Implementation of a trauma registry in a brazilian public hospital: the first 1,000 patients

OBJECTIVE: Show the steps of a Trauma Registry (TR) implementation in a Brazilian public hospital and evaluate the initial data from the database.METHODS: Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais) and analysis of the initial results of the first 1,000 patients.RESULTS: The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS) could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7%) and the importance of aggression as a cause of injuries in our environment (47.5%), surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%.CONCLUSION: Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.

Jejunum and ileum blunt trauma: what has changed with the implementation of multislice computed tomography?

OBJECTIVE: to evaluate the impact of the new technology of multidetector computed tomography (MDCT) in improving the accuracy and early diagnosis of BSBI.METHODS: patients with blunt small bowel injuries (BSBI) grade> I were identified retrospectively and their CT scans reviewed by an experienced radiologist. Clinical and tomographic findings were analyzed and patients grouped as "pre-MDCT" and "post-MDCT", according to the time of implementation of a 64-slice MDCT.RESULTS: of the 26 patients with BSBI 16 had CT scans. Motor vehicle collision (62.5%) was the most frequent mechanism of injury. In the pre-MDCT period, five of the 13 patients (38.5%) had abdominal CT, and in the post-MDCT, 11 of 13 patients (84.6%) had the exam. During pre-MDCT, all CT scans were abnormal with findings of pneumoperitoneum (60%), free fluid (40%) and bowel wall enhancement (20%). In the post-MDCT group, all exams but one were abnormal and the most frequent findings were free fluid (90.9%), bowel wall enhancement (72.7%), and pneumoperitoneum (54.5%). However, the rate of delayed laparotomy did not change. The mortality rate in both groups were similar, with 20% during pre-MDCT and 18.2% during post-MDCT.CONCLUSION: the use of MDCT in abdominal trauma in our service has increased the sensibility of the diagnosis, but has had no impact on outcome so far.

Scheduling of guarded command based models

Formal methods provide a means of reasoning about computer programs in order to prove correctness criteria. One subtype of formal methods is based on the weakest precondition predicate transformer semantics and uses guarded commands as the basic modelling construct. Examples of such formalisms are Action Systems and Event-B. Guarded commands can intuitively be understood as actions that may be triggered when an associated guard condition holds. Guarded commands whose guards hold are nondeterministically chosen for execution, but no further control flow is present by default. Such a modelling approach is convenient for proving correctness, and the Refinement Calculus allows for a stepwise development method. It also has a parallel interpretation facilitating development of concurrent software, and it is suitable for describing event-driven scenarios. However, for many application areas, the execution paradigm traditionally used comprises more explicit control flow, which constitutes an obstacle for using the above mentioned formal methods. In this thesis, we study how guarded command based modelling approaches can be conveniently and efficiently scheduled in different scenarios. We first focus on the modelling of trust for transactions in a social networking setting. Due to the event-based nature of the scenario, the use of guarded commands turns out to be relatively straightforward. We continue by studying modelling of concurrent software, with particular focus on compute-intensive scenarios. We go from theoretical considerations to the feasibility of implementation by evaluating the performance and scalability of executing a case study model in parallel using automatic scheduling performed by a dedicated scheduler. Finally, we propose a more explicit and non-centralised approach in which the flow of each task is controlled by a schedule of its own. The schedules are expressed in a dedicated scheduling language, and patterns assist the developer in proving correctness of the scheduled model with respect to the original one.

ESTABLISH & DEPLOY DOWNSTREAM MARKETING CAPABILITIES: a case study research following the framework implementation journey

According to many academic researches, the development of marketing capabilities can enhance organizational performance. Similarly, downstream marketing capabilities have an important role in accomplishment the organizational goals. Particularly the downstream marketing capabilities identified in this research are the Marketing Communication, Selling, Marketing implementation, and Market information management. These four capabilities are summarized under the following abilities. First, the ability to manage customers’ opinion regarding the offered value from the organization. Second, the ability of the organization to obtain orders from new and established customers. Third, the ability of aligning and translate the marketing strategy into an operating action plan along with the deployment of the organizational resources. Forth, the continuous process of gathering and managing information about the markets. Moreover, the literature review of this research shed light on the elements that compose the downstream marketing capabilities. Specifically, this research examined the downstream processes and the required information required to control these processes based on the American Productivity and Quality Center’s Process Classification Framework. Furthermore, the literature review examined some of the technological tools that are used in marketing processes, and also some managerial implication regarding the management of the downstream marketing employees. Along with the investigation of downstream marketing capabilities, the literature review investigated the utilization and the benefits of Component Business Model and Process Classification Framework, as they are defined by the organizations that developed them. Besides this initial study, the research presents how the examined organization is using the two frameworks together by cross-referring them. Finally, the research presents the optimal deployment of the collected downstream capabilities elements in the current organizational structure. The optimal deployment has been grounded on the information collected from the literature review but also from internal documentation, provided from the examined organization. By comparing the optimal deployment and the current condition on the organization, the research exhibits some points for improvement, but also some of the projects that are currently in progress inside the organization and eventually will provide solutions to these downsides.

De-escalation of commitment management strategy in IT project management methodology: case of ERP implementation project by IT consulting company

According to several surveys and observations, the percentage of successfully conducted IT projects without over-budgeting and delays in time schedule are extremely low. Many projects also are evaluated as failures in terms of delivered functionality. Nuldén (1996) compares IT projects with bad movies; after watching for 2 hours, one still tries to finish it even though one understands that it is a complete waste of time. The argument for that is 'I've already invested too much time to terminate it now'. The same happens with IT projects: sometimes the company continues wasting money on these projects for a long time, even though there are no expected benefits from these projects. Eventually these projects are terminated anyway, but until this moment, the company spends a lot. The situation described above is a consequence of “escalation of commitment” - project continuation even after a manager receives negative feedback of the project’s success probability. According to Keil and Mähring (2010), even though escalation can occur in any type of project, it is more common among complex technological projects, such as IT projects. Escalation of commitment very often results in runaway projects. In order to avoid it, managers use de-escalation strategies, which allow the resources to be used in more effective. These strategies lead to project termination or turning around, which stops the flow of wasted investments. Numbers of researches explore escalation of commitment phenomena based on experiments and business cases. Moreover, during the last decade several frameworks were proposed for de-escalation strategy. However, there is no evidence of successful implementation of the de-escalation of commitment strategy in the literature. In addition, despite that fact that IT project management methodologies are widely used in the companies, none of them cover the topic of escalation of commitment risks. At the same time, there are no researches proposing the way to implement de-escalation of commitment strategy into the existing project management methodology The research is focused on a single case of large ERP implementation project by the consulting company. Hence, the main deliverables of the study include suggestions of improvement in de-escalation methods and techniques in the project and in the company. Moreover, the way to implement these methods into existing project management methodology and into the company general policies is found.

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.

IT service catalog : a case study of the implementation need in a Pan-Nordic Insurance Company

IT service catalog is an increasingly important issue as many IT organizations have been realizing it as a central communication and visualization tool to bridge the gap between IT and the business. This study reviews relevant literature on IT service catalog and related issues on IT services delivery. Furthermore, the study shows how IT service catalog can enhance IT effectiveness as well as provide more benefits when integrating with Configuration Management Database. In order to analyze whether IT service catalog is needed to be implemented in a Pan-Nordic Insurance Company, this study also investigates the current IT services delivery of a case study. The findings of the study show the problems in the current situation of IT services delivery in the case. The characteristics of IT service catalog are recommended in order to help with the mentioned flaws.

Establishment of a health and safety management system according to the OHSAS 18001 standard

The thesis develops guidelines for the implementation of the health and safety management system according to the OHSAS 18001 standard, as well as the feasible threat analysis, project proposal schedule, future system quality improvements and organizational change evaluation. The theoretical part clarifies determination of occupational health and safety, its management system, the OHSAS 18001 standard and integrated management system compounded of triple ISO 14001, ISO 9001 and OHSAS 18001 standards. The literature includes such important aspects as human factor, organizational policies, possible benefits, threats, organizational safety culture, Deming’s quality improvement cycle, system implementation, maintenance and cost matters. The empirical part demonstrates real-life situation by using Andritz Pulp & Paper Oy as a case study. Prior the thesis proposal, Andritz Group is analysed including separate business areas, acquisition and integration strategies, current status of the health and safety management and parallel experiences of the largest business area Andritz Hydro. The proposal is aimed at improving the current health and safety system for the permanent and sub-contracted employees at Andritz Pulp & Paper both in Finland and in various projects globally.

Novel Methods for Error Modeling and Parameter Identification of a Redundant Serial-Parallel Hybrid Robot

To obtain the desirable accuracy of a robot, there are two techniques available. The first option would be to make the robot match the nominal mathematic model. In other words, the manufacturing and assembling tolerances of every part would be extremely tight so that all of the various parameters would match the “design” or “nominal” values as closely as possible. This method can satisfy most of the accuracy requirements， but the cost would increase dramatically as the accuracy requirement increases. Alternatively, a more cost-effective solution is to build a manipulator with relaxed manufacturing and assembling tolerances. By modifying the mathematical model in the controller, the actual errors of the robot can be compensated. This is the essence of robot calibration. Simply put, robot calibration is the process of defining an appropriate error model and then identifying the various parameter errors that make the error model match the robot as closely as possible. This work focuses on kinematic calibration of a 10 degree-of-freedom (DOF) redundant serial-parallel hybrid robot. The robot consists of a 4-DOF serial mechanism and a 6-DOF hexapod parallel manipulator. The redundant 4-DOF serial structure is used to enlarge workspace and the 6-DOF hexapod manipulator is used to provide high load capabilities and stiffness for the whole structure. The main objective of the study is to develop a suitable calibration method to improve the accuracy of the redundant serial-parallel hybrid robot. To this end, a Denavit–Hartenberg (DH) hybrid error model and a Product-of-Exponential (POE) error model are developed for error modeling of the proposed robot. Furthermore, two kinds of global optimization methods, i.e. the differential-evolution (DE) algorithm and the Markov Chain Monte Carlo (MCMC) algorithm, are employed to identify the parameter errors of the derived error model. A measurement method based on a 3-2-1 wire-based pose estimation system is proposed and implemented in a Solidworks environment to simulate the real experimental validations. Numerical simulations and Solidworks prototype-model validations are carried out on the hybrid robot to verify the effectiveness, accuracy and robustness of the calibration algorithms.

Marketers’ perception of the implementation of social media marketing: Evidence from large Finnish companies’ marketing campaigns

Social media is a multidimensional marketing and communications channel which can support and enhance a business’ reputation, sales and even longevity. Social media as a business tool encourages an interaction between customers and companies which gives opportunities for a company to better understand their customers, to target them more effectively and to collaborate and create dialogues with them which is not possible through traditional media channels. The aim of a social media strategy is to increase brand awareness, image, loyalty and recognition. The peer networks that social media creates allows a company to disseminate information through loyal customers to new and prospective customers to ultimately increase reach. The purpose of the study is to understand the marketer’s perspective of social media marketing use and how it is currently utilized in marketing and communications activities in Finland. Three companies were interviewed covering fourteen different implementations of social media marketing campaigns. These were then analysed to ascertain the utilization methods and experience gained on recent campaigns in the Finnish market The utilization of social media marketing was analysed using the methods of thematic analysis and inductive and abductive reasoning. Elements and themes were drawn out of the separate interviews to create a framework with which to explore, evaluate and match theories that define social media usage by companies. It became clear from all of the interviews that social media as a tool is most effective when it captures the viewer’s interest through rich and entertaining content. This directed the theoretical research towards Engagement Theory and Content Marketing which look to emphasize the importance of communities, collaboration, interaction, and peer-sharing as the key drivers of a social media marketing campaign.

The Shadow Moiré method using the phase shifting technique and digital image processing: computational implementation and application to the 3D-reconstruction of a buckled plate

The Shadow Moiré fringe patterns are level lines of equal depth generated by interference between a master grid and its shadow projected on the surface. In simplistic approach, the minimum error is about the order of the master grid pitch, that is, always larger than 0,1 mm, resulting in an experimental technique of low precision. The use of a phase shift increases the accuracy of the Shadow Moiré technique. The current work uses the phase shifting method to determine the surfaces three-dimensional shape using isothamic fringe patterns and digital image processing. The current study presents the method and applies it to images obtained by simulation for error evaluation, as well as to a buckled plate, obtaining excellent results. The method hands itself particularly useful to decrease the errors in the interpretation of the Moiré fringes that can adversely affect the calculations of displacements in pieces containing many concave and convex regions in relatively small areas.

Inverse convection problem of simultaneous estimation of two boundary heat fluxes in parallel plate channels

This paper deals with the use of the conjugate gradient method of function estimation for the simultaneous identification of two unknown boundary heat fluxes in parallel plate channels. The fluid flow is assumed to be laminar and hydrodynamically developed. Temperature measurements taken inside the channel are used in the inverse analysis. The accuracy of the present solution approach is examined by using simulated measurements containing random errors, for strict cases involving functional forms with discontinuities and sharp-corners for the unknown functions. Three different types of inverse problems are addressed in the paper, involving the estimation of: (i) Spatially dependent heat fluxes; (ii) Time-dependent heat fluxes; and (iii) Time and spatially dependent heat fluxes.

Surface Tension Implementation for Gensmac2d

In the present work we describe a method which allows the incorporation of surface tension into the GENSMAC2D code. This is achieved on two scales. First on the scale of a cell, the surface tension effects are incorporated into the free surface boundary conditions through the computation of the capillary pressure. The required curvature is estimated by fitting a least square circle to the free surface using the tracking particles in the cell and in its close neighbors. On a sub-cell scale, short wavelength perturbations are filtered out using a local 4-point stencil which is mass conservative. An efficient implementation is obtained through a dual representation of the cell data, using both a matrix representation, for ease at identifying neighbouring cells, and also a tree data structure, which permits the representation of specific groups of cells with additional information pertaining to that group. The resulting code is shown to be robust, and to produce accurate results when compared with exact solutions of selected fluid dynamic problems involving surface tension.

Seismic motion simulation based on Cassino Parallel Manipulator

In this paper we present a study of feasibility by using Cassino Parallel Manipulator (CaPaMan) as an earthquake simulator. We propose a suitable formulation to simulate the frequency, amplitude and acceleration magnitude of seismic motion by means of the movable platform motion by giving a suitable input motion. In this paper we have reported numerical simulations that simulate the three principal earthquake types for a seismic motion: one at the epicenter (having a vertical motion), another far from the epicenter (with the motion on a horizontal plane), and a combined general motion (with a vertical and horizontal motion).

Design and implementation of a peer-to-peer client for device management

The aim of this master’s thesis was to specify a system requiring minimal configuration and providing maximal connectivity in the vein of Skype but for device management purposes. As peer-to-peer applications are pervasive and especially as Skype is known to provide this functionality, the research was focused on these technologies. The resulting specification was a hybrid of a tiered hierarchical network structure and a Kademlia based DHT. A prototype was produced as a proof-of-concept for the hierarchical topology, demonstrating that the specification was feasible.