Regulatory governance of ‘training markets’, ‘market failure’, and ‘quasi’ markets: historical dimensions of the post-initial training market in the Netherlands

This article examines regulatory governance of the post-initial training market in The Netherlands. From an historical perspective on policy formation processes, it examines market formation in terms of social, economic, and cultural factors in the development of provision and demand for post-initial training; the roles of stakeholders in the longterm construction of regulatory governance of the market; regulation of and public providers; policy responses to market failure; and tripartite division of responsibilities between the state, social partners, commercial and publicly-funded providers. Historical description and analysis examine policy narratives of key stakeholders with reference to: a) influence of societal stakeholders on regulatory decision-making; b) state regulation of the post-initial training market; c) public intervention regulating the market to prevent market failure; d) market deregulation, competition, employability and individual responsibility; and, e) regulatory governance to prevent ‘allocative failure’ by the market in non-delivery of post-initial training to specific target groups, particularly the low-qualified. Dominant policy narratives have resulted in limited state regulation of the supply-side, a tripartite system of regulatory governance by the state, social partners and commercial providers as regulatory actors. Current policy discourses address interventions on the demand-side to redistribute structures of opportunity throughout the life courses of individuals. Further empirical research from a comparative historical perspective is required to deepen contemporary understandings of regulatory governance of markets and the commodification of adult learning in knowledge societies and information economies. (DIPF/Orig.)

Custos da gestão da qualidade na manutenção e sustentação dos Sistemas de Armas da Força Aérea

Atualmente, as organizações tendem a desenvolverem-se com o objetivo de se tornarem mais eficazes e eficientes. Neste contexto, esta investigação visa propor um modelo que permita calcular os Custos da Qualidade (CQ) na manutenção e sustentação dos Sistemas de Armas da Força Aérea (FA), contribuindo para a melhoria contínua do Sistema de Gestão da Qualidade e Aeronavegabilidade (SGQA). Assim, neste estudo é avaliada a utilização do modelo “Prevenção, Avaliação e Falhas” (PAF) para o cálculo dos CQ no SGQA, a forma como os Sistemas de Informação (SI) podem contribuir para este cálculo e qual a estrutura do sistema que deverá integrar e operacionalizar este modelo. Esta investigação desenvolve-se mediante um raciocínio hipotético-dedutivo, utilizando uma estratégia qualitativa aplicada num estudo de caso ao SA Epsilon Tb-30. Após apresentar um enquadramento teórico, são testadas as hipóteses identificadas através de análise documental e entrevistas a elementos com funções-chave neste âmbito. Verifica-se então a possibilidade de utilizar o modelo PAF para o cálculo dos CQ no SGQA. Contudo, é necessário adaptar os SI e os processos do sistema para a sua operacionalização. Finalmente, é proposto um plano para implementação do modelo de CQ, assim como são apresentadas algumas recomendações para o seu desenvolvimento. Abstract: Nowadays, the organizations tend to self-develop in order to increase their efficiency and effectiveness. In this context, this study has the purpose to propose a Quality Cost (CQ) model within the scope of maintenance and sustainability of Portuguese Air Force (FA) weapon systems, contributing to the continuous improvement of its Airworthiness and Quality Management System (SGQA). Therefore, throughout this study is evaluated the implementation of Prevention, Appraisal and Failure (PAF) model for CQ calculation, how the Information Systems (SI) can contribute for this calculus and what SGQA structure should integrate and operationalize this model. In this investigation is used a hypothetical-deductive reasoning, through a qualitative strategy applied to a case study in Epsilon TB-30 aircraft. After presenting an initial theoretical study, the raised hypotheses are tested through the relevant document analysis and interviews with elements in key functions within this scope. With this study it’s shown the possibility to use PAF model to calculate CQ of the SGQA. However, it’s necessary to adapt the SI and the system processes to get the operationalization of this model. Finally, an implementation plan of the evaluated CQ model is proposed, and some recommendations are made for its future development.

Usefulness of the Hepatocyte Growth Factor as a Predictor of Mortality in Patients Hospitalized With Acute Heart Failure Regardless of Ejection Fraction

Hepatocyte growth factor (HGF) plays a role in the improvement of cardiac function and remodeling. Their serum levels are strongly related with mortality in chronic systolic heart failure (HF). The aim of this study was to study prognostic value of HGF in acute HF, interaction with ejection fraction, renal function, and natriuretic peptides. We included 373 patients (age 76 ± 10 years, left ventricular ejection fraction [LVEF] 46 ± 14%, 48% men) consecutively admitted for acute HF. Blood samples were obtained at admission. All patients were followed up until death or close of study (>1 year, median 371 days). HGF concentrations were determined using a commercial enzyme-linked immunosorbent assay (human HGF immunoassay). The predictive power of HGF was estimated by Cox regression with calculation of Harrell C-statistic. HGF had a median of 1,942 pg/ml (interquartile rank 1,354). According to HGF quartiles, mortality rates (per 1,000 patients/year) were 98, 183, 375, and 393, respectively (p <0.001). In Cox regression analysis, HGF (hazard ratio1SD = 1.5, 95% confidence interval 1.1 to 2.1, p = 0.002) and N-terminal pro b-type natriuretic peptide (NT-proBNP; hazard ratio1SD = 1.8, 95% confidence interval 1.2 to 2.6, p = 0.002) were independent predictors of mortality. Interaction between HGF and LVEF, origin, and renal function was nonsignificant. The addition of HGF improved the predictive ability of the models (C-statistic 0.768 vs 0.741, p = 0.016). HGF showed a complementary value over NT-proBNP (p = 0.001): mortality rate was 490 with both above the median versus 72 with both below. In conclusion, in patients with acute HF, serum HGF concentrations are elevated and identify patients at higher risk of mortality, regardless of LVEF, ischemic origin, or renal function. HGF had independent and additive information over NT-proBNP.

‘Failure to maintain’: care rationing and the clinical and financial burden of nurse sensitive hospital-acquired complications in complex older patients

Background: The ageing population, with concomitant increase in chronic conditions, is increasing the presence of older people with complex needs in hospital. People with dementia are one of these complex populations and are particularly vulnerable to complications in hospital. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications through their skilled brokerage between patient needs and hospital functions. A range of patient outcome measures that are sensitive to nursing care has been tested in nursing work environments across the world. However, none of these measures have focused on hospitalised older patients. Method: This thesis explores nursing-sensitive complications for older patients with and without dementia using an internationally recognised, risk-adjusted patient outcome approach. Specifically explored are: the differences between rates of complications; the costs of complications; and cost comparisons of patient complexity. A retrospective cohort study of an Australian state’s 2006–07 public hospital discharge data was utilised to identify patient episodes for people over age 50 (N=222,440) where dementia was identified as a primary or secondary diagnosis (N=44,422). Extra costs for patient episodes were estimated based on length of stay (LOS) above the average for each patient’s Diagnosis Related Group (DRG) (N=157,178) and were modelled using linear regression analysis to establish the strongest patient complexity predictors of cost. Results: Hospitalised patients with a primary or secondary diagnosis of dementia had higher rates of complications than did their same-age peers. The highest rates and relative risk for people with dementia were found in four key complications: urinary tract infections; pressure injuries; pneumonia, and delirium. While 21.9% of dementia patients (9,751/44,488, p<0.0001) suffered a complication, only 8.8% of non-dementia patients did so (33,501/381,788, p<0.0001), giving dementia patients a 2.5 relative risk of acquiring a complication (p<0.0001). These four key complications in patients over 50 both with and without dementia were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and double the increased estimated mean episode cost (199%, or A$16,403/ A$8,240). These four complications were associated with 24.7% of the estimated cost of additional days spent in hospital in 2006–07 in NSW (A$226million/A$914million). Dementia patients accounted for 22.0% of these costs (A$49million/A$226million) even though they were only 10.4% of the population (44,488/426,276 episodes). Hospital-acquired complications, particularly for people with a comorbidity of dementia, cost more than other kinds of inpatient complexity but admission severity was a better predictor of excess cost. Discussion: Four key complications occur more often in older patients with dementia and the high rate of these complications makes them expensive. These complications are potentially preventable. However, the care that can prevent them (such as mobility, hydration, nutrition and communication) is known to be rationed or left unfinished by nurses. Older hospitalised people who have complex needs, such as those with dementia, are more likely to experience care rationing as their care tends to take longer, be less predictable and less curative in nature. This thesis offers the theoretical proposition that evidence-based nursing practices are rationed for complex older patients and that this rationed care contributes to functional and cognitive decline during hospitalisation. This, in turn, contributes to the high rates of complications observed. Thus four key complications can be seen as a ‘Failure to Maintain’ complex older people in hospital. ‘Failure to Maintain’ is the inadequate delivery of essential functional and cognitive care for a complex older person in hospital resulting in a complication, and is recommended as a useful indicator for hospital quality. Conclusions: When examining extra length of stay in hospital, complications and comorbid dementia are costly. Complications are potentially preventable, and dementia care in hospitals can be improved. Hospitals and governments looking to decrease costs can engage in risk-reduction strategies for common nurse sensitive complications such as healthy nursing work environments that minimise nurses’ rationing of functional and cognitive care. The conceptualisation of complex older patients as ‘business as usual’ rather than a ‘burden’ is likely necessary for sustainable health care services of the future. The use of the ‘Failure to Maintain’ indicators at institution and state levels may aid in embedding this approach for complex older patients into health organisations. Ongoing investigation is warranted into the relationships between the largest health services expense (hospitals), the largest hospital population (complex older patients), and the largest hospital expense (nurses). The ‘Failure to Maintain’ quality indicator makes a useful and substantive contribution to further clinical, administrative and research developments.

SLOPE STABILITY ANALYSIS OF MOUNT MEAGER, SOUTH-WESTERN BRITISH COLUMBIA, CANADA

The Mount Meager Volcanic Complex (MMVC) in south-western British Columbia is a potentially active, hydrothermally altered massif comprising a series of steep, glaciated peaks. Climatic conditions and glacial retreat has led to the further weathering, exposure and de-buttressing of steep slopes composed of weak, unconsolidated material. This has resulted in an increased frequency of landslide events over the past few decades, many of which have dammed the rivers bordering the Complex. The breach of these debris dams presents a risk of flooding to the downstream communities. Preliminary mapping showed there are numerous sites around the Complex where future failure could occur. Some of these areas are currently undergoing progressive slope movement and display features to support this such as anti-scarps and tension cracks. The effect of water infiltration on stability was modelled using the Rocscience program Slide 6.0. The main site of focus was Mount Meager in the south- east of the Complex where the most recent landslide took place. Two profiles through Mount Meager were analysed along with one other location in the northern section of the MMVC, where instability had been detected. The lowest Factor of Safety (FOS) for each profile was displayed and an estimate of the volume which could be generated was deduced. A hazard map showing the inundation zones for various volumes of debris flows was created from simulations using LAHARZ. Results showed the massif is unstable, even before infiltration. Varying the amount of infiltration appears to have no significant impact on the FOS annually implying that small changes of any kind could also trigger failure. Further modelling could be done to assess the impact of infiltration over shorter time scales. The Slide models show the volume of material that could be delivered to the Lillooet River Valley to be of the order of 109 m3 which, based on the LAHARZ simulations, would completely inundate the valley and communities downstream. A major hazard of this is that the removal of such a large amount of material has the potential to trigger an explosive eruption of the geothermal system and renew volcanic activity. Although events of this size are infrequent, there is a significant risk to the communities downstream of the complex.

INVESTIGATIVE COMPARISON OF TANK AND RECOVERED ASPHALT SAMPLES THROUGH PHYSICAL PERFORMANCE TESTING AND CHEMICAL ANALYSIS

Despite the development of improved performance test protocols by renowned researchers, there are still road networks which experience premature cracking and failure. One area of major concern in asphalt science and technology, especially in cold regions in Canada is thermal (low temperature) cracking. Usually right after winter periods, severe cracks are seen on poorly designed road networks. Quality assurance tests based on improved asphalt performance protocols have been implemented by government agencies to ensure that roads being constructed are at the required standard but asphalt binders that pass these quality assurance tests still crack prematurely. While it would be easy to question the competence of the quality assurance test protocols, it should be noted that performance tests which are being used and were repeated in this study, namely the extended bending beam rheometer (EBBR) test, double edge-notched tension test (DENT), dynamic shear rheometer (DSR) test and X-ray fluorescence (XRF) analysis have all been verified and proven to successfully predict asphalt pavement behaviour in the field. Hence this study looked to probe and test the quality and authenticity of the asphalt binders being used for road paving. This study covered thermal cracking and physical hardening phenomenon by comparing results from testing asphalt binder samples obtained from the storage ‘tank’ prior to paving (tank samples) and recovered samples for the same contracts with aim of explaining why asphalt binders that have passed quality assurance tests are still prone to fail prematurely. The study also attempted to find out if the short testing time and automated procedure of torsion bar experiments can replace the established but tedious procedure of the EBBR. In the end, it was discovered that significant differences in performance and composition exist between tank and recovered samples for the same contracts. Torsion bar experimental data also indicated some promise in predicting physical hardening.

Initiation and early crack growth in VHCF of stainless steels : Experimental and theoretical analysis

Mechanical fatigue is a failure phenomenon that occurs due to repeated application of mechanical loads. Very High Cycle Fatigue (VHCF) is considered as the domain of fatigue life greater than 10 million load cycles. Increasing numbers of structural components have service life in the VHCF regime, for instance in automotive and high speed train transportation, gas turbine disks, and components of paper production machinery. Safe and reliable operation of these components depends on the knowledge of their VHCF properties. In this thesis both experimental tools and theoretical modelling were utilized to develop better understanding of the VHCF phenomena. In the experimental part, ultrasonic fatigue testing at 20 kHz of cold rolled and hot rolled stainless steel grades was conducted and fatigue strengths in the VHCF regime were obtained. The mechanisms for fatigue crack initiation and short crack growth were investigated using electron microscopes. For the cold rolled stainless steels crack initiation and early growth occurred through the formation of the Fine Granular Area (FGA) observed on the fracture surface and in TEM observations of cross-sections. The crack growth in the FGA seems to control more than 90% of the total fatigue life. For the hot rolled duplex stainless steels fatigue crack initiation occurred due to accumulation of plastic fatigue damage at the external surface, and early crack growth proceeded through a crystallographic growth mechanism. Theoretical modelling of complex cracks involving kinks and branches in an elastic half-plane under static loading was carried out by using the Distributed Dislocation Dipole Technique (DDDT). The technique was implemented for 2D crack problems. Both fully open and partially closed crack cases were analyzed. The main aim of the development of the DDDT was to compute the stress intensity factors. Accuracy of 2% in the computations was attainable compared to the solutions obtained by the Finite Element Method.

An Analysis of the Early Prediction of Highway Construction Project Completion using the Contract Status Report

History has shown that projects move in and out of poor status through the life of the project. Predicting the success or failure of a project to complete on time because of its recent history on the contract status report could provide our project managers another tool for monitoring contract progress. In many instances, poor contract progress results in the loss of contract time and late completion of projects. This research evaluates the combinations of work type, point in time physical work begins, recent poor status, and contract bid amount as indicators of late project completion.

Prediction Nomogram for 68Ga-PSMA-11 PET/CT in different clinical settings of PSA failure after radical treatment for Prostate Cancer

Objective The objective of this study was to develop a clinical nomogram to predict gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA-11-PET/CT) positivity in different clinical settings of PSA failure. Materials and methods Seven hundred three (n = 703) prostate cancer (PCa) patients with confirmed PSA failure after radical therapy were enrolled. Patients were stratified according to different clinical settings (first-time biochemical recurrence [BCR]: group 1; BCR after salvage therapy: group 2; biochemical persistence after radical prostatectomy [BCP]: group 3; advanced stage PCa before second-line systemic therapies: group 4). First, we assessed 68Ga-PSMA-11-PET/CT positivity rate. Second, multivariable logistic regression analyses were used to determine predictors of positive scan. Third, regression-based coefficients were used to develop a nomogram predicting positive 68Ga-PSMA-11-PET/CT result and 200 bootstrap resamples were used for internal validation. Fourth, receiver operating characteristic (ROC) analysis was used to identify the most informative nomogram’s derived cut-off. Decision curve analysis (DCA) was implemented to quantify nomogram’s clinical benefit. Results 68Ga-PSMA-11-PET/CT overall positivity rate was 51.2%, while it was 40.3% in group 1, 54% in group 2, 60.5% in group 3, and 86.9% in group 4 (p < 0.001). At multivariable analyses, ISUP grade, PSA, PSA doubling time, and clinical setting were independent predictors of a positive scan (all p ≤ 0.04). A nomogram based on covariates included in the multivariate model demonstrated a bootstrap-corrected accuracy of 82%. The nomogram-derived best cut-off value was 40%. In DCA, the nomogram revealed clinical net benefit of > 10%. Conclusions This novel nomogram proved its good accuracy in predicting a positive scan, with values ≥ 40% providing the most informative cut-off in counselling patients to 68Ga-PSMA-11-PET/CT. This tool might be important as a guide to clinicians in the best use of PSMA-based PET imaging.

Analysis and detection of partial discharges in an electric motor of a hybrid supercar.

The objective of this thesis was the development of a new detection method of partial discharge (PD) activity in the stator of an electrical hybrid supercar fed by a silicon carbide converter, for which detection with common methods make it very difficult to separate PD pulses from switching noise. This work focused on the analysis and detection of partial discharges making use of an antenna, a peak detector, and an oscilloscope capable of capturing the electromagnetic pulses emitted during PD activity. Validation of the proposed method was done by comparing the partial discharge inception voltage (PDIV) detected by this system with the one obtained from an optical method of proven accuracy, with different rise times and samples. Further development of this method, if proved successful on a full stator, can help increasing the overall reliability of the car, potentially allowing for real time detection of PD activity and predictive maintenance before failure of the insulation system in a hybrid vehicle.

Enhancing the reliability of electric transportation motors through insulation coordination and improved qualification

The ambitious goals of increasing the efficiency, performance and power densities of transportation drives cannot be met with compromises in the motor reliability. For the insulation specialists the challenge will be critical as the use of wide-bandgap converters (WBG, based on SiC and GaN switches) and the higher operating voltages expected for the next generation drives will enhance the electrical stresses to unprecedented levels. It is expected for the DC bus in aircrafts to reach 800 V (split +/-400 V) and beyond, driven by the urban air mobility sector and the need for electrification of electro-mechanical/electro-hydraulic actuators (an essential part of the "More Electric Aircraft" concept). Simultaneously the DC bus in electric vehicles (EV) traction motors is anticipated to increase up to 1200 V very soon. The electrical insulation system is one of the most delicate part of the machine in terms of failure probability. In particular, the appearance of partial discharges (PD) is disruptive on the reliability of the drive, especially under fast repetitive transients. Extensive experimental activity has been performed to extend the body of knowledge on PD inception, endurance under PD activity, and explore and identify new phenomena undermining the reliability. The focus has been concentrated on the impact of the WGB-converter produced waveforms and the environmental conditions typical of the aeronautical sector on insulation models. Particular effort was put in the analysis at the reduced pressures typical of aircraft cruise altitude operation. The results obtained, after a critical discussion, have been used to suggest a coordination between the insulation PD inception voltage with the converter stresses and to propose an improved qualification procedure based on the existing IEC 60034-18-41 standard.

Vibro-acoustic analysis of additively manufactured acoustic metamaterials

In the last decade it emerged the interest in new types of acoustic insulating materials, called acoustic metamaterials. These materials are composed by a host and inclusions and are arranged periodically or non-periodically in sub-wavelength elements called meta-atoms. Their inclusions and internal geometries can be manipulated to tailor the acoustic properties, reducing weight, and increasing at the same time their efficiency. Thanks to the high absorbing characteristics that they can achieve, their usage is of particularly interest as material of the core in sandwich panels of aerospace structures to reduce vibrations and noise inside passengers aircraft’s cabin. In addition, since the low frequency signals are difficult to be damped with conventional materials, their usage can guarantee a high transmission loss at low frequencies, obtaining a positive benefit on passengers’ comfort. The performances and efficiency of these materials are enhanced thanks to the new additive manufacturing techniques opposed to the conventional ones uncapable to pro- duce such complex internal geometries. The aim of this work is to study, produce and redesign micro-perforated sandwich panels of a literature case study to achieve high performances in the low frequency range, e.g., below 2000 Hz. Some geometrical parameters, such as perforation ratio and diameter of holes, were considered to realize different models and see the differences in the sound transmission loss. The models were produced by means of Fused Deposition Modelling using an Acrylonitrile Butadiene Styrene (ABS Plus p430) material on a commercial additive manufacturing system. Finally, the frequency response analysis was carried out with Mul2 software, based on the Carrera’s Unified Formulation (CUF) to understand the acoustic and structural properties of the material employed, analyzing the plates’ displacements and the TL results.

Quantitative analysis of pre- and post-operative valvular annulus deformations following valvular insufficiency

Valvular insufficiency is a growingly common valvular heart disease that frequently is associated with regurgitation. Atrioventricular incompetency can lead to overall ventricular and atrial enlargement, volume overload, heart impairment and, if not treated, can culminate in heart failure. With the advances in technology and the increasing interest in devices that have lower post-operative burden on patients, transcatheter mitral and tricuspid valve repair systems are going through a phase of rapid development and growing use. In this work, we aimed to quantitatively assess the morphology of mitral and tricuspid annuli in patients who underwent transcatheter valve repair with MitraClip/TriClip, before and after the intervention, using three-dimensional transoesophageal echocardiography images, in order to evaluate the geometrical changes of the annulus following the intervention. For our purposes, firstly, we implemented a tool for the visualization and navigation of the volumetric data across the cardiac cycle. Then, in order to track the annulus over the cardiac cycle, we extracted five rotational slices from the volume data, selected two initial points on each slice, and tracked these points across the cardiac cycle using KLT algorithm. In a first stage we led a parameters optimization for the tracking method, and we studied the sensitivity of the KLT algorithm to the initialization points, that are manually chosen by the user. In a second stage, we analysed 10 subjects (5 for mitral regurgitation and 5 for tricuspid regurgitation), tracking their annulus before and after valve repairment. In conclusion, we found in all our 10 subjects that immediately after the intervention there is a shortening of the major diameters of the valves, mainly the shortest diameter, due to the clip application, that leads to a reduction of the perimeter and the area of the annulus.

Modeling, simulation, and control of a formation of multirotor aircraft for cooperative transportation of suspended loads

The work presented in this thesis aims to contribute to innovation in the Urban Air Mobility and Delivery sector and represents a solid starting point for air logistics and its future scenarios. The dissertation focuses on modeling, simulation, and control of a formation of multirotor aircraft for cooperative load transportation, with particular attention to environmental sustainability. First, a simulation and test environment is developed to assess technologies for suspended load stabilization. Starting from the mathematical model of two identical multirotors, formation-flight-keeping and collision-avoidance algorithms are analyzed. This approach guarantees both the safety of the vehicles within the formation and that of the payload, which may be made of people in the very near future. Afterwards, a mathematical model for the suspended load is implemented, as well as an active controller for its stabilization. The key focus of this part is represented by both analysis and control of payload oscillatory motion, by thoroughly investigating load kinetic energy decay. At this point, several test cases were introduced, in order to understand which strategy is the most effective and safe in terms of future applications in the field of air logistics.

Experimental analysis of the aerodynamic and mixing performance of a ventilation device

Numerous types of acute respiratory failure are routinely treated using non-invasive ventilatory support (NIV). Its efficacy is well documented: NIV lowers intubation and death rates in various respiratory disorders. It can be delivered by means of face masks or head helmets. Currently the scientific community’s interest about NIV helmets is mostly focused on optimising the mixing between CO2 and clean air and on improving patient comfort. To this end, fluid dynamic analysis plays a particularly important role and a two- pronged approach is frequently employed. While on one hand numerical simulations provide information about the entire flow field and different geometries, they exhibit require huge temporal and computational resources. Experiments on the other hand help to validate simulations and provide results with a much smaller time investment and thus remain at the core of research in fluid dynamics. The aim of this thesis work was to develop a flow bench and to utilise it for the analysis of NIV helmets. A flow test bench and an instrumented mannequin were successfully designed, produced and put into use. Experiments were performed to characterise the helmet interface in terms of pressure drop and flow rate drop over different inlet flow rates and outlet pressure set points. Velocity measurements by means of Particle Image Velocimetry were performed. Pressure drop and flow rate characteristics from experiments were contrasted with CFD data and sufficient agreement was observed between both numerical and experimental results. PIV studies permitted qualitative and quantitative comparisons with numerical simulation data and offered a clear picture of the internal flow behaviour, aiding the identification of coherent flow features.