Made available in DSpace on 2014-06-11T19:32:05Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-15Bitstream added on 2014-06-13T19:02:21Z : No. of bitstreams: 1 oliveira_fhs_dr_botfm.pdf: 1109354 bytes, checksum: 0cd1da052963c400f897bebd38a2f468 (MD5) / Universidade Estadual Paulista (UNESP) / O trauma torácico (TT) é uma situação bastante comum no politraumatizado nos dias de hoje. Uma das injúrias provocadas pelo TT é a perda da estabilidade torácica consequente a fraturas múltiplas do gradil costal (tórax instável). O paciente com tórax instável pode ser tratado clinicamente com intubação oro-traqueal e ventilação mecânica, como também pode ser submetido à cirurgia para fixação das fraturas costais. Na busca da melhor evidência para decisão do tratamento justifica-se a procura da resposta através de uma revisão sistemática. Avaliar a eficácia e segurança do tratamento cirúrgico quando comparado ao tratamento clínico em pacientes com trauma torácico fechado com tórax instável. Revisão sistemática de ensaios clínicos aleatorizados avaliando a eficácia e segurança do tratamento cirúrgico quando comparado ao tratamento clínico. Estudos relevantes foram identificados eletronicamente por meio de bases de dados MEDLINE, EMBASE, LILACS, Cochrane Controlled Trials register (CENTRAL). Referências bibliográficas também foram pesquisadas para encontrar estudos não indexados. A qualidade metodológica foi avaliada com formulários retirados do HANDBOOK (Higgins & Green 2009), e as análises estatísticas foram executadas através do REVNAN 5.0.2 fornecido pela Colaboração Cochrane. Nas bases eletrônicas de dados foram selecionados seis estudos, desses apenas dois estudos cumpriam os critérios de inclusão para se fazer uma metanálise. Nestes estudos foram analisados 77 pacientes, dos quais 38 foram tratados cirurgicamente e 39 tratados conservadoramente. Apenas quatro desfechos avaliados eram comuns aos dois estudos, mortalidade, incidência de pneumonia, tempo de ventilação mecânica (tVM) e tempo de internação em UTI (tUTI). Apenas para a mortalidade não houve diferença estatística após a metanálise. Já o tVM, tUTI e incidência... / The thoracic trauma (TT) is a common situation in polytraumatized today. One of the injuries caused by the TT is the loss of stability resulting in multiple fractures of thoracic rib cage (flail chest). The patient with flail chest can be treated medically with orotracheal intubation and mechanical ventilation, but also may undergo surgery to fix the costal fractures. In search of the best evidence for treatment decision justifies the search for an answer through a systematic review. To evaluate the efficacy and safety of surgical treatment compared to medical treatment in patients with blunt chest trauma with flail chest. A systematic review of randomized controlled trials evaluating the efficacy and safety of surgical treatment compared to medical treatment. Relevant studies were identified through electronic databases MEDLINE, EMBASE, LILACS, Cochrane Controlled Trials register (CENTRAL). References were also searched to find studies not indexed. Methodological quality was assessed with forms taken from the HANDBOOK (Higgins & Green 2009), and the statistical analyzes were performed by REVNAN 5.0 provided by the Cochrane Collaboration. The electronic databases were selected six studies, only two of these studies met the inclusion criteria for doing a meta-analysis. These studies analyzed 77 patients in whom 38 were treated surgically and 39 treated conservatively. Only four outcomes evaluated were common to both studies, mortality, incidence of pneumonia, mechanical ventilation time (MVt) and length of stay in ICU (ICUt). Just for mortality showed no statistical difference after the meta-analysis. Already MVt, ICUt and incidence of pneumonia showed a statistical difference favoring the surgical group. Based on the results of this systematic review and meta-analysis we can conclude that there is scientific evidence currently available providing surgical treatment for unstable chest... (Complete abstract click electronic access below)

No description available.

Resumo: O trauma torácico (TT) é uma situação bastante comum no politraumatizado nos dias de hoje. Uma das injúrias provocadas pelo TT é a perda da estabilidade torácica consequente a fraturas múltiplas do gradil costal (tórax instável). O paciente com tórax instável pode ser tratado clinicamente com intubação oro-traqueal e ventilação mecânica, como também pode ser submetido à cirurgia para fixação das fraturas costais. Na busca da melhor evidência para decisão do tratamento justifica-se a procura da resposta através de uma revisão sistemática. Avaliar a eficácia e segurança do tratamento cirúrgico quando comparado ao tratamento clínico em pacientes com trauma torácico fechado com tórax instável. Revisão sistemática de ensaios clínicos aleatorizados avaliando a eficácia e segurança do tratamento cirúrgico quando comparado ao tratamento clínico. Estudos relevantes foram identificados eletronicamente por meio de bases de dados MEDLINE, EMBASE, LILACS, Cochrane Controlled Trials register (CENTRAL). Referências bibliográficas também foram pesquisadas para encontrar estudos não indexados. A qualidade metodológica foi avaliada com formulários retirados do HANDBOOK (Higgins & Green 2009), e as análises estatísticas foram executadas através do REVNAN 5.0.2 fornecido pela Colaboração Cochrane. Nas bases eletrônicas de dados foram selecionados seis estudos, desses apenas dois estudos cumpriam os critérios de inclusão para se fazer uma metanálise. Nestes estudos foram analisados 77 pacientes, dos quais 38 foram tratados cirurgicamente e 39 tratados conservadoramente. Apenas quatro desfechos avaliados eram comuns aos dois estudos, mortalidade, incidência de pneumonia, tempo de ventilação mecânica (tVM) e tempo de internação em UTI (tUTI). Apenas para a mortalidade não houve diferença estatística após a metanálise. Já o tVM, tUTI e incidência... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The thoracic trauma (TT) is a common situation in polytraumatized today. One of the injuries caused by the TT is the loss of stability resulting in multiple fractures of thoracic rib cage (flail chest). The patient with flail chest can be treated medically with orotracheal intubation and mechanical ventilation, but also may undergo surgery to fix the costal fractures. In search of the best evidence for treatment decision justifies the search for an answer through a systematic review. To evaluate the efficacy and safety of surgical treatment compared to medical treatment in patients with blunt chest trauma with flail chest. A systematic review of randomized controlled trials evaluating the efficacy and safety of surgical treatment compared to medical treatment. Relevant studies were identified through electronic databases MEDLINE, EMBASE, LILACS, Cochrane Controlled Trials register (CENTRAL). References were also searched to find studies not indexed. Methodological quality was assessed with forms taken from the HANDBOOK (Higgins & Green 2009), and the statistical analyzes were performed by REVNAN 5.0 provided by the Cochrane Collaboration. The electronic databases were selected six studies, only two of these studies met the inclusion criteria for doing a meta-analysis. These studies analyzed 77 patients in whom 38 were treated surgically and 39 treated conservatively. Only four outcomes evaluated were common to both studies, mortality, incidence of pneumonia, mechanical ventilation time (MVt) and length of stay in ICU (ICUt). Just for mortality showed no statistical difference after the meta-analysis. Already MVt, ICUt and incidence of pneumonia showed a statistical difference favoring the surgical group. Based on the results of this systematic review and meta-analysis we can conclude that there is scientific evidence currently available providing surgical treatment for unstable chest... (Complete abstract click electronic access below) / Orientador: Paulo Eduardo de Oliveira Carvalho / Coorientador: Antonio José Maria Cataneo / Banca: Regina P. El Dib / Banca: Samuel Marek Reibscheid / Banca: Olavo Ribeiro Rodrigues / Banca: João Alessio Juliano Perfeito / Doutor

This dissertation presents the results of a research effort aimed at improving the current occupant injury criteria typically used to assess occupant injury risk in crashes involving roadside hardware such as guardrail. These metrics attempt to derive the risk of injury based solely on the response of the vehicle during a collision event. The primary purpose of this research effort was to determine if real-world crash injury prediction could be improved by augmenting the current vehicle-based metrics with vehicle-specific structure and occupant restraint performance measures. Based on an analysis of the responses of 60 crash test dummies in full-scale crash tests, vehicle-based occupant risk criteria were not found to be an accurate measure of occupant risk and were unable to predict the variation in occupant risk for unbelted, belted, airbag only, or belt and airbag restrained occupants. Through the use of Event Data Recorder (EDR) data coupled with occupant injury data for 214 real-world crashes, age-adjusted injury risk curves were developed relating vehicle-based metrics to occupant injury in real-world frontal collisions. A comparison of these risk curves based on model fit statistics and an ROC curve analysis indicated that the more computationally intensive metrics that require knowledge of the entire crash pulse offer no statistically significant advantage over the simpler delta-V crash severity metric in discriminating between serious and non-serious occupant injury. This finding underscores the importance of developing an improved vehicle-based injury metric. Based on an analysis of 619 full-scale frontal crash tests, adjustments to delta-V that reflect the vehicle structure performance and occupant restraint performance are found to predict 4 times the variation of resultant occupant chest acceleration than delta-V alone. The combination of delta-V, ridedown efficiency, and the kinetic energy factor was found to provide the best prediction of the occupant chest kinematics. Real-world crash data was used to evaluate the developed modified delta-V metrics based on their ability to predict injury in real-world collisions. Although no statistically significant improvement in injury prediction was found, the modified models did show evidence of improvement over the traditional delta-V metric. / Ph. D.

A colheita mecanizada florestal é uma atividade custosa com diversos fatores a serem gerenciados e controlados para que se torne uma atividade viável e competitiva. Para a aplicação em povoamentos florestais de baixo volume por hectare, a escolha do sistema de colheita ideal é fator determinante para o sucesso operacional e financeiro do processo. O presente estudo avaliou dois sistemas de colheita: um convencional - composto por: \"Harvester\" e \"Forwarder\" - e outro alternativo - composto por: \"Feller-buncher\", \"Skidder\", \"Flail\", \"Power-Clamp\" e \"Garra-Traçadora\". Os sistemas de colheita foram aplicados em florestas de baixo volume unitário, sendo a UP-A com 0,14 m³.árv.-1 com 48,07 hectares e a UP-B com 0,11 m³.árv.-1 com 80,88ha. Foi realizado estudo de tempo contínuo para o apontamento dos indicadores de desempenho de disponibilidade mecânica, eficiência operacional e índice de utilização, bem como coleta do número de árvores produzidas por cada máquina de cada um dos sistemas em ciclos de 30min. de forma aleatória. Os custos horários foram divididos em: custos fixos - compostos por: custo de depreciação, juros, seguros e estrutura - e custos variáveis - representados pelos valores correspondentes a: combustível, lubrificantes, mão de obra e manutenção. O custo de produção (R$.m-3 de cada máquina e somatório de cada sistema) foi obtido por meio da soma dos custos fixos e variáveis de cada máquina e divisão entre sua produção horária apontada pelos técnicos florestais ao longo do estudo. Na análise estatística, aplicou-se o teste de BOX-COX para avaliar a homogeneidade da variância da produção horária (m³.h-1) com a variância homogeneizada pela transformação logarítmica, fez-se a análise de variância (ANOVA) da variável m³.h-1 de cada um dos sistemas para cada uma das unidades de produção e, sequencialmente, realizou-se o teste de comparação de médias dos sistemas de colheita e unidades de produção, comparados pelo teste de Tukey a 5%. Os custos fixos do sistema convencional totalizaram 221,59 R$.h-1, sendo estes 52,77% dos custos totais deste sistema, já o sistema alternativo apresentou um custo total fixo de 668,55 R$.h-1, representando 45,75% dos custos totais horários. Os custos variáveis do sistema convencional totalizaram 198,29 R$.h-1, compondo 47,23% dos custos totais, e para o sistema alternativo, os custos variáveis totalizaram 792,68 R$.h-1, representando 54,25% dos custos totais. O custo de produção do sistema convencional na UP-A foi de 19,38 R$.m-³ e na UP-B foi de 23,85 R$.m-³. Já para o sistema alternativo, obteve-se na UP-A um custo de 14,62 R$.m-³ e para UP-B um valor de 19,99 R$.m-³. Em conclusão, verificou-se que, para ambas as situações de floresta estudadas, o sistema alternativo de colheita foi mais competitivo em relação ao sistema convencional. / The forest mechanized harvesting operation is a costly activity with many factors to be managed and controlled in order to become a viable and competitive activity. Thus when applied to forest stands with low volume per hectare, choosing the ideal harvesting system is a determining factor for the operational and financial success. The present study analyzed two harvesting systems, one named traditional, which is composed of \"Harvester\" and \"Forwarder\" and a second named alternate consisting of \"Feller-buncher\", \"Skidder\", \"Flail\", \"Power-Clamp\" and \"Grapple-Saw\". Both systems were applied to harvest forests of low unit volume, and the UP-A with 0.14 m³.tree-1 with 48.07 hectares and UP-B with 0.11 m³.tree-1 with 80.88 hectares. The study was conducted with continuous time for the appointment of the performance indicators of mechanical availability, operational efficiency and utilization rates, also was collected the number of trees produced by each machine in each system in cycles of 30 minutes at random. Hourly costs were divided into fixed costs, consisting of depreciation cost, interest, insurance and variable cost structure was represented by the cost of fuel, lubricants, labor and maintenance. The production cost of R$.m-3 of each machine and the sum of each system was obtained by the sum of the fixed and variable costs of each machine and divided by their hourly production indicated by forest technicians throughout the study. Statistical analysis was applied to the BOX-COX test to evaluate the homogeneity of the variance of output per hour (m³.hour-1), with the variance homogenized by logarithmic transformation was made the variance analysis (ANOVA) of the variable m³.hour-1 of each harvest system for each forest production units and sequentially held the mean test comparison of harvest systems and forest production units, compared by Tukey test at 5%. The fixed costs of the traditional system totaled R$ 221.59 per hour effective worked these being 52.77% of the total costs of the system, since the alternative system presented a total fixed cost of R$ 668.55 per effective worked hour, representing 45.75% of the total costs. The variable costs of the traditional system totaled R$ 198.29 per effective worked hour, composing 47.23% of total costs, and for the alternative system, variable costs totaled R$ 792.68 per worked hour effectively representing 54.25% of total costs. The production cost of the traditional system in UP-A was R$ 19.38 per m³ and UP-B of R$ 23.85 per m³, for the alternative system has obtained in the UP-A a cost of R$ 14.62 per m³ and for the UP-B R$ 19.99 per m³. It is concluded that for both situations of forests studied, the alternative harvest system was more competitive compared to the traditional system in terms of R$.m-3.

A colheita mecanizada florestal é uma atividade custosa com diversos fatores a serem gerenciados e controlados para que se torne uma atividade viável e competitiva. Para a aplicação em povoamentos florestais de baixo volume por hectare, a escolha do sistema de colheita ideal é fator determinante para o sucesso operacional e financeiro do processo. O presente estudo avaliou dois sistemas de colheita: um convencional - composto por: \"Harvester\" e \"Forwarder\" - e outro alternativo - composto por: \"Feller-buncher\", \"Skidder\", \"Flail\", \"Power-Clamp\" e \"Garra-Traçadora\". Os sistemas de colheita foram aplicados em florestas de baixo volume unitário, sendo a UP-A com 0,14 m³.árv.-1 com 48,07 hectares e a UP-B com 0,11 m³.árv.-1 com 80,88ha. Foi realizado estudo de tempo contínuo para o apontamento dos indicadores de desempenho de disponibilidade mecânica, eficiência operacional e índice de utilização, bem como coleta do número de árvores produzidas por cada máquina de cada um dos sistemas em ciclos de 30min. de forma aleatória. Os custos horários foram divididos em: custos fixos - compostos por: custo de depreciação, juros, seguros e estrutura - e custos variáveis - representados pelos valores correspondentes a: combustível, lubrificantes, mão de obra e manutenção. O custo de produção (R$.m-3 de cada máquina e somatório de cada sistema) foi obtido por meio da soma dos custos fixos e variáveis de cada máquina e divisão entre sua produção horária apontada pelos técnicos florestais ao longo do estudo. Na análise estatística, aplicou-se o teste de BOX-COX para avaliar a homogeneidade da variância da produção horária (m³.h-1) com a variância homogeneizada pela transformação logarítmica, fez-se a análise de variância (ANOVA) da variável m³.h-1 de cada um dos sistemas para cada uma das unidades de produção e, sequencialmente, realizou-se o teste de comparação de médias dos sistemas de colheita e unidades de produção, comparados pelo teste de Tukey a 5%. Os custos fixos do sistema convencional totalizaram 221,59 R$.h-1, sendo estes 52,77% dos custos totais deste sistema, já o sistema alternativo apresentou um custo total fixo de 668,55 R$.h-1, representando 45,75% dos custos totais horários. Os custos variáveis do sistema convencional totalizaram 198,29 R$.h-1, compondo 47,23% dos custos totais, e para o sistema alternativo, os custos variáveis totalizaram 792,68 R$.h-1, representando 54,25% dos custos totais. O custo de produção do sistema convencional na UP-A foi de 19,38 R$.m-³ e na UP-B foi de 23,85 R$.m-³. Já para o sistema alternativo, obteve-se na UP-A um custo de 14,62 R$.m-³ e para UP-B um valor de 19,99 R$.m-³. Em conclusão, verificou-se que, para ambas as situações de floresta estudadas, o sistema alternativo de colheita foi mais competitivo em relação ao sistema convencional. / The forest mechanized harvesting operation is a costly activity with many factors to be managed and controlled in order to become a viable and competitive activity. Thus when applied to forest stands with low volume per hectare, choosing the ideal harvesting system is a determining factor for the operational and financial success. The present study analyzed two harvesting systems, one named traditional, which is composed of \"Harvester\" and \"Forwarder\" and a second named alternate consisting of \"Feller-buncher\", \"Skidder\", \"Flail\", \"Power-Clamp\" and \"Grapple-Saw\". Both systems were applied to harvest forests of low unit volume, and the UP-A with 0.14 m³.tree-1 with 48.07 hectares and UP-B with 0.11 m³.tree-1 with 80.88 hectares. The study was conducted with continuous time for the appointment of the performance indicators of mechanical availability, operational efficiency and utilization rates, also was collected the number of trees produced by each machine in each system in cycles of 30 minutes at random. Hourly costs were divided into fixed costs, consisting of depreciation cost, interest, insurance and variable cost structure was represented by the cost of fuel, lubricants, labor and maintenance. The production cost of R$.m-3 of each machine and the sum of each system was obtained by the sum of the fixed and variable costs of each machine and divided by their hourly production indicated by forest technicians throughout the study. Statistical analysis was applied to the BOX-COX test to evaluate the homogeneity of the variance of output per hour (m³.hour-1), with the variance homogenized by logarithmic transformation was made the variance analysis (ANOVA) of the variable m³.hour-1 of each harvest system for each forest production units and sequentially held the mean test comparison of harvest systems and forest production units, compared by Tukey test at 5%. The fixed costs of the traditional system totaled R$ 221.59 per hour effective worked these being 52.77% of the total costs of the system, since the alternative system presented a total fixed cost of R$ 668.55 per effective worked hour, representing 45.75% of the total costs. The variable costs of the traditional system totaled R$ 198.29 per effective worked hour, composing 47.23% of total costs, and for the alternative system, variable costs totaled R$ 792.68 per worked hour effectively representing 54.25% of total costs. The production cost of the traditional system in UP-A was R$ 19.38 per m³ and UP-B of R$ 23.85 per m³, for the alternative system has obtained in the UP-A a cost of R$ 14.62 per m³ and for the UP-B R$ 19.99 per m³. It is concluded that for both situations of forests studied, the alternative harvest system was more competitive compared to the traditional system in terms of R$.m-3.

There is currently a global increase in Eucalyptus pulpwood plantations. Harvesting systems traditionally utilised in the northern hemisphere are being used in Eucalyptus pulpwood plantations worldwide. However, the small tree size and complexity of debarking Eucalyptus have provided harvesting with productivity and cost challenges not previously experienced in northern-hemisphere conditions. Much research has been invested in these two harvesting methods in northern-hemisphere species and conditions. There is little research available on mechanised processing-machine productivity and costs in Eucalyptus. This investigation aimed to quantify the effect that tree and bundle size has on the productivity of different processing machines in Eucalyptus plantation pulpwood. This was done through regression analysis, whereby productivity models that included tree size and bundle size were constructed. The research also aimed to determine whether or not the multi-stem systems were more cost-effective in smaller tree sizes. The research investigated five mechanised harvesting options that forestry managers could use in Eucalyptus pulpwood plantations. These systems consisted of one CTL system, one full-tree system with single-stem processing and three full-tree systems with multi-stem processing. The CTL system used a harvester to process the trees into logs and to extract them. The full-tree system with single-stem processing used a dangle-head processor (DHP) to process trees into logs. The first full-tree system with multi-stem processing used a chain-flail debrancher debarker (CFDD) to produce debarked and debranched tree lengths, which were slashed into logs. The remaining full-tree, multi-stem systems both produced chips. The first used a chain-flail debrancher debarker chipper (CFDDC) and the second, a CFDD feeding into a stand-alone disc chipper (CFDD&C). The productivity data, measured as m3 per productive machine hour (PMH), was then statistically analysed using regression techniques. Productivity equations were formulated, considering tree size and bundle size, as well as the quadratic functions of these two variables and the interaction between them. Bundle size was only applicable to the multi-stem processing machines. The productivity equations successfully predicted processing-machine productivity, using tree size and bundle size as input variables. Apart from the 0.075 m3 tree size class, the CFDD had the highest overall productivity. The costs of the five systems were then calculated for different tree sizes. No single system was more cost-effective than the others across all tree sizes. In 0.075 m3 trees, the CFDDC system proved the most cost-effective. All systems evidenced high costs in the 0.075 m3 trees, ranging between $19.43 per m3 for the CFDDC system to $28.84 for the harvester system. In 0.40 m3 trees, the cost differences between systems were lower, ranging from $6.91 per m3 for the DHP system to $11.84 per m3 for the CFDD&C. This study confirms that the CTL system was very expensive to operate in the small tree sizes (0.075 m3). There is a cross-over point at 0.25 m3 per tree, where the CTL system costs become lower than those of the full-tree system. At the 0.40 m3 tree size, the full-tree system is slightly more expensive than the CTL system. Copyright / Dissertation (MSc)--University of Pretoria, 2012. / Plant Production and Soil Science / unrestricted

Chest compressions during cardiopulmonary resuscitation (CPR) may be associated with iatrogenic chest wall injuries. The extent to which these CPR-associated chest wall injuries contribute to a delay in the respiratory recovery of cardiac arrest survivors has not been sufficiently explored. In a single-center retrospective cohort study, surviving intensive care unit (ICU) patients, who had undergone CPR due to medical reasons between 1 January 2018 and 30 June 2019, were analyzed regarding CPR-associated chest wall injuries, detected by chest radiography and computed tomography. Among 109 included patients, 38 (34.8%) presented with chest wall injuries, including 10 (9.2%) with flail chest. The multivariable logistic regression analysis identified flail chest to be independently associated with the need for tracheostomy (OR 15.5; 95% CI 2.77–86.27; p = 0.002). The linear regression analysis identified pneumonia (β 11.34; 95% CI 6.70–15.99; p < 0.001) and the presence of rib fractures (β 5.97; 95% CI 1.01–10.93; p = 0.019) to be associated with an increase in the length of ICU stay, whereas flail chest (β 10.45; 95% CI 3.57–17.33; p = 0.003) and pneumonia (β 6.12; 95% CI 0.94–11.31; p = 0.021) were associated with a prolonged duration of mechanical ventilation. Four patients with flail chest underwent surgical rib stabilization and were successfully weaned from the ventilator. The results of this study suggest that CPR-associated chest wall injuries, flail chest in particular, may impair the respiratory recovery of cardiac arrest survivors in the ICU. A multidisciplinary assessment may help to identify patients who could benefit from a surgical treatment approach.