Engine Light Repair Shop Evaluation for a Brazilian Airline

The maintenance cost of a commercial aircraft comprises airframe, components, and engines. The most expensive of them are engines, which may represent up to 60% of an aircraft cost, and therefore will have a significant impact on any airline finance. As a result, engine fleet maintenance management is crucial for any airline sustainability. Apart from heavy maintenance where life limited parts are replaced and its performance restored, aircraft engines are often required to come off wing for light repair due to operational issues like foreign object damage, high oil consumption, and vibration issues. In other cases, even though being operational, engines are required to come off the wing and undertake repair processes to comply with lease return conditions. Although these light repairs may be simple and relatively short in time, they require the engines to be transported to dedicated repair shops impacting engine availability due to shop slots unavailability and the logistics. This drives airlines to have additional spare engines on its fleet increasing its operating costs. This project is aimed at evaluating the pros and cons any Brazilian airline may have if it decides to have its engine shop for light repairs. Due to the complexity of the engine repair process, this project will be focused on a specific repair for a specific engine, which, if developed internally, may allow airlines to expand their light repair capability and, in the long term, improve engine availability

Anestesia total intravenosa (ATI) para herniorrafias umbilicais em bezerros

The total intravenous anesthesia (TIVA) is an option for some surgeries in bovines for fields. The aim of this study was to evaluate blood gases effects, cardiorespiratory and glycemia on calves submitted the umbilical herniorraphy. We used eight calves aged from 9 ± 4 months, weighting 111 ± 43 kg. The animals were pre-treated with xylazine (0.05 mg/kg IV) and after 15 minutes was administered ketamine (2.0 mg/kg IV) followed by the continuous infusion of xylazine (0.05 mg/ml), guaifenesin (50 mg/mL) and ketamine (1mg/ml) at a rate of infusion of 2mL/kg/hour. The blood gases and glucose samples were collected immediately before the MPA (MB) and the 5, 40 and 80 after the starting of TIVA (M5, M40 e M80). The other variables were measured in MB, 15 minutes after the MPA (Mx) and every 10 minutes after the starting of TIVA, entiring 80 minutes. The heart rate was higher in MB than in the other stages (p <0.05) and respiratory rate increased in M20 and M50 compared to MB and Mx (p <0.05). The PvCO2 increased while PaO2 decreased in M40 and M80, for MB (p <0.05), PVCO2 in M80 was lower than in MB (p <0.05). The pHv was smaller in M80 than M5 and MB (p <0.05), and HCO3 was lower in MB (p <0.05) compared to the others. The glucose was higher in M40 and M80 and M5 for MB (p <0.05). The recovery time was 152 ± 60 minutes after the end of the administration of the infusion of anesthetics. It was conclude that the anesthetic technique employed promoted respiratory depression, increased blood glucose and prolonged period of anesthetic recovery in calves.La anestesia total intravenosa (ATI) es una opción para algunas cirugías en vacunos a campo. Se objetivó evaluar los efectos hemogasométricos, cardiorrespiratorios y la glicemia de la ATI en terneros sometidos a la herniorrafía umbilical. Fueron utilizados ocho terneros con edad de 9 ± 4 meses, pesando 111 ± 43 Kg. Los animales fueron pre medicados con xilazina (0,05 mg/Kg. IV) y después de 15 minutos se administró ketamina (2,0 mg/Kg. IV) seguida de infusión continua de xilazina (0,05 mg/mL), éter gliceril guayacol (50mg/mL) y ketamina (1mg/mL), en una tasa de infusión de 2mL/Kg./hora. Se recolectaron muestras de sangre para hemogasometría y glicemia inmediatamente antes de la MPA (MB) y a los 5, 40 y 80 minutos después del inicio de la ATI (M5, M40 e M80). Las demás variables fueron aferidas en MB, 15 minutos después de la MPA (Mx) y a cada 10 minutos después del inicio de la ATI, totalizando 80 minutos. La frecuencia cardiaca fue más grande en MB de que en los demás momentos (p<0,05) y la frecuencia respiratoria más grande en M20 y M50 comparado la MB y Mx (p<0,05). La PVCO2 fue más grande y la PAO2 fue más pequeña en M40 y M80, en relación a MB (p<0,05), PVO2 fue más pequeña en M80 de que en MB (p<0,05). El pHV fue más pequeño en M80 de que en MB y M5 (p<0,05) y el HCO3 fue más pequeño en MB (p<0,05) en relación a los demás. La glicemia fue más grande en M40 y M80 en relación a M5 y MB (p<0,05). El período de tiempo para la recuperación anestésica fue de 152 ± 60 minutos después del fin de la administración de la infusión. Se llegó a la conclusión de que la técnica anestésica empleada promovió depresión respiratoria, aumento de glicemia y período prolongado de recuperación anestésica en vacunos.A anestesia total intravenosa (ATI) é uma opção para algumas cirurgias em bovinos a campo. Objetivou-se avaliar os efeitos hemogasométricos, cardiorrespiratórios e a glicemia da ATI em bezerros submetidos à herniorrafia umbilical. Foram utilizados oito bezerros com idade de 9 4 meses, pesando 111 43 kg. Os animais foram pré- medicados com xilazina (0,05 mg/kg IV) e após 15 minutos administrou-se quetamina (2,0 mg/kg IV) seguida da infusão contínua de xilazina (0,05 mg/mL), éter gliceril guaiacol (50 mg/mL) e quetamina (1 mg/mL), numa taxa de infusão de 2 mL/kg/hora. Foram colhidas amostras de sangue para hemogasometria e glicemia imediatamente antes da MPA (MB) e aos 5, 40 e 80 minutos após o início da ATI (M5, M40 e M80). As demais variáveis foram aferidas em MB, 15 minutos após a MPA (Mx) e a cada 10 minutos após o início da ATI, totalizando 80 minutos. Os valores da freqüência cardíaca foram maiores em MB do que nos demais momentos (p<0,05) e a freqüência respiratória se elevou em M20 e M50 comparado a MB e Mx (p<0,05). A PVCO2 foi superior enquanto que a PAO2 foi inferior em M40 e M80, em relação a MB (p<0,05). Já a PVO2 apresentou valores menores em M80 do que em MB (p<0,05). O pHV foi inferior em M80 quando comparado a MB e M5 (p<0,05) e o HCO3 foi inferior em MB (p<0,05) em relação aos demais. A glicemia apresentou valores superiores em M40 e M80 em relação a M5 e MB (p<0,05) e o período de tempo para a recuperação anestésica foi de 152 ± 60 minutos após o final da administração da infusão dos agentes anestésicos. Conclui-se que a técnica anestésica empregada em bezerros promoveu depressão respiratória, aumento da glicemia e prolongado período de recuperação anestésica

Changing rate of serious infections in biologic-exposed rheumatoid arthritis patients : data from South American registries BIOBADABRASIL and BIOBADASAR

Most reports on serious infections (SI) in rheumatoid arthritis (RA) patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) are from the USA and Western Europe. Data from other regions are largely missing. We report data from South American countries with different backgrounds and health-care systems but similar registries. We merged 2010-2016 data from two registries, BIOBADABRASIL (Brazil) and BIOBADASAR (Argentina), which share the same protocol, online platform and data monitoring process. Patients with active RA were included when they began the first bDMARD or a conventional synthetic DMARD (csDMARD, control group). The SI incidence rate (IR) per 1000 patient/years and adjusted IR ratio (aIRR) were estimated for bDMARDs and csDMARDs. Data were analysed for 3717 RA patients with an exposure of 13,380 patient/years. The 2591 patients treated with bDMARDs (64% tumour necrosis factor-alpha inhibitors (TNFi)) had a follow-up of 9300years, and the 1126 treated with csDMARDs had an exposure of 4081 patient/years. The SI IR was 30.54 (CI 27.18-34.30) for all bDMARDs and 5.15 (CI 3.36-7.89) for csDMARDs. The aIRR between the two groups was 2.03 ([1.05, 3.9] p=0.034) for the first 6months of treatment but subsequently increased to 8.26 ([4.32, 15.76] p<0.001). The SI IR for bDMARDs decreased over time in both registries, dropping from 36.59 (28.41-47.12) in 2012 to 7.27 (4.79-11.05) in 2016. While SI remains a major concern in South American patients with RA treated with bDMARDs, a favourable trend toward a reduction was observed in the last years3882129213

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)