Protocolo para prescrição ou adaptação de recursos pedagógicos para alunos com paralisia cerebral

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Formulação de um índice de qualidade de gestão de resíduos sólidos urbanos

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Escalonamento de tarefas em sistemas distribuídos baseado no conceito de propriedade distribuída

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A Universidade Federal do Pará no processo de modernização da gestão universitária

O desafio de encontrar novos meios de administrar as organizações públicas, os quais não estivessem limitados aos indicadores financeiros e contábeis, foi a grande motivação para o surgimento do planejamento estratégico nas instituições de ensino superior, através de um sistema de gestão estratégica que traduz a missão e a estratégia de organizações, análise do ambiente interno e externo a organização. Esta dissertação aborda a questão da modernização da gestão, através de um estudo de caso de caráter descritivo realizado na Universidade Federal do Pará (UFPA), de como foi implantado o processo para “aprimorar o sistema de planejamento institucional” com vistas a buscar soluções conjuntas aos problemas enfrentados pelo fator negativo - precariedade do sistema de planejamento - diagnosticado no Plano de Desenvolvimento Institucional da UFPA 2001-2010, tendo a Pró-Reitoria de Planejamento e Desenvolvimento Institucional – PROPLAN, como Unidade Central de Planejamento, responsável em desenvolver e implantar instrumentos gerenciais, padronizados, uniformizando as diretrizes gerais oferecendo a todos os segmentos da universidade um eixo comum, norteador das políticas da Universidade, observadas as peculiaridades da sua configuração multicampi. O objetivo principal desta dissertação é identificar as ações estabelecidas no processo para “aprimorar o sistema de planejamento institucional visando reduzir a precariedade do sistema de planejamento na Universidade Federal do Pará”. A metodologia utilizada é a pesquisa qualitativa e como técnica de coleta de dados utilizou-se a pesquisa documental. Os resultados encontrados indicam que a preocupação com estratégias na gestão universitária, são fatos relativamente recentes e que se encontra em profundas transformações, sendo que, no período analisado, a preocupação maior se dá nas unidades acadêmicas. Foi possível observar que as fases do processo de planejamento das ações não se realizam completamente em todas as Unidades e Campi, pois o sistema de acompanhamento do processo de planejamento, praticamente não existiu. Por conseguinte, até então, inexistia uma cultura de planejamento na organização, com a ausência de integração das ações de planejamento entre as Unidades Acadêmicas e a Unidade Central de Planejamento, contribuindo, assim, com a precariedade do Sistema de Planejamento Institucional na UFPA. Conclui-se assim, que houve um avanço nas mudanças planejadas e executadas, tornando a UFPA uma organização isomórfica, as unidades da UFPA que enfrentam as mesmas condições ambientais, foram compelidas a imitarem umas as outras, as características organizacionais foram modificadas consensualmente, através de decisões colegiadas, por meio de uma gestão democrática, tornando, assim, os elementos estruturais isomórficos, consistindo então, conforme a teoria, em estruturas organizacionais que refletem uma realidade socialmente construída. Mas, apesar de ter ocorrido um avanço nas mudanças planejadas e executadas, a universidade utiliza determinados mecanismos não porque acredite que a tornem mais eficaz, mas porque são mecanismos impostos, por pressões externas, a universidade tem que cumprir atos formais, regras, leis e sanções, numa relação de dominação e dependência, configurando-se o isomorfismo institucional coercitivo. Como, também, conclui-se conforme informações coletadas que não ocorreu uma mudança organizacional no sentido amplo, e sim, algumas modificações específicas. Avaliando-se, então, pode-se dizer que a UFPA conseguiu tornar suas Unidades homogêneas nas práticas administrativas, especificamente na prática de planejar, na busca de aperfeiçoar o sistema de planejamento das ações da UFPA – ao se observar que, das vinte e oito Unidades regimentalmente constituídas até 2006, dezenove elaboraram Planos de Gestão para o período de 2002 a 2009, representando que 64% das unidades realizaram as ações planejadas na sua totalidade. E, 36%, nove Unidades não constituíram Planos de Gestão, não utilizaram, instrumentos gerenciais padronizados, uniformizando as diretrizes gerais oferecendo a todos os segmentos da universidade um eixo comum, norteador das políticas da Universidade.

Fundamentos para o planejamento e gestão metropolitanos por ilhas e bacias hidrográficas: uma alternativa para região metropolitana de Belém

Esta dissertação faz uma reflexão sobre a ausência de um efetivo sistema de planejamento e gestão da Região Metropolitana de Belém (RMB), fundamental para equacionar seus problemas plurimunicipais. Trata-se de um trabalho que além de fazer tal reflexão, sugere fundamentos que contribuam para a construção de uma proposta de planejamento e gestão da RMB, com base na adaptação de determinados instrumentos instituídos pela Política Nacional de Recursos Hídricos, Lei nº. 9.433/97. Esta adaptação foi possível a partir da compreensão e identificação da estrutura hidrográfica do território da RMB que, associadas aos instrumentos de gestão adotados pela referida Lei, resultou em instrumentos institucionais e técnicos que primam pelo uso das bacias hidrográficas metropolitanas como unidades estratégicas de planejamento e gestão e pelo uso de princípios de participação democrática no equacionamento dos problemas de interesse dos municípios dessa região.

Planejamento e controle da produção: reestruturação no layout de apertadeiras eletrônicas em uma linha de produção do ramo de autopeças

In industrial plants, there is a department responsible for planning the use of productive resources to find the best possible way to set out plans in strategic, tactical and operational levels. This department is known as PCP or PPCP, which means Planning and Production Control and Planning, Programming and Production Control, respectively. This work presents the use of some of the tools from this department, in particular the Aggregate Production Planning, to propose a new layout of electronic nutrunners for an auto parts industry output line. Through some process indicators analyzes, was identified some productivity losses. The higher loss rate occurred by the electronic nutrunners breaking, and so this work was focused in these devices. Some premises were adopted for the use of electronic nut runners, setting an ideal cycle time for the operation of the production line and making calculations to define the minimum amount of electronic nutrunners to find the production demand without damaging the equipment. With this work we observed that a relevant factor for the constant breaks of electronic nutrunners is because these are working with overload, in other words, the amount of installed equipment is not enough to supply the demand without failures

Tomotherapy dose distribution verification using MAGIC-f polymer gel dosimetry

Purpose: This paper presents the application of MAGIC-f gel in a three-dimensional dose distribution measurement and its ability to accurately measure the dose distribution from a tomotherapy unit. Methods: A prostate intensity-modulated radiation therapy (IMRT) irradiation was simulated in the gel phantom and the treatment was delivered by a TomoTherapy equipment. Dose distribution was evaluated by the R2 distribution measured in magnetic resonance imaging. Results: A high similarity was found by overlapping of isodoses of the dose distribution measured with the gel and expected by the treatment planning system (TPS). Another analysis was done by comparing the relative absorbed dose profiles in the measured and in the expected dose distributions extracted along indicated lines of the volume and the results were also in agreement. The gamma index analysis was also applied to the data and a high pass rate was achieved (88.4% for analysis using 3%/3 mm and of 96.5% using 4%/4 mm). The real three-dimensional analysis compared the dose-volume histograms measured for the planning volumes and expected by the treatment planning, being the results also in good agreement by the overlapping of the curves. Conclusions: These results show that MAGIC-f gel is a promise for tridimensional dose distribution measurements. (C) 2012 American Association of Physicists in Medicine. [http://dx.doi.org/10.1118/1.4704496]

Applicazione di strumenti e metodi per la gestione ambientale di un territorio vasto - Sviluppo di un sistema di gestione ambientale in un ente pubblico secondo lo schema europeo EMAS e analisi di un sistema energetico territoriale

Environmental Management includes many components, among which we can include Environmental Management Systems (EMS), Environmental Reporting and Analysis, Environmental Information Systems and Environmental Communication. In this work two applications are presented: the developement and implementation of an Environmental Management System in local administrations, according to the European scheme "EMAS", and the analysis of a territorial energy system through scenario building and environmental sustainability assessment. Both applications are linked by the same objective, which is the quest for more scientifically sound elements; in fact, both EMS and energy planning are oftec carachterized by localism and poor comparability. Emergy synthesis, proposed by ecologist H.T. Odum and described in his book "Environmental Accounting: Emergy and Environmental Decision Making" (1996) has been chosen and applied as an environmental evaluation tool, in order complete the analysis with an assessment of the "global value" of goods and processes. In particular, eMergy syntesis has been applied in order to improve the evaluation of the significance of environmental aspects in an EMS, and in order to evaluate the environmental performance of three scenarios of future evolution of the energy system. Regarding EMS, in this work an application of an EMS together with the CLEAR methodology for environmental accounting is discussed, in order to improve the identification of the environmental aspects; data regarding environmental aspects and significant ones for 4 local authorities are also presented, together with a preliminary proposal for the integration of the assessment of the significance of environmental aspects with eMergy synthesis. Regarding the analysis of an energy system, in this work the carachterization of the current situation is presented together with the overall energy balance and the evaluation of the emissions of greenhouse gases; moreover, three scenarios of future evolution are described and discussed. The scenarios have been realized with the support of the LEAP software ("Long Term Energy Alternatives Planning System" by SEI - "Stockholm Environment Institute"). Finally, the eMergy synthesis of the current situation and of the three scenarios is shown.

Validation of the Swiss Monte Carlo Plan for a static and dynamic 6 MV photon beam

Monte Carlo (MC) based dose calculations can compute dose distributions with an accuracy surpassing that of conventional algorithms used in radiotherapy, especially in regions of tissue inhomogeneities and surface discontinuities. The Swiss Monte Carlo Plan (SMCP) is a GUI-based framework for photon MC treatment planning (MCTP) interfaced to the Eclipse treatment planning system (TPS). As for any dose calculation algorithm, also the MCTP needs to be commissioned and validated before using the algorithm for clinical cases. Aim of this study is the investigation of a 6 MV beam for clinical situations within the framework of the SMCP. In this respect, all parts i.e. open fields and all the clinically available beam modifiers have to be configured so that the calculated dose distributions match the corresponding measurements. Dose distributions for the 6 MV beam were simulated in a water phantom using a phase space source above the beam modifiers. The VMC++ code was used for the radiation transport through the beam modifiers (jaws, wedges, block and multileaf collimator (MLC)) as well as for the calculation of the dose distributions within the phantom. The voxel size of the dose distributions was 2mm in all directions. The statistical uncertainty of the calculated dose distributions was below 0.4%. Simulated depth dose curves and dose profiles in terms of [Gy/MU] for static and dynamic fields were compared with the corresponding measurements using dose difference and γ analysis. For the dose difference criterion of ±1% of D(max) and the distance to agreement criterion of ±1 mm, the γ analysis showed an excellent agreement between measurements and simulations for all static open and MLC fields. The tuning of the density and the thickness for all hard wedges lead to an agreement with the corresponding measurements within 1% or 1mm. Similar results have been achieved for the block. For the validation of the tuned hard wedges, a very good agreement between calculated and measured dose distributions was achieved using a 1%/1mm criteria for the γ analysis. The calculated dose distributions of the enhanced dynamic wedges (10°, 15°, 20°, 25°, 30°, 45° and 60°) met the criteria of 1%/1mm when compared with the measurements for all situations considered. For the IMRT fields all compared measured dose values agreed with the calculated dose values within a 2% dose difference or within 1 mm distance. The SMCP has been successfully validated for a static and dynamic 6 MV photon beam, thus resulting in accurate dose calculations suitable for applications in clinical cases.

Generalized eMC implementation for Monte Carlo dose calculation of electron beams from different machine types

The electron Monte Carlo (eMC) dose calculation algorithm available in the Eclipse treatment planning system (Varian Medical Systems) is based on the macro MC method and uses a beam model applicable to Varian linear accelerators. This leads to limitations in accuracy if eMC is applied to non-Varian machines. In this work eMC is generalized to also allow accurate dose calculations for electron beams from Elekta and Siemens accelerators. First, changes made in the previous study to use eMC for low electron beam energies of Varian accelerators are applied. Then, a generalized beam model is developed using a main electron source and a main photon source representing electrons and photons from the scattering foil, respectively, an edge source of electrons, a transmission source of photons and a line source of electrons and photons representing the particles from the scrapers or inserts and head scatter radiation. Regarding the macro MC dose calculation algorithm, the transport code of the secondary particles is improved. The macro MC dose calculations are validated with corresponding dose calculations using EGSnrc in homogeneous and inhomogeneous phantoms. The validation of the generalized eMC is carried out by comparing calculated and measured dose distributions in water for Varian, Elekta and Siemens machines for a variety of beam energies, applicator sizes and SSDs. The comparisons are performed in units of cGy per MU. Overall, a general agreement between calculated and measured dose distributions for all machine types and all combinations of parameters investigated is found to be within 2% or 2 mm. The results of the dose comparisons suggest that the generalized eMC is now suitable to calculate dose distributions for Varian, Elekta and Siemens linear accelerators with sufficient accuracy in the range of the investigated combinations of beam energies, applicator sizes and SSDs.

Seasonal variation in orthopedic health services utilization in Switzerland: the impact of winter sport tourism

BACKGROUND: Climate- or holiday-related seasonality in hospital admission rates is well known for many diseases. However, little research has addressed the impact of tourism on seasonality in admission rates. We therefore investigated the influence of tourism on emergency admission rates in Switzerland, where winter and summer leisure sport activities in large mountain regions can generate orthopedic injuries. METHODS: Using small area analysis, orthopedic hospital service areas (HSAo) were evaluated for seasonality in emergency admission rates. Winter sport areas were defined using guest bed accommodation rate patterns of guest houses and hotels located above 1000 meters altitude that show clear winter and summer peak seasons. Emergency admissions (years 2000-2002, n = 135'460) of local and nonlocal HSAo residents were evaluated. HSAo were grouped according to their area type (regular or winter sport area) and monthly analyses of admission rates were performed. RESULTS: Of HSAo within the defined winter sport areas 70.8% show a seasonal, summer-winter peak hospital admission rate pattern and only 1 HSAo outside the defined winter sport areas shows such a pattern. Seasonal hospital admission rates in HSAo in winter sport areas can be up to 4 times higher in winter than the intermediate seasons, and they are almost entirely due to admissions of nonlocal residents. These nonlocal residents are in general -and especially in winter- younger than local residents, and nonlocal residents have a shorter length of stay in winter sport than in regular areas. The overall geographic distribution of nonlocal residents admitted for emergencies shows highest rates during the winter as well as the summer in the winter sport areas. CONCLUSION: Small area analysis using orthopedic hospital service areas is a reliable method for the evaluation of seasonality in hospital admission rates. In Switzerland, HSAo defined as winter sport areas show a clear seasonal fluctuation in admission rates of only nonlocal residents, whereas HSAo defined as regular, non-winter sport areas do not show such seasonality. We conclude that leisure sport, and especially ski/snowboard tourism demands great flexibility in hospital beds, staff and resource planning in these areas.

Leaf transmission reduction using moving jaws for dynamic MLC IMRT

The aim of this work is to investigate to what extent it is possible to use the secondary collimator jaws to reduce the transmitted radiation through the multileaf collimator (MLC) during an intensity modulated radiation therapy (IMRT). A method is developed and introduced where the jaws follow the open window of the MLC dynamically (dJAW method). With the aid of three academic cases (Closed MLC, Sliding-gap, and Chair) and two clinical cases (prostate and head and neck) the feasibility of the dJAW method and the influence of this method on the applied dose distributions are investigated. For this purpose the treatment planning system Eclipse and the Research-Toolbox were used as well as measurements within a solid water phantom were performed. The transmitted radiation through the closed MLC leads to an inhomogeneous dose distribution. In this case, the measured dose within a plane perpendicular to the central axis differs up to 40% (referring to the maximum dose within this plane) for 6 and 15 MV. The calculated dose with Eclipse is clearly more homogeneous. For the Sliding-gap case this difference is still up to 9%. Among other things, these differences depend on the depth of the measurement within the solid water phantom and on the application method. In the Chair case, the dose in regions where no dose is desired is locally reduced by up to 50% using the dJAW method instead of the conventional method. The dose inside the chair-shaped region decreased up to 4% if the same number of monitor units (MU) as for the conventional method was applied. The undesired dose in the volume body minus the planning target volume in the clinical cases prostate and head and neck decreased up to 1.8% and 1.5%, while the number of the applied MU increased up to 3.1% and 2.8%, respectively. The new dJAW method has the potential to enhance the optimization of the conventional IMRT to a further step.

Rollout of CampusContent

CampusContent (CC) is a DFG-funded competence center for eLearning with its own portal. It links content and people who support sharing and reuse of high quality learning materials and codified pedagogical know-how, such as learning objectives, pedagogical scenarios, recommended learning activities, and learning paths. The heart of the portal is a distributed repository whose contents are linked to various other CampusContent portals. Integrated into each portal are user-friendly tools for designing reusable learning content, exercises, and templates for learning units and courses. Specialized authoring tools permit the configuration, adaption, and automatic generation of interactive Flash animations using Adobe's Flexbuilder technology. More coarse-grained content components such as complete learning units and entire courses, in which contents and materials taken from the repository are embedded, can be created with XML-based authoring tools. Open service interface allow the deep or shallow integration of the portal provider's preferred authoring and learning tools. The portal is built on top of the Enterprise Content Management System Alfresco, which comes with social networking functionality that has been adapted to accommmodate collaboration, sharing and reuse within trusted communities of practice.

Frameless linac-based (Novalis TX) stereotactic treatment for vestibular schwannoma that extend distally into the iac (Internal Acoustic Canal): an analysis of the dose to the cochlea

Objectives: We compare the dose parameters between 3 different radiosurgery delivery techniques which may have an impact on cochlea function. Methods: Five patients with unilateral vestibular schwannoma (VS) were selected for this study. Planning procedure was carried out using the BrainLAB® iPlan planning system v. 4.5. For each patient three different planning techniques were used: dynamic arc (DA) with 5 arcs per plan, hybrid arc (HA) with 5 arcs per plan and IMRT with 8 fields per plan. For each technique, two plans were generated with different methods: with the first method (PTV coverage) it was the goal to fully cover the PTV with at least 12 Gy (normalization: 12 Gy covered 99% of the PTV) and with the second method (cochlea sparing) it was the goal to spare the cochlea (normalization: 12 Gy covers 50% of the PTV/V4Gy of cochlea lower than 1%). Plan evaluation was done considering target volume and coverage (conformity and homogeneity) and OAR constraints (mean (Dmean) and maximum dose (Dmax) to cochlea, Dmax to brainstem and cochlea). The total number of monitor units (MU) was analyzed. Results: The median tumor volume was 0.95 cm³ (range, 0.86-3 cm³). The median PTV was 1.44 cm³ (range, 1-3.5 cm³). The median distance between the tumor and the cochlea's modiulus was 2.7 mm (range, 1.8-6.3 mm). For the PTV coverage method, when we compared the cochlear dose in VS patients planned with DA, HA and IMRT, there were no significant differences in Dmax (p = 0.872) and in Dmean (p= 0.860). We found a significant correlation (p< 0.05) between the target volume and the cochlear Dmean for all plans with Pearson's coefficient correlation of 0.90, 0.92 and 0.94 for the DA, HA and IMRT techniques, respectively. For the cochlea sparing method, when we compared the cochlear dose in VS patients planned with DA, HA and IMRT, there were no significant differences in Dmax (p = 0.310) and in Dmean (p= 0.275). However, in this group the V4Gy of the ipsilateral cochlea represents less than 1%. When using the HA or IMRT technique, the homogeneity and conformity in the PTV, but also the number of MUs were increased in comparison to the DA technique. Conclusion: VS tumors that extend distally into the IAC had an equivalent sparing of cochlea with DA approach compared with the HA and IMRT techniques. Disclosure: No significant relationships.

Risk of Second Malignant Neoplasms Following Proton Arc Therapy and Volumetric Modulated Arc Therapy for Prostate Cancer

The risk of second malignant neoplasms (SMNs) following prostate radiotherapy is a concern due to the large population of survivors and decreasing age at diagnosis. It is known that parallel-opposed beam proton therapy carries a lower risk than photon IMRT. However, a comparison of SMN risk following proton and photon arc therapies has not previously been reported. The purpose of this study was to predict the ratio of excess relative risk (RRR) of SMN incidence following proton arc therapy to that after volumetric modulated arc therapy (VMAT). Additionally, we investigated the impact of margin size and the effect of risk-minimized proton beam weighting on predicted RRR. Physician-approved treatment plans were created for both modalities for three patients. Therapeutic dose was obtained with differential dose-volume histograms from the treatment planning system, and stray dose was estimated from the literature or calculated with Monte Carlo simulations. Then, various risk models were applied to the total dose. Additional treatment plans were also investigated with varying margin size and risk-minimized proton beam weighting. The mean RRR ranged from 0.74 to 0.99, depending on risk model. The additional treatment plans revealed that the RRR remained approximately constant with varying margin size, and that the predicted RRR was reduced by 12% using a risk-minimized proton arc therapy planning technique. In conclusion, proton arc therapy was found to provide an advantage over VMAT in regard to predicted risk of SMN following prostate radiotherapy. This advantage was independent of margin size and was amplified with risk-optimized proton beam weighting.