Projetos de cuidado em Fisioterapia

As práticas de cuidado em fisioterapia, em muitas situações, resgatam a função do fisioterapeuta de executor de técnicas que lhe era atribuída nos primórdios da profissão. Ao exercer essa função meramente técnica, muitas vezes deixando-se substituir pelo equipamento nas suas ações, o profissional compromete o estabelecimento do vínculo terapeuta-paciente, contribuindo para o esvaziamento do encontro em saúde. Nessas situações, predomina o êxito técnico (a eficiência na realização do procedimento) sobre o sucesso prático (os benefícios trazidos para vida das pessoas). Para que o sucesso prático seja atingido, é fundamental que haja o questionamento sobre o que sonham as pessoas, profissionais e pacientes, para as suas vidas e para a saúde, quais são suas perspectivas e projetos de vida, seus projetos de felicidade. Nesse sentido, é imprescindível considerar, também, os projetos de felicidade dos profissionais da saúde enquanto sujeitos desse encontro. Afinal, é a partir deles que o profissional elabora o seu projeto de cuidado para cada paciente. Assim, esse trabalho buscou compreender os elementos que configuram a construção de projetos de cuidado em fisioterapia a partir da reflexão dos próprios fisioterapeutas. Para tanto, utilizou-se a metodologia qualitativa de pesquisa por meio de entrevistas semi-estruturadas para que fossem produzidas narrativas da história de vida do trabalho. Os discursos foram analisados integralmente e a categorização foi feita em três sub-temas: exercício profissional, relação com os pacientes e reflexões. Foi possível perceber que muitos dos arranjos de trabalho estabelecidos visam coibir o vínculo profissional-paciente, transformando-o em valor de troca e mercantilizando a relação terapêutica. Expropriada do vínculo, a prática se resume à realização de procedimentos independentes de sua finalidade, minando as possibilidades de sucesso prático. Nesse caso, não é a tecnologia que gera o afastamento e a mecanização, mas são as estratégias de mercantilização do cuidado fisioterápico. Essa situação só pode ocorrer por um processo de subordinação do profissional e seu saber, o que está fortemente associado a condições de trabalho exploratórias. Podemos dizer que a mercantilização do cuidado facilita a restrição sobre as condições de trabalho e também é fruto dela. O problema é que essa restrição é vista pelos profissionais como não definitiva, mas como um caminho para se alcançar reconhecimento na busca pelo exercício liberal da fisioterapia. A intenção desse estudo não foi traçar um plano normativo de conduta para a profissão, mas imaginamos que o equacionamento dessas questões passa necessariamente pelo reconhecimento, pelas inquietações e indignações com o problema. O que se espera, portanto, é facilitar esse processo de desconforto por meio da proximidade dessas questões trazidas pelas narrativas.

High pressure states in condensed matter: I. High pressure behavior of the iron-sulphur system with applications to the earth's core. II. Empirical equation of state for organic compounds at high pressures

Part I:

The earth's core is generally accepted to be composed primarily of iron, with an admixture of other elements. Because the outer core is observed not to transmit shear waves at seismic frequencies, it is known to be liquid or primarily liquid. A new equation of state is presented for liquid iron, in the form of parameters for the 4th order Birch-Murnaghan and Mie-Grüneisen equations of state. The parameters were constrained by a set of values for numerous properties compiled from the literature. A detailed theoretical model is used to constrain the P-T behavior of the heat capacity, based on recent advances in the understanding of the interatomic potentials for transition metals. At the reference pressure of 10⁵ Pa and temperature of 1811 K (the normal melting point of Fe), the parameters are: ρ = 7037 kg/m³, K_S0 = 110 GPa, K_S' = 4.53, K_S" = -.0337 GPa-1, and γ = 2.8, with γ α ρ^-1.17. Comparison of the properties predicted by this model with the earth model PREM indicates that the outer core is 8 to 10 % less dense than pure liquid Fe at the same conditions. The inner core is also found to be 3 to 5% less dense than pure liquid Fe, supporting the idea of a partially molten inner core. The density deficit of the outer core implies that the elements dissolved in the liquid Fe are predominantly of lower atomic weight than Fe. Of the candidate light elements favored by researchers, only sulfur readily dissolves into Fe at low pressure, which means that this element was almost certainly concentrated in the core at early times. New melting data are presented for FeS and FeS₂ which indicate that the FeS₂ is the S-hearing liquidus solid phase at inner core pressures. Consideration of the requirement that the inner core boundary be observable by seismological means and the freezing behavior of solutions leads to the possibility that the outer core may contain a significant fraction of solid material. It is found that convection in the outer core is not hindered if the solid particles are entrained in the fluid flow. This model for a core of Fe and S admits temperatures in the range 3450K to 4200K at the top of the core. An all liquid Fe-S outer core would require a temperature of about 4900 K at the top of the core.

Part II.

The abundance of uses for organic compounds in the modern world results in many applications in which these materials are subjected to high pressures. This leads to the desire to be able to describe the behavior of these materials under such conditions. Unfortunately, the number of compounds is much greater than the number of experimental data available for many of the important properties. In the past, one approach that has worked well is the calculation of appropriate properties by summing the contributions from the organic functional groups making up molecules of the compounds in question. A new set of group contributions for the molar volume, volume thermal expansivity, heat capacity, and the Rao function is presented for functional groups containing C, H, and O. This set is, in most cases, limited in application to low molecular liquids. A new technique for the calculation of the pressure derivative of the bulk modulus is also presented. Comparison with data indicates that the presented technique works very well for most low molecular hydrocarbon liquids and somewhat less well for oxygen-bearing compounds. A similar comparison of previous results for polymers indicates that the existing tabulations of group contributions for this class of materials is in need of revision. There is also evidence that the Rao function contributions for polymers and low molecular compounds are somewhat different.

Smooth sets for borel equivalence relations and the covering property for σ-ideals of compact sets

This thesis is divided into three chapters. In the first chapter we study the smooth sets with respect to a Borel equivalence realtion E on a Polish space X. The collection of smooth sets forms σ-ideal. We think of smooth sets as analogs of countable sets and we show that an analog of the perfect set theorem for Σ¹₁ sets holds in the context of smooth sets. We also show that the collection of Σ¹₁ smooth sets is ∏¹₁ on the codes. The analogs of thin sets are called sparse sets. We prove that there is a largest ∏¹₁ sparse set and we give a characterization of it. We show that in L there is a ∏¹₁ sparse set which is not smooth. These results are analogs of the results known for the ideal of countable sets, but it remains open to determine if large cardinal axioms imply that ∏¹₁ sparse sets are smooth. Some more specific results are proved for the case of a countable Borel equivalence relation. We also study I(E), the σ-ideal of closed E-smooth sets. Among other things we prove that E is smooth iff I(E) is Borel.

In chapter 2 we study σ-ideals of compact sets. We are interested in the relationship between some descriptive set theoretic properties like thinness, strong calibration and the covering property. We also study products of σ-ideals from the same point of view. In chapter 3 we show that if a σ-ideal I has the covering property (which is an abstract version of the perfect set theorem for Σ¹₁ sets), then there is a largest ∏¹₁ set in I^int (i.e., every closed subset of it is in I). For σ-ideals on 2^ω we present a characterization of this set in a similar way as for C₁, the largest thin ∏¹₁ set. As a corollary we get that if there are only countable many reals in L, then the covering property holds for Σ¹₂ sets.

Source characteristics of recent and historic earthquakes in Central and Southern California: results from forward modeling

The long- and short-period body waves of a number of moderate earthquakes occurring in central and southern California recorded at regional (200-1400 km) and teleseismic (> 30°) distances are modeled to obtain the source parameters-focal mechanism, depth, seismic moment, and source time history. The modeling is done in the time domain using a forward modeling technique based on ray summation. A simple layer over a half space velocity model is used with additional layers being added if necessary-for example, in a basin with a low velocity lid.

The earthquakes studied fall into two geographic regions: 1) the western Transverse Ranges, and 2) the western Imperial Valley. Earthquakes in the western Transverse Ranges include the 1987 Whittier Narrows earthquake, several offshore earthquakes that occurred between 1969 and 1981, and aftershocks to the 1983 Coalinga earthquake (these actually occurred north of the Transverse Ranges but share many characteristics with those that occurred there). These earthquakes are predominantly thrust faulting events with the average strike being east-west, but with many variations. Of the six earthquakes which had sufficient short-period data to accurately determine the source time history, five were complex events. That is, they could not be modeled as a simple point source, but consisted of two or more subevents. The subevents of the Whittier Narrows earthquake had different focal mechanisms. In the other cases, the subevents appear to be the same, but small variations could not be ruled out.

The recent Imperial Valley earthquakes modeled include the two 1987 Superstition Hills earthquakes and the 1969 Coyote Mountain earthquake. All are strike-slip events, and the second 1987 earthquake is a complex event With non-identical subevents.

In all the earthquakes studied, and particularly the thrust events, constraining the source parameters required modeling several phases and distance ranges. Teleseismic P waves could provide only approximate solutions. P_(nl) waves were probably the most useful phase in determining the focal mechanism, with additional constraints supplied by the SH waves when available. Contamination of the SH waves by shear-coupled PL waves was a frequent problem. Short-period data were needed to obtain the source time function.

In addition to the earthquakes mentioned above, several historic earthquakes were also studied. Earthquakes that occurred before the existence of dense local and worldwide networks are difficult to model due to the sparse data set. It has been noticed that earthquakes that occur near each other often produce similar waveforms implying similar source parameters. By comparing recent well studied earthquakes to historic earthquakes in the same region, better constraints can be placed on the source parameters of the historic events.

The Lompoc earthquake (M=7) of 1927 is the largest offshore earthquake to occur in California this century. By direct comparison of waveforms and amplitudes with the Coalinga and Santa Lucia Banks earthquakes, the focal mechanism (thrust faulting on a northwest striking fault) and long-period seismic moment (10^(26) dyne cm) can be obtained. The S-P travel times are consistent with an offshore location, rather than one in the Hosgri fault zone.

Historic earthquakes in the western Imperial Valley were also studied. These events include the 1942 and 1954 earthquakes. The earthquakes were relocated by comparing S-P and R-S times to recent earthquakes. It was found that only minor changes in the epicenters were required but that the Coyote Mountain earthquake may have been more severely mislocated. The waveforms as expected indicated that all the events were strike-slip. Moment estimates were obtained by comparing the amplitudes of recent and historic events at stations which recorded both. The 1942 event was smaller than the 1968 Borrego Mountain earthquake although some previous studies suggested the reverse. The 1954 and 1937 earthquakes had moments close to the expected value. An aftershock of the 1942 earthquake appears to be larger than previously thought.

Part I - The radiation of elastic waves from a spherical cavity in a half space. Part II - Precision determination of focal depths and epicenters of earthquakes.

Part I: The dynamic response of an elastic half space to an explosion in a buried spherical cavity is investigated by two methods. The first is implicit, and the final expressions for the displacements at the free surface are given as a series of spherical wave functions whose coefficients are solutions of an infinite set of linear equations. The second method is based on Schwarz's technique to solve boundary value problems, and leads to an iterative solution, starting with the known expression for the point source in a half space as first term. The iterative series is transformed into a system of two integral equations, and into an equivalent set of linear equations. In this way, a dual interpretation of the physical phenomena is achieved. The systems are treated numerically and the Rayleigh wave part of the displacements is given in the frequency domain. Several comparisons with simpler cases are analyzed to show the effect of the cavity radius-depth ratio on the spectra of the displacements.

Part II: A high speed, large capacity, hypocenter location program has been written for an IBM 7094 computer. Important modifications to the standard method of least squares have been incorporated in it. Among them are a new way to obtain the depth of shocks from the normal equations, and the computation of variable travel times for the local shocks in order to account automatically for crustal variations. The multiregional travel times, largely based upon the investigations of the United States Geological Survey, are confronted with actual traverses to test their validity.

It is shown that several crustal phases provide control enough to obtain good solutions in depth for nuclear explosions, though not all the recording stations are in the region where crustal corrections are considered. The use of the European travel times, to locate the French nuclear explosion of May 1962 in the Sahara, proved to be more adequate than previous work.

A simpler program, with manual crustal corrections, is used to process the Kern County series of aftershocks, and a clearer picture of tectonic mechanism of the White Wolf fault is obtained.

Shocks in the California region are processed automatically and statistical frequency-depth and energy depth curves are discussed in relation to the tectonics of the area.

Essays on Correlated Equilibrium and Voter Turnout

This thesis consists of three essays in the areas of political economy and game theory, unified by their focus on the effects of pre-play communication on equilibrium outcomes.

Communication is fundamental to elections. Chapter 2 extends canonical voter turnout models, where citizens, divided into two competing parties, choose between costly voting and abstaining, to include any form of communication, and characterizes the resulting set of Aumann's correlated equilibria. In contrast to previous research, high-turnout equilibria exist in large electorates and uncertain environments. This difference arises because communication can coordinate behavior in such a way that citizens find it incentive compatible to follow their correlated signals to vote more. The equilibria have expected turnout of at least twice the size of the minority for a wide range of positive voting costs.

In Chapter 3 I introduce a new equilibrium concept, called subcorrelated equilibrium, which fills the gap between Nash and correlated equilibrium, extending the latter to multiple mediators. Subcommunication equilibrium similarly extends communication equilibrium for incomplete information games. I explore the properties of these solutions and establish an equivalence between a subset of subcommunication equilibria and Myerson's quasi-principals' equilibria. I characterize an upper bound on expected turnout supported by subcorrelated equilibrium in the turnout game.

Chapter 4, co-authored with Thomas Palfrey, reports a new study of the effect of communication on voter turnout using a laboratory experiment. Before voting occurs, subjects may engage in various kinds of pre-play communication through computers. We study three communication treatments: No Communication, a control; Public Communication, where voters exchange public messages with all other voters, and Party Communication, where messages are exchanged only within one's own party. Our results point to a strong interaction effect between the form of communication and the voting cost. With a low voting cost, party communication increases turnout, while public communication decreases turnout. The data are consistent with correlated equilibrium play. With a high voting cost, public communication increases turnout. With communication, we find essentially no support for the standard Nash equilibrium turnout predictions.

Free algebras in Von Neumann-Bernays-Gӧdel set theory and positive elementary inductions in reasonable structures

This thesis consists of two independent chapters. The first chapter deals with universal algebra. It is shown, in von Neumann-Bernays-Gӧdel set theory, that free images of partial algebras exist in arbitrary varieties. It follows from this, as set-complete Boolean algebras form a variety, that there exist free set-complete Boolean algebras on any class of generators. This appears to contradict a well-known result of A. Hales and H. Gaifman, stating that there is no complete Boolean algebra on any infinite set of generators. However, it does not, as the algebras constructed in this chapter are allowed to be proper classes. The second chapter deals with positive elementary inductions. It is shown that, in any reasonable structure ᶆ, the inductive closure ordinal of ᶆ is admissible, by showing it is equal to an ordinal measuring the saturation of ᶆ. This is also used to show that non-recursively saturated models of the theories ACF, RCF, and DCF have inductive closure ordinals greater than _ω.

Two-step digit-set-restricted modified signed-digit addition-subtraction algorithm and its optoelectronic implementation

A novel, to our knowledge, two-step digit-set-restricted modified signed-digit (MSD) addition-subtraction algorithm is proposed. With the introduction of the reference digits, the operand words are mapped into an intermediate carry word with all digits restricted to the set {(1) over bar, 0} and an intermediate sum word with all digits restricted to the set {0, 1}, which can be summed to form the final result without carry generation. The operation can be performed in parallel by use of binary logic. An optical system that utilizes an electron-trapping device is suggested for accomplishing the required binary logic operations. By programming of the illumination of data arrays, any complex logic operations of multiple variables can be realized without additional temporal latency of the intermediate results. This technique has a high space-bandwidth product and signal-to-noise ratio. The main structure can be stacked to construct a compact optoelectronic MSD adder-subtracter. (C) 1999 Optical Society of America.

One-step digit-set-restricted modified signed-digit adder using an incoherent correlator based on a shared content-addressable memory

An efficient one-step digit-set-restricted modified signed-digit (MSD) adder based on symbolic substitution is presented. In this technique, carry propagation is avoided by introducing reference digits to restrict the intermediate carry and sum digits to {1,0} and {0,1}, respectively. The proposed technique requires significantly fewer minterms and simplifies system complexity compared to the reported one-step MSD addition techniques. An incoherent correlator based on an optoelectronic shared content-addressable memory processor is suggested to perform the addition operation. In this technique, only one set of minterms needs to be stored, independent of the operand length. (C) 2002 society or Photo-Optical Instrumentation Engineers.

Efficient two-step digit-set-restricted modified signed-digit algorithm based on optoelectronic shared content-addressable memory

A two-step digit-set-restricted modified signed-digit (MSD) adder based on symbolic substitution is presented. In the proposed addition algorithm, carry propagation is avoided by using reference digits to restrict the intermediate MSD carry and sum digits into {(1) over bar ,0} and {0, 1}, respectively. The algorithm requires only 12 minterms to generate the final results, and no complementarity operations for nonzero outputs are involved, which simplifies the system complexity significantly. An optoelectronic shared content-addressable memory based on an incoherent correlator is used for experimental demonstration. (c) 2005 Society of Photo-Optical Instrumentation Engineers.

Konexio konikodun hortzetako inplanteak: ateratze indarraren zehaztapena. Eredu analitikoa eta saiakuntza esperimentalak

[EU]Txosten honetan konexio konikodun hortzetako inplante baten eraginkortasuna aztertzen da. Zehatzagoak izanik, inplante bat ahotik kanporatu ahal izateko beharrezkoa den indarra aztertu egiten da, kontuan hartuz aldagai horren balioa ezagutzea ezinbestekoa dela pazientearen osasuna eta konforta ziurtatzeko. Proiektu honek zein eremutan garrantzia edukiko duen ikusteko, lehenik eta behin testuingurua deskribatuko da. Horren ondoren helburu nagusiak eta onura zientifiko-tekniko zein ekonomikoak adieraziko dira. Helburuak lortzeko posibleak diren bide desberdinak aztertuko dira, eta bakoitzaren abantailak eta desabantailak kontuan hartuz kasu honi hobeto egokitzen zaion alternatiba aukeratuko da. Jarraian, metodo horri dagokion azalpenari ekingo zaio, proiektuaren garapenean egindako lanak pausoz pauso deskribatuz. Proiektuaren hasieratik amaierara arte egindako lanen planifikazioa era argi batean adierazteko Gantt diagrama erabiliko da. Bertan hiru etapa nagusi ezberdindu daitezke: saiakuntzen aurre-diseinua, kanpaina esperimentala eta emaitzen interpretazioa. Azkenik, egindako saiakuntzen eta analisien emaitzak laburbilduko dira, horiek dakartzaten ondorioak azalduz. Puntu honekin hasiera batean planteatutako helburuei erantzun bat emango zaie, eta proiektu honen ondoren jarraitu ahal izango diren hurrengo pausoak aipatuko dira.

Efficient two-step digit-set-restricted modified signed-digit algorithm based on optoelectronic shared content-addressable memory

A two-step digit-set-restricted modified signed-digit (MSD) adder based on symbolic substitution is presented. In the proposed addition algorithm, carry propagation is avoided by using reference digits to restrict the intermediate MSD carry and sum digits into {(1) over bar ,0} and {0, 1}, respectively. The algorithm requires only 12 minterms to generate the final results, and no complementarity operations for nonzero outputs are involved, which simplifies the system complexity significantly. An optoelectronic shared content-addressable memory based on an incoherent correlator is used for experimental demonstration. (c) 2005 Society of Photo-Optical Instrumentation Engineers.

Projeto Expande com balanço de uma experiência de programação a partir das necessidades.

O estudo que se segue é uma proposta de reflexão sobre a programação de saúde para a população usuária do SUS, em especial a assistência oncológica, as sucessivas estratégias político-administrativas e medidas de soluções a serem ofertadas à população portadora de câncer. Percebe-se o desequilíbrio entre a operacionalidade real e a operacionalidade suposta ideal, para dar conta dos casos novos de câncer (CNC)/ano, a atenção à saúde concentrada nos grandes centros urbanos, reflexo de um estímulo a investimentos em saúde direcionados aos centros urbanos, localidades de maior crescimento econômico e social. Objetivando o balanço de uma experiência de programação a partir das necessidades, tomamos como norte o Projeto Expande, para a análise da real assistência em oncologia no país, que se traduz no conjunto: oferta de serviço necessidade de tratamento específico para a população demanda, identificando déficit e necessidade. Nesse sentido, com base na programação e nas informações de produtividade SUS/Brasil, disponíveis no INCA , optamos por acompanhar os dados referentes ao ano 2008, quantificados e analisados, tendo como ponto de partida a estimativa de CNC/ano 2008, parâmetros assistenciais estimativa de necessidade máxima). Este estudo, com esse modelo, objetivou levantar subsídios que supostamente contribuam para o aprimoramento da Política de Atenção ao Câncer, em especial uma Política de Expansão Oncológica para o país.