958 resultados para D. Fracture
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Abundant crops of Glycymeris have been made in the neritic bioclastic deposits of the Aquitaine Basin. After an outline about the Chattian taxa, the 5 Lower Miocene lineages are presented; G. cor is plainly predominant. Then, the Middle Miocene faunas are also detaiIed, G. inflatus and G. bimaculatus being the most frequent taxa. A test of biometrical analysis about the G. cor species is presented.
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OBJECTIVE To analyze the incremental cost-utility ratio for the surgical treatment of hip fracture in older patients.METHODS This was a retrospective cohort study of a systematic sample of patients who underwent surgery for hip fracture at a central hospital of a macro-region in the state of Minas Gerais, Southeastern Brazil between January 1, 2009 and December 31, 2011. A decision tree creation was analyzed considering the direct medical costs. The study followed the healthcare provider’s perspective and had a one-year time horizon. Effectiveness was measured by the time elapsed between trauma and surgery after dividing the patients into early and late surgery groups. The utility was obtained in a cross-sectional and indirect manner using the EuroQOL 5 Dimensions generic questionnaire transformed into cardinal numbers using the national regulations established by the Center for the Development and Regional Planning of the State of Minas Gerais. The sample included 110 patients, 27 of whom were allocated in the early surgery group and 83 in the late surgery group. The groups were stratified by age, gender, type of fracture, type of surgery, and anesthetic risk.RESULTS The direct medical cost presented a statistically significant increase among patients in the late surgery group (p < 0.005), mainly because of ward costs (p < 0.001). In-hospital mortality was higher in the late surgery group (7.4% versus 16.9%). The decision tree demonstrated the dominance of the early surgery strategy over the late surgery strategy: R$9,854.34 (USD4,387.17) versus R$26,754.56 (USD11,911.03) per quality-adjusted life year. The sensitivity test with extreme values proved the robustness of the results.CONCLUSIONS After controlling for confounding variables, the strategy of early surgery for hip fracture in the older adults was proven to be dominant, because it presented a lower cost and better results than late surgery.
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The interlaminar fracture toughness in pure mode II (GIIc) of a Carbon-Fibre Reinforced Plastic (CFRP) composite is characterized experimentally and numerically in this work, using the End-Notched Flexure (ENF) fracture characterization test. The value of GIIc was extracted by a new data reduction scheme avoiding the crack length measurement, named Compliance-Based Beam Method (CBBM). This method eliminates the crack measurement errors, which can be non-negligible, and reflect on the accuracy of the fracture energy calculations. Moreover, it accounts for the Fracture Process Zone (FPZ) effects. A numerical study using the Finite Element Method (FEM) and a triangular cohesive damage model, implemented within interface finite elements and based on the indirect use of Fracture Mechanics, was performed to evaluate the suitability of the CBBM to obtain GIIc. This was performed comparing the input values of GIIc in the numerical models with the ones resulting from the application of the CBBM to the numerical load-displacement (P-) curve. In this numerical study, the Compliance Calibration Method (CCM) was also used to extract GIIc, for comparison purposes.
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The structural integrity of multi-component structures is usually determined by the strength and durability of their unions. Adhesive bonding is often chosen over welding, riveting and bolting, due to the reduction of stress concentrations, reduced weight penalty and easy manufacturing, amongst other issues. In the past decades, the Finite Element Method (FEM) has been used for the simulation and strength prediction of bonded structures, by strength of materials or fracture mechanics-based criteria. Cohesive-zone models (CZMs) have already proved to be an effective tool in modelling damage growth, surpassing a few limitations of the aforementioned techniques. Despite this fact, they still suffer from the restriction of damage growth only at predefined growth paths. The eXtended Finite Element Method (XFEM) is a recent improvement of the FEM, developed to allow the growth of discontinuities within bulk solids along an arbitrary path, by enriching degrees of freedom with special displacement functions, thus overcoming the main restriction of CZMs. These two techniques were tested to simulate adhesively bonded single- and double-lap joints. The comparative evaluation of the two methods showed their capabilities and/or limitations for this specific purpose.
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The morphological and structural modifications induced in sapphire by surface treatment with femtosecond laser radiation were studied. Single-crystal sapphire wafers cut parallel to the (0 1 2) planes were treated with 560 fs, 1030 nm wavelength laser radiation using wide ranges of pulse energy and repetition rate. Self-ordered periodic structures with an average spatial periodicity of similar to 300 nm were observed for fluences slightly higher than the ablation threshold. For higher fluences the interaction was more disruptive and extensive fracture, exfoliation, and ejection of ablation debris occurred. Four types of particles were found in the ablation debris: (a) spherical nanoparticles about 50 nm in diameter; (b) composite particles between 150 and 400 nm in size; (c) rounded resolidified particles about 100-500 nm in size; and (d) angular particles presenting a lamellar structure and deformation twins. The study of those particles by selected area electron diffraction showed that the spherical nanoparticles and the composite particles are amorphous, while the resolidified droplets and the angular particles, present a crystalline a-alumina structure, the same of the original material. Taking into consideration the existing ablation theories, it is proposed that the spherical nanoparticles are directly emitted from the surface in the ablation plume, while resolidified droplets are emitted as a result of the ablation process, in the liquid phase, in the low intensity regime, and by exfoliation, in the high intensity regime. Nanoparticle clusters are formed by nanoparticle coalescence in the cooling ablation plume. (C) 2013 Elsevier B.V. All rights reserved.
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ABSTRACT OBJECTIVE To identify individual and hospital characteristics associated with the risk of readmission in older inpatients for proximal femoral fracture in the period of 90 days after discharge. METHODS Deaths and readmissions were obtained by a linkage of databases of the Hospital Information System of the Unified Health System and the System of Information on Mortality of the city of Rio de Janeiro from 2008 to 2011. The population of 3,405 individuals aged 60 or older, with non-elective hospitalization for proximal femoral fracture was followed for 90 days after discharge. Cox multilevel model was used for discharge time until readmission, and the characteristics of the patients were used on the first level and the characteristics of the hospitals on the second level. RESULTS The risk of readmission was higher for men (hazard ratio [HR] = 1.37; 95%CI 1.08–1.73), individuals more than 79 years old (HR = 1.45; 95%CI 1.06–1.98), patients who were hospitalized for more than two weeks (HR = 1.33; 95%CI 1.06-1.67), and for those who underwent arthroplasty when compared with the ones who underwent osteosynthesis (HR = 0.57; 95%CI 0.41–0.79). Besides, patients admitted to state hospitals had lower risk for readmission when compared with inpatients in municipal (HR = 1.71; 95%CI 1.09–2.68) and federal hospitals (HR = 1.81; 95%CI 1.00–3.27). The random effect of the hospitals in the adjusted model remained statistically significant (p < 0.05). CONCLUSIONS Hospitals have complex structures that reflect in the quality of care. Thus, we propose that future studies may include these complexities and the severity of the patients in the analysis of the data, also considering the correlation between readmission and mortality to reduce biases.
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Ramsey pricing has been proposed in the pharmaceutical industry as a principle to price discriminate among markets while allowing to recover the (fixed) R&D cost. However, such analyses neglect the presence of insurance or the fund raising costs for most of drug reimbursement. By incorporating these new elements, we aim at providing some building blocks towards an economic theory incorporating Ramsey pricing and insurance coverage. We show how coinsurance affects the optimal prices to pay for the R&D investment. We also show that under certain conditions, there is no strategic incentive by governments to set coinsurance rates in order to shift the financial burden of R&D. This will have important implications to the application of Ramsey pricing principles to pharmaceutical products across countries.
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Electronics Letters Vol.38, nº 19
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The mode III interlaminar fracture of carbon/epoxy laminates was evaluated with the edge crack torsion (ECT) test. Three-dimensional finite element analyses were performed in order to select two specimen geometries and an experimental data reduction scheme. Test results showed considerable non-linearity before the maximum load point and a significant R-curve effect. These features prevented an accurate definition of the initiation point. Nevertheless, analyses of non-linearity zones showed two likely initiation points corresponding to GIIIc values between 850 and 1100 J/m2 for both specimen geometries. Although any of these values is realistic, the range is too broad, thus showing the limitations of the ECT test and the need for further research.
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L'analyse pollinique des sédiments argileux, riches en macrorestes de végétaux, du "Belasien» (Crétacé inférieur) de Buarcos a permis reconnaître la présence d'une riche microflore. On a, nottament, reconnu la présence de: Concavisporites punctatus, Auritulinosporites complexis, Chomotriletes sp., Trilobosporites cf. bernissartensis, Apiculatisporites vulgaris, Cicatricosisporites sp. 1, Cicatricosisporites sp. 2. Cicatricosisporites sp. 3, Cicatricosisporites sp. 4, Cicatricosisporites sp. 5, Cicatricosisporites sp. 6. Costatoperforosporites fistulosus, Ceratosporites sp. l, C. cf. equalis, Ischyosporites teixeirae n. sp., Liburnisporites sp. AequitriraditeS cf. spinulosus, Cedripites lusitanicus, Clavatipollenites cf. hughesi. Après discution de la stratigraphie des diffèrentes espèces on sugère une âge barremo-aptien pour cette association malgré la présence de l'ensemble Apiculalisporites vulgaris-Classopollls major plutôt d'âge Aptien.
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Dissertação de doutoramento em História dos Descobrimentos e da Expansão Portuguesa
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Les résultats des études PISA – aussi bien en ce qui concerne celle de 2000 comme celle de 2003 - n’ont guêre été satisfaisants pour de nombreux pays de l’OCDE (ce n’est pas le cas pour la Belgique!). Par exemple Portugal, s’il présente des résultats comparables à la moyenne des pays européens ou même supérieurs pour la région de Lisbonne et la vallée du Tage, présente des résultats inférieurs pour l’ensemble du territoire. La Suisse est, curieusement, un autre pays qui se situe en deçà des expectatives. Selon le rapport 2003 (Ramalho, 2004 :50), les études comparatives en littéracie (lecture) et en numéracie n’ont pas dmontré de différence significative par rapport aux résultats de 2000. Nous avons pris connaissance dune étude suisse qui avait pris pour point de dpart des résultats également dfavorables, pour ce pays, au même rapport PISA : cette recherche analyse l’insertion socio-économique des familles comme également l’influence des transmissions familiales sur les parcours scolaires des élèves.
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Este trabalho tem por objetivo caracterizar a desnutrição protéico-energética associada a parasitose intestinal em grupo de 149 crianças de ambos os sexos, na faixa etária de 3 a 72 meses, da cidade de Mirassol D'Oeste, na região do Projeto Polonoroeste em Mato Grosso. De cada criança foram coletados os seguintes dados: sexo, peso, idade e amostra de fezes para exame parasitológico. Os dados peso/idade obtidos foram analisados pelos critérios de GOMEZ. Utilizou-se como padrão de referência o National Center for Health Statistic (NCHS). Para diagnóstico dos parasitas intestinais executou-se o método de Hoffman, Pons e Janer. O grupo estudado constitui-se em sua maioria de crianças desnutridas, sendo a forma leve de desnutrição mais comum que as formas moderada e grave. As enteroparasitoses foram encontradas em 69% das amostras examinadas. A "Giardia lamblia" foi o protozoário mais comum e o "Ancilostomídeo" o helminto mais encontrado. O teste X² não mostrou relação de dependncia entre o estado nutricional e a freqüência de enteroparasitoses.
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Thèse pour obtenir le grade de DOCTEUR DE L' UNIVERSITÉ PARIS XII, Discipline: Urbanisme Aménagement