Implementation of the Eclipse Process Framework Composer Tool for the Documentation of Quality Management Systems: A Case Applied in Healthcare Services

This document presents the implementation of the Eclipse Process Framework Composer EPFC tool, in a company in the health sector, which where it were using physical documentation to register the processes QMS Quality Management Systems, in this one it is explained the process of adapting the tool, to migrate the documentary structure of the company, through the application of a model that correlates the attributes of the tool with the documentary structure. The proposed model allows the construction of document structures for the QMS that guide the user in their processes and procedures within the organization. Therefore, it is proposed that by promoting knowledge management and reducing the execution time of the processes, it will be possible for companies to be more productive, improve customer service, failure rates in the development of activities be minimized and, and reduces the lead time in the processes. Finally, it was obtained a documentary platform developed under a process approach that implements interactive diagrams that aim to facilitate the understanding of each of the elements that make up the QMS

A Novel Non-invasive Approach for Measuring Upper Airway Collapsibility in Mice

Introduction: Invasive procedures were previously developed for measuring pharyngeal collapsibility in rodents during expiration, when declining neuromuscular activity makes the airway unstable. We developed a non-invasive approach for streamlining collapsibility measurements by characterizing responses in physiologic markers of dynamic expiratory airflow obstruction to negative nasal pressure challenges.Methods: Anesthetized mice were instrumented to monitor upper airway pressure-flow relationships with head-out plethysmography while nasal pressure was ramped down from ~ +5 to −20 cm H2O over several breaths. Inspiratory and expiratory flow, volume, and timing characteristics were assessed breath-wise. Pcrit was estimated at transitions in expiratory amplitude and timing parameters, and compared to gold standard PCRIT measurements when nasal and tracheal pressures diverged during expiration. Predictions equations were constructed in a development data set (n = 8) and applied prospectively to a validation data set (n = 16) to estimate gold standard PCRIT.Results: The development data demonstrated that abrupt reversals in expiratory duration and tidal volume during nasal pressure ramps predicted gold standard PCRIT measurements. After applying regression equations from the development to a validation dataset, we found that a combination of expiratory amplitude and timing parameters proved to be robust predictors of gold standard PCRIT with minimal bias and narrow confidence intervals.Conclusions: Markers of expiratory airflow obstruction can be used to model upper airway collapsibility, and can provide sensitive measures of changes in airway collapsibility in rodents. This approach streamlines repeated non-invasive PCRIT measurements, and facilitates studies examining the impact of genetic, environmental, and pharmacologic factors on upper airway control

Cost Effectiveness and Cost Containment in the Era of Interferon-Free Therapies to Treat Hepatitis C Virus Genotype 1

Abstract Background. Interferon-free regimens to treat hepatitis C virus (HCV) genotype 1 are effective but costly. At this time, payers in the United States use strategies to control costs including (1) limiting treatment to those with advanced disease and (2) negotiating price discounts in exchange for exclusivity. Methods. We used Monte Carlo simulation to investigate budgetary impact and cost effectiveness of these treatment policies and to identify strategies that balance access with cost control. Outcomes included nondiscounted 5-year payer cost per 10000 HCV-infected patients and incremental cost-effectiveness ratios. Results. We found that the budgetary impact of HCV treatment is high, with 5-year undiscounted costs of $1.0 billion to 2.3 billion per 10000 HCV-infected patients depending on regimen choices. Among noncirrhotic patients, using the least costly interferon-free regimen leads to the lowest payer costs with negligible difference in clinical outcomes, even when the lower cost regimen is less convenient and/or effective. Among cirrhotic patients, more effective but costly regimens remain cost effective. Controlling costs by restricting treatment to those with fibrosis stage 2 or greater disease was cost ineffective for any patient type compared with treating all patients. Conclusions. Treatment strategies using interferon-free therapies to treat all HCV-infected persons are cost effective, but short-term cost is high. Among noncirrhotic patients, using the least costly interferon-free regimen, even if it is not single tablet or once daily, is the cost-control strategy that results in best outcomes. Restricting treatment to patients with more advanced disease often results in worse outcomes than treating all patients, and it is not preferred

Comprehensive molecular portraits of human breast tumours

We analysed primary breast cancers by genomic DNA copy number arrays, DNA methylation, exome sequencing, messenger RNA arrays, microRNA sequencing and reverse-phase protein arrays. Our ability to integrate information across platforms provided key insights into previously defined gene expression subtypes and demonstrated the existence of four main breast cancer classes when combining data from five platforms, each of which shows significant molecular heterogeneity. Somatic mutations in only three genes (TP53, PIK3CA and GATA3) occurred at.10% incidence across all breast cancers; however, there were numerous subtype-associated and novel gene mutations including the enrichment of specific mutations in GATA3, PIK3CA and MAP3K1 with the luminal A subtype. We identified two novel protein-expression-defined subgroups, possibly produced by stromal/microenvironmental elements, and integrated analyses identified specific signalling pathways dominant in each molecular subtype including a HER2/phosphorylated HER2/EGFR/phosphorylated EGFR signature within the HER2-enriched expression subtype. Comparison of basal-like breast tumours with high-grade serous ovarian tumours showed many molecular commonalities, indicating a related aetiology and similar therapeutic opportunities. The biological finding of the four main breast cancer subtypes caused by different subsets of genetic and epigenetic abnormalities raises the hypothesis that much of the clinically observable plasticity and heterogeneity occurs within, and not across, these major biological subtypes of breast cancer. © 2012 Macmillan Publishers Limited. All rights reserved

Fitting very short finger stumps with silicone prosthesis: A nonsurgical method

10.1177/0309364612469386Prosthetics and Orthotics International375415-420POIN

Autoclaved autograft bone combined with vascularized bone and bone marrow

Clinical Orthopaedics and Related Research320220-230CORT

Slipped capital femoral epiphysis in adulthood with associated hypopituitarism

Journal of Orthopaedic Surgery3285-89JOTS

Application of the IR transmission method and the Mossbauer effect to the crystallization of calcium gallate glass

Crystallization of infrared-light transmitting 40CaO·60Ga2O3 glass caused by heat treatment, Full-size image (<1 K)γ-ray irradiation and YAG laser irradiation was investigated. The X-ray diffraction (XRD) data revealed that a CaGa4O7 phase was precipitated by heat treatment. The Avrami index (n) of 1.7±0.2 obtained from `the Fourier transform infrared (FT-IR) transmission method' combined with the Johnson–Mehl–Avrami (JMA) equation indicated that the crystallization proceeded three dimensionally. The activation energy (Ea) of 7.2±0.3 eV obtained from the JMA plot was equal to that obtained from the Kissinger plot in the differential thermal analysis: Ea=7.1±0.2 eV. Mössbauer spectra of 40CaO·59Ga2O3·Full-size image (<1 K)2O3 samples showed the oxidation of iron from Fe2+ to Fe3+. Mössbauer spectra of the 40CaO·59Ga2O3·Full-size image (<1 K)2O3 samples irradiated with the YAG laser also showed an oxidation of Fe2+ to Fe3+. In case of Full-size image (<1 K)γ-ray irradiated samples, however, a reduction of the iron from Fe3+ to Fe2+ was observed. This result indicates that Fe3+ occupies substitutional sites of Ga3+ in the gallate glass