971 resultados para Emergency Room utilization


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The aim of this study was to identify the relation between the evapotranspirometer demand and the supply of water from local rainfall, evaluating the possibility of using water excess for irrigation of Green Roofs in the State of Mato Grosso, in Brazil. The study was done using a series of historical data provided by the National Institute of Meteorology (INMET - Instituto Nacional de Meteorologia) which has official climatological stations in 12 cities and regions of the State. The evapotranspiration values were obtained by the Penman-Monteith method and by the Climatic Water Balance (CWB) by the Thornthwaite and Mather method using Available Water Capacity (AWC) of 12mm. With the CWB the excess and deficit were calculated, which were used for the estimative of the volume and area of a reservoir as a function of a collector area of a roof of 100m² and the volume of supplementary water for irrigation. With the obtained results, it was found that in most investigated regions of the State the use of green roofs is not compromised by the water deficiency. On the other hand, the use of a reservoir to accumulate the rain water excess may be impractical, because it requires a considerable area for installation and also because of the high cost of the land.

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The objective of this master’s thesis was twofold: first to examine the concept of customer value and its drivers and second to identify information use practices. The first part of the study represents explorative research that was carried out by examining a case company’s customer satisfaction data that was used to identify sales and technical customer service related value drivers on a detailed attribute level. This was followed by an examination of whether these attributes had been commented on in a positive or a negative light and what were the reasons why the case company had received higher or lower ratings than its competitor. As a result a classification of different sales and technical customer service related attributes was created. The results indicated that the case company has performed well, but that the results varied on the company’s business segment level. The case company’s staff, service and the benefits from a long-lasting relationship came up in a positive light whereas attitude, flexibility and reaction time came up in a negative light. The reasons for a higher or lower score in comparison to competitor varied. The results indicated that a customer’s satisfaction with the company’s performance did not always mean that the company was outperforming the competition. The second part of the study focused on customer satisfaction information use from the viewpoints of information access, dissemination and reaction. The study was conducted by running an internal survey among the case company’s staff. The results showed that information use practices varied across the company and some units or teams had taken a more proactive approach to the information use than others.

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OBJECTIVE: To analyze the profile of patients served by the air medical rescue system in the Metropolitan Region of Campinas, evaluating: triage and mobilization criteria; response time; on-site care and transport time; invasive procedures performed in the Pre-Hospital Care (PHC); severity of patients; morbidity and mortality.METHODS: We conducted a prospective, descriptive study in which we analyzed medical records of patients rescued between July 2010 and December 2012. During this period, 242 victims were taken to the HC-Unicamp. Of the 242 patients, 22 were excluded from the study.RESULTS: of the 220 cases evaluated, 173 (78.6%) were male, with a mean age of 32 years. Blunt trauma was the most prevalent (207 cases - 94.1%), motorcycle accidents being the most common mechanisms of injury (66 cases - 30%), followed by motor vehicle collisions (51 cases - 23.2%). The average response time was 10 ± 4 minutes and the averaged total pre-hospital time was 42 ± 11 minutes. The mean values of the trauma indices were: RTS = 6.2 ± 2.2; ISS = 19.2 ± 12.6; and TRISS = 0.78 ± 0.3. Tracheal intubation in the pre-hospital environment was performed in 77 cases (35%); 43 patients (19.5%) had RTS of 7.84 and ISSd"9, being classified as over-triaged. Of all patients admitted, the mortality was 15.9% (35 cases).CONCLUSION: studies of air medical rescue in Brazil are required due to the investments made in the pre-hospital care in a country without an organized trauma system. The high rate of over-triage found highlights the need to improve the triage and mobilization criteria.

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The objective is to reinforce the importance of blood reinfusion as a cheap, safe and simple method, which can be used in small hospitals, especially those in which there is no blood bank. Moreover, even with the use of devices that perform the collection and filtration of blood, more recent studies show that the cost-benefit ratio is much better when autologous transfusion is compared with blood transfusions, even when there is injury to hollow viscera and blood contamination. It is known that the allogeneic blood transfusion carries a number of risks to patients, among them are the coagulation disorders mediated by excess enzymes in the conserved blood, and deficiency in clotting factors, mainly the Factor V, the proacelerin. Another factor would be the risk of contamination with still unknown pathogens or that are not investigated during screening for selection of donors, such as the West Nile Fever and Creutzfeldt-Jacob, better known as "Mad Cow" disease. Comparing both methods, we conclude that blood autotransfusion has numerous advantages over heterologous transfusion, even in large hospitals. We are not against blood transfusions, just do not agree that the patient's own blood is discarded without making sure there will be enough blood in stock to get him out of the hemorrhagic shock.

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Objective: To retrospectively analyze the relationship of time of care, combined with possible post-appendectomy complications, with the promptness of transfer of patients seen in Emergency Care Units (UPA) to the emergency hospital.Methods: We analyzed patients with preoperative diagnosis of acute appendicitis undergoing appendectomy from January to July 2012. Patients were divided into two groups according to the site of the first care. Group A included patients who received initial care directly in the emergency department of the Lourenço Jorge County Hospital (HMLJ) and group B consisted of patients seen in the UPA and forwarded to HMLJ to undergo surgical treatment.Results: the average time between initial treatment and surgery in group A was 29 hours (SD = 21.95) and 54 hours in group B (SD = 54.5). Considering the onset of symptoms, the patients in group A were operated on average 67 hours after (SD = 42.55), while group B, 90 hours (SD = 59.58). After the operation, patients in group A were hospitalized, on average, for 94 hours (SD = 73.53) and group B, 129 hours (SD = 193.42).Conclusion: there was no significant difference in the time elapsed between the onset of symptoms, initial treatment and early surgical treatment, or time elapsed between surgery and discharge.

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ABSTRACTObjective:to investigate the effect of standardized interventions in the management of tube thoracostomy patients and to assess the independent effect of each intervention.Methods:A chest tube management protocol was assessed in a retrospective cohort study. The tube thoracostomy protocol (TTP) was implemented in August 2012, and consisted of: antimicrobial prophylaxis, chest tube insertion in the operating room (OR), admission post chest tube thoracostomy (CTT) in a hospital floor separate from the emergency department (ED), and daily respiratory therapy (RT) sessions post-CTT. The inclusion criteria were, hemodynamic stability, patients between the ages of 15 and 59 years, and injury severity score (ISS) < 17. All patients had isolated injuries to the chest wall, lung, and pleura. During the study period 92 patients were managed according to the standardized protocol. The outcomes of those patients were compared to 99 patients treated before the TTP. Multivariate logistic regression analysis was performed to assess the independent effect of each variable of the protocol on selected outcomes.Results:Demographics, injury severity, and trauma mechanisms were similar among the groups. As expected, protocol compliance increased after the implementation of the TTP. There was a significant reduction (p<0.05) in the incidence of retained hemothoraces, empyemas, pneumonias, surgical site infections, post-procedural complications, hospital length of stay, and number of chest tube days. Respiratory therapy was independently linked to significant reduction (p<0.05) in the incidence of seven out of eight undesired outcomes after CTT. Antimicrobial prophylaxis was linked to a significant decrease (p<0.05) in retained hemothoraces, despite no significant (p<0.10) reductions in empyema and surgical site infections. Conversely, OR chest tube insertion was associated with significant (p<0.05) reduction of both complications, and also significantly decreased the incidence of pneumonias.Conclusion:Implementation of a TTP effectively reduced complications after CTT in trauma patients.

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The made research is focused on possibility of application of non ferrous metals in boiler pressure parts as a substitute of currently used ferrous-base alloys. The main issue was to define resistive ability of some perspective non ferrous metals to chlorine induced corrosion. Experimental study was performed using simultaneous thermal analysis (STA) in the temperature range of 400-700 °C. The chloride induced corrosion was simulated by mixtures of metal samples with potassium chloride treated by synthetic air. The advantage of synergetic effect of non ferrous alloys compare to single metals is shown due to the obtained data from conducted thermal balance tests.

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Utilization of social media is increasingly common in B2B marketing. Social media is an efficient and cheap marketing and communication channel available for everyone, and thus extremely attractive marketing medium. The more companies get involved in social media the more failures are reported. It is not enough for a company to just be present in social media. Succeeding on it requires hard work, investing time and money, and ability to measure and to monitor performance. With an increasing number of companies failing in utilizing social media, together with lack of research on strategic utilization of social media focusing on B2B marketing, measuring, and monitoring create a purpose for this research. The aim of this research is to discover methods for measuring and monitoring effects of strategic utilization of social media in B2B marketing. Most relevant financial and non-financial indicators are discussed, and the methods by which these can be monitored and measured. In addition, effects of strategic utilization of social media on the case company are measured and analyzed. The research methodology used in this research is a participatory action research, which includes elements of both qualitative and quantitative research methods. The case company examined in the research provides a unique opportunity to follow through all phases of strategic utilization of social media for B2B marketing purposes concluding real effects of social media to the case company, and thus gain a deep understanding about this new marketing medium in the perspective of B2B marketing. Duration of the research period is seven months. During this time, information is collected, measured, and analyzed. Case company does not have any other marketing activities simultaneously which makes it possible to examine social media apart from effects of other visible marketing activities. Effects of strategic utilization of social media can be monitored and measured in many ways. Methods that should be used depend on goals set for social media. Fundamental nature of social media requires multidimensional assessment, and thus effects should be measured, and monitored considering both financial and non-financial indicators. The results implicates that effects of strategic utilization of social media are relatively wide ranged. According to the findings, social media affects positively on brand, number of web page visitors, visitor behavior, and on distribution of awareness. According to investment calculations social media is a legitimate investment for case company. Results also implicate that by using social media case company gains conversation, arouses interest, gets attention, and creates interactivity. In addition and as a side note, winter holiday season appears to have a great effect on social media activity of B2B companies’ representatives.

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Particle Image Velocimetry, PIV, is an optical measuring technique to obtain velocity information of a flow in interest. With PIV it is possible to achieve two or three dimensional velocity vector fields from a measurement area instead of a single point in a flow. Measured flow can be either in liquid or in gas form. PIV is nowadays widely applied to flow field studies. The need for PIV is to obtain validation data for Computational Fluid Dynamics calculation programs that has been used to model blow down experiments in PPOOLEX test facility in the Lappeenranta University of Technology. In this thesis PIV and its theoretical background are presented. All the subsystems that can be considered to be part of a PIV system are presented as well with detail. Emphasis is also put to the mathematics behind the image evaluation. The work also included selection and successful testing of a PIV system, as well as the planning of the installation to the PPOOLEX facility. Already in the preliminary testing PIV was found to be good addition to the measuring equipment for Nuclear Safety Research Unit of LUT. The installation to PPOOLEX facility was successful even though there were many restrictions considering it. All parts of the PIV system worked and they were found out to be appropriate for the planned use. Results and observations presented in this thesis are a good background to further PIV use.

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Forest biomass represents a geographically distributed feedstock, and geographical location affects the greenhouse gas (GHG) performance of a given forest-bioenergy system in several ways. For example, biomass availability, forest operations, transportation possibilities and the distances involved, biomass end-use possibilities, fossil reference systems, and forest carbon balances all depend to some extent on location. The overall objective of this thesis was to assess the GHG emissions derived from supply and energy-utilization chains of forest biomass in Finland, with a specific focus on the effect of location in relation to forest biomass’s availability and the transportation possibilities. Biomass availability and transportation-network assessments were conducted through utilization of geographical information system methods, and the GHG emissions were assessed by means of lifecycle assessment. The thesis is based on four papers in which forest biomass supply on industrial scale was assessed. The feedstocks assessed in this thesis include harvesting residues, smalldiameter energy wood and stumps. The principal implication of the findings in this thesis is that in Finland, the location and availability of biomass in the proximity of a given energyutilization or energy-conversion plant is not a decisive factor in supply-chain GHG emissions or the possible GHG savings to be achieved with forest-biomass energy use. Therefore, for the greatest GHG reductions with limited forest-biomass resources, energy utilization of forest biomass in Finland should be directed to the locations where most GHG savings are achieved through replacement of fossil fuels. Furthermore, one should prioritize the types of forest biomass with the lowest direct supply-chain GHG emissions (e.g., from transport and comminution) and the lowest indirect ones (in particular, soil carbon-stock losses), regardless of location. In this respect, the best combination is to use harvesting residues in combined heat and power production, replacing peat or coal.

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During vehicle deceleration due to braking there is friction between the lining surface and the brake drum or disc. In this process the kinetic energy of vehicle is turned into thermal energy that raises temperature of the components. The heating of the brake system in the course of braking is a great problem, because besides damaging the system, it may also affect the wheel and tire, which can cause accidents. In search of the best configuration that considers the true conditions of use, without passing the safety limits, models and formulations are presented with respect to the brake system, considering different braking conditions and kinds of brakes. Some modeling was analyzed using well-known methods. The flat plate model considering energy conservation was applied to a bus, using for this a computer program. The vehicle is simulated to undergo an emergency braking, considering the change of temperature on the lining-drum. The results include deceleration, braking efficiency, wheel resistance, normal reaction on the tires and the coefficient of adhesion. Some of the results were compared with dynamometer tests made by FRAS-LE and others were compared with track tests made by Mercedes-Benz. The convergence between the results and the tests is sufficient to validate the mathematical model. The computer program makes it possible to simulate the brake system performance in the vehicle. It assists the designer during the development phase and reduces track tests.

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Waste has been incinerated for energy utilization for more than a hundred years, but the harmful emissions emitted from the incineration plants did not begin to cause concern until the 1980s. Many plants were shutdown and the waste incineration plant in Kyläsaari Helsinki was one of them. In later years, new landfill regulations have increased the interest in waste incineration. During the last year, four new plants were taken into operation in Finland, Westenergy in Vaasa among them. The presence of dust has been observed indoors at Westenergy waste incineration plant. Dust is defined as particles with a diameter above 10 μm, while fine particles have a diameter smaller than 2.5 μm, ultrafine under 0.1 μm and nanoparticles under 0.05 μm. In recent years, the focus of particle health research has been changed to investigate smaller particles. Ultrafine particles have been found to be more detrimental to health than larger particles. Limit values regulating the concentrations of ultrafine particles have not been determined yet. The objective of this thesis was to investigate dust and particles present inside the Westenergy waste incineration facility. The task was to investigate the potential pollutant sources and to give recommendations of how to minimize the presence of dust and particles in the power plant. The total particle number concentrations and size distributions where measured at 15 points inside the plant with an Engine Exhaust Particle Sizer (EEPS) Spectrometer. The measured particles were mainly in the ultrafine size range. Dust was only visually investigated, since the main purpose was to follow the dust accumulation. The measurement points inside the incineration plant were chosen according to investigate exposure to visitors and workers. At some points probable leakage of emissions were investigated. The measurements were carried out during approximately one month in March–April 2013. The results of the measurements showed that elevated levels of dust and particles are present in the indoor air at the waste incineration plant. The cleanest air was found in the control room, warehouse and office. The most polluted air was near the sources that were investigated due to possible leakage and in the bottom ash hall. However, the concentrations were near measured background concentrations in European cities and no leakage could be detected. The high concentrations were assumed to be a result of a lot of dust and particles present on surfaces that had not been cleaned in a while. The main source of the dust and particles present inside the waste incineration plant was thought to be particles and dust from the outside air. Other activities in the area around the waste incineration facility are ground work activities, stone crushing and traffic, which probably are sources of particle formation. Filtration of the outside air prior entering the facility would probably save personnel and visitors from nuisance and save in cleaning and maintenance costs.