Implementation of the trauma registry as a tool for quality improvement in trauma care in a brazilian hospital: the first 12 months

ABSTRACTObjective:to analyze the implementation of a trauma registry in a university teaching hospital delivering care under the unified health system (SUS), and its ability to identify points for improvement in the quality of care provided.Methods:the data collection group comprised students from medicine and nursing courses who were holders of FAPESP scholarships (technical training 1) or otherwise, overseen by the coordinators of the project. The itreg (ECO Sistemas-RJ/SBAIT) software was used as the database tool. Several quality "filters" were proposed to select those cases for review in the quality control process.Results:data for 1344 trauma patients were input to the itreg database between March and November 2014. Around 87.0% of cases were blunt trauma patients, 59.6% had RTS>7.0 and 67% ISS<9. Full records were available for 292 cases, which were selected for review in the quality program. The auditing filters most frequently registered were laparotomy four hours after admission and drainage of acute subdural hematomas four hours after admission. Several points for improvement were flagged, such as control of overtriage of patients, the need to reduce the number of negative imaging exams, the development of protocols for achieving central venous access, and management of major TBI.Conclusion: the trauma registry provides a clear picture of the points to be improved in trauma patient care, however, there are specific peculiarities for implementing this tool in the Brazilian milieu.

Construction and validation of a surgical skills assessment tool for general surgery residency program

Objective: To develop and validate an instrument for measuring the acquisition of technical skills in conducting operations of increasing difficulty for use in General Surgery Residency (GSR) programs. Methods: we built a surgical skills assessment tool containing 11 operations in increasing levels of difficulty. For instrument validation we used the face validaity method. Through an electronic survey tool (Survey MonKey(r)) we sent a questionnaire to Full and Emeritus members of the Brazilian College of Surgeons - CBC - all bearers of the CBC Specialist Title. Results: Of the 307 questionnaires sent we received 100 responses. For the analysis of the data collected we used the Cronbach's alpha test. We observed that, in general, the overall alpha presented with values near or greater than 0.70, meaning good consistency to assess their points of interest. Conclusion: The evaluation instrument built was validated and can be used as a method of assessment of technical skill acquisition in the General Surgery Residency programs in Brazil.

Pumping system optimization tool

Pumping systems account for over 20 % of all electricity consumption in European industry. Optimization and correct design of such systems is important and there is a reasonable amount of unrealized energy saving potential in old pumping systems. The energy efficiency and therefore also the energy consumption of a pumping system heavily depends on the correct dimensioning and selection of devices. In this work, a graphical optimization tool for pumping systems is developed in Matlab programming language. The tool selects optimal pump, electrical motor and frequency converter for existing pumping process and calculates the life cycle costs of the whole system. The tool could be used as an aid when choosing the machinery and to analyze the energy consumption of existing systems. Results given by the tool are compared to the results of laboratory tests. The selection of pump and motor works reasonably well, but the frequency converter selection still needs development

Sheep production as a Senecio spp. control tool

Since poisoning by Senecio spp. is one of the main causes of cattle death in southern Brazil, control of these plants is a priority for the local livestock production. After the pasture has been mowed, grazing by 16 sheep was efficient for controlling Senecio brasiliensis and Senecio madagascariensis populations in a 5.5-hectare area that had long been severely infested with these species. A total of 28,629 plants among S. brasiliensis (flower-of-souls, 10,122) and S.madagascariensis (fireweed, 18,507) were almost completely eliminated in a two-year period. The number of sheep was kept at 3.0 stock units/ha, but a variable number of cattle were temporarily stocked according to pasture availability. The major sanitary practice applied to the sheep was anthelmintic administration. Liver biopsies taken from sheep and cattle before and after experimental period didn't reveal any change associable with seneciosis. The performance levels of the sheep were comparable to those observed in flocks managed under traditional extensive grazing systems in southern Brazil.

Storytelling as a branding tool in social media

Tutkimuksen tavoitteena on kuvailla tarinankerrontaa brändin rakennuksen välineenä, ja selvittää mitkä ovat tarinankerronnan erityispiirteet sosiaalisessa mediassa. Aikaisempien teorioiden ja julkaisujen avulla kootaan viitekehys joka osoittaa käsitteiden vaikutukset toisiinsa. Tutkimus osoittaa tarinankerronnan vaikuttavan vahvistavasti kaikkiin brändipääoman ulottuvuuksiin, lähinnä tunteita herättävien ja muistettavuutta lisäävien ominaisuuksiensa ansiosta. Empiirisessä osiossa selvitetään laadullisen sisällönanalyysin keinoin kuinka yleistä brändien tarinankerronta tällä hetkellä on, ja kuvaillaan millaisia tarinoita yritykset kertovat. Aineisto koostuu sadan suosituimman brändin Facebookissa jakamista videomuotoisista tarinoista. Tutkimus osoitti, että brändien tarinankerronta sosiaalisessa mediassa on toistaiseksi melko vähäistä. Tarinat voidaan luokitella kirjallisuudesta tuttujen tarinatyyppien mukaisesti. Suurin osa brändien esittämistä tarinoista pyrkii synnyttämään yleisössä ihailun ja nostalgian tunteita, mutta useat tarinat myös sisältävät humoristisia piirteitä.

Jatkuvan äänitehojakautuman algoritmi pitkien käytävien äänikenttien mallintamiseen

JÄKÄLA-algoritmi (Jatkuvan Äänitehojakautuman algoritmi Käytävien Äänikenttien LAskentaan) ja sen NUMO- ja APPRO-laskentayhtälöt perustuvat käytävällä olevan todellisen äänilähteen kuvalähteiden symmetriaan. NUMO on algoritmin numeerisen ratkaisun ja APPRO likiarvoratkaisun laskentayhtälö. Algoritmia johdettaessa oletettiin, että absorptiomateriaali oli jakautunut tasaisesti käytävän ääntä heijastaville pinnoille. Suorakaiteen muotoisen käytävän kuvalähdetason muunto jatkuvaksi äänitehojakautumaksi sisältää kolme muokkausvaihetta. Aluksi suorakaiteen kuvalähdetaso muunnetaan neliön muotoiseksi. Seuraavaksi neliön muotoisen kuvalähdetason samanarvoiset kuvalähteet siirretään koordinaattiakselille diskreetiksi kuvalähdejonoksi. Lopuksi kuvalähdejono muunnetaan jatkuvaksi äänitehojakautumaksi, jolloin käytävän vastaanottopisteen äänenpainetaso voidaan laskea integroimalla jatkuvan äänitehojakautuman yli. JÄKÄLA-algoritmin validiteetin toteamiseksi käytettiin testattua kaupallista AKURI-ohjelmaa. AKURI-ohjelma antoi myös hyvän käsityksen siitä, miten NUMO- ja APPRO-yhtälöillä lasketut arvot mahdollisesti eroavat todellisilla käytävillä mitatuista arvoista. JÄKÄLA-algoritmin NUMO- ja APPRO-yhtälöitä testattiin myös vertaamalla niiden antamia tuloksia kolmen erityyppisen käytävän äänenpainetasomittauksiin. Tässä tutkimuksessa on osoitettu, että akustisen kuvateorian pohjalta on mahdollista johtaa laskenta-algoritmi, jota voidaan soveltaa pitkien käytävien äänikenttien pika-arvioinnissa paikan päällä. Sekä teoreettinen laskenta että käytännön äänenpainetasomittaukset todellisilla käytävillä osoittivat, että JÄKÄLA-algoritmin yhtälöiden ennustustarkkuus oli erinomainen ideaalikäytävillä ja hyvä niillä todellisilla käytävillä, joilla ei ollut ääntä heijastavia rakenteita. NUMO- ja APPRO-yhtälöt näyttäisivät toimivan hyvin käytävillä, joiden poikkileikkaus oli lähes neliön muotoinen ja joissa pintojen suurin absorptiokerroin oli korkeintaan kymmenen kertaa pienintä absorptiokerrointa suurempi. NUMO- ja APPRO-yhtälöiden suurin puute on, etteivät ne ota huomioon pintojen erilaisia absorptiokertoimia eivätkä esineistä heijastuvia ääniä. NUMO- ja APPRO- laskentayhtälöt poikkesivat mitatuista arvoista eniten käytävillä, joilla kahden vastakkaisen pinnan absorptiokerroin oli hyvin suuri ja toisen pintaparin hyvin pieni, ja käytävillä, joissa oli massiivisia, ääntä heijastavia pilareita ja palkkeja. JÄKÄLA-algoritmin NUMO- ja APPRO-yhtälöt antoivat tutkituilla käytävillä kuitenkin selvästi tarkempia arvoja kuin Kuttruffin likiarvoyhtälö ja tilastollisen huoneakustiikan perusyhtälö. JÄKÄLA-algoritmin laskentatarkkuutta on testattu vain neljällä todellisella käytävällä. Algoritmin kehittämiseksi tulisi jatkossa käytävän vastakkaisia pintoja ja niiden absorptiokertoimia käsitellä laskennassa pareittain. Algoritmin validiteetin varmistamiseksi on mittauksia tehtävä lisää käytävillä, joiden absorptiomateriaalien jakautumat poikkeavat toisistaan.

Waste-to-Energy Scenarios in the China Context

Waste incineration plants are increasingly established in China. A low heating value and high moisture content, due to a large proportion of biowaste in the municipal solid waste (MSW), can be regarded as typical characteristics of Chinese MSW. Two incineration technologies have been mainly established in China: stoker grate and circular fluidized bed (CFB). Both of them are designed to incinerate mixed MSW. However, there have been difficulties to reach the sufficient temperature in the combustion process due to the low heating value of the MSW. That is contributed to the usage of an auxiliary fossil fuel, which is often used during the whole incineration process. The objective of this study was to design alternative Waste-to-energy (WTE) scenarios for existing WTE plants with the aim to improve the material and energy efficiency as well as the feasibility of the plants. Moreover, the aim of this thesis was to find the key factors that affect to the feasibility of the scenarios. Five different WTE plants were selected as study targets. The necessary data for calculation was gained from literature as well as received from the operators of the target WTE plants. The created scenarios were based on mechanical-biological treatment (MBT) technologies, in which the produced solid recovered fuel (SRF) was fed as an auxiliary fuel into a WTE plant replacing the fossil fuel. The mechanically separated biowaste was treated either in an anaerobic digestion (AD) plant, a biodrying plant, a thermal drying plant, or a combined AD plant + thermal drying plant. An interactive excel spreadsheet based computation tool was designed to estimate the viability of the scenarios in different WTE cases. The key figures of the improved material and energy efficiency, such as additional electricity generated and avoided waste for landfill, were got as results. Furthermore, economic indicators such as annual profits (or costs), payback period, and internal rate of return (IRR) were gained as results. The results show that the AD scenario was the most profitable in most of the cases. The current heating value of MSW and the tipping fee for the received MSW appeared as the most important factor in terms of feasibility.

Modeling of residual stresses and distortion due to welding in fillet welds

Welding has a growing role in modern world manufacturing. Welding joints are extensively used from pipes to aerospace industries. Prediction of welding residual stresses and distortions is necessary for accurate evaluation of fillet welds in relation to design and safety conditions. Residual stresses may be beneficial or detrimental, depending whether they are tensile or compressive and the loading. They directly affect the fatigue life of the weld by impacting crack growth rate. Beside theoretical background of residual stresses this study calculates residual stresses and deformations due to localized heating by welding process and subsequent rapid cooling in fillet welds. Validated methods are required for this purpose due to complexity of process, localized heating, temperature dependence of material properties and heat source. In this research both empirical and simulation methods were used for the analysis of welded joints. Finite element simulation has become a popular tool of prediction of welding residual stresses and distortion. Three different cases with and without preload have been modeled during this study. Thermal heat load set is used by calculating heat flux from the given heat input energy. First the linear and then nonlinear material behavior model is modeled for calculation of residual stresses. Experimental work is done to calculate the stresses empirically. The results from both the methods are compared to check their reliability. Residual stresses can have a significant effect on fatigue performance of the welded joints made of high strength steel. Both initial residual stress state and subsequent residual stress relaxation need to be considered for accurate description of fatigue behavior. Tensile residual stresses are detrimental and will reduce the fatigue life and compressive residual stresses will increase it. The residual stresses follow the yield strength of base or filler material and the components made of high strength steel are typically thin, where the role of distortion is emphasizing.

Bronchoalveolar lavage as a tool for evaluation of cellular alteration during Aelurostrongylus abstrusus infection in cats

Bronchoalveolar lavage (BAL) is a procedure that retrieves cells and other elements from the lungs for evaluation, which helps in the diagnosis of pulmonary diseases. The aim of this study was to perform this procedure for cellular analysis of BAL fluid alterations during experimental infection with Aelurostrongylus abstrusus in cats. Fourteen cats were individually inoculated with 800 third stage larvae of A. abstrusus and five non-infected cats lined as a control group. The BAL procedure was performed through the use of an endotracheal tube on the nineteen cats with a mean age of 18 months, on 0, 30, 60, 90, 120, 180 and 270 days after infection. Absolute cell counts in the infected cats revealed that alveolar macrophages and eosinophils were the predominant cells following infection. This study shows that the technique allows us to retrieve cells and first stage larvae what provides information about the inflammatory process caused by aelurostrongylosis.

Critical aspects on the behavior of material from the mechanical tool-workpiece interaction in single point diamond turning

Some material aspects such as grain size, purity and anisotropy exert an important influence on surface quality, especially in single point diamond turning. The aim of this paper is to present and discuss some critical factors that can limit the accuracy of ultraprecision machining of non-ferrous metals and to identify the effects of them on the cutting mechanism with single point diamond tools. This will be carried out through observations of machined surfaces and chips produced using optical and scanning electron microscopy. Solutions to reduce the influence of some of these limiting factors related with the mechanism of generation of mirror-like surfaces will be discussed.

Investigation on diamond turning of silicon crystal - generation mechanism of surface cut with worn tool

This paper discusses the effect of tool wear on surface finish in single-point diamond turning of single crystal silicon. The morphology and topography of the machined surface clearly show the type of cutting edge wear reproduced onto the cutting grooves. Scanning electron microscopy is used in order to correlate the cutting edge damage and microtopography features observed through atomic force microscopy. The possible wear mechanisms affecting tool performance and surface generation during cutting are also discussed. The zero degree rake angle single point diamond tool presented small nicks on the cutting edge. The negative rake angle tools presented more a type of crater wear on the rake face. No wear was detected on flank face of the diamond tools.

Influence of Cutting Conditions on Tool Life, Tool Wear and Surface Finish in the Face Milling Process

The main goal of this work is to study the influence of cutting conditions - cutting speed, feed velocity and feed per tooth - on tool life and surface finish of the workpiece in the face milling of flat surfaces. Aiming to achieve this goal, several milling experiments were carried out with different cutting speeds, feed velocities and feeds per tooth. In the first phase of the experiments, cutting speed was varied without varying feed velocity, which caused a variation in feed per tooth. In the second phase of the experiments, cutting speed and feed velocity were varied in such a way that feed per tooth was kept constant. Tool flank wear and surface roughness of the workpiece were measured as cutting time elapsed. The main conclusions of this work are that a) cutting speed has a strong influence on tool life, regardless of whether feed velocity or feed per tooth varies and b) an increase in surface roughness of the workpiece is not closely related to an increase in wear of the primary cutting edge.

Hot tool temperature analysis though infrared images

Textile manufacture occupies a prominent place in the national economy. Because of its importance researches have been made on the development of new materials, equipment and methods used in the production process. The cutting of textiles starts in the basic stage, to be followed by the process of the making of clothes and other articles. In the hot cutting of fabric, one of the variables of great importance in the control of the process is the contact temperature between the tool and the fabric. This work presents a technique for the measurement of the temperature based on the processing of infrared images. With this purpose, it was developed a system which is composed of an infrared camera, a framegrabber PC board and a software which analyses the punctual temperature in the cut area enabling the operator to achieve the necessary control of other variables involved in the process.