[pt] O trabalho tem como tema a introdução da televisão educativa no Estado da Guanabara, destacando as experiências pioneiras dos cursos de formação para a preparação para a televisão educativa oferecidos para docentes e profissionais técnicos interessados em radiodifusão instrutiva e educacional. O período analisado compreende os anos entre 1960 e 1975, momento em que houve um crescimento significativo de vagas escolares na rede pública de ensino do Estado da Guanabara por causa da política educacional do governo de Carlos Lacerda que ampliou o número de escolas e determinou o funcionamento das mesmas em três turnos diurnos e o turno noturno. O aumento ao incentivo a escolarização era parte também de um projeto internacional, capitaneado pela UNESCO de erradicação do analfabetismo e fortalecimento da ideologia industrial capitalista que precisava de mão de obra qualificada para manter os padrões de desenvolvimento estimulados para época. Assim, a necessidade de professores também aumentou. A programação da televisão educativa deveria estar a serviço da educação formal e não formal das audiências, e também para a qualificação e formação de professores. Vários cursos foram oferecidos em circuito fechado e aberto de televisão educativa. No período pesquisado, houve a inauguração do Centro Brasileiro de Televisão Educativa, que junto ao Instituto de Educação investiram na formação de pessoal para a criação e definição de um modelo de teleducação que atendesse as necessidades da população local. Entre as iniciativas, destacamos a telenovela educativa João da Silva, exibida nos anos de 1970, que foi o primeiro curso supletivo usado no formato de telenovela direcionada ao ensino primário, com certificação aos alunos/telespectadores que se submetiam a processo de avaliação para conclusão referente às quatro séries do primeiro grau. A metodologia de pesquisa utilizada consiste na análise de conteúdo de documentos oficiais do Instituto de Educação, jornais da época, entrevista, analise do arquivo pessoal das famílias de Gilson Amado e Lourival Marques. Trabalhamos a partir dos pressupostos de história e teoria social cuja base filosófica se apoia na ideia de que a realidade é social e culturalmente construída. / [en] The work s theme is about the introduction of educational television in Guanabara State, standing out the pioneering experiences of training courses to prepare for the educational television to teaching staff and to technical professionals interested in instructional and educational broadcasting. The time frame analyzed between 1960 and 1975, represent a moment in which there was an increase of school places in the local public school system because of the educational policy implemented during the government of Carlos Lacerda that enlarged the number of schools and established the four-shift system in schools. The incentive to schooling was also part of an international project, led by UNESCO for the eradication of illiteracy and strengthening of industrial capitalist ideology that needed a qualified workforce to maintain the patterns of development stimulated to season. The programming of educational television should be at the service of formal and non-formal education of hearings, and also for the qualification and training of teachers. Several courses were offered in open and closed loop of educational television. At the same period was inaugurated the Fundação Centro Brasileiro de Televisão Educativa, alongside the Guanabara State Institute of Education, invested in training of personnel for the creation and definition of a model tele-education that met the needs of the local population. Among the initiatives, we emphasis on the educational telenovela João da Silva, displayed in the 1970s, which was the first course of youth and adult education that used the format of the telenovela directed to primary education, with certification students/viewers that if they subjected the assessment process to conclusion regarding the four series of the 1st degree. The research methodology consists in the content analysis of official documents of the Institute of Education, newspapers, interviews, review of the personal file of the families of Gilson Amado and Lourival Marques. We work on the assumptions of history and social theory whose philosophical basis if supports the idea that the reality is socially and culturally constructed.

Det är mycket dyrt att utveckla markinfrastruktur för att försörja hela jorden med internet. Detta ärspeciellt fallet i glesbebyggda områden då det finns lite ekonomisk vinning. Sverige som är ett stortoch glesbefolkat land har stora områden av denna typ. Samtidigt är Sverige ett högteknologiskt landdär en stor majoritet av befolkningen använder internet och mobiltelefoni dagligen. Det skapar ettdilemma som är mycket kostsamt att lösa med markbunden teknologi.Sveriges regering samarbetar med teleoperatörer. De köper licenser på auktion för att få användaradiospektrum inom Sverige vilket är en begränsad resurs. I utbyte måste de uppnå vissa täcknings-krav. Dessa teleoperatörer åläggs därmed att täcka Sveriges yt a med potentiell uppkoppling och mo-bilt internet och ingår i ett avtal med regeringen för att få verka.Det är däremot inte särskilt ekonomiskt att göra detta på landsbygden där det bor få människor ochnyttjande av individuella markstationer blir mycket låg. Detta leder då till att dessa master är mycketolönsamma och det är dessutom ett slöseri med resurse r såsom mark, område, natur, material ochpengar. Företag är därför beredda att spendera stora mängder pengar på att undvika att belastas medkrav från Sveriges regering för att utföra detta.Samtidigt är satellitinternet på frammarsch och fler och fler personer världen över införskaffar inter-net via satellit. Detta har blivit ett alternativ.Mycket trådlös teknologi använder specifika olika radiofrekvenser för att överföra information. Dennya typen av satellitinternet använder generellt radiofrekvenser i de så kallade Ku - och Ka-bandenvilka påverkas av vatten. Detta innebär till exempel att regn eller snö ger viss påverkan på kvalitén avden trådlösa förbindelsen.En fråga som bör utredas är hur satellitinternet jämför sig med existerande tekniker som 4G och 5G.På detta sätt kan man uppskatta deras användbarhet.Detta examensarbete fokuserar på att hjälpa till att samla in kunskap i den frågan. För att åstad-komma detta, har det utförts prestandamätningar på relevanta faktorer av en tjänst som tillhanda-håller satellitinternet. Starlink, som är den mest utvecklade s atellitinternettjänsten är föremål fördessa mätningar. Resultatet har blivit mätningar av Starlinks prestanda samt jämförelser mellan4G/5G och Starlink som förhoppningsvis kan belysa Starlinks användbarhet i Norden.Mätningarna indikerar att Starlink har god tillförlitlighet som är jämförbar med mobilnät men i Sve-rige har Starlink onödig fördröjning på cirka 20 millisekunder på grund av att markstationerna ärbelägna i Centraleuropa. / It is very expensive to develop ground-based infrastructure to supply the entire earth with internet.This is especially the case in loosely populated areas where the economic incentive is very low for acompany. Sweden which is a large country with a small population has many areas in this category.At the same time, Sweden is a technologically advanced nation where most people use the internetand mobile telephony daily.The Swedish government cooperates with teleoperators. These teleoperators buy licenses on auctionto be able to use radio spectrum within Sweden which is a limited resource. In exchange they need tofulfill certain quotas on reception and wireless service. The operators are in this way obligated by theSwedish government to supply the country with the potential for reception .However, this is not very economic in rural areas where few people live, and the usage of individualground stations is low. This leads to ground stations being very unprofitable and is also a waste ofresources such as land, materials and capital. Companies are willing to spend large sums of money toavoid obligation to do this.At the same time satellite internet is becoming increasingly sophisticated and more and more peopleworldwide are starting to adopt satellite internet.A lot of wireless technology uses specific different radio frequencies to transmit information. The newtype of satellite internet generally uses frequencies within the Ku - and Ka-bands which are both af-fected by water. This means that for example, rain or snow could affect the quality of the wirelessconnection.A question that should be discussed is how satellite internet compares to existing technologies like4G and 5G. If this is done, it will be easier for involved parties to estimate its usefulness.This bachelor’s thesis focuses on gathering information to help resolve the question of how usefulsatellite internet can be. To accomplish this, performance measurements have been performed on aservice that provides satellite internet. Starlink, which is the most deployed satellite internet service,has been the subject of these measurements. The result is measurements on the performance of Star-link and comparisons between 4G/5G and Starlinks that can hopefully help shed some light on Star-links usefulness in Scandinavia.The measurements indicate that Starlink delivers a reliable connection that can be compared to mo-bile service but that in Sweden there is an added delay of circa 20 milliseconds due to the groundstations being located in central Europe.

Estratégia de corrida é forma pela qual os corredores distribuem a velocidade durante uma competição. Objetivando otimizar a utilização dos recursos energéticos, bem como melhorar o desempenho geral na prova, durante uma corrida de 5 km os atletas comumente adotam uma estratégia caracterizada por um início em alta velocidade, seguido por um trecho intermediário em velocidade inferior, e finalmente os atletas aumentam a velocidade quando se aproximam dos 400 m finais da prova. Sabe-se que o treinamento intervalado de alta intensidade (TIAI) realizado ao longo de 3 a 6 semanas é capaz de promover melhoras significativas nas variáveis fisiológicas determinantes do desempenho aeróbio, tais como VO2max, EC, VP, e OBLA. Uma vez que os atletas monitoram a PSE baseado em sinais internos (fisiológicos) e externos (ambiente), e desta forma alteram a velocidade para evitarem o término prematuro do exercício, acredita-se que melhoras em tais variáveis fisiológicas possam permitir que os corredores modifiquem a estratégia de corrida. Portanto, o principal objetivo do presente estudo foi analisar a influência de quatro semanas de TIAI sobre a PSE e também sobre a estratégia de corrida adotada por corredores durante um teste contra-relógio de 5 km (T5). Vinte sujeitos, homens, corredores recreacionais de longa distância foram distribuídos de forma contrabalançada em grupo controle (CON, n = 10; 33,5 ± 6,2 anos) e grupo treinamento intervalado (TINT, n = 10; 32,9 ± 8,6 anos). TINT realizou uma sessão de TIAI duas vezes por semana, enquanto que CON manteve seu programa regular de treinamento. Antes e após o período de intervenção, os corredores realizaram: 1) um teste incremental até exaustão para se obter o início do acúmulo de lactato sanguíneo (OBLA), o consumo máximo de oxigênio (VO2max), e a velocidade pico em esteira (VP); 2) um teste submáximo de carga constante para se medir a economia de corrida (EC); 3) e um teste contra-relógio de 5 km (T5) em pista para se estabelecer a estratégia de corrida. O programa de TIAI produziu uma melhora relevante no VO2max (effect size = 0,219), OBLA (effect size = 0,489), EC (effect size = -0,593), e VP (effect size = 0,622). Não foram detectadas alterações significativas na estratégia de corrida, TT5, VT5 e PSET5 durante o T5, comparando ambas as condições (pré e pós-treinamento) ou entre os grupos (TINT e CON; P > 0,05). Esses achados sugerem que melhoras nas variáveis fisiológicas induzidas por um programa de quatro semanas de TIAI não são acompanhadas por alterações similares na PSE e na estratégia de corrida durante um teste contra-relógio de 5 km / Pacing strategy has been defined as the manner by which the runners distribute their speed during a competition. In order to optimize the use of the energetic resources, as well as improve the general race performance, during a 5-km running race, athletes usually adopt a pacing strategy characterized by a fast start (400 m), followed by a period of slower speed during the middle (400 4600 m), and a significant increase in running speed during the last part of the race (400 m). It is well recognized that high-intensity interval training (HIIT) performed along 3 to 6 weeks is able to promote significant improvements in physiological variables determinants of endurance performance, such as VO2max, RE, PTS, and OBLA. Since athletes monitor their RPE based on the internal (physiological) and external (environment) signals, and change their running speed in order to prevent a premature exercise termination, its believed that improvements in such physiological variables could enable athletes to modify the pacing strategy. Thus, the main purpose of this study was to analyze the influence of 4 weeks of high-intensity interval training (HIIT) on the rating of perceived exertion (RPE) and the pacing strategy adopted by runners during a 5-km running time-trial (T5). Twenty male, recreational long-distance runners were randomly assigned into control group (CG, n = 10) or high-intensity interval-training group (HIITG, n = 10). The HIITG performed a high-intensity interval-training session twice per week, while CG maintained its regular training program. Before and after the training period, the runners performed the following tests: 1) an incremental exercise test to exhaustion to measure the onset of blood lactate accumulation (OBLA), maximal oxygen uptake (VO2max), and peak treadmill speed (PTS); 2) a submaximal speed-constant test to measure the running economy (RE); 3) a 5-km running time-trial on an outdoor track to establish pacing strategy. HIIT program produced a relevant improvement on the VO2max (effect size = 0.219), OBLA (effect size = 0.489), RE (effect size = -0.593), and PTS (effect size = 0.622). There were no significant differences on pacing strategy, TT5, ST5 and RPE response during the 5-km running time-trial between both conditions (pre- and post-training) or between groups (HIITG and CG; P > 0.05). These findings suggest that improvements on the physiological variables induced by a 4-week HIIT program are not accompanied by similar modifications on the RPE and running pacing strategy during a 5-km running time-trial

Estratégia de corrida é forma pela qual os corredores distribuem a velocidade durante uma competição. Objetivando otimizar a utilização dos recursos energéticos, bem como melhorar o desempenho geral na prova, durante uma corrida de 5 km os atletas comumente adotam uma estratégia caracterizada por um início em alta velocidade, seguido por um trecho intermediário em velocidade inferior, e finalmente os atletas aumentam a velocidade quando se aproximam dos 400 m finais da prova. Sabe-se que o treinamento intervalado de alta intensidade (TIAI) realizado ao longo de 3 a 6 semanas é capaz de promover melhoras significativas nas variáveis fisiológicas determinantes do desempenho aeróbio, tais como VO2max, EC, VP, e OBLA. Uma vez que os atletas monitoram a PSE baseado em sinais internos (fisiológicos) e externos (ambiente), e desta forma alteram a velocidade para evitarem o término prematuro do exercício, acredita-se que melhoras em tais variáveis fisiológicas possam permitir que os corredores modifiquem a estratégia de corrida. Portanto, o principal objetivo do presente estudo foi analisar a influência de quatro semanas de TIAI sobre a PSE e também sobre a estratégia de corrida adotada por corredores durante um teste contra-relógio de 5 km (T5). Vinte sujeitos, homens, corredores recreacionais de longa distância foram distribuídos de forma contrabalançada em grupo controle (CON, n = 10; 33,5 ± 6,2 anos) e grupo treinamento intervalado (TINT, n = 10; 32,9 ± 8,6 anos). TINT realizou uma sessão de TIAI duas vezes por semana, enquanto que CON manteve seu programa regular de treinamento. Antes e após o período de intervenção, os corredores realizaram: 1) um teste incremental até exaustão para se obter o início do acúmulo de lactato sanguíneo (OBLA), o consumo máximo de oxigênio (VO2max), e a velocidade pico em esteira (VP); 2) um teste submáximo de carga constante para se medir a economia de corrida (EC); 3) e um teste contra-relógio de 5 km (T5) em pista para se estabelecer a estratégia de corrida. O programa de TIAI produziu uma melhora relevante no VO2max (effect size = 0,219), OBLA (effect size = 0,489), EC (effect size = -0,593), e VP (effect size = 0,622). Não foram detectadas alterações significativas na estratégia de corrida, TT5, VT5 e PSET5 durante o T5, comparando ambas as condições (pré e pós-treinamento) ou entre os grupos (TINT e CON; P > 0,05). Esses achados sugerem que melhoras nas variáveis fisiológicas induzidas por um programa de quatro semanas de TIAI não são acompanhadas por alterações similares na PSE e na estratégia de corrida durante um teste contra-relógio de 5 km / Pacing strategy has been defined as the manner by which the runners distribute their speed during a competition. In order to optimize the use of the energetic resources, as well as improve the general race performance, during a 5-km running race, athletes usually adopt a pacing strategy characterized by a fast start (400 m), followed by a period of slower speed during the middle (400 4600 m), and a significant increase in running speed during the last part of the race (400 m). It is well recognized that high-intensity interval training (HIIT) performed along 3 to 6 weeks is able to promote significant improvements in physiological variables determinants of endurance performance, such as VO2max, RE, PTS, and OBLA. Since athletes monitor their RPE based on the internal (physiological) and external (environment) signals, and change their running speed in order to prevent a premature exercise termination, its believed that improvements in such physiological variables could enable athletes to modify the pacing strategy. Thus, the main purpose of this study was to analyze the influence of 4 weeks of high-intensity interval training (HIIT) on the rating of perceived exertion (RPE) and the pacing strategy adopted by runners during a 5-km running time-trial (T5). Twenty male, recreational long-distance runners were randomly assigned into control group (CG, n = 10) or high-intensity interval-training group (HIITG, n = 10). The HIITG performed a high-intensity interval-training session twice per week, while CG maintained its regular training program. Before and after the training period, the runners performed the following tests: 1) an incremental exercise test to exhaustion to measure the onset of blood lactate accumulation (OBLA), maximal oxygen uptake (VO2max), and peak treadmill speed (PTS); 2) a submaximal speed-constant test to measure the running economy (RE); 3) a 5-km running time-trial on an outdoor track to establish pacing strategy. HIIT program produced a relevant improvement on the VO2max (effect size = 0.219), OBLA (effect size = 0.489), RE (effect size = -0.593), and PTS (effect size = 0.622). There were no significant differences on pacing strategy, TT5, ST5 and RPE response during the 5-km running time-trial between both conditions (pre- and post-training) or between groups (HIITG and CG; P > 0.05). These findings suggest that improvements on the physiological variables induced by a 4-week HIIT program are not accompanied by similar modifications on the RPE and running pacing strategy during a 5-km running time-trial

This qualitative study develops a model of a virtual community for people with longterm, severe physical or mobility disabilities. The model also has implications for the wider community of people with disabilities. The study uses the Strauss and Corbin grounded theory methodology to inform the investigation from which a systematic theory has been developed. On the basis of this theory, the study proposes strategies for implementing the virtual community model. In-depth interviews were conducted with twelve Queenslanders with paraplegia, quadriplegia or other severe, long-term physical or mobility disabilities and with six health care professionals, service providers, information personnel and policy advisers involved in their well-being. The methodology used one interview question to determine their experiences and perceptions regarding virtual communities and the use of Information and Communications Technology (ICT). Each interview explored in detail the elements, enablers and barriers behind the usage of ICT and/or assistive technology. The personal responses and narratives of the people with disabilities who use the technology and their allied health care professionals were analysed and interpreted for meaning before the transcripts were returned to these participants for validation. Rich explanations were derived. Details of the various response categories of these interviews were analysed as part of the grounded theory, constant comparison methodology, and the relationship to the literature was considered. These de-constructed meanings were compared and contrasted with those in the current literature. The central theme to emerge from these narratives is that people with long-term disabilities regain a sense of control and independence in their lives through the use of ICT, as they move towards an on-line community. Other major themes that emerged from being on-line indicated that being on-line tended to break down people's isolation, while potentially changing the work paradigm (both vexed issues for people with disabilities). Information and communications technology and on-line communities offer ways to enhance every person's inclusion, participation and empowerment in our society. The primary outcome of the study is a theory regarding the character of virtual communities for people with long-term, severe mobility impairments that stakeholders may consider whenever such a virtual community is proposed. The theory is represented as a virtual community model. The model identifies the need for "a sense of control" as the foundational element of virtual communities for the disabled, and distinguishes the key domains in which disabled people participate in virtual communities. The barriers and enablers to their participation are specified within it. The model also provides a framework within which virtual communities can be facilitated. It melds six types of e-communities or sets of well-developed discrete categories (for example, themes, concepts) that the data from this study revealed: education-oriented, fantasy-oriented, information-oriented, interestoriented, relationship-oriented and transaction-oriented, depending on the type(s) of consumer need(s) to be met. The study concludes that although the technology itself provides strategies for independence and thus facilitates self-empowerment, it is also capable of being disempowering. Many interviewees referred to this aspect as a "double-edged sword". Empowerment and dis-empowerment are intersecting processes because of digital divide and information literacy issues and this "double-edged sword", which virtual reality presents for people with physical disabilities. Based on the new knowledge and the model as the outcomes of this study, a range of recommendations are discussed that have application in the community for persons with mobility impairments.

Dans cette thèse, nous apportons la contribution à la conception de robots médicaux, en proposant une démarche de conception simultanée de la structure mécanique du robot. Par opposition à une vision séquentielle naturelle de la conception, la formalisation du processus créatif permet une simultanéité, ouvrant la voie à des structures innovantes dédiées : en robotique médicale, faible masse et faible compacité de la structure mécanique sont souvent recherchées. A partir d’un descriptif de démarches existantes, nous effectuons la conception d’un robot de télé-échographie et d’un robot de chirurgie mini-invasive. Pour les deux applications, de fortes contraintes sont présentes. En télé-échographie, la portabilité est très recherchée, requérant une faible compacité. Pour la chirurgie mini-invasive, les moto-réducteurs du robot in vivo doivent être dimensionnés au plus juste. Ici, nous avons formalisé l’amélioration de la compacité d’une structure parallèle pour la télé-échographie. Les résultats montrent une amélioration de la compacité de l’ordre de 5%. Dans le même esprit, nous avons formalisé la synthèse dimensionnelle de deux robots 2R-R-R de chirurgie mini-invasive in vivo. Nous réalisons l’optimisation simultanée entre le dimensionnement des moto-réducteurs et des longueurs des corps pour tendre vers une simultanéité totale du processus créatif, ce qui nous permet d’améliorer les performances en termes de force et vitesse à l’effecteur. Ces expériences de conception montrent les limites à une simultanéité stricte. Nous indiquons le besoin d’adapter outils et méthodes de conception mécatronique pour une simultanéité en conception robotique tenant compte de l’aspect imparfait du processus créatif. / In this thesis, we propose a contribution to the design of medical robots, by offering a concurrent design or simultaneous approach. As opposed to a natural sequential view of the design process, the formalization of the creative process allows simultaneity, paving the way for innovative structures, dedicated: in the medical robotic field, low mass and low compactness of the mechanical structure are often sought. From a description of existing approaches, we design a tele-ultrasound robot and a minimally invasive surgery robot. For both applications, high physical integration is required. For tele-ultrasound robots, portability is highly sought, requiring low compactness. For minimally invasive surgery, geared motors of the in vivo robot must be sized correctly. Here, we formalized the improvement of compactness of an existing parallel structure for remote ultrasound application. The results show an improvement of compactness of around 5%. In the same way, we formalize the dimensional synthesis of two robots 2R-R-R for in vivo minimally invasive surgery. The results show the under-sizing of some actuators. We perform simultaneous optimization between the design of geared motors and lengths of the body of a robot 2R-RR, tendering towards full simultaneity of the creative process, allowing to improve minimal force and velocity at the end-effector of the robot. These experiments of design show limits to a strict simultaneity. We indicate the need to adapt the tools and methods of mechatronic design for simultaneous robotics design, taking into account the imperfect aspect of the creative process.

Examines the use of vernacular, country guitar styles in an electro-acoustic environment. Special attention is given to performance practices and explanation of techniques. Electro-acoustic techniques-including sound design and spatialization-are given with sonogram analyses and excerpts from the score. Compositional considerations are contrasted with those of Mario Davidovsky and Jean-Claude Risset with special emphasis on electro-acoustic approaches. Contextualization of the piece in reference to other contemporary, electric guitar music is shown with reference to George Crumb and Chiel Meijering.

Hoy en día, la complejidad de los sistemas software y la gran relevancia que han adquirido los requisitos no funcionales son retos que han de abordarse durante el proceso de desarrollo software. En los últimos años, estas propiedades han provocado un gran incremento en el tiempo y el personal necesario para llevar a cabo los procesos de desarrollo y mantenimiento del software. Por ello, existe un gran interés en mejorar dichos procesos. Esta tesis presenta un nuevo enfoque de desarrollo para sistemas software complejos. Dicho enfoque, llamado PRISMA, da soporte a estos nuevos retos y permite satisfacer la elevada competitividad del mercado. El enfoque PRISMA se ha materializado en un marco de trabajo formado por un modelo, un lenguaje, una metodología y un prototipo de herramienta CASE (Computer-Aided Software Engineering). El modelo de PRISMA combina dos aproximaciones para definir arquitecturas software: el Desarrollo de Software Basado en Componentes (DSBC) y el Desarrollo de Software Orientado a Aspectos (DSOA). Las principales aportaciones del modelo es la manera en la que integra ambas aproximaciones para obtener sus ventajas y su lenguaje formal. PRISMA tiene en cuenta los requisitos no funcionales desde las primeras etapas del ciclo de vida software y mejora su reutilización y el mantenimiento. Todo ello gracias a la descomposición que realiza de los sistemas software utilizando dos conceptos diferentes: aspectos y elementos arquitectónicos (componentes y conectores). PRISMA proporciona un Lenguaje de Descripción de Arquitecturas Orientado a Aspectos (LDAOA) formal para la especificación de arquitecturas software orientadas a aspectos. El LDAOA de PRISMA es independiente de cualquier tecnología y está basado en lenguajes formales para evitar la ambigüedad y poder aplicar técnicas de generación automática de código. La metodología de PRISMA apuesta por el desarrollo de software siguiendo el Paradigma de la Prototipación Automática mediante la aplicación del e / Pérez Benedí, J. (2006). Prisma: aspect-oriented software architectures [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/1928 / Palancia

Den ökade användningen av E-Hälsa i Sverige, delvis driven av den rådande Coronaviruspandemin, illustreras tydligt av det digitala vårdmötet - “nätdoktorn”. Lagen om tillgänglighet till digital offentlig service (DOS-lagen) trädde i kraft 2019. Den bestämmer krav för att statliga, regionala, och kommunala aktörer ska säkerställa att tjänsterna de erbjuder är tillgängliga för alla. Om de inte är det ska en redogörelse finnas som förklarar varför, och hur de planerar att åtgärda bristerna. Lagen inkluderar privata aktörer som finansieras med offentliga medel. Den träder först i kraft för mobilapplikationer i slutet av juni 2021. Målet med denna studien var att ta reda på hur tillgängliga dessa privata aktörer faktiskt är, och till vilken grad de riskerar att exkludera människor. Detta målet uppnåddes genom att jämföra de tre mest populära mobila applikationer som erbjuder digitala vårdmöten, emot kriterierna i WCAG 2.1 till nivå AA. Kriterierna testades med två mobiltelefoner: en med operativsystemet Android, och en med iOS. Samtliga applikationer visade sig till stor del inte följa riktlinjerna. En fullständig redogörelse gjordes för vilka applikationer som bröt mot vilka riktlinjer, med relevanta skärmdumpar inkluderade. Resultaten analyserades efter hur detta kan påverka användaren, och diskuterades utefter hur detta kan påverka samhället i stort. Tidigare forskning kring den digitala klyftan, samt tillgång till digital sjukvård, jämfördes med resultaten för att forma studiens slutsatser. Undersökningen visar tydligt att avvikelser från riktlinjerna skapar problem för funktionsvarierade användare, och att endast en av applikationerna erbjuder stöd för fler språk utöver svenska och engelska. Studien instämmer även med tidigare forskare om att framtida forskning och utveckling av E-Hälsa och digital tillgänglighet måste vara användardriven - specifikt driven av funktionsvarierade användare. / The sharp increase in E-Health usage driven by the COVID-19 pandemic has in Sweden most notably been observed in the rise of mobile applications offering remote health care-consultations. The law of accessible digital public service has been in effect since 2019. It compels governmental, regional, and municipal bodies to ensure that their services are accessible for everyone and, if not, to produce a full accounting of how and why. This includes private agents who provide a publicly funded service. This law only starts applying to mobile applications from June in 2021. The aim of the study was to find out how accessible the services these agents provide are, and to what degree they may risk excluding people. The aim was achieved by comparing the three most popular mobile applications that provide remote consultations, against the success criterions of the WCAG 2.1 to level AA. One phone running Android and one running iOS were used in testing. All three applications were found to be largely non-conforming to the guidelines. A full accounting was made of how the tested success criterions were met by each application, with included screenshot examples. The results were analysed in view of the direct implication on the user, and discussed concerning what implications they may have on a societal level. Corollaries were drawn to past research of access to digital healthcare and the digital divide to form conclusions. A lack of accessibility in these applications was concluded to threaten work towards social sustainability. Breaching the guidelines directly creates problems for disabled users, and only one of the applications supports a great range of languages. In agreement with past researchers, future accessibility research and WCAG-analysis is strongly suggested to be user-centered - specifically centered around disabled users.

La préadaptation vise à optimiser la santé d’un individu entre le diagnostic de cancer et la chirurgie. L’approche multimodale, qui cible deux composantes ou plus comme l’activité physique, la nutrition et le soutien psychosocial, est recommandée. Ce type d’intervention est généralement proposé en clinique et en suivi individuel, ce qui peut limiter l’accessibilité et les bénéfices tirés d’une pratique d’activité physique en groupe. Pour mieux répondre aux besoins des individus ayant reçu un diagnostic de cancer, nous avons développé et testé un programme de télé-préadaptation multimodale en groupe en évaluant l’implantabilité (acceptabilité, fidélité, faisabilité) et les effets préliminaires (capacité physique, santé mentale, soutien social, activité physique). Les participants (n=25) étaient évalués virtuellement par un kinésiologue et complétaient un questionnaire au départ (T1), pré-chirurgie (T2) et 12 semaines post-chirurgie (T3). Trois séances en groupe de 90 minutes par semaine, avec une composante exercice et éducative, étaient supervisées virtuellement par un kinésiologue. Des analyses descriptives et statistiques (test-T pairé et Wilcoxon) ont été réalisées. L’évaluation de l’implantabilité suggère un niveau élevé d’acceptabilité (satisfaction, utilité, sécurité, intentions futures en activité physique et recommandation à un proche (88%-100%)); de fidélité (dispensé comme prévu, mais quelques adaptations effectuées); et de faisabilité (rétention (98%), adhérence (70%)). La principale barrière est le faible taux de référencement de patients éligibles (31%). Les effets préliminaires suggèrent une amélioration au 2-minute Step Test (+18,86 pas), au 30-second Sit-to-Stand (+1,10 répétition) et pour le volume hebdomadaire d'activité physique modérée (+104,80 minutes) entre T1 et T2, ainsi qu’une diminution du niveau de stress (-0,53) et de la qualité de vie (-8,68) entre T1 et T3. L’évaluation de la mise à l’échelle et de la viabilité de ce programme est envisageable pour réduire les barrières à l’activité physique et les inégalités d’accès aux soins en contexte de cancer. / Prehabilitation aims to optimize an individual's health between cancer diagnosis and surgery. A multimodal approach, which targets two or more components such as physical activity, nutrition and psychosocial support, is recommended. This type of intervention is usually offered in-clinic and with one-on-one follow-ups, which may limit the accessibility and benefits of a group-based physical activity program. To better meet the needs of individuals diagnosed with cancer, we developed and tested a virtual multimodal group prehabilitation program assessing the implementability (acceptability, fidelity, feasibility) and preliminary effects (physical capacity, mental health, social support, physical activity). Participants (n=25) were assessed virtually by a kinesiologist and completed a questionnaire at baseline (T1), pre-surgery (T2) and 12 weeks post-surgery (T3). Three 90-minute group sessions per week were virtually supervised by a kinesiologist and comprised an exercise and educational component. Descriptive and statistical analyses (paired t-test and Wilcoxon) were performed. The evaluation of implementability suggests a high level of acceptability (satisfaction, usefulness, safety, future physical activity intentions and recommendation to a relative (88%-100%)); fidelity (delivered as planned, but some adaptations were made); and feasibility (retention (98%), adherence (70%)). The main barrier is the low rate of eligible referrals (31%). Preliminary effects suggest an improvement in the 2-minute Step Test (+18.86 steps), the 30-second Sit-to-Stand (+1.10 repetitions), and the moderate physical activity weekly volume (+104.80 minutes) between T1 and T2, as well as a decrease in stress level (-0.53) and quality of life (-8.68) between T1 and T3. Scalability and viability can be assessed and show promise to reduce barriers to physical activity and inequities in access to care in the cancer setting.