Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-10-04T22:23:59Z No. of bitstreams: 1 BrunaCostaMouraDoVale_DISSERT.pdf: 1188349 bytes, checksum: a8d43623afa31dc2808818a05740b034 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-10-13T20:53:39Z (GMT) No. of bitstreams: 1 BrunaCostaMouraDoVale_DISSERT.pdf: 1188349 bytes, checksum: a8d43623afa31dc2808818a05740b034 (MD5) / Made available in DSpace on 2017-10-13T20:53:39Z (GMT). No. of bitstreams: 1 BrunaCostaMouraDoVale_DISSERT.pdf: 1188349 bytes, checksum: a8d43623afa31dc2808818a05740b034 (MD5) Previous issue date: 2017-06-29 / As infec??es relacionadas ? assist?ncia ? sa?de (IRAS) s?o atualmente um dos principais problemas de sa?de p?blica. Os estafilococos coagulase-negativa (ECN) est?o entre as esp?cies mais prevalentes neste tipo de infec??o, devido ? sua capacidade de colonizar dispositivos m?dicos invasivos. A clorexidina ? extensivamente utilizada no ambiente hospitalar como forma de preven??o e controle de IRAS. No entanto, a literatura relata a exist?ncia de cepas com susceptibilidade reduzida ocasionada possivelmente pela presen?a dos genes qacA/B. O objetivo do estudo foi investigar a susceptibilidade ? clorexidina e sua rela??o com a presen?a dos genes qacA/B em 211 isolados de ECN provenientes de diferentes hospitais da cidade do Natal-RN. As amostras foram identificadas por testes bioqu?micos convencionais; a susceptibilidade ? antimicrobianos foi realizada pela metodologia disco-difus?o; a determina??o da Concentra??o Inibit?ria M?nima (CIM) para a clorexidina foi avaliada pela t?cnica de dilui??o em ?gar; a t?cnica da PCR foi utilizada para pesquisar os genes qacA/B e o gene mecA. No total de 211 amostras de ECN, 69% foram isolados a partir hemoculturas. As esp?cies mais frequentes foram S. epidermidis, S. hominis hominis, S. auricularis e S. haemolyticus, respectivamente. As cepas apresentaram um perfil de resist?ncia a multidrogas de 87%, incluindo resist?ncia ? oxacilina; 31% demonstraram susceptibilidade reduzida ? clorexidina. Os genes qacA/B foram detectados tanto em amostras resistentes ? clorexidina (32/32) quanto em amostras suscept?veis (17/32). Grande parte das cepas com susceptibilidade reduzida ? clorexidina exibiram tamb?m multirresist?ncia aos antibi?ticos testados (94%). A identifica??o de cepas com susceptibilidade reduzida ? clorexidina nesse estudo representa uma amea?a as pr?ticas de controle de IRAS. Apesar de todas as cepas resistentes ? clorexidina possu?rem os genes qacA/B, sua presen?a n?o foi um fator determinante para a express?o da resist?ncia, necessitando de estudos adicionais. A diminui??o da susceptibilidade ? antiss?pticos pode levar ? persist?ncia bact?rias no ambiente hospitalar contribuindo, dessa forma, para a sobreviv?ncia de cepas multirresistentes. / Health Care Associated Infections (HAI) are currently a of major public health problem. The coagulase-negative Staphylococci (CNS) are among the most prevalent species in this type of infection due to their ability to colonize invasive medical devices. Chlorhexidine is extensively used in the hospital setting as a means of prevention and control of HAI. However, the existence of strains with reduced susceptibility caused possibly by the presence of the qacA/B genes has been reported in the literature. The main of this study was to investigate the susceptibility to chlorhexidine and its relation to the presence of the qacA/B genes in 211 isolates of ECN from diferente hospitals in the city of Natal-RN. Samples were identified by standard biochemical tests; the susceptibility to antimicrobials was performed using the disc-diffusion methodology; the susceptibility to chlorhexidine was evaluated by determining the Minimum Inhibitory Concentration (MIC) by the agar dilution technique; the PCR method was used to investigate the qacA/B genes and mecA gene. In total of 211 CNS samples, 69% were isolated from blood cultures. The most frequent species were S. epidermidis, S. hominis hominis, S. auricularis and S. haemolyticus, respectively. The strains had a multidrug resistance profile of 87%, including resistance to oxacillin; 31% demonstrated reduced susceptibility to chlorhexidine. The qacA/B genes were detected in both chlorhexidine resistant (32/32) and susceptible samples (17/32). Most of the strains with reduced susceptibility to chlorhexidine also showed multidrug resistance to the tested antibiotics (94%). Identification of strains with reduced susceptibility to chlorhexidine in this study poses a threat to HAIs control practices. Although all strains resistant to chlorhexidine had the qacA/B genes, their presence was not a determining factor for the expression of the resistance, requiring additional studies. The decrease in susceptibility to antiseptics may allow bacteria to persist in the hospital environment, thus contributing to the survival of multiresistant strains.

Introdução: A utilização de dispositivos de assistência ventricular esquerda (DAVE) proporciona melhor manejo dos pacientes que necessitam de métodos alternativos como ponte para o transplante cardíaco. Parcela significativa dos pacientes sob uso de DAVE desenvolve falência de ventrículo direito (VD), com elevada mortalidade. Propusemos estudo experimental para desenvolvimento de método de descompressão do VD em pacientes sob assistência mecânica esquerda e disfunção biventricular. Método: Foi realizado estudo experimental em cães adultos, com disfunção biventricular em fibrilação ventricular, mantidos em uso de DAVE com bomba centrífuga. Os animais foram divididos em dois grupos. No Grupo A, foi realizada descompressão do VD através de anastomose cavo-pulmonar, com anastomose da veia cava superior na artéria pulmonar direita. No grupo B, não foi realizado o \"shunt\". Após o preparo inicial foi iniciada assistência circulatória átrio esquerdo-aorta. Foram realizadas medidas hemodinâmicas e laboratoriais no momento inicial e aos 30, 60 e 90 minutos de assistência nos dois grupos. Resultados: Os dados hemodinâmicos e laboratoriais iniciais foram semelhantes nos dois grupos. No Grupo A, houve melhora da pressão arterial media (p<0,0001) durante a assistência. O fluxo pulmonar também foi maior no grupo A (p<0,0001), resultando em maior fluxo na bomba centrífuga, principalmente aos 90 min(1,2L/min X 0,5L/min, p<0,0001). A dosagem de lactato sérico no último momento de estudo foi menor no grupo A (27,6mg/dL versus 47,6mg/dL, p<0,05). Conclusão: Concluímos que a anastomose cavo-pulmonar promove descompressão do VD em modelo de disfunção bi-ventricular aguda sob assistência circulatória isolada do ventrículo esquerdo. A descompressão do VD leva a aumento do fluxo pulmonar e melhor desempenho hemodinâmico da assistência ao ventrículo esquerdo. / Introduction: The use of Left Ventricular Assist Devices promotes better clinical handling of patients in the need of alternative methods as bridge to heart transplant. A significant part of them develop right ventricle failure, leading to high death incidence. We have proposed an experimental study for the development of a method to decompress the right ventricle in biventricular failure patients under Left Ventricular Assist Devices . Method: Experimental study with adult dogs with acute biventricular failure in ventricular fibrillation under left assist device by centrifugal pump. The animals were divided in 2 groups. In Group A decompression of RV was made by cavo-pulmonary anastomosis between superior vena cava and right pulmonary artery. In Group B the anastomosis was not performed. After initial preparation left atrium-aorta circulatory support begun. Hemodinamic and laboratory measures were taken at start time and at 30, 60 and 90 minutes of circulatory support. Results: Initial laboratory and haemodinamic data were similar in both groups. Group A had better mean arterial pressure during support(p<0,0001). Pulmonary blood flow was higher in Group A resulting in higher pump flow, mainly at 90 minutes(1,2L/minX0,5L/min, p<0,0001). Serum lactate was lower at 90 minutes in Group A(27,6mg/dL x 47,6mg/dL, p<0,05). Conclusion: We conclude that the cavo-pulmonary anastomosis led to right ventricle decompression in an experimental model of acute biventricular failure under isolated left ventricle circulatory support. The right ventricle decompression generated enhancement in pulmonary blood flow and better circulatory support performance.

Background: Temporary mechanical circulatory support device without sternotomy has been highly advocated for severe cardiogenic shock patient but little is known when coupled with amniotic stem cell therapy. Case presentation: This case reports the first dual therapy of temporary left ventricular extracorporeal device CentriMag with distal banding technique and human amniotic stem cell injection for treating a severe refractory cardiogenic shock of an 68-year-old female patient. A minimally-invasive off-pump LVAD was established by draining from the left ventricle and returning to the right axillary artery with distal arterial banding to prevent right upper extremity hyperperfusion. Amniotic stem cells were injected intramyocardially at the left ventricular apex, lateral wall, inferior wall, and right subclavian vein. Conclusion: The concomitant use of the temporary minimally-invasive off-pump CentriMag placement and stem cell therapy not only provided an alternative to cardiopulmonary bypass and full-median sternotomy procedures but may have also synergistically enhanced myocardial reperfusion and regeneration.

Heart failure (HF) is a widely prevalent state in developing countries, especially among people over 65, with percentages up to 10% of the population in the US. In all developed countries the expenditure related to congestive heart failure consists of a high percentage of the total health care expenditure, reaching 60% in the UK (1991 1). One of the main strategies for dealing with HF is the use of cardiac assist devices. Among these the most widely used device is the Intra-Aortic balloon pump (IABP). The IABP has as the main aims to increase coronary flow during inflation, and decrease end diastolic pressure and ventricular afterload during deflation. The device was introduced for the first time into clinical practice over 40 years ago, but open issues still remain with the performance of the device. In fact, both inflation and deflation effectiveness are compromised when the balloon operates at an angle to the horizontal, which is often the operating position of the device in intensive care units. The main aim of the work described in this thesis is to investigate the IABP in order to improve the efficacy of this therapy, in terms of IAB design and IABP timing effectiveness. For this purpose the balloon was first filmed in an experimental set-up to visualize its wall-motion with a high speed camera. The results of this investigation were the input for the development of different designs of balloon, tested at horizontal and angled positions. Both, inflation and deflation effectiveness were augmented using different shaped balloons in an experimental set-up characterized by static pressure as well as in one characterized by physiological pressure waveform. The improved performance was associated to an improved clinical outcome on a PV diagram. In addition different pumps and pump settings were studied in an experimental set-up, characterized by physiological aortic pressure waveform, in order to estimate the influence of different pump manufacturers and triggers on the performance of the device. In this case one of the pumps (Teleflex), with the new technology for pressure measurement via a fibre optic sensor, showed to best trigger the IAB after inflation onset, while the highest number of assisted beats was obtained when this pump was set on electrocardiogram (ECG) triggering. Nonetheless a first development of multi-dimensional computational model of the IAB counterpulsation was realized with the aim of establishing the effect of this therapy on relevant areas, such as aortic root, and in order to have an insight on the 3-D flow field in the surrounding of IAB: these information can be crucial for the optimisation of the balloon’s shape. In conclusion, the key finding was that a change in balloon shape influences both, inflation and deflation mechanics at horizontal and semi-recumbent positions, and this strategy can be used for maximising the IABP clinical benefits. With the aid of the computational model it will be possible to further develop the already tested balloon different shapes. Not less important, IABP therapy was demonstrated to be crucially influenced by the pump setting and mode (triggering inflation and deflation onsets), hence the clinical operator is addressed to change the pump mode of operation according to the patient’s condition to maximise the potential benefit of this therapy.

京都大学 / 新制・論文博士 / 博士(医学) / 乙第13428号 / 論医博第2232号 / 新制||医||1053(附属図書館) / (主査)教授 湊谷 謙司, 教授 佐藤 俊哉, 教授 福田 和彦 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

As autonomy increases in today’s vehicles, the demands increase on both safety and comfort functions. Vehicle Hold, which holds the vehicle stationary without requiring the driver to press the brake pedal, is an example of such as function. This thesis aims to develop a concept for a Drive Away Release from this hold state, following several requirements regarding such as rollback, comfort, manual and autonomous drive mode, driving direction, road inclinations, with or without a trailer, and following the safety standard ISO 26262. In order to develop the concept function, a study of the state-of-the-art was made, followed by modeling the dynamics and control. The control algorithm was validated and tested first by running co-simulations between Matlab/Simulink and CarMaker. It was then implemented in a test vehicle. The test vehicle did not have all systems which are usually provided, demanding estimations to be made, such as the road inclination and vehicle mass. For manual drive mode, the driver controls the propulsion torque, and the control algorithm is based on releasing the brakes depending on estimations of the gravitational and propulsion torques. For autonomous drive mode, the vehicle is supposed to follow an acceleration reference. The control algorithm for autonomous drive mode is then extended with two feedforward compensators, one from reference and one from the gravitational torque, which is regarded as a disturbance, and with a feedback PI controller. To ensure that rollback do not occur at drive away release, a rollback prevention safety feature was also developed. The results of both the simulations and the test drives show that the concept function provides comfortable drive-off for most inclinations, drive modes and directions, without causing an undesired rollback

Advanced Driving Assistance Systems (ADAS) has the potential to decrease the number of fatal accidents in traffic. However, in some cases, drivers with the systems in their car are resistant against using them. Exploring the underlying reasons and factors of the low-usage of ADAS was the purpose of this thesis. The thesis consists of Study I, an exploratory interview study with ten drivers who had cars with ADAS. The goal of Study I was to highlight the possible reasons behind the low usage of ADAS. The results of Study I were used to design Study II, which consisted of a survey targeted to drivers who had access to the ADAS adaptive cruise control and lane keep assist (N = 49). The results indicate that the factors or circumstances that affect usage depend on the ADAS and the user groups. Some identified underlying factors for low usage behavior of ADAS are the need to monitor the vehicle more when ADAS is activated and lack of trust in own ability when using ADAS compared to the high usage group. / Advanced Driving Assistance Systems (ADAS) har potential att förhindra antalet dödsfall i trafiken. Det förekommer att förare som har systemen i sin bil, väljer bort att använda dem. Syftet med den här uppsatsen var att undersöka underliggande orsaker och faktorer till låg användningsgrad av ADAS. Uppsatsen består av två studier. Studie I är en explorativ intervjustudie med tio förare som hade bilar med ADAS. Målet med Studie I var att ringa in de möjliga bakomliggande faktorerna för låg användningsgrad av ADAS. Resultaten från Studie I användes för att utforma en enkätstudie till Studie II som var riktad till förare som hade bilar med förarstödsystemen adaptiv farthållare och körfältsassistans (N = 49). Resultaten pekar på att de underliggande orsakerna och faktorerna beror på vilken ADAS som avses samt vilket användargrupp föraren tillhör. Några underliggande faktorer för låg användingsgruppen tycks vara känsla av att behöva övervaka fordonet samt lägre grad av tilltro till den egna förmågan än vad höganvändingsgrupper rapporterade.

Title: Selected gravitational effects in the Universe Author: Mgr. Tomáš Franc Department: Astronomical Institute of Charles University Supervisor: doc. RNDr. Marek Wolf, CSc., Astronomical Institute of Charles University Abstract: In this Thesis we have given an overview of tidal phenomena with their explanations and also explained the gravitational assist with examples of its use. We have created many pictures and 17 animations for better understanding of these topics. This part of the Thesis is focused on high school students and their teachers, it can be used by teachers for their inspiration for lessons, or students and more generally people interested in these topics can read this part as a study text. The main part of the Thesis is the result of research conducted on 13 high schools in the Czech Republic. 800 students took part in the research; its purpose was to find out students' knowledge of tidal phenomena and the gravitational assist. The research was carried out in the form of questionnaires. Keywords: gravity, tidal phenomena, gravitational assist, pedagogical research

This study evaluates the impact of untreated preoperative severe mitral valve regurgitation (MR) on outcomes after left ventricular assist device (LVAD) implantation. Of the 234 patients who received LVAD therapy in the Heart Center Leipzig during a 6-year period, we selected those who had echocardiographic images of good quality and excluded those who underwent mitral valve replacement prior to or mitral valve repair during LVAD placement. The 128 patients selected were divided into 2 groups: Group A with severe MR (n = 65) and Group B with none to moderate MR (n = 63, 28 with moderate MR). We evaluated transthoracic echocardiography preoperatively [15 (7–28) days before LVAD implantation; median (interquartile range)] and postoperatively up to the last available follow-up [501 (283–848) days after LVAD]. We collected mortality, complications and clinical status indicators of the patient cohort. We observed a significant decrease in the severity of MR after LVAD implantation (severe MR 51% pre- vs 6% post-LVAD implantation, P < 0.001). There was no difference between groups in terms of right heart failure, rate of urgent heart transplantation, pump thrombosis or ventricular arrhythmias. There was no difference in 1-year survival and 3-year survival (87.7% vs 88.4% and 71.8% vs 66.6% for Groups A and B, respectively, P = 0.97). We concluded that preoperative severe MR resolves in the majority of patients early on after LVAD implantation and is not associated with worse clinical outcomes or intermediate-term survival.:Inhaltsverzeichnis Abkürzungsverzeichnis 3 1. Einführung 4 2. Formatierte Publikation 12 3. Zusammenfassung der Arbeit 19 4. Literaturverzeichnis 23 5. Anlagen 28 5.1. Statistical analysis of echocardiographic parameters in follow-up 28 5.2. Statistical Models Used 30 Darstellung des eignen wissenschaftlichen Beitrages 32 Erklärung über die eigenständige Abfassung der Arbeit 33 Lebenslauf 34 Publikationen 37 Danksagung 38

The Indiana Department of Transportation (INDOT) manages and maintains over 3,000 miles of interstates across the state. Assessing lane marking quality is an important part of agency asset tracking and typically occurs annually. The current process requires agency staff to travel the road and collect representative measurements. This is quite challenging for high volume multi-lane facilities. Furthermore, it does not scale well to the additional 5,200 centerline miles of non-interstate routes. <div><br></div><div>Modern vehicles now have technology on them called “Lane Keep Assist” or LKA, that monitor lane markings and notify the driver if they are deviating from the lane. This thesis evaluates the feasibility of monitoring when the LKA systems can and cannot detect lane markings as an alternative to traditional pavement marking asset management techniques. This information could also provide guidance on what corridors are prepared for level 3 autonomous vehicle travel and which locations need additional attention. </div><div><br></div><div>In this study, a 2019 Subaru Legacy with LKA technology was utilized to detect pavement markings in both directions along Interstates I-64, I-65, I-69, I-70, I-74, I90, I-94 and I-465 in Indiana during the summer of 2020. The data was collected in the right most lane for all interstates except for work zones that required temporary lane changes. The data was collected utilizing two go-pro cameras, one facing the dashboard collecting LKA information and one facing the roadway collecting photos of the user’s experience. Images were taken at 0.5 second frequency and were GPS tagged. Data collection occurred on over 2,500 miles and approximately 280,000 images were analyzed. The data provided outputs of: No Data, Excluded, Both Lanes Not Detected, Right Lane Not Detected, Left Lane Not Detected, and Both Lanes Detected. </div><div><br></div><div>The data was processed and analyzed to create spatial plots signifying locations where markings were detectable and locations where markings were undetected. Overall, across 2,500 miles of travel (right lane only), 77.6% of the pavement markings were classified as both detected. The study found</div><div><br></div><div>• 2.6% the lane miles were not detected on both the left and right side </div><div>• 5.2% the lane miles were not detected on the left side </div><div>• 2.0% the lane miles were not detected on the right side 8 </div><div><br></div><div>Lane changes, inclement weather, and congestion caused 12.5% of the right travel lane miles to be excluded. The methodology utilized in this study provides an opportunity to complement the current methods of evaluating pavement marking quality by transportation agencies. </div><div><br></div><div>The thesis concludes by recommending large scale harvesting of LKA from a variety of vendors so that complete lane coverage during all weather and light conditions can be collected so agencies have an accurate assessment of how their pavement markings perform with modern LKA technology. Not only will this assist in identifying areas in need of pavement marking maintenance, but it will also provide a framework for agencies and vehicle OEM’s to initiate dialog on best practices for marking lines and exchanging information.</div>