974 resultados para Medical Design
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This paper addresses the challenging task of computing multiple roots of a system of nonlinear equations. A repulsion algorithm that invokes the Nelder-Mead (N-M) local search method and uses a penalty-type merit function based on the error function, known as 'erf', is presented. In the N-M algorithm context, different strategies are proposed to enhance the quality of the solutions and improve the overall efficiency. The main goal of this paper is to use a two-level factorial design of experiments to analyze the statistical significance of the observed differences in selected performance criteria produced when testing different strategies in the N-M based repulsion algorithm. The main goal of this paper is to use a two-level factorial design of experiments to analyze the statistical significance of the observed differences in selected performance criteria produced when testing different strategies in the N-M based repulsion algorithm.
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For efficient planning of waste collection routing, large municipalities may be partitioned into convenient sectors. The real case under consideration is the municipality of Monção, in Portugal. Waste collection involves more than 1600 containers over an area of 220 km2 and a population of around 20,000 inhabitants. This is mostly a rural area where the population is distributed in small villages around the 33 boroughs centres (freguesia) that constitute the municipality. In most freguesias, waste collection is usually conducted 3 times a week. However, there are situations in which the same collection is done every day. The case reveals some general and specific characteristics which are not rare, but are not widely addressed in the literature. Furthermore, new methods and models to deal with sectorization and routing are introduced, which can be extended to other applications. Sectorization and routing are tackled following a three-phase approach. The first phase, which is the main concern of the presentation, introduces a new method for sectorization inspired by Electromagnetism and Coulomb’s Law. The matter is not only about territorial division, but also the frequency of waste collection, which is a critical issue in these types of applications. Special characteristics related to the number and type of deposition points were also a motivation for this work. The second phase addresses the routing problems in each sector: new Mixed Capacitated Arc Routing with Limited Multi-Landfills models will be presented. The last phase integrates Sectoring and Routing. Computational results confirm the effectiveness of the entire novel approach.
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OBJECTIVE: Long-term follow-up after endovascular aneurysm repair (EVAR) is very scarce, and doubt remains regarding the durability of these procedures. We designed a retrospective cohort study to assess long-term clinical outcome and morphologic changes in patients with abdominal aortic aneurysms (AAAs) treated by EVAR using the Excluder endoprosthesis (W. L. Gore and Associates, Flagstaff, Ariz). METHODS: From 2000 to 2007, 179 patients underwent EVAR in a tertiary institution. Clinical data were retrieved from a prospective database. All patients treated with the Excluder endoprosthesis were included. Computed tomography angiography (CTA) scans were retrospectively analyzed preoperatively, at 30 days, and at the last follow-up using dedicated tridimensional reconstruction software. For patients with complications, all remaining CTAs were also analyzed. The primary end point was clinical success. Secondary end points were freedom from reintervention, sac growth, types I and III endoleak, migration, conversion to open repair, and AAA-related death or rupture. Neck dilatation, renal function, and overall survival were also analyzed. RESULTS: Included were 144 patients (88.2% men; mean age, 71.6 years). Aneurysms were ruptured in 4.9%. American Society of Anesthesiologists classification was III/IV in 61.8%. No patients were lost during a median follow-up of 5.0 years (interquartile range, 3.1-6.4; maximum, 11.2 years). Two patients died of medical complications ≤ 30 days after EVAR. The estimated primary clinical success rates at 5 and 10 years were 63.5% and 41.1%, and secondary clinical success rates were 78.3% and 58.3%, respectively. Sac growth was observed in 37 of 142 patients (26.1%). Cox regression showed type I endoleak during follow-up (hazard ratio, 3.74; P = .008), original design model (hazard ratio, 3.85; P = .001), and preoperative neck diameter (1.27 per mm increase, P = .006) were determinants of sac growth. Secondary interventions were required in 32 patients (22.5%). The estimated 10-year rate of AAA-related death or rupture was 2.1%. Overall life expectancy after AAA repair was 6.8 years. CONCLUSIONS: EVAR using the Excluder endoprosthesis provides a safe and lasting treatment for AAA, despite the need for maintained surveillance and secondary interventions. At up to 11 years, the risk of AAA-related death or postimplantation rupture is remarkably low. The incidences of postimplantation sac growth and secondary intervention were greatly reduced after the introduction of the low-permeability design in 2004.
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No nosso contexto hiper-moderno, há factores que influenciam a nossa percepção e consequente grau de afeição ou rejeição para com as entidades. Pese embora o facto de que a marca gráfica (desvinculada do signo tipográfico) ser uma parcela dentro do conjunto maior do design de identidade, esta merece ser estudada na actual conjuntura: uma conjuntura onde está presente uma crise financeira e social, com altos níveis de desemprego e situações que, embora não sendo nefastas, não devem ser ignoradas – como é o caso da crescente criação de identidades em outsourcing ou da maior acessibilidade aos computadores e processos criativos por parte de designers e não designers. O nosso principal objectivo é o de criar um um manual de práticas compilando uma gramática da marca gráfica que a explicite aos jovens designers. Já verificamos que esta ferramenta pode ser transferida para conceber e analisar outros artefactos gráficos. Pretendemos examinar se são válidos na contemporaneidade os axiomas da gestalt ou os preceitos formulados nos anos 50/60 como os de Jacques Bertin, continuando a ser uma boa base no processo de criação e percepção das marcas gráficas. Com a mudança de paradigmas que as novas tecnologias forjaram no zeitgeist do design e na actual conjuntura, procuramos confirmar se esses preceitos são válidos tanto nas marcas intemporais como nas marcas contemporâneas e fluídas, e criar uma ferramenta pedagógica que contribua para implementar uma literacia visual que descodifique este signo icónico, dentro desta nova realidade. Nela, com o acesso aos novos meios digitais, de interacção e colaboração, surgem expressões emotivas por parte de designers, estudantes e utilizadores nos sites da especialidade, sobre marcas gráficas, provando o interesse no objectivo deste projecto em curso.
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In this paper, a module for homograph disambiguation in Portuguese Text-to-Speech (TTS) is proposed. This module works with a part-of-speech (POS) parser, used to disambiguate homographs that belong to different parts-of-speech, and a semantic analyzer, used to disambiguate homographs which belong to the same part-of-speech. The proposed algorithms are meant to solve a significant part of homograph ambiguity in European Portuguese (EP) (106 homograph pairs so far). This system is ready to be integrated in a Letter-to-Sound (LTS) converter. The algorithms were trained and tested with different corpora. The obtained experimental results gave rise to 97.8% of accuracy rate. This methodology is also valid for Brazilian Portuguese (BP), since 95 homographs pairs are exactly the same as in EP. A comparison with a probabilistic approach was also done and results were discussed.
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In the present study the frequencies of immunity against hepatitis B (HB) and of potentially contaminating accidents among medical students of a Brazilian public university were evaluated. Of all the 400 students who should have been immunized, 303 (75.7%), 66.3% of whom were women, answered an anonymous, self-administered questionnaire. Serum anti-HBs were determined in 205 of them and titers > 10 UI/L were considered to be protective. A total of 86.8% of students had received three doses of HB vaccine. The frequency of immunity among women (96.4%) was higher (p = 0.04) than that among men (87.7%). Among those who did not have immunity, 12/13 (92.3%) had been vaccinated before entering medical school. Only 11% of the students with complete vaccination had previously verified serological response to the vaccine. A total of 23.6% reported having been somehow exposed to blood or secretions. Among final-year students, this frequency was 45.0%, being similar among men (47.8%) and women (43.2%). Of all these accidents, 57.7% were due to body fluids coming in contact with mucosa and 42.3% due to cut and puncture accidents. The results from this study show that: 1) the frequency of immunity against HB is high among the evaluated medical students, although verification of response to vaccination is not a concern for them; 2) anti-HBs titers should be verified after complete vaccination and on a regular basis, especially by men; and 3) the frequency of potentially contaminating accidents is high.
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The inter-disciplinarity of information systems, applied discipline and activity of design, and the study from different paradigms perspectives explains the diversity of problems addressed. The context is broad and includes important issues beyond technology, as the application, use, effectiveness, efficiency and their organizational and social impacts. In design science, the research interest is in contributing to the improvement of the processes of the design activity itself. The relevance of research in design science is associated with the result obtained for the improvement of living conditions in organizational, inter-organizational and Society contexts. In the research whose results are artifacts, the adoption of design research as a process of research is crucial to ensure discipline, rigor and transparency. Based on a literature review, this paper clarifies the terms of design science and design research. This is the main motivation for presenting this paper, determinant for the phase in research in technologies and information systems which are the three research projects presented. As a result the three projects are discussed in relation to the concepts of design science and design research.
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In a scientific research project is important to define the underlying philosophical orientation of the project, because this will influence the choices made in respect of scientific methods used, as well as the way they will be applied. It is crucial, therefore, that the philosophy and research design strategy are consistent with each other. These questions become even more relevant in qualitative research. Historically, the interpretive research philosophy is more associated to the scientific areas of social sciences and humanities where the subjectivity inherent to human intervention is more explicitly defined. Information systems field are, primarily, trapped in computer science field, though it also integrates issues related with management and organizations field. This shift from a purely technological guidance for the consideration of the problems of management and organizations has fostered the rise of research projects according to the interpretive philosophy and using qualitative methods. This paper explores the importance of alignment between the epistemological orientation and research design strategy, in qualitative research projects. As a result, it is presented two PhD projects, with different research design strategies, that are being developed in the technology and information systems field, in the light of the interpretive paradigm.
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BACKGROUND: The Ethiopian mountain adder (Bitis parviocula) is a viperid known only from a few locations in southwestern Ethiopia. METHODS: a total of 30 µg of B. arietans and B. parviocula venoms were run on a 10-20% Tricine gel. To assay lethality dose fifty (LD50), five groups of eight mice for each venom were used. Hemorrhagic activity for crude venom was tested. Fibrinogenolytic activity of crude venom was measured using (2.5 mg/mL) of fibrinogen solution and (0.03 mg/mL) of crude venom. Gelatinase activity of the venom was tested on a Kodak X-OMAT TM film. Crude venoms of B. parviocula and B. arietans were tested for their abilities to affect clotting time, clotting rate and platelet function on whole human blood. RESULTS: The (SAIMR) antivenom was confirmed in this study to neutralize the lethal activity of venom from Bitis parviocula. The ED50s of SAIMR antivenom on B. parviocula and B. arietans neutralized half of 18.2 and 66.7 mg of venom, respectively. The hemorrhagic activities (MHDs) of B. parviocula and B. arietans were 0.88 and 1.7 µg, respectively. Bitis arietans and B. parviocula venoms degradated α and β chains at different times. The γ chains remained unaffected. Bitis parviocula venom did not exhibit gelatinase activity, while B. arietans had a MGD of 6.9 µg. At 3 mg/mL, the crude venoms of B. parviocula and B. arietans did not significantly affect clotting time or clotting rate. CONCLUSIONS: The SAIMR antivenom is very effective in neutralizing the venom of B. parviocula and should be considered in treating envenomations by these snakes.
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The aim of this cross-sectional study was to determine, among medical students at a public university in Rio de Janeiro, Brazil, the acceptance of the pandemic influenza A/H1N1 vaccine during the 2010 mass immunization campaign and the vaccine safety in this group and, among unvaccinated students, the reasons for refusing vaccination. Of a total of 858 students, 678 (79%) participated in the study. Vaccination coverage was 60.4% among students aged 20 to 39 years (an age group targeted for vaccination) and 43.8% among those who did not belong to this age group. The most frequent adverse reactions to the vaccine were pain at the injection site (8.7%) and fever (7.9%). There were no serious adverse reactions. Among students aged 20 to 39 years, the most common reasons for refusing the vaccine were "lack of time" (42.4%), "fear of adverse reactions" (41.9%), and "difficult access to the vaccine" (11.5%). Other reasons for vaccine refusal were "uncertainties about vaccine safety and efficacy" and "vaccination was not needed". To increase the acceptance of the influenza vaccine, a comprehensive immunization program should be offered to these students.
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The authors present a case of a 27-year-old multiparous woman, with multiple thrombophilia, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter. At 15th week of gestation, following an acute deep venous thrombosis of the right inferior limb, anticoagulant therapy with low-molecular-weight heparin (LMWH) was instituted without improvement in her clinical status. Subsequently, at 18 weeks of pregnancy, LMWH was switched to warfarin. At 30th week of gestation, the maintenance of high thrombotic risk was the premise for placement of an inferior vena cava filter for prophylaxis of pulmonary embolism during childbirth and postpartum. There were no complications and a vaginal delivery was accomplished at 37 weeks of gestation. Venal placement of inferior vena cava filters is an attractive option as prophylaxis for pulmonary embolism during pregnancy.
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Dissertação para obtenção do Grau de Mestre em Engenharia Electrotécnica e de Computadores
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A cross-sectional study was conducted to assess the frequencies and characteristics of occupational exposures among medical and nursing students at a Brazilian public university, in addition to their prevention and post-exposure behavior. During the second semester of 2010, a self-administered semi-structured questionnaire was completed by 253/320 (79.1%) medical students of the clinical course and 149/200 (74.5%) nursing students who were already performing practical activities. Among medical students, 53 (20.9%) suffered 73 injuries, which mainly occurred while performing extra-curricular activities (32.9%), with cutting and piercing objects (56.2%), in the emergency room (39.7%), and as a result of lack of technical preparation or distraction (54.8%). Among nursing students, 27 (18.1%) suffered 37 injuries, which mainly occurred with hollow needles (67.6%) in the operating room or wards (72.2%), and as a result of lack of technical preparation or distraction (62.1%). Among medical and nursing students, respectively, 96.4% and 48% were dissatisfied with the instructions on previously received exposure prevention; 48% and 18% did not always use personal protective equipment; 67.6% and 16.8% recapped used needles; 49.3% and 35.1% did not bother to find out the source patient's serological results post-exposure; and 1.4% and 18.9% officially reported injuries. In conclusion, this study found high frequencies of exposures among the assessed students, inadequate practices in prevention and post-exposure, and, consequently, the need for training in “standard precautions” to prevent such exposures.
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Dissertação para obtenção do Grau de Mestre em Engenharia Biomédica
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The aim of this cross-sectional study was to determine the hepatitis B vaccination coverage among medical students at a public university in Rio de Janeiro, Brazil, and their compliance with the postvaccination serologic testing recommendations. Of the total of 858 students, 675 (78.7%) participated in the study. Among the participants, 48.9% (95% CI: 45.1% to 52.7%) were vaccinated against hepatitis B (received ≥ 3 doses of the vaccine), 31.6% were not (received 0, 1 or 2 doses), and 19.6% did not know their vaccination status. Hepatitis B vaccination coverage increased from 26.0% among first-year students to 70.6% among sixth-year students while the prevalence of unknown vaccination status decreased from 39.7% among first-year students to 2.4% among sixth-year students. The frequency of unvaccinated students ranged from 23.7% among fifth-year students to 34.4% among first-year students. Only 34.8% of the vaccinated students performed the anti-HBs testing after vaccination. Among these medical students, we found a low adherence to the hepatitis B vaccination and to the postvaccination serologic testing. A comprehensive hepatitis B immunization program should be offered to students at this medical school.