish, according to the vision of the administrative design manager, responsible for the organization of the technicians' group that will develop it.

A tuberculose multirresistente (TBMR) - resistência simultânea a rifampicina e isoniazida, principais fármacos do esquema de tratamento da tuberculose (TB), gera mais ônus aos doentes e aos Serviços de Saúde, pois acarreta maiores custos, aumenta o tempo de tratamento e relaciona-se a prognósticos desfavoráveis. A TBMR ocorre devido à falha em algum princípio do tratamento, seja por parte dos profissionais e serviços de saúde, seja por questões ligadas ao doente. Frente a isso, o presente estudo objetivou identificar e analisar as condições de produção da TBMR relacionadas ao doente e seu entorno. Esta investigação foi realizada junto aos sujeitos em seguimento em um hospital de referência do interior paulista, entre janeiro de 2010 a janeiro de 2012. Foi utilizada a abordagem qualitativa. Por meio da análise dos prontuários médicos do serviço terciário, caracterizamos o universo do estudo - composto por todos os doentes já seguidos pela instituição, descrevendo e analisando dados sociodemográficos e clínicos correspondentes. Caracterizamos, também, a amostra estudada, formada por oito doentes de TBMR em seguimento, detalhando seu contexto de vida e trajetória com a doença, assim como a estruturação municipal para seu acompanhamento. A segunda etapa do trabalho constituiu na análise das percepções dos sujeitos a cerca do adoecimento por TB e pela forma MR. Os dados foram coletados por meio de entrevistas semi-estruturadas, gravadas e transcritas na íntegra. Os textos resultantes constituíram o corpus do estudo, organizado com recurso do software Atlas. Ti versão 7.0 e analisado sob o referencial teórico da Análise de Discurso, de matriz francesa. Os resultados da investigação baseiam-se na análise de três aspectos: percurso diagnóstico - em que é apontadas a percepção da doença e dos sintomas, as histórias pessoais e familiares do adoecimento por TB, o desenvolver até a obtenção do diagnóstico e as histórias de fracasso dos tratamentos convencionais; tratamento e acompanhamento dos casos MR - momento em que são discutidas questões ligadas a percepção do tratamento pelos doentes, as modalidades de supervisão empreendidas, os instrumentos e insumos fornecidos, além do apoio da rede familiar; coordenação da assistência - em que são analisadas as nuances da relação entre os diferentes serviços envolvidos na atenção ao doente, tanto dentro do mesmo nível assistencial quanto em sua intersecção com a atenção terciária, a fim de compreender suas fragilidades e promover as potencialidades para o tratamento dos sujeitos. Essas condições de produção mostraram-se complexas, ao passo que sofrem influência das peculiaridades da forma como os serviços locais de atenção organizando-se para atender esses doentes, além de questões relacionadas à trajetória de vida e doença desses sujeitos, apontando para a necessidade de ampliação do espaço de negociação dentro do sistema de saúde. / Multidrug-resistant tuberculosis - simultaneous resistance to rifampicin and isoniazid, the main drugs in the treatment for tuberculosis (TB), generates more onuses to patients and Health Services because it involves higher costs, increases the treatment time and relates to the unfavorable outcomes. MDR-TB occurs due to failure in some treatment principles, either by professionals and health services, or by patient issues. Concerning this, the present study aimed to identify and analyze the conditions of MDR-TB production related to the patients and their surroundings. This investigation was conducted with the subjects followed up in a referral hospital in São Paulo State, between January 2010 and January 2012. It was used a qualitative approach. By analyzing the medical records of the tertiary service, we characterized the universe of the study - consisting of all patients who were already followed by the institution, describing and analyzing the demographic and clinical data matching. We also characterized the sample, formed by eight MDR-TB patients in follow-up, detailing the context of their lives and the disease trajectory, as well as the municipal structure to monitor them. The second stage of the work consisted of analyzing the subjects\' perceptions about TB development and MR strain. Data was collected through semi-structured interviews which were recorded and fully transcribed. The resulting texts constituted the corpus of the study, organized using the Atlas.Ti software version 7.0 and analyzed from the theoretical framework of Discourse Analysis of French matrix. The results are based on analysis of three aspects: The first is diagnosis route - which shows the disease and symptoms perception of the patient, personal and family histories of TB development, the disease development until the diagnosis, and the failed conventional treatment stories. The second aspect was treatment and monitoring of MDR cases - when cases are discussed we focused on the following aspects: perceptions of treatment by patients, undertaken methods of supervision, instruments and inputs provided, and the familiar support network. The third is assistance coordination - where the nuances of the relationship between several departments involved in the patient care are analyzed, within the same care level as well as its intersection with tertiary care in order to understand their weaknesses and promote the potential treatments for the subjects. These production conditions proved to be complex whereas the local care services peculiarities influence the way they are organized to assist these patients, as well as aspects related to life and illness trajectory of these subjects, indicating the need of expanding the negotiation space within the health system

Despite significant progress in GPS/INS integration-based direct geo-referencing (DGR) technology over the past decade, its performance still needs to be improved in terms of accuracy and tolerance to GPS outages. This is mainly due to the limited geometric strength of the GPS satellite constellation, the quality of INS and the system integration technology. This research is focused on pseudolite (PL) augmentation to enhance the geometric strength of the GPS satellite constellation, and the Neural Network (NN) aided Kalman filter (KF) system integration algorithm to improve the geo-referencing system's performance during GPS outages. The main research contributions are summarized as below: a) Systematic errors introduced by pseudolites have been investigated. Theoretical and numerical analyses reveal that errors of troposphere delay modelling, differential nonlinearity and pseudolite location are sensitive to pseudolite receiver geometry. Their effect on final positioning solutions can be minimised by selecting optimal pseudolite and receiver locations, which is referred to as geometry design. Optimal geometry design for pseudolite augmented systems has been proposed based on simulation results in airborne surveying scenarios. b) Nonlinear geometry bias, or nonlinearity, exists in single difference processes when the unit vectors from the reference and user receivers to a satellite or pseudolite are non-parallel. Similar to long baseline differential GPS (DGPS), nonlinearity is a serious issue in pseudolite augmentation. A Projected Single Difference (PSD) method has been introduced to eliminate nonlinear geometry bias. An optimized expression has been derived to calculate the direction of project vectors, and the advantages of applying PSD in pseudolite augmented airborne DGPS have been demonstrated. c) A new method for pseudolite tropospheric delay modelling has been proposed, which is based on single-differenced GPS tropospheric delay models. The performance of different models has been investigated through simulations and field testing. The advantages and limitations of each method have been analysed. It is determined that the Bouska model performs relatively well in all ranges and elevations if the meteorological parameters in the models can be accurately collected. d) An adaptive pseudolite tropospheric delay modelling method has been developed to reduce modelling error by estimating meteorological parameters in real-time, using GPS and pseudolite measurements. Test results show that pseudolite tropospheric delay modelling errors can be effectively mitigated by the proposed method. e) A novel geo-referencing system based on GPS/PL/INS integration has been developed as an alternative to existing GPS/INS systems. With the inclusion of pseudolite signals to enhance availability and geometry strength of GPS signals, the continuity and precision of the GPS/INS system can be significantly improved. Flight trials have been conducted to evaluate the system performance for airborne mapping. The results show that the accuracy and reliability of the geo-referenced solution can be improved with the deployment of one or more pseudolites. f) Two KF and NN hybrid methods have been proposed to improve geo-referenced results during GPS outages. As the KF prediction diverges without measurement update, the performance of a GPS/INS integrated system degrades rapidly during GPS outages. Neural networks can overcome this limitation of KF. The first method uses NN to map vehicle manoeuvres with KF measurement in a loosely coupled GPS/INS system. In the second method, an NN is trained to map INS measurements with selected KF error states in a tightly coupled GPS/INS system when GPS signals are available. These training results can be used to modify KF time updates. Optimal input/output and NN structure have been investigated. Field tests show that the proposed hybrid methods can dramatically improve geo-referenced solutions during GPS outages.

This paper exposes the problems and challenges organizations face when integrating aged systems, web based systems and web services. The paper focuses on how people with different titles in an organization experience systems integration and the factors that contribute to project failure or success. The research methodology used in this is Grounded Theory and the resulting theory of this paper has taken form through the coding of transcribed interviews, which have gone through a constant comparing to other theories in the area of interest, mostly articles about success factors in system integration. The resulting outcome is a success model aimed to describe the underlying indicators to achieve project success. The success model consists of three factors that contribute to success in integration projects. The factors are: globalization, governance and balance. Integration projects are very complex in nature, more so than normal projects as there are more stakeholders involved and more interests to take into consideration. Due to the complex nature of integration projects, the need for a holistic view arises. It's crucial for an integration project that stakeholders take the interests and needs of other projects taking place simultaneously into consideration. The governance aspect of systems integration deals with the planning of strategies, communication and cooperation with other stakeholders involved within the integration project. It's crucial for integration projects to shift focus from individual goals and individual interest to mutual goals and interests. The third and final factor contributing to success in integration projects is balance. The balance between technical issues and organizational issues is crucial for the success of projects. It's very common that organizations focus on technical issues and neglect the organizational issues.

Tai yra verslas verslui užsakymų valdymo architektūrinių sprendimų tyrimas. Sukurtoje platformoje kompanijos gali komunikuoti tarpusavyje, sudaryti užsakymus, keistis bylomis bei dokumentais, ieškoti kitų paslaugų tiekėjų ir gauti informaciją apie juos. Pasitikėjimas tarp įmonių yra labai svarbus, o ši platforma padeda tai pasiekti. Bendravimas su klientais ir tiekėjais paprastai užima daug laiko ir reikalauja naudoti daug skirtingų įrankių, pavyzdžiui, el. paštą, telefoninius skambučius, Skype, ryšių su klientais valdymo sistemas ir t. t. Šio sprendimo idėja yra į vieną vietą sutraukti visus svarbiausius įrankius ir palengvinti kasdienį vadybininkų darbą. Aukštos kokybės paslaugų užtikrinimui reikalinga integracija su kitomis išorinėmis verslo valdymo sistemomis, o kad tai būtų pasiekta, reikalingos saityno tarnybos. Siekiant išsiaiškinti, kokios tarnybos ir jų konfigūracijos geriausiai tinka šiam tikslui pasiekti, buvo atliktas tyrimas ir eksperimentas, kurie aprašyti šiame dokumente. Šį dokumentą sudaro trys pagrindinės dalys. Pirmojoje dalyje aprašoma galimų sprendimų analizė ir saityno tarnybų savybių tyrimas. Antrojoje dalyje aprašoma sukurta platforma, jos aktualumas ir funkcionalumas. Taip pat pateikiamos vartotojo sąsajos, panaudojimo atvejų schemos ir klasių diagrama. Šioje dalyje atsakoma į klausimus, kodėl vartotojai turėtų pasirinkti būtent šią platformą ir kokias problemas ji sukurta spręsti. Paskutiniojoje dalyje aprašomas eksperimentas, kuriuo buvo nustatomas... [toliau žr. visą tekstą] / This is a research on architectural solutions of business to business orders management systems. It’s a B2B platform where different companies can communicate, exchange orders and documents and search for other providers. Trust building is important for all companies and this platform can help to make it happen. Communication between companies requires a lot of time and use of different tools, e.g. email, phone calls, Skype, file storage places, CRMs and so on. Idea is to implement all necessary equipment in one place and let managers to do their daily work easier. To provide high quality services it’s important to ensure good communication between platform and outside business management systems. There was made a research for which are the best fitting solutions to be integrated as web services. This document is consisted of three major parts. First part describes analysis of available solutions and research of web services technology. Second part describes developed project and its features. There is user interface, use case, data structures and competitors review. This is whole about project and why it would be good choice for our targeted audience. The last part describes the research that was done during this project. It was essential to determine which protocol and data models are most efficient. For this project there were created two additional applications - one as web service and other one as a client. Client application sent requests to service and calculated its... [to full text]

Integration ist eine fortwährende Aufgabe in betrieblichen Informationssystemen. Durch den Einsatz verschiedener personeller und maschineller Aufgabenträger kommt es zu wiederkehrenden Integrationsproblemen, die vorrangig durch externe Dienstleister gelöst werden. Das zentrale Problem dieser Arbeit ist, dass in der Wissenschaft diskutiertes Lösungswissen in Form von Mustern existiert, aber keinen Eingang in die Praxis findet. Um dieses Problem zu untersuchen, wurde eine qualitative empirische Untersuchung durchgeführt, welche erstmals im deutschsprachigen Raum Wirkungszusammenhänge und Entscheidungsmechanismen in Integrationsprojekten analysiert. Als Ergebnis der qualitativen Erhebung kann festgehalten werden, dass dem Dienstleistungscharakter der Integration bisher zu wenig Beachtung geschenkt wurde und dass Integrationsmuster nicht eingesetzt werden, weil der Abstraktionsgrad des so konservierten Lösungswissens nicht zum Abstraktionsgrad der Problemstellungen passt. Deshalb definiert die Arbeit zunächst ein Dienstleistungsmodell der Integration, welches sich auf die empirische Untersuchung stützt. Danach wird auf der Grundla-ge einer eigenschaftsbasierten Definition von Integrationsmustern eine Grundmenge an Mustern aus der Literatur extrahiert, die weiter abstrahiert werden. Als Abstraktionsprinzipien werden die Klassifikation und die Generalisierung eingesetzt. Abstrakte Integrationsmuster können als Ressourcen in ein Dienstleistungsmodell eingehen. Für die Klassifikation wurde ein erweiterbares und flexibles Klassifikationsverfahren – die Facettenklassifikation – gewählt. Diese ermöglicht jederzeit das Hinzufügen weiterer Facetten. Die Einordnung eines Musters muss nur innerhalb einer Facette disjunkt sein, es kann aber in andere Facetten eingeordnet werden. Die verwendeten Facetten entstammen sowohl dem Problem als auch dem Lösungsbereich. Jeder Facette liegt eine umfassende Analyse zugrunde. Die Klassifikation bildet den Ausgangspunkt der erneuten Generalisierung. Muster mit ähnlichen bzw. identischen Ausprägungen werden erfasst und auf ein gemeinsames Konzept untersucht. Diese Generalisierung wurde exemplarisch für zwei Mustergruppen durchgeführt. Dabei wurden die beiden abstrakten Integrationsmuster „zusätzlicher Zugriffspunkt“ sowie „Vermittler“ identifiziert. Die entwickelten Konzepte flossen in eine umfangreiche Evaluation ein, welche am Beispiel einer konkreten Dienstleistung im Bereich der E-Procurement-Integration durchgeführt wurde. Die Unabhängigkeit der Bewertung konnte dadurch sichergestellt werden, dass weder der Dienstleister noch der Kunde an der zuvor durchgeführten empirischen Untersuchung beteiligt waren. Der erarbeitete Lösungsvorschlag wurde in einer Laborumgebung implementiert. Das vollständige Integrationsszenario ist dabei auf der Basis einer Virtualisierungsumgebung realitätsnah nachgebildet worden. Neben Instanzen der Kundensysteme mit identischem Versions- und Patch-Stand kamen auch Datenbestände aus Produktivsystemen zum Einsatz. Die Integrationshilfsmittel wurden ebenfalls in der Laborumgebung eingerichtet. Durch abstrakte Integrationsmuster verbessert sich die Dienstleistungserbringung. Auf der Kundenseite bewirkt dies eine Verbesserungen der Integrations- und Unternehmensarchitektur sowie die Erschließung weiteren Verbesserungspotenzials. Für den Dienstleister ergibt sich neben einem veränderten Dienstleistungsmodell vor allem die Möglichkeit, einmalige Angebote in ein konfigurierbares Standarddienstleistungsangebot zu überführen. Zusätzlich kann eine verbesserte Ressourcennutzung (vor allem der Humanressourcen) anhand des veränderten Dienstleistungsmodells nachgewiesen werden. Im Rahmen der Arbeit konnte so ein Ansatz entwickelt werden, der die empirisch belegten Abstraktionsprobleme behebt und die Einsetzbarkeit von bestehendem Lösungswissen verbessert. Gleichzeitig werden die Wirkungsmechanismen und Entscheidungszusammenhänge durch das Dienstleistungsmodell besser erfass-, erklär- und vor allem planbar.

Mechatronic systems encompass a wide range of disciplines, including mechanical and electrical engineering, and hence the development process for mechatronic system is collaborative in nature. Currently the collaborative development of mechatronic systems is inefficient and error-prone because contemporary design environments do not allow sufficient information flow of design and manufacturing data across different engineering domains. Mechatronic systems need to be designed in an integrated fashion allowing designers from multiple engineering domains to receive updates regarding design modifications throughout the design process. One approach to facilitate integrated design of mechatronic systems is to integrate mechanical with electrical engineering CAD systems. Currently there exist numerous techniques that were developed to support various levels of integration between CAD/CAE systems. Standardized data exchange formats, e.g., STEP and IGES, support information exchange between various different CAD and PDM systems. Multi-Representation Architecture (Peak et al.) supports the integration of geometric information in CAD tools with analysis information in CAE tools. Other integration techniques include the Core Product Model (developed at NIST), Active Semantic Networks (Roller et al.), Constraint Linking Bridge (Kleiner et al.), and others. All these techniques have their areas of focus as well as research gaps that need to be covered. One area that needs research attention is the information exchange between mechanical and electrical domains, which is the focus of this thesis. In this thesis, the information exchange between mechanical and electrical domains is explored from two perspectives: conceptual design perspective, in which constraint relationship between attributes of mechanical and electrical components is identified and classified based on the physical forms, functions, and behavior of the mechatronic system; system realization perspective, in which the identified constraints are modeled for propagation between MCAD and ECAD systems. SysML is used to model the constraints between mechanical and electrical components. By means of an illustrative example (a robot arm), the constraint modeling and propagation developed in my thesis are demonstrated and implemented utilizing a MCAD system (SolidWorks) and an ECAD system (EPLAN Electric P8).

Despite significant progress in GPS/INS integration-based direct geo-referencing (DGR) technology over the past decade, its performance still needs to be improved in terms of accuracy and tolerance to GPS outages. This is mainly due to the limited geometric strength of the GPS satellite constellation, the quality of INS and the system integration technology. This research is focused on pseudolite (PL) augmentation to enhance the geometric strength of the GPS satellite constellation, and the Neural Network (NN) aided Kalman filter (KF) system integration algorithm to improve the geo-referencing system's performance during GPS outages. The main research contributions are summarized as below: a) Systematic errors introduced by pseudolites have been investigated. Theoretical and numerical analyses reveal that errors of troposphere delay modelling, differential nonlinearity and pseudolite location are sensitive to pseudolite receiver geometry. Their effect on final positioning solutions can be minimised by selecting optimal pseudolite and receiver locations, which is referred to as geometry design. Optimal geometry design for pseudolite augmented systems has been proposed based on simulation results in airborne surveying scenarios. b) Nonlinear geometry bias, or nonlinearity, exists in single difference processes when the unit vectors from the reference and user receivers to a satellite or pseudolite are non-parallel. Similar to long baseline differential GPS (DGPS), nonlinearity is a serious issue in pseudolite augmentation. A Projected Single Difference (PSD) method has been introduced to eliminate nonlinear geometry bias. An optimized expression has been derived to calculate the direction of project vectors, and the advantages of applying PSD in pseudolite augmented airborne DGPS have been demonstrated. c) A new method for pseudolite tropospheric delay modelling has been proposed, which is based on single-differenced GPS tropospheric delay models. The performance of different models has been investigated through simulations and field testing. The advantages and limitations of each method have been analysed. It is determined that the Bouska model performs relatively well in all ranges and elevations if the meteorological parameters in the models can be accurately collected. d) An adaptive pseudolite tropospheric delay modelling method has been developed to reduce modelling error by estimating meteorological parameters in real-time, using GPS and pseudolite measurements. Test results show that pseudolite tropospheric delay modelling errors can be effectively mitigated by the proposed method. e) A novel geo-referencing system based on GPS/PL/INS integration has been developed as an alternative to existing GPS/INS systems. With the inclusion of pseudolite signals to enhance availability and geometry strength of GPS signals, the continuity and precision of the GPS/INS system can be significantly improved. Flight trials have been conducted to evaluate the system performance for airborne mapping. The results show that the accuracy and reliability of the geo-referenced solution can be improved with the deployment of one or more pseudolites. f) Two KF and NN hybrid methods have been proposed to improve geo-referenced results during GPS outages. As the KF prediction diverges without measurement update, the performance of a GPS/INS integrated system degrades rapidly during GPS outages. Neural networks can overcome this limitation of KF. The first method uses NN to map vehicle manoeuvres with KF measurement in a loosely coupled GPS/INS system. In the second method, an NN is trained to map INS measurements with selected KF error states in a tightly coupled GPS/INS system when GPS signals are available. These training results can be used to modify KF time updates. Optimal input/output and NN structure have been investigated. Field tests show that the proposed hybrid methods can dramatically improve geo-referenced solutions during GPS outages.

Orientadores: Joao Mauricio Rosario, Carlos Alberto Mariotoni / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Mecanica / Made available in DSpace on 2018-08-10T18:38:42Z (GMT). No. of bitstreams: 1 Canato_DecioAlbino_M.pdf: 1316639 bytes, checksum: 03ff0dfdee3deb1d7b4e3db678e77539 (MD5) Previous issue date: 2007 / Resumo: A automação residencial é uma modernidade cada vez mais presente nas residências. As soluções tecnológicas disponíveis no mercado deixaram de ser vistas como um luxo para poucos e se tornaram sinônimo de conforto e segurança acessível a todos os usuários interessados. Para construtores e incorporadores, o diferencial é oferecer aos clientes uma infraestrutura de automação de modo a permitir que o morador possa adequar o conforto e a segurança às suas necessidades e orçamento. Programar as luzes e cortinas para criar um cenário agradável no ambiente, ou ainda acessar os sistemas de segurança de sua residência, seja por telefone ou através da internet, são algumas das soluções existentes e acessíveis no mundo da automação. Atualmente, para formar um mecanismo automático em uma residência basta ir a qualquer loja de construção civil e comprá-los sem muita dificuldade. A dúvida que gera quando se faz este tipo de automação, compradas em lojas faça você mesmo, ou seja, montadas em blocos e sem planejamento prévio, é a questão da integração entre os dispositivos automáticos, não existe uma comunicação entre eles, agindo de forma independente, criados sem uma modelagem pré-definida, gerando gastos e transtornos nos projetos atuais e futuros. Para que as diversas opções possam ser integradas de maneira única e pessoal, ou seja, de acordo com a escolha de quem irá utilizá-las, é necessária a criação de uma infra-estrutura adequada. Isto significa prever em projeto o cabeamento, a instalação elétrica e seus acessórios responsáveis pela distribuição de sinais de dados, voz e imagens pela residência O compromisso deste trabalho é a realização de uma integração de sistemas domésticos automatizados baseados na vasta experiência locada na indústria, visto através das modelagens e integrações de sistemas complexos, ou seja, transportar a tecnologia já dominada da automação industrial para uma tecnologia já não tão recente que é a automação doméstica / Abstract: Home autonomation is a modern feature that is becoming more common, nowadays technological solutions available are synonym of comfort and safety instead of being considered an expensive luxury. Different autonomation options are now acquirable for general costumers. For contractors and incorporate, the main issue is to offer an autonomation structure allowing the costumer to suit comfort and safety to the family budget. Programming light intensity and curtains for a nicer atmosphere, being able to reach home security system either using phone or internet are some of the solutions available for home autonomation. Nowadays, autonomation systems can be purchased in many different stores. The main issue related to this kind of commercially available autonomation is that the different parts of the system are not integrated and are not able to communicate, being a potential source of extra costs and problems. On the other hand, if the autonomation system is planned for a specific house, considering who is going to use the system, most problems could be avoided. Creating a specific autonomation project means plan the electric installation, the wires design and related accessories responsible for data distribution, voice and image storage. The aim of this work is to provide an integration of home systems based on the wide experience accumulated by industrial autonomation, exporting the well-known technology for home autonomation / Mestrado / Mecanica dos Sólidos e Projeto Mecanico / Mestre em Engenharia Mecânica

A tuberculose multirresistente (TBMR) - resistência simultânea a rifampicina e isoniazida, principais fármacos do esquema de tratamento da tuberculose (TB), gera mais ônus aos doentes e aos Serviços de Saúde, pois acarreta maiores custos, aumenta o tempo de tratamento e relaciona-se a prognósticos desfavoráveis. A TBMR ocorre devido à falha em algum princípio do tratamento, seja por parte dos profissionais e serviços de saúde, seja por questões ligadas ao doente. Frente a isso, o presente estudo objetivou identificar e analisar as condições de produção da TBMR relacionadas ao doente e seu entorno. Esta investigação foi realizada junto aos sujeitos em seguimento em um hospital de referência do interior paulista, entre janeiro de 2010 a janeiro de 2012. Foi utilizada a abordagem qualitativa. Por meio da análise dos prontuários médicos do serviço terciário, caracterizamos o universo do estudo - composto por todos os doentes já seguidos pela instituição, descrevendo e analisando dados sociodemográficos e clínicos correspondentes. Caracterizamos, também, a amostra estudada, formada por oito doentes de TBMR em seguimento, detalhando seu contexto de vida e trajetória com a doença, assim como a estruturação municipal para seu acompanhamento. A segunda etapa do trabalho constituiu na análise das percepções dos sujeitos a cerca do adoecimento por TB e pela forma MR. Os dados foram coletados por meio de entrevistas semi-estruturadas, gravadas e transcritas na íntegra. Os textos resultantes constituíram o corpus do estudo, organizado com recurso do software Atlas. Ti versão 7.0 e analisado sob o referencial teórico da Análise de Discurso, de matriz francesa. Os resultados da investigação baseiam-se na análise de três aspectos: percurso diagnóstico - em que é apontadas a percepção da doença e dos sintomas, as histórias pessoais e familiares do adoecimento por TB, o desenvolver até a obtenção do diagnóstico e as histórias de fracasso dos tratamentos convencionais; tratamento e acompanhamento dos casos MR - momento em que são discutidas questões ligadas a percepção do tratamento pelos doentes, as modalidades de supervisão empreendidas, os instrumentos e insumos fornecidos, além do apoio da rede familiar; coordenação da assistência - em que são analisadas as nuances da relação entre os diferentes serviços envolvidos na atenção ao doente, tanto dentro do mesmo nível assistencial quanto em sua intersecção com a atenção terciária, a fim de compreender suas fragilidades e promover as potencialidades para o tratamento dos sujeitos. Essas condições de produção mostraram-se complexas, ao passo que sofrem influência das peculiaridades da forma como os serviços locais de atenção organizando-se para atender esses doentes, além de questões relacionadas à trajetória de vida e doença desses sujeitos, apontando para a necessidade de ampliação do espaço de negociação dentro do sistema de saúde. / Multidrug-resistant tuberculosis - simultaneous resistance to rifampicin and isoniazid, the main drugs in the treatment for tuberculosis (TB), generates more onuses to patients and Health Services because it involves higher costs, increases the treatment time and relates to the unfavorable outcomes. MDR-TB occurs due to failure in some treatment principles, either by professionals and health services, or by patient issues. Concerning this, the present study aimed to identify and analyze the conditions of MDR-TB production related to the patients and their surroundings. This investigation was conducted with the subjects followed up in a referral hospital in São Paulo State, between January 2010 and January 2012. It was used a qualitative approach. By analyzing the medical records of the tertiary service, we characterized the universe of the study - consisting of all patients who were already followed by the institution, describing and analyzing the demographic and clinical data matching. We also characterized the sample, formed by eight MDR-TB patients in follow-up, detailing the context of their lives and the disease trajectory, as well as the municipal structure to monitor them. The second stage of the work consisted of analyzing the subjects\' perceptions about TB development and MR strain. Data was collected through semi-structured interviews which were recorded and fully transcribed. The resulting texts constituted the corpus of the study, organized using the Atlas.Ti software version 7.0 and analyzed from the theoretical framework of Discourse Analysis of French matrix. The results are based on analysis of three aspects: The first is diagnosis route - which shows the disease and symptoms perception of the patient, personal and family histories of TB development, the disease development until the diagnosis, and the failed conventional treatment stories. The second aspect was treatment and monitoring of MDR cases - when cases are discussed we focused on the following aspects: perceptions of treatment by patients, undertaken methods of supervision, instruments and inputs provided, and the familiar support network. The third is assistance coordination - where the nuances of the relationship between several departments involved in the patient care are analyzed, within the same care level as well as its intersection with tertiary care in order to understand their weaknesses and promote the potential treatments for the subjects. These production conditions proved to be complex whereas the local care services peculiarities influence the way they are organized to assist these patients, as well as aspects related to life and illness trajectory of these subjects, indicating the need of expanding the negotiation space within the health system