Pour répondre aux exigences du gouvernement fédéral quant aux temps d’attente pour les chirurgies de remplacement du genou et de la hanche, les établissements canadiens ont adopté des stratégies de gestion des listes d’attentes avec des niveaux de succès variables. Notre question de recherche visait à comprendre Quels facteurs ont permis de maintenir dans le temps un temps d’attente répondant aux exigences du gouvernement fédéral pendant au moins 6-12 mois? Nous avons développé un modèle possédant quatre facteurs, inspiré du modèle de Parsons (1977), afin d’analyser les facteurs comprenant la gouvernance, la culture, les ressources, et les outils. Trois études de cas ont été menées. En somme, le 1er cas a été capable d’obtenir les exigences pendant six mois mais incapable de les maintenir, le 2e cas a été capable de maintenir les exigences > 18 mois et le 3e cas a été incapable d’atteindre les objectifs. Des documents furent recueillis et des entrevues furent réalisées auprès des personnes impliquées dans la stratégie. Les résultats indiquent que l’hôpital qui a été en mesure de maintenir le temps d’attente possède certaines caractéristiques: réalisation exclusive de chirurgie de remplacement de la hanche et du genou, présence d’un personnel motivé, non distrait par d’autres préoccupations et un esprit d’équipe fort. Les deux autres cas ont eu à faire face à une culture médicale moins homogène et moins axés sur l’atteinte des cibles; des ressources dispersées et une politique intra-établissement imprécise. Le modèle d’hôpital factory est intéressant dans le cadre d’une chirurgie surspécialisée. Toutefois, les patients sont sélectionnés pour des chirurgies simples et dont le risque de complication est faible. Il ne peut donc pas être retenu comme le modèle durable par excellence. / In response to federal government requirements regarding wait times for elective hip and knee surgery, hospitals have adopted wait list management strategies, with variable success. This research examined organizational and systemic factors that made it possible to keep wait times within federally established limits of 6-12 months. We used a model based on Parsons’ model. Four dimensions were used to analyze the following factors: governance, culture, resources, and tools. Three cases studies were done: Case 1 was able to meet the requirements for six months but unable to sustain this level; Case 2 was able to maintain compliance with requirements for > 18 months; and Case 3 was never able to meet the requirements. Documents were collected and interviews conducted with people involved in the strategies. In all, eight interviews were conducted at each site and all documents related to each strategy were collected. The results indicated that the one hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit. The two other cases had to contend with a medical culture that was less homogeneous and they were less focused on meeting targets and had resources that were dispersed as well as unclear inter-organizational policies. In the end, the hospital factory model is appealing in the context of superspecialized surgery. However, because patients are selected for simple surgeries, with little risk of complications, it cannot be promoted as a sustainable model of excellence.

En 1998, R. Gompf a défini un invariant homotopique des champs de plans orientés des 3-variétés fermées orientées. Cet invariant est défini pour les champs de plans orientés xi; de toute 3-variété fermée orientée M dont la première classe de Chern c_1(xi) est un élément de torsion de H_2(M;Z). Dans le premier chapitre de la thèse, nous définissons une extension de l’invariant de Gompf pour toutes les 3-variétés compactes orientées à bord et nous étudions ses variations lors de chirurgies lagrangiennes. Il en résulte que l’invariant de Gompf étendu peut être vu comme un invariant de type fini de degré 2.L’invariant Théta est un invariant de variétés de dimension 3 parallélisées qui provient de la partie de degré 1 du développement perturbatif de la théorie de Chern-Simons. G. Kuperberg et D. Thurston ont identifié l’invariant Théta(M,tau) d’une sphère d’homologie entière M munie d’une parallélisation tau; à lambda_cw(M) + 1/4·p_1(tau) où lambda_cw désigne la généralisation de Walker de l’invariant de Casson et p_1 est un invariant de la parallélisation définie à partir d’une première classe de Pontrjagin. C. Lescop a étendu l’invariant Théta aux sphères d’homologie rationnelle munies d’une classe d’homotopie de combings et elle a montré que pour toute sphère d’homologie rationnelle M munie d’un combing X, la formule Théta(M,[X]) = 3·lambda_cw(M) + 1/4·p_1([X]) était encore valable pour une extension ad hoc des nombres de Pontrjagin aux combings. Elle a aussi donné une formule combinatoire pour l’invariant Théta d’une sphère d’homologie rationnelle présentée par un diagramme de Heegaard et munie d’un combing associé au diagramme, et elle a démontré combinatoirement que cette formule définit un invariant homotopique des couples (M,[X]). Dans le prolongement de ce travail, le deuxième chapitre de la thèse présente une preuve combinatoire de la décomposition de cet invariant combinatoire comme 3·lambda_cw(M) + 1/4·p_1([X]). Cette preuve repose sur la théorie des invariants de type fini des sphères d’homologie rationnelle relativement aux chirurgies lagrangiennes établie par D. Moussard en 2012 / In 1998, R. Gompf defined a homotopy invariant of oriented 2-plane fields in 3-manifolds. This invariant is defined for oriented 2-plane fields xi in a closed oriented 3-manifold M when the first Chern class c_1(xi) is a torsion element of H_2(M;Z). In Chapter I, we define an extension of the Gompf invariant for all compact oriented 3-manifolds with boundary and we study its iterated variations under Lagrangian-preserving surgeries. It follows that the extended Gompf invariant has degree two for a suitable finite type invariant theory.The Theta-invariant is an invariant of parallelized 3-manifolds constructed from the degree one part of the perturbative expansion of Chern–Simons theory. G. Kuperberg and D. Thurston identified the invariant Theta(M,tau) of a rational homology 3-sphere M equipped with a parallelization tau with 3·lambda_cw(M) + 1/4·p_1(tau) where lambda_cw denotes Walker’s generalization of the Casson invariant and where p_1 is an invariant of parallelizations defined using a first Pontrjagin class. C. Lescop extended the Theta-invariant to rational homology 3-spheres equipped with a homotopy class of combings and she showed that for all rational homology 3-sphere M equipped with a combing X, the relation Theta(M,[X]) = 3·lambda_cw(M) + 1/4·p_1([X]) still holds using an ad hoc extension of the Pontrjagin numbers for combings. She also gave a combinatorial formula for the Theta-invariant of a rational homology 3-sphere represented by a Heeagaard diagram and equipped with a combing associated to the diagram, and she proved that this formula defines a homotopy invariant of the pair (M,[X]), in a combinatorial way. Following this work, Chapter II presents a combinatorial proof of the decomposition of this combinatorial invariant as 3·lambda_cw(M) + 1/4·p_1([X]). This proof relies on the finite type invariant theory for rational homology 3-spheres with respect to Lagrangian-preserving surgeries established by D. Moussard in 2012

Made available in DSpace on 2011-05-04T12:36:29Z (GMT). No. of bitstreams: 0 Previous issue date: 2009 / Empresas e instituições que produzem sistemas de informações precisam estar sempre em busca de metodologias e estratégias tecnológicas que aumentem seu poder de organizar e disponibilizar seus dados. Precisam estabelecer mecanismos de interoperabilidade dos seus sistemas próprios e com outros externos, principalmente nesses tempos em que a Internet se impõe como tecnologia predominante. Isto implica em transmitir e receber conhecimentos de domínios de conhecimentos de várias fontes. A Web semântica foi concebida com esse intuito. A construção de ontologias através de uma linguagem própria, a Ontology Web Language, disponibiliza formatos estruturados e organizados que podem ser associados às páginas da Internet. Essas tecnologias estão permitindo a construção de softwares para buscas e interpretações automáticas de conteúdos. Neste trabalho é proposto estudo dessas tecnologias seguindo o percurso do conhecimento nas suas várias fases e apoiadas pela larga discussão na comunidade científica. Através de um estudo de caso, percorre os caminhos necessários para construção de uma aplicação sobre os dados da Política Nacional de Cirurgias Eletivas do Ministério da Saúde em bases relacionais, utilizando o contexto da Web semântica. Almeja, dessa forma,introduzir o tema Ontologias e Web semântica ao corpo dirigente e técnico do Departamento de Informática do Sistema Único de Saúde do Ministério da Saúde na perspectiva de sua adoção em futuros trabalhos da instituição, produtora de sistemas e disseminação de informações de interesse público. / Companies and institutions that develop systems need to be always on the search of technological methodologies and strategies which increase their power to organize and to make their data available. They need to establish mechanisms of interoperability of their own systems and with external systems, especially in these times in which the Internet shows itself as the predominant technology. This imply in transmitting and receiving knowledge from several sources of knowledge domains. The Semantic Web was conceived with this intention. The construction of ontologies through an own language, the Ontology Web Language - OWL, makes available structure and organized formats which can be associated to Internet pages. These technologies are allowing the construction of software to automatic search and content interpretation. In this work it is proposed the study of these technologies following the course of knowledge in its several phases and supported by wide discussion on the scientific community. The aim, through a case study, is to run the necessary paths to build an application about data of the National Policy on elective surgeries of the Ministry of Health in relational databases, using the context of the Semantic Web. In this way, it´s expected to introduce the Ontologies and Semantic Web themes to the directory and technical staff of the Ministry of Health toward their adoption in future works of an institution, that produces systems and spreads valuable information to the society.

Made available in DSpace on 2014-06-11T19:24:12Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-07-23Bitstream added on 2014-06-13T20:12:10Z : No. of bitstreams: 1 carnier_le_me_bauru.pdf: 1982119 bytes, checksum: b4ab862bfa7521b0f63af29532202451 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A hospitalização infantil para realização de cirurgia envolve uma sobrecarga emocional tanto para as crianças quanto para sua família. Sabendo que adultos e crianças são atingidos de modo semelhante pelo stress, este estudo avaliou o nível de stress de acompanhantes e crianças em situação pré-cirúrgica e as estratégias de enfrentamento (coping) das crianças nesta situação. Participaram 63 crianças, com idade entre 7 e 12 anos, hospitalizadas para cirurgias eletivas, e seus acompanhantes. Para verificar as variáveis sociodemográficas e de hospitalização das crianças, um Questionário de Levantamento de Informações, elaborado para este estudo, foi aplicado nos acompanhantes. Para avaliar a presença de stress nas crianças, foi aplicada a Escola de Stress Infantil (ESI) e, nos acompanhantes, o Inventário de Sintomas de Stress para adultos de Lipp (ISSL). Aplicou-se o Instrumento de Avaliação das Estratégias de Enfrentamento da Hospitalização (AEH) para identificar as estratégias de enfrentamento utilizadas pelas crianças para lidar com a hospitalização. Observou-se que cerca de 12,7% das crianças apresentaram stress e 23,8% possibilidade de stress, especialmente para sintomas psicológicos (33%), relacionados às variáveis: idade (sete a oito anos), sexo feminino, não ter experiência anterior com cirurgia e receber pouca informação acerca do período perioperatório. As crianças informadas pelo médico e com informação sobre o procedimento cirúrgico, apresentaram menor nível de stress. A maioria dos acompanhantes (76%) foram diagnosticados como estressados, com prevalência da fase de resistência e sintomas psicológicos principalmente as do sexo feminino. As crianças pontuaram mais comportamentos facilitadores da hospitalização como: tomar medicação, assistir TV e conversar. Meninas, crianças com idade igual ou superior a 11 anos e crianças... / Children's hospitalization for surgery may involve an emotional burden for both, the child and for his family. Knowing that adults and children alike are affected by stress, this study evaluated the stress level of caregivers and children in pre-surgical situation and the coping strategies of children in this situation. Participated in this study 63 children aged between seven and 12 years hospitalized for elective sugery and their carers. To determine the sociodemographic variables and hospitalizationn of children, a questionnaire survey of information prepared for this study was applied in companions. To evaluate the the presence of stress in children, was applied the Escala de Stress Infantil (ESI) and, in accompanying the Inventário de Sintomas de Stress para adultos de Lipp (ISSL). To identify the coping strategies used bu children to cope with hospitalization was applied the Instrumento de Avaliação das Estratégias de Enfrentamento da Hospitalização (AEH). It was observed that approximately 12.7% of children showed stress and 23.8% possibility of stress, especially for psychological psychological symptoms (33%), related to the variables age (seven to eight years), female, have no previous experience with surgery and receive little information about the perioperative period. The children reported by the physician and the surgical procedure had a lower level of stress. The most caregivers (76%) were diagnosed as stressed, with a prevalecence of resistance phase and psychological symptons. The fact that a woman companion and chief caregiver, in addition to being a companion of young children with no previous surgical experience and female was related with higher stress. The children scored more facilitative behaviors of hospitalization as taking medication, watching TV and chatting. Girls, children aged less than 11 years and children ... (Complete abstract click electronic access below)

Urbanová, Zdeňka: A Woman in Art. /Diploma Thesis/ Prague 2011 - Charles University in Prague, Faculty of Education, Department of Art, 100 standard pages focus of the thesis: theoretical and research study with an art project subject: interception of gender stereotypes and use of women art in an artistic production aim: to find out if pupils use gender stereotypes during their perception and to try to information them with this issue contribution, knowledge: an evocation of the interest in this issue in the context of art key words: women art, feminism, gender, gender stereotypes, identity, sexuality, erotic, plastic sur- geries, doll, art education

This study investigates the potential of Spatial Frequency Domain Imaging (SFDI) as a non-invasive imaging technique for tissue analysis in the context of Mohs surgery, a standard procedure for skin cancer removal with margin control. The current practice of performing multiple histopathologic sections during the procedure is time-consuming and labor-intensive. SFDI, utilizing optical measurements, offers quantitative imaging of biological tissues, enabling the assessment of their function and structure. This makes it particularly suitable for imaging sensitive tissues like the skin and the eye. By accurately measuring the optical properties of tissues, a deeper understanding of their characteristics and the interaction of light with tissue can be achieved. In this study, a novel transillumination SFDI system was designed and utilized to obtain spectral data from examined 2 mm thick tissue-simulating phantoms. The results demonstrated the potential of the transmission-based SFDI as a valuable tool in tissue analysis,providing rapid and accurate information about tissue properties. The implementation of transmission-based SFDI system holds promise for enhancing tissue-conserving surgeries. By enabling direct analysis of tissue properties at the point of care, this system could eliminate the need for histopathologic processing. Consequently, it can provide rapid and accurate information about tissue characteristics without the need for histopathologic processing, allowing for more precise and efficient surgical procedures and better patient outcomes

Au sein d’un établissement hospitalier, le bloc opératoire représente un des secteurs les plus emblématiques et les plus coûteux. Le fonctionnement du bloc opératoire est orchestré par un programme opératoire qui consiste à construire un planning prévisionnel des interventions chirurgicales à réaliser pendant un horizon donné. La littérature abondante sur le sujet est unanime sur le fait que la construction du programme opératoire est une tâche complexe, car il s’agit non seulement de planifier et d’ordonnancer les interventions, mais aussi de satisfaire des exigences souvent antagonistes. Ce projet est le fruit d’une collaboration entre la Communauté d’Agglomération de Sarreguemines Confluences et la Région Lorraine, des membres du secteur hospitalier (Hôpital Robert Pax de Sarreguemines) et l’équipe Gestion Industrielle et Logistique (GIL) du Laboratoire de Génie Industriel, de Production et de Maintenance (LGIPM). L’objectif de cette recherche est d’apporter une aide aux gestionnaires du bloc opératoire, qui ont besoin de plus en plus des méthodes et des outils d’aide à la décision en vue d’optimiser leur fonctionnement. Pour répondre à ce besoin nous nous intéressons dans la première partie de cette thèse à la gestion des opérations électives en prenant en compte différentes contraintes et en particulier la disponibilité des chirurgiens. Nous nous plaçons dans le contexte d’une stratégie « open scheduling » et nous proposons deux modèles mathématiques permettant d’élaborer le programme opératoire. La complexité des modèles mathématiques et leur explosion combinatoire rendent difficile la recherche de l’optimum pour des tailles réalistes. Ceci nous a donc amené à proposer une heuristique constructive utilisant le modèle proposé et permettant d’obtenir des solutions là où la méthode exacte ne nous le permettait pas. Dans la seconde partie de cette thèse, nous considérons l’intégralité du processus opératoire (brancardage vers le bloc opératoire, préparation et anesthésie, acte chirurgicale et réveil). Nous modélisons ce processus comme un flow shop hybride à 4 étages avec contrainte de blocage de type RSb, et nous le résolvons à l’aide d’un algorithme génétique dont l’objectif est de synchroniser toutes les ressources nécessaires, en respectant au mieux le programme opératoire prévisionnel. Outre les opérations électives, nous nous intéressons dans la dernière partie aux opérations urgentes. Nous proposons un outil d’aide à la décision pour la gestion des opérations urgentes. En prenant en considération la pathologie et la gravité de l’état du patient, nous distinguons principalement 3 degrés d’urgences et proposons pour chacune un algorithme permettant d’intégrer en temps réel ces opérations dans le programme prévisionnel, tout en minimisant différents critères (temps d’attente avant affectation, heures supplémentaires, décalage par rapport aux anciennes dates de débuts) / The operating theater is one of the most critical and expensive hospital resources. Indeed, a high percentage of hospital admissions are due to surgical interventions. Rising expenditures spur health care organizations to organize their processes more efficiently and effectively. This thesis is supported by the urban community of Sarreguemines-France and the region of Lorraine-France, and is carried out in collaboration with the Centre Hospitalier de Sarreguemines - Hôpital Robert Pax. In the first part of this work, we propose two mathematical programming models to help operating theater managers in developing an optimal operating rooms scheduling. We also propose a constructive heuristic to obtain near optimal results for realistic sizes of the problem. In the second part of our work, the whole scheduling process is modeled as a hybrid four-stage flow shop problem with RSb blocking constraint, and is solved by a genetic algorithm. The objective is to synchronize all the needed resources around the optimal daily schedule obtained with the proposed mathematical model. The last part of our work is dedicated to non-elective surgeries. We propose a decision support tool, guiding the operating room manager, to handle this unpredictable flow of patients. Non-elective patients are classified according to their medical priority. The main contribution of the proposed decision support tool is to provide online assignment strategies to treat each non elective patient category. Proposed assignments are riskless on patient’s health. According to non-elective surgery classes, the proposed adjusted schedule minimizes different criteria such as patient’s waiting time, deviation from the firstly scheduled starting time of a surgery and the amount of resulting overtime

Made available in DSpace on 2016-04-28T20:40:05Z (GMT). No. of bitstreams: 1 Raquel Pinheiro Niehues Antoniassi.pdf: 792039 bytes, checksum: ba267b7e185acb65be357015e69cbfad (MD5) Previous issue date: 2009-05-29 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The present work aims to make a bibliographic survey of the knowledge produced in the scientific literature of the Psychology in which it refers to the acting of a psychologist in surgical contexts. For so much, a metodological proceeding was proposed and tested for realization of bibliographic survey, whose stages allowed its structuring. A search in Brazilian journals of Psychology Qualis A and/or B, indexed on basis of virtual data BVS-Psi, for published articles from 2001 to 2008, with at least a psychologist as author and/or co-author was performed. Of a total of 7.550 published articles, there were selected 17 articles, which were paying attention to the established criteria of inclusion. For analysis, there were delimited categories of identification (author, place and chronology); of metodological and theoretic characteristics (theoretical approach, type of study and method); and of content (white type of surgery, population of the acting, proposed intervention and obtained results). It was noticed that the articles were published by psychologists (71,05 %), who are linked to postgraduate courses in institutions of superior teaching, especially USP (47,06 %). Empirical inquiries (76,48 %) were predominant, with cognitivecomportamental theoretical approach (41,18 %). There prevailed the use of semidirected interviews in the pre and/or post surgical period (23,54 %) with the objective to value feelings at pre and/or post surgical contexts (23,54 %) of the adult patient (47,06 %). There are proposed techniques of psychological intervention of evaluation (76,48 %) and pre-surgical preparation (52,95 %), aiming to prevent complications resulting from psychological factors. Because of the shortage of publications devoted specifically to the study of this form of acting, the necessity of new fronts of studies for a deep understanding of the means of acting of the psychologist in surgical contexts was discussed and proposed / O presente trabalho tem como objetivo realizar um mapeamento bibliográfico do conhecimento produzido na literatura científica da Psicologia no que se refere à atuação do psicólogo em contextos cirúrgicos. Para tanto, foi proposto e testado um procedimento metodológico para realização de mapeamento bibliográfico, cujas etapas permitiram sua estruturação. Realizou-se uma busca em periódicos brasileiros de Psicologia Qualis A e/ou B, indexados na base de dados virtual BVSPsi, por artigos publicados de 2001 a 2008, com ao menos um psicólogo como autor e/ou co-autor. De um total de 7.550 artigos publicados, foram selecionados 17 artigos, que atendiam aos critérios de inclusão estabelecidos. Para análise, foram delimitadas as categorias de identificação (autor, local e cronologia); de características teórico-metodológicas (abordagem teórica, tipo de estudo e método); e de conteúdo (tipo de cirurgia, população alvo da atuação, intervenção proposta e resultados obtidos). Observou-se que as pesquisas foram publicadas por psicólogos (71,05%), que se encontram vinculados a cursos de pós-graduação em instituições de ensino superior, notadamente a USP (47,06%). Predominam-se pesquisas empíricas (76,48%), com abordagem teórica cognitivo-comportamental (41,18%). Prevaleceu a utilização de entrevistas semi-dirigidas nos períodos pré e/ou póscirúrgicos (23,54%) com o objetivo de avaliar sentimentos em contextos pré e/ou pós-cirúrgicos (23,54%) do paciente adulto (47,06%). Propõem-se técnicas de intervenção psicológica de avaliação (76,48%) e preparo pré-cirúrgico (52,95%), com finalidade de prevenir complicações decorrentes de fatores psicológicos. Diante da escassez de publicações dedicadas especificamente ao estudo dessa forma de atuação, é discutida e problematizada a necessidade de novas frentes de estudos para uma compreensão mais ampla das possibilidades de atuação do psicólogo em contextos cirúrgicos

In the field of craniomaxillofacial (CMF) surgery, surgical planning is an important and necessary procedure due to the complex nature of the craniofacial skeleton. Computed tomography (CT) has brought about a revolution in virtual diagnosis, surgical planning and simulation, and evaluation of treatment outcomes. It provides high-quality 3D image and model of skull for Computer-aided surgical planning system (CSPS). During the planning process, one of the essential steps is to reestablish the dental occlusion. In the first project, a new approach is presented to automatically and efficiently reestablish dental occlusion. It includes two steps. The first step is to initially position the models based on dental curves and a point matching technique. The second step is to reposition the models to the final desired occlusion based on iterative surface-based minimum distance mapping with collision constraints. With linearization of rotation matrix, the alignment is modeled by solving quadratic programming. The simulation was completed on 12 sets of digital dental models. Two sets of dental models were partially edentulous, and another two sets have first premolar extractions for orthodontic treatment. Two validation methods were applied to the articulated models. The results show that using the proposed method, the dental models can be successfully articulated with a small degree of deviations from the occlusion achieved with the gold-standard method. Low contrast resolution in CBCT image has become its major limitation in building skull model. Intensive hand-segmentation is required to reconstruct the skull model. Thin bone images are particularly affected by this limitation. In the second project, a novel segmentation approach is presented based on wavelet active shape model (WASM) for a particular interest in the outer surface of the anterior wall of maxilla. 19 CBCT datasets are used to conduct two experiments. This model-based segmentation approach is validated and compared with three different segmentation approaches. The results show that the performance of this model-based segmentation approach is better than those of the other approaches. It can achieve 0.25 +/- 0.2mm of surface error distance from the ground truth of the bone surface. Field of view (FOV) can be reduced in order to reduce unnecessary radiation dose in CBCT. This ROI imaging is common in most of the dentomaxillofacial imaging and orthodontic practices. However, a truncation effect is created due to the truncation of projection images and becomes one of the limitation in CBCT. In the third project, a method for small region of interest (ROI) imaging and reconstruction of the image of ROI in CBCT and two experiments for measurement of dosage are presented. The first experiment shows at least 60% and 70% of radiation dose can be reduced. It also demonstrates that the image quality was still acceptable with little variation of gray by using the traditional truncation correction approach for ROI imaging. The second experiment demonstrates that the images reconstructed by CBCT reconstruction algorithms without truncation correction can be degraded to unacceptable image quality.

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