A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial.

Background: increasing numbers of patients are surviving critical illness, but survival may be associated with a constellation of physical and psychological sequelae that can cause on going disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period. This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness. The intervention is currently being evaluated in a randomised trial (ISRCTN09412438; funder Chief Scientists Office, Scotland). Methods: the intervention was developed using the Medical Research Council (MRC) framework for developing complex healthcare interventions. We ensured representation from a wide variety of stakeholders including content experts from multiple specialties, methodologists, and patient representation. The intervention construct was initially based on literature review, local observational and audit work, qualitative studies with ICU survivors, and brainstorming activities. Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline (No. 83), publicly available patient stories (Healthtalkonline), a stakeholder event in collaboration with the James Lind Alliance, and local piloting. Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant (GRA) role. Several rounds of external peer review during successive funding applications also contributed to development. Results: the final construct for the complex intervention involved a dedicated GRA trained to pre-defined competencies across multiple rehabilitation domains (physiotherapy, dietetics, occupational therapy, and speech/language therapy), with specific training in post-critical illness issues. The intervention was from ICU discharge to 3 months post-discharge, including inpatient and post-hospital discharge elements. Clear strategies to provide information to patients/families were included. A detailed taxonomy was developed to define and describe the processes undertaken, and capture them during the trial. The detailed process measure description, together with a range of patient, health service, and economic outcomes were successfully mapped on to the modified CONSORT recommendations for reporting non-pharmacologic trial interventions. Conclusions: the MRC complex intervention framework was an effective guide to developing a novel post-ICU rehabilitation intervention. Combining a clearly defined new healthcare role with a detailed taxonomy of process and activity enabled the intervention to be clearly described for the purpose of trial delivery and reporting. These data will be useful when interpreting the results of the randomised trial, will increase internal and external trial validity, and help others implement the intervention if the intervention proves clinically and cost effective.

Modelling the development of an online learning resource by health care professionals

The aim of this study was to model the process of development for an Online Learning Resource (OLR) by Health Care Professionals (HCPs) to meet lymphoedema-related educational needs, within an asset-based management context. Previous research has shown that HCPs have unmet educational needs in relation to lymphoedema but details on their specific nature or context were lacking. Against this background, the study was conducted in two distinct but complementary phases. In Phase 1, a national survey was conducted of HCPs predominantly in community, oncology and palliative care services, followed by focus group discussions with a sample of respondents. In Phase 2, lymphoedema specialists (LSs) used an action research approach to design and implement an OLR to meet the needs identified in Phase 1. Study findings were analysed using descriptive statistics (Phase 1), and framework, thematic and dialectic analysis to explore their potential to inform future service development and education theory. Unmet educational need was found to be specific to health care setting and professional group. These resulted in HCPs feeling poorly-equipped to diagnose and manage lymphoedema. Of concern, when identified, lymphoedema was sometimes buried for fear of overwhelming stretched services. An OLR was identified as a means of addressing the unmet educational needs. This was successfully developed and implemented with minimal additional resources. The process model created has the potential to inform contemporary leadership theory in asset-based management contexts. This doctoral research makes a timely contribution to leadership theory since the resource constraints underpinning much of the contribution has salience to current public services. The process model created has the potential to inform contemporary leadership theory in asset-based management contexts. Further study of a leadership style which incorporates cognisance of Cognitive Load Theory and Self-Determination Theory is suggested. In addition, the detailed reporting of process and how this facilitated learning for participants contributes to workplace education theory

Review of order fulfilment models for Catalogue Mass Customization

Mass Customization (MC) is not a mature business strategy and hence it is not clear that a single or small group of operational models are dominating. Companies tend to approach MC from either a mass production or a customization origin and this in itself gives reason to believe that several operational models will be observable. This paper reviews actual and theoretical fulfilment systems that enterprises could apply when offering a pre-engineered catalogue of customizable products and options. Issues considered are: How product flows are structured in relation to processes, inventories and decoupling point(s); - Characteristics of the OF process that inhibit or facilitate fulfilment; - The logic of how products are allocated to customers; - Customer factors that influence OF process design and operation. Diversity in the order fulfilment structures is expected and is found in the literature. The review has identified four structural forms that have been used in a Catalogue MC context: - fulfilment from stock; - fulfilment from a single fixed decoupling point; - fulfilment from one of several fixed decoupling points; - fulfilment from several locations, with floating decoupling points. From the review it is apparent that producers are being imaginative in coping with the demands of high variety, high volume, customization and short lead times. These demands have encouraged the relationship between product, process and customer to be re-examined. Not only has this strengthened interest in commonality and postponement, but, as is reported in the paper, has led to the re-engineering of the order fulfilment process to create models with multiple fixed decoupling points and the floating decoupling point system

Predicting risk of violence through a self-appraisal questionnaire

The Self-Appraisal Questionnaire (SAQ) is a self-report that predicts the risk of violence and recidivism and provides relevant information about treatment needs for incarcerated populations. The objective of the present study was to evaluate the concurrent and predictive validity of this self-report in Spanish offenders. The SAQ was administered to 276 offenders recruited from several prisons in Madrid (Spain). SAQ total scores presented high levels of internal consistency (alpha = .92). Correlations of the instrument with violence risk instruments were statistically significant and showed a moderate magnitude, indicating a reasonable degree of concurrent validity. The ROC analysis carried out on the SAQ total score revealed an AUC of .80, showing acceptable accuracy discriminating between violent and nonviolent recidivist groups. It is concluded that the SAQ total score is a reliable and valid measure to estimate violence and recidivism risk in Spanish offenders.

Avaliação do desempenho segundo a metodologia do balanced scorecard: aplicação à gestão hospitalar no Algarve

Dissertação de mest. em Gestão Empresarial, Faculdade de Economia, Univ. do Algarve, 2004

Geotechnical Data and Numerical Analysis of Edifice Collapse and Related Hazards at Pacaya Volcano, Guatemala

The continual eruptive activity, occurrence of an ancestral catastrophic collapse, and inherent geologic features of Pacaya volcano (Guatemala) demands an evaluation of potential collapse hazards. This thesis merges techniques in the field and laboratory for a better rock mass characterization of volcanic slopes and slope stability evaluation. New field geological, structural, rock mechanical and geotechnical data on Pacaya is reported and is integrated with laboratory tests to better define the physical-mechanical rock mass properties. Additionally, this data is used in numerical models for the quantitative evaluation of lateral instability of large sector collapses and shallow landslides. Regional tectonics and local structures indicate that the local stress regime is transtensional, with an ENE-WSW sigma 3 stress component. Aligned features trending NNW-SSE can be considered as an expression of this weakness zone that favors magma upwelling to the surface. Numerical modeling suggests that a large-scale collapse could be triggered by reasonable ranges of magma pressure (greater than or equal to 7.7 MPa if constant along a central dyke) and seismic acceleration (greater than or equal to 460 cm/s2), and that a layer of pyroclastic deposits beneath the edifice could have been a factor which controlled the ancestral collapse. Finally, the formation of shear cracks within zones of maximum shear strain could provide conduits for lateral flow, which would account for long lava flows erupted at lower elevations.

Toxoplasma gondii Infection in Hunted Wild Boars (Sus scrofa): Heart Meat Juice as an Alternative Sample to Serum for the Detection of Antibodies

Toxoplasmosis is a global zoonosis caused by the protozoan parasite Toxoplasma gondii. Detection of antibodies to T. gondii in serum samples from hunted animals may represent a key step for public health protection. It is also important to assess the circulation of this parasite in wild boar population. However, in hunted animals, collection of blood is not feasible and meat juice may represent an alternative sample. The purpose of the present study was to evaluate heart meat juice of hunted wild boars as an alternative sample for post-mortem detection of antibodies to T. gondii by modified agglutination test (MAT). The agreement beyond chance between results from meat juice assessed with Cohen’s kappa coefficient revealed that the 1:20 meat juice dilution provided the highest agreement. McNemars’s test further revealed 1:10 as the most suitable meat juice dilution, as the proportion of positive paired samples (serum and meat juice from the same animal) did not differ at this dilution. All together, these results suggest a reasonable accuracy of heart meat juice to detect antibodies to T. gondii by MAT and support it as an alternative sample in post-mortem analysis in hunted wild boars.

Deposition of thin films by a non-equilibrium atmospheric pressure Plasma Jet: a poly-diagnostic study

The use of atmospheric pressure plasmas for thin film deposition on thermo-sensitive materials is currently one of the main challenges of the plasma scientific community. Despite the growing interest in this field, the existing knowledge gap between gas-phase reaction mechanisms and thin film properties is still one of the most important barriers to overcome for a complete understanding of the process. In this work, thin films surface characterization techniques, combined with passive and active gas-phase diagnostic methods, were used to provide a comprehensive study of the Ar/TEOS deposition process assisted by an atmospheric pressure plasma jet. SiO2-based thin films exhibiting a well-defined chemistry, a good morphological structure and high uniformity were studied in detail by FTIR, XPS, AFM and SEM analysis. Furthermore, non-intrusive spectroscopy techniques (OES, filter imaging) and laser spectroscopic methods (Rayleigh scattering, LIF and TALIF) were employed to shed light on the complexity of gas-phase mechanisms involved in the deposition process and discuss the influence of TEOS admixture on gas temperature, electron density and spatial-temporal behaviours of active species. The poly-diagnostic approach proposed in this work opens interesting perspectives both in terms of process control and optimization of thin film performances.

Development of methodologies supporting the sustainable and safe integration of offshore conventional and renewable energy production

Against a backdrop of rapidly increasing worldwide population and growing energy demand, the development of renewable energy technologies has become of primary importance in the effort to reduce greenhouse gas emissions. However, it is often technically and economically infeasible to transport discontinuous renewable electricity for long distances to the shore. Another shortcoming of non-programmable renewable power is its integration into the onshore grid without affecting the dispatching process. On the other hand, the offshore oil & gas industry is striving to reduce overall carbon footprint from onsite power generators and limiting large expenses associated to carrying electricity from remote offshore facilities. Furthermore, the increased complexity and expansion towards challenging areas of offshore hydrocarbons operations call for higher attention to safety and environmental protection issues from major accident hazards. Innovative hybrid energy systems, as Power-to-Gas (P2G), Power-to-Liquid (P2L) and Gas-to-Power (G2P) options, implemented at offshore locations, would offer the opportunity to overcome challenges of both renewable and oil & gas sectors. This study aims at the development of systematic methodologies based on proper sustainability and safety performance indicators supporting the choice of P2G, P2L and G2P hybrid energy options for offshore green projects in early design phases. An in-depth analysis of the different offshore hybrid strategies was performed. The literature reviews on existing methods proposing metrics to assess sustainability of hybrid energy systems, inherent safety of process routes in conceptual design stage and environmental protection of installations from oil and chemical accidental spills were carried out. To fill the gaps, a suite of specific decision-making methodologies was developed, based on representative multi-criteria indicators addressing technical, economic, environmental and societal aspects of alternative options. A set of five case-studies was defined, covering different offshore scenarios of concern, to provide an assessment of the effectiveness and value of the developed tools.

Development and application of a computer-based methodology for design for additive manufacturing of automotive components

The research project aims to improve the Design for Additive Manufacturing of metal components. Firstly, the scenario of Additive Manufacturing is depicted, describing its role in Industry 4.0 and in particular focusing on Metal Additive Manufacturing technologies and the Automotive sector applications. Secondly, the state of the art in Design for Additive Manufacturing is described, contextualizing the methodologies, and classifying guidelines, rules, and approaches. The key phases of product design and process design to achieve lightweight functional designs and reliable processes are deepened together with the Computer-Aided Technologies to support the approaches implementation. Therefore, a general Design for Additive Manufacturing workflow based on product and process optimization has been systematically defined. From the analysis of the state of the art, the use of a holistic approach has been considered fundamental and thus the use of integrated product-process design platforms has been evaluated as a key element for its development. Indeed, a computer-based methodology exploiting integrated tools and numerical simulations to drive the product and process optimization has been proposed. A validation of CAD platform-based approaches has been performed, as well as potentials offered by integrated tools have been evaluated. Concerning product optimization, systematic approaches to integrate topology optimization in the design have been proposed and validated through product optimization of an automotive case study. Concerning process optimization, the use of process simulation techniques to prevent manufacturing flaws related to the high thermal gradients of metal processes is developed, providing case studies to validate results compared to experimental data, and application to process optimization of an automotive case study. Finally, an example of the product and process design through the proposed simulation-driven integrated approach is provided to prove the method's suitability for effective redesigns of Additive Manufacturing based high-performance metal products. The results are then outlined, and further developments are discussed.

Numerical modeling and experimental validation of the recrystallization behaviour in the extrusion of 6XXX aluminum alloys

The microstructure of 6XXX aluminum alloys deeply affects mechanical, crash, corrosion and aesthetic properties of extruded profiles. Unfortunately, grain structure evolution during manufacturing processes is a complex phenomenon because several process and material parameters such as alloy chemical composition, temperature, extrusion speed, tools geometries, quenching and thermal treatment parameters affect the grain evolution during the manufacturing process. The aim of the present PhD thesis was the analysis of the recrystallization kinetics during the hot extrusion of 6XXX aluminum alloys and the development of reliable recrystallization models to be used in FEM codes for the microstructure prediction at a die design stage. Experimental activities have been carried out in order to acquire data for the recrystallization models development, validation and also to investigate the effect of process parameters and die design on the microstructure of the final component. The experimental campaign reported in this thesis involved the extrusion of AA6063, AA6060 and AA6082 profiles with different process parameters in order to provide a reliable amount of data for the models validation. A particular focus was made to investigate the PCG defect evolution during the extrusion of medium-strength alloys such as AA6082. Several die designs and process conditions were analysed in order to understand the influence of each of them on the recrystallization behaviour of the investigated alloy. From the numerical point of view, innovative models for the microstructure prediction were developed and validated over the extrusion of industrial-scale profiles with complex geometries, showing a good matching in terms of the grain size and surface recrystallization prediction. The achieved results suggest the reliability of the developed models and their application in the industrial field for process and material properties optimization at a die-design stage.

Innovation in conceptual design of chemical processes

Nowadays, the chemical industry has reached significant goals to produce essential components for human being. The growing competitiveness of the market caused an important acceleration in R&D activities, introducing new opportunities and procedures for the definition of process improvement and optimization. In this dynamicity, sustainability is becoming one of the key aspects for the technological progress encompassing economic, environmental protection and safety aspects. With respect to the conceptual definition of sustainability, literature reports an extensive discussion of the strategies, as well as sets of specific principles and guidelines. However, literature procedures are not completely suitable and applicable to process design activities. Therefore, the development and introduction of sustainability-oriented methodologies is a necessary step to enhance process and plant design. The definition of key drivers as support system is a focal point for early process design decisions or implementation of process modifications. In this context, three different methodologies are developed to support design activities providing criteria and guidelines in a sustainable perspective. In this framework, a set of key Performance Indicators is selected and adopted to characterize the environmental, safety, economic and energetic aspects of a reference process. The methodologies are based on heat and material balances and the level of detailed for input data are compatible with available information of the specific application. Multiple case-studies are defined to prove the effectiveness of the methodologies. The principal application is the polyolefin productive lifecycle chain with particular focus on polymerization technologies. In this context, different design phases are investigated spanning from early process feasibility study to operative and improvements assessment. This flexibility allows to apply the methodologies at any level of design, providing supporting guidelines for design activities, compare alternative solutions, monitor operating process and identify potential for improvements.

Towards the sustainable production of methyl methacrylate: A comparative analysis of industrial chemical production processes using life cycle assessment methodology

Increasing environmental awareness has been a significant driving force for innovations and process improvements in different sectors and the field of chemistry is not an outlier. Innovating around industrial chemical processes in line with current environmental responsibilities is however no mean feat. One of such hard to overhaul process is the production of methyl methacrylate (MMA) commonly produced via the acetone cyanohydrin (ACH) process developed back in the 1930s. Different alternatives to the ACH process have emerged over the years and the Alpha Lucite process has been particularly promising with a combined plant capacity of 370,000 metric tonnes in Singapore and Saudi Arabia. This study applied Life Cycle Assessment methodology to conduct a comparative analysis between the ACH and Lucite processes with the aim of ascertaining the effect of applying principles of green chemistry as a process improvement tool on overall environmental impacts. A further comparison was made between the Lucite process and a lab-scale process that is further improvement on the former, also based on green chemistry principles. Results showed that the Lucite process has higher impacts on resource scarcity and ecosystem health whereas the ACH process has higher impacts on human health. On the other hand, compared to the Lucite process the lab-scale process has higher impacts in both the ecosystem and human health categories with lower impacts only in the resource scarcity category. It was observed that the benefits of process improvements with green chemistry principles might not be apparent in some categories due to some limitations of the methodology. Process contribution analysis was also performed and it revealed that the contribution of energy is significant, therefore a sensitivity analysis with different energy scenarios was performed. An uncertainty analysis using Monte Carlo analysis was also performed to validate the consistency of the results in each of the comparisons.

Uso de redes neurais artificiais na identificação de vocalização de suínos

Animal welfare has been an important research topic in animal production mainly in its ways of assessment. Vocalization is found to be an interesting tool for evaluating welfare as it provides data in a non-invasive way as well as it allows easy automation of process. The present research had as objective the implementation of an algorithm based on artificial neural network that had the potential of identifying vocalization related to welfare pattern indicatives. The research was done in two parts, the first was the development of the algorithm, and the second its validation with data from the field. Previous records allowed the development of the algorithm from behaviors observed in sows housed in farrowing cages. Matlab® software was used for implementing the network. It was selected a retropropagation gradient algorithm for training the network with the following stop criteria: maximum of 5,000 interactions or error quadratic addition smaller than 0.1. Validation was done with sows and piglets housed in commercial farm. Among the usual behaviors the ones that deserved enhancement were: the feed dispute at farrowing and the eventual risk of involuntary aggression between the piglets or between those and the sow. The algorithm was able to identify through the noise intensity the inherent risk situation of piglets welfare reduction.

Otimização do descascamento químico de raízes do yacon (Polymnia sonchifolia Poepp.)

A full factorial design 2³ was used to evaluate the effect of process variables in chemical peeling of yacon roots, cultivated in Curitiba, State of Paraná. Eleven treatments, with three central points, were done in which they had been evaluated at three different levels of sodium hydroxide solution, % (g/100 mL) [6, 10, 14], temperature of the same solution, °C [70, 80, 90], and residence time in the sodium hydroxide solution, minutes [2, 4, 6]. All the studied variables had affected significantly (p<0.05) the yield of yacon roots subjected to chemical peeling. The variable that most affected the yield was the time of permanence in the sodium hydroxide solution. The mathematical model obtained for the yield (%) was good with R² aj = 0.8497, and non significant lack of fit (p=0.9312).Therefore, the model can be used for predictive purposes. In the central point a satisfactory yield (84% to 87%) with a high percentage of removed peel was obtained (96% to 98%) indicating that the treatment with 10% of sodium hydroxide solution, temperature of 80º C per 4 minutes can be used in the chemical peeling of yacon roots.