scholarly journals Aluminium release and fluid warming: provocational setting and devices at risk

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Thorsten Perl ◽  
N. Kunze-Szikszay ◽  
A. Bräuer ◽  
M. Quintel ◽  
T. Roy ◽  
...  
Keyword(s):  
Organic Acids ◽  
Saline Solution ◽  
Management Strategies ◽  
High Volume ◽  
Electrolyte Solutions ◽  
Temperature Management ◽  
Fluid Composition ◽  
Neutral Ph ◽  
Warming Devices ◽  
High Aluminium

Abstract Background Fluid warming, recommended for fluid rates of > 500 ml h-1, is an integral part of patient temperature management strategies. Fluid warming devices using an uncoated aluminium containing heating element have been reported to liberate aluminium resulting in critical aluminium concentrations in heated fluids. We investigated saline solution (0.9%), artificially spiked with organic acids to determine the influence of fluid composition on aluminium release using the uncoated enFlow® device. Additionally, the Level1® as a high volume fluid warming device and the ThermoSens® device were investigated with artificial spiked fluid at high risk for aluminum release and a clinically used crystalloid solution. Results Saline solution spiked with lactate more than acetate, especially at a non neutral pH, led to high aluminium release. Next to the enFlow® device, aluminium release was observed for the Level1® device, but not for the coated ThermoSens®-device. Conclusion Uncoated aluminium containing fluid warming devices lead to potentially toxic levels of aluminium in heated fluids, especially in fluids with non-neutral pH containing organic acids and their salts like balanced electrolyte solutions.

Aluminium Release and Fluid Warming: Provocational Setting and Devices at Risk

2021 ◽  
Author(s):  
Thorsten Perl ◽  
Kunze-Szikszay Nils ◽  
Anselm Bräuer ◽  
Quintel Michael ◽  
Terrance Roy ◽  
...  
Keyword(s):  
At Risk ◽  
Organic Acids ◽  
Saline Solution ◽  
Management Strategies ◽  
High Volume ◽  
Temperature Management ◽  
Fluid Composition ◽  
Warming Devices ◽  
Warming Device ◽  
High Aluminum

Abstract BACKGROUND: Fluid warming, recommended for fluid rates of > 500 ml h-1, is an integral part of patient temperature management strategies. Fluid warming devices using an uncoated aluminum containing heating element have been reported to liberate aluminum resulting in critical aluminum concentrations in heated fluids. We investigated saline solution (0.9%), artificially spiked with organic acids to determine the influence of fluid composition on aluminum liberation using the uncoated enFlow® device. Additionally the Level1® as a high volume fluid warming device and the ThermoSens® device were investigated. RESULTS: Saline solution spiked with lactate more than acetate, especially at a non acid pH, led to high aluminum liberation. Next to the enFlow® device, aluminum liberation was observed for the Level1® device, but not for the coated TermoSens®-device. CONCLUSION: Uncoated aluminum containing fluid warming devices lead to potential toxic levels of aluminum in heated fluids, especially in non acid fluids containing organic acids and their salts.

scholarly journals Work Stress among Professionals in Building Construction Industry in Nigeria

2011 ◽  
Vol 11 (3) ◽  
pp. 45-57 ◽  
Author(s):  
Eziyi Offia Ibem ◽  
Michael Nwabueze Anosike ◽  
Dominic Ezenwa Azuh ◽  
Tim O. Mosaku
Keyword(s):  
Construction Industry ◽  
Work Stress ◽  
Management Strategies ◽  
High Volume ◽  
Time Frame ◽  
Building Construction ◽  
Stress Factors ◽  
Project Delivery ◽  
Building Projects ◽  
Structural Engineers

This study was undertaken to identify key stress factors among professionals in building construction industry in Nigeria. This is in view of the fact that to date, very little is known about work stress among professionals in building construction industry in this country. The study involved the administration of questionnaire to 107 professionals including architects, builders, civil/structural engineers and quantity surveyors randomly selected from 60 ongoing building projects in Anambra, Ogun and Kaduna States, Nigeria. The data was analysed using descriptive statistics, and findings show that the principal sources of stress were high volume of work, uncomfortable site office environment, lack of feedback on previous and ongoing building projects, and variations in the scope of work in ongoing building projects. The paper suggests that taking responsibility for work which one has adequate capacity to handle, establishing realistic budgets and time frame for project delivery, provision of spatially adequate, visually and thermally comfortable site offices, adoption of appropriate job design practice and education of professionals on stress management strategies will reduce the incidence of stress among professionals in building industry in Nigeria. 

Access Management

2005 ◽  
Vol 1931 (1) ◽  
pp. 117-128
Author(s):  
Jerome Gluck ◽  
Jean Michel ◽  
Michael Geiger ◽  
Maya Varughese
Keyword(s):  
New York ◽  
Traffic Congestion ◽  
Management Strategies ◽  
New York State ◽  
High Volume ◽  
York State Department ◽  
Department Of Transportation ◽  
Access Management ◽  
Accident Rate ◽  
Wide Range

This paper discusses issues encountered in developing a retrofit project for a roadway in a densely developed, commercialized area. The project was initiated, directed, and funded by the New York State Department of Transportation (NYSDOT). Numerous major shopping centers and a high volume of through traffic produce congestion and affect safety. NY-27, also known as Sunrise Highway, is a principal arterial in suburban Long Island. The conditions along NY-27 reflect what happens when development approvals are granted by local land use agencies without sufficient consideration of whether the transportation system can accommodate the associated traffic. NYSDOT, in this case, was put in the position of attempting to implement a retrofit project to mitigate the traffic and safety conditions. The proximity of shopping center driveways to each other and to nearby intersections results in weaving movements and heavy turning-movement volumes that block the through travel lanes and cause overlapping conflicts. The significant traffic congestion and high accident rate reflect the problems caused by inadequate access spacing and need for improved access management. The improvement options identified represented a wide range of access management strategies and configurations. The options were screened and modified to reflect community desires and business concerns. This paper reviews operational and safety problems, identifies a theoretical access configuration along the NY-27 corridor that could mitigate these problems, and reviews the alternative that was approved and is being progressed. The approved alternative reflects real-world considerations that affect a retrofit project.

Time for a Revolution: Smart Energy and Microgrid Use in Disaster Response

2014 ◽  
Vol 8 (3) ◽  
pp. 252-259 ◽  
Author(s):  
David Wayne Callaway ◽  
Erin Noste ◽  
Peter Woods McCahill ◽  
A.J. Rossman ◽  
Dominique Lempereur ◽  
...  
Keyword(s):  
Disaster Response ◽  
Gap Analysis ◽  
Management Strategies ◽  
High Volume ◽  
Energy Utilization ◽  
Power Sources ◽  
Medical Response ◽  
Modern Health Care ◽  
Energy Independence ◽  
Alternative Power

AbstractModern health care and disaster response are inextricably linked to high volume, reliable, quality power. Disasters place major strain on energy infrastructure in affected communities. Advances in renewable energy and microgrid technology offer the potential to improve mobile disaster medical response capabilities. However, very little is known about the energy requirements of and alternative power sources in disaster response. A gap analysis of the energy components of modern disaster response reveals multiple deficiencies. The MED-1 Green Project has been executed as a multiphase project designed to identify energy utilization inefficiencies, decrease demands on diesel generators, and employ modern energy management strategies to expand operational independence. This approach, in turn, allows for longer deployments in potentially more austere environments and minimizes the unit's environmental footprint. The ultimate goal is to serve as a proof of concept for other mobile medical units to create strategies for energy independence. (Disaster Med Public Health Preparedness. 2014;0:1–8)

Effects of homœopathic preparations of organic acids and minerals on the oxidative metabolism of human neutrophils

1993 ◽  
Vol 82 (04) ◽  
pp. 237-244 ◽  
Author(s):  
Salvatore Chirumbolo ◽  
Andrea Signorini ◽  
Ivo Bianchi ◽  
Guiseppe Lippi ◽  
Paolo Bellavite
Keyword(s):  
Organic Acids ◽  
Oxidative Metabolism ◽  
Saline Solution ◽  
Superoxide Production ◽  
Human Neutrophils ◽  
Critical Factors ◽  
Inhibitory Effects ◽  
Series Of Experiments

AbstractA number of different potencies of commercially available homœopathic preparations in saline solution were tested for their ability to regulate the oxidative metabolism (superoxide production) and adhesion function of human neutrophils in vitro. 15% to 30% inhibition of oxidative metabolism was caused by Sulphur 6x, Manganum phosphoricum 6x and 8x, and Magnesium phosphoricum 6x and 8x. Phosphorus slightly reduced superoxide production, with varying results in a series of experiments. Using Magnesium phosphoricum and Phosphorus, small inhibitory effects (8–11%) were noted event at high potencies. Among the organic acids, a group (Acidum malicum 4x and Acidum fumaricum 4x) enhanced superoxide production, while others either inhibited the response (Acidum citricum and Acidum succinicum, 3x and 4x) or had no effect (Acidum α-ketoglutaricum and Acidum cis-aconitum). Attempts to reproduce these effects using solutions prepared in the laboratory confirmed the inhibitory effects of Manganum phosphoricum 6x and of organic acids in the 3x, while other data indicated that critical factors in the methodology of preparation may affect the results.

Rapid Hypothermic Aortic Flush Can Achieve Survival without Brain Damage after 30 Minutes Cardiac Arrest in Dogs

2000 ◽  
Vol 93 (6) ◽  
pp. 1491-1499 ◽  
Author(s):  
Wilhelm Behringer ◽  
Stephan Prueckner ◽  
Rainer Kentner ◽  
Samuel A. Tisherman ◽  
Ann Radovsky ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Bypass ◽  
Brain Death ◽  
Abdominal Aorta ◽  
Normal Saline ◽  
Saline Solution ◽  
Circulatory Arrest ◽  
High Volume ◽  
Group I ◽  
Group Ii

Background Neither exsanguination to pulselessness nor cardiac arrest of 30 min duration can be reversed with complete neurologic recovery using conventional resuscitation methods. Techniques that might buy time for transport, surgical hemostasis, and initiation of cardiopulmonary bypass or other resuscitation methods would be valuable. We hypothesized that an aortic flush with high-volume cold normal saline solution at the start of exsanguination cardiac arrest could rapidly preserve cerebral viability during 30 min of complete global ischemia and achieve good outcome. Methods Sixteen dogs weighing 20-25 kg were exsanguinated to pulselessness over 5 min, and circulatory arrest was maintained for another 30 min. They were then resuscitated using closed-chest cardiopulmonary bypass and had assisted circulation for 2 h, mild hypothermia (34 degrees C) for 12 h, controlled ventilation for 20 h, and intensive care to outcome evaluation at 72 h. Two minutes after the onset of circulatory arrest, the dogs received a flush of normal saline solution at 4 degrees C into the aorta (cephalad) via a balloon catheter. Group I (n = 6) received a flush of 25 ml/kg saline with the balloon in the thoracic aorta; group II (n = 7) received a flush of 100 ml/kg saline with the balloon in the abdominal aorta. Results The aortic flush decreased mean tympanic membrane temperature (Tty) in group I from 37.6 +/- 0.1 to 33.3 +/- 1.6 degrees C and in group II from 37.5 +/- 0.1 to 28.3 +/- 2.4 degrees C (P = 0.001). In group 1, four dogs achieved overall performance category (OPC) 4 (coma), and 2 dogs achieved OPC 5 (brain death). In group II, 4 dogs achieved OPC 1 (normal), and 3 dogs achieved OPC 2 (moderate disability). Median (interquartile range [IQR]) neurologic deficit scores (NDS 0-10% = normal; NDS 100% = brain death) were 69% (56-99%) in group I versus 4% (0-15%) in group II (P = 0.003). Median total brain histologic damage scores (HDS 0 = no damage; > 100 = extensive damage; 1,064 = maximal damage) were 144 (74-168) in group I versus 18 (3-36) in group II (P = 0.004); in three dogs from group II, the brain was histologically normal (HDS 0-5). Conclusions A single high-volume flush of cold saline (4 degrees C) into the abdominal aorta given 2 min after the onset of cardiac arrest rapidly induces moderate-to-deep cerebral hypothermia and can result in survival without functional or histologic brain damage, even after 30 min of no blood flow.

scholarly journals A Review of Evidence: Using Respirators to prevent Sars-Cov-2 Transmission

2020 ◽  
Author(s):  
Adam Nulty
Keyword(s):  
Management Strategies ◽  
Standard Of Care ◽  
High Volume ◽  
Protective Equipment ◽  
Compliance Cost ◽  
Isolation Technique ◽  
Risk Management Strategies ◽  
Dental Practices ◽  
Evidenced Based ◽  
Fluid Penetration

This literature review has been compiled to form an evidenced-based review on the standards for Dental Practices in their choice and use of personal protective equipment (PPE) within the COVID-19 Pandemic and beyond: it is prepared on the basis of the current best available evidence. The review encompasses risk management strategies for both Dental Personnel and Patients in the application and use of Face Masks & Respirators.In summation, from the evidence available, it is apparent that in the lab setting N95/FFP2 masks are superior in their efficiency but in the clinical setting such a difference is not seen as clearly. As such the minimum standard of care should be that of a standard surgical mask. Faced with the emergence of the virulent disease that is Covid-19, it is logical to use FFP2/N95 respirator masks in aerosol generating procedures where they offer greater resistance to fluid penetration and a better face seal when adequately fit tested as a gold standard. But if a dry field isolation technique involving high volume evacuation is used, there is no clear benefit of respirator masks (N95/FFP2 or N99/FFP3) when balanced with the extra risk of compliance, cost and comfort in wearing a standard fluid-resistant surgical mask.

The role of water management in unlocking unconventional resources

2014 ◽  
Vol 54 (2) ◽  
pp. 481
Author(s):  
Gary Crisp ◽  
John Walsh ◽  
Mark Shaw ◽  
Chris Hertle
Keyword(s):  
Water Management ◽  
Shale Gas ◽  
Management Strategies ◽  
Water Source ◽  
High Volume ◽  
Technology Selection ◽  
Holistic View ◽  
Field Development ◽  
Unconventional Resources ◽  
Unconventional Resource

Water management for unconventional resources is a complex, multidisciplinary subject that cannot be overlooked. Traditional oilfield development strategies view water as an afterthought that must be dealt with once the field matures and water cut begins to escalate. When this strategy is employed for shale gas developments, water usage is higher than necessary, trucking costs become high, and site remediation becomes time consuming and costly. For shale gas developments, the high-volume and high-quality requirements of water during the lifecycle of field development are a game changer. Water management for unconventional resources requires logistics planning, engagement of field services providers, and technology selection. Each of these issues need to be addressed in the early planning stages and must be tailored for the location and water types involved. This extended abstract takes a holistic view of water management for unconventional resource development across Australia. Management strategies are compared and contrasted for the different unconventional resource types, across different locations, considering all of the factors mentioned above, together with an understanding of regulatory differences, water source options, disposal options, and the different types of water involved. These factors are compared (in the context of North American developments) for CSG in Queensland, tight gas, and unconventional shale gas developments in the Cooper Basin and WA. As these different resources are developed, it is important to understand why the water management strategies are, and must be, different (as discussed in this extended abstract).

Abstract 339: Quality of Physician Care Coordination During Inter-Facility Transfer for Cardiac Arrest Patients

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Stephen N Holby ◽  
Daniel Munoz ◽  
Sean P Collins ◽  
Timothy J Vogus ◽  
Cathy A Jenkins ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Care Coordination ◽  
Medical Center ◽  
Quality Care ◽  
High Volume ◽  
Temperature Management ◽  
Adjusted Relative Risk ◽  
Rater Reliability ◽  
Timeliness Of Care

Objectives: We sought to evaluate whether the quality of coordination between physicians transferring comatose cardiac arrest survivors to a high-volume cardiac arrest center for targeted temperature management (TTM) was associated with timeliness of care. Methods: We conducted a retrospective analysis of inter-facility transfers to Vanderbilt University Medical Center for TTM between October 2016 and October 2018. We examined the relationship between Relational Coordination (RC) - a validated measure comprised of 7 dimensions of communication (frequency, timeliness, accuracy, problem solving) and relationship quality (respect, knowledge sharing, shared goals) - during recorded phone conversations between transferring and accepting physicians and time-to-acceptance. Investigators listened to recorded phone conversations and used a scoring guide to assign a score between 1 and 100 for each of the 7 dimensions of RC. Results: We identified 18 patients meeting criteria. TTM was initiated or continued in 72% (13 of 18). Median time-to-acceptance was 2.77 (interquartile range [IQR] 2.0, 4.1) minutes, and duration of calls was 3.95 (IQR 2.7, 5.2) minutes. Inter-rater reliability for overall RC was high (rho=0.87). The correlation between RC and the time-to-acceptance was significant in univariate analyses (adjusted relative risk=0.96, 95%CI 0.93, 1.0, p=0.05). Secondary analyses did not find a significant relationship between RC and timeliness measures. Conclusions: In this sample of patients transferred for TTM, we found that RC had a high inter-rater reliability. We also found that higher quality care coordination for cardiac arrest survivors was associated with faster physician acceptance. To better understand how the quality of care coordination impacts timeliness of care and patient outcomes, future work using a larger cohort should examine whether higher RC among a broader set of stakeholders (physicians, emergency medical services, families, etc.) is associated with timeliness measures after adjusting for other factors.

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