Influencia del tallado en la lisura superficial del esmalte / The influence of carving on surface smoothness of enamel

Al momento de realizar una preparación dental existen diferentes alternativas. Dentro del instrumental rotatorio hay dos opciones: la turbina dental (ultra-velocidad) y el micromotor acoplado a un contra-ángulo multiplicador (alta velocidad). El propósito de este estudio fue evaluar cualitativamente la diferencia en la lisura superficial sobre esmalte, que se genera al desgastarlo, utilizando para esto, una turbina dental y un micromotor eléctrico acoplado a un contra-ángulo multiplicador 1:5 (anillo rojo). Se realizó un análisis cualitativo sobre una muestra de 24 superficies de esmalte obtenidas de 12 premolares extraídos por indicación ortodóntica, los cuales fueron preparados y observados al microscopio óptico. Luego de observar las 24 superficies al microscopio se pudo constatar una mayor lisura superficial sobre el esmalte al utilizar micromotor eléctrico acoplado a contraángulo multiplicador en comparación con turbina (AU)

How to use χ2 test correctly——the score test and the implementation of SAS software / 四川精神卫生

The purpose of this article was to introduce the score test and the SAS implementation. Concretely， there were five common forms of the score test statistics， namely the general score test statistic，the robust score test statistic，the residual score test statistic，the generalized score test statistic，and the Lagrange multiplier test statistic. The score test was mainly used in the following three situations， namely， testing whether part or all of the regression coefficients were 0， testing whether a single effect was not in the regression model，and testing whether the parallel line hypothesis was established. The paper used two examples and the SAS software to realize the various score tests mentioned above， and focused on explaining the output results related to the score tests.

Low cost system to measure active power in electrosurgical units

Abstract Introduction: The real-time measurement of active power delivered to patients during the electrosurgical act is still an engineering challenge. Besides, there is no electrosurgical unit on the market capable of doing it according to the normative requirement. Methods This work presents the design of an electronic structure capable to probe the electrosurgical equipment output electrical signals, using low-costs very common resistors, and High Frequency distortions compensation circuits, and process them to provide an analogue signal proportional to the active power, allowing the knowledge and control of the energy delivered to the biological tissue. The reading circuits and the active power calculation method are presented. The power calculation is performed in two stages. The first one consists of a multiplier circuit that uses the readings voltage and current quantities to determine the instantaneous output power, and the second stage is formed by an integrating circuit which determines the average power value, resulting in a rippled continuous voltage, proportional to the active power delivered to the patient or biological tissue. Results Practical tests of the compensation technical are statistically evaluated by means of linear regressions. Results of 23 tests are summarized in a way to demonstrate de effectiveness of the proposed system. Conclusion Analysis of the results demonstrate the efficiency of the proposed system, whose average error is lower than 5%, and correlating them with the standard IEC 60601-2-2, that regulates the operation of electrosurgery units.

Estimation of the Optimal CA-CFAR Threshold Multiplier in Pareto Clutter with Known Parameters

The performance of the CA-CFAR processor is affected by certain clutter variations. Although problems caused by sudden clutter changes have already been corrected in multiple CFAR proposals, the influence of slow statistical variations in the background signal is often ignored. To solve this problem, the authors estimated the optimal CA-CFAR threshold multiplier values necessary to adapt the processor to the clutter slow statistical changes. The application of the results guarantees that the operational false alarm probability of the processor will only exhibit a small deviation from the value conceived in the design. The clutter was simulated with a Pareto distribution with a known fluctuating shape parameter according to recent papers that strongly suggest the use of this distribution. The current research completes an important step in the design of an adaptive detector that operates without a priori knowledge of the shape parameter In addition, the authors provide mathematical expressions that allow the direct application of the results in the design of radar detectors.

El desempeño del procesador CA-CFAR es afectado por ciertas variaciones del clutter Mientras que los problemas causados por los cambios repentinos del clutter han sido corregidos por múltiples propuestas CFAR, se ignora frecuentemente la influencia de las variaciones estadísticas lentas de la señal de fondo. Para resolver este problema, los autores estimaron los valores óptimos del multiplicador del umbral CA-CFAR necesarios para adaptar el procesador a los cambios estadísticos lentos, garantizando por tanto que la probabilidad de falsa alarma del detector exhibirá solamente una ligera desviación con respecto al valor concebido en el diseño. El clutter fue simulado con una distribución Pareto con parámetro de forma conocido de antemano, de acuerdo a publicaciones recientes que sugieren fuertemente el uso de esta distribución. La investigación actual completa un paso importante en el diseño de detectores adaptativos que operan sin el conocimiento a priori del parámetro de forma. Adicionalmente, los autores proporcionan expresiones matemáticas que permiten la aplicación directa de los resultados en el diseño de detectores de radar.

O desempenho do processador CA-CFAR está afectada por certas variações da desordem. Enquanto os problemas causados por mudanças bruscas de lixo foram corrigidos para múltiplas propostas CFAR, é muitas vezes ignorado a influ-ência de variações estatísticas lento do sinal de fundo. Para resolver esse problema, os autores estimaram os valores ideais do limiar necessário multiplicador CA-CFAR para adaptar o processador para retardar alterações estatísticas, garantizando, portanto, a probabilidade de falsa detector de alarme apenas um ligeiro desvio da valor concebido no design. A desordem foi simulado com um parâmetro de distribuição de Pareto conhecidos na maneira previamente, de acordo com publicações recentes que sugerem fortemente a utilização desta distribuição. A investigação actual complete um passo importante na concepção de detectores adaptativas que operam sem conhecimento a priori do parâmetro de forma. Addi-cionalmente, os autores fornecem expressões matemáticas que permitem a aplicação direta dos resultados do projeto de detectores de radar.

Formação e prática de multiplicadores em testes rápidos para o vírus da imunodeficiência humana na região da Baixada Litorânea/RJ / Training and practice of multipliers in rapid tests for human immunodeficiency virus in the region of Baixada Litorânea / RJ

O objetivo deste trabalho foi investigar a formação e a prática de multiplicadores em Testes Rápidos para Diagnóstico do Vírus da Imunodeficiência Humana (TRD/HIV) na região da Baixada Litorânea no estado do Rio de Janeiro. Trata-se de um estudo descritivo exploratório de campo com abordagem qualitativa. Os dados foram obtidos entre os meses de outubro e dezembro de 2014 através de entrevistas semiestruturadas com treze trabalhadores da saúde, sendo nove multiplicadores regionais e quatro coordenadores municipais de programas de DST/Aids. A análise temática dos dados permitiu identificar duas categorias principais: a) Formação de multiplicadores regionais: diversidade de atividades e b) Replicação e descentralização do TRD/HIV: entre críticas e obstáculos. A primeira categoria permitiu observar que os multiplicadores avaliaram positivamente seu processo de formação na região, e que estes são perpassados por características de três tipos de atividades: técnica, educacional e cuidadora, de acordo com sua preferência pela multiplicação ou execução/aconselhamento. A segunda categoria reuniu análises afinadas às perspectivas da prática de replicação dos multiplicadores, e discutiu a oferta da formação de executores/aconselhadores, além das perspectivas de descentralização do TRD/HIV na região. Detectou-se baixo número de oficinas replicadas no período de um ano. As principais dificuldades relacionadas à replicação foram a diminuição da carga horária de replicação, a pouca disponibilidade dos multiplicadores regionais e a ausência de apoio político da gestão municipal para a efetivação das oficinas. A morosidade no processo de descentralização da testagem rápida para as unidades municipais foi relacionada em parte ao pequeno número de multiplicadores formados na região e sua pouca disponibilidade. Por outro lado, reconheceu-se o fato de que há unidades sem condições mínimas para a implantação do TRD e, nesses casos, os participantes apontaram desmotivação dos executores/aconselhadores municipais formados diante da desorganização dos serviços nas unidades. Apesar das críticas e do reconhecimento de obstáculos, percebeu-se a perspectiva de um trabalho colaborativo no processo de replicação, em especial por parte de coordenadores formados multiplicadores. Os participantes defenderam a realização de oficinas periódicas pela secretaria estadual de saúde ou a possibilidade dessa formação ser descentralizada para os multiplicadores regionais de modo a diminuir a dependência dos municípios em relação à disponibilidade dos multiplicadores regionais. Conclui-se que, para que a replicação aos municípios aconteça, são necessários movimentos frequentes de sensibilização desde as instâncias de gestão/gerência até as equipes de saúde. O estudo resultou em um encontro regional envolvendo SES, CIES regional e sujeitos participantes no qual foi ratificada a importância da proposição de ações capazes de articular sujeitos envolvidos com as ações programáticas, fortalecendo estratégias de aproximação em âmbito regional, promovendo a prática reflexiva e possibilitando espaços de produção de saberes e enfrentamento de fragilidades na concepção da Educação Permanente em Saúde

The goal of this study was to investigate the qualification and practice of multipliers in rapid tests for diagnosis of human immunodeficiency virus (TRD/HIV) in the Coastal Lowlands region of Rio de Janeiro state. It is an exploratory descriptive study, with a qualitative approach. The data were collected between October and December 2014 through semi-structured interviews with thirteen health workers, and nine regional multipliers and four municipal coordinators of sexually transmitted diseases programs (DST). Subject analysis of the data allowed us to identify two main categories: a) Regional multipliers Qualification: Diverse activity b) TRD/HIV replication and Decentralization: between critics and obstacles. The first category observed that the multiplier positively analyzed their training process in the region and these are crossed by three types of characteristics of activities: technical, educational and caregiver, according to their preference by multiplying, execution or advice. The second category brought together multiplier prospect analyses of replication practice and discussed the offer of training executors/advisers, besides the decentralization prospects of TRD/HIV in the region. A low number of replicated workshops in a one year period of time were detected. The main difficulties related to replication were the reduction of workload replication, the limited availability of regional multipliers and the lack of political support from municipal management to perform the workshops. The rapid testing unit delay and the municipal decentralization process for the units were related to the small number of trained multipliers in the region and their limited availability. On the other hand, it was recognized that there were no minimum conditions for the TRD implementation to take place and lower motivation was pointed out by executors /advisers. Despite the obstacles recognition and criticism, collaborative work perspective in the replication process was noticed, especially by coordinator-trained multipliers. Participants called for periodic workshops held by the health state board or the possibility of such training is decentralized to regional multipliers, in order to reduce the dependence of municipalities regarding the availability of regional multipliers. In conclusion, in order for replication to occur the municipalities are required to have frequent awareness movements, from management/manages level / up to health teams. The study resulted in a regional meeting involving the health state board, the Education and Health integration services (CIES) and the participating subjects that were ratified by the importance of proposing programmatic actions to articulate involved individuals with program activities, strengthening strategies approach at the regional level, promoting reflective practice and enabling knowledge production room and coping with weaknesses in the design of Continuing Education in Health

The Economic Impact of a Rural Hospital to local Economy / 예방의학회지

Demand for high quality medical care has recently been increasing in step with high level of income and education. Patients prefer the use of large general hospitals to small community hospitals. Large hospitals, usually located at urban area, expand their capacities to cope with the increasing demand, therefore, they easily secure revenue necessary for growth and development of hospitals. However, small community hospitals are facing with serious financial difficulties caused from the reduction of patients in one hand and the inflation of cost in another. If small rural hospitals were closed, the closure would have negative impacts on local economies in addition to the decrease in access to medical care. Community leaders should have an insight on the contribution of community hospitals to local economies. They could make a rational decision on the hospital closure only with the understanding of hospital's contribution to the community. This study is designed to develop an economic model to estimate the contribution of rural hospital to local economies, and also to apply this model with a specific hospital. The contribution of a hospital to local economies consists of two elements, direct effect and multiplier effects. The direct impacts include hospital's local purchasing power, employee's local purchasing power, and the consumption of patients coming from outside the community. The direct impact induces multiplication effect in the local economy. The seed money invested to other industries grows through economic activities in the economy. The seed money invested to other industries grows through economic activities in the region. This study estimated the direct effect with the data of expenditure of the case hospital. The total effect was calculated by multiplied the direct effect with a multiplier. The multiplier was drown from the ratio of marginal propensity of income and expenditure. Beside the estimation of the total impacts, the economic effect from the external resources was also analyzed by the use of the ratio of patients coming outside the region. The results are as follows. 1. The direct economic contribution of the hospital to the local economy is 1,104 million won. 2. The value of multiplier in the region is 2.976. 3. The total economic effect is 3,286 million won, and the multiplication effect is 2,182 million won. 4. The economic contribution from the external resources is 245 million won which is 7.5% of the total economic effect.