Palvelusetelien prosessit ja hallinnolliset kustannukset Helsingin kaupungin sosiaali- ja terveysvirastossa

Diplomityö käsittelee Helsingin sosiaali- ja terveysviraston palvelusetelitoimintaa eräänä ostopalvelun järjestämistapana. Vakinaistettuja palveluseteleitä on kaksi-toista, joista työhön on valittu viisi kustannuksiltaan ja lukumääriltään suurinta palveluseteliä. Tutkimuksessa mallinnetaan kahden keskenään erilaisimman palve-lusetelin prosessikuvaukset, vanhusten palveluasumisen (sosh) ja suun terveyden-huollon (tervh) palveluseteleille ja kuvataan niiden hallinnolliset työvaiheet ja toi-minnot. Empiirinen aineisto koostuu aiemmin kerätystä hallinnollisen työajan da-tasta, jonka avulla eri toimintoihin sitoutuneiden hallinnollisten kustannuksien las-kenta on suoritettu hyödyntäen aikaperusteista toimintolaskentaa. Aikaperusteisen toimintolaskennan avulla saadaan esille kirjanpidon ulkopuolelle jääviä piileviä prosessikustannuksia. Lisäksi diplomityössä tehdään edullisuusvertailua oman vas-taavan palvelutoiminnan ja palvelusetelien välillä. Terveydenhuollon palvelusetelien hallinnolliset prosessit osoittautuvat hallinnolli-sesti ja kustannuksien osalta kuormittavammaksi kuin sosiaalihuollon vastaavat prosessit. Terveydenhuollon palveluseteliprosessit ovat luonteeltaan monivaihei-sempia, ne ovat toimenpiteellisiä ja kertaluonteisia, joka lisää asiakasvolyymia ja tiedon välittämisen tarvetta sosiaali- ja terveysviraston ja palveluntuottajan välillä. Hallinnollinen kustannuslisä on vuoden 2013 palvelusetelitoiminnan volyymeillä suun terveydenhuollossa +24%, kolonoskopiassa +9%, ikäihmisten päivätoimin-nassa +8%, vammaisten henkilökohtaisessa avussa +5% ja vanhusten palveluasu-misessa +1%. Hallinnollisten kustannusten esiin tuomiseksi tulee terveydenhuollon palvelusetelien kirjanpidon kustannuksissa käyttää kerrointa 1,167 ja sosiaalihuol-lon palvelusetelien kustannuksissa kerrointa 1,046. Edullisuusvertailussa suun terveydenhuollon ja kolonoskopian palvelusetelit osoittautuvat omaa toimintaa kalliimmiksi, vanhusten palveluasuminen, ikäihmisten päivätoiminta ja vammais-ten henkilökohtainen apu on edullisempaa tuottaa palvelusetelillä. Palveluseteli-toiminnan kustannushyöty ei ole ainoa tekijä toimintaa suunnitelleessa. Hoitota-kuuseen vastaaminen, asiakasorientaation ja vapaavalintaisuuden lisääntyminen, sekä palvelun sujuvuus vaikuttavat myös palvelusetelitoiminnan kehittämisessä.

Distribution of biglycan and decorin in rat dental tissue

Biglycan and decorin are small leucine-rich proteoglycans that play several biological and structural roles in different tissues and organs. Several reports have indicated that biglycan participates in odontoblast and ameloblast differentiation and in the calcification process. In the present study we show that the expression of biglycan changes from within the ameloblasts and odontoblasts to the extracellular space according to the stage of animal development. In predentin and in the pulp space, however, biglycan was continually expressed throughout the period of investigation. In contrast, decorin was absent in odontoblasts and in ameloblasts and was exclusively expressed in predentin throughout the period of observation. In young rats, however, decorin was expressed in the extracellular spaces of the pulp, where it was concentrated mainly in the peripheral pulp.

Dental fear in adolescents' transition to early adulthood

The aims of the study were to assess the validity of a clinical dental fear question (Short Dental Fear Question, SDFQ) and an instrument measuring interaction between adolescents and dental staff (Patient Dental Staff Interaction Questionnaire, PDSIQ). Also, adolescents’ subjective perception of interaction with dental staff, the association with adolescents’ dental fear and sense of coherence as well as a multi-professional small-group intervention model for decreasing high dental fear were assessed. The study sample comprised Finnish adolescents in transition to early adulthood, aged 18–26 years (n = 777, n = 773, n = 5), except for a sample of 15-year-old adolescents (n = 27). Dental fear, sense of coherence (SOC) and the adolescents’ perceived interaction with dental staff were assessed with questionnaires. The principles of fear treatment such as gradual exposure, relaxation, encouragement and cornerstones of the reteaming method based on a solution-focused framework to maintain motivation and peer support were used to decrease fear in the intervention study. The SDFQ was found to be a valid dental fear instrument and the PDSIQ a valid interaction instrument with five factors of interaction retrieved: ‘kind atmosphere and mutual communication’, ‘roughness’, ‘insecurity’, ‘trust and safety’, and ‘shame and guilt’. Highly fearful young adults more often perceived their interaction with dental staff as negative, more often felt insecure and had a weaker sense of coherence compared to their peers with no to moderate dental fear. The results of the intervention study showed that young adults’ high dental fear decreased and their commitment to dental treatment increased. The SDFQ is clinically feasible and informative instrument in measuring dental fear. Knowledge of the level of fear enables dental staff to better consider an adolescent’s fear. Dental staff should be aware that a supportive interaction style, creating trust and safety, is especially beneficial for highly dentally fearful young adults. A weak SOC may affect young adults’ high dental fear in that they would not have enough tools to manage their fear. A multi-professional small therapeutic group seems to increase fearful young adults’ resources for confronting dental treatment.

Inductance Calculation of Tooth-Coil Permanent-Magnet Synchronous Machines

Analytical calculation methods for all the major components of the synchronous inductance of tooth-coil permanentmagnet synchronous machines are reevaluated in this paper. The inductance estimation is different in the tooth-coil machine compared with the one in the traditional rotating field winding machine. The accuracy of the analytical torque calculation highly depends on the estimated synchronous inductance. Despite powerful finite element method (FEM) tools, an accurate and fast analytical method is required at an early design stage to find an initialmachine design structure with the desired performance. The results of the analytical inductance calculation are verified and assessed in terms of accuracy with the FEM simulation results and with the prototype measurement results.

Hysteresis Losses in Sintered NdFeB Permanent Magnets in Rotating Electrical Machines

Permanent magnet materials are nowadays widely used in the electrical machine manufacturing industry. Eddy current loss models of permanent magnets used in electrical machines are frequently discussed in research papers. In magnetic steel materials we have, in addition to eddy current losses, hysteresis losses when AC or a rotating flux travels through the material. Should a similar phenomenon also be taken into account in calculating the losses of permanent magnets? Actually, every now and then authors seem to assume that some significant hysteresis losses are present in rotating machine PMs. This paper studies the mechanisms of possible hysteresis losses in PMs and their role in PMs when used in rotating electrical machines.

Unequal Teeth Widths for Torque Ripple Reduction in Permanent Magnet Synchronous Machines With Fractional-Slot Non-Overlapping Windings

Permanent magnet synchronous machines with fractional-slot non-overlapping windings (FSPMSM), also known as tooth-coil winding permanent magnet synchronous machines (TCW PMSM), have been under intensive research during the latest decade. There are many optimization routines explained and implemented in the literature in order to improve the characteristics of this machine type. This paper introduces a new technique for torque ripple minimization in TCW PMSM. The source of torque harmonics is also described. The low order torque harmonics can be harmful for a variety of applications, such as direct drive wind generators, direct drive light vehicle electrical motors, and for some high precision servo applications. The reduction of the torque ripple harmonics with the lowest orders (6th and 12th) is realized by machine geometry optimization technique using finite element analysis (FEA). The presented optimization technique includes the stator geometry adjustment in TCW PMSMs with rotor surface permanent magnets and with rotor embedded permanent magnets. Influence of the permanent magnet skewing on the torque ripple reduction and cogging torque elimination was also investigated. It was implemented separately and together with the stator optimization technique. As a result, the reduction of some torque ripple harmonics was attained.

Direct-Driven Interior Magnet Permanent Magnet Synchronous Motors for a Full Electric Sports Car

The design process of direct-driven permanent magnet synchronous machines (PMSMs) for a full electric 4 ´ 4 sports car is presented. The rotor structure of the machine consists of two permanent magnet layers embedded inside the rotor laminations thus resulting in some inverse saliency, where the q-axis inductance is larger than the d-axis one. An integer slot stator winding was selected to fully take advantage of the additional reluctance torque. The performance characteristics of the designed PMSMs were calculated by applying a twodimensional finite element method. Cross-saturation between the d- and q-axes was taken into account in the calculation of the synchronous inductances. The calculation results are validated by measurements.

Design and Drive-Cycle Based Analysis of Direct-Driven Permanent Magnet Synchronous Machine for a Small Urban Use Electric Vehicle

A direct-driven permanent magnet synchronous machine for a small urban use electric vehicle is presented. The measured performance of the machine at the test bench as well as the performance over the modified New European Drive Cycle will be given. The effect of optimal current components, maximizing the efficiency and taking into account the iron loss, is compared with the simple id=0 – control. The machine currents and losses during the drive cycle are calculated and compared with each other.

Analytic evaluation of three-phase short circuit demagnetization and hysteresis loss risk in rotor-surface-magnet Permanent-Magnet Synchronous Machines

Permanent magnet synchronous machines (PMSM) have become widely used in applications because of high efficiency compared to synchronous machines with exciting winding or to induction motors. This feature of PMSM is achieved through the using the permanent magnets (PM) as the main excitation source. The magnetic properties of the PM have significant influence on all the PMSM characteristics. Recent observations of the PM material properties when used in rotating machines revealed that in all PMSMs the magnets do not necessarily operate in the second quadrant of the demagnetization curve which makes the magnets prone to hysteresis losses. Moreover, still no good analytical approach has not been derived for the magnetic flux density distribution along the PM during the different short circuits faults. The main task of this thesis is to derive simple analytical tool which can predict magnetic flux density distribution along the rotor-surface mounted PM in two cases: during normal operating mode and in the worst moment of time from the PM’s point of view of the three phase symmetrical short circuit. The surface mounted PMSMs were selected because of their prevalence and relatively simple construction. The proposed model is based on the combination of two theories: the theory of the magnetic circuit and space vector theory. The comparison of the results in case of the normal operating mode obtained from finite element software with the results calculated with the proposed model shows good accuracy of model in the parts of the PM which are most of all prone to hysteresis losses. The comparison of the results for three phase symmetrical short circuit revealed significant inaccuracy of the proposed model compared with results from finite element software. The analysis of the inaccuracy reasons was provided. The impact on the model of the Carter factor theory and assumption that air have permeability of the PM were analyzed. The propositions for the further model development are presented.

Cost Reduction of Permanent Magnet Synchronous Machines

Electrical machine drives are the most electrical energy-consuming systems worldwide. The largest proportion of drives is found in industrial applications. There are, however many other applications that are also based on the use of electrical machines, because they have a relatively high efficiency, a low noise level, and do not produce local pollution. Electrical machines can be classified into several categories. One of the most commonly used electrical machine types (especially in the industry) is induction motors, also known as asynchronous machines. They have a mature production process and a robust rotor construction. However, in the world pursuing higher energy efficiency with reasonable investments not every application receives the advantage of using this type of motor drives. The main drawback of induction motors is the fact that they need slipcaused and thus loss-generating current in the rotor, and additional stator current for magnetic field production along with the torque-producing current. This can reduce the electric motor drive efficiency, especially in low-speed, low-power applications. Often, when high torque density is required together with low losses, it is desirable to apply permanent magnet technology, because in this case there is no need to use current to produce the basic excitation of the machine. This promotes the effectiveness of copper use in the stator, and further, there is no rotor current in these machines. Again, if permanent magnets with a high remanent flux density are used, the air gap flux density can be higher than in conventional induction motors. These advantages have raised the popularity of PMSMs in some challenging applications, such as hybrid electric vehicles (HEV), wind turbines, and home appliances. Usually, a correctly designed PMSM has a higher efficiency and consequently lower losses than its induction machine counterparts. Therefore, the use of these electrical machines reduces the energy consumption of the whole system to some extent, which can provide good motivation to apply permanent magnet technology to electrical machines. However, the cost of high performance rare earth permanent magnets in these machines may not be affordable in many industrial applications, because the tight competition between the manufacturers dictates the rules of low-cost and highly robust solutions, where asynchronous machines seem to be more feasible at the moment. Two main electromagnetic components of an electrical machine are the stator and the rotor. In the case of a conventional radial flux PMSM, the stator contains magnetic circuit lamination and stator winding, and the rotor consists of rotor steel (laminated or solid) and permanent magnets. The lamination itself does not significantly influence the total cost of the machine, even though it can considerably increase the construction complexity, as it requires a special assembly arrangement. However, thin metal sheet processing methods are very effective and economically feasible. Therefore, the cost of the machine is mainly affected by the stator winding and the permanent magnets. The work proposed in this doctoral dissertation comprises a description and analysis of two approaches of PMSM cost reduction: one on the rotor side and the other on the stator side. The first approach on the rotor side includes the use of low-cost and abundant ferrite magnets together with a tooth-coil winding topology and an outer rotor construction. The second approach on the stator side exploits the use of a modular stator structure instead of a monolithic one. PMSMs with the proposed structures were thoroughly analysed by finite element method based tools (FEM). It was found out that by implementing the described principles, some favourable characteristics of the machine (mainly concerning the machine size) will inevitable be compromised. However, the main target of the proposed approaches is not to compete with conventional rare earth PMSMs, but to reduce the price at which they can be implemented in industrial applications, keeping their dimensions at the same level or lower than those of a typical electrical machine used in the industry at the moment. The measurement results of the prototypes show that the main performance characteristics of these machines are at an acceptable level. It is shown that with certain specific actions it is possible to achieve a desirable efficiency level of the machine with the proposed cost reduction methods.

Influence of Travelling Current Linkage Harmonics on Inductance Variation, Torque Ripple and Sensorless Capability of Tooth-Coil Permanent-Magnet Synchronous Machines

This paper introduces an important source of torque ripple in PMSMs with tooth-coil windings (TC-PMSMs). It is theoretically proven that saturation and cross-saturation phenomena caused by the non-synchronous harmonics of the stator current linkage cause a synchronous inductance variation with a particular periodicity. This, in turn, determines the magnitude of the torque ripple and can also deteriorate the performance of signal-injection-based rotor position estimation algorithms. An improved dq- inductance model is proposed. It can be used in torque ripple reduction control schemes and can enhance the self-sensing capabilities of TC-PMSMs

Association between dental-oral health in young adults and salivary glutathione, lipid peroxidation and sialic acid levels and carbonic anhydrase activity

The aim of the present study was to evaluate the relationship between salivary oxidative stress and dental-oral health. Healthy young adults, matched for gender and age, with (N = 21, 10 men, mean age: 20.3 ± 1 years) and without (N = 16, 8 men, mean age: 21.2 ± 1.8 years) caries were included in this study. The World Health Organization (WHO) caries diagnostic criteria were used for determining the decayed, missing, filled teeth (DMFT) index. The oral hygiene and gingival status were assessed using the simplified oral hygiene index and gingival index, respectively. Unstimulated salivary total protein, glutathione (GSH), lipid peroxidation and total sialic acid levels, carbonic anhydrase activity, and salivary buffering capacity were determined by standard methods. Furthermore, salivary pH was measured with pH paper and salivary flow rate was calculated. Simplified oral hygiene index and gingival index were not significantly different between groups but DMFT scores were significant (P < 0.01). Only, GSH values were significantly different (P < 0.05) between groups (2.2 and 1.6 mg/g protein in young adults without caries and with caries, respectively). There was a significant negative correlation between DMFT and GSH (r = -0.391; P < 0.05; Pearson's correlation coefficient). Our results suggest that there is an association between caries history and salivary GSH levels.

Lipopolysaccharide-induced dental pulp cell apoptosis and the expression of Bax and Bcl-2 in vitro

Lipopolysaccharide exerts many effects on many cell lines, including cytokine secretion, and cell apoptosis and necrosis. We investigated the in vitro effects of lipopolysaccharide on apoptosis of cultured human dental pulp cells and the expression of Bcl-2 and Bax. Dental pulp cells showed morphologies typical of apoptosis after exposure to lipopolysaccharide. Flow cytometry showed that the rate of apoptosis of human dental pulp cells increased with increasing lipopolysaccharide concentration. Compared with controls, lipopolysaccharide promoted pulp cell apoptosis (P < 0.05) from 0.1 to 100 μg/mL but not at 0.01 μg/mL. Cell apoptosis was statistically higher after exposure to lipopolysaccharide for 3 days compared with 1 day, but no difference was observed between 3 and 5 days. Immunohistochemistry showed that expression of Bax and Bcl-2 was enhanced by lipopolysaccharide at high concentrations, but no evident expression was observed at low concentrations (0.01 and 0.1 μg/mL) or in the control groups. In conclusion, lipopolysaccharide induced dental pulp cell apoptosis in a dose-dependent manner, but apoptosis did not increase with treatment duration. The expression of the apoptosis regulatory proteins Bax and Bcl-2 was also up-regulated in pulp cells after exposure to a high concentration of lipopolysaccharide.

Restoration of the rabbit corneal surface after total epithelial debridement and complete limbal excision

How is the corneal epithelium restored when all of it plus the limbus have been eliminated? This investigation explored the possibility that this may be achieved through the conjunctival epithelium. The corneal epithelium of the right eye of 12 rabbits (Oryctolagus cuniculus) was totally scraped followed by surgical excision of the limbus plus 1.0-1.5 mm of the adjacent conjunctiva. Antibiotics and corticosteroids were applied for 1 week after surgery. Histological and immunohistochemical techniques were used to monitor the events taking place on the eye surface 2 weeks and 1, 3 and 6 months thereafter. Initially, the corneal surface was covered by conjunctival-like epithelium. After 1 month and more prominently at 3 and 6 months an epithelium displaying the morphological features of the cornea and reacting with the AE5 antibody was covering the central region. It is likely that the corneal epithelium originated from undifferentiated cells of the conjunctiva interacting with the corneal stroma.