The Experts below are selected from a list of 9243 Experts worldwide ranked by ideXlab platform
Calvin B. Ernst - One of the best experts on this subject based on the ideXlab platform.
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An analysis of vascular surgical Manpower requirements and vascular surgical rates in the United States
Journal of Vascular Surgery, 2011Co-Authors: Ira M. Rutkow, Calvin B. ErnstAbstract:Abstract Inherent in any analysis of vascular surgical Manpower must be accurate data on surgical rates and numbers of surgeons who perform vascular operations. For in-depth analysis of age-sex standardized vascular operative rates from 1979 to 1984 and a determination of current Manpower levels, data from the National Center for Health Statistics (NCHS) and the American Board of Surgery (ABS) were reviewed. During 1979 to 1984, total vascular surgical procedures increased 50%. In 1983 such operations comprised 11% of all general surgical procedures and 3% of all operations performed in this country. In 1983, 95,000 carotid endarterectomies, 74,000 peripheral bypasses, 39,000 abdominal aortic aneurysm repairs, and 28,000 aorto-iliac-femoral bypasses were performed. Through November 1984, among approximately 1600 surgeons who had applied to take the General Vascular Surgery Examination, 676 took the examination and 545 passed. What percentage of all vascular surgeons these 1600 represent is unknown. Consequently, what percentage of the total vascular operative load their own experiences represent is uncertain. As of May 1985, the Residency Review Committee for General Surgery had approved 42 fellowship positions in 29 vascular training programs. How these training figures will change to meet optimal Manpower requirements remains undefined. Although data concerning operative rates have become more precise, forecasting Manpower Needs will be met with skepticism because of unknown current and future numbers of vascular surgeons and their average caseloads. Regardless of these uncertainties, vascular surgeons, program directors, and health analysts should be aware of such information because until we know how many vascular surgeons are necessary to provide optimal care, training and certification can not rationally evolve. (J VASC SURG 1986;3:74-83.)
Ira M. Rutkow - One of the best experts on this subject based on the ideXlab platform.
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An analysis of vascular surgical Manpower requirements and vascular surgical rates in the United States
Journal of Vascular Surgery, 2011Co-Authors: Ira M. Rutkow, Calvin B. ErnstAbstract:Abstract Inherent in any analysis of vascular surgical Manpower must be accurate data on surgical rates and numbers of surgeons who perform vascular operations. For in-depth analysis of age-sex standardized vascular operative rates from 1979 to 1984 and a determination of current Manpower levels, data from the National Center for Health Statistics (NCHS) and the American Board of Surgery (ABS) were reviewed. During 1979 to 1984, total vascular surgical procedures increased 50%. In 1983 such operations comprised 11% of all general surgical procedures and 3% of all operations performed in this country. In 1983, 95,000 carotid endarterectomies, 74,000 peripheral bypasses, 39,000 abdominal aortic aneurysm repairs, and 28,000 aorto-iliac-femoral bypasses were performed. Through November 1984, among approximately 1600 surgeons who had applied to take the General Vascular Surgery Examination, 676 took the examination and 545 passed. What percentage of all vascular surgeons these 1600 represent is unknown. Consequently, what percentage of the total vascular operative load their own experiences represent is uncertain. As of May 1985, the Residency Review Committee for General Surgery had approved 42 fellowship positions in 29 vascular training programs. How these training figures will change to meet optimal Manpower requirements remains undefined. Although data concerning operative rates have become more precise, forecasting Manpower Needs will be met with skepticism because of unknown current and future numbers of vascular surgeons and their average caseloads. Regardless of these uncertainties, vascular surgeons, program directors, and health analysts should be aware of such information because until we know how many vascular surgeons are necessary to provide optimal care, training and certification can not rationally evolve. (J VASC SURG 1986;3:74-83.)
Peter C Wyer - One of the best experts on this subject based on the ideXlab platform.
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p269 adaptation of a north american institutionally based health technology assessment ihta model to a private brazilian health care organization bhco
BMJ Quality & Safety, 2013Co-Authors: Alves S Da Silva, Cabanelas M Pazos, Pereira P De Souza, Rascao P Cardoso, Peter C WyerAbstract:Background Brazilian Guidelines, developed by medical societies, are sparsely used by federal agencies to determine coverage. To date there is no organised approach to clinical policy and guideline development or for dialogue with regulators within BHCOs. Amil, the largest BHCO, covers 6 million lives distributed across 8 regions and delivers care to many through its own medical centres. Objectives To develop a minimally resourced clinical policy and implementation capability within Amil together with a training programme on a national level. Methods Our approach is based on observation of the Penn Health System and the Kaiser Permanente (KP) models of IHTA. We are profiling current capacity for integrating umbrella reviews with mining and interpretation of internally generated practice data, and are identifying resource and Manpower Needs. To promote cultural change on national scale we reformulated an annual training workshop made in partnership with NYAM and McMaster and opened to participants within and without Amil, including Health Ministry and Regulatory Agencies, by addressing guideline development, adaptation and implementation skills. Results Our approach identifies knowledge gaps within the organisation and develops related guidelines and outcomes assessment to be internally used through Electronic Health Records and to be presented to regulators as proposal for change. The framework was built on a piloted approach on bariatric surgery and on the identification of additional target areas. Our capacity building programme has trained over 250 individuals within and without Amil, including policy developers within regional and national health ministries. Conclusion An IHTA programme within a BHCO may offer a capacity building model useful for national development.
Maycon Diego Ribeiro - One of the best experts on this subject based on the ideXlab platform.
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Design of greenhouse subirrigation bench
2014Co-Authors: Maycon Diego RibeiroAbstract:Resumo: No cultivo em ambientes protegidos, o uso da irrigação é necessário, requerendo alta frequência e gerando dependência tecnológica do produtor na aplicação de água e fertilizantes. Irrigações inadequadas potencializam problemas, trazendo prejuízos financeiros pela baixa produtividade e desperdício de solução nutritiva (SN) e energia. Adicionalmente, o descarte inadequado desses insumos pode contaminar o solo e, consequentemente, o lençol freático. Estudos mostram que os sistemas de subirrigação têm potencial para obter altas eficiências na irrigação nesses ambientes, principalmente, quando há a recirculação da solução nutritiva. Porém, os equipamentos existentes atualmente no mercado foram desenvolvidos sem critérios de engenharia e produzidos em pequena escala para atender condições específicas de produção resultando em elevado custo inicial. Adicionalmente, a falta de conhecimentos sobre a sua aplicabilidade para diferentes sistemas de produção e sobre recomendações do manejo hídrico e nutricional para culturas distintas, proporciona outra limitação na sua aplicação, desencoraja sua adoção pelos produtores. O projeto e construção de uma mesa de subirrigação utilizando critérios de engenharia, que permitam o reuso da SN e o controle automático do manejo hídrico nutricional para diferentes culturas, disponibilizará um equipamento com potencial para ser inserido no mercado nacional de produção em ambientes protegidos. O objetivo desse trabalho foi projetar uma mesa de subirrigação automatizada com reuso da SN, a partir da aplicação de critérios de projeto de engenharia. Essa pesquisa foi dividida nas seguintes etapas: levantamento de informações sobre sistemas de subirrigação existentes no mercado, avaliação de campo de um sistema em operação, estabelecimento de parâmetros de dimensionamento por simulação, e a construção e avaliação de protótipo de equipamento. Os levantamentos realizados não localizaram fabricantes nacionais de equipamentos de subirrigação, e mostraram que os equipamentos em operação apresentavam projetos desenvolvidos empiricamente e construídos a partir de demanda específica do produtor. O sistema de subirrigação em operação avaliado apresentou baixa eficiência de irrigação e aplicação de água devido a perdas e ao descarte de SN. Os critérios adotados para o projeto da mesa de subirrigação foram ergonômicos e de segurança, funcionalidade e aplicabilidade, a escolha do material construtivo. A aplicação dos critérios adotados possibilitou o estabelecimento das seguintes características da mesa de subirrigação: largura de 1,58 m, comprimento variável, altura da borda de 0,06 m, chapa de poliestireno de alto impacto para a mesa e perfis de alumínio para a estrutura. A variação da combinação da vazão e do diâmetro do orifício de dreno associado ao controle automático do nível da lâmina na mesa de subirrigação atendem as exigências de manejo hídrico de diferentes culturas possibilitam a redução do uso de mão de obra e evita descartes com a recirculação da SN. Os resultados de avaliação da mesa de subirrigação construída permitiram identificar diferentes combinações de manejo associada à variação da altura e tempo de permanência da SN no interior da mesa. Concluiu-se que a mesa de subirrigação construída a partir de critérios de projeto de engenharia, com controle automático da reutilização da SN, tem potencial para ser inserido no mercado de ambiente protegido, tendo a opção de ser empregada em diferentes recipientes de produção, cultura e manejo.Abstract: Irrigation is a mandatory practice in greenhouse production, requiring high frequency and generating farmer technological dependency in water and fertilizers application. Low irrigation efficiencies increase production problems, bringing financial losses due to low yield and nutrient solution (NS) waste and energy cost. Additionally, the unsuitable disposal of these inputs can contaminate the soil and hence, the water resources. Studies showed that subirrigation systems have the potential for high efficiencies in greenhouse irrigation, especially when the recirculation of the nutrient solution is employed. However, subirrigation equipments currently available on the Brazilian market were designed without engineering criteria and produced on a small scale to meet specific production conditions, determining high initial investment cost. Furthermore, the lack of knowledge about its applicability to different production systems and water and nutritional management for distinct crops, provides another restriction in its application, and discourages producers in adopting this system. The design and construction of a subirrigation bench based on engineering criteria, enabling the NS reuse and the automatic control of water and nutrient management for different crops will provide a device with the potential to be introduced in the domestic market of greenhouse production. The objective of this work was to design an automated subirrigation bench with NS reuse, applying the fundamentals of engineering design criteria. This research was divided into the following steps: an information survey on commercial subirrigation systems, a subirrigation system field evaluation, and establishment of parameters for sizing simulation and the construction and evaluation of prototype equipment. The survey results do not tracked national companies that manufacture detailed subirrigation equipment, and shown that equipment found in farm operations was designed and developed empirically and constructed from specific producer demands. The evaluated subirrigation system revealed low values of irrigation and water application efficiencies due to NS losses and frequent disposal. The criteria adopted for the subirrigation bench design were based on ergonomic and safety, functionality and applicability issues, and the manufacture material selection. The implemented design criteria enabled the establishment of the following subirrigation bench features: width 1.58 m, length adjustable, edge height of 0.06 m, high impact polystyrene sheets for the bench frame and aluminum sheets for the supporting structure. The combinations of operation flow rate and drain orifice diameters, associated to the automated level control, allowed to establish water and nutrient management for different crops, reducing Manpower Needs and avoiding NS disposal due to the recirculated practice. The evaluation results of the assembled subirrigation bench showed that different management combinations can be performed by varying the NS depth and its residence time inside the equipment. It was concluded that the subirrigation bench constructed based on engineering design criteria, with automated management system and NS reuse, has the potential to be introduced in the greenhouse production market, with the option to be implemented to various crops and containers
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Design of greenhouse subirrigation bench
Universidade Estadual de Campinas . Faculdade de Engenharia Agrícola, 2013Co-Authors: Maycon Diego RibeiroAbstract:No cultivo em ambientes protegidos, o uso da irrigação é necessário, requerendo alta frequência e gerando dependência tecnológica do produtor na aplicação de água e fertilizantes. Irrigações inadequadas potencializam problemas, trazendo prejuízos financeiros pela baixa produtividade e desperdício de solução nutritiva (SN) e energia. Adicionalmente, o descarte inadequado desses insumos pode contaminar o solo e, consequentemente, o lençol freático. Estudos mostram que os sistemas de subirrigação têm potencial para obter altas eficiências na irrigação nesses ambientes, principalmente, quando há a recirculação da solução nutritiva. Porém, os equipamentos existentes atualmente no mercado foram desenvolvidos sem critérios de engenharia e produzidos em pequena escala para atender condições específicas de produção resultando em elevado custo inicial. Adicionalmente, a falta de conhecimentos sobre a sua aplicabilidade para diferentes sistemas de produção e sobre recomendações do manejo hídrico e nutricional para culturas distintas, proporciona outra limitação na sua aplicação, desencoraja sua adoção pelos produtores. O projeto e construção de uma mesa de subirrigação utilizando critérios de engenharia, que permitam o reuso da SN e o controle automático do manejo hídrico nutricional para diferentes culturas, disponibilizará um equipamento com potencial para ser inserido no mercado nacional de produção em ambientes protegidos. O objetivo desse trabalho foi projetar uma mesa de subirrigação automatizada com reuso da SN, a partir da aplicação de critérios de projeto de engenharia. Essa pesquisa foi dividida nas seguintes etapas: levantamento de informações sobre sistemas de subirrigação existentes no mercado, avaliação de campo de um sistema em operação, estabelecimento de parâmetros de dimensionamento por simulação, e a construção e avaliação de protótipo de equipamento. Os levantamentos realizados não localizaram fabricantes nacionais de equipamentos de subirrigação, e mostraram que os equipamentos em operação apresentavam projetos desenvolvidos empiricamente e construídos a partir de demanda específica do produtor. O sistema de subirrigação em operação avaliado apresentou baixa eficiência de irrigação e aplicação de água devido a perdas e ao descarte de SN. Os critérios adotados para o projeto da mesa de subirrigação foram ergonômicos e de segurança, funcionalidade e aplicabilidade, a escolha do material construtivo. A aplicação dos critérios adotados possibilitou o estabelecimento das seguintes características da mesa de subirrigação: largura de 1,58 m, comprimento variável, altura da borda de 0,06 m, chapa de poliestireno de alto impacto para a mesa e perfis de alumínio para a estrutura. A variação da combinação da vazão e do diâmetro do orifício de dreno associado ao controle automático do nível da lâmina na mesa de subirrigação atendem as exigências de manejo hídrico de diferentes culturas possibilitam a redução do uso de mão de obra e evita descartes com a recirculação da SN. Os resultados de avaliação da mesa de subirrigação construída permitiram identificar diferentes combinações de manejo associada à variação da altura e tempo de permanência da SN no interior da mesa. Concluiu-se que a mesa de subirrigação construída a partir de critérios de projeto de engenharia, com controle automático da reutilização da SN, tem potencial para ser inserido no mercado de ambiente protegido, tendo a opção de ser empregada em diferentes recipientes de produção, cultura e manejo.Irrigation is a mandatory practice in greenhouse production, requiring high frequency and generating farmer technological dependency in water and fertilizers application. Low irrigation efficiencies increase production problems, bringing financial losses due to low yield and nutrient solution (NS) waste and energy cost. Additionally, the unsuitable disposal of these inputs can contaminate the soil and hence, the water resources. Studies showed that subirrigation systems have the potential for high efficiencies in greenhouse irrigation, especially when the recirculation of the nutrient solution is employed. However, subirrigation equipments currently available on the Brazilian market were designed without engineering criteria and produced on a small scale to meet specific production conditions, determining high initial investment cost. Furthermore, the lack of knowledge about its applicability to different production systems and water and nutritional management for distinct crops, provides another restriction in its application, and discourages producers in adopting this system. The design and construction of a subirrigation bench based on engineering criteria, enabling the NS reuse and the automatic control of water and nutrient management for different crops will provide a device with the potential to be introduced in the domestic market of greenhouse production. The objective of this work was to design an automated subirrigation bench with NS reuse, applying the fundamentals of engineering design criteria. This research was divided into the following steps: an information survey on commercial subirrigation systems, a subirrigation system field evaluation, and establishment of parameters for sizing simulation and the construction and evaluation of prototype equipment. The survey results do not tracked national companies that manufacture detailed subirrigation equipment, and shown that equipment found in farm operations was designed and developed empirically and constructed from specific producer demands. The evaluated subirrigation system revealed low values of irrigation and water application efficiencies due to NS losses and frequent disposal. The criteria adopted for the subirrigation bench design were based on ergonomic and safety, functionality and applicability issues, and the manufacture material selection. The implemented design criteria enabled the establishment of the following subirrigation bench features: width 1.58 m, length adjustable, edge height of 0.06 m, high impact polystyrene sheets for the bench frame and aluminum sheets for the supporting structure. The combinations of operation flow rate and drain orifice diameters, associated to the automated level control, allowed to establish water and nutrient management for different crops, reducing Manpower Needs and avoiding NS disposal due to the recirculated practice. The evaluation results of the assembled subirrigation bench showed that different management combinations can be performed by varying the NS depth and its residence time inside the equipment. It was concluded that the subirrigation bench constructed based on engineering design criteria, with automated management system and NS reuse, has the potential to be introduced in the greenhouse production market, with the option to be implemented to various crops and containers
Alves S Da Silva - One of the best experts on this subject based on the ideXlab platform.
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p269 adaptation of a north american institutionally based health technology assessment ihta model to a private brazilian health care organization bhco
BMJ Quality & Safety, 2013Co-Authors: Alves S Da Silva, Cabanelas M Pazos, Pereira P De Souza, Rascao P Cardoso, Peter C WyerAbstract:Background Brazilian Guidelines, developed by medical societies, are sparsely used by federal agencies to determine coverage. To date there is no organised approach to clinical policy and guideline development or for dialogue with regulators within BHCOs. Amil, the largest BHCO, covers 6 million lives distributed across 8 regions and delivers care to many through its own medical centres. Objectives To develop a minimally resourced clinical policy and implementation capability within Amil together with a training programme on a national level. Methods Our approach is based on observation of the Penn Health System and the Kaiser Permanente (KP) models of IHTA. We are profiling current capacity for integrating umbrella reviews with mining and interpretation of internally generated practice data, and are identifying resource and Manpower Needs. To promote cultural change on national scale we reformulated an annual training workshop made in partnership with NYAM and McMaster and opened to participants within and without Amil, including Health Ministry and Regulatory Agencies, by addressing guideline development, adaptation and implementation skills. Results Our approach identifies knowledge gaps within the organisation and develops related guidelines and outcomes assessment to be internally used through Electronic Health Records and to be presented to regulators as proposal for change. The framework was built on a piloted approach on bariatric surgery and on the identification of additional target areas. Our capacity building programme has trained over 250 individuals within and without Amil, including policy developers within regional and national health ministries. Conclusion An IHTA programme within a BHCO may offer a capacity building model useful for national development.