O consumo de drogas e álcool constitui cada vez mais um problema social e de saúde pública, pelas consequências negativas que provocam no desenvolvimento emocional e físico dos indivíduos. Existem poucas referências na literatura avaliando o uso destas substâncias por portadores de doença falciforme (DF). Estes pacientes apresentam crises álgicas severas, recorrentes, frequentemente controladas por opióides. O comprometimento da qualidade de vida predispõe a ocorrência de transtornos psiquiátricos não-psicóticos, como depressão por exemplo, tornando o grupo vulnerável ao uso abusivo de substâncias. Objetivos: avaliar o consumo de álcool e drogas em pacientes portadores de DF acompanhados pelo Centro de Referência de Doença Falciforme (CRAF) do Hospital de Clínicas de Porto Alegre (HCPA), estimar o percentual de pacientes em tratamento da doença falciforme que fazem uso abusivo de álcool e drogas, e colaborar com o estudo que avaliará a efetividade de um centro de referência multidisciplinar para esta população. Métodos: estudo transversal, de uma amostra de conveniência, com 139 pacientes portadores de DF acompanhados no CRAF do HCPA. Resultados: a prevalência do uso abusivo foi de 1,5% para o álcool e 3,0% para o tabaco, e não se identificou o uso abusivo de outras substâncias, inclusive opióides. O padrão para o uso de substâncias não foi influenciado pela exposição ou por transtornos psiquiátricos não-psicóticos. Conclusão: São necessários mais estudos para reforçar estes achados, mas demonstra-se a segurança do uso de analgésicos opióides para o manejo das crises dolorosas apresentadas pelos portadores de DF. / Drug abuse is increasingly becoming a social and public health problem, because of the negative consequences that such abuse causes on the emotional and physical development of individuals. There are few references in the literature evaluating the use of these substances by individuals with sickle cell disease (SCD). These patients have severe and recurrent pain crises, frequently needing opioids drugs to control it. The compromised quality of life can predispose this population to the occurrence of non-psychotic psychiatric disorders such as depression, making them vulnerable to substance abuse. Objectives: To evaluate the level of consumption of alcohol and drugs in patients with SCD followed by Sickle Cell Disease Reference Center (CRAF) at Hospital de Clínicas de Porto Alegre; to estimate the percentage of patients in treatment of SCD who abuse alcohol and drugs, and to collaborate with the study evaluating the effectiveness of the CRAF. Methods: cross-sectional study of a convenience sample of 139 patients with SCD treated at CRAF. Results: the prevalence of abusive use of the studied population was 1.5% for alcohol and 3.0% for tobacco, and no abusive use of any other substance, including opioids, was identified. It was verified that the pattern for substance use was not influenced by exposure to substances or the presence of non-psychotic psychiatric disorders. Conclusion: More studies are needed to reinforce these findings, but they suggested that the use of opioid analgesics for the management of SCD painful crises is safe and do not induces substance abuse.

Mancais são elementos importantes para o funcionamento adequado de muitos conjuntos mecânicos. Sendo assim, o contínuo desenvolvimento de novos tipos de mancais permite melhorar as condições atuais de funcionamento de dispositivos com necessidades específicas. Além disso, novos mancais proporcionam novos recursos para novos projetos. Este trabalho visa investigar a funcionalidade de um novo tipo de mancal rotativo híbrido resultante da combinação de um par de mancais magnéticos radiais passivos com um par de mancais de escora. Na direção radial, o eixo é mantido em posição central graças a dois mancais magnéticos compostos por imãs permanentes. Na direção axial, a restrição do movimento é devido a um par de mancais de escora localizados nas extremidades do eixo. Pelo ajuste do entreferro de cada par magnético é possível minimizar a carga axial que age em cada mancal de escora. Por meio de estudos baseados no método dos elementos finitos e experimentações, pretende-se esclarecer a relação entre os parâmetros construtivos e o desempenho do mancal. Os experimentos envolvem a verificação do desempenho do mancal por meio de um conjunto para testes, bem como um estudo de caso. O conjunto para testes possibilitou um ensaio de desgaste acelerado, onde uma esfera de aço, utilizada como pivô, manteve contato com uma superfície de PVC rígido. Tal ensaio resultou em um desgaste desprezível da superfície de contato devido à aplicação do novo conceito proposto, validando o mancal híbrido. Em relação ao estudo de caso, o mancal proposto foi empregado em uma bomba centrífuga representando um dispositivo de assistência ventricular, sendo seu desempenho discutido. Através da comparação entre algumas configurações possíveis para este tipo mancal, a rigidez radial é apresentada e discutida. Embora não constitua objeto principal deste trabalho, são discutidos os aspectos ligados ao desgaste causado pelo contato decorrente do uso dos mancais de escora, analisando o benefício do uso conjunto do mancal magnético com o mancal de escora. A expectativa é a de que este tipo de mancal possa ser utilizado em aplicações onde a existência de uma força resultante na direção radial seja muito pequena se comparada com os esforços presentes na direção axial. / Bearings are important elements for the proper working of many mechanical assemblies. Thus, the continuous development of new types of bearings improves the current operating conditions of devices with specific needs. In addition, new bearings provide new resources for new projects. This research aims to investigate the functionality of a new type of hybrid rotational bearing that combines a pair of radial magnetic bearing with a pair of thrust bearings. In the radial direction, the central axis is kept in position due to two magnetic bearings comprising permanent magnets. In the axial direction, the movement is constrained due to a pair of thrust bearings located at the shaft ends. By adjusting the air gap of each magnetic pair, it is possible to minimize the axial load that acts on each thrust bearing. Through studies based on finite elements methods and experiments, the relationship between the constructive parameters and the performance of the bearing are clarified. The experiments involve the performance checking of the proposed bearing through a test bed and a case study. The test bed allows an accelerated wear test, using a steel sphere as pivot against a rigid PVC surface. This test showed that the wear of PVC contact surface was negligible due to the applications of the proposed bearing concept, validating the hybrid bearing. Regarding the case study, the bearing was used in a centrifugal pump representing a ventricular assist device, and so the performance was discussed. By comparing some possible settings for this bearing type, the radial stiffness is presented and discussed. Although it is not the main goal of this paper, it was discussed the aspects related to the wear caused by contact from the use of thrust bearings in order to analyze the benefits of using magnetic bearing with the thrust bearing. The expectation is that this type of bearing can be used in applications where there is a very small net force acting in the radial direction compared with forces acting in the axial direction.

O presente estudo apresenta o desenvolvimento de uma Bomba de Sangue Ápico Aórtica (BSAA) para uso como dispositivo de assistência ventricular esquerda. A BSAA é um dispositivo que já se encontrava em desenvolvimento antes do início deste trabalho e o ponto de partida deste estudo foi a realização de ensaios In Vivo. Os ensaios In Vivo foram realizados em porcos (Landrace, sem gênero definido e massa de 45 a 90 Kg) o tempo de pós-operatório programado foi de 6 horas. Ao total foram realizados 7 experimentos, sendo que um dos experimentos não foi incluso na análise dos resultados devido a complicações na cirurgia. Em três experimentos, as 6 horas de pós-operatório foram cumpridas, em 1 experimento, o animal veio a óbito após 5h30 e em dois experimentos o animal veio a óbito antes da BSAA entrar em uso. Através dos ensaios In Vivo, foi possível implementar diversas melhorias no dispositivo, principalmente no sistema de conexão das cânulas. Foi realizado um ensaio para determinar a geometria de topo da cânula de entrada, mostrando que o modelo com cânula tubular simples é o mais adequado. Em um ensaio de durabilidade foram observadas duas falhas: o desacoplamento do rotor por desgaste do pivô inferior do mancal e uma fratura no eixo do mancal. A fratura no eixo foi analisada por uma simulação computacional. Foi proposta uma modificação no eixo do mancal para eliminar uma região com acúmulo de tensões. Para solucionar o degaste do pivô inferior foi proposta uma modificação na topologia do estator que, deixando de ser axial e se tornando radial. Para verificar o efeito do estator radial na redução do desgaste no mancal foi realizado um ensaio de desgaste, este ensaio mostrou a influência da carga no mancal em relação ao desgaste e serviu para fundamentar a implementação do estator radial. O protótipo da BSAA com estator radial foi construído. Neste modelo, foi possível reduzir o tamanho do dispositivo. Os resultados do ensaio para determinar o Índice Normalizado de Hemólise (INH) do modelo com estator radial mostraram que um INH clinicamente satisfatório. O estudo do desempenho hidrodinâmico do modelo com estator radial mostrou que o dispositivo é capaz de gerar pressão e fluxo para seu uso na assistência ventricular esquerda. Os resultados deste trabalho permitiram aprofundar o conhecimento sobre o desempenho da BSAA em condições reais de uso, possibilitando a melhoria do dispositivo e redução do desgaste visando seu uso em terapias de longo prazo. / This study presents the development of an Apico-Aortic Blood Pump (AABP) a left ventricle assist device. AABP is a device that was already in development before the beginning of this research and the starting point were Acute In Vivo experiments. The In Vivo experiments were performed in pigs (Landrace, gender not defined and weight 45 to 90 Kg), post operatory time was 6 hours. 7 experiments were performed and one of them was not included in the data analysis due to complications in the surgical procedure that lead to animal\'s early death and thus its exclusion. In 3 experiments, the 6 hours of post operatory were achieved, in one experiment the animal died after 5h30 minutes and in two experiments, the animal died before AAPB implantation. These In Vivo experiments allowed AAPB improvement mainly in the connection system. A study to select the edge geometry of the inlet cannulae was performed, the results appointed that a tube shape cannulae model would be more appropriated for the device ease implantation. In the durability test two failures occurred: rotor decoupling due to wear in the lower pivot of the bearing system and a fracture in the bearing axis. The fracture in the bearing axis was further studied by computer simulation, which results lead to a modification in the axis geometry to eliminate a region with accumulated tension. To solve wear problem in the lower pivot, a stator topology modification was explored, AABP\'s stator would became radial instead of axial as it was in the original model. In order to verify the effect of the radial stator in reducing wear on the lower pivot, a wear test was performed. In this test, the influence of load on the wear production rate was observed and the results appointed that reducing the load would reduce the wear. These results were the basis for stator change to the radial topology. An AAPB prototype with the radial stator was constructed and this model had lower dimensions than the original model with axial stator. Normalized Index of Hemolysis (NIH) obtained with the prototype with the radial stator was in the clinically satisfactory limit. Hydrodynamic performance of the model with the radial stator indicated that this device could provide pressure and flow for its use as a left ventricle assist device. Results from this thesis allowed a deeper knowledge from AABP performance in real use conditions, which lead to the improvement of the device and through this study was possible to know and implement features aiming to enhance AAPB\'s durability for its use in long-term therapies.

Objectifs: Malgré beaucoup de progrès dans la gestion médico-électrique, certains problèmes demeurent et plusieurs patients souffrant d'insuffisance cardiaque sont encore dans l'impasse. Ainsi, les dispositifs d'assistance ventriculaire gauche (LVAD) ont été développés pour réduire les conséquences de l'insuffisance cardiaque et améliorer la qualité de vie. Malgré les avantages évidents, plusieurs complications : thrombo-embolie, infection dû au câble d'alimentation externe, dépendance aux batteries demeurent. L'ICOMS est un nouveau concept de LVAD mélangeant une pompe entièrement intraventriculaire, synchronisé avec le cœur et relié à une batterie interne. Méthodes et résultats : L'intervalle de fonctionnement prévu est un débit de 0.8 to 6.7 10-5 m3/s à une vitesse de rotation de 733 to 942 rad/s, avec des pressions physiologiques. Le point de fonctionnement choisi pour la conception est un débit de 3.3 10-5 m3/s et 10.6 103 Pa . Dans cette étude, Une simulation numérique est réalisée avec des profils de lames différents pour chaque région de fluide étudié. Les performances telles que l'efficacité, la contrainte de cisaillement sont analysée pour vérifier l'efficacité pour les patients atteints d'insuffisance cardiaque. Afin d'obtenir le meilleur résultat avec le logiciel ANSYS, le modèle k-ε turbulent a été appliquée pour obtenir des caractéristiques d'écoulement entre l'entrée et à la sortie de l'évacuateur du redresseur de la pompe. Les résultats numériques montrent une performance acceptable pour les adultes pour délivrer des pressions physiologiques avec une efficacité hydraulique de 10 à 37% ainsi qu'un niveau acceptable de stress de cisaillement maximale le long de la surface de la partie mobile de la pompe. La deuxième partie de l'étude est une étude expérimentale où un prototype a été testé sur banc d'essai. Les résultats ont montré que la pompe pourrait fonctionner et améliorer le débit cardiaque de 1.7 à 6.7 10-5 m3/s. Les résultats in vitro convergent vers les résultats numériques. Pour les tests in vivo, 6 moutons ont été opérés pour l'implantation du LVAD. L'ICOMS a été implanté dans l'apex du ventricule gauche. Plusieurs paramètres hémodynamiques et échocardiographiques ont été stockés dans des conditions normales ou pathologiques. Conclusion: Nous avons montré que l'ICOMS pourrait présenter un effet potentiel pour réduire les conséquences de l'insuffisance cardiaque. De nouvelles expérimentations sont nécessaires pour confirmer notre résultat et optimiser ce nouveau LVAD / Objectives: Despite much progress in medical-electrical management, some problems remain and several heart failure patients are still in a no option solution. In this way, artificial hearts as Left Ventricular Assist Device (LVAD) have been developed. Despite evident benefits, several complications as thromboembolism, driveline infection, batteries dependency remain. ICOMS is a new LVAD concept mixing a fully intraventricular pump, heat rate-synchronized and connected with intracorporeal batteries. Methods and Results : It is expected to deliver 0.8 to 6.7 10-5 m3/s at rotational speeds of 733 to 942 rad/s over physiologic pressures and has a selected design point of 3.3 10-5 m3/s and 10.6 103 Pa . In this study, the axial blood pump with motor connected to impeller has been selected to numerical simulation. This selection is based on axial flow pump with different blade profile for each fluid region and studied on its performance such as efficiency, wall shear stress and considering effective operation for cardiac failure patients. In order to achieve the best result with the ANSYS software, k-ε turbulent model has been applied to obtain the flow characteristics from inducer inlet to straightener outlet of the pump. Numerical results show acceptable performance to deliver physiologic pressures with hydraulic efficiency of 10 to 37 % as well as acceptable maximum shear stress level along the blade tip surface of the impeller. The second part of the study is an experimental investigation where a prototype device was tested in a test bench circulation loop have shown that the pump could operate and improve the cardiac output of 1.7 to 6.7 10-5 m3/s. In vitro results converge to numerical results. For test vivo 6 sheep were operated for the LVAD implantation with the support of cardiopulmonary by-pass. The ICOMS was implanted into the LV apex. Several hemodynamic and echocardiographic parameters were stored as well as in normal or pathological conditions and analyzed. Conclusion: We showed that the ICOMS could present a potential effect in the LV support reducing the heart failure criteria. As evidence, further experimentations are necessary to confirm our result and to optimize this new LVAD

The main aim of the master thesis titled "Syria and the concept responsibility to assist: new approach towards conflict resolution?" is to find out whether the extension of the doctrine of responsibility to protect by the concept of responsibility to assist that is based on the support of nonviolent movements could work as a new approach towards conflict resolution and thanks to this it could constitute another way of international assistance and civilian protection in cases when it is the regime that perpetrates the violence against its own population. For this reason the thesis, via the Syrian civil war that offers wide range of internal responses to the violence perpetrated by the regime against civilians, focuses on three different forms of international involvement and assistance. These are the international military intervention under the third pillar of R2P, the backing of domestic violent groups and insurgents and last but not least the assistance to nonviolent movements and civil initiatives in the form of R2A as a potential expansion of the second pillar under the R2P doctrine. These approaches are analyzed with regard to the issues of state sovereignty and moral responsibility to protect civilians that arises from the inconsistency of these two aspects in relation to any kind of...

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Patienten mit Herzinsuffizienz im Endstadium erhalten zunehmend linksventrikuläre Unterstützungssysteme (LVAD) als Dauertherapiemittel oder zur Überbrückung bis zu einer möglichen Herztransplantation. Diese Patientenklientel ist grundsätzlich durch die Driveline, als potenzielle Eintrittsstelle für Mikroorganismen, einem Infektionsrisiko ausgesetzt. Die Mundhöhle beinhaltet diverse Bakterien, die sich auch systemisch verbreiten können und so eine mögliche Quelle für Driveline-Infektionen darstellen. Es ist jedoch unklar, ob bei LVAD-Patienten Erkrankungen der Mundhöhle durch Bakteriämien zu systemischen Komplikationen und Driveline-Infektionen führen können. Aktuell fehlt es an Studien zum Mundgesundheitszustand bei diesen Patienten und über einen möglichen Zusammenhang von oralen Erkrankungen und Driveline-Infektionen. Ziel dieser Studie war daher die Beurteilung des Mundgesundheitsverhaltens, des Mundgesundheitszustands sowie der mundgesundheitsbezogenen Lebensqualität von LVAD-Patienten. Bei den in dieser Studie untersuchten LVAD-Patienten traten vermehrt schwere Parodontitiden auf. Da Parodontitis das Risiko und das Ausmaß einer systemischen Bakteriämie erhöht und möglicherweise zu kardiovaskulären Komplikationen führen könnte, kann dieser Zustand als potenziell problematisch betrachtet werden. Die aktuelle Studie konnte jedoch keinen Zusammenhang zwischen Driveline-Infektionen und dem vorliegenden zahnärztlichen Behandlungsbedarf bestätigen, sodass der Einfluss der Mundgesundheit auf systemische, krankheits- und gerätebezogene Parameter unklar bleibt. Insgesamt scheint die Erarbeitung eines interdisziplinären zahnärztlichen Versorgungskonzeptes nötig, um die unzureichende Mundgesundheitssituation von LVAD-Patienten zu verbessern.:1 Einführung 1.1 Herzinsuffizienz 1.1.1 Definition und Klassifikation 1.1.2 Ätiologie und Epidemiologie 1.1.3 Therapie 1.2 Ventrikuläre Unterstützungssysteme 1.2.1 Einteilung, Funktionsprinzipien und Aufbau 1.2.2 Indikation und Therapiekonzepte 1.2.3 Komplikationen und Überlebensraten 1.3 Mundgesundheit bei Herzinsuffizienzpatienten 1.3.1 Mundgesundheit 1.3.2 Karies 1.3.3 Parodontitis 1.3.4 Bedeutung der Mundgesundheit bei Herzinsuffizienzpatienten und zahnärztliche Therapiekonzepte 1.4 Zielsetzung und Fragestellung 2 Publikationsmanuskript 3 Zusammenfassung der Arbeit 4 Ausblick 5 Literaturverzeichnis 6 Wissenschaftliche Präsentationen 7 Darstellung des eigenen Beitrages 8 Erklärung über die eigenständige Abfassung der Arbeit 9 Danksagung

Background: The use of percutaneous left ventricular assist devices in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) is evolving. The aim of the study was to assess the long-term outcome of patients with AMICS depending on early initiation of Impella CP® support prior to a percutaneous coronary intervention (PCI). Methods: We retrospectively reviewed all patients who underwent PCI and Impella CP® support between 2014 and 2016 for AMICS at our institution. We compared survival to discharge between those with support initiation before (pre-PCI) and after (post-PCI) PCI. Results: A total of 73 consecutive patients (69±12 years old, 27.4% female) were supported with Impella CP® and underwent PCI for AMICS (34 pre-PCI vs. 39 post-PCI). All patients were admitted with cardiogenic shock, and 58.9% sustained cardiac arrest. Survival at discharge was 35.6%. Compared with the post-PCI group, patients in the pre-PCI group had more lesions treated (p=0.03), a higher device weaning rate (p=0.005) and higher survival to discharge as well as to 30 and 90 days after device implantation, respectively (50.0% vs. 23.1%, 48.5% vs. 23.1%, 46.9 vs. 20.5%, p < 0.05). Kaplan–Meier analysis showed a higher survival at one year (31.3% vs. 17.6%, log-rank p-value=0.03) in the pre-PCI group. Impella support initiation before PCI was an independent predictor of survival up to 180 days after device implantation. Conclusions: In this small, single-centre, non-randomized study Impella CP® initiation prior to PCI was associated with higher survival rates at discharge and up to one year in AMICS patients presenting with high risk for in-hospital mortality.

Indiana University-Purdue University Indianapolis (IUPUI) / Automotive technology has grown from strength to strength in the recent years. The main focus of research in the near past and the immediate future are autonomous vehicles. Autonomous vehicles range from level 1 to level 5, depending on the percentage of machine intervention while driving. To make a smooth transition from human driving and machine intervention, the prediction of human driving behavior is critical. This thesis is a subset of driving behavior prediction. The objective of this thesis is to predict the possibility of crash and implement an appropriate active safety system to prevent the same. The prediction of crash requires data of transition between lanes, and speed ranges. This is achieved through a variation of hidden Markov model. With the crash prediction and analysis of the Markov models, the required ADAS system is activated. The above concept is divided into sections and an algorithm was developed. The algorithm is then scripted into MATLAB for simulation. The results of the simulation is recorded and analyzed to prove the idea.

This thesis takes a closer look at the complex maneuver known as gravity assist, a popular method of interplanetary travel. The maneuver is used to gain or lose momentum by flying by planets, which induces a speed and direction change. A simulation model is created using the General Mission Analysis Tool (GMAT), which is intended to be easily reproduced and altered to match any desired gravity assist maneuver. The validity of its results is analyzed, comparing them to available data from real missions. Some parameters, including speed and trajectory, are found to be extremely reliable. The model is then used as a tool to investigate the way that different parameters impact this complex environment, and the advantages of performing thrusting burns at different points during the maneuver are explored. According to theory, thrusting at the point of closest approach to the planet is thought to be the most efficient method for changing speed and direction of flight. However, the results from this study show that thrusting before this point can have some major advantages, depending on the desired outcome. The reason behind this is concluded to be the high sensitivity of the gravity assist maneuver to the altitude and location of the point of closest approach. / Detta examensarbete tittar närmare på den komplexa manöver inom banmekanik som kallas gravitationsassisterad manöver, vilken är vanligt förekommande vid interplanetära rymduppdrag. Manövern används för att öka eller minska farkostens rörelsemängd genom att flyga förbi nära planeter, vilket ger upphov till en förändring i fart och riktning. En simuleringsmodell är skapad i NASAs mjukvara GMAT med syftena att den ska vara reproducerbar samt möjlig att ändra för olika gravitationsassisterade manövrar. Resultaten från simuleringarna är validerade mot tillgängliga data från riktigt rymduppdrag. Vissa parametrar, som fart och position, har en väldigt bra överenstämmelse. Modellen används sedan för att noggrannare undersöka hur olika parametrar påverkar det komplexa beteendet vid en graviationsassisterad manöver, genom att specifikt titta på effekterna av en pålagd dragkraft från motorn under den gravitationsassisterade manövern. Teoretiskt fås mest effekt på fart och riktning om dragkraften från motorn läggs på vid punkten närmast planeten. Resultaten från denna studie visar att beroende på vilken parameter man vill ändra så kan man erhålla mer effekt genom att lägga på dragkraften innan den närmsta punkten. Förklaringen till detta är att den gravitationsassisterade manövern är väldigt icke-linjär, så en tidigare pålagd dragkraft kan kraftigt förändra farkostens bana nära planeten, så att farkosten t.ex. kommer närmare och då påverkas mer.