Cidadão e comunidade : que relevância no processo de contratualizaç

RESUMO - Nas últimas décadas, a especialização dos cuidados médicos tem conduzido a uma fragmentação do sistema de prestação, que, associada a uma deficiente coordenação entre serviços, cuidados e prestadores, torna a navegabilidade dos utentes nos sistemas de saúde uma tarefa complexa. Um novo modelo de organização, assente na procura de valor para os cidadãos, deve adoptar uma abordagem sistémica, que tenha subjacente uma coordenação integrada de serviços, numa perspectiva de ciclo de cuidados. Reorientar a prestação de cuidados para a obtenção de resultados e valor em saúde, exige uma reengenharia em torno da estrutura, organização e avaliação1 dos cuidados, requerendo, nomeadamente: i) instrumentos e ferramentas que auxiliem e estruturem este novo modelo; ii) assumpção dos papéis definidos para cada um dos actores do sistema, nomeadamente ao nível da coordenação; iii) encorajamento à adopção de modelos de contratualização, pagamento e competição, que responsabilizem os actores envolvidos não só pela prática que desenvolvem, mas pelos resultados em saúde. Estes mecanismos constituem uma oportunidade para expandir e sustentar abordagens, programas e intervenções integradas. Investir num sistema de pagamento por valor em saúde — P4V — payment for value, traduz uma aposta na relação entre diagnóstico, tratamento, resultados clínicos e custos, enquanto estratégia para assegurar ganhos em qualidade dos cuidados, eficiência dos processos e valor em saúde para o cidadão. Neste contexto, a gestão da doença enquanto modelo direccionado para o reforço da perspectiva e participação activa do cidadão, e avaliação compreensiva de novas formas de organização e gestão do sistema de prestação, constitui um instrumento para informar e sustentar esse processo de reengenharia do sistema. Um modelo que procura assegurar o encontro entre o estado da arte na prestação de cuidados e um nível óptimo, garantindo a qualidade de vida expectável para a pessoa com doença crónica. ----------------- ---------ABSTRACT – In the last decades advanced medical sciences trend to specialized care and fragmented health systems, leaving patients with a challenge on navigating services and care, requiring them to see a sequence of specialists each delivering discrete interventions. To overcome these challenges, every health system must redefine health care delivery to use its resources more efficiently and improve quality of care through an organization of the system as a whole. A system currently organized around value for patients, entails a framework that comprises the entire set of activities needed to address a patient´s medical condition, over the full cycle of care. Value- based care delivery therefore requires an integrated practice, both across services and time, and implies a movement through new structures, organization models, evaluation efforts and payment systems that enables, catalyze and reinforces the extension and sustainability of the steps needed to the change required. A shift from a payment for performance to a payment for value focuses attention on maximizing the overall value of care, and encourages coordination and integration between components of care that extends from screening, diagnoses, all the way through treatment, outcomes and costs, and ensuring an incentive for potentially high value types of care as well as innovation. These leave the actors of the system with the task of best allocating and valuing components of care. Disease management as a model designed to structure patient engagement and involvement in their care, and assure a comprehensive evaluation and monitoring of new organization and care delivery strategies align an opportunity as a source of information and sustainability for the progress of a growing number of likeminded efforts now underway across care delivery for chronic diseases. This framework will allow the fulfillment of the gap between sta

Autonomous bathymetry for risk assessment with ROAZ robotic surface vehicle

The use of unmanned marine robotic vehicles in bathymetric surveys is discussed. This paper presents recent results in autonomous bathymetric missions with the ROAZ autonomous surface vehicle. In particular, robotic surface vehicles such as ROAZ provide an efficient tool in risk assessment for shallow water environments and water land interface zones as the near surf zone in marine coast. ROAZ is an ocean capable catamaran for distinct oceanographic missions, and with the goal to fill the gap were other hydrographic surveys vehicles/systems are not compiled to operate, like very shallow water rivers and marine coastline surf zones. Therefore, the use of robotic systems for risk assessment is validated through several missions performed either in river scenario (in a very shallow water conditions) and in marine coastlines.

Radar Based Collision detection developments on USV ROAZ II

This work presents the integration of obstacle detection and analysis capabilities in a coherent and advanced C&C framework allowing mixed-mode control in unmanned surface systems. The collision avoidance work has been successfully integrated in an operational autonomous surface vehicle and demonstrated in real operational conditions. We present the collision avoidance system, the ROAZ autonomous surface vehicle and the results obtained at sea tests. Limitations of current COTS radar systems are also discussed and further research directions are proposed towards the development and integration of advanced collision avoidance systems taking in account the different requirements in unmanned surface vehicles.

ROAZ Autonomous Surface Vehicle Design and Implementation

The design of an Autonomous Surface Vehicle for operation in river and estuarine scenarios is presented. Multiple operations with autonomous underwater vehicles and support to AUV missions are one of the main design goals in the ROAZ system. The mechanical design issues are discussed. Hardware, software and implementation status are described along with the control and navigation system architecture. Some preliminary test results concerning a custom developed thruster are presented along with hydrodynamic drag calculations by the use of computer fluid dynamic methods.

Swordfish: an Autonomous Surface Vehicle for Network Centric Operations

The design and development of the swordfish autonomous surface vehicle (ASV) system is discussed. Swordfish is an ocean capable 4.5 m long catamaran designed for network centric operations (with ocean and air going vehicles and human operators). In the basic configuration, Swordfish is both a survey vehicle and a communications node with gateways for broadband, Wi-Fi and GSM transports and underwater acoustic modems. In another configuration, Swordfish mounts a docking station for the autonomous underwater vehicle Isurus from Porto University. Swordfish has an advanced control architecture for multi-vehicle operations with mixed initiative interactions (human operators are allowed to interact with the control loops).

AUV Control and Communication using Underwater Acoustic Networks

Underwater acoustic networks can be quite effective to establish communication links between autonomous underwater vehicles (AUVs) and other vehicles or control units, enabling complex vehicle applications and control scenarios. A communications and control framework to support the use of underwater acoustic networks and sample application scenarios are described for single and multi-AUV operation.

Autonomous Surface Vehicle Docking Manoeuvre with Visual Information

This work presents a hybrid coordinated manoeuvre for docking an autonomous surface vehicle with an autonomous underwater vehicle. The control manoeuvre uses visual information to estimate the AUV relative position and attitude in relation to the ASV and steers the ASV in order to dock with the AUV. The AUV is assumed to be at surface with only a small fraction of its volume visible. The system implemented in the autonomous surface vehicle ROAZ, developed by LSA-ISEP to perform missions in river environment, test autonomous AUV docking capabilities and multiple AUV/ASV coordinated missions is presented. Information from a low cost embedded robotics vision system (LSAVision), along with inertial navigation sensors is fused in an extended Kalman filter and used to determine AUV relative position and orientation to the surface vehicle The real time vision processing system is described and results are presented in operational scenario.

Marine Operations with the SWORDFISH Autonomous Surface Vehicle

IEEE Robótica 2007 - 7th Conference on Mobile Robots and Competitions, Paderne, Portugal 2007

Hybrid Maneuver for Gradient Search with Multiple Coordinated AUVs

This work presents a hybrid maneuver for gradient search with multiple AUV's. The mission consists in following a gradient field in order to locate the source of a hydrothermal vent or underwater freshwater source. The formation gradient search exploits the environment structuring by the phenomena to be studied. The ingredients for coordination are the payload data collected by each vehicle and their knowledge of the behaviour of other vehicles and detected formation distortions.

Standard commercial education robotic platform: intermediate solution to teaching robotics

Teaching robotics to students at the beginning of their studies has become a huge challenge. Simulation environments can be an effective solution to that challenge where students can interact with simulated robots and have the first contact with robotic constraints. From our previous experience with simulation environments it was possible to observe that students with lower background knowledge in robotics where able to deal with a limited number of constraints, implement a simulated robotic platform and study several sensors. The question is: after this first phase what should be the best approach? Should the student start developing their own hardware? Hardware development is a very important part of an engineer's education but it can also be a difficult phase that could lead to discouragement and loss of motivation in some students. Considering the previous constraints and first year engineering students’ high abandonment rate it is important to develop teaching strategies to deal with this problem in a feasible way. The solution that we propose is the integration of a low-cost standard robotic platform WowWee Rovio as an intermediate solution between the simulation phase and the stage where the students can develop their own robots. This approach will allow the students to keep working in robotic areas such as: cooperative behaviour, perception, navigation and data fusion. The propose approach proved to be a motivation step not only for the students but also for the teachers. Students and teachers were able to reach an agreement between the level of demand imposed by the teachers and satisfaction/motivation of the students.

Analysis of Two Arms Working in Cooperation

This paper analyzes the performance of two cooperative robot manipulators. In order to capture the working performancewe formulated several performance indices that measure the manipulability, the effort reduction and the equilibrium between the two robots. In this perspective the proposed indices we determined the optimal values for the system parameters. Furthermore, it is studied the implementation of fractional-order algorithms in the position/force control of two cooperative robotic manipulators holding an object.

Cascade Control of a Hexapod Robot

6th International Conference on Climbing and Walking Robots and the Support Technologies for Mobile Machines, Catania, Italy, 17-19 September

Kinematic Manipulability of Robotic Systems

Many tasks involving manipulation require cooperation between robots. Meanwhile, it is necessary to determine the adequate values for the robot parameters to obtain a good performence. This paper discusses several aspects related with the manipulability of two co-operative robots when handling objects with different lengths and orientations. In this line of thought, a numerical tool is developed for the calculation and the graphical visualization of the manipulability measure.

Energy analysis of Multi-legged Locomotion Systems

4th International Conference on Climbing and Walking Robots - From Biology to Industrial Applications

Decentralized Target Tracking based on Multi-Robot Cooperative Triangulation

Target tracking with bearing-only sensors is a challenging problem when the target moves dynamically in complex scenarios. Besides the partial observability of such sensors, they have limited field of views, occlusions can occur, etc. In those cases, cooperative approaches with multiple tracking robots are interesting, but the different sources of uncertain information need to be considered appropriately in order to achieve better estimates. Even though there exist probabilistic filters that can estimate the position of a target dealing with incertainties, bearing-only measurements bring usually additional problems with initialization and data association. In this paper, we propose a multi-robot triangulation method with a dynamic baseline that can triangulate bearing-only measurements in a probabilistic manner to produce 3D observations. This method is combined with a decentralized stochastic filter and used to tackle those initialization and data association issues. The approach is validated with simulations and field experiments where a team of aerial and ground robots with cameras track a dynamic target.