Com o aumento da expectativa de vida nas últimas décadas, tem ocorrido aumento concomitante da prevalência da estenose aórtica degenerativa e da doença aterosclerótica arterial coronária. O presente estudo visa avaliar a influência da doença ateroslerótica arterial coronária crítica na mortalidade hospitalar de pacientes portadores de estenose aórtica submetidos à substituição valvar isolada ou combinada à revascularização do miocárdio. No período de janeiro de 2001 a março de 2006, no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, foram analisados 448 pacientes submetidos à substituição valvar aórtica isolada (grupo GI) e 167 pacientes submetidos à substituição valvar aórtica combinada à revascularização do miocárdio (grupo GII). Os dados pré-operatórios eleitos para análise foram: sexo, idade, índice de massa corpórea, antecedentes de: acidente vascular cerebral, diabete melito, doença pulmonar obstrutiva crônica, febre reumática, hipertensão arterial sistêmica, endocardite, infarto agudo do miocárdio, tabagismo, fração de ejeção do ventrículo esquerdo, doença aterosclerótica arterial coronária crítica, fibrilação atrial crônica; operação valvar aórtica prévia (conservadora), classe funcional de insuficiência cardíaca congestiva, valor sérico de creatinina e de colesterol total, tamanho da prótese utilizada, extensão (completa ou incompleta) e número de anastomoses distais da revascularização do miocárdio, tempo de circulação extracorpórea e tempo de pinçamento aórtico. No estudo estatístico empregou-se análise univariada (teste Qui-Quadrado e teste t de Student) e multivariada (regressão logística) para avaliação da influência da doença aerosclerótica arterial coronária crítica na mortalidade hospitalar dos dois grupos estudados. No grupo GI (substituição valvar aórtica isolada), a mortalidade hospitalar foi 14,3% (64 óbitos), sendo 14,5% (58 óbitos) nos pacientes sem doença aterosclerótica arterial coronária crítica associada (grupo GIB) e 12,8% (6 óbitos) nos que apresentavam essa associação (grupo GIA). No grupo GII (substituição valvar aórtica combinada à revascularização do miocárdio), a mortalidade hospitalar foi 17,6% (29 óbitos), sendo 16,1% (20 óbitos) nos pacientes submetidos à substituição valvar aórtica combinada à revascularização completa do miocárdio (grupo GIIA) e 20,9% (9 óbitos) nos com revascularização incompleta do miocárdio (grupo GIIB). Nos pacientes submetidos à substituição valvar aórtica isolada, a presença de doença aterosclerótica arterial coronária crítica associada, em pelo menos duas artérias, influenciou a mortalidade hospitalar (p= 0,016). Nos pacientes submetidos à substituição valvar aórtica combinada à revascularização do miocárdio, o número de artérias coronárias com doença aterosclerótica crítica e a extensão da revascularização do miocárdio realizada não influenciaram a mortalidade hospitalar (p>0,05), mas a realização de mais de três anastomoses distais influenciou (p= 0,03). / With the increase in life expectancy in recent decades has occurred concomitant increase in the prevalence of degenerative aortic stenosis and atherosclerotic coronary artery disease. This study aim to evaluate the influence of critical atherosclerotic coronary artery disease in hospital mortality of patients with aortic stenosis underwent isolated valve replacement or combined coronary artery bypass grafting. In the period of january 2001 to March 2006, at the Heart Institute University of Sao Paulo Medical Center were examined 448 patients underwent isolated aortic valve replacement (GI group) and 167 patients underwent combined aortic valve replacement and coronary artery bypass grafting (GII group). Preoperative data analised were: sex, age, body mass index, history of stroke, diabetes mellitus, chronic obstructive pulmonary disease, rheumatic fever, hypertension, endocarditis, myocardial infarction, smoking, chronic atrial fibrillation. Left ventricular ejection fraction, concomitant critical atherosclerotic coronary artery disease, previous surgical aortic valvuloplasty, congestive heart failure functional class, serum creatinine and cholesterol level, aortic valve prosthesis size, concomitant complete or incomplete coronary artery bypass grafting and number of bypass grafts, cardiopulmonary bypass and aortic cross clamping time. Univariate statistical analysis (Chi-square and Student\'s t test) and multivariate (logistic regression) were used to evaluate the influence of critical atherosclerotic coronary artery disease in hospital mortality of two groups. GI group (isolated aortic valve replacement) hospital mortality was 14.3% (64 deaths), and 14.5% (58 deaths) in patients without associated critical atherosclerotic coronary artery disease (GIB group) and 12.8% (6 deaths) in patients with that association (GIA group). GII group (combined aortic valve replacement and coronary artery bypass grafting) hospital mortality was 17.6% (29 deaths), and 16.1% (20 deaths) in patients underwent combined aortic valve replacement and complete coronary artery bypass grafting (GIIA group) and 20.9% (9 deaths) in patients with combined incomplete coronary artery bypass grafting (GIIB group). In patients underwent isolated aortic valve replacement, associated critical atherosclerotic coronary artery disease, of at least two arteries, influenced hospital mortality (p = 0016). In patients underwent combined aortic valve replacement and coronary artery bypass grafting, the number of coronary arteries with critical atherosclerotic disease and coronary artery bypass grafting extension didnt influenced hospital mortality (p> 0.05), but more than three coronary distal anastomoses influenced the hospital mortality (p = 0.03).

The field of structural design optimization is one with great breadth and depth in many engineering applications. From the perspective of a designer, three distinct numerical methodologies may be employed. These include size, shape, and topology optimization, in which the ordering typically (but not always) corresponds to the order of increasing complexity and computational expense. This, of course, depends on the particular problem of interest and the selected numerical methods. The primary focus of this research employs density-based topology optimization with the goal of improving structural resistance to failure. Beginning with brittle fracture, two topology optimization based formulations are proposed in which low weight designs are achieved with substantially increased fracture resistance. In contrast to the majority of the current relevant literature which favors stress constraints with linear elastic physics, we explicitly simulate brittle fracture using the phase field method during the topology optimization procedure. In the second formulation, a direct comparison is made against results obtained using conventional stress-constrained topology optimization and the improved performance is numerically demonstrated. Multiple enhancements are proposed including a numerical efficiency gain based on the Schur-complement during the analytical sensitivity analysis and a new function which provides additional path information to the optimizer, making the gradient-based optimization problem more tractable in the presence of brittle fracture physics. Subsequently, design for ductile failure and buckling resistance is addressed and a numerically efficient topology optimization formulation is proposed which may provide significant design improvements when ductile materials are used and extreme loading situations are anticipated. The proposed scheme is examined regarding its impact on both the peak load carrying capacity of the structure and the amount of external work required to achieve this peak load, past which the structure may no longer be able to support any increase in the external force. The optimized structures are also subjected to a post-optimization verification step in which a large deformation phase field fracture model is used to numerically compare the performance of each design. Significant gains in structural strength and toughness are demonstrated using the proposed framework. Additionally, the failure behavior of 3D-printed polymer composites is investigated, both numerically and experimentally. A large deformation phase field fracture model is derived under the assumption of plane-stress for numerical efficiency. Experimental results are compared to numerical simulations for a composite system consisting of three stiff circular inclusions embedded into a soft matrix. In particular, we examine how geometric parameters, such as the distances between inclusions and the length of initial notches affect the failure pattern in the soft composites. It is shown that the mechanical performance of the system (e.g. strength and toughness) can be tuned through selection of the inclusion positions which offers useful insight for material design. Finally, a size optimization technique for a cardiovascular stent is proposed with application to a balloon expandable prosthetic heart valve intended for the pediatric population born with Congenital Heart Disease (CHD). Multiple open heart surgical procedures are typically required in order to replace the original diseased valve and subsequent prosthetic valves with those of larger diameter as the patient grows. Most expandable prosthetic heart valves currently in development to resolve this issue do not incorporate a corresponding expandable conduit that is typically required in a neonate without a sufficiently long Right Ventricular Outflow Tract (RVOT). Within the context of a particular design, a numerical methodology is proposed for designing a metallic stent incorporated into the conduit between layers of polymeric glue. A multiobjective optimization problem is solved, not only to resist the retractive forces of the glue layers, but also to ensure the durability of the stent both during expansion and while subject to the anticipated high cycle fatigue loading. It is demonstrated that the surrogate-based optimization strategy is effective for understanding the trade-offs between each performance metric and ultimately efficiently arriving at a single optimized design candidate. Finally, it is shown that the desired expandability of the device from 12mm to 16mm inner diameter is achievable, effectively eliminating at least one open heart surgical procedure for certain children born with CHD.

This work is aiming to the area of biomechanics and deals with the experimental finding of appropriate kinematic ratios of crank mechanism on racing bicycle and transtibial prosthesis of racing cyclists with an assessment of kinematic ratios depending on the overall athletic performance. The primary aim of the work is investigation of the impact of inappropriate existing kinematic ratios of leg prosthesis and crank mechanism on the kinematics and dynamics of top athlete. The work presents experiments that proposes find out appropriate kinematic ratio of the length of kinematic members and possibility to improve overall athletic performance. The measurement is supplemented about cycling analysis of racer realized via cameras tracking system and measuring muscle activity by EMG. The work also includes a description of impact of various factors on cycling.

The master thesis deals with the engineering design and realization of a transtibial prosthesis for recreational in-line skating. The first part of thesis summarize background information about skating. The next part analyzes the kinematics of ankle joint based on gained information and own measurement by Motion capture method in Kinovea software. The thesis continues with realization of more versions of prosthesis followed by testing with patient. Finally, the thesis discus measured data.

Background: Some patients with chronic middle ear disease and multiple failed revisions, who also need a hearing aid, may benefit from an active middle ear implant. An advantage of an active middle ear implant is that the ear canal is unoccluded. Methods: Following extensive experimental development in temporal bones and investigations of various locations and attachments of a Vibrant Soundbridge transducer, a new titanium clip holder for the vibrant floating mass transducer was developed. This assembly is a total ossicular replacement prosthesis (TORP) that is placed on the stapes footplate. Six patients were implanted with this device. Results: Acoustic results demonstrate significantly improved gain, especially in the high frequencies, which is typically unobtainable by conventional hearing aids. Conclusion: The simple procedure of placing an active TORP assembly on the stapes footplate, similar to the implantation of a passive TORP prosthesis during tympanoplasty, offers promising treatment for cases of incurable middle ear disease. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Syfte: Syftet med denna studie var att undersöka vad kliniker upplever påverkar förskrivningsprocessen av mikroprocesstyrd knäkomponent (MPK) i de olika regionerna i Sverige. Metod: Kvalitativ analys med semistrukturerade intervjuer genomfördes. Intervjuerna genomfördes och spelades in med Zoom eller Teams programvara och data analyserades sedan tematiskt.  Resultat: 9 legitimerade ortopedingenjörer samt en legitimerad fysioterapeut från åtta olika regioner deltog i studien. Under dataanalysen identifierades fyra huvudteman samt 10 underteman. Huvudteman var: utvärdering av patientens lämplighet för MPK, utmaningar med att beräkna patientutfall, förskrivningsbarriärer och externa påverkande faktorer. Deltagarna upplevde att beräkning av patientutfall, budgetrestriktioner och att vara beroende av subjektiva bedömningar av patienter som stora utmaningar med förskrivningsprocessen av en MPK.  Slutsats: Deltagarna upplevde att förskrivningsprocessen av MPK påverkas av flertal olika faktorer; från regionala budgetar och ansökningsprocesser, till deltagarnas erfarenhet och förmåga att bedöma lämpliga MPK-kandidater. Deltagarna uttryckte utmaningar med att förskrivningsprocessen var känslobaserad och till stor del beroende av subjektiva och generella utvärderingar av patienten. Detta gjorde att ett stort ansvar av bedömningen om vem som bör få ett MPK förskrivet, låg på deltagarna själva, vilket ansågs kan bidra till inkonsekventa patientbehandlingar. Deltagarna upplevde att ett nationellt förskrivningssystem möjligen hade kunnat bidra till att processen var mer rättvis för patienterna samt underlätta processen för de själva. / Purpose: The study investigates clinicians’ experience of what is affecting the prescription of microprocessor-controlled prosthetic knees (MPKs) in different regions in Sweden. Method: Qualitative analysis with semi-structured interviews were conducted. The interviews were conducted and recorded using Zoom or Teams software and data was thereafter thematically analysed. Results: 9 certified prosthetists and a certified physiotherapist from eight different regions participated. During data analysis four main themes were identified along with ten subthemes. The key themes were: assessing candidate for MPK, challenges in estimating outcomes, barriers to prescribing and external influencing factors. Estimating patient outcomes, budget limitations and being dependent on subjective patient evaluations were expressed as major factors affecting the prescription of MPKs. Conclusion: The prescription of MPKs was found to be affected by several factors; from regional budgets and application processes to clinicians’ experience in assessing suitable MPK-candidates. The clinicians expressed challenges in that the prescribing process was emotionally based and relied on subjective and generalised patient assessments. This made decision-making regarding who to prescribe an MPK to, highly dependent on the clinicians’ own experience and knowledge which according to them, could lead to inconsistent treatments. Clinicians felt that a national prescription system could possibly ensure fairer patient evaluations and make the process easier for themselves.

Dans ce travail de thèse, nous proposons une base de connaissances, destinée à une prothèse de mémoire « intelligente », appelée CaptainMemo, qui a pour but d’aider les malades d’Alzheimer, à pallier leurs problèmes de dégénérescence mnésique. Cette base de connaissances est basée sur l’ontologie temporelle, multiculturelle et multilingue PersonLink, permettant à la prothèse de mémoire une représentation sémantique rigoureuse, multilingue et temporelle des liens interpersonnels. L’ontologie PersonLink est déréférençable et présente dans le Web de données.Le multilinguisme et la représentation temporelle sont deux grands sujets de recherche en informatique et en Web sémantique en particulier. Le multilinguisme appliqué à la représentation des relations interpersonnelles requiert un traitement spécifique, car il est lié au multiculturalisme. Par ailleurs, le passage d’une culture/langue à une autre s’avère une grande problématique de recherche. En effet, la traduction littérale n’est pas toujours permise, surtout quand il s’agit des relations interpersonnelles, car elles sont culturellement dépendantes. Dans ce contexte, nous proposons une approche permettant la représentation des ontologies dans plusieurs cultures/langues. Cette approche, en se basant sur un algorithme de traduction, permet le passage d’une culture/langue à une autre sans faire de la traduction littérale mais plutôt une traduction culturelle. Ainsi, en adoptant cette approche, notre ontologie PersonLink permet une représentation exacte des relations interpersonnelles, qui prend en considération l’aspect culturel pour la définition de chaque relation, et lui attribue le terme adéquat selon la langue liée à la culture dans laquelle elle est représentée. Les relations interpersonnels régissent à des règles et contraintes qui les définissent selon chaque culture, ces contraintes sont représentées sémantiquement dans l’ontologie PersonLink via OWL2. Cependant, il est difficile de prendre en considération ces contraintes lors de l’introduction de la dimension temporelle pour représenter les intervalles de temps de ces relations interpersonnelles, surtout quand ces dernières sont diachroniques et leurs intervalles de temps sont qualitatifs. En effet, les modèles et solutions déjà existantes permettent de faire une représentation temporelle des intervalles de temps (ex 4D-Fluents), et de lier entre ces intervalles de temps (ex Relations d’Allen), mais ne prennent pas en considération les contraintes sémantiques des relations interpersonnelles. Dans ce sens, nous proposons une approche qui permet une représentation sémantique, basée sur les contraintes OWL2, pour la représentation des intervalles de temps qualitatifs. Enfin, pour traiter l’intelligence de la prothèse de mémoire CaptainMemo, nous proposons une approche pour le raisonnement sur les intervalles dans le temps. Dans cette approche nous introduisons un ensemble de règles SWRL pour affirmer des relations d’Allen temporelles inférées, permettant aux raisonneurs, tel que Pellet qui prend en charge les règles DL-Safe, d’être employés pour l'inférence et la vérification de la cohérence sur les relations temporelles entre différents intervalles de temps. La table des compositions des relations entre intervalles de temps a ainsi été considérablement réduite, car elle se base sur un ensemble tractable de ces relations, ce qui en résulte un temps de traitement de raisonnement plus réduit. / In this thesis, we propose a knowledge base for a "smart" memory prosthesis, called CaptainMemo, which aims to help Alzheimer's patients to overcome their memory impairments. This knowledge base is built over the temporal, multicultural and multilingual PersonLink ontology. This ontology gives the memory prosthesis a rigorous, multilingual and temporal semantic representation of interpersonal relationships. The PersonLink ontology is dereferenceable and available in the Linked Data. Multilingualism and temporal representation are two major research topics in computer science and in the Semantic Web in particular.Multilingualism applied to the representation of interpersonal relationships requires specific treatment because it is linked to multiculturalism. In addition, the transition from one culture / language to another is a major research problem. Indeed, literal translation is not always allowed, especially when it comes to interpersonal relationships, because they are culturally dependent. In this context, we propose an approach allowing the representation of ontologies in several cultures / languages. This approach, based on a translation algorithm, allows the transition from one culture / language to another by making a cultural translation rather than a literal one. Thus, by adopting this approach, our PersonLink ontology allows an exact representation of interpersonal relationships, because it takes into consideration the cultural aspect for the definition of each relationship, and assigns the appropriate term according to the language related to this culture. Interpersonal relationships are governed by rules and constraints that define them according to each culture, these constraints are represented semantically in the PersonLink ontology using OWL2. However, it is difficult to consider these constraints when introducing the temporal dimension to represent the time intervals of these interpersonal relationships, especially when these are diachronic and their time intervals are qualitative. Indeed, the legacy models and solutions make it possible to make a temporal representation of the time intervals (e.g. 4D-Fluents), and to link between these time intervals (e.g. Allen Relations), but do not take into account the semantics constraints of interpersonal relationships. In this context, we propose an approach that allows a semantic representation, based on OWL2 constraints, for the representation of qualitative time intervals. Finally, to deal with the intelligence of the CaptainMemo memory prosthesis, we propose an approach for reasoning over time intervals. In this approach we introduce a set of SWRL rules to assert inferred temporal Allen relationships, allowing reasoners, such as Pellet that supports DL-Safe rules, to be used for the inference and the verification of consistency over the temporal relationships between different time intervals. Thus, the table of compositions of the relations between time intervals has been considerably reduced, since it is based on a tractable set of these relations, and, consequently, the processing time of the reasoning becomes shorter.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: New glass ceramics and Computer-Aided Design/Computer Assisted Manufacture (CAD/CAM) have become common aspects of modern dentistry. The use of posterior ceramic crowns with a high level of esthetics, fabricated using the CAD/CAM technology is a current treatment modality. Several materials have been used to fabricate these crowns, including lithium disilicate glass-ceramics, which have not been fully investigated in the literature. Objective: to investigate the load to fracture of lithium disilicate glass ceramic posterior crowns fabricated by CAD/CAM technology with different material thicknesses adhesively cemented on epoxy resin. Methods: Four groups of different ceramic thicknesses (0.5 mm, 1 mm, 1.5 mm, and 2 mm) were fabricated by milling CAD/CAM lithium disilicate IPS emax CAD blocks. A total of 68 posterior crowns were surface treated and luted with a resin adhesive cement on an epoxy resin model. Samples were fatigued then loaded to fracture using a universal testing machine to test the fracture strength. Statistical comparisons between various crown thicknesses were performed using one-way ANOVA followed by Fisher's Protected Least Significant Differences. Results: There was a significant difference in the load-to-fracture (N) value for all comparisons of the four thickness groups (p < 0.0001), except 2 mm vs. 1.5 mm (p = 0.325). The mean load-to-fracture (N) was significantly higher for 2 mm than for 1 mm or 0.5 mm. Additionally, the mean load-to-fracture was significantly higher for 1.5 mm than for 1 mm or 0.5 mm. Furthermore, the mean load-to-fracture was significantly higher for 1 mm than for 0.5 mm. Conclusion: Within the limitation of this study, it is advisable for clinical applications to consider a crown thickness of 1.5 mm or greater of milled lithium disilicate for posterior single teeth.

The first part of this work focuses on ways to replace missing source voice in case of patients after total laryngectomy. The commonly used methods of voice rehabilitation are mentioned. Simple computational models are used to explore several principles of generating artificial source voice. Based on the knowledge of how a healthy human voice is generated, one of the ways to generate artificial source voice was chosen – a reed-based element in the configuration (-, +). The function of the reed-based element is based on a periodic bending of the reed and in the airflow cutoff created by this motion. The (-,+) configuration of the reed-based element causes a different behaviour, when compared to healthy vocal folds, important is, however, whether the generated acoustic signal has the right spectral characteristics, which enable the generation of voiced vowels of the human speech. Both experimental and computational models are used to study the behaviour of the reed-based element. The design of the experimental model is based on the preliminary experiments with simple reed-based elements, which were carried out at the beginning of my studies. The new experimental model is designed in such a way, that it enables changes to the reed geometry and its position towards the reed stop. The measurements carried out on the experimental model are mainly acoustical (measurements of the generated acoustical signal), but optical measurements of the reed´s movement and position are possible and used as well. Because of the nature of the reed-based element´s behavior, the fluid structure interaction must be taken into consideration in the computational model. A two-way model of fluid structure interaction is used between the fluid part of the computational model and the structural one. A partitioned solution is used to solve the fluid-structure interaction. The effect of specific input parameters on the function of both models (experimental and computational) is monitored. The influences of input parameters on the basic frequency of the generated signal (source voice), on the stability of the function and on other important characteristics are evaluated. The final chapters focus on the design of voice prosthesis in general. Some specific issues, which need to be solved when designing voice prosthesis, are highlighted.

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