Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-02-22T19:52:03Z No. of bitstreams: 1 ClaudioHenriqueSilvaDeFreitas_DISSERT.pdf: 1740254 bytes, checksum: 894f0ff9f21933b0594b76c6cfa325a8 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-08T00:31:33Z (GMT) No. of bitstreams: 1 ClaudioHenriqueSilvaDeFreitas_DISSERT.pdf: 1740254 bytes, checksum: 894f0ff9f21933b0594b76c6cfa325a8 (MD5) / Made available in DSpace on 2017-03-08T00:31:33Z (GMT). No. of bitstreams: 1 ClaudioHenriqueSilvaDeFreitas_DISSERT.pdf: 1740254 bytes, checksum: 894f0ff9f21933b0594b76c6cfa325a8 (MD5) Previous issue date: 2016-09-28 / Este estudo teve como objetivo analisar o processo de trabalho e as a??es do t?cnico de enfermagem na cl?nica cir?rgica do Edif?cio Central de Interna??o do Hospital Universit?rio Onofre Lopes, ECI-HUOL. Buscou-se, assim, entender como se d? a organiza??o do trabalho, mais especificamente em rela??o ?s atividades assistenciais. O estudo descritivo proposto foi realizado no setor de cl?nica cir?rgica do Hospital Universit?rio Onofre Lopes em Natal/RN e incluiu 18 enfermeiros e 54 t?cnicos de enfermagem atuantes no referido setor. A partir de uma an?lise inicial dos impressos e protocolos dispon?veis, constatou-se a defici?ncia na sistematiza??o dos procedimentos e a limita??o de instrumentos que possam guiar os t?cnicos na defini??o de uma l?gica ou sequenciamento de suas a??es. Com o uso de instrumentos variados (observa??o, question?rio fechado do tipo survey), foi feita uma an?lise de como se d? a organiza??o do trabalho da enfermagem e constatou-se que, na ?tica dos envolvidos, este se processa de maneira aleat?ria, sem um instrumento formal que ordene as atividades ou indique quem deve orientar o sequenciamento ou prioridade das a??es assistenciais. Os resultados indicaram tamb?m que, de modo geral, tal fragilidade de par?metros propicia certa personaliza??o na assist?ncia, traduzida numa atua??o que expressa os h?bitos adquiridos e a vis?o particular de cada profissional em rela??o ao processo. Conclui-se, ent?o, que, longe de buscar um enrijecimento e controle absoluto do agir, ? necess?rio otimizar a organiza??o do trabalho a partir da escolha e ado??o de procedimentos que informem e padronizem a assist?ncia, evitando, assim, que a indefini??o quanto aos par?metros comprometa o tratamento institu?do, trazendo riscos ? sa?de do paciente. / This study aimed to analyze the work process and the nursing technician's actions in the surgical sectors of the Central building of hospitalization of University Hospital Onofre Lopes, ECI - HUOL. It attempted to thus understand how is the organization of work, specifically in relation to welfare activities. The proposed descriptive study was performed in surgical sector of Onofre Lopes University Hospital in Natal / RN and included 18 nurses and 54 nurse technicians who work in that sector. From an initial analysis of forms and available protocols, it was found that has a deficiency in the systematization of the procedures and the limitation of tools that can guide the technicians in the definition of a logic or sequence of its shares. With the use of various instruments (observation, closed questionnaire type survey), an analysis of how is the organization of nursing work was done. It was found that, in the view of those involved, their activities are performed randomly, without a formal instrument to order the actions or indicate who should guide the sequencing and priority of care actions. The results also indicated that, in general, such fragility parameters provide some personalization in care, translated into a performance that expresses the acquired habits and the particular vision of each professional regarding the process. It was concluded, then, that far get a stiffening and absolute control of the act, it is necessary to optimize the organization of work from the choice and adoption of procedures to report and standardize the assistance, thus avoiding the uncertainty as to the parameters compromise the treatment given, bringing risks to patient health.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-03-20T22:18:32Z No. of bitstreams: 1 IsabelleCamposDeAzevedo_DISSERT.pdf: 1420654 bytes, checksum: bdfaecb12b12b0811c4b71d4ba2dfdac (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-03-23T21:22:49Z (GMT) No. of bitstreams: 1 IsabelleCamposDeAzevedo_DISSERT.pdf: 1420654 bytes, checksum: bdfaecb12b12b0811c4b71d4ba2dfdac (MD5) / Made available in DSpace on 2017-03-23T21:22:49Z (GMT). No. of bitstreams: 1 IsabelleCamposDeAzevedo_DISSERT.pdf: 1420654 bytes, checksum: bdfaecb12b12b0811c4b71d4ba2dfdac (MD5) Previous issue date: 2016-12-13 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior (CAPES) / O Transplante de C?lulas-Tronco Hematopo?ticas (TCTH) ? utilizado como estrat?gia de tratamento para uma s?rie de agravos malignos e n?o malignos herdados ou adquiridos, com possibilidade de cura ou aumento da sobrevida livre da doen?a. O presente estudo objetivou caracterizar o perfil cl?nico e epidemiol?gico dos pacientes que realizaram TCTH em um servi?o de refer?ncia no estado do Rio Grande do Norte (RN), estimar a sobrevida global dos transplantados e identificar as terapias que favorecem o aumento da sobrevida global. A primeira parte ocorreu junto ao servi?o de refer?ncia do estado do RN para realiza??o do TCTH. Trata de um estudo de abordagem quantitativa, do tipo coorte retrospectiva, descritivo e anal?tico, de base hospitalar que abordou 272 pacientes que realizaram TCTH. Os dados foram coletados no Servi?o de Arquivo M?dico e Estat?stica entre os meses de mar?o e setembro de 2016 por meio dos prontu?rios registrados entre os anos de 2008 e 2015, oito anos de execu??o do procedimento. Para a an?lise descritiva foi utilizado software livre estat?stico R vers?o 3.0.0 e para o c?lculo das probabilidades de sobrevida foi empregado o m?todo Kaplan-Meier por meio do Statistic Package for Social Sciences (SPSS) vers?o 22.0. Para o c?lculo da probabilidade de associa??o entre as caracter?sticas analisadas e os ?bitos foi utilizado o teste do Qui-quadrado de tend?ncia. A segunda parte do estudo se deu pela constru??o de uma Revis?o Sistem?tica (RS) da literatura sobre as terapias que favorecem o aumento a sobrevida de pacientes que realizaram o TCTH. O Protocolo de Pesquisa foi aprovado em seus aspectos ?ticos e metodol?gicos pelo Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte, com aprova??o em 01 de julho de 2015, sob o parecer no. 1.132.720 e CAAE no. 46202715.7.0000.5537. Dos 272 prontu?rios analisados houve predom?nio do sexo masculino 52,94%, com m?dia de 38,69 anos, 18,38% eram pardos e 47,06% casados. De acordo com as caracter?sticas cl?nicas, 23,16% apresentou como diagn?stico principal o Mieloma M?ltiplo, as toxicidades mais desenvolvidas foram as gastrointestinais (93,38%), todos os pacientes receberam tratamento por meio de antineopl?sticos, o TCTH realizado com maior frequ?ncia foi o alog?nico (54,78%), com c?lulas do sangue perif?rico (77,94%) e doador aparentado (71,81%). Cerca de 9% dos pacientes realizaram mais de um TCTH, 4,04% desenvolveu a Doen?a do Enxerto Contra Hospedeiro (DECH), dentre estes 54,55% apresentou o tipo cr?nico, a causa de morte mais registrada nas declara??es de ?bito foi o choque s?ptico (48,19%) e a sobrevida global dos pacientes transplantados foi de 4,03 meses, sem diferen?a estatisticamente significativa quando comparados os pacientes de acordo com o sexo (p=0,859). Quanto aos achados da RS n?o foi poss?vel identificar um consenso para definir a melhor forma de tratamento para o favorecimento do aumento da sobrevida global nos estudos revisados. A escolha da terap?utica adequada depender? especialmente das caracter?sticas cl?nicas apresentadas pelos indiv?duos. Entretanto, de forma geral, os planos terap?uticos utilizados pelo bra?o experimento dos ensaios cl?nicos analisados obtiveram melhores respostas para o aumento da sobrevida global dos indiv?duos testados. Portanto, conclui-se que h? a necessidade de realiza??o de outros estudos do tipo multic?ntricos que apresentem os perfis epidemiol?gicos e cl?nicos do TCTH no Brasil, haja vista que estes possibilitam a problematiza??o da realidade e a publica??o de evid?ncias confi?veis para atualiza??o dos conhecimentos cient?ficos. / Hematopoietic stem cell transplantation (HSCT) is used as a treatment strategy for a series of inherited or acquired malignant and non-malignant diseases, with the possibility of cure or increase in disease-free survival. The objective of this study was to characterize the clinical and epidemiological profile of the patients who underwent HSCT at a referral service in the state of Rio Grande do Norte (RN), to estimate the overall survival of transplant recipients and to identify therapies that favor increased overall survival. The first part occurred with the reference service of the state of the RN to perform the HSCT. This is a quantitative, retrospective, descriptive and analytical, hospital-based quantitative study that addressed 272 patients who underwent HSCT. The data were collected in the Medical Record and Statistic Service between March and September 2016 through medical records recorded between the years 2008 and 2015, eight years of execution of the procedure. For the descriptive analysis, statistical free software R version 3.0.0 was used and the Kaplan-Meier method was used to calculate survival probabilities using the Statistic Package for Social Sciences (SPSS) version 22.0. The trend chi-square test was used to calculate the probability of association between the characteristics analyzed and the deaths. The second part of the study was the construction of a Systematic Review (SR) of the literature on the therapies that favor the increase in the survival of patients who underwent HSCT. The Research Protocol was approved in its ethical and methodological aspects by the Research Ethics Committee of the Federal University of Rio Grande do Norte, with approval on July 1, 2015, under no. 1,132,720 and CAAE no. 46202715.7.0000.5537. Of the 272 patient charts analyzed, there was a predominance of males 52.94%, with a mean of 38.69 years, 18.38% were brown and 47.06% married. According to the clinical characteristics, 23.16% had as main diagnosis Multiple Myeloma, the most developed toxicities were gastrointestinal (93.38%), all patients received treatment with antineoplastics, the most frequently performed HSCT was (54.78%) with peripheral blood cells (77.94%) and related donor (71.81%). About 9% of the patients had more than one HSCT, 4.04% developed the Graft versus Host Disease (GVHD), of which 54.55% presented the chronic type, the most registered cause of death in the death certificates was Septic shock (48.19%) and overall survival of transplanted patients was 4.03 months, with no statistically significant difference when patients were compared according to sex (p = 0.859). Regarding the SR findings, it was not possible to identify a consensus to define the best form of treatment to favor the increase in overall survival in the reviewed studies. The choice of appropriate therapy will depend especially on the clinical characteristics presented by individuals. However, in general, the therapeutic plans used by the experimental arm of the analyzed clinical trials obtained better answers to increase the overall survival of the individuals tested. Therefore, it is concluded that there is a need to carry out other multicenter studies that present the epidemiological and clinical profiles of HSCT in Brazil, since these make it possible to problematize reality and to publish reliable evidence to update scientific knowledge.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-03T19:26:48Z No. of bitstreams: 1 MariaQuiteriaBatistaMeirelles_DISSERT.pdf: 1550125 bytes, checksum: 2b21e1b16d2860faba1a42ff07af5ffd (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-04T22:36:40Z (GMT) No. of bitstreams: 1 MariaQuiteriaBatistaMeirelles_DISSERT.pdf: 1550125 bytes, checksum: 2b21e1b16d2860faba1a42ff07af5ffd (MD5) / Made available in DSpace on 2017-04-04T22:36:40Z (GMT). No. of bitstreams: 1 MariaQuiteriaBatistaMeirelles_DISSERT.pdf: 1550125 bytes, checksum: 2b21e1b16d2860faba1a42ff07af5ffd (MD5) Previous issue date: 2016-11-28 / O perfil epidemiol?gico da infec??o pelo HIV/aids no Brasil passou por mudan?as nos ?ltimos anos, sendo o fen?meno conhecido como feminiza??o da epidemia, caracterizado pelo aumento do n?mero de casos em mulheres em idade f?rtil e consequente aumento do risco de transmiss?o vertical. O estudo descreve o perfil epidemiol?gico das gestantes HIV+/aids no Rio Grande do Norte (RN) e no Brasil e analisa a qualidade dos dados dispon?veis no Sistema Nacional de Informa??o de Agravos de Notifica??o (SINAN). A qualidade dos dados dispon?veis foi avaliada segundo a completude dos registros, sendo classificada em excelente, regular e ruim. No estado do RN, avaliou ainda a presen?a de disson?ncia na notifica??o de gestantes e mulheres HIV+/aids entre os servi?os de Vigil?ncia Epidemiol?gica do RN e os dados dispon?veis no SINAN/DATASUS. Ademais, analisou o comportamento da s?rie hist?rica das gestantes HIV+/aids, no per?odo de 2000 a 2013, no Brasil, regi?es e unidades federativas, segundo ra?a/cor, realiza??o do pr?-natal, faixa et?ria e escolaridade. Para a an?lise da tend?ncia do coeficiente de gestantes HIV+/aids foi usado o m?todo de regress?o polinomial. Foram selecionados fatores contextuais relacionados com a epidemia e ap?s a realiza??o de uma regress?o linear m?ltipla, foram selecionados aqueles capazes de explicar o percentual de varia??o do coeficiente de gestantes HIV+/aids. No estado do RN, entre 2007 e 2014, os dados evidenciaram uma completude considerada excelente nas vari?veis s?cio demogr?ficas. J? para as vari?veis referentes ao pr?-natal e ao parto, variou de ruim a regular. Foi identificada disson?ncia na notifica??o de gestantes e mulheres HIV+/aids entre os servi?os de Vigil?ncia Epidemiol?gica do RN e os dados dispon?veis no SINAN/DATASUS. As gestantes HIV+/aids se caracterizaram por estarem na faixa et?ria reprodutiva, negras, escolaridade inferior a oito anos e residentes na zona urbana. No Brasil, no per?odo de 2000 a 2014, a maioria das vari?veis s?cio demogr?ficas obteve uma completude excelente, sendo regular para a maioria das vari?veis relacionadas ao pr?-natal e ao parto. Observou-se ainda que a epidemia tem um comportamento heterog?neo, seguindo uma tend?ncia crescente na maioria dos estados. Em rela??o ?s vari?veis ra?a/cor, realiza??o do pr?-natal, faixa et?ria e escolaridade, pode-se observar que as adolescentes que n?o fizeram pr?-natal, pretas e analfabetas tiveram um maior incremento m?dio anual no coeficiente de infec??o por HIV/aids. Entre os fatores contextuais quanto maior o n?mero de homens infectados por HIV maior foi o aumento no percentual de varia??o do coeficiente de infec??o de gestantes HIV+/aids. O incremento no IDHM e na Taxa de brancos/negros correspondeu a uma diminui??o no percentual de varia??o do coeficiente de infec??o de gestantes HIV+/aids. Conclui-se que os sistemas de informa??o embora permitam um conhecimento acerca das gestantes HIV+/aids, ? necess?rio otimizar a notifica??o dos casos, aumentar a completude e consequentemente a qualidade da informa??o produzida, seja em n?vel nacional, estadual ou municipal, diminuindo a disson?ncia entre os dados produzidos nesses tr?s n?veis. O perfil epidemiol?gico das gestantes HIV/aids reflete a vulnerabilidade social dessas mulheres, traduzido no incremento observado ao longo da s?rie hist?rica e nos fatores contextuais a ele correlacionados. / The epidemiological profile of HIV / AIDS infection in Brazil has undergone changes in recent years, the phenomenon known as feminization of the epidemic, characterized by the increase in the number of cases in women of childbearing age and consequent increase in the risk of vertical transmission. The study describes the epidemiological profile of HIV + / AIDS pregnant women in Rio Grande do Norte (RN) and Brazil and analyzes the quality of the data available in the National Information System for Notification Diseases (SINAN). The quality of the available data was evaluated according to the completeness of the records, being classified as excellent, fair and poor. In the state of the RN, it also evaluated the presence of dissonance in the notification of pregnant women and HIV + / AIDS women between the services of Epidemiological Surveillance of the RN and the data available in SINAN / DATASUS. In addition, it analyzed the behavior of the historical series of HIV + / AIDS pregnant women, from 2000 to 2013, in Brazil, regions and federative units, according to race / color, prenatal, age and schooling. For the analysis of the tendency of the coefficient of HIV + / AIDS pregnant women, the polynomial regression method was used. We selected contextual factors related to the epidemic and after multiple linear regression, we selected those capable of explaining the percentage of variation of the coefficient of HIV + / AIDS pregnant women. In the state of the RN, between 2007 and 2014, the data showed a completeness considered excellent in the socio-demographic variables. As for the variables related to prenatal care and delivery, it ranged from poor to regular. Dissonance was identified in the notification of pregnant women and HIV + / AIDS women between the services of Epidemiological Surveillance of the NB and the data available in SINAN / DATASUS. HIV + / HIV pregnant women were characterized by being in the reproductive age group, black, schooling less than eight years old and living in the urban area. In Brazil, from 2000 to 2014, most socio-demographic variables obtained excellent completeness, being regular for most variables related to prenatal and childbirth. It was also observed that the epidemic has a heterogeneous behavior, following a growing tendency in most states. In relation to the race / color, prenatal, age and schooling variables, it can be observed that adolescents who did not have prenatal, black and illiterate had a greater average annual increase in the coefficient of HIV / AIDS infection. Among the contextual factors, the higher the number of men infected with HIV, the greater the percentage of variation in the infection coefficient of HIV + / AIDS pregnant women. The increase in the HDI and the White / Black Rate corresponded to a decrease in the percentage of variation in the infection coefficient of HIV + / AIDS pregnant women. It is concluded that information systems, although they allow a knowledge about HIV + / AIDS pregnant women, it is necessary to optimize the notification of cases, increase the completeness and consequently the quality of the information produced, be it at the national, state or municipal level, reducing the dissonance Between the data produced at these three levels. The epidemiological profile of HIV / AIDS pregnant women reflects the social vulnerability of these women, reflected in the increase observed throughout the historical series and in contextual factors correlated to it.

Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2017-04-17T23:08:15Z No. of bitstreams: 1 FlaviaAndreiaPereiraSoaresDosSantos_TESE.pdf: 3962298 bytes, checksum: d43e38cba2487744a56a8215f55f09f3 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2017-04-20T21:25:51Z (GMT) No. of bitstreams: 1 FlaviaAndreiaPereiraSoaresDosSantos_TESE.pdf: 3962298 bytes, checksum: d43e38cba2487744a56a8215f55f09f3 (MD5) / Made available in DSpace on 2017-04-20T21:25:51Z (GMT). No. of bitstreams: 1 FlaviaAndreiaPereiraSoaresDosSantos_TESE.pdf: 3962298 bytes, checksum: d43e38cba2487744a56a8215f55f09f3 (MD5) Previous issue date: 2016-12-22 / O modelo de aten??o ? sa?de ressalta a import?ncia do enfermeiro obstetra na melhoria do atendimento ? mulher no ciclo grav?dico-puerperal. No entanto, consolidar a atua??o deste profissional na assist?ncia ao parto de risco habitual constitui um desafio devido ?s cren?as, valores, condi??es estruturais e organizacionais das institui??es que definem o poder-saber das rela??es sociais nos locais de trabalho. O objetivo dessa pesquisa ? construir uma abordagem te?rico explicativa da autonomia do enfermeiro obstetra na assist?ncia ao parto de risco habitual no ?mbito da cultura hospitalar. Estudo qualitativo, com delineamento te?rico-metodol?gico da Etnografia, desenvolvido em tr?s maternidades p?blicas no estado do Rio Grande do Norte, Brasil. Participaram tr?s gestores e vinte e tr?s enfermeiros obstetras. A coleta de dados ocorreu de julho a outubro de 2016, ap?s a aprova??o do Comit? de ?tica em Pesquisa da Universidade Federal do Rio Grande do Norte, CAAE n? 55187716.9.0000.5537. As informa??es foram coletadas mediante a observa??o participante, di?rio de campo, entrevistas semiestruturadas e de grupo focal. Utilizou-se o Atlas.ti software e os preceitos do m?todo etnogr?fico de Spradley para a an?lise dos dados, realizada simultaneamente ? coleta. Tr?s termos cobertos emergiram: Viv?ncia do enfermeiro obstetra em diferentes contextos de atua??o hospitalar; Rela??es sociais e de poder no ?mbito hospitalar; Aspectos profissionais e gerenciais relacionados ? autonomia do enfermeiro obstetra. Os temas foram conceptualizados com base em Foucault sobre o poder na constru??o da autonomia. Os conceitos e as suas rela??es compreenderam uma explica??o te?rica da autonomia do enfermeiro obstetra na assist?ncia ao parto de risco habitual no ?mbito da cultura hospitalar. O modelo constru?do neste estudo desvelou que o enfermeiro obstetra vivencia diferentes contextos estruturais, organizacionais e culturais capazes de influenciar o seu poder decis?rio na assist?ncia ao parto. Nesses espa?os, desencadeiam-se rela??es sociais e de poder que reproduzem o conceito de autonomia vinculado ao paradigma dominante de individualismo e de rela??es de dom?nio e submiss?o. Vislumbra-se a autonomia constitu?da por um saber-poder que amplia e respalda a atua??o do enfermeiro obstetra por meio de um valor ?tico enaltecedor do trabalho multiprofissional. Deste modo, a autonomia ? conquistada por aqueles que assumem o papel na transforma??o da sua pr?xis a partir das rela??es de poder estabelecidas com o outro na perspectiva do crescimento conjunto. / The health care model denotes the obstetrical nurse?s importance for the improvement of quality care for the pregnant or puerperal woman. However, the presence of this professional in the birthing process in institutions is a challenge primarily because of the beliefs, values, strutural and organizational conditions of the work places that model the power relations of the professional. This is a qualitative study with an ethnographic theoretical-methodological and conducted in three public maternities in the State of Rio Grande do Norte, Brazil. Three managers and 23 obstetrical nurses participated in the study. Data was collected during July and October in 2016 after approval from the Research Ethics Committee of the Universidade Federal do Rio Grande do Norte, CAAE n? 55187716.9.0000.5537. Information was collected by participant observation, individual and focal group interviews with nurses, and registered in field notes. The collection was halted when no new data emerged. The Atlas.ti software and Spradley?s tenets were used for data analysis conducted simultaneously with the date collection. Three cover terms emerged: Obstetrical nurse?s experience in diferent hospital care contexts; Social relations and power presente in the institutional care to minimal risk births; Professional and institutional aspects related to the obstetrical nurse?s autonomy. The themes were conceptualized based on Foucault?s principles about power and autonomy construction. The concepts and their relations conform a theoretical explanation of the obstetrical nurse?s autonomy is a contribution to the care of the minimal risk birth in the hospital cultural context. The connstructed model unveils the obstetrical nurse in the experience with diferent structural conditions, oranized practies, and the hospital?s cultural ambiance that influence the decision power in birthcare. This space, the institutions and the professionals develop social and power relations that enhance the concept of autonomy connected to the dominant individualistic paradigm and dominance/submissive relations. The model projcts an autonomy constructed by a power/knowledge that expands and supports the nurse?s actions by an ethical value it enhances the multiprofissional work in that the challenges and barriers are resolved by dialogue, not imposition. Those considerations enable to affirm that autonomy is not given but conquered by those that are aware of their role in the transformation of the pr?xis based on the power relations that are established with others in a perspective for joint growth.

Submitted by Alex Sandro R?go (alex@ifpb.edu.br) on 2016-11-23T18:41:52Z No. of bitstreams: 1 IDENTIFICA??O E CLASIFICA??O DE SINALIZA??O HORIZONTAL EM AUTOVIAS UTILIZANDO OPENCV_Francisco_Alves.pdf: 5288985 bytes, checksum: e866e75315506b47d3d232ff39ce4a97 (MD5) / Approved for entry into archive by Alex Sandro R?go (alex@ifpb.edu.br) on 2016-11-23T18:43:51Z (GMT) No. of bitstreams: 1 IDENTIFICA??O E CLASIFICA??O DE SINALIZA??O HORIZONTAL EM AUTOVIAS UTILIZANDO OPENCV_Francisco_Alves.pdf: 5288985 bytes, checksum: e866e75315506b47d3d232ff39ce4a97 (MD5) / Made available in DSpace on 2016-11-23T18:43:51Z (GMT). No. of bitstreams: 1 IDENTIFICA??O E CLASIFICA??O DE SINALIZA??O HORIZONTAL EM AUTOVIAS UTILIZANDO OPENCV_Francisco_Alves.pdf: 5288985 bytes, checksum: e866e75315506b47d3d232ff39ce4a97 (MD5) Previous issue date: 2016-11-23 / Acidentes de tr?nsito podem ser fatais, causando a morte ou invalidez de motoristas e pedestres. Desta forma, muitos pesquisadores est?o desenvolvendo meios para deixar os ve?culos mais seguros, atrav?s do uso de sistemas de apoio ? condu??o que auxiliem os motoristas nas mais diversas situa??es no tr?nsito. O objetivo deste trabalho ? propor um sistema para detec??o e classifica??o de linhas de sinaliza??o horizontais em autovias. Sistemas deste tipo podem ajudar a diminuir a quantidade de acidentes de tr?nsito, auxiliando o condutor do ve?culo a permanecer em sua faixa e realizar ultrapassagens apenas em locais permitidos. As imagens das autovias, capturadas por uma c?mera fixada ao para-brisa no interior do ve?culo, s?o analisadas quadro a quadro em tempo real. O sistema proposto foi desenvolvido na linguagem de programa??o C++, utilizando a biblioteca OpenCV, de c?digo aberto, amplamente empregada em vis?o computacional. Dentre outras t?cnicas, utilizou-se o detector de bordas de Canny e a Transformada Probabil?stica de Hough para identifica??o de segmentos de reta. Adicionalmente, foram desenvolvidos m?todos geom?tricos para otimiza??o e elimina??o de segmentos desnecess?rios e um algoritmo para estima??o do ponto de fuga, o qual auxilia na identifica??o dos segmentos mais relevantes para o sistema. Foram realizados sete experimentos apresentando diferentes n?veis de dificuldade. Acur?cias na faixa de valores de 86,58% a 100% foram alcan?adas. Em m?dia, os experimentos obtiveram uma acur?cia de 94,56% na classifica??o dos diferentes tipos de sinaliza??es horizontais.

Numerical modelling and simulation are powerful tools for analysis and design, and with the improvement of computational power and numerical methods they are being applied on complex phenomena and systems. This work shows examples of the application of a very sophisticated numerical method, namely the Spectral/hp element method, in the study of the flow inside bioinspired complex geometries. The two topics investigated are fluid dynamic instabilities in a constricted channel and flow inside a paediatric ventricular assist device were studied by means of computational fluid mechanics. The constricted channel is an idealized model of a nasal cavity, which is characterized by complex airway channels, and also bears some resemblance to a human artery in the presence of an atherosclerotic plaques. The paediatric ventricular assist device is an actual device, designed by the Bioengineering research group of the Heart Institute of the Medicine School of the University of São Paulo, which works as a pump that assists the left ventricle of patients waiting for transplantation. Therefore, the aim of this thesis is to contribute in the understanding of biological and bio-inspired geometries flows, using computational tools. Linear and nonlinear stability were carried out for the constricted channel. Three different flow regimes were investigated: symmetric steady flow, which is stable for low Reynolds number, asymmetric steady flow, which rises as a result of the primary bifurcation of the symmetric flow and pulsatile flow. Direct stability analysis was carried out to determine the unstable regions and the critical values for each flow regime. The physical mechanisms behind the transition processes were studied by means of direct numerical simulations to characterize the bifurcations. Since the bifurcations had subcritical behaviour, the relevance of non-normal growth in these flows was assessed. Dependence on phase, Reynolds number and spanwise wavenumber of optimal modes were extensively investigated in stable regions of the three flow regimes. Convective instabilities were also studied in order to comprehend the physical mechanisms which led the optimal modes to their maxima growth, and different convective mechanisms were found. The flow inside the paediatric ventricular assist device was analyzed by means of threedimensional numerical simulations. A computational model based on special boundaries conditions was developed to model the pulsatile flow. In this model, the opening and closure of the mitral valve and diaphragm were represented with the use of specially devised boundary conditions. The driving force and the flow direction of the diaphragm were defined by velocity distribution on the diaphragm wall, and the opening and closure of the mitral valve were performed by a velocity waveform which goes to zero in the systolic period. Flow patterns, velocity fields and time-average wall shear rate were analyzed to evaluate the performance of the device. / Modelagem e simulação numéricas são ferramentas poderosas para análise e design, e com a melhoria do poder computacional e dos métodos numéricos, eles estão sendo aplicados em fenômenos e sistemas complexos. Este trabalho mostra exemplos de aplicações de um método numérico sofisticado, o método dos elementos espectrais/hp, no estudo do escoamento dentro de geometrias complexas bio-inspiradas. Os dois tópicos investigados são: instabilidades em dinâmica de fluido em um canal constrito e o escoamento dentro de um dispositivo de assistência ventricular pediátrica. O canal constrito é um modelo idealizado de uma cavidade nasal, que é caracterizada por canais complexos da via aérea, e também tem semelhança com uma artéria humana na presença de placas ateroscleróticas. O dispositivo de assistência ventricular pediátrica é um dispositivo real, projetado pelo grupo de pesquisa de Bioengenharia do Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, que funciona como uma bomba que auxilia o ventrículo esquerdo dos pacientes à espera de transplante. Portanto, o objetivo desta tese é contribuir na compreensão de escoamentos em geometrias biológicas e bio-inspiradas, usando ferramentas computacionais. Análises de estabilidade linear e não linear foram feitas para um canal constrito. Três diferentes regimes de escoamento foram empregados: escoamento estacionário simétrico, que é estável para baixo número de Reynolds, escoamento assimétrico, o qual é resultado da primeira bifurcação do escoamento simétrico e escoamento pulsátil. Análise de estabilidade direta foi executada para determinar as regiões instáveis em cada regime de escoamento. Os mecanismos físicos por trás do processo de transição foram estudados por meio de simulação numérica direta para caracterizar as bifurcações. Uma vez que, as bifurcações tiveram um comportamento subcrítico, a relevância do crescimento não normal nestes escoamentos foi avaliado. Assim, dependência com a fase, número de Reynolds e número de onda do modo tridimensional foram extensivamente investigados em regiões estáveis para os três regimes de escoamento. Instabilidades convectivas foram também estudadas a fim de compreender os mecanismos físicos que conduzem os modos ótimos para seus crescimentos máximos, e diferentes mecanismos convectivos foram encontrados. O escoamento dentro do dispositivo de assistência ventricular pediátrico foi analisado por meios de simulações numéricas tridimensionais. Um modelo computacional baseado em condições de contorno especiais foi desenvolvido para modelar o escoamento pulsátil. Neste modelo, a abertura e fechamento da válvula mitral e diafragma foram representados com o uso de condições de contorno especialmente elaboradas. A força motora e o direcionamento do fluxo do diafragma foram definidos por uma distribuição de velocidades na parede do diafragma, e a abertura e fechamento da válvula mitral foram executadas por uma função de onda de velocidade que vai a zero no período sistólico. Padrões do escoamento, campos de velocidade e tensão de cisalhamento no tempo foram analisadas para avaliar o desempenho do dispositivo.

Atualmente, sabe-se que grande parte dos acidentes graves ocorridos envolvendo uma diversidade de sistemas como plataformas de petróleo, aeronaves ou plantas de processos industriais, poderiam ser evitados caso possuíssem dispositivos de controle projetados especificamente para manter a segurança durante a ocorrência de falhas no funcionamento dos mesmos. Por outro lado, observam-se complicações em realizar o controle de sistemas remotos em que é possível não haver garantia de monitoração em tempo real, como o caso de sondas espaciais ou robôs de exploração. Neste contexto, podem-se encontrar ambas as dificuldades no controle do funcionamento de um Dispositivo de Assistência Ventricular (DAV) que desempenha a função de auxiliar o bombeamento de sangue para o sistema circulatório de um paciente com insuficiência cardíaca. Este tipo de dispositivo, quando usado para terapia de destino, deve apresentar um elevado nível de segurança, pois, caso haja falha, o risco de morte é eminente. Por sua vez, o sistema deve apresentar um elevado índice de autonomia, já que as características comportamentais e fisiológicas de um paciente estão em constante mudança e afetam diretamente o modo como deve ocorrer a interação entre o DAV e o sistema cardiovascular do paciente. Sendo assim, há uma necessidade premente de aprimoramento do projeto de sistemas de controle de DAVs autônomos e seguros. A proposta do presente trabalho consiste em aplicar conceitos mecatrônicos para o projeto de um sistema de controle de DAVs e, considerando a natureza dos sinais que indicam a ocorrência de falhas, considerar a teoria de Sistemas a Eventos Discretos (SED), ferramentas de análise de risco e técnicas de diagnóstico e tratamento de falhas para a obtenção de modelos de controle considerando-se uma arquitetura modular e distribuída. Desta forma, foi desenvolvida uma arquitetura de controle supervisório para DAVs considerando características de variações de comportamento do sistema circulatório do paciente e do próprio DAV. Esta arquitetura de controle contempla o diagnóstico e tratamento de falhas desenvolvendo um método para a classificação de falhas e, de acordo com a severidade de cada uma delas é proposto um sistema de controle que atua na regeneração ou degeneração do DAV para um estado seguro, v observando, também, o cumprimento de normas médicas e técnicas de segurança. Para atingir este objetivo, propõe-se uma sistemática para o projeto do sistema de controle para DAVs considerando o aspecto multidisciplinar pertinente a este contexto. A base dessa sistemática consiste em realizar uma efetiva análise de risco do sistema utilizando a ferramenta de estudo HAZOP (Hazard and Operability Studies). A partir do conhecimento obtido sobre o comportamento do sistema em situações críticas desenvolvem-se modelos formais utilizando rede Bayesiana e rede de Petri para o diagnóstico e tratamento das possíveis falhas. O comportamento do DAV controlado pode ser analisado de duas formas: (i) a partir de ensaios in vitro utilizando técnicas de análise por simulação e ferramentas computacionais adequadas, além de testes em simuladores cardiovasculares físicos que emulam interação com o sistema circulatório humano; (ii) a partir de ensaios in vivo em animais que poderão ser utilizados para simular modelos físicos de insuficiência cardíaca e permitir uma avaliação fidedigna dos efeitos do implante do DAV. O procedimento proposto foi aplicado para um caso real de desenvolvimento de um DAV envolvendo uma equipe de pesquisadores da Escola Politécnica da USP e do Instituto Dante Pazanesse de Cardiologia. Assim, é possível obter-se um sistema de controle autônomo e seguro que atenda normas técnicas aderentes a esse assunto e os rigorosos requisitos de projeto impostos a essa classe de sistema. / Nowadays, it is kwon that the several of severe disasters compromising a great variety of systems such as oil platforms, aircrafts or industrial plants, could have been avoided if these systems had controllers designed specifically to maintain the safety levels in case of fault. On the other side, many complications are observed on performing the control of remote systems, where there is no guarantee of real time monitoring of the system, as in space probes or reconnaissance robots. In this context, both obstacles can be found on the control of ventricular assist devices (VAD), which have the role of assisting to pump the blood into the patients circulatory system, in case of irregular heartbeat or heart failure. Devices such as the VAD must possess very high safety levels, as in case of fault, the consequences are severe and might result on the dead of the patient. Nevertheless, these systems must have high degree of autonomy, as the patients physiology and behavior are constantly changing, and these changes impact directly the interactions between the VAD and the patient´s cardiovascular system. Thus, there is a pressing need to improve the design of safe and autonomous control systems for VADs. The present work proposes applying mechatronic concepts to the development of control systems for VADs, considering the nature of the fault indicating signals, as well as the Discrete Event Systems (DES) theory and through the application of tools for risk analysis, and fault diagnostic and treatment techniques aiming the development of control models based on modular and distributed architectures. Thereby, a VAD supervisory control architecture was developed, where the behavior variations of the patient´s circulatory system as well as of the VAD were taken into consideration. This control architecture features the diagnostic and treatment of faults, where methods for faults classification where developed, and according to the severity each fault is proposed a control system that performs the regeneration or degeneration of the VAD to a secure state and is according to medical standards and safety techniques. To achieve this goal is proposed a systematic for the design of the VAD control system considering the multidisciplinary context of the device. The foundation of this systematic is the performance of an effective risk analysis through the use of the toolset known vii as HAZOP (Hazard and Operability Studies). From the knowledge acquired about the system behavior during critical conditions, formal models are developed employing Bayesian Networks and Petri Nets for the diagnostic and treatment of faults. The behavior of the controlled VAD can be analyzed in two possible ways: (i) from in vitro experiments, through the use of simulation analysis tools and proper computational tools, as well as tests on real cardiovascular simulators, where the interactions between the VAD and the human circulatory system can be emulated; (ii) from in vivo experiments, animals can be used to simulate physical models of irregular heartbeat or heart failure and allow reliable valuations of the VAD implant. The proposed procedure was applied on the VAD development, which was performed by a team of researchers from the Escola Politécnica da USP and from the Instituto Dante Pazanesse de Cardiologia. Thus, is possible to achieve an autonomous and safe control system that complies with the applicable technical standards, as well as the strict project requirements for this class of system.

Abstract Guidelines and instructions derived from adult randomized controlled trials are generally followed in pediatric ventilation, as there have been no large trials of this kind in children. Current treatment strategies aim at preventing ventilator-induced lung injury by avoiding too large tidal volumes, supporting patient's spontaneous breathing and preventing lung collapse with positive end-expiratory airway pressure. Neurally adjusted ventilatory assist (NAVA) is a novel ventilation mode that provides respiratory support proportional to the electrical activity of the diaphragm (Edi). The aims of this thesis were to assess daily practices in pediatric ventilation in Finland and to compare NAVA with conventional ventilation in terms of safety and quality of care. Current treatment practices were studied with a preliminary enquiry and a 3-month prospective survey that was offered to all hospital units providing ventilatory care for children <16 years of age. NAVA was compared with current standard ventilation in a crossover trial involving 18 pediatric patients and in a larger controlled trial in which 170 patients were randomized to receive either NAVA or conventional ventilation. Respiratory distress was the most common indication for invasive ventilation in neonates, and postoperative care in older children. The principles of lung-protective ventilation were generally accepted and the goals were achieved in the majority of treatment episodes. The low incidence of pediatric invasive ventilation favours centralization. NAVA proved to be a safe and feasible primary ventilation mode in pediatric intensive care. It improved patient-ventilator synchrony and led to lower peak inspiratory pressures and oxygen requirements. It also reduced the need for sedation during longer treatment periods. Information derived from the Edi-signal could be used to optimize the level of sedation and to identify patients with a potential risk of extubation failure. / Tiivistelmä Nykyisin käytössä olevat menetelmät lasten hengityskonehoidossa perustuvat suurelta osin aikuisilla tehtyihin tutkimuksiin ja totuttuihin tapoihin, sillä lasten hengityskonehoidosta on olemassa vain vähän tutkittua tietoa. Hengityskonehoidon aiheuttamaa keuhkovauriota pyritään ehkäisemään välttämällä suuria kertahengitystilavuuksia, tukemalla potilaan omia hengityksiä ja säilyttämällä ilmateissä positiivinen paine uloshengityksen aikanakin. Neuraalisesti ohjattu ventilaatio (NAVA) on uusi hengityskonehoitomuoto, joka tukee potilaan omia hengityksiä ohjaamalla koneen antamaa tukea pallealihaksen sähköisen signaalin avulla. Tämän tutkimuksen tavoitteena oli selvittää lasten hengityskonehoidon nykytilaa Suomessa sekä tutkia, voidaanko NAVAa käyttämällä parantaa hoidon laatua ja turvallisuutta. Nykyisiä hoitokäytäntöjä selvitettiin vuonna 2010 kysely- ja seurantatutkimuksella, johon kutsuttiin mukaan kaikki Suomessa lapsia ja vastasyntyneitä hoitavat tehohoito-osastot. NAVAa verrattiin nykyiseen hengityskonehoitoon 18 potilaan vaihtovuoroisessa tutkimuksessa sekä suuremmassa 170 lapsipotilaan satunnaistetussa kontrolloidussa tutkimuksessa. Eri syistä johtuvat hengitysvaikeudet ovat yleisin syy hengityskonehoitoon vastasyntyneillä ja suurten leikkausten jälkeinen hoito isommilla lapsilla. Keuhkoja säästävän hoidon periaatteet ovat Suomessa yleisesti hyväksyttyjä ja toteutuvat valtaosassa hoitojaksoja. Hengityskonehoitojaksojen määrän vähäisyys puoltaa hoidon keskittämistä suuriin sairaaloihin. NAVAa käyttämällä hengityskoneen antama tuki ajoittuu paremmin potilaan omien hengitysten mukaan ja sen avulla saavutetaan matalammat ilmatiepaineet sekä vähäisempi lisähapen tarve. Pitkissä hoitojaksoissa NAVA vähentää rauhoittavan lääkityksen tarvetta, ja pallealihaksen signaalia seuraamalla on mahdollista optimoida sedaatioaste aikaisempaa tarkemmin. Palleasignaalia voidaan myös hyödyntää arvioitaessa potilaan valmiutta hengitystuesta vieroittamiseen.

With aging, the sensory, motor, and central nervous system deficiencies lead to inadequate bicycle postural control in older cyclists. Similarly, variety in riding skills leads to different bicycle postural control strategies. Cycling seems to be an automated task but keeping the bicycle stable at low speed, pedaling, and steering requires continuous physical and cognitive effort, and in long term may lead to fatigue induced by steering and stabilizing the e-bike at low forward speeds especially in older cyclists. E-bikes enables riders to cycle for langer duration and distance by reducing the physical fatigue. There is an increasing societal interest in electric bicycles where in 2021, 26. 73 billion US dollars worldwide have been invested on e-bikes and by 2027 this global market size will increase to 53.53 billion US dollars (Statista). However, with increased numbers of e-bikes, bicycle accidents due to inadequate steering and balance control by older cyclists have increased, which suggests needs for extra safety measures to maintain balance on a bicycle for challenging situation such as facing undesired disturbances or low forward speeds. We developed a prototype steering assist which aims to increase safety and improve the user experience, by reducing the steering effort and enhancing the bicycle postural control (rider-bike balance control). We investigated the potential effectiveness ofthe steering assist technology in real life challenging situations. Our present study should be considered exploratory research to find the potential effectiveness of the steering assist technology in improving the user experience and safety compared to a non-assistive e-bike. The improved bicycle postural control is validated by smaller range, variability, and rate of steering and roll trajectories when the rider is subjected to an unwanted disturbance. Improved bicycle postural control is expected based on the reduced need for compensatory behavior in the presence of assistive technology. Decreased steering effort is expected due to reduced demand for acute steering control in the anticipatory control strategy.

The resolution of functional mitral valve regurgitation (MR) in patients awaiting left ventricular assist device (LVAD) implantation is discussed controversially. The present study analyzed MR and echocardiographic parameters of the third-generation LVAD HeartMate 3 (HM3) over 3 years. Of 135 LVAD patients (with severe MR, n = 33; with none, mild, or moderate MR, n = 102), data of transthoracic echocardiography were included preoperatively to LVAD implantation, up to 1 month postoperatively, and at 1, 2, and 3 years after LVAD implantation. Demographic data and clinical characteristics were collected. Severe MR was reduced immediately after LVAD implantation in all patients. The echocardiographic parameters left ventricular end-diastolic diameter (P < .001), right ventricular end-diastolic diameter (P < .001), tricuspid annular plane systolic excursion (P < .001), and estimated pulmonary artery pressure (P < .001) decreased after HM3 implantation independently from the grade of MR prior to implantation and remained low during the 2 years follow-up period. Following LVAD implantation, right heart failure, ventricular arrhythmias, ischemic stroke as well as pump thrombosis and bleeding events were comparable between the groups. The incidences of death and cardiac death did not differ between the patient groups. Furthermore, the Kaplan-Meier analysis showed that survival was comparable between the groups (P = .073). HM3 implantation decreases preoperative severe MR immediately after LVAD implantation. This effect is long-lasting in most patients and reinforces the LVAD implantation without MR surgery. The complication rates and survival were comparable between patients with and without severe MR.