Dissertations / Theses on the topic 'Long term average spectra'

The technique of �open throat� is a pedagogical concept transmitted through the oral tradition of singing. This thesis explored the pedagogical perceptions and practices of �open throat� using empirical methodologies to assess technical skill and associated vocal quality. In the first study (Mitchell, Kenny, Ryan, & Davis, 2003), we assessed the degree of consensus amongst singing pedagogues regarding the definition of, and use in the singing studio of the technique called �open throat.� Results indicated that all fifteen pedagogues described �open throat� technique as fundamental to singing training and were positive about the sound quality it achieved, especially in classical singing. It was described as a way of maximising pharyngeal space or abducting the false vocal folds. Hypotheses generated from pedagogical beliefs expressed in this first study were then tested acoustically (Mitchell & Kenny, 2004a, 2004b). Six advanced singing students sang in two conditions: �optimal� (O), using maximal open throat, �sub-optimal� (SO), using reduced open throat and loud sub-optimal (LSO) to control for the effect of loudness. From these recordings, acoustic characteristics of vibrato (Mitchell & Kenny, 2004b) and energy distribution (Mitchell & Kenny, 2004a) were examined. Subsequent investigations of the vibrato parameters of rate, extent and onset, revealed that extent was significantly reduced and onset increased when singers did not use the technique. As inconsistent vibrato is considered indicative of poor singing, it was hypothesized that testing the energy distribution in these singers� voices in each condition would identify the timbral changes associated with open throat. Visual inspection of long term average spectra (LTAS) confirmed differences between O and SO, but conventional measures applied to long term average spectra (LTAS), comparing energy peak height [singing power ratio (SPR)] and peak area [energy ratio (ER)] were not sensitive to the changes identified through visual inspection of the LTAS. These results were not consistent with the vibrato findings and suggest that conventional measures of SPR and ER are not sufficiently sensitive to evaluate LTAS. In the fourth study, fifteen expert listeners consistently and reliably identified the presence of open throat technique with 87% accuracy (Mitchell & Kenny, in press). In the fifth study, LTAS measurements were examined with respect to the perceptual ratings of singers. There was no relationship between perceptual rankings of vocal beauty and acoustic rankings of vocal quality (Kenny & Mitchell, 2004, in press). There is a vast literature of spectral energy definitions of good voice but the studies in this thesis have indicated that current acoustic methods are limited in defining vocal quality. They also suggest that current work in singing has not sufficiently incorporated perceptual ratings and descriptions of sound quality or the relationship between acoustic and perceptual factors with pedagogical practices.

Made available in DSpace on 2015-12-06T23:06:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2005<br>Fundo de Auxílio aos Docentes e Alunos da UNIFESP (FADA)<br>O conhecimento das diferenças entre as vozes de atores e não atores, nos seus aspectos perceptivos e acústicos - especialmente por meio do Long-term average spectrum - podem contribuir para o re-direcionamento tanto da avaliação quanto da preparação vocal destes que buscam uma técnica vocal econômica e eficiente, os atores. Não há em nosso meio estudos da voz de atores utilizando o LTAS o objetivo do presente estudo é estabelecer as diferenças entre as vozes de atores e não atores nas loudness habitual, moderada e forte, por meio da análise acústica e perceptiva auditiva e verificar as correlações entre as diferentes variáveis Trata-se de um estudo de desenho transversal, do qual participaram 11 atores e 10 não atores do gênero masculino, tendo no português brasileiro a sua língua-mãe, sem queixas de voz, e com idade variando entre 20 e 60 anos para garantir uma voz madura, fora do período de muda vocal e não presbifônica As variáveis acústicas analisadas foram: nível de pressão sonora médio, proporção alpha, freqüência fundamental, nível de pressão sonora da freqüência fundamental, freqüência do primeiro formante, nível de pressão sonora do primeiro formante, diferença entre LI eLO. Para calcular o nível de pressão sonora médio, a proporção Alpha e a freqüência fundamental, usamos o sistema de análise computadorizada lntelligent Speech Analyser (Raimo Toivonen M. Se. Eng.). Os espectros do LTAS para cada indivíduo foram feitos por meio do Analisador de Sinal HewIlett-Packard 3561A. A extensão de freqüências analisada pelo programa foi de O-10kHz, janelamento Hanning, com resolução de janela de tempo de 40msec e largura de banda de 37.5Hz. Os sons não vozeados, sons fracos, sons da qualidade do /s/ e as pausas foram automaticamente cortados pelo programa. As variáveis perceptivo-auditivas analisadas foram: o grau de projeção, o grau de loudness, e o grau de tensão. Para fazer a avaliação perceptivo-auditiva, as 21 vozes foram gravadas de maneira aleatória em CDs, um para cada loudness. As vozes foram apresentadas para um grupo de 8 fonoaudiólogas especialistas em voz, com mais de 5 anos de profissão, e treino em avaliação perceptiva auditiva Os resultados da análise perceptiva auditiva mostraram diferenças estatisticamente significantes entre os dois grupos, em todas as loudness, na proporção alpha que foi menor para o grupo de atores (p < .001), e no nível de pressão sonora do "formante do ator" que foi maior para atores (p < .001). Na análise perceptiva auditiva, o grau de projeção e de loudness foi maior para atores que para não atores nas três loudness (p <.001). No LTAS, atores apresentaram o "formante do ator" nas três loudness e não atores, nas loudness moderada e forte. Os valores dos "fonnante do ator" para atores foram de -23,4dB, -19,3dB e -19,4dB respectivamente para loudness habitual, moderada e forte e para não atores, -25,4dB e - 24,5dB respectivamente para loudness moderada e forte. Para ambos os grupos, a freqüência central do "fonnante do ator" está em 3.4 kHz Podemos concluir que as vozes de atores e não atores se diferenciaram significativamente tanto na análise acústica quanto na perceptiva auditiva. Algumas variáveis acústicas, proporção alpha e "fonnante do ator", correlacionaram-se significativamente com o grau de loudness da análise perceptivo auditiva. No L T AS dos atores o "fonnante do ator" foi verificado em todas as loudness..<br>The knowledge about the differences between actors and non actors’ voices, regarding perceptual and acoustic parameters – especially through the Long-term average spectrum – could contribute for a better evaluation and vocal preparation of those who pursue an economic and efficient vocal technique like actors themselves. There are not studies, in our country, of the actors’ voices using LTAS. The objective of the present study is to establish the differences between actors and non actors’ voices in habitual, median and strong loudness through acoustic and perceptual analysis and verify the correlations between the different variables. It is a cross-sectional study with the participation of 11 actors and 10 non actors of the male gender, who had Brazilian Portuguese as their mother tongue, without voice complaints, and within the 20 to 60 age group to ensure a mature voice, out of the vocal mutational period and not yet presbifonic. The acoustic variables analyzed were: sound pressure level, alpha proportion, fundamental frequency, sound pressure level of the fundamental frequency, frequency of the first formant, sound pressure level of the first formant, difference between L1 and L0. To calculate the sound pressure level, alpha proportion and the fundamental frequency, it was used the system of computerized analysis Intelligent Speech Analyser. (Raimo Toivonen M. Sc. Eng.). The LTAS’ spectrums for each individual were done through the Hewllett-Packard 3561A signal analyzer. The frequency range analyzed by the program was 0-10kHz, Hanning window, which gives time window of 40 msec and bandwidth of 37.5 Hz. The program excluded the voiceless sounds, weak sounds, s-kind of sounds and pauses. The perceptual variables analyzed were: degree of projection, degree of loudness and degree of tightness. To allow the perceptual evaluation, the 21 voices were randomly recorded in CDs. The voices were presented to 8 speech therapists specialized in voice, with more than 5 years of experience and trained for perceptual evaluation. The results of the acoustic analysis showed statistically significant differences between the groups in all the loudness, for alpha proportion, that was smaller in the actors group (p <. 001), and the sound pressure level of the “actors formant”, that was greater for actors (p <. 001). In the perceptual analysis the degree of projection and loudness were greater among actors in the three loudness (p <. 001), In the LTAS, actors presented an “actor’s formant” in the three loudness and non-actors in the median and strong loudness. The mean values of the “actor’s formant” in the actors group was -23.4dB, -19.3dB, and -19,4dB in the habitual, median and strong loudness respectively, and in the non actors group, -25.4dB, -24.4dB in the median and strong loudness respectively. For both groups the central frequency of the “actor's formant” was 3.4 kHz. We can conclude that actors and non actor’s voices were significantly differentiated either in the acoustic or in the perceptual analysis. Some acoustic variables, as alpha proportion and “actor’s formant”, significantly correlated with the degree of loudness in the perceptual analysis. The “actor’s formant” in the LTAS was verified for actors in all the three loudness.<br>BV UNIFESP: Teses e dissertações

Through the analysis of the spectral characteristics of thousands of mastered (or remastered) commercial recordings from a variety of genres over the history of popular music, researchers have studied stylistic trends and spectral conventions. The aim of this study was to further explore, analyse and compare the spectral characteristics of two broad but distinct popular music genres: rock and vocal-based electronic music. The main reason for this choice of genres being that rock generally predominantly is based on (amplified) acoustical elements (e.g. acoustic drums and acoustic/electric bass/guitars) and that electronic music generally predominantly is based on electronic elements (e.g. beats and synthesizers). The stimuli for the study consisted of 24 top-five hit songs from the Billboard charts between 2016-2020, divided by genre. A fast fourier transform approach was used for the computation of target spectrums as well as low level descriptors for the two independent datasets of recordings. Spectral analysis followed with the goal of answering the following research questions: What do the spectral stylistic conventions appear to be in rock versus vocal-based electronic music and what spectral differences/similarities exists between these two distinct popular music genres? The results showed that there were some significant spectral differences between the two genres, especially noticeable in the low end of the frequency spectrum. Other genre-specific spectral trends and overall spectral conventions were found as well.

For the construction of a wind farm, one needs to assess the wind resources of the considered site location. Using reference time series from numerical weather prediction models, global assimilation databases or observations close to the area considered, the on-site measured wind speeds and wind directions are corrected in order to represent the actual long-term wind conditions. This long-term correction (LTC) is in the typical case performed by making use of the linear regression within the Measure-Correlate-Predict (MCP) method. This method and two other methods, Sector-Bin (SB) and Synthetic Time Series (ST), respectively, are used for the determination of the uncertainties that are associated with LTC.The test area that has been chosen in this work, is located in the region of the North Sea, using 22 quality controlled meteorological (met) station observations from offshore or nearby shore locations in Denmark, Norway and Sweden. The time series that has been used cover the eight year period from 2002 to 2009 and the year with the largest variability in the wind speeds, 2007, is used as the short-term measurement period. The long-term reference datasets that have been used are the Weather Research and Forecast model, based on both ECMWF Interim Re-Analysis (ERA-Interim) and National Centers for Environmental Prediction Final Analysis (NCEP/FNL), respectively and additional reference datasets of Modern Era Re-Analysis (MERRA) and QuikSCAT satellite observations. The long-term period for all of the reference datasets despite QuikSCAT, correspond to the one of stations observations. The QuikSCAT period of observations used cover the period from November 1st, 1999 until October 31st, 2009.The analysis is divided into three parts. Initially, the uncertainty connected to the corresponding reference dataset, when used in LTC method, is investigated. Thereafter the uncertainty due to the concurrent length of the on-site measurements and reference dataset is analyzed. Finally, the uncertainty is approached using a re-sampling method of the Non-Parametric Bootstrap. The uncertainty of the LTC method SB, for a fixed concurrent length of the datasets is assessed by this methodology, in an effort to create a generic model for the estimation of uncertainty in the predicted values for SB.The results show that LTC with WRF model datasets based on NCEP/FNL and ERA-Interim, respectively, is slightly different, but does not deviate considerably in comparison when comparing with met station observations. The results also suggest the use of MERRA reference dataset in connection with long-term correction methods. However, the datasets of QuikSCAT does not provide much information regarding the overall quality of long-term correction, and a different approach than using station coordinates for the withdrawal of QuikSCAT time series is preferred. Additionally, the LTC model of Sector-Bin is found to be robust against variation in the correlation coefficient between the concurrent datasets. For the uncertainty dependence of concurrent time, the results show that an on-site measurement period of one consistent year or more, gives the lowest uncertainties compared to measurements of shorter time. An additional observation is that the standard deviation of long-term corrected means decreases with concurrent time. Despite the efforts of using the re-sampling method of Non-Parametric Bootstrap the estimation of the uncertainties is not fully determined. However, it does give promising results that are suggested for investigation in further work.<br>För att bygga en vindkraftspark är man i behov av att kartlägga vindresurserna i det aktuella området. Med hjälp av tidsserier från numeriska vädermodeller (NWP), globala assimileringsdatabaser och intilliggande observationer korrigeras de uppmätta vindhastigheterna och vindriktningarna för att motsvara långtidsvärdena av vindförhållandena. Dessa långtidskorrigeringsmetoder (LTC) genomförs generellt sett med hjälp av linjär regression i Mät-korrelera-predikera-metoden (MCP). Denna metod, och två andra metoder, Sektor-bin (SB) och Syntetiska tidsserier (ST), används i denna rapport för att utreda de osäkerheter som är knutna till långtidskorrigering.Det testområde som är valt för analys i denna rapport omfattas av Nordsjöregionen, med 22 meteorologiska väderobservationsstationer i Danmark, Norge och Sverige. Dessa stationer är till största del belägna till havs eller vid kusten. Tidsserierna som används täcker åttaårsperioden från 2002 till 2009, där det året med högst variabilitet i uppmätt vindhastighet, år 2007, används som den korta mätperiod som blir föremål för långtidskorrigeringen. De långa referensdataseten som använts är väderprediktionsmodellen WRF ( Weather Research and Forecast Model), baserad både på data från NCEP/FNL (National Centers for Environmental Prediciton Final Analysis) och ERA-Interim (ECMWF Interim Re-analysis). Dessutom används även data från MERRA (Modern Era Re-Analysis) och satellitobservationer från QuikSCAT. Långtidsperioden för alla dataset utom QuikSCAT omfattar samma period som observationsstationerna. QuikSCAT-datat som använts omfattar perioden 1 november 1999 till 31 oktober 2009.Analysen är indelad i tre delar. Inledningsvis behandlas osäkerheten som är kopplad till referensdatans ingående i långtidskorrigeringsmetoderna. Därefter analyseras osäkerhetens beroende av längden på den samtidiga datan i referens- och observationsdataseten. Slutligen utreds osäkerheten med hjälp av en icke-parametrisk metod, en s.k. Bootstrap: Osäkerheten i SB-metoden för en fast samtidig längd av tidsserierna från observationer och referensdatat uppskattas genom att skapa en generell modell som estimerar osäkerheten i estimatet.Resultatet visar att skillnaden när man använder WRF-modellen baserad både på NCEP/FNL och ERA-Interim i långtidskorrigeringen är marginell och avviker inte markant i förhållande till stationsobservationerna. Resultatet pekar också på att MERRA-datat kan användas som långtidsreferensdataset i långtidsdkorrigeringsmetoderna. Däremot ger inte QuikSCAT-datasetet tillräckligt med information för att avgöra om det går att använda i långtidskorrigeringsmetoderna. Därför föreslås ett annat tillvägagångssätt än stationsspecifika koordinater vid val av koordinater lämpliga för långtidskorrigering. Ytterligare ett resultat vid analys av långtidskorrigeringsmetoden SB, visar att metoden är robust mot variation i korrelationskoefficienten.Rörande osäkerhetens beroende av längden på samtidig data visar resultaten att en sammanhängande mätperiod på ett år eller mer ger den lägsta osäkerheten i årsmedelvindsestimatet, i förhållande till mätningar av kortare slag. Man kan även se att standardavvikelsen av de långtidskorrigerade medelvärdena avtar med längden på det samtidiga datat. Den implementerade ickeparametriska metoden Bootstrap, som innefattar sampling med återläggning, kan inte estimera osäkerheten till fullo. Däremot ger den lovande resultat som föreslås för vidare arbete.

Objective: This study’s purpose was to examine dietary quality, macronutrient intake, and micronutrient adequacy among long term weight loss maintainers (WLM) in a commercial weight management program. Methods: Participants were 1,207 WLM in WW (formerly Weight Watchers) who had maintained a 9.1 kg or greater weight loss (29.7 kg on average) for 3.4 years, and had an average BMI of 28.3 kg/m2. A control group of weight stable adults with obesity (Controls; N=102) had a BMI of 41.1 kg/m2 and 2.3 kg or less weight change over the previous five years. Results: WLM vs. Controls had a 10.1 point higher HEI-2015 score (70.2 [69.7 - 70.7] vs 60.1 [58.4 - 61.8], respectively; p=0.0001) in analyses that adjusted for group difference in demographic factors. WLM versus Controls had a significantly higher average percentage of calories from carbohydrates (50.3% [49.7 - 50.8] vs 46.7% [44.8 - 48.7], respectively; p=0.0001) and protein (18.2% [18.0-18.5] vs 15.9% [15.1-16.6], respectively; p=0.0001) and lower percentage of calories from fat (32.3% [31.9-32.8] vs 37.4% [35.8-38.9], respectively; p=0.0001). Examining micronutrients, WLM had significantly higher odds for meeting the EAR for copper (OR=5.8 [2.6-13.1]; p=0.0001), magnesium (OR=2.9 [1.8-4.7]; p=0.0001), potassium (OR=4.7 [1.4-16.5]; p=0.015), vitamin A (OR=2.8 [1.7-4.8]; p=0.0001), thiamin (OR=2.3 [1.3-4.1]; p=0.003), riboflavin (OR=6.5 [2.2-19.3]; p=0.001), vitamin B6 (OR=2.91 [1.6-5.2]; p=0.0001), vitamin C (OR=5.0 [2.8-8.8]; p=0.0001), folate (OR=2.2 [1.3-3.7]; p=0.003), and vitamin E (OR=1.8 [1.1-2.8]; p=0.014) and didn’t differ in calcium (OR=1.15 [0.7-1.7]; p=0.823), iron (OR=1.9 [0.8-4.6]; p=0.151), phosphorus (OR=2.0 [0.9-4.5]; p=0.101), selenium (OR=1.6 [0.6-3.8]; p=0.332), zinc (OR=1.7 [0.9-3.0]; p=0.095), niacin (B3) (OR=1.9 [0.8-4.1]; p=0.136), vitamin B12 (OR=1.2 [0.5-2.8]; p=0.625), and vitamin D (OR=1.5 [0.9-2.4]; p=0.09). Conclusions In a widely available commercial program, WLM consumed a healthier and more micronutrient rich diet than adults who were weight stable with obesity. Future research is needed to examine whether improved micronutrient status among WLM reduces risk of chronic disease.

Kyoto University (京都大学)<br>0048<br>新制・課程博士<br>博士(人間・環境学)<br>甲第22535号<br>人博第938号<br>新制||人||223(附属図書館)<br>2019||人博||938(吉田南総合図書館)<br>京都大学大学院人間・環境学研究科共生人間学専攻<br>(主査)准教授 櫻川 貴司, 教授 立木 秀樹, 教授 日置 尋久<br>学位規則第4条第1項該当

Detecting abnormal operating conditions, which will lead to faults developing later, has important economic implications for industries trying to meet their performance and production goals. It is unacceptable to wait for failures that have potential safety, environmental and financial consequences. Moving from a “reactive” strategy to a “proactive” strategy can improve critical equipment reliability and availability while constraining maintenance costs, reducing production deferrals, decreasing the need for spare parts. Once the fault initiates, predicting its progression and deterioration can enable timely interventions without risk to personnel safety or to equipment integrity. This work presents an online-integrated condition monitoring and prognostics framework that addresses the above issues holistically. The proposed framework aligns fully with ISO 17359:2011 and derives from the I-P and P-F curve. Depending upon the running state of machine with respect to its I-P and P-F curve an algorithm will do one of the following: (1) Predict the ideal behaviour and any departure from the normal operating envelope using a combination of Evolving Clustering Method (ECM), a normalised fuzzy weighted distance and tracking signal method. (2) Identify the cause of the departure through an automated diagnostics system using a modified version of ECM for classification. (3) Predict the short-term progression of fault using a modified version of the Dynamic Evolving Neuro-Fuzzy Inference System (DENFIS), called here MDENFIS and a tracking signal method. (4) Predict the long term progression of fault (Prognostics) using a combination of Autoregressive Integrated Moving Average (ARIMA)- Empirical Mode Decomposition (EMD) for predicting the future input values and MDENFIS for predicting the long term progression of fault (output). The proposed model was tested and compared against other models in the literature using benchmarks and field data. This work demonstrates four noticeable improvements over previous methods: (1) Enhanced testing prediction accuracy, (2) comparable processing time if not better, (3) the ability to detect sudden changes in the process and finally (4) the ability to identify and isolate the problem source with high accuracy.

The stock market is a non-linear field, but many of the best-known portfolio optimization algorithms are based on linear models. In recent years, the rapid development of machine learning has produced flexible models capable of complex pattern recognition. In this paper, we propose two different methods of portfolio optimization; one based on the development of a multivariate time-dependent neural network,thelongshort-termmemory(LSTM),capable of finding lon gshort-term price trends. The other is the linear Markowitz model, where we add an exponential moving average to the input price data to capture underlying trends. The input data to our neural network are daily prices, volumes and market indicators such as the volatility index (VIX).The output variables are the prices predicted for each asset the following day, which are then further processed to produce metrics such as expected returns, volatilities and prediction error to design a portfolio allocation that optimizes a custom utility function like the Sharpe Ratio. The LSTM model produced a portfolio with a return and risk that was close to the actual market conditions for the date in question, but with a high error value, indicating that our LSTM model is insufficient as a sole forecasting tool. However,the ability to predict upward and downward trends was somewhat better than expected and therefore we conclude that multiple neural network can be used as indicators, each responsible for some specific aspect of what is to be analysed, to draw a conclusion from the result. The findings also suggest that the input data should be more thoroughly considered, as the prediction accuracy is enhanced by the choice of variables and the external information used for training.<br>Aktiemarknaden är en icke-linjär marknad, men många av de mest kända portföljoptimerings algoritmerna är baserad på linjära modeller. Under de senaste åren har den snabba utvecklingen inom maskininlärning skapat flexibla modeller som kan extrahera information ur komplexa mönster. I det här examensarbetet föreslår vi två sätt att optimera en portfölj, ett där ett neuralt nätverk utvecklas med avseende på multivariata tidsserier och ett annat där vi använder den linjära Markowitz modellen, där vi även lägger ett exponentiellt rörligt medelvärde på prisdatan. Ingångsdatan till vårt neurala nätverk är de dagliga slutpriserna, volymerna och marknadsindikatorer som t.ex. volatilitetsindexet VIX. Utgångsvariablerna kommer vara de predikterade priserna för nästa dag, som sedan bearbetas ytterligare för att producera mätvärden såsom förväntad avkastning, volatilitet och Sharpe ratio. LSTM-modellen producerar en portfölj med avkastning och risk som ligger närmre de verkliga marknadsförhållandena, men däremot gav resultatet ett högt felvärde och det visar att vår LSTM-modell är otillräckligt för att använda som ensamt predikteringssverktyg. Med det sagt så gav det ändå en bättre prediktion när det gäller trender än vad vi antog den skulle göra. Vår slutsats är därför att man bör använda flera neurala nätverk som indikatorer, där var och en är ansvarig för någon specifikt aspekt man vill analysera, och baserat på dessa dra en slutsats. Vårt resultat tyder också på att inmatningsdatan bör övervägas mera noggrant, eftersom predikteringsnoggrannheten.

Neste trabalho estudamos um controlador denominado rastreador linear quadrático (RLQ) com custo médio de longo prazo (CMLP) para sistemas lineares com saltos markovianos (SLSM). Mostramos que o conceito de detetabilidade uniforme, juntamente com a hipótese de que o regulador linear quadrático associado ao RLQ tenha custo uniformemente limitado, são suficientes para que o controle obtido seja estabilizante em um certo sentido. A partir deste resultado, e considerando as mesmas hipóteses, demonstramos a existência do CMLP. Com isto, estendemos os resultados dispostos na literatura desde que consideramos um sistema variante no tempo e uma estrutura mais geral para a cadeia deMarkov. Além disto, avaliamos a aplicação deste controlador no planejamento da operação de um sistema hidrotérmico. Para isto, utilizamos o sistema de usinas do rio São Francisco, em dois casos de estudo, para comparar o desempenho do controlador estudado em relação à solução ótima para o problema, encontrada com o uso da programação dinâmica estocástica, e em relação à solução obtida via programação dinâmica determinística. Os resultados sugerem que o RLQ pode representar uma alternativa interessante para o problema de planejamento hidrotérmico<br>In the present work we study the reference tracking controller (RTC) for the long run average cost (LRAC) problem for Markov jump linear systems. We show that uniform detectability and an hypothesis that the linear quadratic regulator associated with the RTC has uniformly bounded cost, together, are sufficient conditions for the obtained control be exponentially stabilizing in a certain sense. This result allows us to demonstrate the existence of the LTAC under the same hypotheses. The results can be regarded as an extension of previous works, since we have considered a more general framework with time-varying systems and quite general Markov chains. As an applicatioin, we consider the operational planning of hydrothermal systems. We have considered some power plants of the Sao Francisco river, in two different scenarios, and we have compared the performances of the RTC and standard controls obtained by deterministic and stochastic dynamic programming, indicating that the RTC may be an interesting alternative for the hydrothermal planning problem

Mestrado em Métodos Quantitativos para a Decisão Económica e Empresarial<br>Os pacientes internados no hospital com um prolongamento da alta hospitalar por razões não clínicas têm sido um tema importante no contexto da sustentabilidade dos sistemas nacionais de saúde. Na primeira parte é apresentada uma revisão da literatura na definição e perfil internacional destes pacientes. A segunda parte explora a situação portuguesa utilizando dados de 2015 referentes a meio milhão de pacientes em Portugal Continental. A terceira parte consiste na estimação de um modelo da Binomial Negativa para identificar as diferenças no tempo de internamento entre um paciente Caso Social e um Não Social. Da revisão da literatura realizada, constata-se que não existe uma definição única universal de Casos Sociais. Estes pacientes representam uma população de idade avançada, com diversas comorbilidades, apresentando estado de fragilidade e dependência, muitas vezes vivendo sozinhos ou em instituições residenciais. O prolongamento de alta destes pacientes está associado a fatores organizativos, socioeconómicos e clínicos. O perfil do Caso Social português é semelhante ao perfil internacional. Estima-se que a nível nacional correspondam a 3% dos pacientes internados. Em 2015, 50% destes pacientes concentra-se em Lisboa e as principais causas associadas prendem-se a falta de cuidador informal e o facto de o paciente viver sozinho. Os resultados do modelo confirmam que os Casos Sociais tendem a ter um tempo de internamento superior aos casos não sociais, mas a diferença é reduzida. Pode ser de interesse uma análise mais detalhada para pacientes outliers com mais de 30 dias de internamento onde a incidência de Casos Sociais é maior.<br>Hospital patients with a prolonged length of stay due to non-medical reasons have become a important topic of discussion in the context of sustainability of national health systems. The first part of this paper provides an extensive literature review on the definitions and international profile of these patients. The second part explores the Portuguese situation using 2015 data of half a million inpatients in mainland Portugal. The third part consists in the estimation of a binomial negative model to identify the differences in length of stay between Social Cases and a Non-Social cases. Given the existing literature, there is no unique and universal definition for these patients. Social cases tend to represent an older population, with several comorbidities, in a frail and dependent state, oftentimes living alone or in nursing homes. Their extended length of stay is mainly associated with organizational, clinical and socio-economic factors. Social cases in Portugal have a profile similar to their international counterparts and represent 3% of total inpatients in public hospitals. In 2015, 50% of them are concentrated in Lisbon area and the main causes for being considered social cases is lack of a caregiver and living alone. The model confirms that social case patients tend to have a longer length of stay compared to non-social cases, but the difference tends to be small. It could be of interest to conduct a more detailed analysis on outlier patients with more than 30 days of bed, where the incidence of social cases is more significant.<br>info:eu-repo/semantics/publishedVersion

Master´s thesis intends to establish the degree of erosion hazard in the given area using ArcGIS and based on the evaluation suggest flood measures. The work contains a description and photographs of the site address, general treatises erosion, the distribution of erosion, formation of erosion, erosion rate calculation faktorek threat and that it affect erosion control measures - water erosion (organizational, cultural and technical), the method used and a description of the software ArcGIS. This thesis describes how to determine the degree of erosion risk using software used. Based on the results obtained, proposal of erosion control measures on the most vulnerable places.

The subject of this diploma thesis is valuation of the production company XY, s.r.o. by using income- based valuation methods. In the first part of this thesis is a strategic analysis, financial analysis and SWOT analysis. In conclusion are used income- based methods and determine the value of the company at 31.12.2011.

This diploma work assess the financial health of the company in the years 2002–2006 on the basis of selected methods of the financial analysis. It includes proposals of possible solutions of identified problems which should result in the improvement of financial situation of the firm in the following years.

碩士<br>國立臺灣大學<br>電機工程學研究所<br>99<br>The unique timbres of different speakers make their speech discriminative. There have been many algorithms trying to quantify the timbre characteristics for speaker identification systems. Long Term Average Spectrum (LTAS), an averaged spectrum on a long term series of the human speech, is one of the most popular technologies to analyze speakers’ characteristics. LTAS is considered to disregard the influence of contents but keep only speakers’ characteristics, and it has been used in many applications on human speech analysis and recognition. In this thesis, the characteristics of the LTAS are analyzed. Experiments demonstrated that the previous arguments on LTAS might only hold in particular situations. LTAS cannot totally disregard the influence of the contents in general. It is improper for speaker identification unless embeds the same content distribution. LTAS somehow represents the speakers’ characteristics, but the content distribution should be considered at the same time. So the previous applications based on the LTAS might be improved.

碩士<br>國立臺灣大學<br>電機工程學研究所<br>100<br>Timbre is the important characteristic that human can distinguish the difference between each other by their voice. This thesis aims to give a feature of timbre that considers both Long Term Average Spectrum (LTAS) and speech content distribution and implements to speaker identification system. LTAS is a feature influenced by both characteristics of speaker and content, so the same speaker still has inconsistent patterns of LTAS. The inconsistency of patterns also directly influences the accuracy of speaker identification using LTAS as feature. To increase the accuracy by considering the effect of content, this thesis proposes the idea of Pseudo LTAS. All Taiwanese Mandarin phonemes are analyzed. Then the influential phonemes are chosen and their average spectra are derived as the components of speaker database. When the test speech signal is inputted, system recognizes its content and synthesizes the pseudo LTAS weighted by the content for individual. Because the contents of Pseudo LTAS and test speech signal are same, the accuracy of speaker identification using Pseudo LTAS as the decision pattern will be better than the one using LTAS which ignores the influence of content. The accuracy of speaker identification system using Pseudo LTAS is 94.2 %.

Despite a continuous development in computer sciences and related disciplines, speaker identification remains one of the most challenging tasks in forensic phonetics. The reason for this is the fact that our knowledge of how identity is reflected in the acoustic signal is still limited. The present study aims to contribute to the search of speaker-specific cues by examining spectral properties of the source signal. Specifically, it examines to what extent three short-term measures of spectral tilt, namely H1-H2, H1-A1 and H1-A3, can discriminate 16 Czech female speakers. It also addresses the influence of vowel quality, syllable status with respect to stress and position of stress group in the utterance on the values of these measures. The results show that these parameters do have some discriminative power, though the contribution of individual parameters differs. The study indicates that discrimination of speakers is the most successful in stressed syllables and argues that individual vowels could differ in their usefulness for speaker identification. The results of LDA based on these short- term measures of spectral tilt were complemented with long-term measures, namely alpha index, Kitzing index and Hammarberg index which quantify the slope of the LTAS. The present study suggests that...

碩士<br>國立中央大學<br>應用地質研究所<br>99<br>According to the Water Resources Agency, there are more than one hundred thousand groundwater pumping wells in Yunlin area, in central Taiwan. In recent decades, the increasing pumping of groundwater for fish farming, industry, household and agriculture causes the decline of groundwater level in coastal area here. Moreover, the great difference of available water resources in wet and dry seasons lead to highly demand of groundwater resource and result in serious land subsidence. Recent observation also indicate that the center of land subsidence moves inland from the coast area due to the continuous pumping of groundwater. Such land subsidence may harm the sustainability of public constructions. To predict the long-term variations of subsidence in Yunlin area, this study employs a modular three-dimensional finite-difference ground-water flow model(MODFLOW) associated with Subsidence and Aquifer-System Compaction (SUB) package to build physical-based numerical model for groundwater flow and land subsidence. This study divides into three major terms: (1) Using MODFLOW to build the three-dimensional groundwater flow model and calibrate the model based on the water level observations from Water Resources Agency. Such long-term groundwater levels are from 1998 to 2003 and from 2005 to 2009. (2) Building a land subsidence model with SUB modulus, and investigates the sensitivity of the consolidation parameters by increasing or decreasing 0.1, 0.2, and 2 times of selected parameters in baseline case, (3) calibrating the aquifer consolidation parameters based on nineteenth multi-level compaction monitoring wells from Water Resources Agency, and analyzing the impacts of land subsidence on three different pumping scenarios in Yunlin area. Results show that: (1) the calibrated model obtains the root mean square error (RMSE) of 4.84 and average absolute percentage error rate (MAPE) of 3.28%. (2) The vertical hydraulic conductivity(K_v^'') and elastic skeletal storage coefficient(Ske) in the clay layer are the high sensitivity parameters for the accumulated land subsidence. The simulated land subsidence show solutions similar with the selected multi-level compaction monitoring wells. (3) Continuous pumping will result in 0.1 and 0.2 meters of subsidence in amount in the later period. Although the groundwater head has no obvious change in the stress period after 20 years, the values of land subsidence increase gradually and continuously. Three pumping scenarios are employed to assess the long-term effects of pumping events on the land subsidence in Yunlin area. The results of first two scenarios show that the values of land subsidence will recover 0.1 meters after 10 years if all the pumping events are stopped at the fifth and tenth years. Such result also indicate that the effective stress caused by pumping is still below the preconsolidation stress in the aquifer and the recovering procedures are mainly controlled elastic compaction. The recovery of land subsidence are about 0.25 meters at Tu Ku junior high school and Keh Tsuoh elementary school stations, and about 0.15 meters at Haifong District school station, Fengan and Chinhu elementary school stations. The Yuan Chang elementary school has greatest recovery about 0.4 meters. The result of third scenario show that the pumping induced effective stress less than the preconsolidation stress will result in 0.8 meters of difference from initial ground levels, while the pumping induced effective stress greater than the preconsolidation stress will lead to 1.5 meters of difference from initial ground levels.

This narrative inquiry explores how Black tradeswomen negotiate the intersections of race and gender in their long-term careers in the U.S. building trades. Much of the literature on women and minority groups in the trades has focused on the success, or lack of success, of these groups in apprenticeship programs. To my knowledge, none has collected rich data focused on the long-term retention of Black women in the trades, nor has any discussed the personal, interpersonal, and institutional strategies this non-traditional group uses to continue working in the construction industry. This study draws on theory and empirical studies from the fields of Peace and Conflict Studies, Black Studies, Gender Studies, Labor Studies, and Psychology to provide a nuanced analysis of the systemic nature of Black tradeswomen’s struggles for gender and racial equity within the workforce, and elucidates the personal, interpersonal, and institutional strategies these women have developed to continue in this field. In-depth interviews conducted with fifteen tradeswomen revealed how they described and made sense of (1) their experiences of entering the trades and how their experiences in the trades changed over time; (2) barriers to their continued success as tradespeople; and (3) the skills and knowledge they developed to sustain themselves professionally. Findings include recommendations for interventions at the levels of pre-apprenticeships, apprenticeships, foremen, and higher to support the retention and promotion of Black tradeswomen in the industry. Tradeswomen highlight the necessity of combining anti-racist and anti-sexist struggles to promote greater inclusion of non-traditional workers. Black tradeswomen illuminate the importance of the cultivation of self-esteem and personal networks on and off the job as mitigating factors in a microaggressive work environment.

RESUMO - Enquadramento: O envelhecimento dos indivíduos nos países mais desenvolvidos e o aumento da incidência de doenças crónicas associadas a estados de dependência e incapacidade têm contribuído para o desenho e implementação de novas políticas de saúde e sociais. Assiste-se, por isso, atualmente, a uma mudança no paradigma da procura de cuidados de saúde, sendo crescente a procura de cuidados de longa duração ou cuidados continuados. O desenvolvimento e implementação de novos modelos de prestação de cuidados de saúde pretendem dar resposta à crescente procura de cuidados continuados, bem como promover a eficiência dos serviços e a disponibilização de camas nos hospitais, retirando dos serviços de agudos as pessoas que não necessitam de cuidados hospitalares, mas sim de cuidados continuados. Neste contexto foi criada em Portugal a Rede Nacional de Cuidados Continuados Integrados (RNCCI), como resposta ao aumento do número de pessoas em situação de dependência, e que necessitam tanto de cuidados de saúde como sociais, e à necessidade de reorganizar e promover a eficiência dos serviços de internamento hospitalar. Objetivo: Determinar o impacto da RNCCI na demora média hospitalar, no período de tempo compreendido entre 1 de Janeiro de 2009 e 31 de Junho de 2011. Métodos: O estudo realizado, com base na revisão da literatura, descreve os principais aspectos referentes ao envelhecimento dos indivíduos e aos cuidados continuados. Foram descritos diferentes modelos e programas organizacionais de prestação de cuidados continuados e o seu impacto na demora média hospitalar. Foi determinada a população em estudo no período de tempo compreendido entre 1 de Janeiro de 2009 e 31 de Junho de 2011. A população foi caraterizada de acordo com o ano e distribuída por dez trimestres para melhor tratamento estatístico e leitura dos dados. Foi considerado o sexo e a faixa etária dos indivíduos sinalizados, de acordo com o GDH de internamento hospitalar e respetiva sub-região de saúde. Foi comparada por trimestre a demora média dos internamentos hospitalares e a demora média hospitalar dos episódios referenciados a nível nacional e ao nível das sub-regiões de saúde. Foram caraterizados os GDH que representam 50% das sinalizações. Foram analisados, por semestre, os três GDH com maior número de referenciações para a RNCCI de acordo com as diferentes regiões de saúde, comparando as respetivas demoras médias nacionais e regionais. Resultados: No periodo de tempo em análise foi verificado que a população com maior utilização dos serviços da RNCCI encontra-se na faixa etária entre 65 ou mais anos, com 79,4% do total de sinalizações efetuadas. Tendo 50% das sinalizações sido referentes aos GDH 14, GDH 211, GDH 533, GDH 818, GDH 810 e GDH 209. Foi apurada uma demora média nacional compreendida entre os 7,3 dias e os 7,7 dias, comparativamente a uma demora média dos episódios referenciados para a RNCCI compreendida entre os 21,9 dias e os 33 dias, para o mesmo período de tempo. Em termos regionais a região de LVT apresenta os valores de demora média mais elevados, com um intervalo entre os 28,8 dias e os 50,3 dias de demora média. Para o GDH 14 foi observada uma demora média dos episódios referenciados compreendida entre os 14,4 dias e os 26,7 dias. No mesmo período de tempo o a demora média nacional para o mesmo GDH situava-se entre os 9,8 dias e os 10,2 dias. Para o GDH 211 foi observada uma demora média dos episódios referenciados compreendida entre os 17,2 dias e os 28,9 dias. Comparativamente a demora média nacional para o mesmo GDH situava-se entre os 12,5 dias e os 13,5 dias. Para o GDH 533 foi observada uma demora média dos episódios referenciados compreendida entre os 23,3 dias e os 52,7 dias. Comparativamente, no mesmo período de tempo, a demora média nacional para o mesmo GDH situava-se entre os 18,7 dias e os 19,7 dias. Conclusões: Foi possível concluir, quanto ao impacto da RNCCI na demora média hospitalar, que a demora média dos episódios referenciados para a Rede é superior à demora média nacional em todo o período de tempo em análise. Relativamente à demora média dos GDH com maior número de referenciações, os GDH 14, 211 e 533, verifica-se que todos eles apresentam uma demora média de referenciação superior à demora média nacional, e demora média regional para o mesmo GDH, em todo o período de tempo do estudo. Ou seja, foi possível verificar que a demora média para indivíduos com o mesmo GDH é superior nos que são referenciados para a RNCCI.<br>ABSTRACT - Background: The aging of individuals in developed countries and the increasing incidence of chronic diseases associated with states of disability, have contributed to the development of new social and health policies. Currently there is an increasing demand for long-term care. The new developed long-term care models intend to provide new solutions to hospital efficiency by removing people that stay hospitalized without the need of acute care, but with the need of long-term care. The Integrated Continued Care National Network (RNCCI) was created in Portugal with the purpose of providing long-term care to the increasing number of people with disabilities that require both health care and social care. One of the main goals of the RNCCI is to promote hospital efficiency and to reduce the average length of stay. Objective: The main objetive of this study is to determine the impact of the RNCCI in the hospital average length of stay in the time period between January 1, 2009 and June 31, 2011. Methods: The study describes the main aspects related to the aging of individuals and longterm care. It is mentioned the different organizational models and programs that provide longterm care and their impact on hospital average length of stay. The population under study was determined in the time period between January 1, 2009 and June 31, 2011. The population was characterized according to the year and distributed for ten quarters to better statistical processing and reading data. For the purposes of the study it was considered the following variables: sex and age of the population in study, respective Diagnosis Related Group (DRG) considering the different health regions. It was compared the average length of stay of all hospital admissions with the average length of stay of all signalized and referenced to the RNCCI episodes. It were identified the DRG responsible for 50 % of the signaling. It were identified the three DRG that have the highest rate of signalized episodes to the RNCCI. They were compared according to the different health regions, and according to their hospital average length of stay. Results: It was found that individuals with greater use of RNCCI services are in the age above 65 years old or more, with 79.4 % of the signaling . It was found that 50 % of the signals were related to DRG 14 , DRG 211 , DRG 533 , DRG 818 , DRG 810 and DRG 209 . The overall hospital average length of stay ranged between 7.3 days and 7.7 days. The hospital average length of stay of all the signalized episodes to the RNCCI ranged between 21.9 days and 33 days. The highest hospital average length of stay was found to be in Lisboa e Vale do Tejo (LVT), with a range between 28.8 days and 50.3 days, for signalized episodes. For all signalized DRG 14 episodes was found a hospital average length of stay ranged between 14.4 days and 26.7 days. In the same period of time, the overall hospital average length of stay for DRG 14 ranged between 9,8 days and 10.2 days. For all signalized DRG 211 episodes was found a hospital average length of stay ranged between 17.2 days and 28.9 days. In the same period of time, the overall hospital average length of stay for DRG 211 ranged between 12.5 days and 13.5 days. For all signalized DRG 533 episodes was found a hospital average length of stay ranged between 23.3 days and 52.7 days. In the same period of time, the overall hospital average length of stay for DRG 533 ranged between 19.7 and 18.7 days. Conclusions: It was found that the hospital average length of stay of all signalized and referenced episodes to the RNCCI is higher that the overall hospital average length of stay, considering the time period under review. All signalized and referenced DRG reveal a hospital average length of stay higher that the overall hospital average length of stay for the same DRG.

RESUMO - Enquadramento: O envelhecimento da população nos países desenvolvidos, o aumento das situações de dependência, das doenças crónicas e da carência social conduzem ao aparecimento na sociedade de novas necessidades tanto a nível social como a nível de saúde, que requerem uma resposta integrada entre os vários níveis de cuidados. Perante esta realidade, surge uma mudança de paradigma que existia e que leva a uma crescente procura de cuidados continuados de longa duração É de extrema importância criar soluções consigam dar respostas adequadas a esta problemática, com o desenvolvimento e implementação de novos modelos de prestação com o objetivo de promover a eficiência dos hospitais e disponibilizando camas nos hospitais de agudos, retirando dos internamentos os utentes que necessitam de cuidados continuados. Em Portugal, foi criada em 2006 a Rede Nacional de Cuidados Continuados (RNCCI), como resposta às enormes mudanças sociais que acarretam um aumento das necessidades tanto a nível de cuidados de saúde como a nível de cuidados sociais. Objetivo: Avaliar o impacto da referenciação para a RNCCI na demora média (DM) hospitalar, no período compreendido entre 1 de Janeiro de 2015 a 31 de Dezembro de 2016, no Hospital Beatriz Ângelo (HBA). Metodologia: Estudo de natureza quantitativa, retrospetivo, caso- controlo, do tipo descritivo. Resultados: No período em análise foi verificado que os utentes com maior referenciação para a RNCCI encontram-se na faixa etária entre os 65 e 84 anos (59,% em 2015 e 54% em 2016). Os resultados evidenciam que os utentes referenciados para a RNCCI pelo HBA têm uma demora média de internamento superior aos utentes não referenciados para a RNCCI, no período estudado. Relativamente aos dez GDH mais referenciados pelo HBA, que constituem 43,7 % das referenciações, constata-se que todos eles têm uma demora média superior quando comparados com os utentes não referenciados, no período em estudo.<br>ABSTRACT - Background: The aging of the population in developed countries, increasing dependency, chronic diseases and social deprivation lead to the emergence of new social and health needs in society, which require an integrated response between the various levels of care. Faced with this reality, there is a paradigm shift that has existed so far leading to a growing demand for long-term care It is extremely important to create solutions to provide adequate responses to this problem, with the development and implementation of new delivery models with the objective of promoting hospital efficiency and providing beds in acute hospitals, removing the patients who need care continued. In Portugal, the National Continuum of Care Network (RNCCI) was created in 2006 in response to the enormous social changes that lead to an increase in the needs of both health care and social care. Objective: The objective of this study is to evaluate the impact of referral for the RNCCI, in the hospital average lengthn of stay in the time period between January 1, 2015 and December 31, 2016, at the Hospital Beatriz Ângelo (HBA) Methodology: Quantitative, retrospective, case-control, descriptive Results: In the period under analysis, it was verified that the users with the highest RNCCI referral are in the age group between 65 and 84 years-59,% in 2015 and 54% in 2016). The results show that the patients referred to the RNCCI by the HBA have an average delay higher than the users not referenced for the RNCCI in the period studied. With respect to the 10 most commonly referred GHDs, which constitute 43.7% of the references, all of them have a higher mean delay compared to unrelated users in the study period.

Dissertação de Mestrado em Cuidados Continuados e Paliativos apresentada à Faculdade de Medicina<br>Abstract: In 2014, the RNCCI recorded the admission of 1.070 patients in Centro Hospitalar e Universitário de Coimbra, EPE (CHUC). However, the process of admission of these patients in the RNCCI took place after a high standby time between their request for referral and the physical placement.My daily experience as a worker in CHUC Intermediate Management Unit led me to consider relevant this problem, focusing on understanding and specifying the conditions and time between the request for referral and the physical placement of the patients in the RNCCI, looking for identifying the underlying social and clinical causes as well as their impact on the CHUC services, and the professionals’ perception directly involved in this kind of study. This perception is mainly about the delay of RNCCI, the consequences to the clinical Units and the suggestions that can minimized or solve this problem. Material and Methods: This is a quantitative and qualitative retrospective study which includes inpatients from Centro Hospitalar e Universitário de Coimbra, Pole Hospitais Universidade de Coimbra, which were referred and admitted in RNCCI during all year 2016. Professionals from medical specialties services and from Social Service were also included. Documental analysis was the instrument adopted for data collection in particular the patients’ reference forms for the RNCCI. Interviews were the other adopted instrument and were conducted to the health professionals - which develop their activities in the clinical services - in a semi-structured way. Results: In 2016, the patients’ hospitalized at the HUC pole of the CHUC called to the RNCCI, were gender similar, the most of them belong to the age group between 80-89 years (36,8%), live-in the district of Coimbra (69,3%), have the 1st cycle (44,1%), and were retired (87,4%). The main causes of hospitalization were bone fracture (19,3%), stroke (18,4%) and cancer (16,9%), correspondent to the orthopedics, internal medicine, and neurology services. These patients were mainly admitted in convalescence units (42,4%), most of them due to their dependency of ADLs (57,1%). It is a population that mostly cohabits with their close family (69,3%), which provides them the basic support. Some of these patients experience social problems, such as alcoholic habits, aggressive behaviors, and low incomes, among others. Their caregivers are in some situations elderly, sick, tired and with little or no willingness to support them, such as the sons. The patients who were called for RNCCI had a mean delay of 31,2 days, while the overall mean of the HUC pole was only 8,6 days, which means an increase of 22,6 days in the referenced patients. The main reasons for this delay are the lack of units’ internment vacancies, the overcome of patients who need these units, as well as the infections and reinfections while patients are waiting for a vacancy. The impact is clearly negative, leading to a bigger exposure of patients to infectious and non-infectious diseases, making it impossible hospitalize new acute patients, among others. When asked about this issue, various interlocutors said that the solutions undergo the increase of the number of nursing homes with social security agreements, the creation of more efficient community responses, and the increase of agility in the process of patients' entry into the RNCCI. Concerning CHUC, the proposed solutions include the creation of a rear-supervision unit to accommodate these patients while they are waiting for vacancies and home hospitalization solutions. Conclusions: It appears that the delay in admission to RNCCI was mainly due to the inability of the network to deal with patients’ needs, the increase of patients who need admission to the RNCCI, and the infections and reinfections suffered during the waiting period. The results of this negative impact are a very significant increase in the average hospital delay (+22,6 days), higher infection risk, and the impossibility of hospitalizing new patients with acute illness or the obligation to hospitalize them outside the suitable service. The main solutions identified to solve this problem are mainly extrinsic to CHUC - increasing the number of nursing homes and community responses adapted to this type of patients, but also intrinsic – the creation of a "rear-internment unit” to accommodate these patients while they are waiting for a vacancy and a home hospitalization unit.<br>Resumo: No Centro Hospitalar e Universitário de Coimbra, EPE (CHUC), registou-se em 2014 a admissão de 1.070 doentes na RNCCI. Contudo, a concretização da entrada destes doentes na RNCCI efetuou-se após um elevado tempo de espera entre a sua referenciação e colocação. Pensamos ser pertinente compreender as condições e o tempo que medeia entre o pedido de referenciação e a colocação dos doentes na RNCCI e as perceções dos profissionais envolvidos neste tipo de processos, relativamente aos fatores que originam o atraso na RNCCI, às consequências que tal atraso acarreta para os Serviços clínicos e às propostas e/ou sugestões capazes de minimizar ou resolver este problema. Material e Métodos:Trata-se de um estudo quantitativo e qualitativo de caracter retrospetivo, que envolve os doentes internados nos Serviços do Pólo HUC do CHUC referenciados e admitidos na RNCCI durante o ano de 2016, bem como os profissionais dos Serviços de especialidades médicas e do Serviço Social do CHUC. Este estudo teve como instrumento de colheita de dados a análise documental, nomeadamente dos formulários de referenciação dos doentes para a RNCCI e a realização de entrevistas semi-estruturadas. Resultados: Os doentes internados no Pólo HUC do CHUC referenciados para a RNCCI em 2016, revelaram ser similares em termos de género e, maioritariamente, pertencer à faixa etária dos 80-89 anos (36,8%), residir no distrito de Coimbra (69,3%), possuir o 1º Ciclo (44,1%) e estar reformados (87,4%). As principais causas de internamento foram a fratura óssea (19,3%), o AVC (18,4%) e a doença oncológica (16,9%), tendo ocorrido predominantemente nos Serviços de Ortopedia, Medicina Interna A e Neurologia. Estes doentes foram admitidos maioritariamente em Unidades de Convalescença (42,4%), devido sobretudo à situação de dependência na realização das suas AVD’s (57,1%). Trata-se de uma população que maioritariamente coabita com a família natural (69,3%), seu principal cuidador, que lhes presta um bom apoio, em particular a nível alimentar. Alguns destes doentes vivenciam problemas sociais, como hábitos alcoólicos, comportamentos agressivos e baixos rendimentos, entre outros. O seu cuidador é nalgumas situações idoso, doente, cansado e com pouca ou nenhuma disponibilidade para apoiar o doente, tal como os filhos. Os doentes analisados que foram referenciados para a RNCCI, registaram uma demora média de 31,2 dias, enquanto que a média global do Pólo HUC é de apenas 8,6 dias, traduzindo um acréscimo de mais 22,6 dias nos doentes referenciados. Os principais motivos deste atraso na admissão na RNCCI, são a insuficiência de vagas de internamento nas suas Unidades, o excesso de doentes que delas necessitam, bem como as infeções e reinfeções registadas enquanto aguardam vaga. O impacto daqui resultante é claramente negativo originando uma maior exposição dos doentes a complicações infeciosas e não infeciosas, impossibilitando o internamento de novos doentes agudos, entre outros. Na opinião dos diversos interlocutores inquiridos, as soluções para este problema passam, ao nível externo, pelo aumento do número de lares de idosos com acordos com a Segurança Social, pela criação de respostas comunitárias mais eficientes, pelo aumento do número de Unidades e ECCI’s da Rede e ainda por uma maior agilidade no processo de ingresso dos doentes na RNCCI. A nível do CHUC, as soluções apontadas passam pela criação de uma Unidade de internamento de retaguarda para acolher estes doentes enquanto aguardam vaga e por soluções de Hospitalização Domiciliária. Conclusões: Verifica-se que o atraso da admissão na RNCCI resultou essencialmente da incapacidade da Rede para fazer face às necessidades dos doentes, do aumento do número de doentes que nela necessitam de ingressar e das infeções e reinfeções de que foram vítimas durante o tempo de espera. Trata-se de um impacto negativo que originou um aumento muito significativo da demora média hospitalar (+22,6 dias), maiores riscos infeciosos para o doente e impossibilidade de internar novos doentes com doença aguda ou obrigatoriedade de os internar fora do Serviço de origem. As principais medidas identificadas para solucionar este problema são essencialmente extrínsecas ao CHUC - aumento do número de lares de idosos convencionados e de respostas comunitárias adaptadas a este tipo de doentes, mas também intrínsecas – criação de uma Unidade de Internamento “de Retaguarda” para acolher estes doentes enquanto aguardam vaga e de uma Unidade de Hospitalização Domiciliária.