Atenção domiciliar como mudança do modelo tecnoassistencial

OBJETIVO: Analisar práticas de atenção domiciliar de serviços ambulatoriais e hospitalares e sua constituição como rede substitutiva de cuidado em saúde. PROCEDIMENTOS METODOLÓGICOS: Estudo qualitativo que analisou, com base na metodologia de caso traçador, quatro serviços ambulatoriais de atenção domiciliar da Secretaria Municipal de Saúde e um serviço de um hospital filantrópico do município de Belo Horizonte, MG, entre 2005 e 2007. Foram realizadas entrevistas com gestores e equipes dos serviços de atenção domiciliar, análise de documentos e acompanhamento de casos com entrevistas a pacientes e cuidadores. A análise foi orientada pelas categorias analíticas integração da atenção domiciliar na rede de saúde e modelo tecnoassistencial. ANÁLISE DOS RESULTADOS: A implantação da atenção domiciliar foi precedida por decisão político-institucional tanto com orientação racionalizadora, buscando a diminuição de custos, quanto com vistas à reordenação tecnoassistencial das redes de cuidados. Essas duas orientações encontram-se em disputa e constituem dificuldades para conciliação dos interesses dos diversos atores envolvidos na rede e na criação de espaços compartilhados de gestão. Pôde-se identificar a inovação tecnológica e a autonomia das famílias na implementação dos projetos de cuidado. As equipes mostraram-se coesas, construindo no cotidiano do trabalho novas formas de integrar os diferentes olhares para transformação das práticas em saúde. Foram observados desafios na proposta de integrar os diferentes serviços de caráter substitutivo do cuidado ao limitar a capacidade da atenção domiciliar de mudar o modelo tecnoassistencial. CONCLUSÕES: A atenção domiciliar possui potencial para constituição de uma rede substitutiva ao produzir novos modos de cuidar que atravessam os projetos dos usuários, dos familiares, da rede social e dos trabalhadores da atenção domiciliar. A atenção domiciliar como modalidade substitutiva de atenção à saúde requer sustentabilidade política, conceitual e operacional, bem como reconhecimento dos novos arranjos e articulação das propostas em curso.

Optimization of modal filters based on arrays of piezoelectric sensors

Modal filters may be obtained by a properly designed weighted sum of the output signals of an array of sensors distributed on the host structure. Although several research groups have been interested in techniques for designing and implementing modal filters based on a given array of sensors, the effect of the array topology on the effectiveness of the modal filter has received much less attention. In particular, it is known that some parameters, such as size, shape and location of a sensor, are very important in determining the observability of a vibration mode. Hence, this paper presents a methodology for the topological optimization of an array of sensors in order to maximize the effectiveness of a set of selected modal filters. This is done using a genetic algorithm optimization technique for the selection of 12 piezoceramic sensors from an array of 36 piezoceramic sensors regularly distributed on an aluminum plate, which maximize the filtering performance, over a given frequency range, of a set of modal filters, each one aiming to isolate one of the first vibration modes. The vectors of the weighting coefficients for each modal filter are evaluated using QR decomposition of the complex frequency response function matrix. Results show that the array topology is not very important for lower frequencies but it greatly affects the filter effectiveness for higher frequencies. Therefore, it is possible to improve the effectiveness and frequency range of a set of modal filters by optimizing the topology of an array of sensors. Indeed, using 12 properly located piezoceramic sensors bonded on an aluminum plate it is shown that the frequency range of a set of modal filters may be enlarged by 25-50%.

A contribution to the exact modal solution of in-plane beam structures

The exact vibration modes and natural frequencies of planar structures and mechanisms, comprised Euler-Bernoulli beams, are obtained by solving a transcendental. nonlinear, eigenvalue problem stated by the dynamic stiffness matrix (DSM). To solve this kind of problem, the most employed technique is the Wittrick-Williams algorithm, developed in the early seventies. By formulating a new type of eigenvalue problem, which preserves the internal degrees-of-freedom for all members in the model, the present study offers an alternative to the use of this algorithm. The new proposed eigenvalue problem presents no poles, so the roots of the problem can be found by any suitable iterative numerical method. By avoiding a standard formulation for the DSM, the local mode shapes are directly calculated and any extension to the beam theory can be easily incorporated. It is shown that the method here adopted leads to exact solutions, as confirmed by various examples. Extensions of the formulation are also given, where rotary inertia, end release, skewed edges and rigid offsets are all included. (C) 2008 Elsevier Ltd. All rights reserved.

Non-linear modal analysis for beams subjected to axial loads: Analytical and finite-element solutions

A rigorous derivation of non-linear equations governing the dynamics of an axially loaded beam is given with a clear focus to develop robust low-dimensional models. Two important loading scenarios were considered, where a structure is subjected to a uniformly distributed axial and a thrust force. These loads are to mimic the main forces acting on an offshore riser, for which an analytical methodology has been developed and applied. In particular, non-linear normal modes (NNMs) and non-linear multi-modes (NMMs) have been constructed by using the method of multiple scales. This is to effectively analyse the transversal vibration responses by monitoring the modal responses and mode interactions. The developed analytical models have been crosschecked against the results from FEM simulation. The FEM model having 26 elements and 77 degrees-of-freedom gave similar results as the low-dimensional (one degree-of-freedom) non-linear oscillator, which was developed by constructing a so-called invariant manifold. The comparisons of the dynamical responses were made in terms of time histories, phase portraits and mode shapes. (C) 2008 Elsevier Ltd. All rights reserved.