Ações em saúde mental na Atenção Básica em Saúde: manobras de conhecimento e negociação de sentidos

O objetivo do estudo foi compreender como as demandas em saúde mental na atenção básica estão sendo identificadas e encaminhadas pelos profissionais envolvidos nas equipes de saúde da família no município do Rio de Janeiro. Especificamente, buscamos compreender como estes profissionais, em uma equipe multidisciplinar, agem no cotidiano da atenção considerando a fluidez nos conceitos de bem-estar / mal-estar mental e como eles lidam com sinais e sintomas que não se resumem a quadros fisiológicos, mas estão estreitamente relacionados às questões sociais e territoriais. Em entrevistas em grupo com cinco equipes, identificou-se mecanismos de diagnóstico operados por estes profissionais para negociar o enquadramento da demanda como mental e, então, escolher e oferecer encaminhamento a esta. Foram tomados como referenciais de análise e discussão os conceitos de nominalismo dinâmico e looping effect, de Ian Hacking, e os conceitos de enactment e lógica do cuidado, de Annemarie Mol. Diante das considerações, percebeu-se que as noções sobre saúde mental nesta esfera de atenção vão sendo negociadas a partir da mobilização de conhecimentos não oficiais, porém já circulantes, entre os profissionais da equipe. Os profissionais operam manobras de conhecimento de acordo com o acervo teórico/prático e de experiência pessoal, sempre de alguma forma referendado ou muitas vezes "traduzido" pelo escopo da biomedicina. Consequentemente, as ações engendradas tem como base um padrão classificatório e biomédico, ainda que adaptado às singularidades locais e às formas de cuidado possíveis para cada equipe. Tais dados sinalizam que, mesmo supostamente humanizada, interdisciplinar, territorializada e menos medicalizada, as ações na atenção básica, no que se referem à saúde mental, se balizam pelo paradigma do conhecimento científico biomédico. Este é visto ainda como referência para os profissionais e é necessário para explicar e atuar sobre os diversos tipos de demanda.

Análise do efeito do envelhecimento e da doença pulmonar obstrutiva crônica sobre a limitação ao fluxo expiratório por meio da técnica de pressão expiratória negativa

O termo limitação ao fluxo expiratório (LFE) refere-se a uma condição na qual o fluxo expiratório máximo obtido durante um ciclo da respiração espontânea é menor que o previsto e permanece constante apesar do aumento do gradiente pressórico. A LFE pode estar presente durante o envelhecimento pulmonar fisiológico, e em afecções pulmonares obstrutivas, como na doença pulmonar obstrutiva crônica (DPOC). A aferição direta para determinar a LFE requer a mensuração do volume pela relação entre o fluxo e a pressão transpulmonar, porém é um método invasivo. Os testes usualmente empregados estão baseados na comparação da curva fluxo-volume expiratório máximo e corrente, porém estas técnicas requerem alto grau de colaboração do indivíduo e podem gerar alteração do tônus muscular brônquico. Estudos sugerem que a Técnica de Pressão Expiratória Negativa (NEP) pode ser aplicada para detecção da LFE, sendo um método simples, não invasivo e que não requer esforço dos voluntários. Contudo, índices quantitativos para a avaliação deste fenômeno ainda não foram definidos, assim como também não foram estudadas a LFE no processo de envelhecimento e nos diversos estágios de obstrução das vias aéreas na DPOC. Neste contexto, os objetivos deste estudo foram: (1) avaliar o comportamento da LFE durante o processo de envelhecimento e (2) estudar a LFE presente nos portadores de DPOC. Trata-se de um estudo transversal controlado com avaliação de casos prevalentes, tendo como unidade de avaliação o indivíduo. Os exames realizados incluíram medidas de espirometria e NEP. Foram selecionados indivíduos saudáveis para o grupo envelhecimento separados em três grupos: grupo jovem (GJ), n=17; grupo meia idade (GMI), n=17 e grupo idoso (GI), n=17. No grupo DPOC foram selecionados indivíduos tabagistas e com doença obstrutiva, sendo classificados de acordo com o nível de obstrução sugerido pela espirometria. Essa classificação resultou em cinco categorias: indivíduos normais ao exame espirométrico (NE, n= 18); com distúrbio ventilatório obstrutivo leve (DVOL, n=15); distúrbio ventilatório obstrutivo moderado (DVOM, n= 18); distúrbio ventilatório obstrutivo acentuado (DVOA, n= 18) e distúrbio ventilatório obstrutivo muito acentuado (DVOMA, n= 18). Todos os indivíduos realizaram os exames de NEP e posteriormente foram submetidos à espirometria. No estudo sobre envelhecimento o parâmetro LFE% foi o que melhor caracterizou a LFE, apresentando uma correlação moderada com a idade. Os parâmetros ∆EF0-50% e ∆EF25-75% apresentaram uma correlação razoável com o progredir da idade, possivelmente devido a LFE no idoso apresentar componentes relacionadas às vias aéreas superiores. No grupo DPOC a NEP caracterizou adequadamente a LFE, sendo o melhor parâmetro a LFE%. Alterações significativas também foram encontradas com os parâmetros ∆EF0-50% e ∆EF25-75%. Avaliando-se a influência da idade neste grupo, pode-se observar que a idade é um fator de contribui para a LFE, no entanto, o efeito preponderante foi a gravidade da doença. Pode-se concluir que: (1) a NEP é útil no estudo da LFE em idosos saudáveis; (2) nestes indivíduos a LFE ocorre principalmente nas vias aéreas extratorácicas; (3) que a NEP é útil na avaliação de pacientes com DPOC, e: (4) que os efeitos da DPOC se sobrepõe ao efeito do envelhecimento.

Bias-free identification of a linear model-predictive steering controller from measured driver steering behavior

Recent developments in modeling driver steering control with preview are reviewed. While some validation with experimental data has been presented, the rigorous application of formal system identification methods has not yet been attempted. This paper describes a steering controller based on linear model-predictive control. An indirect identification method that minimizes steering angle prediction error is developed. Special attention is given to filtering the prediction error so as to avoid identification bias that arises from the closed-loop operation of the driver-vehicle system. The identification procedure is applied to data collected from 14 test drivers performing double lane change maneuvers in an instrumented vehicle. It is found that the identification procedure successfully finds parameter values for the model that give small prediction errors. The procedure is also able to distinguish between the different steering strategies adopted by the test drivers. © 2006 IEEE.

Path-following steering control for articulated vehicles

Passive steering systems have been used for some years to control the steering of trailer axles on articulated vehicles. These normally use a 'command steer' control strategy, which is designed to work well in steady-state circles at low speeds, but which generates inappropriate steer angles during transient low-speed maneuvers and at high speeds. In this paper, 'active' steering control strategies are developed for articulated heavy goods vehicles. These aim to achieve accurate path following for tractor and trailer, for all paths and all normal vehicle speeds, in the presence of external disturbances. Controllers are designed to implement the path-following strategies at low and high speeds, whilst taking into account the complexities and practicalities of articulated vehicles. At low speeds, the articulation and steer angles on articulated heavy goods vehicles are large and small-angle approximations are not appropriate. Hence, nonlinear controllers based on kinematics are required. But at high-speeds, the dynamic stability of control system is compromised if the kinematics-based controllers remain active. This is because a key state of the system, the side-slip characteristics of the trailer, exhibits a sign-change with increasing speeds. The low and high speed controllers are blended together using a speed-dependent gain, in the intermediate speed range. Simulations are conducted to compare the performance of the new steering controllers with conventional vehicles (with unsteered drive and trailer axles) and with vehicles with command steer controllers on their trailer axles. The simulations show that active steering has the potential to improve significantly the directional performance of articulated vehicles for a wide range of conditions, throughout the speed range. © VC 2013 by ASME.

Multispacecraft refueling optimization considering the J2 perturbation and window constraints

The optimization of a near-circular low-Earth-orbit multispacecraft refueling problem is studied. The refueling sequence, service time, and orbital transfer time are used as design variables, whereas the mean mission completion time and mean propellant consumed by orbital maneuvers are used as design objectives. The J2 term of the Earth's nonspherical gravity perturbation and the constraints of rendezvous time windows are taken into account. A hybridencoding genetic algorithm, which uses normal fitness assignment to find the minimum mean propellant-cost solution and fitness assignment based on the concept of Pareto-optimality to find multi-objective optimal solutions, is presented. The proposed approach is demonstrated for a typical multispacecraft refueling problem. The results show that the proposed approach is effective, and that the J2 perturbation and the time-window constraints have considerable influences on the optimization results. For the problems in which the J2 perturbation is not accounted for, the optimal refueling order can be simply determined as a sequential order or as the order only based on orbitalplane differences. In contrast, for the problems that do consider the J2 perturbation, the optimal solutions obtained have a variety of refueling orders and use the drift of nodes effectively to reduce the propellant cost for eliminating orbital-plane differences. © 2013 by the American Institute of Aeronautics and Astronautics, Inc. All rights reserved.

Emergências em Medicina Dentária

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

Cyclic Pursuit: Symmetry, Reduction and Nonlinear Dynamics

In this dissertation, we explore the use of pursuit interactions as a building block for collective behavior, primarily in the context of constant bearing (CB) cyclic pursuit. Pursuit phenomena are observed throughout the natural environment and also play an important role in technological contexts, such as missile-aircraft encounters and interactions between unmanned vehicles. While pursuit is typically regarded as adversarial, we demonstrate that pursuit interactions within a cyclic pursuit framework give rise to seemingly coordinated group maneuvers. We model a system of agents (e.g. birds, vehicles) as particles tracing out curves in the plane, and illustrate reduction to the shape space of relative positions and velocities. Introducing the CB pursuit strategy and associated pursuit law, we consider the case for which agent i pursues agent i+1 (modulo n) with the CB pursuit law. After deriving closed-loop cyclic pursuit dynamics, we demonstrate asymptotic convergence to an invariant submanifold (corresponding to each agent attaining the CB pursuit strategy), and proceed by analysis of the reduced dynamics restricted to the submanifold. For the general setting, we derive existence conditions for relative equilibria (circling and rectilinear) as well as for system trajectories which preserve the shape of the collective (up to similarity), which we refer to as pure shape equilibria. For two illustrative low-dimensional cases, we provide a more comprehensive analysis, deriving explicit trajectory solutions for the two-particle "mutual pursuit" case, and detailing the stability properties of three-particle relative equilibria and pure shape equilibria. For the three-particle case, we show that a particular choice of CB pursuit parameters gives rise to remarkable almost-periodic trajectories in the physical space. We also extend our study to consider CB pursuit in three dimensions, deriving a feedback law for executing the CB pursuit strategy, and providing a detailed analysis of the two-particle mutual pursuit case. We complete the work by considering evasive strategies to counter the motion camouflage (MC) pursuit law. After demonstrating that a stochastically steering evader is unable to thwart the MC pursuit strategy, we propose a (deterministic) feedback law for the evader and demonstrate the existence of circling equilibria for the closed-loop pursuer-evader dynamics.

Ca2+- and volume-sensitive chloride currents are differentially regulated by agonists and store-operated Ca2+ entry.

Using patch-clamp and calcium imaging techniques, we characterized the effects of ATP and histamine on human keratinocytes. In the HaCaT cell line, both receptor agonists induced a transient elevation of [Ca2+]i in a Ca2+-free medium followed by a secondary [Ca2+]i rise upon Ca2+ readmission due to store-operated calcium entry (SOCE). In voltage-clamped cells, agonists activated two kinetically distinct currents, which showed differing voltage dependences and were identified as Ca2+-activated (ICl(Ca)) and volume-regulated (ICl, swell) chloride currents. NPPB and DIDS more efficiently inhibited ICl(Ca) and ICl, swell, respectively. Cell swelling caused by hypotonic solution invariably activated ICl, swell while regulatory volume decrease occurred in intact cells, as was found in flow cytometry experiments. The PLC inhibitor U-73122 blocked both agonist- and cell swelling–induced ICl, swell, while its inactive analogue U-73343 had no effect. ICl(Ca) could be activated by cytoplasmic calcium increase due to thapsigargin (TG)-induced SOCE as well as by buffering [Ca2+]i in the pipette solution at 500 nM. In contrast, ICl, swell could be directly activated by 1-oleoyl-2-acetyl-sn-glycerol (OAG), a cell-permeable DAG analogue, but neither by InsP3 infusion nor by the cytoplasmic calcium increase. PKC also had no role in its regulation. Agonists, OAG, and cell swelling induced ICl, swell in a nonadditive manner, suggesting their convergence on a common pathway. ICl, swell and ICl(Ca) showed only a limited overlap (i.e., simultaneous activation), although various maneuvers were able to induce these currents sequentially in the same cell. TG-induced SOCE strongly potentiated ICl(Ca), but abolished ICl, swell, thereby providing a clue for this paradox. Thus, we have established for the first time using a keratinocyte model that ICl, swell can be physiologically activated under isotonic conditions by receptors coupled to the phosphoinositide pathway. These results also suggest a novel function for SOCE, which can operate as a "selection" switch between closely localized channels.

Framework for Establishing Limits of Tabular Aerodynamic Models for Flight Dynamics Analysis

This paper describes the use of the Euler equations for the generation and testing of tabular aerodynamic models for flight dynamics analysis. Maneuvers for the AGARD Standard Dynamics Model sharp leading-edge wind-tunnel geometry are considered as a test case. Wind-tunnel data is first used to validate the prediction of static and dynamic coefficients at both low and high angles, featuring complex vortical flow, with good agreement obtained at low to moderate angles of attack. Then the generation of aerodynamic tables is described based on a data fusion approach. Time-optimal maneuvers are generated based on these tables, including level flight trim, pull-ups at constant and varying incidence, and level and 90 degrees turns. The maneuver definition includes the aircraft states and also the control deflections to achieve the motion. The main point of the paper is then to assess the validity of the aerodynamic tables which were used to define the maneuvers. This is done by replaying them, including the control surface motions, through the time accurate computational fluid dynamics code. The resulting forces and moments are compared with the tabular values to assess the presence of inadequately modeled dynamic or unsteady effects. The agreement between the tables and the replay is demonstrated for slow maneuvers. Increasing rate maneuvers show discrepancies which are ascribed to vortical flow hysteresis at the higher rate motions. The framework is suitable for application to more complex viscous flow models, and is powerful for the assessment of the validity of aerodynamics models of the type currently used for studies of flight dynamics.

Timing and mode of delivery in twins : the ongoing controversy

Tese de doutoramento, Medicina (Ginecologia e Obstetrícia), Universidade de Lisboa, Faculdade de Medicina, 2014

A memória do testemunho e a influência das emoções na recolha e preservação da prova

Tese de doutoramento, Ciências e Tecnologias da Saúde (Desenvolvimento Humano e Social), Universidade de Lisboa, Faculdade de Medicina, 2015

Application of fractional controllers for quad rotor

This paper studies the application of fractional algorithms in the control of a quad-rotor rotorcraft. The development of a flight simulator provide the evaluation of the controller algorithm. Several basic maneuvers are investigated, namely the elevation and the position control.

Influência de diferentes estratégias de estabilização lombopélvica e de programas de exercícios de controlo motor no Active Straight Leg Raise

Introdução: O Active Straight Leg Raise (ASLR) tem sido sugerido como um indicador clínico da estabilidade lombopélvica. Estratégias passivas e ativas podem contribuir para aumentar esta estabilidade, assim como programas de exercício baseados nas mesmas estratégias ativas. Objetivos: Comparar os efeitos imediatos da compressão pélvica manual (CP), do drawing-in (DI) e do bracing abdominal (BA) durante o ASLR em indivíduos com e sem dor lombopélvica crónica e inespecífica, e avaliar o efeito prolongado das manobras de estabilização ativas através dos programas de exercícios de controlo motor, Pilates e McGill. Métodos: Estudo transversal, com uma amostra de 111 voluntários, 52 sem dor lombopélvica (NLPPG) e 59 com dor lombopélvica (LPPG), e estudo experimental, formado pelo LPPG dividido em 19 no grupo controlo (GC), 20 no grupo pilates (GP) e 20 no grupo mcgill (GMg). Foi avaliado o ASLR padrão, o ASLR com CP, o ASLR com DI e ASLR com BA. Os participantes foram avaliados antes e após as 8 semanas de implementação dos programas exercícios de McGill e Richardson, apenas aos respetivos grupos. Resultados: O LPPG apresentou significativamente maior score no ASLR comparativamente ao NLPPG (z=-9,361; p<0,001). Apesar do BA ter apresentado scores inferiores às restantes estratégias (p<0,001), todas elas foram capazes de diminuir o score do ASLR (p<0,001). Após a aplicação dos programas de exercícios, verificou-se que o GP (p<0,001) e o GMg (p<0,001) apresentaram scores significativamente menores no ASLR, relativamente ao GC. No GP e no GMg verificou-se uma diminuição do score do ASLR (Z=-4,028; p<0,001; Z=-4,179; p<0,001, respetivamente). Além disso, GMg apresentou uma tendência para apresentar menores scores do ASLR comparativamente ao GP. Conclusão: Qualquer uma destas manobras de estabilização quando adicionada ao ASLR pode aumentar a estabilidade lombopélvica, especialmente o BA. Os exercícios de Pilates e de McGill permitiram melhorar os scores do ASLR.

Vision-Based Assisted Teleoperation for Inspection Tasks with a Small ROV

It is well-known that ROVs require human intervention to guarantee the success of their assignment, as well as the equipment safety. However, as its teleoperation is quite complex to perform, there is a need for assisted teleoperation. This study aims to take on this challenge by developing vision-based assisted teleoperation maneuvers, since a standard camera is present in any ROV. The proposed approach is a visual servoing solution, that allows the user to select between several standard image processing methods and is applied to a 3-DOF ROV. The most interesting characteristic of the presented system is the exclusive use of the camera data to improve the teleoperation of an underactuated ROV. It is demonstrated through the comparison and evaluation of standard implementations of different vision methods and the execution of simple maneuvers to acquire experimental results, that the teleoperation of a small ROV can be drastically improved without the need to install additional sensors.

Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction.

PURPOSE: Implanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters. The aim of this study was to evaluate the feasibility, safety, and efficacy of these techniques. METHODS AND MATERIALS: Through a femoral or brachial venous access, a snare is used to remove fibrin sheath around the IVAD catheter tip. If device dysfunction is caused by catheter adherences to the vessel wall, a new "mechanical adhesiolysis" maneuver was performed. IVAD salvage procedures performed between 2005 and 2013 were analyzed. Data included clinical background, catheter tip position, success rate, recurrence, and rate of complication. RESULTS: Eighty-eight salvage procedures were performed in 80 patients, mostly women (52.5 %), with a mean age of 54 years. Only a minority (17.5 %) of evaluated catheters were located at an optimal position (i.e., cavoatrial junction ±1 cm). Mechanical adhesiolysis or other additional maneuvers were used in 21 cases (24 %). Overall technical success rate was 93.2 %. Malposition and/or vessel wall adherences were the main cause of technical failure. No complications were noted. CONCLUSION: These IVAD salvage techniques are safe and efficient. When a catheter is adherent to the vessel wall, mechanical adhesiolysis maneuvers allow catheter mobilization and a greater success rate with no additional risk. In patients who still require long-term use of their IVAD, these procedures can be performed safely to avoid catheter replacement.