Sensibilidade e especificidade no diagnóstico de hipertensão por diferentes métodos

OBJETIVO: Avaliar a sensibilidade e a especificidade de diferentes protocolos de medida da pressão arterial para o diagnóstico da hipertensão em adultos. MÉTODOS: Estudo transversal com amostra não probabilística de 250 funcionários de ambos os sexos de instituição pública na faixa etária de 35 a 74 anos em Vitória, ES, entre 2008 e 2010. Os participantes tiveram suas pressões arteriais aferidas por três métodos: medida clínica, automedida e medida ambulatorial por 24 horas. Foram coletados dados antropométricos (peso, estatura e circunferências) e realizada entrevista. Os métodos foram confrontados e analisados em relação à medida ambulatorial 24 h (padrão-ouro). Foram calculadas as medidas de desempenho diagnóstico: sensibilidade, especificidade, valores preditivos positivos e negativos e acurácia. A metodologia de Bland & Altman foi utilizada para verificar a concordância entre a variabilidade pressórica na medida ambulatorial (desvio-padrão relativo ao período diurno) e a variabilidade pressórica na automedida (desvio-padrão das quatro medidas). Adotou-se nível de significância de 5% para todos os testes. RESULTADOS: A automedida apresentou maior sensibilidade (S = 84%; IC95%: 75;93) e acurácia global (0,817; p < 0,001) no diagnóstico da hipertensão que a medida clínica (S = 79%; IC95%: 73;86 e AG = 0,815; p < 0,001). Apesar da forte correlação com o método de medida ambulatorial durante a vigília (r = 0,843; p = 0,000), a automedida não mostrou boa concordância com o referido método para a medida sistólica (viés = 5,82; IC95%: 4,49;7,15). Foram identificados sete (2,8%) indivíduos com hipertensão do avental branco, 26 (10,4%) com hipertensão mascarada e 46 (18,4%) com efeito do avental branco. CONCLUSÕES: Os resultados sugerem que a automedida apresenta sensibilidade superior à medida clínica para identificar verdadeiros hipertensos na população. Os valores de predição negativa encontrados confirmam a superioridade da automedida em relação à medida clínica no que tange à capacidade do teste em apontar os indivíduos verdadeiramente normotensos. Contudo, não pode substituir a medida clínica, que ainda é o método mais fidedigno.

Implementação do TFM na Sakthi Portugal com recurso à metodologia Kaizen

No âmbito da unidade curricular Dissertação/Projeto/Estágio do 2ºano do Mestrado em Engenharia mecânica – Ramo Gestão Industrial do Instituto Superior de Engenharia do Porto, o presente trabalho de dissertação foi enquadrado num projeto industrial de melhoria com Instituto Kaizen, empresa de consultoria operacional. O projeto foi desenvolvido numa empresa de produção de componentes em ferro nodular destinados à indústria automóvel do mercado europeu, a Sakthi Portugal,SA. A realização deste projeto teve como objetivo a implementação do sistema de planeamento em Pull (produção puxada) na logística interna da Sakthi Portugal,SA recorrendo à metodologia Kaizen. Esta metodologia consiste na aplicação de ferramentas de TFM - Total Flow Management, integradas no Kaizen Management System. Neste projeto recorreu-se especialmente a um dos pilares que o constituem, o pilar do “Fluxo da Logística Interna”. Neste pilar encontram-se as várias metodologias utilizadas na otimização do fluxo de material e informação na logística interna. Estas metodologias foram aplicadas, com o objetivo do sistema produtivo operar de acordo com a necessidade do cliente, obtendo deste modo a minimização dos custo e o aumento da produtividade e qualidade. Em resultado da aplicação da metodologia seguida, foi possível atingir-se os objetivos definidos inicialmente e em alguns casos foi possível superar esses objetivos. Em função da abordagem integrada que foi seguida, conseguiu-se uma diminuição do “lead time” do processo de fabrico, redução dos produtos em curso de fabrico, libertação de espaço e redução de inventários. Estas melhorias resultaram numa movimentação interna na fábrica mais facilitada e num aumento global da produtividade. Como consequência positiva dos efeitos deste trabalho, pode-se apontar o facto de que a Sakthi Portugal SA aumentou a sua competitividade por tornar-se numa empresa mais dinâmica, mais adaptada ao mercado e com níveis de satisfação do cliente muito superiores.

Melhoria da eficiência energética do processo de produção de molas para a indústria automóvel

Trabalho Final de Mestrado para obtenção do grau de Mestre em Engenharia Química e Biológica

Ethernet-based systems: contributions to the holistic analysis

A number of characteristics are boosting the eagerness of extending Ethernet to also cover factory-floor distributed real-time applications. Full-duplex links, non-blocking and priority-based switching, bandwidth availability, just to mention a few, are characteristics upon which that eagerness is building up. But, will Ethernet technologies really manage to replace traditional Fieldbus networks? To this question, Fieldbus fundamentalists often argue that the two technologies are not comparable. In fact, Ethernet technology, by itself, does not include features above the lower layers of the OSI communication model. Where are the higher layers that permit building real industrial applications? And, taking for free that they are available, what is the impact of those protocols, mechanisms and application models on the overall performance of Ethernetbased distributed factory-floor applications? In this paper we provide some contributions that may pave the way towards providing some reasonable answers to these issues.

From simulation to statistical analysis: timeliness assessment of ethernet/IP-based distributed systems

A number of characteristics are boosting the eagerness of extending Ethernet to also cover factory-floor distributed real-time applications. Full-duplex links, non-blocking and priority-based switching, bandwidth availability, just to mention a few, are characteristics upon which that eagerness is building up. But, will Ethernet technologies really manage to replace traditional Fieldbus networks? Ethernet technology, by itself, does not include features above the lower layers of the OSI communication model. In the past few years, it is particularly significant the considerable amount of work that has been devoted to the timing analysis of Ethernet-based technologies. It happens, however, that the majority of those works are restricted to the analysis of sub-sets of the overall computing and communication system, thus without addressing timeliness at a holistic level. To this end, we are addressing a few inter-linked research topics with the purpose of setting a framework for the development of tools suitable to extract temporal properties of Commercial-Off-The-Shelf (COTS) Ethernet-based factory-floor distributed systems. This framework is being applied to a specific COTS technology, Ethernet/IP. In this paper, we reason about the modelling and simulation of Ethernet/IP-based systems, and on the use of statistical analysis techniques to provide usable results. Discrete event simulation models of a distributed system can be a powerful tool for the timeliness evaluation of the overall system, but particular care must be taken with the results provided by traditional statistical analysis techniques.

Engineering hybrid wired/wireless fieldbus networks - a case study

Advances in networking and information technologies are transforming factory-floor communication systems into a mainstream activity within industrial automation. It is now recognized that future industrial computer systems will be intimately tied to real-time computing and to communication technologies. For this vision to succeed, complex heterogeneous factory-floor communication networks (including mobile/wireless components) need to function in a predictable, flawless, efficient and interoperable way. In this paper we re-visit the issue of supporting real-time communications in hybrid wired/wireless fieldbus-based networks, bringing into it some experimental results obtained in the framework of the RFieldbus ISEP pilot.

Industrial ethernet: building blocks for a holistic approach

For industrial environments it is true that Ethernet technologies are there to stay. In fact, a number of characteristics are boosting the eagerness of extending Ethernet to also cover factory-floor applications. Fullduplex links, non-blocking and priority-based switching, bandwidth availability, just to mention a few, are characteristics upon which that eagerness is building up. But, will Ethernet technologies really manage to replace traditional field bus networks? Fieldbus fundamentalists often argue that the two things are not comparable. In fact, Ethernet technology, by itself, does not include features above the lower layers of the OSI communication model. Where are the higher layers and the application enablers that permit building real industrial applications? And, taking for free that they are available, what is the impact of those protocols, mechanisms and application models on the overall performance of Ethernet-based distributed factory-floor applications?

Position paper on time and event-triggered communication services in the context of e-manufacturing

Modern factories are complex systems where advances in networking and information technologies are opening new ways towards higher efficiency. Such move is being driven by market rules with ever-increasing competition levels, in search for faster time-to-market, improved process yield, non-stop operations, flexible manufacturing and tighter supply-chain coupling. All these aims present a common requirement, i.e. a realtime flow of information, from the plant-floor up to the management, maintenance, suppliers and clients, to support accurate monitoring and control of the factory. This stresses the importance achieved by the communication infrastructure in modern manufacturing industry. This paper presents the authors view concerning the current trends in modern factory communication systems. It addresses the problems of seamlessly integrating different information flows with diverse requirements, mainly in terms of timeliness. In this aspect, the debate between event-triggered and time-triggered communication is revisited as well as the joint support for both types of traffic. Finally, a view of where factory communication systems are moving to is also presented, showing the impact of open and widely available technologies.

Industrial multimedia put into practice

Recent developments in the factory floor technologies together with the widespread use of TCP/IP and the Internet are increasing the eagerness to support a new wide class of devices and applications, such as industrial multimedia applications, in factory floor networks. This paper presents how this new field of applications can be put into practice, via a manufacturing cell field trial being implemented. This manufacturing automation field trial involves the use of traditional distributed computer control systems and 'factory-floor-oriented' multimedia (e.g. voice, video) application services.

Ethernet goes real-time: a survey on research and technological developments

Ethernet is the most popular LAN technology. Its low price and robustness, resulting from its wide acceptance and deployment, has created an eagerness to expand its responsibilities to the factory-floor, where real-time requirements are to be fulfilled. However, it is difficult to build a real-time control network using Ethernet, because its MAC protocol, the 1-persistent CSMA/CD protocol with the BEB collision resolution algorithm, has unpredictable delay characteristics. Many anticipate that the recent technological advances in Ethernet such as the emerging Fast/Gigabit Ethernet, micro-segmentation and full-duplex operation using switches will also enable it to support time-critical applications. This technical report provides a comprehensive look at the unpredictability inherent to Ethernet and at recent technological advances towards real-time operation.

Queuing and routing in a hierarchical powerline communication system

Although power-line communication (PLC) is not a new technology, its use to support data communication with timing requirements is still the focus of ongoing research. A new infrastructure intended for communication using power lines from a central location to dispersed nodes using inexpensive devices was presented recently. This new infrastructure uses a two-level hierarchical power-line system, together with an IP-based network. Due to the master-slave behaviour of the PLC medium access, together with the inherent dynamic topology of power-line networks, a mechanism to provide end-to-end communication through the two levels of the power-line system must be provided. In this paper we introduce the architecture of the PLC protocol layer that is being implemented for this end.

Timing analysis of a multiple logical ring wired/wireless PROFIBUS network

Recently, there have been a few research efforts towards extending the capabilities of fieldbus networks to encompass wireless support. In previous works we have proposed a hybrid wired/wireless PROFIBUS network solution where the interconnection between the heterogeneous communication media was accomplished through bridge-like interconnecting devices. The resulting networking architecture embraced a multiple logical ring (MLR) approach, thus with multiple independent tokens, to which a specific bridging protocol extension, the inter-domain protocol (IDP), was proposed. The IDP offers compatibility with standard PROFIBUS, and includes mechanisms to support inter-cell mobility of wireless nodes. We advance that work by proposing a worst-case response timing analysis of the IDP.

INDEPTH: timeliness assessment of ethernet/IP-based systems

The continuous improvement of Ethernet technologies is boosting the eagerness of extending their use to cover factory-floor distributed real time applications. Indeed, it is remarkable the considerable amount of research work that has been devoted to the timing analysis of Ethernet-based technologies in the past few years. It happens, however, that the majority of those works are restricted to the analysis of sub-sets of the overall computing and communication system, thus without addressing timeliness in a holistic fashion. To this end, we address an approach, based on simulation, aiming at extracting temporal properties of commercial-off-the-shelf (COTS) Ethernet-based factory-floor distributed systems. This framework is applied to a specific COTS technology, Ethernet/IP. We reason about the modeling and simulation of Ethernet/IP-based systems, and on the use of statistical analysis techniques to provide useful results on timeliness. The approach is part of a wider framework related to the research project INDEPTH NDustrial-Ethernet ProTocols under Holistic analysis.

Enabling inter-domain transactions in bridge-based hybrid wired/wireless PROFIBUS networks

The marriage of emerging information technologies with control technologies is a major driving force that, in the context of the factory-floor, is creating an enormous eagerness for extending the capabilities of currently available fieldbus networks to cover functionalities not considered up to a recent past. Providing wireless capabilities to such type of communication networks is a big share of that effort. The RFieldbus European project is just one example, where PROFIBUS was provided with suitable extensions for implementing hybrid wired/wireless communication systems. In RFieldbus, interoperability between wired and wireless components is achieved by the use specific intermediate networking systems operating as repeaters, thus creating a single logical ring (SLR) network. The main advantage of the SLR approach is that the effort for protocol extensions is not significant. However, a multiple logical ring (MLR) approach provides traffic and error isolation between different network segments. This concept was introduced in, where an approach for a bridge-based architecture was briefly outlined. This paper will focus on the details of the inter-Domain Protocol (IDP), which is responsible for handling transactions between different network domains (wired or wireless) running the PROFIBUS protocol.

Doenças crônicas não transmissíveis no Brasil: prioridade para enfrentamento e investigação

As Doenças Crônicas Não Transmissíveis representam a maior carga de morbimortalidade no Brasil. Em 2011, o Ministério da Saúde lançou seu Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis, enfatizando ações populacionais para controlar as doenças cardiovasculares, diabetes, câncer e doença respiratória crônica, predominantemente pelo controle do fumo, inatividade física, alimentação inadequada e uso prejudicial de álcool. Apesar da produção científica significativa sobre essas doenças e seus fatores de risco no Brasil, poucos são os estudos de coorte nessa temática. Nesse contexto, o Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil) acompanha 15.105 servidores públicos do País. Seus dados espelham a realidade brasileira de altas prevalências de diabetes e hipertensão e dos fatores de risco. A diversidade das informações produzidas permitirá aprofundar o entendimento causal dessas doenças e subsidiar políticas públicas para seu enfrentamento.