Fisioterapia e reabilitação em Portugal : o financiamento como factor crítico do desempenho

RESUMO - Num contexto em que a prestação de cuidados de Fisioterapia e Reabilitação é identificada como apresentando uma desigualdade e desajustamento da oferta regional superior à dos restantes cuidados de saúde, assim como uma falta de adequação dos preços praticados, perante as condições de oferta e procura actualmente existentes, o presente trabalho tem por objectivo investigar, no domínio do Desempenho, a influência do Financiamento na definição da prestação destes cuidados, tendo como pressuposto genérico que as decisões estratégicas e a reestruturação produtiva das organizações de saúde são condicionadas pelo sistema de preços. Considera-se que o actual sistema de Financiamento/Pagamento provoca um constrangimento na qualidade da resposta destes cuidados a dois níveis: um primeiro nível, ao colocar o pagamento no âmbito dos Meios Complementares de Diagnóstico e Terapêutica (MCDTs) a contratar pelo Serviço Nacional de Saúde, com isso determinando a configuração organizativa do sistema; um segundo nível de constrangimento que incide sobre as estruturas das organizações prestadoras, pela modelação que induz, nomeadamente a nível da sua produção. Na impossibilidade de tratar as duas dimensões do problema, pela falta de indicadores de desempenho deste sector, analisou-se, relativamente ao segundo nível de constrangimento, a produção de fisioterapia de três organizações que, potencialmente, teriam o mesmo o mesmo perfil de oferta por se enquadrarem num mesmo perfil de procura. Os resultados reflectem o pressuposto genérico do trabalho e abrem espaço para colocar como futura hipótese de investigação a razão da(s) causa(s) que poderão estar subjacentes à discrepância encontrada na média de tratamentos por sessão (duas vezes e meia) na produção das duas organizações que foi possível comparar.------------------- ABSTRACT - In a context where the provision of Physical Therapy and Rehabilitation care is identified as having a regional mismatch of supply and inequality above all the others health cares, and a lack of adequacy of prices in the current conditions of supply and demand, the present work has, as main purpose, to investigate, in the field of Performance, the Payment’s influence in shaping the provision of such health care. The general assumption tracking this analysis is that the strategic decisions on productive structure of health care organizations are influenced by the price systems. It is considered that the current Finance / Payment system causes two levels of constraints on the quality of such health care: a first constraint, as it putts its payment under the Supplementary Means of Diagnosis and Therapy (MCDTs), witch ends up establishing the organizational setup of the system; a second level of constraint by modelling the internal structure of these organizations. The lack of indicators characterizing the performance of this sector, addressed the present study to the second dimension, in witch was analysed the physical therapy production in three organizations that, potentially, would have the same profile of supply responding to similar characteristics of demand. The results reflect the above mentioned general assumption that supported the work, and leave an open space for future research, about the reason (s) that lay behind the discrepancy found between the average of treatments per session (two and a half times) in

Improved fluorescent proteins for single-molecule research in molecular tracking and co-localization

Three promising variants of autofluorescent proteins have been analyzed photophysically for their proposed use in single-molecule microscopy studies in living cells to compare their superiority to other fluorescent proteins previously reported regarding the number of photons emitted. The first variant under investigation the F46L mutant of eYFP has a 10% greater photon emission rate and > 50% slower photobleaching rate on average than the standard eYFP fluorophore. The monomeric red fluorescent protein (mRFP) has a fivefold lower photon emission rate, likely due to the monomeric content, and also a tenfold faster photobleaching rate than the DsRed fluorescent protein. In contrast, the previously reported eqfp611 has a 50% lower emission rate yet photobleaches more than a factor 2 slowly. We conclude that the F46L YFP and the eqfp611 are superior new options for single molecule imaging and tracking studies in living cells. Studies were also performed on the effects of forced quenching of multiple fluorescent proteins in sub-micrometer regions that would show the effects of dimerization at low concentration levels of fluorescent proteins and also indicate corrections to stoichiometry patterns with fluorescent proteins previously in print. We also introduce properties at the single molecule level of new FRET pairs with combinations of fluorescent proteins and artificial fluorophores.

Six-element circuit for maximum power point tracking in photovoltaic-motor systems with variable-frequency drives

A low-cost circuit was developed for stable and efficient maximum power point (MPP) tracking in autonomous photo voltaic-motor systems with variable-frequency drives (VFDs). The circuit is made of two resistors, two capacitors, and two Zener diodes. Its input is the photovoltaic (PV) array voltage and its output feeds the proportional-integral-derivative (PID) controller usually integrated into, the drive. The steady-state frequency-voltage oscillations induced by the circuit were treated in a simplified mathematical model, which was validated by widely characterizing a PV-powered centrifugal pump. General procedures for circuit and controller tuning were recommended based on model equations. The tracking circuit presented here is widely applicable to PV-motor system with VFDs, offering an. efficient open-access technology of unique simplicity. Copyright (C) 2010 John Wiley & Sons, Ltd.

Tracking of plasma lipids and lipoproteins, within-person and year-to-year variability in plasma cholesterol levels among participants from age 8 to 18 in Project HeartBeat!

Coronary heart disease remains the leading cause of death in the United States and increased blood cholesterol level has been found to be a major risk factor with roots in childhood. Tracking of cholesterol, i.e., the tendency to maintain a particular cholesterol level relative to the rest of the population, and variability in blood lipid levels with increase in age have implications for cholesterol screening and assessment of lipid levels in children for possible prevention of further rise to prevent adulthood heart disease. In this study the pattern of change in plasma lipids, over time, and their tracking were investigated. Also, within-person variance and retest reliability defined as the square root of within-person variance for plasma total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides and their relation to age, sex and body mass index among participants from age 8 to 18 years were investigated. ^ In Project HeartBeat!, 678 healthy children aged 8, 11 and 14 years at baseline were enrolled and examined at 4-monthly intervals for up to 4 years. We examined the relationship between repeated observations by Pearson's correlations. Age- and sex-specific quintiles were calculated and the probability of participants to remain in the uppermost quintile of their respective distribution was evaluated with life table methods. Plasma total cholesterol, HDL-C and LDL-C at baseline were strongly and significantly correlated with measurements at subsequent visits across the sex and age groups. Plasma triglyceride at baseline was also significantly correlated with subsequent measurements but less strongly than was the case for other plasma lipids. The probability to remain in the upper quintile was also high (60 to 70%) for plasma total cholesterol, HDL-C and LDL-C. ^ We used a mixed longitudinal, or synthetic cohort design with continuous observations from age 8 to 18 years to estimate within person variance of plasma total cholesterol, HDL-C, LDL-C and triglycerides. A total of 5809 measurements were available for both cholesterol and triglycerides. A multilevel linear model was used. Within-person variance among repeated measures over up to four years of follow-up was estimated for total cholesterol, HDL-C, LDL-C and triglycerides separately. The relationship of within-person and inter-individual variance with age, sex, and body mass index was evaluated. Likelihood ratio tests were conducted by calculating the deviation of −2log (likelihood) within the basic model and alternative models. The square root of within-person variance provided the retest reliability (within person standard deviation) for plasma total cholesterol, HDL-C, LDL-C and triglycerides. We found 13.6 percent retest reliability for plasma cholesterol, 6.1 percent for HDL-cholesterol, 11.9 percent for LDL-cholesterol and 32.4 percent for triglycerides. Retest reliability of plasma lipids was significantly related with age and body mass index. It increased with increase in body mass index and age. These findings have implications for screening guidelines, as participants in the uppermost quintile tended to maintain their status in each of the age groups during a four-year follow-up. The magnitude of within-person variability of plasma lipids influences the ability to classify children into risk categories recommended by the National Cholesterol Education Program. ^

Communication Architecture for Tracking and Interoperable Services at Hospitals: A Real Deployment Experience

Any new hospital communication architecture has to support existing services, but at the same time new added features should not affect normal tasks. This article deals with issues regarding old and new systems’ interoperability, as well as the effect the human factor has in a deployed architecture. It also presents valuable information, which is a product of a real scenario. Tracking services are also tested in order to monitor and administer several medical resources.

Vision-Based Tracking, Odometry and Control for UAV Autonomy

El principal objetivo de este trabajo es proporcionar una solución en tiempo real basada en visión estéreo o monocular precisa y robusta para que un vehículo aéreo no tripulado (UAV) sea autónomo en varios tipos de aplicaciones UAV, especialmente en entornos abarrotados sin señal GPS. Este trabajo principalmente consiste en tres temas de investigación de UAV basados en técnicas de visión por computador: (I) visual tracking, proporciona soluciones efectivas para localizar visualmente objetos de interés estáticos o en movimiento durante el tiempo que dura el vuelo del UAV mediante una aproximación adaptativa online y una estrategia de múltiple resolución, de este modo superamos los problemas generados por las diferentes situaciones desafiantes, tales como cambios significativos de aspecto, iluminación del entorno variante, fondo del tracking embarullado, oclusión parcial o total de objetos, variaciones rápidas de posición y vibraciones mecánicas a bordo. La solución ha sido utilizada en aterrizajes autónomos, inspección de plataformas mar adentro o tracking de aviones en pleno vuelo para su detección y evasión; (II) odometría visual: proporciona una solución eficiente al UAV para estimar la posición con 6 grados de libertad (6D) usando únicamente la entrada de una cámara estéreo a bordo del UAV. Un método Semi-Global Blocking Matching (SGBM) eficiente basado en una estrategia grueso-a-fino ha sido implementada para una rápida y profunda estimación del plano. Además, la solución toma provecho eficazmente de la información 2D y 3D para estimar la posición 6D, resolviendo de esta manera la limitación de un punto de referencia fijo en la cámara estéreo. Una robusta aproximación volumétrica de mapping basada en el framework Octomap ha sido utilizada para reconstruir entornos cerrados y al aire libre bastante abarrotados en 3D con memoria y errores correlacionados espacialmente o temporalmente; (III) visual control, ofrece soluciones de control prácticas para la navegación de un UAV usando Fuzzy Logic Controller (FLC) con la estimación visual. Y el framework de Cross-Entropy Optimization (CEO) ha sido usado para optimizar el factor de escala y la función de pertenencia en FLC. Todas las soluciones basadas en visión en este trabajo han sido probadas en test reales. Y los conjuntos de datos de imágenes reales grabados en estos test o disponibles para la comunidad pública han sido utilizados para evaluar el rendimiento de estas soluciones basadas en visión con ground truth. Además, las soluciones de visión presentadas han sido comparadas con algoritmos de visión del estado del arte. Los test reales y los resultados de evaluación muestran que las soluciones basadas en visión proporcionadas han obtenido rendimientos en tiempo real precisos y robustos, o han alcanzado un mejor rendimiento que aquellos algoritmos del estado del arte. La estimación basada en visión ha ganado un rol muy importante en controlar un UAV típico para alcanzar autonomía en aplicaciones UAV. ABSTRACT The main objective of this dissertation is providing real-time accurate robust monocular or stereo vision-based solution for Unmanned Aerial Vehicle (UAV) to achieve the autonomy in various types of UAV applications, especially in GPS-denied dynamic cluttered environments. This dissertation mainly consists of three UAV research topics based on computer vision technique: (I) visual tracking, it supplys effective solutions to visually locate interesting static or moving object over time during UAV flight with on-line adaptivity approach and multiple-resolution strategy, thereby overcoming the problems generated by the different challenging situations, such as significant appearance change, variant surrounding illumination, cluttered tracking background, partial or full object occlusion, rapid pose variation and onboard mechanical vibration. The solutions have been utilized in autonomous landing, offshore floating platform inspection and midair aircraft tracking for sense-and-avoid; (II) visual odometry: it provides the efficient solution for UAV to estimate the 6 Degree-of-freedom (6D) pose using only the input of stereo camera onboard UAV. An efficient Semi-Global Blocking Matching (SGBM) method based on a coarse-to-fine strategy has been implemented for fast depth map estimation. In addition, the solution effectively takes advantage of both 2D and 3D information to estimate the 6D pose, thereby solving the limitation of a fixed small baseline in the stereo camera. A robust volumetric occupancy mapping approach based on the Octomap framework has been utilized to reconstruct indoor and outdoor large-scale cluttered environments in 3D with less temporally or spatially correlated measurement errors and memory; (III) visual control, it offers practical control solutions to navigate UAV using Fuzzy Logic Controller (FLC) with the visual estimation. And the Cross-Entropy Optimization (CEO) framework has been used to optimize the scaling factor and the membership function in FLC. All the vision-based solutions in this dissertation have been tested in real tests. And the real image datasets recorded from these tests or available from public community have been utilized to evaluate the performance of these vision-based solutions with ground truth. Additionally, the presented vision solutions have compared with the state-of-art visual algorithms. Real tests and evaluation results show that the provided vision-based solutions have obtained real-time accurate robust performances, or gained better performance than those state-of-art visual algorithms. The vision-based estimation has played a critically important role for controlling a typical UAV to achieve autonomy in the UAV application.

Unimpaired autoreactive T-cell traffic within the central nervous system during tumor necrosis factor receptor-mediated inhibition of experimental autoimmune encephalomyelitis.

The critical role of tumor necrosis factor (TNF) as a mediator in autoimmune inflammatory processes is evident from in vivo studies with TNF-blocking agents. However, the mechanisms by which TNF, and possibly also its homologue lymphotoxin alpha, contributes to development of pathology in rheumatoid arthritis and Crohn disease and in animal models like experimental autoimmune encephalomyelitis is unclear. Possibilities include regulation of vascular adhesion molecules enabling leukocyte movement into tissues or direct cytokine-mediated effector functions such as mediation of tissue damage. Here we show that administration of a TNF receptor (55 kDa)-IgG fusion protein prevented clinical signs of actively induced experimental autoimmune encephalomyelitis. Significantly, the total number of CD4+ T lymphocytes isolated from the central nervous system of clinically healthy treated versus diseased control animals was comparable. By using a CD45 congenic model of passively transferred experimental autoimmune encephalomyelitis to enable tracking of myelin basic protein-specific effector T lymphocytes, prevention of clinical signs of disease was again demonstrated in treated animals but without quantitative or qualitative impediment to the movement of autoreactive T lymphocytes to and within the central nervous system. Thus, despite the uninterrupted movement of specific T lymphocytes into the target tissue, subsequent disease development was blocked. This provides compelling evidence for a direct effector role of TNF/lymphotoxin alpha in autoimmune tissue damage.

The influence of variations in eating disorder-related symptoms on processing of emotional faces in a non-clinical female sample:an eye-tracking study

This study aimed to: i) determine if the attention bias towards angry faces reported in eating disorders generalises to a non-clinical sample varying in eating disorder-related symptoms; ii) examine if the bias occurs during initial orientation or later strategic processing; and iii) confirm previous findings of impaired facial emotion recognition in non-clinical disordered eating. Fifty-two females viewed a series of face-pairs (happy or angry paired with neutral) whilst their attentional deployment was continuously monitored using an eye-tracker. They subsequently identified the emotion portrayed in a separate series of faces. The highest (n=18) and lowest scorers (n=17) on the Eating Disorders Inventory (EDI) were compared on the attention and facial emotion recognition tasks. Those with relatively high scores exhibited impaired facial emotion recognition, confirming previous findings in similar non-clinical samples. They also displayed biased attention away from emotional faces during later strategic processing, which is consistent with previously observed impairments in clinical samples. These differences were related to drive-for-thinness. Although we found no evidence of a bias towards angry faces, it is plausible that the observed impairments in emotion recognition and avoidance of emotional faces could disrupt social functioning and act as a risk factor for the development of eating disorders.

Minimalist Hardware Architectures for Agent Tracking and Guidance

The philosophy of minimalism in robotics promotes gaining an understanding of sensing and computational requirements for solving a task. This minimalist approach lies in contrast to the common practice of first taking an existing sensory motor system, and only afterwards determining how to apply the robotic system to the task. While it may seem convenient to simply apply existing hardware systems to the task at hand, this design philosophy often proves to be wasteful in terms of energy consumption and cost, along with unnecessary complexity and decreased reliability. While impressive in terms of their versatility, complex robots such as the PR2 (which cost hundreds of thousands of dollars) are impractical for many common applications. Instead, if a specific task is required, sensing and computational requirements can be determined specific to that task, and a clever hardware implementation can be built to accomplish the task. Since this minimalist hardware would be designed around accomplishing the specified task, significant reductions in hardware complexity can be obtained. This can lead to huge advantages in battery life, cost, and reliability. Even if cost is of no concern, battery life is often a limiting factor in many applications. Thus, a minimalist hardware system is critical in achieving the system requirements. In this thesis, we will discuss an implementation of a counting, tracking, and actuation system as it relates to ergodic bodies to illustrate a minimalist design methodology.

Tracking people in 3D using position, size and shape

This paper presents a prototype tracking system for tracking people in enclosed indoor environments where there is a high rate of occlusions. The system uses a stereo camera for acquisition, and is capable of disambiguating occlusions using a combination of depth map analysis, a two step ellipse fitting people detection process, the use of motion models and Kalman filters and a novel fit metric, based on computationally simple object statistics. Testing shows that our fit metric outperforms commonly used position based metrics and histogram based metrics, resulting in more accurate tracking of people.