On mechanics and monitoring of plunge-roll rotary dressing of grinding wheels

A study is made into the mechanics and monitoring of rotary plunge-roll dressing of grinding wheels using a roll with multi-layer diamonds contained in a hybrid, metal-ceramic bond. A fundamental relationship is obtained between grinding/dressing specific energy and the dressing aggressiveness number Aggrd, revealing a distinct size effect. Results also indicate (i) a nearly linear relationship between grinding and dressing specific energy, and (ii) direct proportionality between dressing specific energy and the acoustic emission (AE) signal. SEM observations indicate that smaller Aggrd produces a grit-dulling phenomenon different from grinding-induced dulling of the grits by attrition, which causes rapid workpiece-material adhesion

Funding models in palliative care: lessons from international experience

Background:Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them.Aim:To assess national models and methods for financing and reimbursing palliative care.Design:Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms.Results:Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following:Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision.Funding is frequently characterised as a mixed system of charitable, public and private payers.The basis on which providers are paid for services rarely reflects individual care input or patient needs.Conclusion:Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest

Integrated care for patients with advanced chronic obstructive pulmonary disease

Przewlekła obturacyjna choroba płuc (POChP) jest trzecią przyczyną zgonów i trzecią przyczyną niesprawności (mierzonej za pomocą wskaźnika DALY) u osób powyżej 60. roku życia. Ciężką lub bardzo ciężką postać POChP (wskaźnik FEV1, odpowiednio, poniżej 50% i 30% należnej wartości) rozpoznaje się u mniej więcej jednej piątej ogółu chorych. Chorzy na zaawansowaną POChP z reguły cierpią z powodu fizycznej i umysłowej niepełnosprawności, w wielu przypadkach źle radzą sobie z problemami wynikającymi z choroby i współistniejących schorzeń. To z kolei stwarza duże ryzyko zaostrzeń POChP, które prowadzą do pogorszenia przebiegu choroby, istotnego zwiększenia kosztów medycznej opieki oraz zwiększenia ryzyka zgonu. Obecna organizacja medycznej opieki dla tej grupy chorych nie zapewnia odpowiednich warunków zdrowotnych i socjalnych. Wydaje się jednak, że zastosowanie modelu zintegrowanej opieki, zalecanego przez Światową Organizację Zdrowia stworzyłoby możliwość poprawy sytuacji chorych na zaawansowane POChP. W Polsce ta forma opieki jest realizowana od kilkunastu lat w zakładach medycyny paliatywnej i hospicjach w odniesieniu do chorych na zaawansowane nowotwory. Wykorzystanie tych doświadczeń powinno pomóc w integracji działań wokół lekarzy rodzinnych i wyspecjalizowanej pielęgniarki, z jednoczesnym zapewnieniem dostępu do specjalistów w zależności od indywidualnych potrzeb chorego. Powinno także umożliwić szersze wykorzystanie pracowników pomocniczych, jak: pracownicy socjalni, pomocnicy medyczni oraz wolontariusze, a także psycholodzy i duchowni (zwłaszcza w końcowej fazie choroby). Pneumonol. Alergol. Pol. 2010; 78, 2: 126-132Chronic obstructive pulmonary disease (COPD) is the third cause of mortality and disability (assed by DALY) among patients above 60 year old. Severe and very severe COPD (FEV1 = equal or less than 50% and 30% of expected value, respectively) is estimated at 20% of all COPD patients. Advanced COPD usually leads to physical and mental deterioration, the patients often manage with the problems caused by the disease and other comorbidities poorly. This leads to increased risk of COPD exacerbations and further deterioration of the patient’s status, increased costs of medical care and eventually increased risk of death. Current organization of medical care for those patients does not provide adequate health and social support for them. However, it seems that introducing an integrated approach proposed by World Health Organization, could improve the situation of advanced COPD patients. In Poland, this kind of care has been provided in advanced cancer patients throughout stationary palliative care units and hospices during the last several years. This experience should be helpful in integrating actions of general practitioners and specialized nurses, as well as providing access for the specialists’ consultations according to the individual needs of the patients. It should also allow for broad cooperation with auxiliary staff, such as social workers, medical assistants and volunteers, as well as psychologists and clergymen (especially in the terminal phase of the disease). Pneumonol. Alergol. Pol. 2010; 78, 2: 126-13

Funding models in palliative care: Lessons from international experience

Background: Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. Aim: To assess national models and methods for financing and reimbursing palliative care. Design: Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Results: Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Provider payment is rarely linked to population need and often perpetuates existing inequitable patterns in service provision. Funding is frequently characterised as a mixed system of charitable, public and private payers. The basis on which providers are paid for services rarely reflects individual care input or patient needs. Conclusion: Funding mechanisms need to be well understood and used with caution to ensure best practice and minimise perverse incentives. Before we can conduct cross-national comparisons of costs and impact of palliative care, we need to understand the funding and policy context for palliative care in each country of interest

Economical and technological study of surface grinding versus face milling in hardened AISI D3 steel machining operations

[EN] This work deals with the technological and economic considerations required to select face milling vs. surface grinding operations in the manufacture of hardened steel flat surfaces for dies and moulds. In terms of technological considerations, factors such as component geometry, material and surface quality (dimensional tolerance and surface finish) are taken into account. The economic considerations include the cost of machine depreciation, labour and consumables (cutting tools in face milling vs. grinding wheels and dressing tool in surface grinding). A case study is presented based on the prismatic components in ceramic tile moulds and their associated manufacturing operations. Surface grinding and face milling experimentation was conducted on cold work steel AISI D3 (with hardness of 60 HRC) with aluminium oxide grinding wheels and coated tungsten carbide cutting tool, respectively. Technological attributes and economics of face milling are compared with surface grinding of this type of mould components. The main conclusion is that face milling with chamfered edge preparation in coated tungsten carbide tools is a competitive process, compared with surface grinding, in terms of product quality and economics.The research team would like to acknowledge the main support of the Caja Castello-Bancaixa Foundation and Universitat Jaume I, which support the project: "Integration of Planning, Execution and Control of High Speed Machining Operations in Collaborative Engineering Environments: Application in Moulds for Tile Industry", the ceramic tile mould company MACER S.L., and would like to extend their gratitude to Roberto Menendez, student of industrial engineering. Particular thanks go to the Programme Alssan: European Union Programme of High Level Scholarships for Latin America (scholarship no. E04D030982MX). Additional support was provided by Tecnologico de Monterrey through the research group in Mechatronics and Intelligent Machines (http://cidyt.mty.itesm/cimec).Vila Pastor, C.; Siller, H.; Rodríguez, C.; Bruscas Bellido, G.; Serrano, J. (2012). Economical and technological study of surface grinding versus face milling in hardened AISI D3 steel machining operations. International Journal of Production Economics. 138(2):273-283. doi:10.1016/j.ijpe.2012.03.028S273283138

Do guidelines influence breathlessness management in advanced lung diseases? A multinational survey of respiratory medicine and palliative care physicians

Background: Respiratory medicine (RM) and palliative care (PC) physicians’ management of chronic breathlessness in advanced chronic obstructive pulmonary disease (COPD), fibrotic interstitial lung disease (fILD) and lung cancer (LC), and the influence of practice guidelines was explored via an online survey. Methods: A voluntary, online survey was distributed to RM and PC physicians via society newsletter mailing lists. Results: 450 evaluable questionnaires (348 (77%) RM and 102 (23%) PC) were analysed. Significantly more PC physicians indicated routine use (often/always) of opioids across conditions (COPD: 92% vs. 39%, fILD: 83% vs. 36%, LC: 95% vs. 76%; all p < 0.001) and significantly more PC physicians indicated routine use of benzodiazepines for COPD (33% vs. 10%) and fILD (25% vs. 12%) (both p < 0.001). Significantly more RM physicians reported routine use of a breathlessness score (62% vs. 13%, p < 0.001) and prioritised exercise training/rehabilitation for COPD (49% vs. 7%) and fILD (30% vs. 18%) (both p < 0.001). Overall, 40% of all respondents reported reading non-cancer palliative care guidelines (either carefully or looked at them briefly). Respondents who reported reading these guidelines were more likely to: routinely use a breathlessness score (χ2 = 13.8; p < 0.001), use opioids (χ2 = 12.58, p < 0.001) and refer to pulmonary rehabilitation (χ2 = 6.41, p = 0.011) in COPD; use antidepressants (χ2 = 6.25; p = 0.044) and refer to PC (χ2 = 5.83; p = 0.016) in fILD; and use a handheld fan in COPD (χ2 = 8.75, p = 0.003), fILD (χ2 = 4.85, p = 0.028) and LC (χ2 = 5.63; p = 0.018). Conclusions: These findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by RM, and continued benzodiazepine use in PC, suggest that a wider range of acceptable therapies need to be developed and trialled

The need to research refractory breathlessness

High-quality research is needed to improve quality of life for people with chronic refractory breathlessness in COP