Manobras de condução assistida para veículos submarinos subactuados

A intervenção humana no manuseamento de veículos submarinos operados remotamente (ROVs) é um requisito necessário para garantir o sucesso da missão e a integridade do equipamento. Contudo, a sua teleoperação não é fácil, pelo que a condução assistida destes veículos torna-se relevante. Esta dissertação propõe uma solução para este problema para ROVs de 3DOF (surge, heave e yaw). São propostas duas abordagens distintas – numa primeira propõe-se um sistema de controlo Image Based Visual Servoing (IBVS) tendo em vista a utilização exclusiva de uma câmara (sensor existente neste tipo de sistemas) por forma a melhorar significativamente a teleoperação de um pequeno ROV; na segunda, propõe-se um sistema de controlo cinemático para o plano horizontal do veículo e um algoritmo de uma manobra capaz de dotar o ROV de movimento lateral através de uma trajectória dente-de-serra. Demonstrou-se em cenários de operação real que o sistema proposto na primeira abordagem permite ao operador de um ROV com 3DOF executar tarefas de alguma complexidade (estabilização) apenas através de comandos de alto nível, melhorando assim drasticamente a teleoperação e qualidade de inspecção do veículo em questão. Foi também desenvolvido um simulador do ROV em MATLAB para validação e avaliação das manobras, onde o sistema proposto na segunda abordagem foi validado com sucesso.

Infective Endocarditis Complicated by Large Aortic Pseudoaneurysm after Cardiac Surgery

A 66-year-old female with Streptococcus viridans aortic and tricuspid infective endocarditis develops, during the course of antibiotic therapy, rupture of a right coronary sinus of Valsalva aneurysm to the right ventricle. An urgent cardiac surgery is preformed with implantation of a mechanical aortic prosthesis and a right coronary sinus plasty. Six months later a huge aortic pseudoaneurysm is diagnosed and she is submitted to a second uneventful surgery. A review is done for the significant features with discussion of diagnosis and therapy.

A control framework for a remotely operated vehicle

A control framework enabling the automated maneuvering of a Remotely Operate Vehicle (ROV) is presented. The control architecture is structured according to the principle of composition of vehicle motions from a minimal set of elemental maneuvers that are designed and verified independently. The principled approach is based on distributed hybrid systems techniques, and spans integrated design, simulation and implementation as the same model is used throughout. Hybrid systems control techniques are used to synthesize the elemental maneuvers and to design protocols, which coordinate the execution of elemental maneuvers within a complex maneuver. This work is part of the Inspection of Underwater Structures (IES) project whose main objective is the implementation of a ROV-based system for the inspection of underwater structures.

Falso Aneurisma Supraclavicular Complexo. Caso Clínico

Os autores apresentam o caso clínico de um indivíduo do sexo masculino, de 29 anos de idade, saudável, vítima de acidente de viação com traumatismo craniano e torácico, de que resultou um período de internamento em unidade de cuidados intensivos durante cerca de 60 dias. Após a alta hospitalar, referiu o aparecimento de massa pulsátil na região supraclavicular esquerda, associada a crescimento lento e ao aparecimento de dor local e irradiada ao membro superior esquerdo. A investigação realizada demonstrou a existência de um falso aneurisma complexo, com fístulas arterio-venosas associadas, dissecando planos musculares cervicais e envolvendo o plexo braquial. Foi submetido a intervenção cirúrgica que consistiu na laqueação da artéria escapular aferente e da comunicação para a veia jugular interna, com redução franca do fluxo luminal. Foi posteriormente realizada injecção eco-guiada de trombina sob manobra de Valsalva, com trombose subsequente do falso aneurisma. Verificou-se desaparecimento rápido das queixas e redução progressiva do volume de massa (follow-up de 6 meses). Os autores discutem a etiopatogenia, a abordagem cirúrgica e a técnica de exclusão do falso aneurisma por meio de injecção eco-guiada de trombina.

Flebectasia da Jugular Externa

A flebectasia da jugular externa é uma entidade nosológica rara, sendo escassas as descrições na literatura mundial. Clinicamente apresenta-se como uma massa cervical de aparecimento ou alargamento durante a manobra de Valsalva. Os autores descrevem um caso clínico, salientando as possibilidades da TC (Tomografia Computorizada) num diagnóstico etiológico e topográfico preciso, sem o recurso a outros meios invasivos.

Exercise-induced ventricular arrhythmias and vagal dysfunction in Chagas disease patients with no apparent cardiac involvement

INTRODUCTION : Exercise-induced ventricular arrhythmia (EIVA) and autonomic imbalance are considered as early markers of heart disease in Chagas disease (ChD) patients. The objective of the present study was to verify the differences in the occurrence of EIVA and autonomic maneuver indexes between healthy individuals and ChD patients with no apparent cardiac involvement. METHODS : A total of 75 ChD patients with no apparent cardiac involvement, aged 44.7 (8.5) years, and 38 healthy individuals, aged 44.0 (9.2) years, were evaluated using echocardiography, symptom-limited treadmill exercise testing and autonomic function tests. RESULTS : The occurrence of EIVA was higher in the chagasic group (48%) than in the control group (23.7%) during both the effort and the recovery phases. Frequent ventricular contractions occurred only in the patient group. Additionally, the respiratory sinus arrhythmia index was significantly lower in the chagasic individuals compared with the control group. CONCLUSIONS : ChD patients with no apparent cardiac involvement had a higher frequency of EIVA as well as more vagal dysfunction by respiratory sinus arrhythmia. These results suggest that even when asymptomatic, ChD patients possess important arrhythmogenic substrates and subclinical disease.

Treatment of delayed rupture of the left ventricle after mitral valve replacement

Rupture of the left ventricle following mitral valve replacement is a catastrophic complication with deadly consequences. We report here the case of a 75-year-old man who underwent elective mitral valve replacement for severe mitral regurgitation. Delayed type 1 rupture of the left ventricle developed 3 hours postoperatively in the intensive care unit. A salvaging maneuver was used, which gained time, allowing reoperation and successful intraventricular repair.

Obstrucao Coronaria apos Implante por Cateter de Protese Valvar Aortica

Fundamentos: O implante por cateter de bioprótese valvar aórtica (TAVI) consolidou-se como alternativa para o tratamento de pacientes com estenose aórtica importante de alto risco cirúrgico. Contudo, há poucos dados na literatura com respeito à obstrução coronária que, apesar de rara, trata-se de grave complicação do TAVI. Objetivo: Avaliar, no contexto brasileiro, a presença dessa importante complicação. Métodos: Foram avaliados todos os casos de obstrução coronária incluídos no Registro Brasileiro de TAVI. Foram coletados dados clínicos, do procedimento, do manejo e de evolução intra-hospitalar. Resultados: Entre 418 pacientes consecutivos do registro, ocorreram três casos de obstrução coronária (incidência de 0,72%). Em sua totalidade, os pacientes eram do sexo feminino, sem cirurgia de revascularização miocárdica (CRM) prévia, com idade média de 85 ± 3 anos, EuroSCORE logístico de 15 ± 6% e STS de 9 ± 4%. Todos os casos foram realizados com a válvula balão-expansível Sapien XT. Em um dos pacientes, com dados de tomografia computadorizada pré-procedimento, verificaram-se origem das artérias coronárias baixa e seio de Valsalva estreito. Todos os pacientes apresentaram-se clinicamente com hipotensão importante e mantida, imediatamente após o implante da válvula, e, apesar de angioplastia com implante de stent, todos os pacientes foram a óbito, sendo dois periprocedimento e um durante hospitalização. Conclusão: A obstrução coronária como complicação do TAVI, apesar de rara, é potencialmente fatal, podendo ocorrer mais frequentemente em mulheres e com as próteses expansíveis por balão. Fatores anatômicos podem estar relacionados com sua ocorrência, ressaltando-se a importância de boa avaliação pré-procedimento no sentido de evitar essa grave complicação.

Heart Rate and Systolic Blood Pressure Variability on Recently Diagnosed Diabetics

Background:Diabetes affects approximately 250 million people in the world. Cardiovascular autonomic neuropathy is a common complication of diabetes that leads to severe postural hypotension, exercise intolerance, and increased incidence of silent myocardial infarction.Objective:To determine the variability of heart rate (HR) and systolic blood pressure (SBP) in recently diagnosed diabetic patients.Methods:The study included 30 patients with a diagnosis of type 2 diabetes of less than 2 years and 30 healthy controls. We used a Finapres® device to measure during five minutes beat-to-beat HR and blood pressure in three experimental conditions: supine position, standing position, and rhythmic breathing at 0.1 Hz. The results were analyzed in the time and frequency domains.Results:In the HR analysis, statistically significant differences were found in the time domain, specifically on short-term values such as standard deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), and number of pairs of successive NNs that differ by more than 50 ms (pNN50). In the BP analysis, there were no significant differences, but there was a sympathetic dominance in all three conditions. The baroreflex sensitivity (BRS) decreased in patients with early diabetes compared with healthy subjects during the standing maneuver.Conclusions:There is a decrease in HR variability in patients with early type 2 diabetes. No changes were observed in the BP analysis in the supine position, but there were changes in BRS with the standing maneuver, probably due to sympathetic hyperactivity.

Midgut of Lepidopteran pupae is a major depot of sequestered, mobilizable, ecdysteroids

Extirpation of endocrine organs - a classic maneuver in hormonal research - has been difficult or impossible in the case of the prothoracic glands (PG) of insects. In larval and pupal Lepidoptera the glands are virtually inaccessible unless one sacrifices the insect. Even then, the PG are not easy to remove in their entirety. Consequently, in order to obtain viable preparations lacking PG, one costomarily makes use of abdomens isolated by litigation or surgery.

Pneumothorax sur prise de cocaïne

Introduction: Les complications dues à la cocaïne inhalée se¦rencontrent de plus en plus fréquemment dans les services d'urgence¦et dans la pratique des médecins de premier recours. La survenue de¦complications pulmonaires aiguës de type pneumothorax est¦méconnue.¦Vignette clinique: Un patient de 25 ans consulte aux urgences en¦raison d'une gêne pharyngée, une odynodysphagie et une dysphonie¦en progression depuis 12 h. Il avoue une prise de cocaïne sniffée à 5¦reprises dans les 6 heures précédant l'apparition des symptômes. Des¦crépitations sous-cutanées sont mise en évidence à la palpation du¦creux sus-claviculaire droit, remontant jusqu'à la base du cou. La¦radiographie thoracique confirme un emphysème sous-cutané des¦creux sus-claviculaires (fig. 1). Le patient bénéficie d'une¦oxygénothérapie et d'une observation, avec une évolution¦spontanément favorable.¦Discussion: Après une prise de cocaïne par inhalation profonde, des¦manoeuvres de Valsalva intenses répétées contre glotte fermée sont¦pratiquées, afin d'augmenter la quantité de substance absorbée et donc¦ses effets. Ceci engendre un gradient de pression entre les alvéoles et¦l'interstitium pulmonaire, entraînant une augmentation de la pression¦intra-alvéolaire, puis une rupture des alvéoles avec libération d'air à¦travers les tissus péri-bronchiques dans le médiastin et les tissus¦sous cutanés. En cas de rupture dans la cavité pleurale, il en résulte¦un pneumothorax. Un tabagisme actif est souvent associé, laissant¦suspecter un effet favorisant du tabac sur la survenue des lésions¦pulmonaires. Un traitement conservateur associant antalgie et¦oxygénothérapie s'avère en général suffisant. En présence d'une¦augmentation de la taille du pneumothorax ou de signes de mise¦sous tension, la pose d'un drain thoracique est indiquée. L'arrêt de la¦consommation de cocaïne et du tabac doit être encouragé.¦Conclusion: Un emphysème sous-cutané ou un pneumothorax¦spontané chez un jeune patient doivent faire suspecter une éventuelle¦consommation de cocaïne. Les questions concernant la prise de¦cocaïne ou d'autres substances (alcool, amphétamines, etc.), ainsi¦que son mode d'utilisation et sa fréquence, doivent être formulées¦clairement et réitérées à plusieurs reprises. Le risque de pneumothorax¦existe également lors de consommation occasionnelle et peut entraîner¦des complications pulmonaires importantes.

The "Squeeze and Wheeze" Sign: A Useful Clinical Sign in Lung Sounds Analysis of Children With Acute Cough.

Cough is a very frequent symptom in children. Different reviews have tried to delineate the best approach to pediatric cough.1 Clinical evaluation remains the most important diagnostic initial step. Although the relations between cough and asthma are not straightforward,2 wheeze should be considered as a physical sign of increased resistance to air flow. Lung function testing is the gold standard for analyzing pulmonary resistance to air flow but has a limited practical value in young children. The clinical evaluation of the presence or absence of wheeze thus remains a primary clinical step in coughing children. Young children do not necessarily breathe deeply in and out when asked to. For years, the author has used a so-called "squeeze and wheeze" maneuver (SWM, see Methods section for definition) to elicit chest signs in young children. The basic idea is to increase expiratory flows in children who do not cooperate adequately during their lung sounds analysis. This study was realized to communicate the author's experience of a yet unreported physical sign and to study its prevalence in young children cared for in a general pediatrics practice.

Surface swimming behavior of the curculionid Ochetina uniformis Pascoe (Erirhininae, Stenopelmini) and Ludovix fasciatus (Gyllenhal) (Curculioninae, Erodiscini)

The swimming behavior exhibited by specimens of L. fasciatus and O. uniformis was analyzed frame-by-frame with video observation recorded with a digital camera, attached to a stereomicroscope. Adults of O. uniformis, an aquatic insect, swim with all three pairs of legs. During the process of swimming the majority of the abdomen and rostrum remain submerged, part of the fore and hind tibiae remain above the surface, while the mid tibiae remain submerged. The mesothoracic legs, during the power-stroke stage, provide the greatest thrust while the metathoracic legs provide the least forward propulsion. The prothoracic legs, extended forward, help to direct the swimming. The semi-aquatic specie L. fasciatus shows the same swimming style as O. uniformis, that is, with movement of all the three pairs of legs; the mesothoracic legs are responsible for the main propulsion. The insect body remains on the water surface during the process of swimming, while the legs remain submerged. Both species complete a swimming cycle in 0.33 and 0.32 seconds, respectively, with an average speed of 1.38 cm/s and a maximum and minimum swimming duration time of 11.15 and 5.05 minutes, respectively, for L. fasciatus. The swimming behavior exhibited by O. uniformis and L. fasciatus corresponds to the style known as a breast strokelike maneuver. This is the first record of this kind of swimming for both species here observed and increases to seven the number of genera of Curculionidae exhibiting this behavior.

Cape Verde - Diagnostic Trade Inttegration study Update - 2013

This Report is an update of the Cape Verde Diagnostic Trade Integration Study, titled Cape Verde’s Insertion into the Global Economy, produced and validated by the Government of Cape Verde in December 2008. Like the previous 2008 study, this Cape Verde Diagnostic Trade Integration Study Update provides a critical examination of the major institutional and production constraints that hinder Cape Verde’s ability to capitalize fully on the growth and welfare gains from its integration into the world economy. As a policy report, this study offers a set of priority policies and measures that can be implemented by both the public and private sectors to mitigate and surmount these supply side and institutional constraints. These recommendations are summarized in an Action Matrix. The Report is fruit of the generous support of the multi-donor program the Enhanced Integrated Framework (EIF). In every crisis there is an opportunity. Four years after the validation of the country’s first Diagnostic Trade Integration Study in 2008, Cape Verde finds itself in a drastically altered external environment. Cape Verde faces a worsened external environment than four years ago, when it was also traversing years of crisis as global food and energy prices escalated. Just as the country was validating its first trade study in late 2008, and celebrating its graduation from the list of Least Developed Countries, the onset of the deepest global recession in recent memory triggered an even worse external situation as the country’s principal source of markets, investments, remittances and aid, the Eurozone, unraveled economically and politically. As the Eurozone crisis spread, it was Cape Verde’s misfortune that the crisis contaminated precisely its biggest Eurozone partners and donors, such as Portugal, Spain and Italy. For such a highly dependent and exposed economy like that of Cape Verde, the deteriorating external sector has had a substantial negative impact on its macroeconomic performance. At the time of the validation workshop and graduation in 2008, no one could have foreseen or predicted the severity of the global crisis that followed. Despite traversing these years of adversity and external shocks, and suffering palpable setbacks, Cape Verde’s economy had proven surprisingly resilient, especially its principal sector, tourism. To its great credit, the country’s economic fundamentals are solid, and have been carefully and prudently managed over the years. For this reason alone, the country has thus far weathered the global and Eurozone crisis. Yet the near and medium term future remains uncertain. The country’s margin for maneuver has narrowed, its options far more limited, and hard choices lie ahead. Thus, there is no better time than now to analyze Cape Verde’s position in the global economy, and to examine the many challenges and opportunities it faces. The first diagnostic trade study outlined an ambitious agenda and set of policy strategies to enhance Cape Verde’s participation in the global economy. Written prior to the global crisis, the study did not, and could not, anticipate the scope and depth of the subsequent global and Eurozone crises. A few short months before the validation of the first DTIS Cape Verde joined the World Trade Organization (WTO). It has spent these four years adjusting to this status and implementing its commitments. At the same time, the country seeks greater economic integration with the European Union. Since 2008 the government has been investing heavily in the country’s economic infrastructure, focusing especially on fostering transformation in key sectors like agriculture, fisheries, tourism and creative industries. For these and many other reasons, it is both timely and urgent to review the road traveled since 2008. It is an opportune moment to reassess the country’s options, to rethink strategies, and to chart a new way forward that it is practical, implementable, and that builds on the country’s competitive advantages and current successes.

Protecting the Public,Iowa Office of Citizens’ Aide/Ombudsman, January 2010

The Ombudsman helps citizens understand and maneuver through the often complicated depths and layers of government. In many cases, assistants facilitate citizen dialogue with an agency, explain the reasons for laws or policies, recommend revisions to unfair policies or unreasonable decisions, and resolve disputes informally. In some cases, the Ombudsman will pursue more formal investigations, take sworn testimony, and issue public reports. Here, in this periodic newsletter, you’ll find a small sampling of the ombudsman’s work over the previous two months. If you need help resolving a problem with state or local government, please see our contact information at the bottom of the page.