Second life battery energy storage systems:converter topology and redundancy selection

Battery energy storage systems have traditionally been manufactured using new batteries with a good reliability. The high cost of such a system has led to investigations of using second life transportation batteries to provide an alternative energy storage capability. However, the reliability and performance of these batteries is unclear and multi-modular power electronics with redundancy have been suggested as a means of helping with this issue. This paper reviews work already undertaken on battery failure rate to suggest suitable figures for use in reliability calculations. The paper then uses reliability analysis and a numerical example to investigate six different multi-modular topologies and suggests how the number of series battery strings and power electronic module redundancy should be determined for the lowest hardware cost using a numerical example. The results reveal that the cascaded dc-side modular with single inverter is the lowest cost solution for a range of battery failure rates.

Cancer therapy combining the modalities of hyperthermia and chemotherapy: In vitro cellular response after rapid heat accumulation in the cancer cell

Hyperthermia is usually used at a sub-lethal level in cancer treatment to potentiate the effects of chemotherapy. The purpose of this study is to investigate the role of heating rate in achieving synergistic cell killing by chemotherapy and hyperthermia. For this purpose, in vitro cell culture experiments with a uterine cancer cell line (MES-SA) and its multidrug resistant (MDR) variant MES-SA/Dx5 were conducted. The cytotoxicity, mode of cell death, induction of thermal tolerance and P-gp mediated MDR following the two different modes of heating were studied. Doxorubicin (DOX) was used as the chemotherapy drug. Indocyanine green (ICG), which absorbs near infrared light at 808nm (ideal for tissue penetration), was chosen for achieving rapid rate hyperthermia. A slow rate hyperthermia was provided by a cell culture incubator. The results show that the potentiating effect of hyperthermia to chemotherapy can be maximized by increasing the rate of heating as evident by the results from the cytotoxicity assay. When delivered at the same thermal dose, a rapid increase in temperature from 37°C to 43°C caused more cell membrane damage than gradually heating the cells from 37°C to 43°C and thus allowed for more intracellular accumulation of the chemotherapeutic agents. Different modes of cell death are observed by the two hyperthermia delivery methods. The rapid rate laser-ICG hyperthermia @ 43°C caused cell necrosis whereas the slow rate incubator hyperthermia @ 43°C induced very mild apoptosis. At 43°C a positive correlation between thermal tolerance and the length of hyperthermia exposure is identified. This study shows that by increasing the rate of heating, less thermal dose is needed in order to overcome P-gp mediated MDR.

A methodology to select an enterprise resource planning system for a small or medium sized enterprise

Enterprise Resource Planning (ERP) systems are software programs designed to integrate the functional requirements, and operational information needs of a business. Pressures of competition and entry standards for participation in major manufacturing supply chains are creating greater demand for small business ERP systems. The proliferation of new offerings of ERP systems introduces complexity to the selection process to identify the right ERP business software for a small and medium-sized enterprise (SME). The selection of an ERP system is a process in which a faulty conclusion poses a significant risk of failure to SME’s. The literature reveals that there are still very high failure rates in ERP implementation, and that faulty selection processes contribute to this failure rate. However, the literature is devoid of a systematic methodology for the selection process for an ERP system by SME’s. This study provides a methodological approach to selecting the right ERP system for a small or medium-sized enterprise. The study employs Thomann’s meta-methodology for methodology development; a survey of SME’s is conducted to inform the development of the methodology, and a case study is employed to test, and revise the new methodology. The study shows that a rigorously developed, effective methodology that includes benchmarking experiences has been developed and successfully employed. It is verified that the methodology may be applied to the domain of users it was developed to serve, and that the test results are validated by expert users and stakeholders. Future research should investigate in greater detail the application of meta-methodologies to supplier selection and evaluation processes for services and software; additional research into the purchasing practices of small firms is clearly needed.^

Three empirical essays on startups' survival using the Kauffman Firm Survey

This dissertation studies newly founded U.S. firms' survival using three different releases of the Kauffman Firm Survey. I study firms' survival from a different perspective in each chapter. ^ The first essay studies firms' survival through an analysis of their initial state at startup and the current state of the firms as they gain maturity. The probability of survival is determined using three probit models, using both firm-specific variables and an industry scale variable to control for the environment of operation. The firm's specific variables include size, experience and leverage as a debt-to-value ratio. The results indicate that size and relevant experience are both positive predictors for the initial and current states. Debt appears to be a predictor of exit if not justified wisely by acquiring assets. As suggested previously in the literature, entering a smaller-scale industry is a positive predictor of survival from birth. Finally, a smaller-scale industry diminishes the negative effects of debt. ^ The second essay makes use of a hazard model to confirm that new service-providing (SP) firms are more likely to survive than new product providers (PPs). I investigate the possible explanations for the higher survival rate of SPs using a Cox proportional hazard model. I examine six hypotheses (variations in capital per worker, expenses per worker, owners' experience, industry wages, assets and size), none of which appear to explain why SPs are more likely than PPs to survive. Two other possibilities are discussed: tax evasion and human/social relations, but these could not be tested due to lack of data. ^ The third essay investigates women-owned firms' higher failure rates using a Cox proportional hazard on two models. I make use of a never-before used variable that proxies for owners' confidence. This variable represents the owners' self-evaluated competitive advantage. ^ The first empirical model allows me to compare women's and men's hazard rates for each variable. In the second model I successively add the variables that could potentially explain why women have a higher failure rate. Unfortunately, I am not able to fully explain the gender effect on the firms' survival. Nonetheless, the second empirical approach allows me to confirm that social and psychological differences among genders are important in explaining the higher likelihood to fail in women-owned firms.^

A multimodal and adaptive real-time human -computer interface for peoples with severe motor disability

This dissertation introduces the design of a multimodal, adaptive real-time assistive system as an alternate human computer interface that can be used by individuals with severe motor disabilities. The proposed design is based on the integration of a remote eye-gaze tracking system, voice recognition software, and a virtual keyboard. The methodology relies on a user profile that customizes eye gaze tracking using neural networks. The user profiling feature facilitates the notion of universal access to computing resources for a wide range of applications such as web browsing, email, word processing and editing. ^ The study is significant in terms of the integration of key algorithms to yield an adaptable and multimodal interface. The contributions of this dissertation stem from the following accomplishments: (a) establishment of the data transport mechanism between the eye-gaze system and the host computer yielding to a significantly low failure rate of 0.9%; (b) accurate translation of eye data into cursor movement through congregate steps which conclude with calibrated cursor coordinates using an improved conversion function; resulting in an average reduction of 70% of the disparity between the point of gaze and the actual position of the mouse cursor, compared with initial findings; (c) use of both a moving average and a trained neural network in order to minimize the jitter of the mouse cursor, which yield an average jittering reduction of 35%; (d) introduction of a new mathematical methodology to measure the degree of jittering of the mouse trajectory; (e) embedding an onscreen keyboard to facilitate text entry, and a graphical interface that is used to generate user profiles for system adaptability. ^ The adaptability nature of the interface is achieved through the establishment of user profiles, which may contain the jittering and voice characteristics of a particular user as well as a customized list of the most commonly used words ordered according to the user's preferences: in alphabetical or statistical order. This allows the system to successfully provide the capability of interacting with a computer. Every time any of the sub-system is retrained, the accuracy of the interface response improves even more. ^

Factors influencing university performance of associate in arts graduates transferring to the state university system

The purpose of this study was to examine the factorsbehind the failure rates of Associate in Arts (AA)graduates from Miami-Dade Community College (M-DCC) transferring to the Florida State University System (SUS). In M-DCC's largest disciplines, the university failure rate was 13% for Business & Management, 13% for Computer Science, and 14% for Engineering. Hypotheses tested were: Hypothesis 1 (H1): The lower division (LD) overall cumulative GPA and/or the LD major field GPA for AA graduates are predictive of the SUS GPA for the Business Management, Computer Science, and Engineering disciplines. Hypothesis 2 (H2): Demographic variables (age, race, gender) are predictive of performance at the university among M-DCC AA graduates in Engineering, Business & Management, and Computer Science. Hypothesis 3 (H3): Administrative variables (CLAST -College Level Academic Skills Test subtests) are predictive of university performance (GPA) for the Business/Management, Engineering, and Computer Science disciplines. Hypothesis 4 (H4): LD curriculum variables (course credits, course quality points) are predictive of SUS performance for the Engineering, Business/Management and Computer Science disciplines. Multiple Regression was the inferential procedureselected for predictions. Descriptive statistics weregenerated on the predictors. Results for H1 identified the LD GPA as the most significant variable in accounting for the variability of the university GPA for the Business & Management, Computer Science, and Engineering disciplines. For H2, no significant results were obtained for theage and gender variables, but the ethnic subgroups indicated significance at the .0001 level. However, differentials in GPA may not have been due directly to the race factor but, rather, to curriculum choices and performance outcomes while in the LD. The CLAST computation variable (H3) was a significant predictor of the SUS GPA. This is most likely due to the mathematics structure pervasive in these disciplines. For H4, there were two curriculum variables significant in explaining the variability of the university GPA (number of required critical major credits completed and quality of the student's performance for these credits). Descriptive statistics on the predictors indicated that 78% of those failing in the State University System had a LD major GPA (calculated with the critical required university credits earned and quality points of these credits) of less than 3.0; and 83% of those failing at the university had an overall community college GPA of less than 3.0.

A study of primary teeth restored by intracoronal restorations in children participating in an undergraduate teaching programme at Cork University Dental School and Hospital, Ireland

Aim: To study the outcomes for restored primary molar teeth; to examine outcomes in relation to tooth type involved, intracoronal restoration complexity and to the material used. Materials and methods: Design: Retrospective study of primary molar teeth restored by intracoronal restorations. A series of restored primary molar teeth for children aged 6-12 years was studied. The principal outcome measure was failure of initial restoration (re-restoration or extraction). Three hundred patient records were studied to include three equal groups of primary molar teeth restored with amalgam, composite or glass ionomer, respectively. Restorative materials, the restoration type, simple (single surface) or complex (multi-surface) restoration, and tooth notation were recorded. Subsequent interventions were examined. Data were coded and entered into a Microsoft Excel database and analysis undertaken using SPSS v.18. Statistical differences were tested using the c2 test of statistical significance. Results: Of the 300 teeth studied, 61 restoration failures were recorded with 11 of those extracted. No significant differences were found between outcomes for upper first, upper second, lower first or lower second primary molars. Outcomes for simple primary teeth restored by intracoronal restorations were significantly better than those for complex intracoronal restorations (P = 0.042). Teeth originally restored with amalgam accounted for 19.7% of the 61 failures, composite for 29.5%, while teeth restored with glass ionomer represented 50.8% of all restoration failures. The differences were significant (P = 0.012). Conclusions: The majority (79.7%) of the 300 restored primary teeth studied were successful, and 3.7% teeth were extracted. Restorations involving more than one surface had almost twice the failure rate of single surface restorations. The difference was significant. Significant differences in failure rates for the three dental materials studied were recorded. Amalgam had the lowest failure rate while the failure rate with glass ionomer was the highest.

JNK regulates Fas receptor mediated apoptosis in prostate cancer cell lines

Prostate Cancer is a disease that primarily affects elderly men. The incidence of prostate cancer has been progressively increasing in the western world over the last two decades. Life expectancy and diet are believed to be the main factors contributing to this increase in prevalence. Prostate cancer is a slowly progressing disorder and patients often live for over 10 years after initially being diagnosed with prostate cancer. However, patients with hormone refractory prostate cancer have a poor prognosis and generally do not survive for longer than 2 or 3 years. Hormone refractory prostate cancer is responsible for over 200,000 deaths each year and current chemotherapeutic regimens are only useful as palliative agents. The long-term survival rate is poor and chemotherapy does not significantly increase this. Cell lines derived from hormone refractory tumours usually display elevated resistance to many cytotoxic drugs. The Fas receptor is a membrane bound protein capable of binding to a ligand called Fas ligand. Engagement of Fas receptor with Fas ligand results in clustering of Fas receptor on the plasma membrane of cells. A number of proteins responsible for initiating apoptosis are recruited to the plasma membrane and are activated in response to elevated local concentrations. This series of events initiates a proteolysis cascade and that culminates in the degradation of structural and enzymatic processes and the repackaging of cellular constituents within membrane bound vesicles that can be endocytosed and recycled by surrounding phagocytic cells. The Fas receptor is believed to be a key mechanism by which immune cells can destroy damaged cells. Consequently, resistance to Fas receptor mediated apoptosis often correlates with tumour progression. It has been reported that prostate cancer cell lines display elevated resistance to Fas receptor mediated apoptosis and this correlates with the stage of tumour from which the cell lines were isolated. JNK, a stress-activated protein kinase, has been implicated both with increased survival and increased apoptosis in prostate cancer. Elevated endogenous JNK activity has been demonstrated to correlate with prostate cancer progression. It has been shown that endogenous JNK activity increases the expression of anti-apoptotic proteins and can increase the resistance of prostate cancer cell lines to chemotherapy. In addition, elevated endogenous JNK activity is required for improved proliferation and transformation of a number of epithelial tumours. However, prolonged JNK activation in response to cytotoxic stimuli can increase the sensitivity of cells to apoptosis. Prolonged JNK activity appears to induce the expression of a separate set of genes responsible for promoting apoptosis. Our group has recently shown that activation of JNK by chemotherapeutic drugs can sensitise DU 145 prostate carcinoma cells to Fas receptor mediated apoptosis. In order toidentify novel targets for treating hormone refractory prostate cancer we have investigated the role of JNK in Fas receptor mediated apoptosis. We have demonstrated that prolonged JNK activation is defective in DU 145 cells in response to Fas receptor activation alone. Co-administering anisomycin, a JNK agonist, greatly enhances the ability of DU 145 cells to undergo apoptosis by increasing the rate of Caspase 8 cleavage. We also investigated the role of endogenous JNK activity in Fas receptor mediated.

The role of acute ambient hypoxia in the regulation of myostatin

When exposed to chronic hypoxia by pathophysiological or environmental causes humans show muscle atrophy, challenging homeostasis and increasing mortality rate. Chronic hypoxia also presents with elevated myostatin peptide, a negative regulator of muscle size. This work induced acute hypoxia in healthy individuals; hypothesizing hypoxia would increase myostatin expression in both muscle and plasma in a concentration- and time-dependent manner. Hypoxia (1 % O2) reduced C2C12 myoblast migration and myotube size in vitro. Myotube atrophy was time-dependent, longer exposures showed greater atrophy. Intracellular myostatin peptide was decreased at every time point measured. Myostatin and downstream signalling pathways in muscle showed a high degree of percentage similarity between mouse and human, when amino acid sequences were directly compared. Healthy males (N = 8) were exposed to 20.9 % O2 or 11.9 % O2 for 2 hours. Following hypoxic exposure myostatin peptide was reduced in muscle but not plasma, relative to control conditions. A second cohort (N = 8) was exposed to 12.5 % O2 for 10 hours. Plasma myostatin was decreased following hypoxia, muscle myostatin trended towards increasing. A third cohort (N = 9; n = 8 lowlander, n = 1 Sherpa) was exposed to 10.7 % or 12.3 % O2 for 2 hours. Plasma myostatin was reduced at both concentrations with no difference between concentrations noted. In response to chronic hypoxia, individuals lose muscle mass. Counter to the hypothesis of an increase in myostatin in both muscle and plasma, here a consistent decrease in plasma myostatin following acute hypoxia is seen. Muscle myostatin shows a variable response, with decreasing intracellular expression seen following a 2 hour hypoxic exposure, and trends towards an increase following 10 hours of hypoxia. Decreases in plasma and muscle myostatin may represent myostatin’s movement towards peripheral compartments in these acute timeframes. Hypoxia alone is capable of altering myostatin in healthy individuals; the effects of hypoxia on myostatin appear to differ between the acute timeframes examined here and chronic exposures in environmental or disease models.

Establishing an EGFR mutation screening service for non-small cell lung cancer - sample quality criteria and candidate histological predictors.

INTRODUCTION: EGFR screening requires good quality tissue, sensitivity and turn-around time (TAT). We report our experience of routine screening, describing sample type, TAT, specimen quality (cellularity and DNA yield), histopathological description, mutation result and clinical outcome. METHODS: Non-small cell lung cancer (NSCLC) sections were screened for EGFR mutations (M+) in exons 18-21. Clinical, pathological and screening outcome data were collected for year 1 of testing. Screening outcome alone was collected for year 2. RESULTS: In year 1, 152 samples were tested, most (72%) were diagnostic. TAT was 4.9 days (95%confidence interval (CI)=4.5-5.5). EGFR-M+ prevalence was 11% and higher (20%) among never-smoking women with adenocarcinomas (ADCs), but 30% of mutations occurred in current/ex-smoking men. EGFR-M+ tumours were non-mucinous ADCs and 100% thyroid transcription factor (TTF1+). No mutations were detected in poorly differentiated NSCLC-not otherwise specified (NOS). There was a trend for improved overall survival (OS) among EGFR-M+ versus EGFR-M- patients (median OS=78 versus 17 months). In year 1, test failure rate was 19%, and associated with scant cellularity and low DNA concentrations. However 75% of samples with poor cellularity but representative of tumour were informative and mutation prevalence was 9%. In year 2, 755 samples were tested; mutation prevalence was 13% and test failure only 5.4%. Although samples with low DNA concentration (2.2 ng/μL), the mutation rate was 9.2%. CONCLUSION: Routine epidermal growth factor receptor (EGFR) screening using diagnostic samples is fast and feasible even on samples with poor cellularity and DNA content. Mutations tend to occur in better-differentiated non-mucinous TTF1+ ADCs. Whether these histological criteria may be useful to select patients for EGFR testing merits further investigation.

Shapes and Dynamics of Blood Cells in Poiseuille and Shear Flows

The dynamics, shape, deformation, and orientation of red blood cells in microcirculation affect the rheology, flow resistance and transport properties of whole blood. This leads to important correlations of cellular and continuum scales. Furthermore, the dynamics of RBCs subject to different flow conditions and vessel geometries is relevant for both fundamental research and biomedical applications (e.g drug delivery). In this thesis, the behaviour of RBCs is investigated for different flow conditions via computer simulations. We use a combination of two mesoscopic particle-based simulation techniques, dissipative particle dynamics and smoothed dissipative particle dynamics. We focus on the microcapillary scale of several μm. At this scale, blood cannot be considered at the continuum but has to be studied at the cellular level. The connection between cellular motion and overall blood rheology will be investigated. Red blood cells are modelled as viscoelastic objects interacting hydrodynamically with a viscous fluid environment. The properties of the membrane, such as resistance against bending or shearing, are set to correspond to experimental values. Furthermore, thermal fluctuations are considered via random forces. Analyses corresponding to light scattering measurements are performed in order to compare to experiments and suggest for which situations this method is suitable. Static light scattering by red blood cells characterises their shape and allows comparison to objects such as spheres or cylinders, whose scattering signals have analytical solutions, in contrast to those of red blood cells. Dynamic light scattering by red blood cells is studied concerning its suitability to detect and analyse motion, deformation and membrane fluctuations. Dynamic light scattering analysis is performed for both diffusing and flowing cells. We find that scattering signals depend on various cell properties, thus allowing to distinguish different cells. The scattering of diffusing cells allows to draw conclusions on their bending rigidity via the effective diffusion coefficient. The scattering of flowing cells allows to draw conclusions on the shear rate via the scattering amplitude correlation. In flow, a RBC shows different shapes and dynamic states, depending on conditions such as confinement, physiological/pathological state and cell age. Here, two essential flow conditions are studied: simple shear flow and tube flow. Simple shear flow as a basic flow condition is part of any more complex flow. The velocity profile is linear and shear stress is homogeneous. In simple shear flow, we find a sequence of different cell shapes by increasing the shear rate. With increasing shear rate, we find rolling cells with cup shapes, trilobe shapes and quadrulobe shapes. This agrees with recent experiments. Furthermore, the impact of the initial orientation on the dynamics is studied. To study crowding and collective effects, systems with higher haematocrit are set up. Tube flow is an idealised model for the flow through cylindric microvessels. Without cell, a parabolic flow profile prevails. A single red blood cell is placed into the tube and subject to a Poiseuille profile. In tube flow, we find different cell shapes and dynamics depending on confinement, shear rate and cell properties. For strong confinements and high shear rates, we find parachute-like shapes. Although not perfectly symmetric, they are adjusted to the flow profile and maintain a stationary shape and orientation. For weak confinements and low shear rates, we find tumbling slippers that rotate and moderately change their shape. For weak confinements and high shear rates, we find tank-treading slippers that oscillate in a limited range of inclination angles and strongly change their shape. For the lowest shear rates, we find cells performing a snaking motion. Due to cell properties and resultant deformations, all shapes differ from hitherto descriptions, such as steady tank-treading or symmetric parachutes. We introduce phase diagrams to identify flow regimes for the different shapes and dynamics. Changing cell properties, the regime borders in the phase diagrams change. In both flow types, both the viscosity contrast and the choice of stress-free shape are important. For in vitro experiments, the solvent viscosity has often been higher than the cytosol viscosity, leading to a different pattern of dynamics, such as steady tank-treading. The stress-free state of a RBC, which is the state at zero shear stress, is still controversial, and computer simulations enable direct comparisons of possible candidates in equivalent flow conditions.

The effect of metoclopramide in capsule enteroscopy

Clinical utility of prokinetics in capsule endoscopy (CE) is not clearly established. The objective of this prospective, randomized, single-blind, controlled trial was to determine if metoclopramide is useful in CE by increasing the rate of complete enteroscopy. Ninety-five patients referred for CE were randomized to no metoclopramide (group B, n = 48) or 10 mg metoclopramide (group A, n = 47). Complete enteroscopy was possible in 38 patients of group A (80.9%) and 37 of group B (77.1%) (P = 0.422) with two cases of gastric retention in group B (4.2%; P = 0.253). Median gastric transit time was 26 min (1-211) in group A and 28 min (4-200) in group B (P = 0.511). Mean small bowel transit time, calculated after excluding 20 patients with incomplete enteroscopy, was similar in both groups (221.2 +/- 89 min vs. 256 +/- 82.2 min; P = 0.083). There were also no differences in the total number of findings (group A 4.5 +/- 4.7; group B 4.7 +/- 3.7, P = 0.815). Administration of 10 mg metoclopramide orally 15 min before capsule ingestion did not significantly increase the rate of total enteroscopies and had no effect on transit times. It also did not modify CE diagnostic yield.

Effect of nitric oxide donors on blood pressure and pulse pressure in acute and subacute stroke

High blood pressure (BP), pulse pressure (PP), and rate pressure product (RPP) areeach associated independently with a poor outcome in acute ischemic stroke. Whereas nitric oxide (NO) donors, such as glyceryl trinitrate (GTN), lower blood pressure in acute ischemic stroke, their effect on other hemodynamic measures is not known. We performed a systematic review of the effects of NO donors on systemic hemodynamic measures in patients with acute/subacute stroke. Randomized controlled trials were identified from searches of the Cochrane Library, Pubmed, and Embase. Information on hemodynamic measures, including systolic BP (SBP), diastolic BP (DBP), and heart rate, were assessed, and hemodynamic derivatives of these were calculated: PP (PP SBP DBP), mean arterial pressure (MAP DBP PP/3), mid blood pressure (MBP (SBP DBP)/2), pulse pressure index (PPI PP/MAP), and RPP (RPP SBP HR). The effect of treatment on hemodynamic measures was calculated as the weighted mean difference (WMD) between treated and control groups with adjustment for baseline. Results: Three trials involving 145 patients were identified; 93 patients received the NO donor, GTN, and 52 control. As compared with placebo, GTN significantly reduced SBP (WMD -9.80 mmHg, p< 0.001), DBP (WMD -4.43 mmHg, p<0.001), MAP (WMD -6.41 mmHg, p< 0.001), MBP (WMD -7.33 mmHg,p<0.001), PP (WMD -6.11 mmHg, p<0.001 ) and PPI (WMD -0.03, p=0.04 ). 3 GTN increased HR (WMD +3.87 bpm, p<0.001) and non-significantly lowered RPP (WMD -323 mmHg.bpm, p=0.14). Conclusion: The NO donor GTN reduces BP, PP and other derivatives in acute and subacute stroke whilst increasing heart rate.

Miotomía extendida en el tratamiento de la acalasia

La acalasia es una enfermedad esofágica poco frecuente que se acompaña de una importante alteración de la calidad de vida de los pacientes. Su etiología no está totalmente aclarada y sus características clínicas principales son la disfagia y la regurgitación. El tratamiento de la acalasia está dirigido al alivio funcional y sintomático mediante la abertura del esfínter esofágico inferior, siendo al momento la miotomía laparoscópica la técnica de elección mientras que las dilataciones neumáticas y la inyección de toxina botulínica deben considerarse como técnicas de recurso en casos seleccionados. Objetivo: Evaluar los resultados de la miotomía extendida más funduplicatura parcial anterior de Dorr como tratamiento de la acalasia por vía laparoscópica, comparándola con nuestra experiencia previa mediante la técnica estándar. Materiales y método: diseño: Estudio prospectivo, descriptivo y longitudinal. Sede: Hospital Latino, Cuenca - Ecuador. Pacientes y método: Desde junio de 1992 hasta diciembre del 2011 se intervinieron 39 pacientes con diagnóstico de acalasia que recibieron tratamiento quirúrgico por medio de cirugía mínimamente invasiva. Se estudió la edad, sintomatología previa, clasificación según Stewart, tiempo de evolución de los síntomas, técnica operatoria realizada, control postoperatorio. Resultados: Se intervinieron 39 paciente, con edad promedio de 66 años, mínima 23 y máxima 81. La sintomatología presentada fue disfagia en el 100%, regurgitación en el 74,4%, pérdida de peso en el 71,8% y odinofagia en el 28.2%. El tiempo de evolución de los síntomas fueron: menor a 2 años 48.7% (n=19), de 2 a 4 años 33.3% (n=13), de 4 a 6 años de 12.8% (n=5), y de 6 a 8 años un 5.1% (n=2). Según Stewart se clasificaron en I 8% (n=3), II 49% (n=19), III 38% (n=15) y IV 5% (n=2).La técnica empleada fue Miotomía + Dorr 57% (n=22), Miotomía extendida + Dorr 20% (n=8), Miotomía sola 18% (n=7), Miotomía + Toupet 5% (n=2). Se ha realizado seguimiento del 75% de pacientes, con resultados excelentes en el 91%, y bueno en el 9%. En los ocho últimos casos se realizó la miotomía extendida más funduplicatura tipo Dorr, brindando resultados excelentes a corto plazo. Conclusión: la miotomía gástrica extendida mejora el resultado de la terapia quirúrgica para la acalasia sin incrementar la tasa de reflujo gastroesofágico anormal cuando se añade una funduplicatura parcial anterior tipo Dorr.

Rentabilização de Capital Humano

A Escola Naval apresenta uma taxa de insucesso na ordem dos 64%, acabando por perder, durante o decorrer do curso, mais de metade dos indivíduos admitidos. Este projeto surge com o intuito de perceber as causas associadas ao baixo rendimento, através da análise dos dados dos indivíduos desde a candidatura ao término do curso, para identificar as caraterísticas (designadas de variáveis) dos indivíduos com maior e com menor probabilidade de sucesso na Escola Naval. Os dados são inicialmente analisados graficamente, onde os candidatos são analisados de forma independente, e os admitidos e os finalistas são analisados em conjunto para se avaliar o comportamento das variáveis no início e no fim dos cursos. Um aumento do peso de uma variável no grupo dos finalistas em relação ao grupo dos admitidos é interpretado como um indicador de bom desempenho. É, ainda, utilizada uma análise estatística para avaliar a associação entre o sucesso e cada uma das variáveis no grupo dos admitidos, e, também, para validar as ilações obtidas através da análise gráfica. O estudo revelou que os indivíduos que entram para a Escola Naval com melhores notas e os indivíduos que tomam conhecimento do concurso de candidatura através da internet são os que apresentam uma maior predisposição para o sucesso, enquanto os indivíduos que têm ambos os pais no ativo são os que apresentam menor probabilidade de sucesso.