Amapola : Pretty Little Poppy

Lyrics in English, French, and Spanish.https://digitalcommons.library.umaine.edu/mmb-vp/6783/thumbnail.jp

Sustitución de medicamentos de marca por genéricos en la consulta de atención primaria

ObjetivoDeterminar el porcentaje de pacientes que tras una explicación adecuada se muestran partidarios de cambiar su medicación habitual por una especialidad farmacéutica genérica (EFG).DiseñoObservacional, transversal.EmplazamientoEn dos centros de salud, uno urbano y otro rural, de la Comunidad Autónoma de Madrid.ParticipantesPacientes que acuden a consulta y son susceptibles de cambiar alguno de los medicamentos que precisan por una EFG.MétodoA los pacientes incluidos se les facilitó una misma información verbal de 40 s de duración explicando qué es una EFG. Seguidamente se completó un cuestionario de 18 preguntas. Se analizó de forma descriptiva la muestra calculando frecuencias y aplicando un análisis bivariante relacionando la variable «aceptación del cambio» con las demás.ResultadosEl 71% de los participantes aceptó el cambio a EFG. El 29% que no lo hizo alegó en un 67,4% que prefería consultarlo con el médico que lo prescribió, en un 45,1% que no iba a tener el mismo efecto, un 16,1% creyó que al ser más barato sería peor y otro 16,1% refirió que en caso de que le supusiera más gasto cambiaría. El médico percibió malestar en el paciente en un 23,4%, y se sintió él mismo satisfecho con la entrevista en un 83,9%, indiferente en un 12,9% e insatisfecho en un 3,2%.ConclusionesProporcionar información al paciente y permitirle participar en la decisión del cambio de medicación resulta muy ventajoso, ya que así se consigue el cambio en casi tres cuartas partes de los casos con un mínimo desgaste profesional y manteniendo una buena relación médicopaciente.ObjectiveTo estimate the percentage of patients who change from current medication to generic medicine once properly informed.DesignObservational, cross-sectional.SettingTwo primary care clinics in Madrid, one rural and the other urban.ParticipantsPatients who came for their consultation and who take prescribed drugs which have generic alternatives.MethodAll patients included received a standard 40 second verbal explanation about generics. Later, the researcher filled out a 18 items test. A descriptive analysis was done taking into account frequencies and applying a bivariable analysis comparing the variable «accepted change» with the others.Results71% of the patients accepted the change to generic medicine, 29% did not. Of the latter, 67.4% said that they preferred to consult with the prescribing physician; 45.1% were of the opinion that it would not have the same effect; a 16.1% said that if it was cheaper, it must be of a worse quality; and another 16.1% said that they would only accept the change if it meant saving some money.The researcher perceived distress and discomfort in 23.4% of the patients. He himself felt satisfied in 83.9% of the cases, indifferent in 12.9% and unsatisfied in 3.2%.ConclusionProviding the adequate information and letting the patients decide for themselves about the substitution of brand for generic drugs resulted in almost three quarters of the cases opting for the change. And this with a minimal professional effort and the added benefit of improving the patient-practioner relationship

5-axis double-flank CNC machining of spiral bevel gears via custom-shaped milling tools -- Part I: modeling and simulation

A new category of 5-axis flank computer numerically controlled (CNC) machining, called \emph{double-flank}, is presented. Instead of using a predefined set of milling tools, we use the shape of the milling tool as a free parameter in our optimization-based approach and, for a given input free-form (NURBS) surface, compute a custom-shaped tool that admits highly-accurate machining. Aimed at curved narrow regions where the tool may have double tangential contact with the reference surface, like spiral bevel gears, the initial trajectory of the milling tool is estimated by fitting a ruled surface to the self-bisector of the reference surface. The shape of the tool and its motion then both undergo global optimization that seeks high approximation quality between the input free-form surface and its envelope approximation, fairness of the motion and the tool, and prevents overcutting. That is, our double-flank machining is meant for the semi-finishing stage and therefore the envelope of the motion is, by construction, penetration-free with the references surface. Our algorithm is validated by a commercial path-finding software and the prototype of the tool for a specific gear model is 3D printed.RYC-2017-22649 BERC 2014-201

Definition of tailor made cutting tools for machining of complex surfaces based on final surface shape

In this work a design methodology to define the best geometry of cutting tool for complex surfaces is defined, being based on the final part surface geometry. The manufacture of components with tailor made shaped tools, based on algorithm calculation and adapted to the geometry of the final piece surface, reduces manufacturing time and maintains piece quality in comparison with traditional cutting tools. Cutting tools are usually cylindrical (end mills) or ball-end mills. With mathematical algorithms can be defined diamond & CBN electroplated form tools, multi-tooth endmills, abrasive grinding tools and so on. The approach here presented can enable the production of tools for manufacturing process such as Super Abrasive Machining (SAM) and Flank milling strategies. Comparison between standard tools and traditional machining processes versus custom-shaped tools was studied in terms of process time. Final applications are numerous, such as, integral blade rotors, spiral bevel gears, blisks and impellers, complex screws, and others

Super Abrasive Machining of Integral Rotary Components Using Grinding Flank Tools

Manufacturing techniques that are applied to turbomachinery components represent a challenge in the aeronautic sector. These components require high resistant super-alloys in order to satisfy the extreme working conditions they have to support during their useful life. Besides, in the particular case of Integrally Bladed Rotors (IBR), usually present complex geometries that need to be roughed and finished by milling and grinding processes, respectively. In order to improve their manufacturing processes, Super Abrasive Machining (SAM) is presented as a solution because it combines the advantages of the use of grinding tools with milling feed rates. However, this innovative technique usually needed high tool rotary speed and pure cutting oils cooling. These issues implied that SAM technique was not feasible in conventional machining centers. In this work, these matters were tackled and the possibility of using SAM in these five-axis centers with emulsion coolants was achieved. To verify this approach, Inconel 718 single blades with non-ruled surfaces were manufactured with Flank-SAM technique and conventional milling process, analyzing cutting forces, surface roughness, and dimension accuracy in both cases. The results show that SAM implies a suitable, controllable, and predictable process to improve the manufacture of aeronautical critical components, such as IBR.FEDE

5-axis double-flank CNC machining of spiral bevel gears via custom-shaped tools – Part II: physical validations and experiments

Recently, a new methodology for 5-axis flank computer numerically controlled (CNC) machining, called double-flank machining, has been introduced (see “5-axis double-flank CNC machining of spiral bevel gears via custom-shaped milling tools–Part I: Modeling and simulation”). Certain geometries, such as curved teeth of spiral bevel gear, admit this approach where the machining tool has tangential contact with the material block on two sides, yielding a more efficient variant of flank machining. To achieve high machining accuracy, the path-planning algorithm, however, does not look only for the path of the tool, but also for the shape of the tool itself. The proposed approach is validated by series of physical experiments using an abrasive custom-shaped tool specifically designed for a particular type of a spiral bevel gear. The potential of this new methodology is shown in the semifinishing stage of gear manufacturing, where it outperforms traditional ball end milling by an order of magnitude in terms of machining time, while keeping, or even improving, the machining error.RYC-2017-22649 KK-2020/0010

Blisk blades manufacturing technologies analysis

The paper presents blisk blades manufactured by different manufacturing processes. In this sense, different milling trajectories are presented, and, super abrasive machining strategies and EDM technologies are also tested. Machining times, costs and surface finish are analysed in order to determine optimal machining process for blisk manufactured in low machinability materials.RYC-2017-2264