Qualidade e satisfação do sistema de seguimento à distância de cardioversores-desfibrilhadores implantáveis

RESUMO - Com o aumento da esperança de vida e das doenças crónicas, cada vez se tem implantado mais cardioversores-desfibrilhadores (CDI) para prevenção de morte súbita. O aumento exponencial no número de implantes aumenta o número de seguimentos dos dispositivos, sobrecarregando os profissionais de saúde e comprometendo a qualidade dos serviços prestados. Segundo as recomendações internacionais, um CDI deverá ser vigiado a cada 3 meses, o que perfaz 4 consultas por ano/doente no mínimo, se não existirem episódios de “choques” ou “descompensações” clínicas, e mensalmente quando é atingido o indicador de substituição electiva do gerador. A evolução da tecnologia, de algoritmos, visualização de episódios e terapias requer recursos técnicos e humanos diferenciados e um gasto de tempo considerável no seguimento. Em países como os Estados Unidos da América, em que os doentes têm de percorrer distâncias muito grandes para aceder aos cuidados de saúde, tornou-se preemente a necessidade de um sistema de vigilância alternativo. Nesse sentido, e usando o conceito da telemedicina, foi criado o seguimento/monitorização à distância de dispositivos cardíacos. Este reduz os custos em consultas, deslocações e recursos humanos, uma vez que contempla apenas uma consulta presencial por ano. Por outro lado, aumenta a segurança do doente com a monitorização periódica e a criação de alarmes, permitindo uma assistência de qualidade e intervenção adequada imediata. Aproveitando as vantagens que este tipo de sistema de transmissão remota oferece, procedeu-se no meu serviço, à distribuição inicial de 62 comunicadores a doentes portadores de CDI´s ou com Ressincronizadores Cardíacos (TRC´s1). Apesar de ser considerada uma melhoria na qualidade dos serviços prestados, é também uma mudança importante na metodologia da consulta feita até aqui. Segundo vários autores, a avaliação da qualidade dos cuidados em saúde está intrinsecamente ligada ao grau de satisfação dos doentes com esses serviços, ou seja, à relação entre as suas expectativas e os resultados percebidos por eles, sendo considerado um importante indicador de qualidade dos serviços. Com este trabalho, pretende-se avaliar a percepção dos doentes face ao novo seguimento em termos de aceitação, satisfação, validade, segurança e confiança no novo sistema. Se este mantém os mesmos padrões de qualidade que o seguimento presencial. Trata-se de um estudo transversal com uma componente retrospectiva de avaliação da nova metodologia de consulta à distância. Para tal, foi elaborado um questionário, que foi aplicado a 40 doentes (17,5% do género feminino e 82,5% do género masculino; média de idades de 65 anos) que constituíram a amostra do estudo. Verificou-se uma média de 5 anos de tempo de implante do CDI. Dos dados obtidos, é de realçar que 70% dos inquiridos estão satisfeitos e 30% estão muito satisfeitos com esta nova metodologia de consulta e cerca 67,4% prefere a consulta à distância. Quando solicitados para comparar a qualidade do serviço prestado entre as duas consultas, 65% respondeu igual e 27,5% melhor. Todos os inquiridos responderam ter confiança e segurança com o sistema de consulta à distância. Cerca de 87,5% dos inquiridos vê-se mesmo a continuar com este tipo de consulta. Os resultados obtidos são bastante satisfatórios no que diz respeito à transição do modo como a consulta de CDI´s é feita. Reflectem também que a tecnologia não é necessariamente uma barreira no acesso aos profissionais de saúde, desde que suportada por algum contacto directo (telefone e através de uma consulta presencial por ano). 1 TRC – Terapia de Ressincronização Cardíaca

Alcances y limitaciones del modelo de privatización del agua en Bolivia como política pública auspiciada desde organismos internacionales (Década 2000-2010)

Bajo la tipología de estudio de caso, la presente investigación pretende explicar la influencia ejercida desde el Banco Mundial en la configuración de políticas públicas nacionales en Bolivia para la privatización del suministro, transporte y acceso al agua potable. El objetivo general de la investigación es explicar los alcances y limitaciones del modelo de privatización del agua en Bolivia como política pública, promovido por el Banco Mundial (BM), en la primera década del siglo XXI. Sosteniendo que el modelo de privatización del BM ha sido permeado y superado por el interés nacional del pueblo boliviano en materia de acceso al agua. Finalmente, la metodología empleada será de corte cualitativa a partir del análisis de documentos oficiales, textos académicos y científicos, legislaciones y disposiciones tomadas desde el BM y desde Bolivia en lo que respecta a la privatización del agua.

The meteorology of the Western Indian Ocean, and the influence of the east African highlands

This paper reviews the meteorology of the Western Indian Ocean and uses a state–of–the–art atmospheric general circulation model to investigate the influence of the East African Highlands on the climate of the Indian Ocean and its surrounding regions. The new 44–year re–analysis produced by the European Centre for Medium range Weather Forecasts (ECMWF) has been used to construct a new climatology of the Western Indian Ocean. A brief overview of the seasonal cycle of the Western Indian Ocean is presented which emphasizes the importance of the geography of the Indian Ocean basin for controlling the meteorology of the Western Indian Ocean. The principal modes of inter–annual variability are described, associated with El Niño and the Indian Ocean Dipole or Zonal Mode, and the basic characteristics of the subseasonal weather over the Western Indian Ocean are presented, including new statistics on cyclone tracks derived from the ECMWF re–analyses. Sensitivity experiments, in which the orographic effects of East Africa are removed, have shown that the East African Highlands, although not very high, play a significant role in the climate of Africa, India and Southeast Asia, and in the heat, salinity and momentum forcing of the Western Indian Ocean. The hydrological cycle over Africa is systematically enhanced in all seasons by the presence of the East African Highlands, and during the Asian summer monsoon there is a major redistribution of the rainfall across India and Southeast Asia. The implied impact of the East African Highlands on the ocean is substantial. The East African Highlands systematically freshen the tropical Indian Ocean, and act to focus the monsoon winds along the coast, leading to greater upwelling and cooler sea–surface temperatures.

TGF-beta superfamily members and ovarian follicle development

In recent years, exciting progress has been made towards unravelling the complex intraovarian control mechanisms that, in concert with systemic signals, coordinate the recruitment, selection and growth of follicles from the primordial stage through to ovulation and corpus luteum formation. A plethora of growth factors, many belonging to the transforming growth factor-beta (TGF-beta) superfamily, are expressed by ovarian somatic cells and oocytes in a developmental, stage-related manner and function as intraovarian regulators of folliculogenesis. Two such factors, bone morphogenetic proteins, RMP-4 and BMP-7, are expressed by ovarian stromal cells and/or theca cells and have recently been implicated as positive regulators of the primordial-to-primary follicle transition. In contrast, evidence indicates a negative role for anti-Mullerian hormone (AMH, also known as Mullerian-inhibiting substance) of pre-granulosa/granulosa cell origin in this key event and subsequent progression to the antral stage. Two other TGF-beta superfamily members, growth and differentiation factor-9 (GDF-9) and BMP-15 (also known as GDF-9B) are expressed in an oocyte-specific manner from a very early stage and play key roles in promoting follicle growth beyond the primary stage; mice with null mutations in the gdf-9 gene or ewes with inactivating mutations in gdf-9 or bmp-15 genes are infertile with follicle development arrested at the primary stage. Studies on later stages of follicle development indicate positive roles for granulosa cell-derived activin, BMP-2, -5 and -6, theca cell-derived BMP-2, -4 and -7 and oocyte-derived BMP-6 in promoting granulosa cell proliferation, follicle survival and prevention of premature luteinization and/or atresia. Concomitantly, activin, TGF-beta and several BMPs may exert paracrine actions on theca cells to attenuate LH-dependent androgen production in small to medium-size antral follicles. Dominant follicle selection in monovular species may depend on differential FSH sensitivity amongst a growing cohort of small antral follicles. Changes in intrafollicular activins, GDF-9, AMH and several BMPs may contribute to this selection process by modulating both FSH- and IGF-dependent signalling pathways in granulosa cells. Activin may also play a positive role in oocyte maturation and acquisition of developmental competence. in addition to its endocrine role to suppress FSH secretion, increased output of inhibin by the selected dominant follicle(s) may upregulate LH-induced androgen secretion that is required to sustain a high level of oestradiol secretion during the pre-ovulatory phase. Advances in our understanding of intraovarian regulatory mechanisms should facilitate the development of new approaches for monitoring and manipulating ovarian function and improving fertility in domesticated livestock, endangered species and man.

Selected statistical indicators of Caribbean countries, vol. XVI, 2003

Includes bibliography

Construção e calibração de amostrador passivo para determinação de ozônio troposférico

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Sinais de vibração no monitoramento do processo de retificação plana de cerâmicas avançadas

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Phylogenetic analysis of rubella virus strains during an outbreak in Sao Paulo, 2007-2008

Rubella virus (RV) is an important human pathogen that causes rubella, an acute contagious disease. It also causes severe birth defects collectively known as congenital rubella syndrome when infection occurs during the first trimester of pregnancy. Here, we present the phylogenetic analysis of RV that circulated in Sao Paulo during the 20072008 outbreak. Samples collected from patients diagnosed with rubella were isolated in cell culture and sequenced. RV RNA was obtained from samples or RV-infected cell cultures and amplified by reverse transcriptase-polymerase chain reaction. Sequences were assigned to genotypes by phylogenetic analysis using RV reference sequences. Seventeen sequences were analyzed, and three genotypes were identified: 1a, 1G, and 2B. Genotypes 1a and 1G, which were isolated in 2007, were responsible for sporadic rubella cases in Sao Paulo. Thereafter, in late 2007, the epidemiological conditions changed, resulting in a large RV outbreak with the clear dominance of genotype 2B. The results of this study provide new approaches for monitoring the progress of elimination of rubella from Sao Paulo, Brazil. J. Med. Virol. 84:16661671, 2012. (c) 2012 Wiley Periodicals, Inc.

Nonlinear tests for genetic studies of complex disease

Linkage and association studies are major analytical tools to search for susceptibility genes for complex diseases. With the availability of large collection of single nucleotide polymorphisms (SNPs) and the rapid progresses for high throughput genotyping technologies, together with the ambitious goals of the International HapMap Project, genetic markers covering the whole genome will be available for genome-wide linkage and association studies. In order not to inflate the type I error rate in performing genome-wide linkage and association studies, multiple adjustment for the significant level for each independent linkage and/or association test is required, and this has led to the suggestion of genome-wide significant cut-off as low as 5 × 10 −7. Almost no linkage and/or association study can meet such a stringent threshold by the standard statistical methods. Developing new statistics with high power is urgently needed to tackle this problem. This dissertation proposes and explores a class of novel test statistics that can be used in both population-based and family-based genetic data by employing a completely new strategy, which uses nonlinear transformation of the sample means to construct test statistics for linkage and association studies. Extensive simulation studies are used to illustrate the properties of the nonlinear test statistics. Power calculations are performed using both analytical and empirical methods. Finally, real data sets are analyzed with the nonlinear test statistics. Results show that the nonlinear test statistics have correct type I error rates, and most of the studied nonlinear test statistics have higher power than the standard chi-square test. This dissertation introduces a new idea to design novel test statistics with high power and might open new ways to mapping susceptibility genes for complex diseases. ^

Métodos diferenciales e interferométricos para la evaluación de deformaciones de la corteza terrestre mediante técnicas GNSS e InSAR = Differential and interferometric methods for evaluation of crustal deformation using GNSS and InSAR techniques

La actividad volcánica interviene en multitud de facetas de la propia actividad humana, no siempre negativas. Sin embargo, son más los motivos de peligrosidad y riesgo que incitan al estudio de la actividad volcánica. Existen razones de seguridad que inciden en el mantenimiento del seguimiento y monitorización de la actividad volcánica para garantizar la vida y la seguridad de los asentamientos antrópicos en las proximidades de los edificios volcánicos. En esta tesis se define e implementa un sistema de monitorización de movimientos de la corteza en las islas de Tenerife y La Palma, donde el impacto social que representa un aumento o variación de la actividad volcánica en las islas es muy severo. Aparte de la alta densidad demográfica del Archipiélago, esta población aumenta significativamente, en diferentes periodos a lo largo del año, debido a la actividad turística que representa la mayor fuente de ingresos de las islas. La población y los centros turísticos se diseminan predominantemente a lo largo de las costas y también a lo largo de los flancos de los edificios volcánicos. Quizá el mantenimiento de estas estructuras sociales y socio-económicas son los motivos más importantes que justifican una monitorización de la actividad volcánica en las Islas Canarias. Recientemente se ha venido trabajando cada vez más en el intento de predecir la actividad volcánica utilizando los nuevos sistemas de monitorización geodésica, puesto que la actividad volcánica se manifiesta anteriormente por deformación de la corteza terrestre y cambios en la fuerza de la gravedad en la zona donde más tarde se registran eventos volcánicos. Los nuevos dispositivos y sensores que se han desarrollado en los últimos años en materias como la geodesia, la observación de la Tierra desde el espacio y el posicionamiento por satélite, han permitido observar y medir tanto la deformación producida en el terreno como los cambios de la fuerza de la gravedad antes, durante y posteriormente a los eventos volcánicos que se producen. Estos nuevos dispositivos y sensores han cambiado las técnicas o metodologías geodésicas que se venían utilizando hasta la aparición de los mismos, renovando métodos clásicos y desarrollando otros nuevos que ya se están afianzando como metodologías probadas y reconocidas para ser usadas en la monitorización volcánica. Desde finales de la década de los noventa del siglo pasado se han venido desarrollando en las Islas Canarias varios proyectos que han tenido como objetivos principales el desarrollo de nuevas técnicas de observación y monitorización por un lado y el diseño de una metodología de monitorización volcánica adecuada, por otro. Se presenta aquí el estudio y desarrollo de técnicas GNSS para la monitorización de deformaciones corticales y su campo de velocidades para las islas de Tenerife y La Palma. En su implementación, se ha tenido en cuenta el uso de la infraestructura geodésica y de monitorización existente en el archipiélago a fin de optimizar costes, además de complementarla con nuevas estaciones para dar una cobertura total a las dos islas. Los resultados obtenidos en los proyectos, que se describen en esta memoria, han dado nuevas perspectivas en la monitorización geodésica de la actividad volcánica y nuevas zonas de interés que anteriormente no se conocían en el entorno de las Islas Canarias. Se ha tenido especial cuidado en el tratamiento y propagación de los errores durante todo el proceso de observación, medida y proceso de los datos registrados, todo ello en aras de cuantificar el grado de fiabilidad de los resultados obtenidos. También en este sentido, los resultados obtenidos han sido verificados con otros procedentes de sistemas de observación radar de satélite, incorporando además a este estudio las implicaciones que el uso conjunto de tecnologías radar y GNSS tendrán en un futuro en la monitorización de deformaciones de la corteza terrestre. ABSTRACT Volcanic activity occurs in many aspects of human activity, and not always in a negative manner. Nonetheless, research into volcanic activity is more likely to be motivated by its danger and risk. There are security reasons that influence the monitoring of volcanic activity in order to guarantee the life and safety of human settlements near volcanic edifices. This thesis defines and implements a monitoring system of movements in the Earth’s crust in the islands of Tenerife and La Palma, where the social impact of an increase (or variation) of volcanic activity is very severe. Aside from the high demographic density of the archipelago, the population increases significantly in different periods throughout the year due to tourism, which represents a major source of revenue for the islands. The population and the tourist centres are mainly spread along the coasts and also along the flanks of the volcanic edifices. Perhaps the preservation of these social and socio-economic structures is the most important reason that justifies monitoring volcanic activity in the Canary Islands. Recently more and more work has been done with the intention of predicting volcanic activity, using new geodesic monitoring systems, since volcanic activity is evident prior to eruption because of a deformation of the Earth’s crust and changes in the force of gravity in the zone where volcanic events will later be recorded. The new devices and sensors that have been developed in recent years in areas such as geodesy, the observation of the Earth from space, and satellite positioning have allowed us to observe and measure the deformation produced in the Earth as well as the changes in the force of gravity before, during, and after the volcanic events occur. The new devices and sensors have changed the geodetic techniques and methodologies that were used previously. The classic methods have been renovated and other newer ones developed that are now vouched for as proven recognised methodologies to be used for volcanic monitoring. Since the end of the 1990s, in the Canary Islands various projects have been developed whose principal aim has been the development of new observation and monitoring techniques on the one hand, and the design of an appropriate volcanic monitoring methodology on the other. The study and development of GNSS techniques for the monitoring of crustal deformations and their velocity field is presented here. To carry out the study, the use of geodetic infrastructure and existing monitoring in the archipelago have been taken into account in order to optimise costs, besides complementing it with new stations for total coverage on both islands. The results obtained in the projects, which are described below, have produced new perspectives in the geodetic monitoring of volcanic activity and new zones of interest which previously were unknown in the environment of the Canary Islands. Special care has been taken with the treatment and propagation of errors during the entire process of observing, measuring, and processing the recorded data. All of this was done in order to quantify the degree of trustworthiness of the results obtained. Also in this sense, the results obtained have been verified with others from satellite radar observation systems, incorporating as well in this study the implications that the joint use of radar technologies and GNSS will have for the future of monitoring deformations in the Earth’s crust.

Does spatial distribution of fauna depend on algal belts on intertidal boulder fields of the French Basque coast ?

To determine good ecological status and conservation of the Sub-Marine area of the Bay of Biscay, the implementation of a new rocky intertidal habitats monitoring is needed. A protocol has been adapted from the Brittany protocol for the water body FRFC11 "Basque coast" for the two indicators "intertidal macroalgae" and "subtidal macroalgae" under the Water Framework Directive to qualify the ecological. However no protocol has been validated for fauna in front of meridional characters of the benthic communities. Investigations carried out on macroalgae communities on intertidal area in WFD framework, since 2008, constitute an important working basis. This is the aim of the Bigorno project (Intertidal Biodiversity of the south of the Bay of Biscay and Observation for New search and Monitoring for decision support), financed by the Agency of Marine Protected Areas and the Departmental Council. To implement knowledge, a sampling protocol has been used in 2015 on the boulder fields of Guéthary. This site is part of Natura 2000 area "rocky Basque coast and offshore extension "It constitutes also a Znieff site and restricted fishing area. The sampling strategy considers the heterogeneity of substrates and the presence of intertidal microhabitats. Two main habitats are present: "mediolittoral rock in exposed area habitat" and "boulder fields". Habitat "intertidal pools and permanent ponds" is also present but, it is not investigated. Sampling effort is of 353 quadrats of 0.1 m², drawn randomly according to a spatially stratified sampling plan, defined by habitat and algal belts. Taxa identification and enumeration are done on each quadrat. The objective of this work is to expose results from data collected during 2015 sampling program. The importance of characterizing benthic fauna communities spatial distribution belonging to the Basque coast according to algal belts defines during the WDF survey was highlighted. Concurrently, indicators of biodiversity were studied.

Indicator species of intertidal boulder fields on the French Basque coast

The rocky Basque coast presents an interest both in terms of biogeography and its patrimonial situation, alongside its habitats, fauna and flora. The aim of the BIGORNO project (Intertidal Biodiversity of the south of the Bay of Biscay and Observation for New research and Monitoring for decision support), financed by the Agency of Marine Protected Areas (AAMP) and the Departmental Council (CD 64), is to respond to significant deficiencies on biocenosis in the southern marine subregion “Bay of Biscay”. Investigations carried out in the WFD, since 2008, constitute an important basis of work for integration of fauna. Field studies undertaken since 2015 consisting of a sampling design suited to the substrates heterogeneity and the presence of microhabitats were established on an intertidal area specifically on a "Boulder fields" habitat. Assessment was undertaken by sampling quadrats of 0.1 m² drawn randomly from a spatially stratified sampling plan. Our study aims for a better understanding of stratification of this habitat and allowed us to highligh tindicator taxa of the "Boulder fields" habitat. Functions included in the package indicspecies (CRAN) were used to conduct indicator species analysis and to assess the significance of the relationship between taxa or taxa combinations and the habitat. It is therefore possible to describe some species or species groups which are specific to boulder fields through the assessment of their functional traits and local biodiversity. These various analyses allow for a sustainable way of monitoring the Basque intertidal rocky shore.

Non-invasive winding fault detection for induction machines based on stray flux magnetic sensors

Non-intrusive monitoring of health state of induction machines within industrial process and harsh environments poses a technical challenge. In the field, winding failures are a major fault accounting for over 45% of total machine failures. In the literature, many condition monitoring techniques based on different failure mechanisms and fault indicators have been developed where the machine current signature analysis (MCSA) is a very popular and effective method at this stage. However, it is extremely difficult to distinguish different types of failures and hard to obtain local information if a non-intrusive method is adopted. Typically, some sensors need to be installed inside the machines for collecting key information, which leads to disruption to the machine operation and additional costs. This paper presents a new non-invasive monitoring method based on GMRs to measure stray flux leaked from the machines. It is focused on the influence of potential winding failures on the stray magnetic flux in induction machines. Finite element analysis and experimental tests on a 1.5-kW machine are presented to validate the proposed method. With time-frequency spectrogram analysis, it is proven to be effective to detect several winding faults by referencing stray flux information. The novelty lies in the implement of GMR sensing and analysis of machine faults.

Use of hierarchical cluster analysis to assess the representativeness of a baseline groundwater quality monitoring network: comparison of New Zealand’s national and regional groundwater monitoring programs

Baseline monitoring of groundwater quality aims to characterize the ambient condition of the resource and identify spatial or temporal trends. Sites comprising any baseline monitoring network must be selected to provide a representative perspective of groundwater quality across the aquifer(s) of interest. Hierarchical cluster analysis (HCA) has been used as a means of assessing the representativeness of a groundwater quality monitoring network, using example datasets from New Zealand. HCA allows New Zealand's national and regional monitoring networks to be compared in terms of the number of water-quality categories identified in each network, the hydrochemistry at the centroids of these water-quality categories, the proportions of monitoring sites assigned to each water-quality category, and the range of concentrations for each analyte within each water-quality category. Through the HCA approach, the National Groundwater Monitoring Programme (117 sites) is shown to provide a highly representative perspective of groundwater quality across New Zealand, relative to the amalgamated regional monitoring networks operated by 15 different regional authorities (680 sites have sufficient data for inclusion in HCA). This methodology can be applied to evaluate the representativeness of any subset of monitoring sites taken from a larger network.

The Atlantic and Gulf Menhaden Purse Seine Fisheries: Origins, Harvesting Technologies, Biostatistical Monitoring, Recent Trends in Fisheries Statistics, and Forecasting

With its genesis in New England during the 1800's, the purse seine fishery for Atlantic menhaden, Brevoortia tyrannus, expanded south and by the early 1900's ranged the length of the eastern seaboard. The purse seine fishery for Gulf menhaden. B. patronus, is of relatively recent development, exploitation of the stock beginning in the late 1940's. Landings from both fisheries annually comprise 35-40% of the total U. S. fisheries landings, ranking menhaden first in terms of volume landed. Technological advances in harvesting methods, fish-spotting capabilities, and vessel designs accelerated after World War II, resulting in larger, faster, and wider-ranging carrier vessels, improved speed and efficiency of the harvest, and reduction in labor requirements. Chief products of the menhaden industry are fish meal, fish oil, and solubles, but research into new product lines is underway. Since 1955 on the Atlantic coast and 1964 on the Gulf coast, the NMFS has monitored the fisheries for biostatistical data. Annual data summaries of numbers-of-fish-at-age harvested, catch tonnage, and fishing effort of the fleet form the basis of routine stock assessments and annual catch forecasts to industry for the upcoming fishing season. After landings declined in the 1960's, the Atlantic menhaden stock has recovered through the 1970's and 1980's. Exceptional year classes of Gulf menhaden in recent years account for record landings during the 1980's.