As lesões por pressão adquiridas em Unidades de Terapia Intensiva (UTI) têm sido reconhecidas como um indicador sensível da prestação de cuidados dos profissionais de saúde, influenciando no tempo de internação, custos do tratamento e impacto emocional aos pacientes. Este estudo objetivou verificar a relação entre ocorrência de lesão por pressão com as variáveis demográficas e clínicas dos pacientes e carga de trabalho de enfermagem em unidade de terapia intensiva. Trata se de um estudo quantitativo e prospectivo desenvolvido em uma UTI geral de um hospital de grande porte e alta complexidade no interior de São Paulo. A coleta de dados foi realizada nos meses de outubro de 2016 a janeiro de 2017, constituindo uma amostra de conveniência de 30 pacientes. Os critérios de inclusão foram: pacientes com idade igual ou maior que 18 anos, internados pela primeira vez na unidade decorrente de tratamento clínico ou cirúrgico, com permanência mínima de 24 horas e ausência de lesões dermatológicas na admissão. A coleta incluiu além dos dados demográficos e clínicos, a aplicação dos instrumentos: Simplified Acute Physiology Score 3 (SAPS 3), Nursing Activities Score (NAS) e a Escala de Braden para mensurar a gravidade do paciente, a carga de trabalho de enfermagem e o risco para lesão por pressão (LP), respectivamente. A avaliação clínica foi realizada diariamente pela pesquisadora até o desfecho da condição dos pacientes. Para verificar a relação entre a ocorrência de lesão e as variáveis estudadas foram realizadas análises univariadas, sendo que para as variáveis dicotômicas foi utilizado o teste exato de Fisher. Para as variáveis quantitativas contínuas foi utilizado o teste de Mann-Whitney/Wilcoxon, uma vez que essas não seguiam uma distribuição normal. Os resultados indicaram que o grupo dos pacientes sem lesão (n=21) era do sexo feminino (66,6%), com idade menor de 60 anos (52,38%), brancos (71,4%), IMC normal (52,4%), tempo mediano de 4 dias de internação, em razão de necessidade de monitorização clínica (42,8%). Nesse grupo, os valores medianos do escore SAPS 3, Braden e NAS foram de 53, 14 e 86 pontos, respectivamente. Os pacientes que desenvolveram lesão por pressão (n=9), também em sua maioria eram mulheres (66,6%), com idade maior ou igual a 60 anos (55,5%), brancos (77,7%), obesos (66,6%), com mediana de internação de 4 dias e admitidos na UTI em razão de instabilidade hemodinâmica (77,8%). As variáveis relativas ao SAPS 3, Braden e NAS apresentaram mediana de 78, 11 e 97 pontos. A incidência global de lesão por pressão encontrada foi de 30%, havendo uma predominância das lesões na região dos calcâneos e glúteos, identificadas do 2º ao 8º dia de internação na unidade. Dentre as características clínicas, destaca-se a instabilidade hemodinâmica dos pacientes que desenvolveram lesão. As variáveis que foram identificadas com relevância estatística nos pacientes acometidos por LP foram índice de gravidade, escore de risco e carga de trabalho. Em razão do tamanho amostral reduzido, não foi possível a realização de análise multivariada para confirmar estes achados, o que se constitui numa limitação do estudo. Uma alta carga de trabalho pode ser um fator de comprometimento associado ao crescimento da incidência, principalmente frente à demanda de cuidados exigida pela clientela e inadequação quali-quantitativa de profissionais de enfermagem / Pressure lesions acquired in Intensive Care Units (ICUs) have long been used as a sensitive indicator of the type of care delivered by health professionals, influencing hospitalization time, costs of treatment and emotional impact to patients. This study was aimed to verify the relationship between the occurrence of pressure ulcers with the demographic and clinical variables of the patients and the nursing workload in the intensive care unit. This is a quantitative and prospective study developed in a general ICU of a large and high complexity hospital in a city of Sao Paulo state. Data collection was performed from October 2016 to January 2017, gathering a convenience sample of 30 patients. The inclusion criteria were: patients aged 18 years or older hospitalized for the first time in the unit due to clinical or surgical treatment, for at least 24 hours and without dermatological lesions at the time of admission. In addition to the demographic and clinical data, the application of the instruments: Simplified Acute Physiology Score 3 (SAPS 3), Nursing Activities Score (NAS) and the Braden Scale to measure: the patient\'s severity; nursing workload and pressure ulcer risk (PU) respectively. The clinical evaluation was performed daily by the researcher until the outcome of the patients\' condition. To verify the relationship between the occurrence of the lesion and the studied variables, univariate analyzes were performed. For the dichotomous variables we used Fisher\'s exact test while the Mann-Whitney / Wilcoxon test was used for the continuous quantitative variables since they did not comply with a normal distribution. The results indicated that the group of patients without lesions (n = 21) was predominantly female (66.6%), aged less than 60 years (52.38%), whites (71.4%), normal BMI 52.4%), median time of 4 days of hospitalization, due to the need for clinical monitoring (42.8%). In this group, the median values of the SAPS 3, Braden and NAS scores were 53, 14 and 86 points respectively. Those patients who developed pressure lesions (n = 9) were also female (66.6%), aged 60 years or older (55.5%), white (77.7%), obese (66.6%), with a median hospitalization of 4 days and admitted to the ICU due to hemodynamic instability (77.8%). The variables related to SAPS 3, Braden and NAS presented a median of 78, 11 and 97 points. The overall incidence of pressure injury was 30%, with a predominance of lesions in the calcaneal and gluteal region, diagnosed between the second and the eighth day of hospitalization. Among their clinical characteristics, we underline the hemodynamic instability of the patients who developed the injury. The following variables showed statistical relevance in the patients affected by PU: severity index, risk score and workload. As a limitation of this study, it was not possible to perform multivariate analysis to confirm these findings due to the reduced sample size. A high workload can act as a factor of impact, associated to the increase in incidence, especially in relation to the demand for care required by the patients as well as the quali-quantitative inadequacy of nursing professionals

abstract: Researchers and practitioners have widely studied road network traffic data in different areas such as urban planning, traffic prediction and spatial-temporal databases. For instance, researchers use such data to evaluate the impact of road network changes. Unfortunately, collecting large-scale high-quality urban traffic data requires tremendous efforts because participating vehicles must install Global Positioning System(GPS) receivers and administrators must continuously monitor these devices. There have been some urban traffic simulators trying to generate such data with different features. However, they suffer from two critical issues (1) Scalability: most of them only offer single-machine solution which is not adequate to produce large-scale data. Some simulators can generate traffic in parallel but do not well balance the load among machines in a cluster. (2) Granularity: many simulators do not consider microscopic traffic situations including traffic lights, lane changing, car following. This paper proposed GeoSparkSim, a scalable traffic simulator which extends Apache Spark to generate large-scale road network traffic datasets with microscopic traffic simulation. The proposed system seamlessly integrates with a Spark-based spatial data management system, GeoSpark, to deliver a holistic approach that allows data scientists to simulate, analyze and visualize large-scale urban traffic data. To implement microscopic traffic models, GeoSparkSim employs a simulation-aware vehicle partitioning method to partition vehicles among different machines such that each machine has a balanced workload. The experimental analysis shows that GeoSparkSim can simulate the movements of 200 thousand cars over an extensive road network (250 thousand road junctions and 300 thousand road segments). / Dissertation/Thesis / Masters Thesis Computer Engineering 2019

Healthcare-associated infections (HAI) are a significant issue in healthcare facilities worldwide. Hand hygiene (HH) remains the most effective method for preventing the incidence of HAI in routine patient care. Past and current interventions focused on the overall improvement of HH compliance, but studies found that the amount of time required to achieve full HH compliance with the existing guidelines may not be practical. Improving HH compliance at critical moments during patient care may be more effective than improving HH compliance at all opportunities. However, there are little to no studies on healthcare workers’ (HCWs) behavior regarding HH during the patient care process. Secondary data analysis on a prospective dataset from the STAR-ICU trial was completed to identify HCWs’ behavior patterns regarding HH during the patient care process. Multiple logistic regression for transitions with random effects using repeated measures and transition modeling was used to identify possible associations between HH compliance and patient care tasks, the order of tasks, and workload. The models adjusted for the effects of HCW type, glove use, and isolation precautions. The study identified 28,826 task sequences and 42,349 HH opportunities. HCWs were slightly less likely to do HH before critical tasks compared with other tasks (OR: 0.97, 95% CI: 0.96-0.99), but more likely to do HH after contaminating tasks compared with other tasks (OR: 1.12, 95% CI: 1.10-1.13). HCWs are also more likely to move from task sequences that have a relatively lower risk to patients to task sequences that have a relatively higher risk to patients than vice versa (65.4% versus 34.7%). HCWs are also less likely to do HH after moving from tasks that have a relatively lower risk to patients to tasks that have a relatively higher risk to patients than vice versa (OR: 0.93, 95% CI:0.92-0.95). HCWs’ HH compliance rates decreased as the workload level increased (OR: 0.93, 95% CI: 0.89-0.98). Workload did not appear to affect HH compliance before critical tasks or after contaminating tasks and did not affect the order in which HCWs perform patient care tasks. Increase in workload was associated with an increase in the odds of critical tasks occurring (OR: 1.55, 95% CI: 1.45-1.65). In conclusion, HCWs are more likely to perform HH after contaminating tasks to prevent contaminating themselves and to reduce the risk of transmission in subsequent task sequences. However, they do not perform tasks in an order that minimizes risk to the patient; instead, it appears that they perform tasks as they come up in routine care. Furthermore, HH is not being performed at critical moments during patient care. Lastly, workload did not affect the order in which HCWs perform patient care tasks, suggesting that HCWs behavior patterns contribute significantly to how they care for patients and perform HH. Interventions targeting the order in which HCWs perform patient care tasks and improving HH compliance before critical tasks may be more effective than those designed to improve HH compliance at all HH opportunities for reducing HAI rates.

Crew coordination in the context of aviation is a specifically choreographed set of tasks performed by each pilot, defined for each phase of flight. Based on the constructs of effective Crew Resource Management and SOPs for each phase of flight, a shared understanding of crew workload and task responsibility is considered representative of well-coordinated crews. Nominal behavior is therefore defined by SOPs and CRM theory, detectable through pilot eye-scan. This research investigates the relationship between the eye-scan exhibited by each pilot and the level of coordination between crewmembers. Crew coordination was evaluated based on each pilot's understanding of the other crewmember's workload. By contrasting each pilot's workload-understanding, crew coordination was measured as the summed absolute difference of each pilot's understanding of the other crewmember's reported workload, resulting in a crew coordination index. The crew coordination index rates crew coordination on a scale ranging across Excellent, Good, Fair and Poor. Eye-scan behavior metrics were found to reliably identify a reduction in crew coordination. Additionally, crew coordination was successfully characterized by eye-scan behavior data using machine learning classification methods. Identifying eye-scan behaviors on the flight deck indicative of reduced crew coordination can be used to inform training programs and design enhanced avionics that improve the overall coordination between the crewmembers and the flight deck interface. Additionally, characterization of crew coordination can be used to develop methods to increase shared situation awareness and crew coordination to reduce operational and flight technical errors. Ultimately, the ability to reduce operational and flight technical errors made by pilot crews improves the safety of aviation.

This research compares methods for measuring pilot mental workload (MWL) from the electrocardiogram (ECG) signal. ECG-based metrics have been used extensively in MWL research. Heart rate (HR) and heart-rate variability (HRV) exhibit changes in response to varying levels of task demand. Classical methods for HRV analysis examine the ECG signal in the linear time and frequency domains. More contemporary research has advanced the notion that nonlinear elements contribute to cardiac control and ECG signal generation, spawning development of analytical techniques borrowed from the domain of nonlinear dynamics (NLD). Applications of nonlinear HRV analysis are substantial in clinical diagnosis settings; however, such applications are less frequent in MWL research, especially in the aviation domain. Specifically, the relative utility of linear and non-linear HRV analysis methods has not been fully assessed in pilot MWL research. This thesis contributes to aforementioned research gap by comparing a non-linear HRV method, utilizing transition probability variances (TPV), to classical time and frequency domain methods, focusing the analysis on sensitivity and diagnosticity. ECG data is harvested from a recent study characterizing spatial disorientation (SDO) risk amongst three candidate off-boresight (OBS) helmet-mounted display (HMD) symbologies in a tactically relevant live-flight task. A comparative analysis of methods on this dataset and supplemental workload analysis for the HMD study are presented. Results indicate the TPV method may exhibit higher sensitivity and diagnosticity than classical methods. However, limitations of this analysis warrant further investigation into this question.

Research has shown that teacher workload is intensifying and teachers are increasingly leaving the profession prior to having taught for 35 years. The purpose of this mixed method, sequential, phenomenological study was to determine (a) how workload intensification impacts teacher performance and well-being, (b) whether or not workload intensification was a primary factor in teachers’ choosing to leave the profession early, and (c) a formula for maximizing teacher performance and well-being. Apple’s workload intensification thesis was the theoretical framework for this study. Quantitative data obtained via a survey (N=484), together with qualitative data collected via four focus group sessions and individual interviews with 15 teachers who had left the profession early, were utilized to determine if there is a problem with workload intensification in this east coast Canadian province. Quantitative data were analyzed using the chi-square test to determine the relationship between the independent variable (workload intensification) and each of the two dependent variables (performance and well-being). Qualitative data were analyzed to determine emergent themes with respect to workload intensification. Findings from this study indicated that there is a significant relationship between the independent variable and each of the two dependent variables. Qualitative data substantiated the quantitative findings that indicated (a) the presence of a problem with workload intensification and (b) that workload intensification is a primary factor in teachers’ choosing to leave the profession early. Recommendations include having administrators address identified current teacher workload issues. Positive social change may result if administrators utilize the derived formula for maximizing teacher performance and well-being when assigning teaching and nonteaching duties to teachers.

The present study investigated whether there is a relationship between workload and cognitive overload with self-efficacy, perfectionism, and psychological resilience as possible moderators. Cognitive Load Theory states that individuals have a finite amount of working memory. When the working memory load has reached its maximum, individuals experience cognitive overload. Employees with a higher workload receive higher amounts of information, increasing their cognitive load, thus being more likely to reach cognitive overload. However, self-efficacious individuals, perfectionists, and resilient individuals are more motivated to reach their goals and will persevere despite obstacles. Therefore, I proposed that perceived workload and perceived cognitive overload would be correlated and that self-efficacy, perfectionism, and resilience would moderate that relationship. Using a web-based questionnaire, 278 adults working at least 25 hours per week were given a series of self-report measures about their perceived workload, cognitive overload, self-efficacy, perfectionism, and resilience. Workload was found to be positively correlated with cognitive overload, but self-efficacy, perfectionism, and resilience did not moderate the relationship between workload and cognitive overload. Subsequent analyses provide limited support that level of education moderates the workload-cognitive overload relationship. As personal characteristics do not moderate the relationship between workload and cognitive overload, management in organizations will want to explore different ways to affect the perceived workload of their employees.

Present-day datacenter networks (DCNs) are designed to achieve full bisection bandwidth in order to provide high network throughput and server agility. However, the average utilization of typical DCN infrastructure is below 10% for significant time intervals. As a result, energy is wasted during these periods. In this thesis we analyze traffic behavior of datacenter networks using traces as well as simulated models. Based on the insight developed, we present techniques to reduce energy waste by making energy use scale linearly with load. The solutions developed are analyzed via simulations, formal analysis, and prototyping. The impact of our work is significant because the energy savings we obtain for networking infrastructure of DCNs are near optimal. A key finding of our traffic analysis is that network switch ports within the DCN are grossly under-utilized. Therefore, the first solution we study is to modify the routing within the network to force most traffic to the smallest of switches. This increases the hop count for the traffic but enables the powering off of many switch ports. The exact extent of energy savings is derived and validated using simulations. An alternative strategy we explore in this context is to replace about half the switches with fewer switches that have higher port density. This has the effect of enabling even greater traffic consolidation, thus enabling even more ports to sleep. Finally, we explore a third approach in which we begin with end-to-end traffic models and incrementally build a DCN topology that is optimized for that model. In other words, the network topology is optimized for the potential use of the datacenter. This approach makes sense because, as other researchers have observed, the traffic in a datacenter is heavily dependent on the primary use of the datacenter. A second line of research we undertake is to merge traffic in the analog domain prior to feeding it to switches. This is accomplished by use of a passive device we call a merge network. Using a merge network enables us to attain linear scaling of energy use with load regardless of datacenter traffic models. The challenge in using such a device is that layer 2 and layer 3 protocols require a one-to-one mapping of hardware addresses to IP (Internet Protocol) addresses. We overcome this problem by building a software shim layer that hides the fact that traffic is being merged. In order to validate the idea of a merge network, we build a simple mere network for gigabit optical interfaces and demonstrate correct operation at line speeds of layer 2 and layer 3 protocols. We also conducted measurements to study how traffic gets mixed in the merge network prior to being fed to the switch. We also show that the merge network uses only a fraction of a watt of power, which makes this a very attractive solution for energy efficiency. In this research we have developed solutions that enable linear scaling of energy with load in datacenter networks. The different techniques developed have been analyzed via modeling and simulations as well as prototyping. We believe that these solutions can be easily incorporated into future DCNs with little effort.

[pt] Alexandre Plastino em sua tese de doutorado apresenta um ambiente de desenvolvimento de aplicações paralelas SPMD (Single Program, Multiple Data) denominado SAMBA que permite a geração de diferentes versões de uma aplicação paralela a partir da incorporação de diferentes algoritmos de balanceamento de carga disponíveis numa biblioteca própria. O presente trabalho apresenta uma ferramenta de geração de carga dinâmica integrada a este ambiente que possibilita criar, em tempo de execução, diferentes perfis de carga externa a serem aplicados a uma aplicação paralela em estudo. Dessa forma, pretende-se permitir que o desenvolvedor de uma aplicação paralela possa selecionar o algoritmo de balanceamento de carga mais apropriado frente a condições variáveis de carga externa. Com o objetivo de validar a integração da ferramenta ao ambiente SAMBA, foram obtidos resultados da execução de duas aplicações SPMD distintas. / [en] Alexandre Plastino s tesis presents a framework for the development of SPMD parallel applications, named SAMBA, that enables the generation of different versions of a parallel application by incorporating different load balancing algorithms from an internal library. This dissertation presents a dynamic workload generation s tool, integrated to SAMBA, that affords to create, at execution time, different external workload profiles to be applied over a parallel application in study. The objective is to enable that a parallel application developer selects the most appropriated load balancing algorithm based in its performance under variable conditions of external workload. In order to validate this integration, two SPMD applications were implemented.

Flight decks of the future are being enhanced through improved avionics that adapt to both aircraft and operator state. Eye tracking allows for non-invasive analysis of pilot eye movements, from which a set of metrics can be derived to effectively and reliably characterize workload, this research will generate quantitative algorithms to classify pilot state through eye tracking metrics. Through various metrics within the realm of eye tracking, flight deck operation research is used to determine metric correlations between a pilot's workload and eye tracking metric patterns. The basic metrics within eye tracking, such as saccadic movement, fixations and link analysis provide clear measurable elements that experimenters analyzed to create a quantitative algorithm that reliably classifies operator workload. The study conducted at the University of Iowa's Operator Performance Lab 737-800 simulator was outfit with a Smarteye remote eye-tracking system that yielded gaze vector resolution down to 1 degree across the flight deck. Three levels of automation and 2 levels of outside visual conditions were changed on a KORD ILS approach between CAT II and CAT III visual conditions, and varying from full autopilot controlled by the pre-programmed flight management system, flight director guidance, and full manual approach with localizer and glide slope guidance. Initial subjective results indicated a successful variation in driving pilot workload across all 12 IFR pilots that were run through the 7 run testing sequence.