Made available in DSpace on 2015-04-14T13:32:36Z (GMT). No. of bitstreams: 1 401600.pdf: 531587 bytes, checksum: b25d1bacf7575790cf35d1987e65faf1 (MD5) Previous issue date: 2008-03-26 / Objetivos: analisar as atitudes m?dicas nas ?ltimas 48 horas de vidas de pacientes adultos que morrem em Unidade de Tratamento Intensivo (UTI), as decis?es de Reanima??o Cardio-Pulmonar (RCP) e de Limita??o do Suporte de Vida (LSV), os fatores determinantes, seus respons?veis e registros, o diagn?stico de ME e a conduta para os n?o doadores. M?todos: estudo observacional retrospectivo com an?lise dos prontu?rios m?dicos de tr?s UTI de Porto Alegre (Brasil), de 2004 e 2005. Intensivistas foram treinados para preencher o protocolo e registrar os dados demogr?ficos e todo o tratamento m?dico oferecido nas ultimas 48 horas de vida. Foram analisados dados gerais de cada paciente (idade, sexo, tempo de interna??o hospitalar e de UTI), do diagn?stico principal (motivo da interna??o hospitalar e em UTI, disfun??es org?nicas das ?ltimas 48 horas de vida, causas dos ?bitos, diagn?stico de morte encef?lica e doa??es) e das condutas (RCP ou LSV). A participa??o dos familiares e dos m?dicos e seus registros foram criteriosamente estudados. Resultados: 710 mortes identificadas, com perda de 10,5%. 636 ?bitos analisados, 87 foram submetidos a RCP (14,0%): mais jovens, menor tempo de interna??o hospitalar e em UTI (p< 0,001), quando comparados aos 538 pacientes submetidos a LSV (86%). Desses, 75% tiveram ONR, com tratamento pleno at? a morte. 67% dos prontu?rios sem registros dessas decis?es. A ME ? rara (11/636), os n?o doadores s?o mantidos com ventila??o e vasopressores at? a PCR. Apenas 25% das fam?lias partilhou dessas decis?es com a equipe m?dica. Conclus?es: A LSV ? pratica dominante em UTI, com escassos registros, sendo a ONR sua forma mais comum, com tratamento pleno mantido at? a morte. A ME e as doa??es s?o raras, os n?o doadores s?o mantidos com vasopressores e ventila??o at? a PCR. Tr?s de cada quatro fam?lias n?o participam dessas decis?es.

Made available in DSpace on 2014-12-17T15:46:23Z (GMT). No. of bitstreams: 1 MariaFMD_DISSERT.pdf: 2073723 bytes, checksum: 689d7589075fd822110e54c97420bb01 (MD5) Previous issue date: 2011-09-23 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This dissertation analyzes the configuration of the financing of Social assistance in the municipality of Natal-RN in the context of their particular expressions of the problematizando municipal budget against neoliberal adjustment macroeconomic policy. The current trends of "disclaimer" and "desfinanciamento" of social protection by the State, in the context of contemporary capitalism, bring strong implications for Social Security, especially through the redirection of public resources to the international capital, which highlights the overlapping economic interests on social needs. Whereas the changes and innovations occurring in connection with the financing of Social assistance policy, the goal of this documentary research is to identify the characteristics and trends of funding this policy in Natal-RN, from the secondary data analysis from the City of Natal, the Ministry of Social development and hunger and Portal of transparency. In the light of the theoretical, research now presented, shows trends of investment in Social assistance in the municipality of Natal-RN, in the period 2005 to 2009, which are: the tiny role membership (08) Social assistance in the municipal budget; the dispersion and fragmentation of the resources of Social assistance in other organs and/or secretariats of municipal administration; the participation of just 47.5% in expenditure from own organ Manager; the low percentage of implementation of resources foreseen in the Annual Budget Laws; the low allocation of resources in Municipal Social Assistance Fund (FUMAS), which contradicts the national policy for Social Assistance-PNAS/2004; and the predominance of government transfers in the composition of the resources of Social assistance in the municipality. The results of this research suggest that the process of financing of Social assistance in Natal is distant from the principles and guidelines pointed by PNAS/2004. In addition to the effort to understand the complexity of the financing of Social assistance in Natal, this work seeks to contribute to a political analysis in the direction of strengthening social control and the struggle for the expansion of investment in social spending / A presente disserta??o analisa a configura??o do financiamento da Assist?ncia Social no munic?pio do Natal RN, no contexto do SUAS, problematizando as express?es particulares do or?amento municipal frente ? pol?tica macroecon?mica de ajuste neoliberal. As atuais tend?ncias de desresponsabiliza??o e desfinanciamento da prote??o social pelo Estado, no contexto do capitalismo contempor?neo, trazem fortes implica??es para a Seguridade Social, especialmente atrav?s do redirecionamento de recursos p?blicos para o capital internacional e nacional, o que evidencia a sobreposi??o dos interesses econ?micos ?s necessidades sociais. Considerando as mudan?as e inova??es ocorridas no ?mbito do financiamento da pol?tica de Assist?ncia Social, o objetivo desta pesquisa ? identificar as caracter?sticas e tend?ncias do financiamento desta pol?tica em Natal RN. Do ponto de vista metodol?gico o estudo privilegiou fontes documentais a partir da an?lise de dados das Leis Or?ament?rias Anuais, Comparativos de despesas, Resumos Financeiros e Resumos dos Balan?os Or?ament?rios, oriundos da Prefeitura Municipal do Natal, Minist?rio de Desenvolvimento Social e Combate ? Fome e Portal da Transpar?ncia. ? luz do referencial te?rico, a investiga??o ora apresentada, revela tend?ncias do investimento na Assist?ncia Social no munic?pio do Natal - RN, no per?odo de 2005 a 2011, quais sejam: a participa??o da Fun??o (08) Assist?ncia Social no or?amento municipal; a dispers?o e pulveriza??o dos recursos da Assist?ncia Social em outros ?rg?os e/ou secretarias da administra??o municipal; o percentual de execu??o dos recursos previstos nas Leis Or?ament?rias Anuais; a baixa aloca??o dos recursos no Fundo Municipal de Assist?ncia Social (FUMAS), o que contraria a Pol?tica Nacional de Assist?ncia Social - PNAS/2004; e a predomin?ncia das transfer?ncias governamentais na composi??o dos recursos da Assist?ncia Social no munic?pio. Os resultados desta investiga??o apontam, ainda, que o processo de financiamento da Assist?ncia Social em Natal est? distante dos princ?pios e diretrizes apontados pela PNAS/2004. Para al?m do esfor?o de compreender a complexidade do financiamento da Assist?ncia Social em Natal, este trabalho busca contribuir para uma an?lise pol?tica na dire??o do fortalecimento do controle social e da luta pela amplia??o do investimento nos gastos sociais

Content assist is one of the most powerful features in integrated development environments (IDE). While a lot of research papers exist on content assist for software programming languages (SPL), hardware description languages (HDL) aren’t covered at all. In this thesis, we improve content assist for SystemVerilog, one of the most widely used HDL, by using different ordering strategies and comparing them to each other. In the end, 6 different strategies are kept: two based on frequencies, one on the usage of the content assist, one on the name of the variable, one on the type of the variable, and one on the distance from their declaration to the cursor position. We test our implementation in 3 different open-source projects well-known and used by the SystemVerilog community: OpenTitan, SweRV, and riscv-dv. We achieve having the expected entry in the top 5 in more than 40% of cases with no prefix and up to 66% of cases with 1 character already typed. / Automatisk komplettering är en av de mest kraftfulla funktionerna i integrerade utvecklingsmiljöer (integrated development environments, IDE). Även om det finns många forskningsartiklar om automatisk komplettering för mjukvaruprogrammeringsspråk (software programming languages, SPL), täcks inte hårdvarubeskrivningsspråk (hardware description language, HDL) alls. I det här examensarbetet förbättras innehållshjälp för SystemVerilog, en av de mest använda HDL:erna, genom att använda olika ordningsstrategier och jämföra dem med varandra. Slutligen behålls 6 olika strategier: två baserade på frekvenser, en baserad på användningen av automatisk komplettering, en baserad på variabelns namn, en baserad på variabelns typ och en baserad på avståndet från deras deklaration till markörens position. Implementeringen testas i 3 olika open source-projekt som är välkända och används av SystemVerilog-användarna: OpenTitan, SweRV och riscvdv. Implementeringen föreslog den förväntade termen bland de fem första förslagen i 40% av fallen där inget prefix var givet och i 66% av fallen när ett tecken var givet

ITC/USA 2009 Conference Proceedings / The Forty-Fifth Annual International Telemetering Conference and Technical Exhibition / October 26-29, 2009 / Riviera Hotel & Convention Center, Las Vegas, Nevada / Virtualization technologies have the potential to transform the telemetry post-processing environment. Significant efficiencies can be gained by migrating telemetry post processing activities to virtual computing platforms. However, while facilitating better server utilization, virtualization also presents several challenges; one of the most difficult of those challenges being security. In virtualization, server environments are replicated in software; unfortunately, the security individual servers provide is not replicated in a software stack implementation of a server environment. After reviewing virtualization fundamentals, security issues and their impact on telemetry post processing will be discussed.

This report discusses the design of read/write assist circuits which are used in a SRAM cell’s design to overcome the cell’s variations. It also explains the variability problems in a SRAM bit-cell and many approaches to address them. The basic operations, SNM concept, and write margin of an SRAM are described theoretically as well as measured in simulation. The write assisted circuit, the Negative Bit-line Voltage Bias scheme, is discussed and implemented at transistor level using a six-transistor (6T) SRAM cell. With the write assisted circuit, the implemented memory array successfully performs a write operation at 0.6V and -25°C, the condition in which the same operation would fail without the write assisted circuit. During the simulation, this write assisted circuit helps to achieve the negative bias voltage of -70mV on the SRAM’s bit-lines. The cost overhead includes chip area, power consumption, and current leakage when this Negative Bit-line Voltage scheme is implemented. / text

Pump thrombosis is the epitome of left ventricular assist device dysfunction for end-stage heart failure patients. With the increased utilization of implantable, long-term, left ventricular assist devices (LVADs), understanding the implications associated with device orientation and interaction with the body is exceedingly important. Components associated with pump thrombosis in the Thoratec© HeartMate II™ (HMII) and the HeartWare© HVAD® devices include the inflow cannula, the outflow graft, and the pump elements as well as pump pocket depth for the HMII specifically. Several studies have been conducted to analyze these interactions with the HMII, however there is minimal to no data available analyzing how the device orientation of the HeartWare HVAD affects hemodynamics and a patient’s risk for developing pump thrombosis. Therefore, the purpose of this pilot study is the simulate the hemodynamic implications associated with Sub-optimal cannula angulation of the HVAD. Using Solidworks 2016 Ed., a simplified, hemo-static model of the left side of the heart was created. Dimensions for the atria, ventricle, and mitral valve were determined through the combination of Trans-Esophageal Echo cardiogram data as well as literature references. Three different inflow cannula angle scenarios were developed including a Control, a Clinically Optimal, and a Sub-optimal. Assumptions included body temperature, no accumulation within the ventricle, and no ejection or contraction. The model consists of static continuous flow set to 5 liters per minute with the assumption that the HeartWare HVAD is completely supporting the left ventricle. The results include both qualitative and quantitative data. Flow trajectory plots for each cannula scenario depict the hemodynamic flow patterns for different time points. Results show visible changes in the Sub-optimal orientation when compared to both the Control and the Clinically Optimal scenario. Additionally, it was determined that there were no statistically significant differences in the velocity vectors for any of the scenarios however, the shear stress values were determined to be significantly different for all time points, p < 0.001 for all scenarios when compared to Control. Though there are several limitations of this study, with sub-optimal inflow cannula angulation, there is a potential increased risk of hemolysis due to increased shear stress.

Background: Right ventricular failure is a serious complication after left ventricular assist device placement. Case Presentation: A 70-year-old male in decompensated heart failure with right ventricular failure after the placement of a left ventricular assist device. A single dual-lumen PROTEKDuo cannula was inserted percutaneously via the internal jugular vein to draw blood from the right atrium and return into the pulmonary artery using the CentriMag system, by passing the failing ventricle. The patient was successfully weaned from right ventricular assist device. Conclusions: In comparison to two-cannula conventional procedures, this right ventrivular assist device system improves patient rehabilitation and minimizes blood loss and risk of infection, while shortening procedure time and improving clinical outcomes in right ventricular failure.

Background: Aortic valve insufficiency (AI) at the time of left ventricular assist device (LVAD) insertion needs to be corrected, however there is little known about how to manage bioprosthetic valvular AI. Case presentation: A 55-year-old female with dilated cardiomyopathy who previously had a bioprosthetic aortic valve replacement needed a LVAD as a bridge to transplant. Her left ventricular ejection fraction was 10% and had mild to moderate transvalvular AI. She underwent a HeartWare HVAD insertion along with aortic valvular coaptation stitch repair (Park's stitch) to the bioprosthetic valve. Conclusion: Her AI improved to trivial with minimal ejection through the bioprosthetic valve. She was transplanted 6 months following the surgery. A Park's stitch to the bioprosthetic aortic valve with more than mild AI might be a good option for bridge to transplant patient.

This thesis deals with the mechanics of the Intra-Aortic Balloon Pump (IABP), the most widely used temporary cardiac assist device, whose beneficial action is based on the principle of counterpulsation. The investigation is carried out in vitro in increasingly more realistic setups, including a mock circulatory system with physiological distribution of peripheral resistance and compliance in which IABP counterpulsation was simulated. Pressure and flow measurements show the effect of variables such as intra-luminal pressure, angle and aortic compliance on balloon hemodynamics. These data are complemented by results on the duration of balloon inflation and deflation obtained by means of high-speed camera visualisation. Furthermore, wave intensity analysis is carried out and it is identified as a possible alternative method for the assessment of IABP performance. This work includes two prototypes of intra-aortic balloons of novel shape with the balloon chamber tapering both from and toward the balloon tip. In clinical terms, with reference to the semi-recumbent position in which patients assisted with the IABP are nursed in the intensive care unit, the results presented in this thesis indicate that operating the balloon at an angle compromises the benefit of counterpulsation when assessed in vitro.

Most current designs for Left Ventricular Assist Devices (LVAD) are based on rotary pumps due to their small size and lack of valves. However, the majority of FDA approved LVADs are larger, positive displacement pumps. One reason for this may be because positive displacement pumps produce pulsatile flow, similar to that of the natural heart, while rotary pumps produce continuous flow. Continuous flow has been shown to support the circulation for short periods of time during open-heart surgery, but it has seen limited success with long-term support. It is thought that pulsatile flow provides many metabolic advantages to patients with high total peripheral resistance (TPR) and lower flowrates. This study focused on modifying a continuous flow multiple disk centrifugal pump (MDCP) into a pulsatile pump, to allow for the combined benefits of the pulsatility from positive displacement pumps and the small size and valveless design of rotary pumps. An efficiency study was carried out by evaluating the hydraulic work output and the power requirements of the pump. The pump was evaluated in both pulsatile and continuous flow modes. In continuous mode, the pump was able to maintain a flow of 5.5 L/min against a pressure head of 60mmHg at 1155rpm. Other LVADs have reported rotational speeds around 2400rpm for centrifugal and 10,000rpm for axial pumps to produce flows around 5 L/min. This indicates that the MDCP is capable of producing flowrates at lower rotational speeds than other LVADs, lessening the mechanical wear of the parts, thus potentially increasing the device's lifespan. In pulsatile mode, cardiac outputs of 5 L/min were achieved against a 55/27mmHg outlet pressure. Higher pressures were unattainable with our current testing apparatus, but the results from the pulsatile tests prove that the MDCP can be operated in a pulsatile fashion and produce normal flowrates at low pressures. The pump efficiency was lower than expected, around 0.7-9% in continuous mode and 3-18% in pulsatile mode, consuming 3.5-28W and 0.5-2.3W, respectively. Utilizing a smaller motor may produce higher efficiencies, since the power requirements will be less without decreasing the flowrates, but a further study should be conducted in order to verify this.