Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro / A educação a distância (EAD) é uma importante estratégia na realização de atividades de educação permanente em saúde. Contudo, as raízes pedagógicas de muitas destas práticas convergem para a reapresentação de uma educação tradicional e transmissora, sobretudo pela inexistência de momentos de interação social que possibilitem a troca e o compartilhamento de saberes. Neste sentido, os fóruns on line são considerados um importante recurso para promover um cenário interativo e estimular processos de construção compartilhada do conhecimento (CCC). Nesta pesquisa, defende-se a tese de que dentro da lógica dos processos de educação permanente em saúde, o fórum representa uma ferramenta interativa e possibilita a construção de saberes compartilhados. Assim, o objetivo geral é analisar os fóruns interativos como espaço de processos de ensino-aprendizagem entre enfermeiros da Estratégia de Saúde da Família em um curso de especialização em saúde da família a distância. Além disso, são objetivos específicos desta pesquisa: compreender a política e os projetos de educação permanente em saúde no Brasil; observar as interações sugestivas de processos de construção compartilhada do conhecimento entre alunos e tutores; analisar a percepção dos discentes do curso sobre o fórum interativo e as possíveis repercussões deste em sua prática profissional. A metodologia escolhidabaseia-se no estudo de caso. Na coleta de dados, foram utilizados questionários on line e análise dos fóruns temáticos das disciplinas do curso, segundo análise de suas redes sociais. Tal análise desdobrou-se na construção de três categorias: as relações comunicacionais e os processos interativos como essencialidades da CCC; a formação de grupos as redes sociais na EAD; o tutor como mediador do espaço virtual. Observou-se, neste estudo, que a construção das redes sociais dentro de uma turma de EAD obedece à mesma lógica daquelas construídas presencialmente, ou seja, é baseada na identificação com o grupo e na aceitação de ideias expostas por um determinado coletivo. Os tutores possuem papel essencial na formação das redes sociais e, também, no surgimento das relações dialógicas. As relações de cooperação dentro dos fóruns interativos indicam a existência de processos de CCC; contudo, assim como nas relações presenciais, é impossível dimensionar a influência e as consequências sociais destas construções na vida dos sujeitos. Conclui-se que o fórum possibilita a existência de relações comunicacionais, porém os desdobramentos interativos, bem como os processos de CCC, dependem, não só do instrumento utilizado, mas de outros fatores, como o estímulo do professor-tutor, a participação dos alunos e a criação de redes sociais cooperativas. / Distance learning (ODL) is an important strategy in conducting continuing education activities in health. However, the pedagogical roots of many of these practices converge to the representation of a traditional and transmitter education, especially due to the lack of social interaction moments allowing the exchange of knowledge. In this regard, on line forums are considered an important resource to promote an interactive scenario and stimulate the shared process of constructing knowledge through communication actions cooperatives. In this research we defend the thesis that within the logic of permanent education processes in health, the forum as a interactive tool of the Internet allows the construction of shared knowledge. Thus, the general objective is to analyze interactive forums as an area of teaching-learning processes between FHS nurses in a distance learning specialization course in family health. In addition, are specific objectives of this research: 1. Understand the policy and projects on permanent education in health in Brazil; 2. Observe interactions suggestive of shared construction of knowledge between students and tutors; 3. To analyze the perception of the course students on the interactive forum and its possible repercussions in their professional practice. The methodological approach chosen is based on case study where data collection used online questionnaires and analysis of thematic forums of course subjects, according to an analysis of their social networks.This analysis was divided in three categories: a) The communication relations and interactive processes as essentialities of Shared Knowledge Construction; b) Formation of groups - social networks in distance education; c) The tutor as a mediator of the virtual space. It was observed in this study that the construction of social networks within a distance education class follows the same logic of those built in person, that is, based on the identification with the group and acceptance of ideas exposed by a certain collective; Tutors have essential role in the formation of social networks and also the emergence of dialogical relations; The cooperation within the interactive forums indicate the existence of shared construction of knowledge, however, as well as in-person relationships, it is impossible to scale the influence and the social consequences of these constructions in subjects' lives. In conclusion, the forum, while interactive element, allows the existence of communication relationships, however the interactive developments and the processes of shared construction of knowledge depend also of other factors such as teacher-tutor incentive, student participation and the creation of cooperative social networks.

Neste trabalho é proposta uma plataforma robótica móvel, concebida de maneira modular e hierárquica, visando o estudo de diversos aspectos aplicados à navegação, tanto autônoma quanto semi-autônoma, em ambientes internos. O sistema proposto possibilita a implementação de arquiteturas reativas e híbridas com aprendizagem, sendo a importância e limitações desta última discutidas. Utilizando a plataforma desenvolvida, uma aplicação de navegação robótica com aprendizagem supervisionada é realizada, usando sensores de ultra-som e através de tele-operação. O objetivo é fazer com que o agente associe, em tempo real, suas próprias respostas sensoriais com as ações motoras realizadas pelo tele-operador, permitindo que a tarefa seja repetida autonomamente com alguma generalização. Para realizar tal mapeamento, uma rede de função de base radial (RBF), usando um algoritmo de aprendizado seqüencial, é apresentada e utilizada. / This work presents a mobile robotic platform, built as a modular and hierarchical approach, aiming at the study of several aspects of indoor navigation. The proposed system allows the implementation of reactive and hybrid architectures with learning, for autonomous or semi-autonomous navigation. The importance and limitations of the learning characteristics are discussed. An application of robotic navigation with supervised learning is implemented using ultrasonic sensors and teleoperation. The aim is the agent to associate, in real time, its own sensorial perception to the motor actions realized by a teleoperator, allowing the task to be repeated in an autonomous way, with some generalization. To make the corresponding mapping, a radial basis function network (RBF), trained by a sequential learning algorithm, is presented and used.

O Acidente Vascular Cerebral (AVC) é uma doença prevalente e incapacitante, cujo atendimento no Brasil é insuficiente e concentrado em poucos centros de alta complexidade. A telemedicina possibilita assistência à saúde através do uso de tecnologias de comunicação entre dois ou mais profissionais, ou entre o profissional e o paciente, que estejam em locais distintos, permitindo aumento do acesso a tratamentos especializados, podendo ser útil na assistência do AVC agudo. Os objetivos deste estudo foram avaliar a viabilidade de uma rede de telemedicina para o AVC no Sistema Único de Saúde na região de Ribeirão Preto e desenvolver um sistema de telemedicina para o AVC. Para a análise da viabilidade, foram realizados o levantamento de indicadores demográficos e epidemiológicos da população de municípios que constituem o Departamento Regional de Saúde de Ribeirão Preto (DRS XIII) e uma análise técnica e econômica relacionada à estrutura necessária. O sistema de registro eletrônico e videoconferência foi desenvolvido por equipe multiprofissional, baseado em diretrizes nacionais para sistemas de informação em saúde e protocolos padronizados para o atendimento do AVC agudo. Concluiu-se que uma rede de telemedicina entre o Hospital das Clínicas de Ribeirão Preto e os outros hospitais que possuem os pré-requisitos para cadastramento como Unidade de AVC no DRS XIII será estratégica para a expansão do atendimento qualificado do AVC na região, e sua viabilidade depende do cadastro destes serviços junto ao Ministério da Saúde, financiamento dos equipamentos e treinamento das equipes assistenciais. O sistema de telemedicina desenvolvido possibilitará o registro seguro dos atendimentos, a educação permanente das equipes e base de dados para pesquisas clínicas, contribuindo para a concretização desta e de outras redes de telemedicina brasileiras. / Stroke is a prevalent and disabling disease, whith insufficient treatment in Brazil, where is concentrated in a few high complexity centers. Telemedicine enables health care through communication technology between two or more professionals, or between the professionals and patients, in different locations, allowing increased access to specialized treatments, therefore useful in acute stroke treatment. This study objectives were to evaluate the feasibility of a public stroke telemedicine network at Ribeirão Preto region and to develop a stroke telemedicine eletronic system. For feasibility study, populational demographic and epidemiological indicators were compiled for the cities that constitute the Regional Health Department of Ribeirão Preto (DRS XIII) and a technical and economic analysis related to the necessary structure was performed. The electronical record and videoconference system was developed by a multiprofessional team, based on national guidelines for health information systems and standardized protocols for acute stroke care. A telemedicine network between the Hospital das Clínicas of Ribeirão Preto and the other hospitals that meet criteria for enrollment as Stroke Units in DRS XIII will be strategic for the expansion of regional qualified stroke care. Its viability depends on the registration of these services at the Health Ministry, equipment financing and assistance teams training. The developed telestroke system will enable the secure record of calls, the permanent education of the teams and a database for clinical research, contributing to the realization of this and other telemedicine networks.

Many devices are available on the market for the evaluation and rehabilitation of patients suffering from muscular disorders. Most of them are small, low-cost, passive devices based on the use of springs and resistive elements and exhibit very limited (or even not any) evaluation capabilities; extended muscular force evaluation is only possible on stationary, expensive, multi-purpose devices, available only in hospitals, which offer many exercise modes (e.g. isokinetic mode) that are not available on other devices.<p><p>The objective of this thesis is to make the functionalities currently only implemented on bulky multi-purpose devices available at a lower cost and in a portable fashion, enabling their use by a large number of independent practitioners and patients, even at home (tele-medecine applications).<p><p>In order to achieve this goal, a portable rehabilitation device, using a magneto-rheological fluid brake as actuator, has been designed. This particular technology was selected for its high level of compactness, simple mechanical design, high controllability, smooth and safe operation. The first part of this thesis is devoted to the design of MR-fluid brakes and their experimental validation. The second part is dedicated to the design of the rehabilitation device and the comparison of its performances with a commercial multi-purpose device (CYBEX). / Doctorat en Sciences de l'ingénieur / info:eu-repo/semantics/nonPublished

Travel demand forecasting is essential for many decisions, such as infrastructure investments and policy measures. Traditionally travel demand modelling has considered trip frequency, mode, destination and route choice. This thesis considers two other choice dimensions, hypothesised to have implications for travel demand forecasting. The first part investigates how the increased possibilities to overcome space that ICT (information and communication technology) provides, can be integrated in travel demand forecasting models. We find that possibilities of modelling substitution effects are limited, irrespective of data source and modelling approach. Telecommuting explains, however, a very small part of variation in work trip frequency. It is therefore not urgent to include effects from telecommuting in travel demand forecasting. The results indicate that telecommuting is a privilege for certain groups of employees, and we therefore expect that negative attitudes from management, job suitability and lack of equipment are important obstacles. We find also that company benefits can be obtained from telecommuting. No evidences that telecommuting gives rise to urban sprawl is, however, found. Hence, there is ground for promoting telecommuting from a societal, individual and company perspective. The second part develops a departure time choice model in a mixed logit framework. This model explains how travellers trade-off travel time, travel time variability, monetary and scheduling costs, when choosing departure time. We explicitly account for correlation in unobserved heterogeneity over repeated SP choices, which was fundamental for accurate estimation of the substitution pattern. Temporal constraints at destination are found to mainly restrict late arrival. Constraints at origin mainly restrict early departure. Sensitivity to travel time uncertainty depends on trip type and intended arrival time. Given appropriate input data and a calibrated dynamic assignment model, the model can be applied to forecast peak-spreading effects in congested networks. Combined stated preference (SP) and revealed preference (RP) data is used, which has provided an opportunity to compare observed and stated behaviour. Such analysis has previously not been carried out and indicates that there are systematic differences in RP and SP data. / QC 20100825

Real-world radiance values can range over eight orders of magnitude from starlight to direct sunlight but few digital cameras capture more than three orders in a single Low Dynamic Range (LDR) image. We approach this problem using established High Dynamic Range (HDR) techniques in which multiple images are captured with different exposure times so that all portions of the scene are correctly exposed at least once. These images are then combined to create an HDR image capturing the full range of the scene. HDR capture introduces new challenges; movement in the scene creates faded copies of moving objects, referred to as ghosts. Many techniques have been introduced to handle ghosting, but typically they either address specific types of ghosting, or are computationally very expensive. We address ghosting by first detecting moving objects, then reducing their contribution to the final composite on a frame-by-frame basis. The detection of motion is addressed by performing change detection on exposure-normalized images. Additional special cases are developed based on a priori knowledge of the changing exposures; for example, if exposure is increasing every shot, then any decrease in intensity in the LDR images is a strong indicator of motion. Recent Superpixel over-segmentation techniques are used to refine the detection. We also propose a novel solution for areas that see motion throughout the capture, such as foliage blowing in the wind. Such areas are detected as always moving, and are replaced with information from a single input image, and the replacement of corrupted regions can be tailored to the scenario. We present our approach in the context of a panoramic tele-presence system. Tele-presence systems allow a user to experience a remote environment, aiming to create a realistic sense of "being there" and such a system should therefore provide a high quality visual rendition of the environment. Furthermore, panoramas, by virtue of capturing a greater proportion of a real-world scene, are often exposed to a greater dynamic range than standard photographs. Both facets of this system therefore stand to benefit from HDR imaging techniques. We demonstrate the success of our approach on multiple challenging ghosting scenarios, and compare our results with state-of-the-art methods previously proposed. We also demonstrate computational savings over these methods.

Background: An intermediate step towards fully autonomous construction equipment is “assisted tele-remote operation”. These sorts of operations imply that an operator remotely supports machines that has encountered a situation that autonomous systems onboard the construction machines (CM) cannot solve. Considering teleoperators are not required to continuously monitor the CM in an assisted tele-remote environment, multiple construction machines can be teleoperated simultaneously. For simplification, “assisted tele-remote operation” will now be referred to as “teleoperations”. Volvo Construction Equipment is currently exploring the possibility to teleoperate wheel loaders, articulated haulers, and excavators from a single platform. To do this, primary controls adapted for operating these machines are needed. The primary controls should be designed with the needs of a teleoperator in mind while taking functionality into account, which is needed when CM are both operated conventionally and in tele-remote applications. This procedure will be referred to as relevant primary controls. As the primary controls from three different CM-types are destined to be combined into one platform, the teleoperations platform will be referred to as “3-1 CM teleoperations platform”. The purpose of this thesis project was to propose a relevant solution to primary controls for a 3-1 CM teleoperations platform. To fulfil this purpose, the following two research questions (RQ) where formulated: • RQ1: What are the challenges for teleoperating construction equipment? • RQ2: What defines primary controls in a 3-1 CM teleoperations platform and how can the layout be improved? Method: Using interviews, observations, and literature as qualitative data collection methods, several insights where gained. A scenario for the CM was defined to define the situation in which the quantitative data collection method would be performed. Needs of current CM operators combined with teleoperators have been analysed and listed. Quantitative data has been collected and analysed to design the layout of the primary controls using the objective data as a basis. Result: The research questions were answered with the following results: • RQ1: Insights that resulted in several themes describing how teleoperations can be developed by looking at different challenges it can face. • RQ2: Specifications of the functions included in the new ‘primary controls’ based on CM functions from the company and from teleoperating experiences from several industries. An analysis on how often the functions for the new ‘primary controls’ were used, was carried out. The answers to the research questions were used as a basis to fulfil the purpose of this thesis project by proposing a conceptual solution for primary controls to a teleoperation’s platform for operating multiple CM. Conclusions: It was established that a 3-1 CM teleoperations platform can be developed towards certain CE-machine types. Moreover, additional analysis with experienced operators of each machine type are needed to improve and verify the most optimal layout of the primary controls and platform. Further research is still required to validate the answers to RQ1 and RQ2.

La thèse est une recherche action ; l'action s'articule autour d'une plateforme de télémédecine, évaluée en matière de processus et de résultats dans des publications scientifiques et en matière éthique dans le présent manuscrit. La plateforme de télé-expertise a été crée sur le modèle développé par le collegium telemedicus (https://collegiumtelemedicus.org) et implantée sur les terrains d'intervention de Médecins Sans Frontières (MSF), organisation non gouvernementale humanitaire. Le système donne accès à un réseau de spécialistes capables de répondre sous quelques heures aux demandes d'avis spécialisés des soignants en situation d'isolement géographique et / ou dans des zones à faibles ressources. Plus de 4000 cas ont été traités à travers la plateforme confirmant le besoin et l'intérêt du service par les soignants présents sur le terrain. Les évaluations scientifiques montrent que le système est fiable et performant. La majorité des utilisateurs juge le service utile et adapté aux besoins du terrain avec un effet positif sur la prise en charge des patients. L'accès à un spécialiste réduit en outre le sentiment d'isolement des praticiens en leur permettant une gestion collégiale des cas et participe à son éducation dans des domaines spécialisés. Un certains nombre de limites existent toutefois, comme les difficultés de suivi des patients ou l'absence de retour adressé à l'expert impliqué sur l'évolution du cas après son avis. L'action est née sous la double impulsion d'un constat d'une perte de chance en l'absence d'accès aux spécialistes et de l'injustice d'accès aux soins spécialisés en situation d'isolement géographique et dans des zones à faibles ressources. Bien que le droit international plaide pour le meilleur soin pour tous, il le conditionne aux ressources disponibles des populations concernées, signant par là même le constat de son impuissance à faire appliquer le droit qu'il proclame. L'action mise en œuvre grâce au soutien opérationnel de MSF (connaissance du terrain, recrutement des spécialistes volontaires...) apporte une réponse concrète et immédiate à cette injustice. L'évaluation rigoureuse du système relève d'une démarche éthique qui vise à s'assurer d'une utilisation efficiente des ressources dans un contexte où leur allocation est un enjeu éthique majeur. L'analyse a permis d'établir dans quelle mesure l'action respecte les principes éthiques de bienfaisance et de non-malfaisance et comment le principe d'autonomie se trouve renforcé par l'accès aux avis spécialisés en améliorant les « capabilités » individuelles. Enfin, l'action interroge nos pratiques de pays à haut revenus, notamment la place et l'organisation de la médecine spécialisée. Les solutions développées dans les zones à faibles revenus constituent des modèles efficaces et économes, susceptibles de faire évoluer la façon de penser la santé et le modèle de soin dans les pays à haut revenus. / The thesis is an action research; the action is based on a telemedicine platform, evaluated in terms of process and results in scientific publications and ethics issues raised in this manuscript. The tele-expertise platform was created on the model developed by the collegium telemedicus (https://collegiumtelemedicus.org) and implemented on the intervention fields of Médecins Sans Frontières (MSF), a humanitarian non-governmental organization. The system provides access to a network of specialists able to respond within a few hours to requests for expert advice to healthcare providers in situations of geographic isolation and / or in low-resource settings. More than 4000 cases were processed through the platform, confirming the need for and interest in the service by healthcare providers working in difficult environments. The scientific assessments show that the system is reliable and efficient. The majority of users judge the service to be useful and well adapted to the needs in the field with a positive impact on patient management and outcomes. Access to specialists also reduces the sense of isolation of practitioners, allowing them collegial case management and assisting in their education in specialized areas. However, a certain number of limitations exist, such as monitoring patient follow-up or lack of feedback sent to the expert involved on the evolution of the case following the provision of expert advice. The action is born from the loss of opportunity caused by the absence of access to specialists, and the injustice represented by restricted access to specialized care in a situation of geographic isolation or in low-resource settings. International law advocates the best possible care for all, but acknowledges that it depends on the available resources of the targeted populations.Thus international law acknowledges its inability to apply the law that it proclaims. The action was implemented thanks to the operational support of MSF (field experience, volunteer specialists recruitment ...). It provides a concrete and immediate response to the injustice of restricted access to expertise from the field. Rigorous evaluation of the system comes within an ethical approach designed to ensure an efficient use of resources in a context where their allocation is a major ethical issue. The analysis helped to establish the extent to which the action respects the ethical principles of beneficence and non-maleficence, and how the principle of autonomy is reinforced by access to expert advice by improving the "capabilities" of the individual. Finally, the action questions existing high-income country practices, including the establishment and organization of specialized medicine. The solutions developed in low-resources areas are effective and efficient models, likely to change the way of thinking about health and care model in high income countries.

Unmanned Aerial Vehicles (UAVs) can navigate in indoor environments and through environments that are hazardous or hard to reach for humans. This makes them suitable for use in search and rescue missions and by emergency response and law enforcement to increase situational awareness. However, even for an experienced UAV tele-operator controlling the UAV in these situations without colliding into obstacles is a demanding and difficult task. This thesis presents a human-UAV interface along with a collision avoidance method, both optimized for a human tele-operator. The objective is to simplify the task of navigating a UAV in indoor environments. Evaluation of the system is done by testing it against a number of use cases and a user study. The results of this thesis is a collision avoidance method that is successful in protecting the UAV from obstacles while at the same time acknowledges the operator’s intentions. / Obemannad luftfarkoster (UAV:er) kan navigera i inomhusmiljöer och genom miljöer som är farliga eller svåra att nå för människor. Detta gör dem lämpliga för användning i sök- och räddningsuppdrag och av akutmottagning och rättsväsende genom ökad situationsmedvetenhet. Dock är det även för en erfaren UAV-teleoperatör krävande och svårt att kontrollera en UAV i dessa situationer utan att kollidera med hinder. Denna avhandling presenterar ett människa-UAV-gränssnitt tillsammans med en kollisionsundvikande metod, båda optimerade för en mänsklig teleoperatör. Målet är att förenkla uppgiften att navigera en UAV i inomhusmiljöer. Utvärdering av systemet görs genom att testa det mot ett antal användningsfall och en användarstudie. Resultatet av denna avhandling är en kollisionsundvikande metod som lyckas skydda UAV från hinder och samtidigt tar hänsyn till operatörens avsikter.

The purpose of this review of literature is to investigate the various roles of video surveillance (VS) in the hospital's intensive care unit (ICU) as well as its legal and ethical implications. Today, hospitals spend more money on the ICU than on any other unit. By 2030, the population of those 65 and over is expected to double. 80% of older adults have at least one chronic diseases (Centers for Disease Control and Prevention, 2013). As a consequence, the demand for ICU services will likely increase, which may burden hospital with additional costs. Because of increasing economic pressures, more hospitals are using video surveillance to enhance quality care and reduce ICU costs (Goran, 2012). Research shows that VS enhances positive outcomes among patients and best practice compliance among hospital staff. The results are fewer reports of patient complications and days spent in the ICU, and an increase in reported hospital savings. In addition, VS is becoming an important tool for the families of newborns in the neonatal ICU (NICU). The belief is that the VS can facilitate parent-baby bonding. In the United States of America, privacy rights impose legal restrictions on VS. These rights come from the U.S. Constitution, Statutory law, Regulatory law, and State law. HIPPA authorizes the patient to control the use and disclosure of his or her health information. Accordingly, hospitals are under obligation to inform patients on their right to protected health information. It is appropriate that hospitals use VS for diagnostic purposes as long as they have obtained patient consent. According to modern day privacy experts Charles Fried and Alan Westin, a violation of a person's privacy equates a violation on their liberty and morality. However, if a physician suspects that a third party person is causing harm to the patient, than the use of covert VS is justifiable.