985 resultados para emergency operating procedures
Resumo:
This study aimed to evaluate the effect of horizontal plate meter with oblong holes operating with one or two seed outlets at different speeds over the accuracy of longitudinal distribution of common bean seeds (Phaseolus vulgaris L.). The experiment was performed in laboratory using the meter with one and two seed outlet points in relation to ten tangential disk plate speeds (0.03 to 0.30 m s-1). It was used a complete randomized design with four replications, summing up 80 experimental treatments. Tangential speed quantitative factor was estimated through a 2nd order polynomial regression. There was no significant difference in the behavior of the seed meter operating with one or two outlets in the metering of bean seeds in all tested speeds, with percentage of single seeds spacing over 60% in tangential speeds below of 0.24 m s-1.
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The wear resistance of rotary plows operating in a clay loam soil was studied. The degree of damage caused to the soil and the amount of mass lost by the tools were determined in order to establish correlations between the physical properties of the soil and the wear mechanisms acting on the tribosystem. Field tests were carried out in 12 plots and a randomized experimental design with 4 levels, 3 replicas per level and 2 passes per plot was applied. The levels relate to the tillage implements employed: rotary tiller, rotary power harrow, small motorized rotary tiller and control (unaltered soil). The highest mass losses were measured in rotary tiller and rotary power harrow's tools, while the small motorized rotary tiller's tools showed generally lower levels of damage. It was determined that the effective contact time between tool and soil, the rotating speed and the sudden impact forces are the most significant factors affecting the wear resistance in field operations. Thirty days after tillage operation the soil samples were taken from each plot at a mean depth of 100 mm in order to determine bulk density, gravimetric moisture content and percentage of aggregates smaller than 5 mm. No significant differences among the values of these properties were found in the experiments. The wear mechanisms acting on the tools' surface are complex and include 2-body and 3-body abrasion as well as the presence of sudden impact forces.
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ABSTRACT The aim of this study was to evaluate the effects of modifying the maintenance programming of equipment used in sugarcane mechanical harvesting, by transferring actions that can be planned to periods when machines are inactive due to meal breaks and other working shift transitions stoppages. A simulation model was developed to represent the maintenance procedures of combines, haulouts, and other vehicles used by a harvest team. Scenarios were tested using alternatives for interventions such as refueling, lubrication and harvester blade replacement, enabling strategies to be focused towards better utilization of cutting, loading, and transport (CLT) system equipment. As a result, it was possible to remove one combine and two haulouts, while maintaining current daily production. The maintenance time for harvesters, which refers to corrective maintenance and the transfer of remaining interventions for periods of inactivity, was reduced from 10.0% to 3.5% over the useful period. This study indicates that maintenance management in the sugarcane sector enables the expanded use of equipment, leading to the greater productivity of the CLT system.
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The development of new technologies to supplement fossil resources has led to a growing interest in the utilization of alternative routes. Biomass is a rich renewable feedstock for producing fine chemicals, polymers, and a variety of commodities replacing petroleumderived chemicals. Transformation of biomass into diverse valuable chemicals is the key concept of a biorefinery. Catalytic conversion of biomass, which reduces the use of toxic chemicals is one of the important approaches to improve the profitability of biorefineries. Utilization of gold catalysts allows conducting reactions under environmentally-friendly conditions, with a high catalytic activity and selectivity. Gold-catalyzed valorization of several biomass-derived compounds as an alternative approach to the existing technologies was studied in this work. Isomerization of linoleic acid via double bond migration towards biologically active conjugated linoleic acid isomers (CLA) was investigated. The activity and selectivity of various gold catalysts towards cis-9,trans-11-CLA and trans-10,cis-12-CLA were investigated in a semi-batch reactor, showing that the yield of the desired products varied, depending on the catalyst support. The structure sensitivity in the selective oxidation of arabinose was demonstrated using a series of gold catalysts with different Au cluster sizes in a shaker reactor operating in a semibatch mode. The gas-phase selective oxidation of ethanol was studied and the influence of the catalyst support on the catalytic performance was investigated. The selective oxidation of the lignan hydroxymatairesinol (HMR), extracted from the Norway spruce (Picea abies) knots, to the lignan oxomatairesinol (oxoMAT) was extensively investigated. The influence of the reaction conditions and catalyst properties on the yield of oxoMAT was evaluated. In particular, the structure sensitivity of the reaction was demonstrated. The catalyst deactivation and regeneration procedures were studied. The reaction kinetics and mechanism were advanced.
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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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OBJECTIVE: to evaluate the efficacy of endovascular repair of popliteal artery aneurysms on maintaining patency of the stent in the short and medium term. METHODS: this was a retrospective, descriptive and analytical study, conducted at the Integrated Vascular Surgery Service at the Hospital da Beneficência Portuguesa de São Paulo. We followed-up 15 patients with popliteal aneurysm, totaling 18 limbs, treated with stent from May 2008 to December 2012. RESULTS: the mean follow-up was 14.8 months. During this period, 61.1% of the stents were patent. The average aneurysm diameter was 2.5cm, ranging from 1.1 to 4.5cm. The average length was 5cm, ranging from 1.5 to 10 cm. In eight cases (47.1%), the lesion crossed the joint line, and in four of these occlusion of the prosthesis occurred. In 66.7% of cases, treatment was elective and only 33.3% were symptomatic patients treated on an emergency basis. The stents used were Viabahn (Gore) in 12 cases (66.7%), Fluency (Bard) in three cases (16.7%), Multilayer (Cardiatis) in two cases (11.1%) and Hemobahn (Gore) in one case (5.6%). In three cases, there was early occlusion (16.6%). During follow-up, 88.2% of patients maintained antiplatelet therapy. There was no leakage at ultrasound (endoleak). No fracture was observed in the stents. CONCLUSION: the results of this study are similar to other published series. Probably, with the development of new devices that support the mechanical characteristics found on the thighs, there will be improved performance and prognosis of endovascular restoration.
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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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Objective: To evaluate perioperative outcomes, safety and feasibility of video-assisted resection for primary and secondary liver lesions. Methods : From a prospective database, we analyzed the perioperative results (up to 90 days) of 25 consecutive patients undergoing video-assisted resections in the period between June 2007 and June 2013. Results : The mean age was 53.4 years (23-73) and 16 (64%) patients were female. Of the total, 84% were suffering from malignant diseases. We performed 33 resections (1 to 4 nodules per patient). The procedures performed were non-anatomical resections (n = 26), segmentectomy (n = 1), 2/3 bisegmentectomy (n = 1), 6/7 bisegmentectomy (n = 1), left hepatectomy (n = 2) and right hepatectomy (n = 2). The procedures contemplated postero-superior segments in 66.7%, requiring multiple or larger resections. The average operating time was 226 minutes (80-420), and anesthesia time, 360 minutes (200-630). The average size of resected nodes was 3.2 cm (0.8 to 10) and the surgical margins were free in all the analyzed specimens. Eight percent of patients needed blood transfusion and no case was converted to open surgery. The length of stay was 6.5 days (3-16). Postoperative complications occurred in 20% of patients, with no perioperative mortality. Conclusion : The video-assisted liver resection is feasible and safe and should be part of the liver surgeon armamentarium for resection of primary and secondary liver lesions.
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Deep cannulation is a prerequisite for successful endoscopic retrograde cholangiopancreatography (ERCP) procedures. Of the biliary procedures, stenting is one of the most common. This study was carried out to investigate current and controversial issues regarding biliary cannulation and stenting. The double guidewire (DGW) technique was studied to analyze its safety and feasibility in biliary cannulation as a single procedure and as a part of the novel three-step cannulation protocol. Female gender was evaluated in regard to difficult cannulation. The use of an angled and a straight tipped guidewire in biliary cannulation was studied in a prospective, randomized trial. Additionally, the patency of the novel antireflux plastic biliary stent was compared to the patency of the conventional plastic biliary stent in a prospective, randomized setting. The DGW method seems safe and feasible as an alternative cannulation technique in biliary cannulation. Female gender was not associated significantly with difficult biliary cannulation in our study, although the cannulation times seemed to be longer and the alternative cannulation techniques seemed to be needed more often in females than males. According to the results of this thesis, an angled tipped guidewire may facilitate biliary cannulation. In controversy to the previous result presented in the literature, the antireflux plastic biliary stent tested herein should not be used, as the patency of the stent was significantly shorter compared to the conventional plastic stent.
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Tämän tutkimuksen tarkoituksena on selvittää, miten riskienhallinnan näkökulma on huomioitu Suomessa toimivien suurten tilintarkastusyhteisöjen asiakashyväksyntäprosesseissa. Asiakashyväksyntä on tilintarkastusprosessin ensimmäinen vaihe. Tutkimuksen tiedonhankinnan strategiana käytettiin teemahaastattelua ja tutkimuksessa haastateltiin kolmea asiakashyväksynnän näkökulmasta eri rooleissa toimivaa tilintarkastajaa. Kirjallisuuskatsauksessa perehdytään sekä tilintarkastusprosessiin että riskienhallintaan liittyvään kirjallisuuteen. Tutkimuksen tuloksena todettiin, että tutkitut tilintarkastusyhteisöt ovat kehittäneet ja formalisoineet asiakashyväksyntäprosessejaan jatkuvasti riskienhallintanäkökulman huomioiden. Automatisoidut tietojärjestelmät ovat nousseet yhä merkittävämpään rooliin ja myös asiakashyväksyntään liittyvää päätöksentekopolkua on mietitty ja uudistettu. Tutkimuksen tuloksena vahvistui näkemys siitä, että aiemmissa tutkimuksissa esitetty toimeksiantoriskin käsite kuvaa myös suomalaisten tilintarkastajien asiakashyväksyntävaiheessa tekemiä riskiarvioita. Merkittävimpinä pidettiin erilaisia tilintarkastusyhteisön maineeseen vaikuttavia riskitekijöitä sekä asiakkaan henkilökysymyksiin liittyviä seikkoja. Tilintarkastajien todettiin tarkastelevan sekä riskin negatiivisia puolia että myös siihen liittyviä positiivisia mahdollisuuksia. Varsinaisia aktiivisia riskienhallinnan toimenpiteitä tärkeämmäksi koettiin se, että asiakkaaseen liittyvät riskit kartoitetaan ja arvioidaan asianmukaisesti. Asiakashyväksynnän merkityksestä riskienhallinnassa voidaan todeta, että sitä pidettiin niin sanottuna ensimmäisenä suojamuurina, jonka avulla voidaan pyrkiä suojautumaan erityisesti sellaisia riskejä vastaan, joihin ei enää myöhemmässä vaiheessa voida tilintarkastustoimenpiteillä vaikuttaa. Tällöin liian korkeariskiset asiakkaat jätetään hyväksymättä - ei niinkään pyritä suunnittelemaan riskiä alentavia toimenpiteitä, joiden avulla asiakas voitaisiin hyväksyä.
Resumo:
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.