Trauma leagues: an alternative way to teach trauma surgery to medical students

OBJECTIVE: to compare the knowledge of medical students between those who are members of the Trauma League (TL) and those from a non-Trauma League (NTL) group of the Federal University of Espírito Santo (UFES).METHODS: cross-sectional, analytical and descriptive study. Two knowledge tests, with 30 questions each, were applied to students from 3rd to 12th period, randomly selecting five students per period, with 50 students in the TL group and 50 in NTL. The questionnaire topics were: pre-hospital care, the mnemonic ABCDE trauma sequence, advanced trauma and imaging. The students' performances were evaluated by graduation-period group: basic (3rd-5th period), intermediary/clinical (6th-8th) and internship (9th-12th).RESULTS: in the first test the average accuracy of the TL group was 20.64 ± 3.17, while for the NTL group, it was 14.76 ± 5.28 (p<0.005). In the second test the average accuracy for the TL group was 21.52 ± 3.64, while for the NTL group, the average was 15.36 ± 29.5 (p<0.005). When divided into graduation periods, it was observed that the TL group showed a higher average across all three groups (p<0.05) in both tests.CONCLUSION: the students who attended the academic league activities have greater knowledge of the issues that are considered relevant to patient trauma care. In all periods of undergraduate academic training, the TL group had greater knowledge of the subject than the NTL group.

Social ventures : the development of the theory of sustainable contributive advantage and initial empirical tests

This thesis attempts to fill gaps in both a theoretical basis and an operational and strategic understanding in the areas of social ventures, social entrepreneurship and nonprofit business models. This study also attempts to bridge the gap in strategic and economic theory between social and commercial ventures. More specifically, this thesis explores sustainable competitive advantage from a resource-based theory perspective and explores how it may be applied to the nonmarket situation of nonprofit organizations and social ventures. It is proposed that a social value-orientation of sustainable competitive advantage, called sustainable contributive advantage, provides a more realistic depiction of what is necessary in order for a social venture to perform better than its competitors over time. In addition to providing this realistic depiction, this research provides a substantial theoretical contribution in the area of economics, social ventures, and strategy research, specifically in regards to resource-based theory. The proposed model for sustainable contributive advantage uses resource-based theory and competitive advantage in order to be applicable to social ventures. This model proposes an explanation of a social venture’s ability to demonstrate consistently superior performance. In order to determine whether sustainable competitive advantage is in fact, appropriate to apply to both social and economic environments, quantitative analyses are conducted on a large sample of nonprofit organizations in a single industry and then compared to similar quantitative analyses conducted on commercial ventures. In comparing the trends and strategies between the two types of entities from a quantitative perspective, propositions are developed regarding a social venture’s resource utilization strategies and their possible impact on performance. Evidence is found to support the necessity of adjusting existing models in resource-based theory in order to apply them to social ventures. Additionally supported is the proposed theory of sustainable contributive advantage. The thesis concludes with recommendations for practitioners, researchers and policy makers as well as suggestions for future research paths.

Palveluliiketoiminnan CCC-varaosahankinta: Toimitusaika ja toimitusvarmuus

Tutkimuksessa tarkastellaan suomalaisen konepajakonsernin palveluliiketoiminnan varaosien CCC-hankintaa. Tutkimuksella haetaan CCC-hankinnan toimitusaikoja ja toimitusvarmuutta parantavia tekijöitä ja ratkaisuja. Tutkimus on toteutettu soveltamalla aiempia tutkimuksia, konepajakonsernin kolmen suurimman yrityksen hankinnan haastatteluja sekä 22 varaosatoimittajan haastatteluja. Erillisten tekijöiden vaikutuksia toimitusaikoihin ja toimitusvarmuuksiin on arvioitu Pearsonin korrelaatio-testeillä. Johtopäätöksiin on päädytty yhdistämällä aiempien tutkimusten tuloksia, eri toimijoille tehtyjä haastatteluja ja tekijöiden vaikutuksia keskenään. Tutkimuksen tulokset osoittavat, että toimitusvarmuutta arvioitaessa tulee ottaa huomioon kolmannen osapuolen myöntämät laatusertifikaatit, toimitusaikaan sen sijaan vaikuttaa negatiivisesti eniten tuotannonohjauksen taso ja parempaan suoritukseen niin toimitusvarmuuden kuin toimitusajankin saralla voidaan päästä kehittämällä yhteistyötä ja siirtämällä entistä enemmän operatiivista vastuuta varaosatoimittajille.

Power cycling lifetime estimation of IGBT power modules based on chip temperature modeling

In this doctoral thesis, methods to estimate the expected power cycling life of power semiconductor modules based on chip temperature modeling are developed. Frequency converters operate under dynamic loads in most electric drives. The varying loads cause thermal expansion and contraction, which stresses the internal boundaries between the material layers in the power module. Eventually, the stress wears out the semiconductor modules. The wear-out cannot be detected by traditional temperature or current measurements inside the frequency converter. Therefore, it is important to develop a method to predict the end of the converter lifetime. The thesis concentrates on power-cycling-related failures of insulated gate bipolar transistors. Two types of power modules are discussed: a direct bonded copper (DBC) sandwich structure with and without a baseplate. Most common failure mechanisms are reviewed, and methods to improve the power cycling lifetime of the power modules are presented. Power cycling curves are determined for a module with a lead-free solder by accelerated power cycling tests. A lifetime model is selected and the parameters are updated based on the power cycling test results. According to the measurements, the factor of improvement in the power cycling lifetime of modern IGBT power modules is greater than 10 during the last decade. Also, it is noticed that a 10 C increase in the chip temperature cycle amplitude decreases the lifetime by 40%. A thermal model for the chip temperature estimation is developed. The model is based on power loss estimation of the chip from the output current of the frequency converter. The model is verified with a purpose-built test equipment, which allows simultaneous measurement and simulation of the chip temperature with an arbitrary load waveform. The measurement system is shown to be convenient for studying the thermal behavior of the chip. It is found that the thermal model has a 5 C accuracy in the temperature estimation. The temperature cycles that the power semiconductor chip has experienced are counted by the rainflow algorithm. The counted cycles are compared with the experimentally verified power cycling curves to estimate the life consumption based on the mission profile of the drive. The methods are validated by the lifetime estimation of a power module in a direct-driven wind turbine. The estimated lifetime of the IGBT power module in a direct-driven wind turbine is 15 000 years, if the turbine is located in south-eastern Finland.

Accuracy of sonography and hysteroscopy in the diagnosis of premalignant and malignant polyps in postmenopausal women

PURPOSE: To evaluate the accuracy of sonographic endometrial thickness and hysteroscopic characteristics in predicting malignancy in postmenopausal women undergoing surgical resection of endometrial polyps. METHODS: Five hundred twenty-one (521) postmenopausal women undergoing hysteroscopic resection of endometrial polyps between January 1998 and December 2008 were studied. For each value of sonographic endometrial thickness and polyp size on hysteroscopy, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated in relation to the histologic diagnosis of malignancy. The best values of sensitivity and specificity for the diagnosis of malignancy were determined by the Receiver Operating Characteristic (ROC) curve. RESULTS: Histologic diagnosis identified the presence of premalignancy or malignancy in 4.1% of cases. Sonographic measurement revealed a greater endometrial thickness in cases of malignant polyps when compared to benign and premalignant polyps. On surgical hysteroscopy, malignant endometrial polyps were also larger. An endometrial thickness of 13 mm showed a sensitivity of 69.6%, specificity of 68.5%, PPV of 9.3%, and NPV of 98% in predicting malignancy in endometrial polyps. Polyp measurement by hysteroscopy showed that for polyps 30 mm in size, the sensitivity was 47.8%, specificity was 66.1%, PPV was 6.1%, and NPV was 96.5% for predicting cancer. CONCLUSIONS: Sonographic endometrial thickness showed a higher level of accuracy than hysteroscopic measurement in predicting malignancy in endometrial polyps. Despite this, both techniques showed low accuracy for predicting malignancy in endometrial polyps in postmenopausal women. In suspected cases, histologic evaluation is necessary to exclude malignancy.

Comparison of Classical and Secondary Cytologic Criteria Relative to Hybrid Capture for Diagnosing Cervical-vaginal Infection by Human Papillomavirus

Objective To compare the diagnostic accuracy of the classic Meisels cytologic criteria and the Schneider secondary criteria relative to the hybrid capture method for diagnosing HPV infection. Methods This was a retrospective study performed at a public university hospital. A total of 41 patients with a cytologic diagnosis of HPV infection and 40 HPV-negative patients were selected for review of the cervical-vaginal smears seeking to classical and secondary criteria. A single pathologist reviewed the slides in search of the criteria. The classical and secondary cytologic criteria were compared with the hybrid capture for diagnosing HPV infection. Bartleti test was applied for the age analysis, and Fisher's exact test was used to compare proportions. The tests were considered significant when the probability of rejecting the null hypothesis was less than 5% (p < 0.05). Results The Meisels criteria were less sensitive (34.0%) than the secondary Schneider criteria (57.5%) when compared with the hybrid capture (p < 0.0001), although the specificity of the former criteria was non-significantly higher (91.2% and 67.7%, respectively). In cases of moderate or intense inflammation, the sensitivity and specificity of the Schneider criteria were decreased, 33.3% and 50.0% respectively (p = 0.0115). Conclusions Compared with hybrid capture for diagnosis of HPV infection, the sensitivity of the secondary Schneider criteria was higher than the classical Meisels criteria.Moderate or intense inflammation reduces the sensitivity and specificity of the secondary Schneider criteria for diagnosing HPV infection using the hybrid capture as the gold standard.

Quality Indicators of Cervical Cytopathology Tests in the Public Service in Minas Gerais, Brazil

Objective The objective of this study is to assess the performance of cytopathology laboratories providing services to the Brazilian Unified Health System (Sistema Único de Saúde - SUS) in the State of Minas Gerais, Brazil. Methods This descriptive study uses data obtained from the Cervical Cancer Information System from January to December 2012. Three quality indicators were analyzed to assess the quality of cervical cytopathology tests: positivity index, percentage of atypical squamous cells (ASCs) in abnormal tests, and percentage of tests compatiblewith high-grade squamous intraepithelial lesions (HSILs). Laboratories were classified according to their production scale in tests per year≤5,000; from 5,001 to 10,000; from 10,001 to 15,000; and 15,001. Based on the collection of variables and the classification of laboratories according to production scale, we created and analyzed a database using Microsoft Office Excel 97-2003. Results In the Brazilian state of Minas Gerais, 146 laboratories provided services to the SUS in 2012 by performing a total of 1,277,018 cervical cytopathology tests. Half of these laboratories had production scales≤5,000 tests/year and accounted for 13.1% of all tests performed in the entire state; in turn, 13.7% of these laboratories presented production scales of > 15,001 tests/year and accounted for 49.2% of the total of tests performed in the entire state. The positivity indexes of most laboratories providing services to the SUS in 2012, regardless of production scale, were below or well below recommended limits. Of the 20 laboratories that performed more than 15,001 tests per year, only three presented percentages of tests compatible with HSILs above the lower limit recommended by the Brazilian Ministry of Health. Conclusion The majority of laboratories providing services to the SUS in Minas Gerais presented quality indicators outside the range recommended by the Brazilian Ministry of Health.

Predictive Capability of HPV and Pap Tests in Screening for Cervical Cancer over a Three-Year Follow-up

Purpose To compare the predictive capability of HPV and Pap smear tests for screening pre-cancerous lesions of the cervix over a three-year follow-up, in a population of users of the Brazilian National Health System (SUS). Methods This is a retrospective cohort study of 2,032 women with satisfactory results for Pap smear and HPV tests using second-generation hybrid capture,made in a previous study. We followed them for 36 months with data obtained from medical records, the Cervix Cancer Information System (SISCOLO), and the Mortality Information System (SIM). The outcome was a histological diagnosis of cervical intraepithelial neoplasia grade 2 or more advanced lesions (CIN2ş). We constructed progression curves of the baseline test results for the period, using the Kaplan-Meier method, and estimated sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios for each test. Results A total of 1,440 women had at least one test during follow-up. Progression curves of the baseline test results indicated differences in capability to detect CIN2ş (p < 0.001) with significantly greater capability when both tests were abnormal, followed by only a positive HPV test. The HPV test was more sensitive than the Pap smear (88.7% and 73.6%, respectively; p < 0.05) and had a better negative likelihood ratio (0.13 and 0.30, respectively). Specificity and positive likelihood ratio of the tests were similar. Conclusions These findings corroborate the importance of HPV test as a primary cervical cancer screening.

Evaluation of the indirect fluorescent antibody test and modified agglutination test for detection of antibodies against Toxoplasma gondii in experimentally infected pigs

The study determined the sensitivity and specificity of the indirect fluorescent antibody test (IFAT) and modified agglutination test (MAT) for anti-Toxoplasma gondii antibody detection by analyzing sera from 46 experimentally infected pigs. Values for sensitivity were 95.7% (confidence interval 95%: 84.0-99.2%) and for specificity 97.8% (confidence interval 95%: 87.0-99.9%) in both tests. There was an optimum agreement of results between IFAT and MAT evidenced by a Kappa test of 0.86. These results validate these tests for the detection of T. gondii infection in pigs. IFAT and MAT despite methodologies with different characteristics and readings have similar accuracy in pig serum samples.

Bus bar aeolian vibration field tests

Large amplitude bus bar aeolian vibration may lead to post insulator damage. Different damping applications are used to decrease the risk of large amplitude aeolian vibration. In this paper the post insulator load caused by the bus bar aeolian vibration and the effect of damping methods are evaluated. The effects of three types of bus bar connectors and three types of primary structures are studied. Two actual damping devices, damping cable and their combinations are studied. The post insulator loads are studied with strain gage based custom made force sensors installed on the both ends of the post insulator and with the displacement sensor installed on the midpoint of the bus bar. The post insulator loads are calculated from the strain values and the damping properties are determined from the displacement history. The bus bar is deflected with a hanging weight. The weight is released and the bus bar is left to free damped vibration. Both actual bus bar vibration dampers RIBE and SBI were very effective against the aeolian vibration. Combining vibration damper with damping cable will increase the damping ratio but it may be unnecessary considering the extra effort. Bus bar connector type or primary structure have no effect on the vertical load. The bending moment at the post insulator with double sided bus bar connector is significantly higher than at the post insulator with single sided bus bar connector. No reliable conclusions about bus bar connector type effect can be done, but the roller bearing type or central bearing type connector may reduce the bending moment. The RHS steel frame as primary structure may increase the bending moment peak values since it is the least rigid primary structure type and it may start to vibrate as a response to the awakening force of the vibrating bus bar.

Modeling, optimizing and simulating robot calibration with accuracy improvement

This work describes techniques for modeling, optimizing and simulating calibration processes of robots using off-line programming. The identification of geometric parameters of the nominal kinematic model is optimized using techniques of numerical optimization of the mathematical model. The simulation of the actual robot and the measurement system is achieved by introducing random errors representing their physical behavior and its statistical repeatability. An evaluation of the corrected nominal kinematic model brings about a clear perception of the influence of distinct variables involved in the process for a suitable planning, and indicates a considerable accuracy improvement when the optimized model is compared to the non-optimized one.

Accuracy of modelling and identification of malfunctions in rotor systems: experimental results

The accuracy of modelling of rotor systems composed of rotors, oil film bearings and a flexible foundation, is evaluated and discussed in this paper. The model validation of different models has been done by comparing experimental results with numerical results by means. The experimental data have been obtained with a fully instrumented four oil film bearing, two shafts test rig. The fault models are then used in the frame of a model based malfunction identification procedure, based on a least square fitting approach applied in the frequency domain. The capability of distinguishing different malfunctions has been investigated, even if they can create similar effects (such as unbalance, rotor bow, coupling misalignment and others) from shaft vibrations measured in correspondence of the bearings.

Dynamiikan simulointi poralaitteiden tuotekehityksessä

Diplomityö käsittelee kallioporalaitteen eliniän kuormitusten arviointiin tarkoitetun simulointimallin rakentamista. Työssä luotiin modulaarinen malli, jolla voidaan simuloida dynaamisesti esteen yliajo. Esteen yliajo on perinteinen tehdastesti uusien laitteiden prototyypeille. Sillä pyritään saamaan selville laitteen maksimikuormitustapaukset. Pintaporalaitteen simulointimalli tehtiin ADAMS-ohjelmistolla laitteen suunnittelussa tehtyjä CAD-malleja hyödyntäen. ADAMS-ohjelmistolla mallinnettiin laitteen yksinkertaistettu mekaniikka siten, että laite oli jaettu viiteen eri moduuliin. Runko ja telasto olivat omana osionaan. Puomi ja syöttölaite oli oma kokoonpanonsa ja ohjaamo sekä katteet olivat kaksi erillistä modulia. Viides moduuli oli hydrauliikka, joka simuloitiin rinnakkaissimulointina EASY5-ohjelmistolla. Simuloituja esteen yliajon tuloksia verrattiin prototyyppilaitteen tehdastestien mitattuihin kuormituksiin. Vertailu tehtiin mallinnettujen neljän sylinterin paineita tarkastelemalla. Tuloksia tarkastellessa havaittiin, että simulaatiomalli antaa varsinkin staattisissa tarkasteluissa oikean suuntaisia tuloksia. Dynaamisissa tilanteissa koneen maksimikuormituksilla mallinnustarkkuus ei tämän työn laajuudessa ole riittävä varsinaiseen eliniän analysointiin. Sen sijaan mallinnustekniikka todettiin periaatteessa toimivaksi ja jatkokehityskelpoiseksi.