For the last two decades heart disease has been the highest single cause of death for the human population. With an alarming number of patients requiring heart transplant, and donations not able to satisfy the demand, treatment looks to mechanical alternatives. Rotary Ventricular Assist Devices, VADs, are miniature pumps which can be implanted alongside the heart to assist its pumping function. These constant flow devices are smaller, more efficient and promise a longer operational life than more traditional pulsatile VADs. The development of rotary VADs has focused on single pumps assisting the left ventricle only to supply blood for the body. In many patients however, failure of both ventricles demands that an additional pulsatile device be used to support the failing right ventricle. This condition renders them hospital bound while they wait for an unlikely heart donation. Reported attempts to use two rotary pumps to support both ventricles concurrently have warned of inherent haemodynamic instability. Poor balancing of the pumps’ flow rates quickly leads to vascular congestion increasing the risk of oedema and ventricular ‘suckdown’ occluding the inlet to the pump. This thesis introduces a novel Bi-Ventricular Assist Device (BiVAD) configuration where the pump outputs are passively balanced by vascular pressure. The BiVAD consists of two rotary pumps straddling the mechanical passive controller. Fluctuations in vascular pressure induce small deflections within both pumps adjusting their outputs allowing them to maintain arterial pressure. To optimise the passive controller’s interaction with the circulation, the controller’s dynamic response is optimised with a spring, mass, damper arrangement. This two part study presents a comprehensive assessment of the prototype’s ‘viability’ as a support device. Its ‘viability’ was considered based on its sensitivity to pathogenic haemodynamics and the ability of the passive response to maintain healthy circulation. The first part of the study is an experimental investigation where a prototype device was designed and built, and then tested in a pulsatile mock circulation loop. The BiVAD was subjected to a range of haemodynamic imbalances as well as a dynamic analysis to assess the functionality of the mechanical damper. The second part introduces the development of a numerical program to simulate human circulation supported by the passively controlled BiVAD. Both investigations showed that the prototype was able to mimic the native baroreceptor response. Simulating hypertension, poor flow balancing and subsequent ventricular failure during BiVAD support allowed the passive controller’s response to be assessed. Triggered by the resulting pressure imbalance, the controller responded by passively adjusting the VAD outputs in order to maintain healthy arterial pressures. This baroreceptor-like response demonstrated the inherent stability of the auto regulating BiVAD prototype. Simulating pulmonary hypertension in the more observable numerical model, however, revealed a serious issue with the passive response. The subsequent decrease in venous return into the left heart went unnoticed by the passive controller. Meanwhile the coupled nature of the passive response not only decreased RVAD output to reduce pulmonary arterial pressure, but it also increased LVAD output. Consequently, the LVAD increased fluid evacuation from the left ventricle, LV, and so actually accelerated the onset of LV collapse. It was concluded that despite the inherently stable baroreceptor-like response of the passive controller, its lack of sensitivity to venous return made it unviable in its present configuration. The study revealed a number of other important findings. Perhaps the most significant was that the reduced pulse experienced during constant flow support unbalanced the ratio of effective resistances of both vascular circuits. Even during steady rotary support therefore, the resulting ventricle volume imbalance increased the likelihood of suckdown. Additionally, mechanical damping of the passive controller’s response successfully filtered out pressure fluctuations from residual ventricular function. Finally, the importance of recognising inertial contributions to blood flow in the atria and ventricles in a numerical simulation were highlighted. This thesis documents the first attempt to create a fully auto regulated rotary cardiac assist device. Initial results encourage development of an inlet configuration sensitive to low flow such as collapsible inlet cannulae. Combining this with the existing baroreceptor-like response of the passive controller will render a highly stable passively controlled BiVAD configuration. The prototype controller’s passive interaction with the vasculature is a significant step towards a highly stable new generation of artificial heart.

Τα τελευταία δεκαπέντε χρόνια έχει προχωρήσει σημαντικά η ανάπτυξη αυτομάτων συστημάτων βοήθειας του οδηγού που στοχεύουν να προειδοποιήσουν για το περιβάλλον οδήγησης και τις πιθανότητες σύγκρουσης με άλλα οχήματα. Τα Πανεπιστήμια, Κρατικοί φορείς και αυτοκινητοβιομηχανίες ρίχνουν ιδιαίτερο βάρος στο θέμα αυτό που έχει κοινωνικές και εμπορικές διαστάσεις. • Κοινωνικές διαστάσεις γιατί η αξιόπιστη λειτουργία συστημάτων βοήθειας οδηγών μπορεί να συμβάλλει αποφασιστικά στη μείωση των τροχαίων ατυχημάτων. • Εμπορικές διαστάσεις γιατί ο ανταγωνισμός των βιομηχανιών αυτοκινήτων σε συνεργασία με εταιρείες παραγωγής συστημάτων αυτοματισμού, οδηγεί σε ένα κυνήγι παρουσίασης πλέον σύγχρονων και «ελκυστικών» συστημάτων για το καταναλωτικό κοινό. Ειδικά στο θέμα των κοινωνικών διαστάσεων, τα παρακάτω στοιχεία δίνουν με πολύ έμφαση το μέγεθος του προβλήματος. Κατά μέσον όρο, τουλάχιστον ένας άνθρωπος πεθαίνει κάθε λεπτό σε τροχαίο ατύχημα. Τα τροχαία ατυχήματα επίσης τραυματίζουν τουλάχιστο 10 εκατομμύρια ανθρώπους, από τους οποίους 2 ή 3 εκατομμύρια σοβαρά. Προβλέπεται ότι οι νοσοκομειακές δαπάνες, οι κατεστραμμένες περιουσίες και άλλα παρεμφερή κόστη θα ανέλθουν στο 1–3 % του παγκοσμίου ακαθαρίστου εθνικού προϊόντος. Αντικείμενο της διπλωματικής εργασίας είναι η μελέτη 26 ερευνητικών εργασιών που ερευνούν διατάξεις εντοπισμού και ανίχνευσης οχημάτων, πεζών, αντικειμένων και οδικών υποδομών, η σύγκριση της μεθοδολογίας τους, ο σχολιασμός πλεονεκτημάτων και μειονεκτημάτων και η αναφορά σε μελλοντικές απαιτήσεις - προκλήσεις. Η δομή της εργασίας είναι η παρακάτω: • Στο κεφάλαιο Ι γίνεται εισαγωγή στο αντικείμενο της εργασίας και παρουσιάζεται σειρά στατιστικών δεδομένων για τα τροχαία ατυχήματα. • Στο κεφάλαιο II γίνεται συνοπτική παρουσίαση των ερευνητικών εργασιών που χρησιμοποιήθηκαν για την παρουσίαση του θέματος. • Στο κεφάλαιο III γίνεται παρουσίαση βασικών στοιχείων εξοπλισμού για τον εντοπισμό και παρακολούθηση του κυκλοφοριακού τοπίου καθώς επίσης αναφορά σε θεωρητικές υπολογιστικές επεξεργασίες. • Στο κεφάλαιο IV γίνεται μια παρουσίαση βασικών ερευνητικών και πειραματικών διατάξεων που έχουν προταθεί ή εφαρμοσθεί για τον εντοπισμό, την ανίχνευση και παρακολούθηση οχημάτων, πεζών, εμποδίων επί των οδών, και υποδομών παραπλεύρως του οδικού δικτύου, έτσι ώστε να παράγεται πληροφορία στον χρήστη της οδού. Πληροφορία που μπορεί να αποδειχθεί από χρήσιμη μέχρι σωτήρια γιατί μπορεί να λειτουργήσει είτε ως προειδοποίηση στον οδηγό είτε ως ερέθισμα για αυτόματη επενέργεια επί των συστημάτων του αυτοκινήτου (π.χ. αυτόματο φρενάρισμα). • Στο κεφάλαιο V γίνεται σχολιασμός και συγκρίσεις των περιγραφεισών μεθόδων, εξάγονται συμπεράσματα και επισημαίνονται κάποιες μελλοντικές ερευνητικές και κατασκευαστικές προκλήσεις. • Στο κεφάλαιο VI αναφέρεται η χρησιμοποιηθείσα βιβλιογραφία. Όλες οι μέθοδοι προσπαθούν να ανταποκριθούν μερικά ή ολικά στα παρακάτω ζητούμενα: ◊ Εντοπισμός στόχων (κινητών και ακινήτων). ◊ Παρακολούθηση συμπεριφοράς κινουμένων στόχων. ◊ Παραγωγή προειδοποίησης (ακουστικά ή οπτικά σήματα). ◊ Αυτόματη επενέργεια σε συστήματα του οχήματος. • Εργαλεία των συστημάτων που παρουσιάζονται είναι συνήθως ένα σύνολο εξοπλισμού παθητικών και ενεργητικών αισθητήρων, ένας πρωτότυπος αλγόριθμος επεξεργασίας των στοιχείων και ένας υπολογιστής για την επεξεργασία και αξιολόγηση των δεδομένων. • Εμπόδια που πρέπει να υπερπηδηθούν είναι η συνθετότητα του περιβάλλοντος οδήγησης (αυτοκινητόδρομοι, επαρχιακοί οδοί, αστικό οδικό δίκτυο κ.λ.π.) και οι μεταβαλλόμενες καιρικές συνθήκες (καλοκαιρία, βροχή, ομίχλη, χιόνι κ.λ.π.). • Κλειδί στην αποτελεσματικότητα είναι η συλλογή των πλέον επίκαιρων δεδομένων και η δημιουργία γρήγορου και στιβαρού αλγόριθμου. • Μέτρο επιτυχίας είναι η συμπεριφορά σε πραγματικές συνθήκες και η δυνατότητα λειτουργικής και οικονομικής ενσωμάτωσης στο όχημα. Οι μελετηθείσες 26 ερευνητικές εργασίες που εντοπίζουν και ανιχνεύουν κατηγοριοποιούνται: 1. Ανάλογα με τον χρησιμοποιούμενο εξοπλισμό Α. Σε διατάξεις απλών ενεργητικών αισθητήρων Β. Σε διατάξεις παθητικών αισθητήρων (οπτικά συστήματα με διάφορες μορφές καμερών) Γ. Σε διατάξεις δυο ειδών αισθητήρων Δ. Σε πολυαισθητηριακές διατάξεις Σημειώνουμε ότι παρουσιάζονται δυο κατηγορίες αισθητήρων: οι ενεργητικοί και οι παθητικοί. Ενεργητικοί αισθητήρες θεωρούνται οι τύπου ραντάρ (mm κύμα), τύπου laser (lidar και scanners) και οι ακουστικού τύπου. Οπτικοί αισθητήρες, όπως συνήθεις κάμερες, θερμογραφικές κάμερες (FLIR - Forward Looking InfraRed), CCD κάμερες (Charge-coupled device cameras) συχνά αναφέρονται ως παθητικοί αισθητήρες γιατί αποκτούν δεδομένα χωρίς παρέμβαση. Αναλύονται τα ιδιαίτερα χαρακτηριστικά των παραπάνω διατάξεων, τα πλεονεκτήματα και τα μειονεκτήματά τους και αναδεικνύεται η επικρατούσα, με την πάροδο του χρόνου, τάση συνδυασμού διαφόρων αισθητήρων. 2. Ανάλογα με τις στοχεύσεις, τους υπολογιστικούς αλγορίθμους και τα ιδιαίτερα χαρακτηριστικά τους. Οι εξετασθείσες μελέτες που εντοπίζουν και παρακολουθούν στόχους του κυκλοφοριακού τοπίου μπορούν να ταξινομηθούν ως προς τους στόχους στις εξής κατηγορίες: 1. Κινούμενα οχήματα – πεζοί (κυρίως αστικό κυκλοφοριακό τοπίο). 2. Κινούμενα οχήματα (αυτοκινητόδρομοι, επαρχιακοί οδοί, αστικές οδοί). 3. Στάσιμα αντικείμενα, οχήματα – πεζοί (αυτοκινητόδρομοι, επαρχιακοί οδοί, αστικές οδοί). 4. Πεζοί (αστικό κυκλοφοριακό τοπίο). 5. Οδικές υποδομές (αυτοκινητόδρομοι) με έμφαση στις κατακόρυφες ταμπέλες και στις ανισόπεδες διαβάσεις. Από την παρουσίαση και τη σύγκριση των εργασιών, προκύπτει ότι το βασικό πρόβλημα που γίνεται προσπάθεια να αντιμετωπιστεί, είναι η εγκατάσταση διατάξεων που θα πρέπει να διακρίνονται, μεταξύ άλλων, από: • Αξιοπιστία όσον αφορά τον εντοπισμό και την παρακολούθηση. • Προσαρμογή σε σύνθετες κυκλοφοριακές συνθήκες όπως είναι μεταβαλλόμενες καιρικές συνθήκες (μειωμένη ορατότητα, χαμηλός φωτισμός, έντονη βροχή, χιόνι κ.λ.π.) είτε πυκνή οδική κυκλοφορία (π.χ. σε οδούς στο αστικό οδικό δίκτυο). • Γρήγορη επεξεργασία των δεδομένων εισόδου με στιβαρούς αλγόριθμους • Ελαχιστοποίηση λανθασμένων προειδοποιήσεων. • Κατασκευαστικό και λειτουργικό κόστος που θα τις καταστούν υλοποιήσιμες σε πλατιά κλίμακα. Από την ανάλυση των στοιχείων των εργασιών προκύπτει ότι υπάρχουν πολλοί τρόποι να μειωθούν σημαντικά τα σφάλματα, διατηρώντας υψηλή ακρίβεια, όπως βελτιωμένες αλγοριθμικές επιλύσεις (π.χ. με χρήση πολλαπλών εργαλείων, προχωρημένων στατιστικών και γνωστικών μεθόδων), συνδυασμός αισθητήρων (π.χ. ορατοί, IR, ραντάρ) και τηλεματική (π.χ. επικοινωνία οχήματος με όχημα, εντοπισμός με μέθοδο GPS). Σε σχέση με το λογισμικό, ένα απαραίτητο βήμα είναι η δημιουργία σταθερών προϋποθέσεων έτσι ώστε τα οπτικά συστήματα εντοπισμού οχήματος να είναι τυποποιήσιμα, επαναδιαμορφούμενα και επεκτάσιμα έτσι ώστε να μπορούν να συνεργαστούν με τη μεγάλη ποικιλία εφαρμογών επεξεργασίας. Πολύ εύστοχη θα ήταν η δημιουργία και ανάπτυξη λογισμικού που θα μπορεί να σχετίζεται με διάφορα επίπεδα αφαίρεσης συμπεριλαμβάνοντας συνδυασμό αισθητήρων, ενοποίηση ποικίλων αλγορίθμων, οικονομική χρήση πόρων, ταξινόμηση και υπολογισμούς. Επίσης η βελτίωση των ταχυτήτων των PCs έχει οδηγήσει σε αρκετά ικανοποιητικά αποτελέσματα όσον αφορά τον χρόνο επεξεργασίας, δεδομένου ότι τα συστήματα εντοπισμού κινουμένου οχήματος έχουν μεγάλες υπολογιστικές απαιτήσεις καθώς χρειάζεται να επεξεργαστούν τις ανακτώμενες εικόνες σε πραγματικό χρόνο ή κοντά σε πραγματικό χρόνο για να εξοικονομήσουν χρόνο στην αντίδραση του οδηγού. Τέλος θα πρέπει να αντικειμενικοποιηθούν οι διαδικασίες αξιολόγησης των παρουσιαζομένων μεθόδων έτσι ώστε να είναι πλέον συγκρίσιμες και ευρύτερα αποδεκτές. / -

Made available in DSpace on 2014-12-17T15:46:30Z (GMT). No. of bitstreams: 1 JeaneMS_DISSERT.pdf: 2473601 bytes, checksum: ac99d77aba9dc59a16c09747c6e3cfd8 (MD5) Previous issue date: 2012-09-19 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The thesis presented here is of interest management to analyze the performance of the State, through the materialization of the professional courses, the process of integration of users CRAS-Paju?ara informal. Therefore, we assume that poverty and inequality reach a significant portion of the world population, in a context where the working class family is seen as an alternative to face the multiple expressions of social issues. Thus, before the changes of Productive Restructuring, marked by flexibility, outsourcing and casualization of labor relations in the world, the working class family must find ways to ensure their survival. In this direction, we discuss the advances, limitations and challenges posed to the Social Assistance Policy in contemporary, situating this context, the role of the state. Furthermore, we discussed the functionality of informality to the capitalist system, showing how capital appropriates of informal work, placing it in its logic, and thus makes the capital-labor ratio increasingly predatory, inhuman and unequal. The methodological procedures for the preparation of this study constitute a literature and documentary, beyond 10 semi-structured interviews directed to users of CRAS-Paju?ara, participants of training courses for the period 2010-2011. In light of the critical-dialectical rationality, and in a context where informal work has increasingly been co-opted as an alternative to huge unemployment in the same direction in which the welfare rises in tackling social inequality, the scope of this study, discusses and reveals the truths and misconceptions that surround this bourgeois discourse, in times of crisis of capital, the city of Natal, Brazil / A disserta??o ora apresentada gestou-se do interesse de analisar a atua??o do Estado, atrav?s da materializa??o dos cursos profissionalizantes, no processo de inser??o dos usu?rios do CRAS-Paju?ara na informalidade. Para tanto, partimos da premissa que a pobreza e a desigualdade social atingem uma parcela significativa da popula??o mundial, num contexto em que a fam?lia da classe trabalhadora ? vista como uma das alternativas para o enfrentamento das m?ltiplas express?es da quest?o social. Assim, frente ?s mudan?as da reestrutura??o produtiva, marcada pela flexibiliza??o, terceiriza??o e precariza??o das rela??es do mundo do trabalho, a fam?lia da classe trabalhadora deve encontrar sa?das para garantir a sua sobreviv?ncia. Nessa dire??o, discutimos os avan?os, limites e desafios postos ? Pol?tica de Assist?ncia Social na contemporaneidade, situando neste contexto, a atua??o do Estado. Al?m disso, debateu a funcionalidade da informalidade para o sistema capitalista, mostrando como o capital se apropria do trabalho informal, inserindo-o na sua l?gica, e assim, torna a rela??o capital-trabalho cada vez mais predat?ria, desumana e desigual. Os procedimentos metodol?gicos adotados para elabora??o desse estudo se constituem de pesquisa bibliogr?fica e documental, al?m de 10 entrevistas semiestruturadas direcionadas aos usu?rios do CRAS-Paju?ara, part?cipes dos cursos profissionalizantes, no per?odo de 2010-2011. ? luz da racionalidade cr?tico-dial?tica, e num contexto em que o trabalho informal tem sido cada vez mais cooptado como alternativa ao desemprego descomunal, na mesma dire??o, em que a assist?ncia social se eleva no enfrentamento ? desigualdade social, o escopo desse estudo, discutiu e desvelou algumas as verdades e equ?vocos que circundam este discurso burgu?s, em tempos de crise do capital, no munic?pio de Natal-RN

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2018-01-16T16:44:35Z No. of bitstreams: 1 SheilaDaSilvaOliveiraDeMedeiros_DISSERT.pdf: 2025345 bytes, checksum: 109d9d09020fa5f1838a8910c03a3e0c (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2018-01-19T11:45:32Z (GMT) No. of bitstreams: 1 SheilaDaSilvaOliveiraDeMedeiros_DISSERT.pdf: 2025345 bytes, checksum: 109d9d09020fa5f1838a8910c03a3e0c (MD5) / Made available in DSpace on 2018-01-19T11:45:32Z (GMT). No. of bitstreams: 1 SheilaDaSilvaOliveiraDeMedeiros_DISSERT.pdf: 2025345 bytes, checksum: 109d9d09020fa5f1838a8910c03a3e0c (MD5) Previous issue date: 2017-08-24 / A produ??o a seguir tem como objetivo central analisar as condi??es de trabalho dos assistentes sociais inseridos no Centros de Refer?ncia de Assist?ncia Social (CRAS) e nos Centros de Refer?ncia Especializados de Assist?ncia Social (CREAS), do munic?pio de Natal/RN, a fim de conhecer e refletir acerca dos limites e das possibilidades presentes no cotidiano profissional, tensionados pelo car?ter assalariado e pelas determina??es do sistema capitalista. Para tanto, o m?todo de pesquisa utilizado apoia-se no materialismo hist?rico-dial?tico, cuja ess?ncia considera aspectos da hist?ria e da conjuntura socioecon?mica a qual faz parte o grupo a ser estudado, bem como a din?mica tempor?ria e contradit?ria da realidade e suas m?ltiplas particularidades. A metodologia adotada, baseia-se, assim, na pesquisa documental e de campo, por meio das quais buscamos o aporte te?rico-metodol?gico nas discuss?es sobre o Trabalho, Pol?ticas Sociais e Servi?o Social, realizando tamb?m 08 (oito) entrevistas semiestruturadas com assistentes sociais pertencentes ?s unidades mencionadas. Tendo em vista as quatro regi?es administrativas de Natal/RN, quais sejam: zona sul, zona oeste, zona leste e zona norte, e da exist?ncia de onze CRAS e quatro CREAS distribu?dos entre elas, buscamos abarcar pelo menos um CRAS e um CREAS por regi?o, contemplando, deste modo, a entrevista com um assistente social em cada uma das institui??es. Com o apoio das informa??es obtidas e como produto da an?lise de conte?do, compreendemos, portanto, algumas tend?ncias as quais podemos sintetizar atrav?s da contraposi??o do que vem sendo preconizado pelo Sistema ?nico de Assist?ncia Social (SUAS) e o que de fato tem sido materializado na pr?tica profissional, em um paradoxo sobre qual se estabelece a pol?tica socioassistencial brasileira, j? que ainda ? facilmente observ?vel o quadro recorrente de precariza??o do trabalho, nesta ?rea. Precariza??o esta, que atinge n?o apenas as condi??es materiais do trabalho, mas a qualidade dos servi?os oferecidos aos usu?rios, bem como a sa?de dos trabalhadores, cada vez mais submetidos aos processos de adoecimento e aos poss?veis atos abusivos presentes nas rela??es trabalhistas contempor?neas. Com efeito, consideramos a import?ncia de an?lises que se dediquem aos moldes do trabalho nesta cena, evidenciando aspectos que envolvam o exerc?cio profissional, mas tamb?m os seus rebatimentos nas demais dimens?es da vida dos trabalhadores, buscando diminuir, atrav?s da luta coletiva, a dist?ncia entre os direitos conquistados e a sua realiza??o. / The following project aims to analyze the working conditions of the caseworkers included in the Social Assistance Referral Centers (SARC) and the Specialized Referral Centers of Social Assistance (SRCSA), in the city of Natal/RN, in order to know and reflect on the limits and possibilities in the professional daily life, worried about their salaried profile and determinations of the capitalist system. For this, the research method used is based on historical-dialectical materialism, whose essence considers aspects of history and socioeconomic conjuncture which is part of the group to be studied, as well as the temporary and contradictory dynamics of reality and its multiple peculiarities. The methodology adopted is based on documentary and field research, through which we seek the theoretical-methodological contribution in the discussions on Work, Social Policies and Social Work, also performing eight (8) semi-structured interviews with caseworkers from the units mentioned. In view of the four administrative regions of Natal/RN, which are: south, west, east and north, and that there are eleven SARC and four SRCSA distributed among them, we looked for include at least one SARC and one SRCSA per region, thus contemplating the interview with a caseworker in each of the institutions. With the support of the information obtained and as a product of the content analysis, we understand, therefore, some tendencies that we can synthesize through the opposition of what has been supported by the Unified Social Assistance System (USAS) and what has in fact been materialized in the professional practice, in a paradox about which the Brazilian social assistance policy is established, since it is still easily observable the recurrent picture of work precarization in this area. This precariousness, which affects not only the material conditions of work, but also the quality of the services offered to users, as well as the health of workers, increasingly subjected to the processes of illness and abusive acts present in labor relations. In fact, we consider the importance of analyzes that are dedicated to the patterns of work in the contemporary scene, highlighting aspects that involve the professional practice, but also its repercussions in the other dimensions of workers' lives, looking for reduce through collective struggle the distance between the acquired rights and their realization.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-08-29T19:59:07Z No. of bitstreams: 1 LuizEduardoLimaDeAndrade_DISSERT.pdf: 1411624 bytes, checksum: 0011e32071c925649836ded980f7d7ba (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-09-05T22:21:57Z (GMT) No. of bitstreams: 1 LuizEduardoLimaDeAndrade_DISSERT.pdf: 1411624 bytes, checksum: 0011e32071c925649836ded980f7d7ba (MD5) / Made available in DSpace on 2016-09-05T22:21:57Z (GMT). No. of bitstreams: 1 LuizEduardoLimaDeAndrade_DISSERT.pdf: 1411624 bytes, checksum: 0011e32071c925649836ded980f7d7ba (MD5) Previous issue date: 2016-05-13 / Introdu??o: A promo??o de uma Cultura de Seguran?a do Paciente (CSP) nas organiza??es de sa?de tem sido recomendada como uma pr?tica que contribui para a redu??o do risco de danos desnecess?rios associados ao cuidado de sa?de, por?m n?o h? evid?ncias das interven??es em sa?de p?blica que devem ser implantadas. O sistema de sa?de brasileiro regulou uma s?rie de medidas para este objetivo, por?m sua efetividade ainda n?o foi avaliada. Objetivo: Analisar o efeito do Programa Nacional de Seguran?a do Paciente (PNSP) na Cultura de Seguran?a do Paciente. M?todo: Trata-se de um delineamento quase-experimental com abordagem descritivo-anal?tica. A CSP foi avaliada em tr?s hospitais com diferentes perfis, tr?s meses antes (n=215) e quinze meses ap?s (n=450) a implanta??o do programa nacional de seguran?a do paciente. Utilizou-se um instrumento validado e adaptado ? realidade brasileira (Hospital Survey On Patient Safety Culture). A evolu??o da CSP foi avaliada por meio de 14 indicadores simples e 2 compostos. Resultados: A CSP teve evolu??o positiva de forma consistente ap?s a implementa??o do PNSP. Os hospitais melhoraram a CSP em 14 dos 16 indicadores avaliados, que incluem 11 das 12 dimens?es avaliadas, a Porcentagem de Respostas Positivas total, a m?dia da nota para a seguran?a do paciente e o ?ndice de CSP. O hospital que apresentou maior melhoria foi o estadual seguido do federal e privado, isto demonstra que o PNSP foi um indutor da homogeneiza??o dos servi?os prestados no Brasil, pois esta ordem era inversa do n?vel de cultura antes do PNSP. Conclus?o: O estudo evidencia uma melhoria consistente da CSP em hospitais ap?s o PNSP, apontando para a efetividade da regula??o nacional externa, que por sua vez aparentam ser moduladas pela variabilidade do contexto interno. / Introdution: Promoting Patient Safety Culture (CSP) in health organizations has been recommended as a practice that contributes to reducing the risk of unnecessary harm associated with health care, but there is no evidence of public health interventions They should be deployed. The Brazilian health system has regulated a series of measures for this purpose, but its effectiveness has not been evaluated. Objective: To analyze the effect of Patient Safety National Program (PNSP) on Patient Safety Culture. Method: This is a longitudinal quase-exprimental design with descriptive and analytical approach. The CSP was evaluated in three hospitals with different profiles, three months before (n = 215) and fifteen months (n = 450) the implementation of national patient safety program. We used a validated instrument and adapted to the Brazilian reality (Hospital Survey On Patient Safety Culture). The development of CSP was evaluated by simple indicators 14 and 2 compounds. Results: The CSP had positive developments consistently following the implementation of PNSP. Hospitals improved CSP in 14 of the 16 indicators assessed, including 11 of the 12 dimensions evaluated, the total Positive Response Percent, the average score for patient safety and the CSP index. The hospital with the highest improvement was the state followed by federal and private, it shows that PNSP was an inducer of improving of services in Brazil, since this order was reversed culture level before PNSP. Conclusion: This study shows a consistent improvement of CSP in hospitals after PNSP, pointing to the effectiveness of external national regulation, which in turn appear to be modulated by the variability of the internal context.

Submitted by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-01-08T13:16:47Z No. of bitstreams: 2 license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) endi_lanza_galvao.pdf: 1678820 bytes, checksum: 33907d9247a67c52afa9d562f393c0ac (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2016-01-11T11:10:26Z (GMT) No. of bitstreams: 2 license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) endi_lanza_galvao.pdf: 1678820 bytes, checksum: 33907d9247a67c52afa9d562f393c0ac (MD5) / Made available in DSpace on 2016-01-11T11:10:27Z (GMT). No. of bitstreams: 2 license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) endi_lanza_galvao.pdf: 1678820 bytes, checksum: 33907d9247a67c52afa9d562f393c0ac (MD5) Previous issue date: 2014 / Desde a cria??o do Sistema ?nico de Sa?de (SUS), o tema regionaliza??o da sa?de tem sido discutido no intuito de implement?-la como estrat?gia de gest?o. Com o objetivo de ampliar a cobertura das a??es e melhorar a qualidade da oferta de servi?os de sa?de, os territ?rios t?m sido organizados regionalmente atrav?s de pactua??es ocorridas nas Comiss?es Intergestores Regional e Comiss?es Intergestores Regional Ampliada. No entanto, contribui??es cient?ficas acerca do planejamento da sa?de no Vale do Jequitinhonha/MG ainda s?o muito escassas na literatura. O presente estudo analisou o processo de planejamento regional desenvolvido por meio dessas comiss?es, durante os anos de 2010 a 2013, no territ?rio da Superintend?ncia Regional de Sa?de de Diamantina/MG. Foi realizado um estudo explorat?rio - descritivo atrav?s de an?lise documental al?m de um estudo epidemiol?gico das interna??es hospitalares por Acidente Vascular Cerebral (AVC), ocorridas em um hospital de refer?ncia da regi?o. Os elementos recolhidos neste estudo mostram que a regionaliza??o do SUS na Regi?o Ampliada de Sa?de Jequitinhonha ? conduzida pelas normatiza??es da Secretaria Estadual de Sa?de e Minist?rio da Sa?de e as Comiss?es Intergestores Regionais parecem configurar uma importante inst?ncia de articula??o entre estado e munic?pios. A rede urbana da regi?o ? formada principalmente por pequenos munic?pios, com destaque para os quatro centros emergentes, Diamantina, Capelinha, Itamarandiba e Ara?ua?, sendo que Diamantina representa o principal eixo articulador de fluxos no setor sa?de. Por?m, os resultados indicam inexist?ncia da pactua??o com a inst?ncia estadual, do fluxo para encaminhamento dos pacientes com AVC. Por?m, verifica-se que a refer?ncia para a cidade de Diamantina j? ocorre sistematicamente, ressaltando a necessidade de concretiza??o desta rede de assist?ncia. / Disserta??o (Mestrado Profissional) ? Programa de P?s-Gradua??o em Sa?de, Sociedade e Ambiente, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2014. / ABSTRACT Since the creation of the Unique Health System (SUS), the regionalization of health has been discussed with a view to its implementation as a management strategy. In order to extend the coverage of actions and improve the quality of health services on offer, territories have been organized regionally through pacts reached in the Regional Intermanagement Commission and the Extended Regional Intermanagement Commission. However, scientific contributions regarding the planning of health in Jequitinhonha Valley/MG are still very scarce in the literature. The present study analyzed the regional planning process developed by these commissions between 2010 and 2013 in the territory of the Regional Superintendence of Health in Diamantina/MG. A descriptive exploratory study was carried out using documental analysis and an epidemiological study of hospitalizations for stroke in a hospital of reference in the region. The data collected in the present study show that the regionalization of the SUS in the Extended Health Region of Jequitinhonha is coordinated by standardizations of the State Secretary of Health and the Ministry of Health. The Regional Intermanagement Commissions seem to set a significant articulation request between state and city, particularly for smaller cities such as the four emerging centers of Diamantina, Capelinha, Itamarandiba and Ara?ua?. Diamantina represents the main axis of flux in the health sector. However, the results of the present study indicate that there are no pacts with state requests, from the flux to transferring stoke patients. However, it was confirmed that the reference for the city of Diamantina already occurs systematically, emphasizing the need to substantiate this service network.

Made available in DSpace on 2012-05-07T14:46:36Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 000001.pdf: 1653816 bytes, checksum: 2febccf842c0431a5cc171cdd4a06251 (MD5) Previous issue date: 2005 / Estuda o processo de patrocínio privado à ciência no Brasil, na primeira metade do século vinte. Mais especificamente estará estudando a relação do industrial Guilherme Guinle com o médico e cientista Carlos Chagas e as ações que dela resultaram: de um lado, a contrução dos hopitais para sifilíticos e para cancerosos, na década de 1920, no Rio de Janeiro, onde suas ações estão diretamente relacionadas à política de Saúde Pública levada a cabo pela gestão de Carlos Chagas frente ao Departamento Nacional de Saúde Pública. E, de outro lado, o apoio aos projetos desenvolvidos por Evandro Chagas, Carlos Chagas Filho e Walter Oswaldo Cruz, ainda com forte vinculação aos ideais do "nacionalismo sanitário" defendido por Carlos Chagas. Em resumo, essa tese pretende explorar os caminhos que permitiram que o mecenato e a filantropia de Guilherme Guinle à ciência e à saúde acontecessem no Rio de Janeiro dos anos de 1920 e 1940. / The objective of this thesis "Between the ballrooms and the laboratory: philanthropy, patronage and scientific practices - Rio de Janeiro, 1920-1940" is the study of private sponsorship to science in Brazil in the first half of the twentieth century. More specifically, I will be studying the relationship between the industrialist Guilherme Guinle and the physician and scientist Carlos Chagas as well as the outcome of it: on one hand, there was the construction of hospitals for syphilitic and cancerous people in Rio de Janeiro in the 1920s. These actions are directly related to the Public Health policies passed during Carlos Chagas' office as chief of the National Public Health Department. And, on the other hand, there was the support given to projects carried out by Evandro Chagas, Carlos Chagas Filho and Walter Oswaldo Cruz, still strongly linked to the ideals of "sanitary nationalism" defended by Carlos Chagas. In a nutshell, this study intends to explore the circumstances which made Guilherme Guinle's patronage and philanthropy to science and health possible in Rio de Janeiro in the 1920s and 1940s. / La thèse "Entre os salões e o laboratório: filantropia, mecenato e práticas científicas - Rio de Janeiro, 1920-1940" vise à analyser le processus de patronage de la science au Brésil, pendant la première moitié du XXè siècle. Il porte notament sur les relations nouées entre un industriel, Guilherme Guinle, et un médecin-savant, Carlos Chagas, ainsi que sur les actions qui en ont résultés. Soit, d’une part, la construction de deux hôpitaux à Rio de Janeiro, au cours de la deuxième décennie du XXè siècle: l’un pour les syphilitiques et l’autre pour les cancéreux; et cela selon un modèle philanthropique qui tient d’ une politique de santé publique mise en oeuvre par l’administration de Carlos Chagas quand il était à la tête du Departamento Nacional de Saúde Pública. D’autre part, le soutien apporté par Guilherme Guinle aux projets développés par Evandro Chagas et Walter Oswaldo Cruz, encore très liés aux idées higyènistes de Carlos Chagas ; et par Carlos Chagas Filho. Bref, cette thèse a comme but de suivre les chemins qui ont permi que le mécénat et la philanthropie de Guilherme Guinle auraient eu lieu à Rio de Janeiro, aux années de 1920 jusqu'à 1940.

Made available in DSpace on 2014-12-17T14:13:42Z (GMT). No. of bitstreams: 1 TalitaPMD.pdf: 427809 bytes, checksum: 50a421cfac59e0568b8486623ec0f5ff (MD5) Previous issue date: 2009-08-07 / Introdu??o: Os idosos constituem os maiores consumidores dos servi?os de sa?de, especialmente os de reabilita??o, tornando imprescind?vel a avalia??o da qualidade da assist?ncia fisioterap?utica prestada. A satisfa??o do paciente tem sido considerada uma das melhores e mais eficazes formas de avaliar o cuidado e direcionar o provedor do servi?o para suprir as necessidades e expectativas do paciente-cliente. O objetivo deste estudo foi investigar os principais aspectos (preditores) que contribuem para a satisfa??o do paciente geri?trico com o tratamento fisioterap?utico ambulatorial. M?todos: Trata-se de um estudo com enfoque epidemiol?gico, transversal e descritivo de cunho explorat?rio. Foi utilizado o instrumento de avalia??o da satisfa??o do paciente com a fisioterapia, desenvolvido e validado para a popula??o brasileira por Mendon?a em 2007, com uma escala de satisfa??o do paciente composta por 23 itens. Os dados foram coletados na sala de espera de 29 cl?nicas de Fisioterapia da rede privada da capital do RN/Brasil e a amostra selecionada de forma n?o-probabil?stica constou de 221 pacientes com idade superior a 60 anos, que realizaram entre 5 e 60 sess?es de fisioterapia onde os dados foram coletados, deveriam ser usu?rios de plano de sa?de e ter condi??es cognitivas preservadas. Resultados: A an?lise fatorial indicou a exist?ncia de quatro fatores com autovalor maior que 1: intera??o pacienteterapeuta (7 itens) α = 0,901; acesso e atendimento de recepcionista e pessoal de apoio (8 itens) α = 0,888; ambiente f?sico e satisfa??o global (5 itens) α = 0,835; e conveni?ncia (3 itens) α = 0,711. Os itens com maiores escores de satisfa??o completa foram os contemplados nos aspectos de intera??o paciente-terapeuta, especialmente o respeito e a gentileza do fisioterapeuta. As associa??es realizadas atrav?s do teste do Qui-quadrado e regress?o log?stica bin?ria entre a satisfa??o do paciente e as vari?veis s?cio-demogr?ficas, percep??o do estado de sa?de e capacidade funcional demonstraram que a satisfa??o do paciente idoso associa significativamente com o sexo e estado civil. Os achados revelam que as mulheres mostram-se mais satisfeitas com a fisioterapia. Conclus?o: Os aspectos interpessoais demonstraram ser preditores relevantes para assist?ncia fisioterap?utica satisfat?ria, especialmente na popula??o idosa que requer aten??o al?m do suporte puramente t?cnico

Made available in DSpace on 2014-12-17T14:13:43Z (GMT). No. of bitstreams: 1 MariaFJO_TESE.pdf: 1503680 bytes, checksum: f1cc4dc149795a5fd482b9f52b71adce (MD5) Previous issue date: 2012-03-12 / A??es promotoras de sa?de e independ?ncia para pessoas idosas s?o indispens?veis. Compreender essa constru??o no cotidiano da provis?o dos cuidados talvez estimule o desenvolvimento de capacita??es ao bem estar nesta popula??o. O objetivo deste estudo foi Identificar a repercuss?o da provis?o do cuidado formal em sa?de bucal na percep??o de senescentes. Desenvolvemos uma pesquisa de base qualitativa com abordagem fenomenol?gica, onde realizamos entrevistas semiestruturadas e individuais com 30 pessoas de idade superior a 50 anos (22 mulheres e 08 homens), em um Centro de Conviv?ncia na cidade de Natal/Rio Grande do Norte, no nordeste do Brasil. Os relatos obtidos foram analisados em cinco est?gios: transcri??o dos discursos sem preocupa??o interpretativa; limpeza de erros lingu?sticos e repeti??es; leitura repetitiva e exaustiva para apreens?o do sentido das informa??es coletadas; sele??o das unidades significativas dos discursos, correspondendo aos trechos relevantes no horizonte do fen?meno em estudo; e compreens?o da ideografia elaborada pelos participantes por grupos tem?ticos simb?licos. Assim, identificamos as ess?ncias tem?ticas de: determinante social e iniquidade em sa?de bucal; e provis?o de cuidados de sa?de bucal e mal-estar f?sico, mental e social. Conclu?mos que a presta??o de cuidados agregando abordagem human?stico-?tica pode levar a viv?ncias dignificantes no processo de envelhecimento, destacadamente quando estimula a promo??o da seguran?a pessoal. O ?mago desse trabalho descortina uma vertente multidisciplinar que perpassa a sa?de, a educa??o e a ?tica

Made available in DSpace on 2014-12-17T14:13:45Z (GMT). No. of bitstreams: 1 VERAGNM_TESE.pdf: 1592448 bytes, checksum: 355e4a82af0f5ad461467bd657774572 (MD5) Previous issue date: 2013-04-02 / A ?lcera venosa constitui importante problema de sa?de p?blica, gera repercuss?o social, econ?mica e mudan?as nos h?bitos de vida, dor, sofrimento, acarretando diminui??o da qualidade de vida. O estudo objetivou avaliar a assist?ncia prestada ?s pessoas com ?lceras venosas atendidas pela Estrat?gia Sa?de da Fam?lia. ? um estudo anal?tico, transversal e quantitativo, realizado com 59 pessoas com ?lceras venosas, atendidas em 36 unidades da Estrat?gia Sa?de da Fam?lia. O estudo obteve aprova??o do projeto de pesquisa pelo Comit? de ?tica da Universidade Federal de Alagoas. Para a coleta dos dados utilizou-se instrumento testado, entrevista, exame f?sico e informa??es dos prontu?rios. Os dados foram organizados em planilha do Microsoft Excel 2007, exportados e analisados em software estat?stico por meio de estat?stica descritiva e inferencial, considerando n?vel de signific?ncia estat?stica de &#961;-valor < 0,05. As pessoas com ?lcera venosa eram do sexo feminino (71,2%), &#8805; 60 anos (67,8%) e estavam em tratamento > 1 ano (69,5%). Possu?am tempo de les?o > 6 meses (64,4%), dor na ?lcera/membro (86,4%) e leito com &#8804; 30% de granula??o/epiteliza??o (78,0%). A qualidade da assist?ncia foi ruim (< 5 aspectos positivos) em 57,6% (&#961;=0,000) e os aspectos que mais interferiram foram as seguintes inadequa??es: profissional que acompanha/realiza curativo (&#961;=0,002, coeficiente de conting?ncia (CC) =0,458, raz?o de chance (RC) =13,9), produtos nos ?ltimos 30 dias (&#961;=0,038, cc=0,334, RC=7,3) e acesso a consulta com angiologista (&#961;=0,041, cc=0,305, RC=4,1). Os aspectos cl?nicos que contribu?ram para o aumento do tempo de assist?ncia foram: tempo de les?o >6 meses (&#961;<0,001), dor (&#961;=0,043), recidiva (&#961;<0,001); nos aspectos assistenciais: inadequa??o dos produtos com 83,1% (&#961;=0,036). Essas caracter?sticas dificultaram a cicatriza??o tecidual, prolongando o tempo de tratamento das les?es,que podem ter contribu?do para a cronicidade das ?lceras