Arquitetura inteligente fuzzy para monitoramento de sinais vitais de pacientes: um estudo de caso em UTI

The area of the hospital automation has been the subject a lot of research, addressing relevant issues which can be automated, such as: management and control (electronic medical records, scheduling appointments, hospitalization, among others); communication (tracking patients, staff and materials), development of medical, hospital and laboratory equipment; monitoring (patients, staff and materials); and aid to medical diagnosis (according to each speciality). This thesis presents an architecture for a patient monitoring and alert systems. This architecture is based on intelligent systems techniques and is applied in hospital automation, specifically in the Intensive Care Unit (ICU) for the patient monitoring in hospital environment. The main goal of this architecture is to transform the multiparameter monitor data into useful information, through the knowledge of specialists and normal parameters of vital signs based on fuzzy logic that allows to extract information about the clinical condition of ICU patients and give a pre-diagnosis. Finally, alerts are dispatched to medical professionals in case any abnormality is found during monitoring. After the validation of the architecture, the fuzzy logic inferences were applied to the trainning and validation of an Artificial Neural Network for classification of the cases that were validated a priori with the fuzzy system

Validação de protocolo de assistência para pessoas com úlcera venosa na atenção primária

People with venous ulcers constitute as an important public health problem, its treatment is onerous and require assistance provided by trained professionals, systematized through protocols, however what lies in the assistance is that the management of this group of people differs from that preconized in the scientific literature, interfering with wound healing and quality of life of affected. In this sense, the construction of a assistance protocol specific to people with venous ulcers (VU) can help professionals of the Family Health Strategy both in patient assessment as and in establishment of quality assistance. Thus, this study aimed to analyse the validity of a multiprofessional assistance protocol for people with venous ulcers in primary care by health professionals using Delphi technique. This is a quantitative study, the methodological type conducted in two steps: first step related to integrative literature review to subsidize the development of the protocol, then these aspects were organized and proposed to the judges of the study through the Delphi technique. The study was initiated after approval by the Research Ethics Committee. The first step was performed between August and September 2012, in the virtual library of health, in the page of the Coordination of Improvement of Higher Education Personnel, of Municipal Health Secretariat and international guidelines of associations and in the subsequent step carried out between September 2012 to January 2013, was performed search by Lattes platform of the National Council of Technological and Scientific Development, in order to identify health professionals in Brazil who act as judges of the instrument and then, via online, the form was submitted to them.The sample for the second step was 51 judges in the first round and 35 for the second round Delphi. The analysis was done by adopting Kappa index ≥ 0.81 and Content Validity Index (CVI)> 0.80. In the first submission for the judges, items that did not reach Kappa and CVI established were: request / realization / test results, demographic data, medical history, risk factors, verification of pain / vital signs / pulse / infection signs / lesion location/ edema and pain treatment. After removal of items which have not obtained Kappa or CVI index established, it was found achieving optimal levels of these index for the categories. In the next step was the ressubmissão of protocol to judges through the Delphi technique in it was found that, of the 15 categories of the protocol, 12 presented higher scores in Delphi 2 phase and the other three categories remained the same Kappa and IVC of the previous phase. As for the average of evaluation requirements of the protocol was found that the scores assigned by the judges were higher in the second phase in nine of the 10 items, remaining the same in only one of the items indicating validity of the instrument before the consensus of the judges. Thus, we accepted the alternative hypothesis in this study, as they were obtained in the second Delphi phase the validity index greater than or equal to the Delphi 1 phase. The formulation of this assistance protocol valid and reproducible will enable a reorganization and redesign of assistance, with standardization of actions and continuity of care for persons with venous ulcers in primary health care

Trauma em idosos atendidos pelo serviço pré-hospitalar móvel

O The aim of this study was to characterize the occurrence of trauma in the elderly population served by the mobile pre-hospital service, in Natal, Rio Grande do Norte. This is a descriptive, transversal and quantitative approach and whose population consisted of 2,080 trauma victims. The sample, of systematic random type, consisted of 400 elderly people, aged from 60 years old, assisted by the Office of Mobile Emergency in Natal / RN, between January 2011 and December 2012. Data collection began after consent and assent of the institution of a Research Ethics Committee under No. 309 505. It was proceeded to documentary retrospective analysis of records of this service through a form of self-development, validated by expert judges considered reliable (α> 0.75) and valid (CVI = 0.97) in their clarity and relevance. Data were tabulated by the Statistical Package for Social Sciences, version 20.0. The results show that older victims have an average age of 74.19 years old, with a prevalence of female involvement by chronic diseases, especially hypertension, average usage of 2.2 routine medications with vital signs within normal limits. The trauma prevailed during the daytime, in the residence of the victims, north of the city and on weekends. Among the mechanisms of trauma were falls, traffic accidents and physical aggression, whose most common type was brain-cerebral trauma and the main consequences were suture wounds and closed fractures. Basic Support Units were as more driven to pre-hospital care (87.8%) and the main destination place consisted of a referral hospital for emergency of the state (57.5%). Among the most commonly performed procedures by nursing staff immobilization with rigid board and neck collar and the peripheral venipuncture, and the main component used for volume replacement to saline were highlighted. There was a significant relationship between the deaths and the mechanism of injury, mechanism of injury and procedures, except medication administration procedures carried out, except immobilization and unit for service. It is highlighted the prevalence of trauma in the elderly, poor follow-up Pre-Hospital Trauma Life Support protocol and the paucity of records and nursing procedures performed. There is need for a protocol of care specific to elderly trauma victims and education strategies for the prevention of such events

Modelo arquitetural de comunicação para monitoramento de pacientes baseado em middleware, computação móvel e ubíqua

Hospital Automation is an area that is constantly growing. The emergency of new technologies and hardware is transforming the processes more efficient. Nevertheless, some of the hospital processes are still being performed manually, such as monitoring of patients that is considered critical because it involves human lives. One of the factors that should be taken into account during a monitoring is the agility to detect any abnormality in vital signs of patients, as well as warning of this anomaly to the medical team involved. So, this master's thesis aims to develop an architecture to automate this process of monitoring and reporting of possible alert to a professional, so that emergency care can be done effectively. The computing mobile was used to improve the communication by distributing messages between a central located into the hospital and the mobile carried by the duty

Evidências de validade de conteúdo de instrumentos para o cuidado à pessoa com lesão cutânea

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES

O conforto do idoso em pós-operatório na perspectiva do enfermeiro

Objetivou-se identificar o cuidado realizado pelo enfermeiro para o conforto de pacientes idosos em pós-operatório. Especificamente objetivou-se: 1) Identificar a perspectiva dos enfermeiros sobre os desconfortos nos contextos físico, psicoespiritual, ambiental e sociocultural evidenciados em idosos no pós-operatório; 2) Verificar as características definidoras e os fatores relacionados inseridos ao diagnóstico de enfermagem conforto prejudicado, identificados pelos enfermeiros no idoso em pós-operatório; 3) Identificar as intervenções de enfermagem para promoção do conforto ao idoso em pós-operatório realizadas pelos enfermeiros no seu cuidar. Trata-se de uma pesquisa exploratória, descritiva, de abordagem quantitativa, desenvolvida em um hospital universitário do Município de Natal/RN, Brasil. A população foi constituída pelos 30 enfermeiros que trabalhavam em unidades de internação cirúrgica e terapia intensiva e que prestavam atendimento à pacientes idosos em pós-operatório. Consideraram-se critérios de inclusão: ter tempo mínimo de seis meses de atividade no setor e fazer parte da escala de serviço no período da coleta dos dados. Como critérios de exclusão: estar de licença ou férias no momento da coleta de dados. Toda população formou o grupo de sujeitos do estudo. A coleta de dados foi concretizada em maio e junho de 2014 utilizando um questionário autoexplicativo, composto por quatro partes: I - Caracterização dos enfermeiros; II - Necessidades de conforto do idoso no pós-operatório; III - Diagnóstico de Enfermagem; IV - Intervenções de enfermagem. O projeto foi aprovado pelo Comitê de Ética em Pesquisa (CEP) da Universidade Federal do Rio Grande do Norte, sob CAAE25976613.7.0000.5537. Os dados foram tabulados no Statistical Package for the Social Sciences (SPSS) 20.0 e apresentados utilizando-se frequências, percentuais e medidas de tendência central. Os resultados mostram que 96,7% dos enfermeiros conceituaram conforto como sinônimo de bem-estar. Houve maior frequência do desconforto dor (100%), ruídos excessivos (56,7%), sensação de deslocamento do ambiente residencial (76,7%) e ansiedade (93,3%). Os enfermeiros evidenciaram como sinais e sintomas que caracterizam o desconforto do idoso após cirurgia, principalmente: dor (75,9%), inquietação (58,6%), sinais vitais (41,4%) e ansiedade (34,5%). O principal fator relacionado foi o efeito secundário relacionado ao tratamento (88%). As principais intervenções realizadas foram: ouvir atentamente (100%) e controle da dor (100%). Estas foram igualmente analisadas como prioritárias para esta ação de cuidado, na porcentagem de 76,7% e 66,7%, respectivamente. Conclui-se que os enfermeiros identificam os desconfortos que afetam os idosos no pós-operatório na diversidade dos contextos estudados, com uma ênfase maior aos desconfortos físicos e em especial, a dor. Além disso, possuem uma percepção ampliada sobre os possíveis sinais e sintomas apresentados pelos idosos em pós-operatório quando estão desconfortáveis, uma vez que evidenciam outras 12 características não previstas no Diagnóstico de Enfermagem Conforto prejudicado e também identificam os fatores relacionados a estes desconfortos. Entretanto, apesar de afirmarem que realizam intervenções para amenizá-los e as registrarem, estes dados não podem ser afirmados que se trata de um padrão da prática destes profissionais, uma vez que não foi realizado a observação do cuidado prestado a esta clientela nem avaliação dos prontuários.

Processamento Inteligente de Sinais de Pressão e Temperatura Adquiridos Através de Sensores Permanentes em Poços de Petróleo

Originally aimed at operational objectives, the continuous measurement of well bottomhole pressure and temperature, recorded by permanent downhole gauges (PDG), finds vast applicability in reservoir management. It contributes for the monitoring of well performance and makes it possible to estimate reservoir parameters on the long term. However, notwithstanding its unquestionable value, data from PDG is characterized by a large noise content. Moreover, the presence of outliers within valid signal measurements seems to be a major problem as well. In this work, the initial treatment of PDG signals is addressed, based on curve smoothing, self-organizing maps and the discrete wavelet transform. Additionally, a system based on the coupling of fuzzy clustering with feed-forward neural networks is proposed for transient detection. The obtained results were considered quite satisfactory for offshore wells and matched real requisites for utilization

Sistema inteligente para estimar a porosidade em sedimentos a partir da análise de sinais GPR

This Thesis presents the elaboration of a methodological propose for the development of an intelligent system, able to automatically achieve the effective porosity, in sedimentary layers, from a data bank built with information from the Ground Penetrating Radar GPR. The intelligent system was built to model the relation between the porosity (response variable) and the electromagnetic attribute from the GPR (explicative variables). Using it, the porosity was estimated using the artificial neural network (Multilayer Perceptron MLP) and the multiple linear regression. The data from the response variable and from the explicative variables were achieved in laboratory and in GPR surveys outlined in controlled sites, on site and in laboratory. The proposed intelligent system has the capacity of estimating the porosity from any available data bank, which has the same variables used in this Thesis. The architecture of the neural network used can be modified according to the existing necessity, adapting to the available data bank. The use of the multiple linear regression model allowed the identification and quantification of the influence (level of effect) from each explicative variable in the estimation of the porosity. The proposed methodology can revolutionize the use of the GPR, not only for the imaging of the sedimentary geometry and faces, but mainly for the automatically achievement of the porosity one of the most important parameters for the characterization of reservoir rocks (from petroleum or water)

Compreendendo a educação para a inclusão digital: uma análise dos sentidos atribuidos pelos monitores das escolas de inclusão digital e cidadania da EMATER-RN

According to the methodological presuppositions of the understanding interview (KAUFMAAN, 1996), the present work aims to understand the Digital Inclusion starting from the oral speeches of eight monitors of Digital Inclusion and Citizenship Schools of the Technical Assistance and Rural Extension Company EMATER, located in municipal districts that belong to six regions of the state of Rio Grande do Norte. It also had the intention to analyze it (the Digital Inclusion), while educational process and its relation with the citizenship. In its first part, an analysis of the discussions about digital inclusion was developed, and a reflection about the new technologies in current times, followed by a contextualization of the rural space and the methodological course of the study, when its guiding axis and the travelled roads were presented, where the object of study is built slowly and progressively through a theoretical elaboration that increases day by day, as of the technologies forged in the field of research and formation of the subject. The second part presents the study of the collected information, that is organized in three chapters denominated as follows: Conceptions of the local context; What does digital inclusion mean? and The monitor as an educator. The reports do evidence a peculiar dissatisfaction with the social reality where they are found, that contradicts the positive reflections and perspectives of the studied authors, once that, within the actual conjuncture, the rural space has acquired another meaning, no longer being seen as a far late place. By trying to define the digital inclusion, the monitors make an association with change, the access to knowledge, active participation in society and improvement of the life conditions. Here a mission sense stands out, related to the ideological precept, which has been managing its activities. Towards the monitor‟s relation within the classroom, the senses evidence how they are and how they have been developing their daily activities. Tensions, fears and insecurities are identified, but at the same time, a compromise. The final considerations implicate to the need of reorientations in the formative process of this professionals, detaching the importance of their activities while agents of inclusion and social transformation

Uma fundamentação matemática para processamento digital de sinais intervalares

This work deals with a mathematical fundament for digital signal processing under point view of interval mathematics. Intend treat the open problem of precision and repesention of data in digital systems, with a intertval version of signals representation. Signals processing is a rich and complex area, therefore, this work makes a cutting with focus in systems linear invariant in the time. A vast literature in the area exists, but, some concepts in interval mathematics need to be redefined or to be elaborated for the construction of a solid theory of interval signal processing. We will construct a basic fundaments for signal processing in the interval version, such as basic properties linearity, stability, causality, a version to intervalar of linear systems e its properties. They will be presented interval versions of the convolution and the Z-transform. Will be made analysis of convergences of systems using interval Z-transform , a essentially interval distance, interval complex numbers , application in a interval filter.

Uma fundamentação para sinais e sistemas intervalares

In this work we use Interval Mathematics to establish interval counterparts for the main tools used in digital signal processing. More specifically, the approach developed here is oriented to signals, systems, sampling, quantization, coding and Fourier transforms. A detailed study for some interval arithmetics which handle with complex numbers is provided; they are: complex interval arithmetic (or rectangular), circular complex arithmetic, and interval arithmetic for polar sectors. This lead us to investigate some properties that are relevant for the development of a theory of interval digital signal processing. It is shown that the sets IR and R(C) endowed with any correct arithmetic is not an algebraic field, meaning that those sets do not behave like real and complex numbers. An alternative to the notion of interval complex width is also provided and the Kulisch- Miranker order is used in order to write complex numbers in the interval form enabling operations on endpoints. The use of interval signals and systems is possible thanks to the representation of complex values into floating point systems. That is, if a number x 2 R is not representable in a floating point system F then it is mapped to an interval [x;x], such that x is the largest number in F which is smaller than x and x is the smallest one in F which is greater than x. This interval representation is the starting point for definitions like interval signals and systems which take real or complex values. It provides the extension for notions like: causality, stability, time invariance, homogeneity, additivity and linearity to interval systems. The process of quantization is extended to its interval counterpart. Thereafter the interval versions for: quantization levels, quantization error and encoded signal are provided. It is shown that the interval levels of quantization represent complex quantization levels and the classical quantization error ranges over the interval quantization error. An estimation for the interval quantization error and an interval version for Z-transform (and hence Fourier transform) is provided. Finally, the results of an Matlab implementation is given

Uma solução para geração automática de trilhas em língua brasileira de sinais em conteúdos multimídia

Deaf people have serious difficulties to access information. The support for sign languages is rarely addressed in Information and Communication Technologies (ICT). Furthermore, in scientific literature, there is a lack of works related to machine translation for sign languages in real-time and open-domain scenarios, such as TV. To minimize these problems, in this work, we propose a solution for automatic generation of Brazilian Sign Language (LIBRAS) video tracks into captioned digital multimedia contents. These tracks are generated from a real-time machine translation strategy, which performs the translation from a Brazilian Portuguese subtitle stream (e.g., a movie subtitle or a closed caption stream). Furthermore, the proposed solution is open-domain and has a set of mechanisms that exploit human computation to generate and maintain their linguistic constructions. Some implementations of the proposed solution were developed for digital TV, Web and Digital Cinema platforms, and a set of experiments with deaf users was developed to evaluate the main aspects of the solution. The results showed that the proposed solution is efficient and able to generate and embed LIBRAS tracks in real-time scenarios and is a practical and feasible alternative to reduce barriers of deaf to access information, especially when human interpreters are not available

Proposta de algoritmo para detecção de vazamentos em oleodutos utilizando análise freqüencial de sinais de pressão

Pipeline leak detection is a matter of great interest for companies who transport petroleum and its derivatives, in face of rising exigencies of environmental policies in industrialized and industrializing countries. However, existing technologies are not yet fully consolidated and many studies have been accomplished in order to achieve better levels of sensitivity and reliability for pipeline leak detection in a wide range of flowing conditions. In this sense, this study presents the results obtained from frequency spectrum analysis of pressure signals from pipelines in several flowing conditions like normal flowing, leakages, pump switching, etc. The results show that is possible to distinguish between the frequency spectra of those different flowing conditions, allowing recognition and announce of liquid pipeline leakages from pressure monitoring. Based upon these results, a pipeline leak detection algorithm employing frequency analysis of pressure signals is proposed, along with a methodology for its tuning and calibration. The proposed algorithm and its tuning methodology are evaluated with data obtained from real leakages accomplished in pipelines transferring crude oil and water, in order to evaluate its sensitivity, reliability and applicability to different flowing conditions

Contribuições para a análise de sinais neuronais e biomédicos

Following the new tendency of interdisciplinarity of modern science, a new field called neuroengineering has come to light in the last decades. After 2000, scientific journals and conferences all around the world have been created on this theme. The present work comprises three different subareas related to neuroengineering and electrical engineering: neural stimulation; theoretical and computational neuroscience; and neuronal signal processing; as well as biomedical engineering. The research can be divided in three parts: (i) A new method of neuronal photostimulation was developed based on the use of caged compounds. Using the inhibitory neurotransmitter GABA caged by a ruthenium complex it was possible to block neuronal population activity using a laser pulse. The obtained results were evaluated by Wavelet analysis and tested by non-parametric statistics. (ii) A mathematical method was created to identify neuronal assemblies. Neuronal assemblies were proposed as the basis of learning by Donald Hebb remain the most accepted theory for neuronal representation of external stimuli. Using the Marcenko-Pastur law of eigenvalue distribution it was possible to detect neuronal assemblies and to compute their activity with high temporal resolution. The application of the method in real electrophysiological data revealed that neurons from the neocortex and hippocampus can be part of the same assembly, and that neurons can participate in multiple assemblies. (iii) A new method of automatic classification of heart beats was developed, which does not rely on a data base for training and is not specialized in specific pathologies. The method is based on Wavelet decomposition and normality measures of random variables. Throughout, the results presented in the three fields of knowledge represent qualification in neural and biomedical engineering

Uma arquitetura para detecção online de transientes em sinais de eletrocardiograma sobre o protocolo IEEE 802.3 com PM-AH

The occurrence of transients in electrocardiogram (ECG) signals indicates an electrical phenomenon outside the heart. Thus, the identification of transients has been the most-used methodology in medical analysis since the invention of the electrocardiograph (device responsible for benchmarking of electrocardiogram signals). There are few papers related to this subject, which compels the creation of an architecture to do the pre-processing of this signal in order to identify transients. This paper proposes a method based on the signal energy of the Hilbert transform of electrocardiogram, being an alternative to methods based on morphology of the signal. This information will determine the creation of frames of the MP-HA protocol responsible for transmitting the ECG signals through an IEEE 802.3 network to a computing device. That, in turn, may perform a process to automatically sort the signal, or to present it to a doctor so that he can do the sorting manually