A new approach to designing reduced scale thermal-hydraulic experiments

Reduced scale experiments are often employed in engineering because they are much cheaper than real scale testing. Unfortunately, though, it is difficult to design a thermal-hydraulic circuit or equipment in reduced scale capable of reproducing, both accurately and simultaneously, all the physical phenomena that occur in real scale and operating conditions. This paper presents a methodology to designing thermal-hydraulic experiments in reduced scale based on setting up a constrained optimization problem that is solved using genetic algorithms (GAs). In order to demonstrate the application of the methodology proposed, we performed some investigations in the design of a heater aimed to simulate the transport of heat and momentum in the core of a pressurized water reactor (PWR) at 100% of nominal power and non-accident operating conditions. The results obtained show that the proposed methodology is a promising approach for designing reduced scale experiments.     

Evaluation of a new computer-assisted surgical planning and navigation system based on two-dimensional fluoroscopy for insertion of a proximal femoral nail: an experimental study

Pertrochanteric femoral fractures are common and intramedullary nailing is an accepted method for their surgical treatment. Accurate placement of the implant is essential to ensure fixation. The conventional technique can require multiple guide wire passes, and relies heavily on fluoroscopy. A computer-assisted planning and navigation system based on two-dimensional fluoroscopy for guide wire placement in the femoral neck has been developed, in order to perform intramedullary pertrochanteric fracture fixation using the proximal femoral nail (PFNA). The planning process was supported by a 'zero-dose C-arm navigation' system. The PFNA was inserted into 12, intact, femoral sawbones guided by the computer-based navigation, and into 12, intact, femoral sawbones using a conventional fluoroscopic-assisted technique. Guide wire and subsequent blade placement in the femoral neck was evaluated. The computer-assisted technique achieved a significant decrease in the number of required fluoroscopic images and in the number of guide wire passes. The obtained average blade placement accuracy in the femoral neck was equivalent to the conventional technique. The operation time was significantly longer in the navigation-assisted group. The addition of computer-assisted planning and surgical guidance to the intramedullary nailing of pertrochanteric femoral fractures offers a number of clinical benefits based on the results of this sawbone study. Further studies including fractured sawbones and cadaver models with extension of the navigation process to all steps of PFNA introduction and with the goal of reducing operation time are indispensable before integration of this navigation system into clinical practice.     

Functional and comparative study of lingual papillae in four species of bear (Ursidae) by scanning electron microscopy

The eight current species of bear (Ursidae) are widely distributed throughout Europe, Asia, and America. They are mainly encountered in the northern hemisphere, except for the spectacled bear and the sun bear, which are also found in the south of the equator. Adaptations of the masticatory apparatus (teeth, tongue, and musculature) to diet are one of the factors that imply the greatest structural changes in the cranium. This diet may be carnivorous, herbivorous, melliferous, or insectivorous, with one type of food predominating according to the time of year. The way in which food is eaten determines the morphology of the lingual surface; generally speaking, all bears put their mouth to the food, which, initially, they lick or they let the food stick to their tongue, as occurs when insects are eaten. As in all mammals, a distinction can be made between mechanical and gustatory papillae and the development and distribution of which depend on the species and their eating habits. In this study of the complete tongues of four species of adult bears, we describe the morphology of the lingual surfaces, the different types of papillae, their characteristics, and topographic distribution. It was seen that there were five main types of lingual papillae: filiform, conical, fungiform, foliate, and vallate. Morphology of the microgrooves and pores was similar to that observed in other mammals. In general, there were no great differences among the four species of bears studied, perhaps due to the similarity in the kind of food they consume in captivity.     

„Medizinische Notwendigkeit“: Herausforderungen eines unscharfen Begriffs

Definition of the problem

“Medical necessity” (MedN) is the central regulatory concept for decisions about which services are covered by German statutory health insurance. Despite its seeming objectivity and dependence on physicians’ expert judgment, the concept is by no means clearly defined.

Arguments

In this first of five planned papers on the conceptual analysis of MedN from the perspectives of philosophy and ethics of medicine, law, and (social) medicine, the focus lies on systemizing ongoing controversies.

Conclusion

Our goal is to come up with a so far missing foundation for detailed debates. We aim to clarify MedN’s conceptual structure, function, contextuality, and ambiguities as well as the fundamental limits of conceptual investigations for the normative questions at issue of regulating medical services.

     

Internationale Rekrutierung und Migration von Ärztinnen, Ärzten und Personal in Gesundheitsfachberufen: ein qualitatives Scoping Review der Public Health Literatur

Background

The international recruitment and migration of health workers has long been debated in the health policy literature. This study assesses to what extent the ethics of international recruitment are targeted in existing public health peer-reviewed literature, with a focus on concepts and in-depth consideration within articles. It further critically discusses hidden implications of this discourse regarding equity-creating health policy.

Methods

We conducted a qualitative scoping literature review searching the databases PubMed and Web of Science. Articles were assessed for quality using the Critical Appraisal Skills Program (CASP) checklist for qualitative research. Drawing on a thematic analysis approach, common themes across the sample were identified, coded and analyzed.

Results

A total of 17 articles were included in the analysis after searches and quality appraisal. These articles predominantly targeted nursing professions and physicians, and were written mainly by authors working in the Global North. Thematic analysis revealed that ethics are generally discussed in connection with overviews regarding the situation of health systems as well as regarding inequities between countries. Their focus lies more on migration between countries than between regions within a country. Proposed solutions are usually of an economic nature and range from global financial equalization between countries to national improvements in working conditions. Creative evaluation schemes for these solutions are rarely discussed in depth. Overall, the academic ethics discussion focuses predominantly on the health systems level, and views migration of health workers as problematic.

Conclusions

Our results suggest that academic research operates and aims to inform policy within the current system, without necessarily proposing fundamental changes to the status quo. Thus, an ethics discourse of health workforce recruitment may serve to increase awareness of inequalities without supporting radical change. Further research into intersectional aspects of health worker migration, including gender and ethnicity, may be useful for the discussion on inequities.

     

Die Relevanz einer institutionalisierten Ethik für eine professionelle Zahnmedizin

Definition of the problem

The concept of “ethics” has recently been incorporated into both the 2014 Model Professional Code for Dentists and the current version of the “National Competence-Based Catalog of Learning Objectives in Dental Medicine” (NKLZ, Nationaler Kompetenzbasierter Lernzielkatalog Zahnmedizin). The study presented here addresses the question which relevance this has for the relevance of the new concept accomplished for the dental profession and society.

Arguments

To this end, the societal processes that are related to the autonomous freedom of action of the dental profession are discussed. Therefore the sociological fields of discourse such as profession (and the effect of its constitutive antinomies), trust, education, expertise, practice of treatments and sanction are reviewed for their potential of having connections to each other and serving as a structural frame concerning an ethically reflected acting of the professional. The basis of the professional freedom of action is the trust of society and the individual patient in the professionally acting dentist.

Conclusion

The study arrives at the conclusion that it was a serious omission for many decades not to make young dentists aware of the ethical foundations of dental activity on an institutionally established basis and thus failing to encourage them to constantly reflect their professional expertise in relation to the problems to be solved. This deficit has now been identified. It is absolutely essential to implement an institutionalized structure dealing with ethical questions within the scope of dental medicine.

     

Learning Structure from Data and Its Application to Ozone Prediction

In this paper we propose an algorithm for structure learning in predictive expert systems based on a probabilistic network representation. The idea is to have the simplest structure (minimum number of links) with acceptable predictive capability. The algorithm starts by building a tree structure based on measuring mutual information between pairs of variables, and then it adds links as necessary to obtain certain predictive performance. We have applied this method for ozone prediction in México City, where the ozone level is used as a global indicator for the air quality in different parts of the city. It is important to predict the ozone level a day, or at least several hours in advance, to reduce the health hazards and industrial losses that occur when the ozone reaches emergency levels. We obtained as a first approximation a tree-structured dependency model for predicting ozone in one part of the city. We observe that even with only three parameters, its estimations are acceptable.A causal network representation and the structure learning techniques produced some very interesting results for the ozone prediction problem. Firstly, we got some insight into the dependence structure of the phenomena. Secondly, we got an indication of which are the important and not so important variables for ozone forecasting. Taking this into account, the measurement and computational costs for ozone prediction could be reduced. And thirdly, we have obtained satisfactory short term ozone predictions based on a small set of the most important parameters.