Rapid standardized operating rooms (RAPSTOR) in thyroid and parathyroid surgery

Abstract Objective To evaluate the impact of a high efficiency rapid standardized OR (RAPSTOR) for hemithyroid/parathyroid surgery using standardized equipment sets (SES) and consecutive case scheduling (CCS) on turnover times (TOT), average case volumes, patient outcomes, hospital costs and OR efficiency/stress. Methods Patients requiring hemithyroidectomy (primary or completion) or unilateral parathyroidectomy in a single surgeon’s practice were scheduled consecutively with SES. Retrospective control groups were classified as sequential (CS) or non-sequential (CNS). A survey regarding OR efficiency/stress was administered. Phenomenography and descriptive statistics were conducted for time points, cost and patient outcome variables. Hospital cost minimization analysis was performed. Results The mean TOT of RAPSTOR procedures (16 min; n = 27) was not significantly different than CS (14 min, n = 14) or CNS (17 min, n = 6). Mean case number per hour was significantly increased in RAPSTOR (1.2) compared to both CS (0.9; p < 0.05) and CNS (0.7; p < 0.05). Average operative time was significantly reduced in RAPSTOR (32 min; n = 28) compared to CNS (48 min; p < 0.05) but not CS (33 min; p = 0.06). Time to discharge was reduced in RAPSTOR (595 min) compared to CNS (1210 min, p < 0.05). There was no difference in complication rate between all groups (p = 0.27). Survey responses suggested improved efficiency, teamwork and workflow. Furthermore, there is associated decrease in direct operative costs for RAPSTOR vs. CS. Conclusion A high efficiency standardized OR for hemithyroid and parathyroid surgery using SES and CCS is associated with improved efficiency and, in this study, led to increased capacity at reduced cost without compromising patient safety. Level of evidence Level 2. Graphical abstract

Download Full-text

The experience of conducting a Cochrane systematic review of the impact of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs

International Journal of Care Pathways ◽

10.1258/jicp.2009.009009 ◽

2009 ◽

Vol 13 (2) ◽

pp. 62-66 ◽

Cited By ~ 2

Author(s):

Thomas Rotter ◽

Leigh Kinsman ◽

Erica James ◽

Andreas Machotta ◽

Holger Gothe ◽

...

Keyword(s):

Systematic Review ◽

Clinical Pathways ◽

Hospital Costs ◽

Evidence Base ◽

Care Group ◽

Level Of Evidence ◽

Organisation Of Care ◽

High Level ◽

Meta Analyses ◽

The Impact

Despite the high prevalence of clinical pathways (CPWs), the results from published studies are inconsistent and contradictory. The plethora of study designs, settings and lack of an agreed definition of a CPW make the relevance of individual studies difficult to apply to clinical settings. It was timely to catalogue and analyse the existing evidence base for CPWs via a rigorous systematic review. Systematic reviews and meta-analyses provide a high level of evidence for the effectiveness of interventions and are commonly employed reviewing strategies for addressing scientific questions in health-related research. This method is especially useful when research results are known to be inconsistent. Instead of conducting another primary evaluation, a detailed review is needed that reflects a summation of available research. This paper reports and discusses methodological and technical issues of a systematic review of the effectiveness of CPWs in hospitals, based on our experience with the Cochrane Effective Practice and Organisation of Care Group.

Download Full-text

Piezoelectric β-polymorph formation of new textiles by surface modification with coating process based on interfacial interaction on the conformational variation of poly (vinylidene fluoride) (PVDF) chains

The European Physical Journal Applied Physics ◽

10.1051/epjap/2020200158 ◽

2020 ◽

Vol 91 (3) ◽

pp. 31301

Author(s):

Nabil Chakhchaoui ◽

Rida Farhan ◽

Meriem Boutaldat ◽

Marwane Rouway ◽

Adil Eddiai ◽

...

Keyword(s):

High Efficiency ◽

Vinylidene Fluoride ◽

Research Work ◽

Research Area ◽

Interfacial Interaction ◽

Tetraethyl Orthosilicate ◽

Poly Vinylidene Fluoride ◽

Carbon Nanofillers ◽

The Impact ◽

Advanced Applications

Novel textiles have received a lot of attention from researchers in the last decade due to some of their unique features. The introduction of intelligent materials into textile structures offers an opportunity to develop multifunctional textiles, such as sensing, reacting, conducting electricity and performing energy conversion operations. In this research work nanocomposite-based highly piezoelectric and electroactive β-phase new textile has been developed using the pad-dry-cure method. The deposition of poly (vinylidene fluoride) (PVDF) − carbon nanofillers (CNF) − tetraethyl orthosilicate (TEOS), Si(OCH2CH3)4 was acquired on a treated textile substrate using coating technique followed by evaporation to transform the passive (non-functional) textile into a dynamic textile with an enhanced piezoelectric β-phase. The aim of the study is the investigation of the impact the coating of textile via piezoelectric nanocomposites based PVDF-CNF (by optimizing piezoelectric crystalline phase). The chemical composition of CT/PVDF-CNC-TEOS textile was detected by qualitative elemental analysis (SEM/EDX). The added of 0.5% of CNF during the process provides material textiles with a piezoelectric β-phase of up to 50% has been measured by FTIR experiments. These results indicated that CNF has high efficiency in transforming the phase α introduced in the unloaded PVDF, to the β-phase in the case of nanocomposites. Consequently, this fabricated new textile exhibits glorious piezoelectric β-phase even with relatively low coating content of PVDF-CNF-TEOS. The study demonstrates that the pad-dry-cure method can potentially be used for the development of piezoelectric nanocomposite-coated wearable new textiles for sensors and energy harvesting applications. We believe that our study may inspire the research area for future advanced applications.

Download Full-text

Helping Students FIG-ure It Out: A Large-Scale Study of Freshmen Interest Groups and Student Success

AERA Open ◽

10.1177/23328584211021857 ◽

2021 ◽

Vol 7 ◽

pp. 233285842110218

Author(s):

Lovenoor Aulck ◽

Joshua Malters ◽

Casey Lee ◽

Gianni Mancinelli ◽

Min Sun ◽

...

Keyword(s):

Interest Groups ◽

Minority Students ◽

Large Scale ◽

Racial Minority ◽

Social Aspects ◽

Racial Minority Students ◽

Freshman Seminars ◽

Enrollment Rates ◽

Survey Responses ◽

The Impact

Freshman seminars are a ubiquitous offering in higher education, but they have not been evaluated using matched comparisons with data at scale. In this work, we use transcript data on over 76,000 students to examine the impact of first-year interest groups (FIGs) on student graduation and retention. We first apply propensity score matching on course-level data to account for selection bias. We find that graduation and re-enrollment rates for FIG students were higher than non-FIG students, an effect that was more pronounced for self-identified underrepresented racial minority students. We then employ topic modeling to analyze survey responses from over 12,500 FIG students to find that social aspects of FIGs were most beneficial to students. Interestingly, references to social aspects were not disproportionately present in the responses of self-identified underrepresented racial minority students.

Download Full-text

Theoretical Studies of the Interaction between Screw Surface and Material in the Mixer

Materials ◽

10.3390/ma14040962 ◽

2021 ◽

Vol 14 (4) ◽

pp. 962

Author(s):

Andrzej Marczuk ◽

Vasily Sysuev ◽

Alexey Aleshkin ◽

Petr Savinykh ◽

Nikolay Turubanov ◽

...

Keyword(s):

Friction Coefficient ◽

High Efficiency ◽

Animal Feed ◽

Structural Features ◽

Power Demand ◽

Friction Coefficients ◽

Length Unit ◽

Mixing Chamber ◽

Size Of Particles ◽

The Impact

Mixing is one of the most commonly used processes in food, animal feed, chemical, cosmetic, etc., industries. It is supposed to provide high-quality homogenous, nutritious mixtures. To provide appropriate mixing of materials while maintaining the process high efficiency and low energy consumption it is crucial to explore and describe the material flow caused by the movement of mixing elements and the contact between particles. The process of mixing is also affected by structural features of the machine components and the mixing chamber, speed of mixing, and properties of the mixed materials, such as the size of particles, moisture, friction coefficients. Thus, modeling of the phenomena that accompany the process of mixing using the above-listed parameters is indispensable for appropriate implementation of the process. The paper provides theoretical power calculations that take into account the material speed change, the impact of the material friction coefficient on the screw steel surface and the impact of the friction coefficient on the material, taking into account the loading height of the mixing chamber and the chamber loading value. Dependencies between the mixer power and the product degree of fineness, rotational speed of screw friction coefficients, the number of windings per length unit, and width of the screw tape have been presented on the basis of a developed model. It has been found that power increases along with an increase in the value of these parameters. Verification of the theoretical model indicated consistence of the predicted power demand with the power demand determined in tests performed on a real object for values of the assumed, effective loading, which was 65–75%.

Download Full-text

Validity of Surrogate Endpoints and Their Impact on Coverage Recommendations: A Retrospective Analysis across International Health Technology Assessment Agencies

Medical Decision Making ◽

10.1177/0272989x21994553 ◽

2021 ◽

pp. 0272989X2199455

Author(s):

Oriana Ciani ◽

Bogdan Grigore ◽

Hedwig Blommestein ◽

Saskia de Groot ◽

Meilin Möllenkamp ◽

...

Keyword(s):

Health Technology Assessment ◽

Technology Assessment ◽

International Health ◽

Surrogate Endpoint ◽

Health Technology ◽

Surrogate Endpoints ◽

Patient Centered ◽

Statistical Validation ◽

Level Of Evidence ◽

The Impact

Background Surrogate endpoints (i.e., intermediate endpoints intended to predict for patient-centered outcomes) are increasingly common. However, little is known about how surrogate evidence is handled in the context of health technology assessment (HTA). Objectives 1) To map methodologies for the validation of surrogate endpoints and 2) to determine their impact on acceptability of surrogates and coverage decisions made by HTA agencies. Methods We sought HTA reports where evaluation relied on a surrogate from 8 HTA agencies. We extracted data on the methods applied for surrogate validation. We assessed the level of agreement between agencies and fitted mixed-effects logistic regression models to test the impact of validation approaches on the agency’s acceptability of the surrogate endpoint and their coverage recommendation. Results Of the 124 included reports, 61 (49%) discussed the level of evidence to support the relationship between the surrogate and the patient-centered endpoint, 27 (22%) reported a correlation coefficient/association measure, and 40 (32%) quantified the expected effect on the patient-centered outcome. Overall, the surrogate endpoint was deemed acceptable in 49 (40%) reports ( k-coefficient 0.10, P = 0.004). Any consideration of the level of evidence was associated with accepting the surrogate endpoint as valid (odds ratio [OR], 4.60; 95% confidence interval [CI], 1.60–13.18, P = 0.005). However, we did not find strong evidence of an association between accepting the surrogate endpoint and agency coverage recommendation (OR, 0.71; 95% CI, 0.23–2.20; P = 0.55). Conclusions Handling of surrogate endpoint evidence in reports varied greatly across HTA agencies, with inconsistent consideration of the level of evidence and statistical validation. Our findings call for careful reconsideration of the issue of surrogacy and the need for harmonization of practices across international HTA agencies.

Download Full-text

Nonlocal and Size-Dependent Dielectric Function for Plasmonic Nanoparticles

Applied Sciences ◽

10.3390/app9153083 ◽

2019 ◽

Vol 9 (15) ◽

pp. 3083

Author(s):

Kai-Jian Huang ◽

Shui-Jie Qin ◽

Zheng-Ping Zhang ◽

Zhao Ding ◽

Zhong-Chen Bai

Keyword(s):

Metallic Nanoparticles ◽

High Efficiency ◽

Finite Size ◽

Plasmonic Nanostructures ◽

Accurate Analysis ◽

Finite Size Effects ◽

Size Dependent ◽

Quantum Size ◽

The Impact ◽

Electron Energy Loss

We develop a theoretical approach to investigate the impact that nonlocal and finite-size effects have on the dielectric response of plasmonic nanostructures. Through simulations, comprehensive comparisons of the electron energy loss spectroscopy (EELS) and the optical performance are discussed for a gold spherical dimer system in terms of different dielectric models. Our study offers a paradigm of high efficiency compatible dielectric theoretical framework for accounting the metallic nanoparticles behavior combining local, nonlocal and size-dependent effects in broader energy and size ranges. The results of accurate analysis and simulation for these effects unveil the weight and the evolution of both surface and bulk plasmons vibrational mechanisms, which are important for further understanding the electrodynamics properties of structures at the nanoscale. Particularly, our method can be extended to other plasmonic nanostructures where quantum-size or strongly interacting effects are likely to play an important role.

Download Full-text

Burden of motorcyclists without helmets in a state without a universal helmet law: a propensity score analysis

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2020-000583 ◽

2020 ◽

Vol 5 (1) ◽

pp. e000583

Author(s):

Michael D Jones ◽

Joel G Eastes ◽

Damjan Veljanoski ◽

Kristina M Chapple ◽

James N Bogert ◽

...

Keyword(s):

Propensity Score ◽

Propensity Score Analysis ◽

Alcohol Intoxication ◽

Civil Liberties ◽

Hospital Charges ◽

Trauma Patients ◽

Level Of Evidence ◽

Helmet Use ◽

Score Analysis ◽

The Impact

BackgroundAlthough helmets are associated with reduction in mortality from motorcycle collisions, many states have failed to adopt universal helmet laws for motorcyclists, in part on the grounds that prior research is limited by study design (historical controls) and confounding variables. The goal of this study was to evaluate the association of helmet use in motorcycle collisions with hospital charges and mortality in trauma patients with propensity score analysis in a state without a universal helmet law.MethodsMotorcycle collision data from the Arizona State Trauma Registry from 2014 to 2017 were propensity score matched by regressing helmet use on patient age, sex, race/ethnicity, alcohol intoxication, illicit drug use, and comorbidities. Linear and logistic regression models were used to evaluate the impact of helmet use.ResultsOur sample consisted of 6849 cases, of which 3699 (54.0%) were helmeted and 3150 (46.0%) without helmets. The cohort was 88.1% male with an average age of 40.9±16.0 years. Helmeted patients were less likely to be admitted to the intensive care unit (20.3% vs. 23.7%, OR 0.82 (0.72–0.93)) and ventilated (7.8% vs. 12.0%, OR 0.62 (0.52–0.75)). Propensity-matched analyses consisted of 2541 pairs and demonstrated helmet use to be associated with an 8% decrease in hospital charges (B −0.075 (0.034)) and a 56% decrease in mortality (OR 0.44 (0.31–0.58)).DiscussionIn a state without mandated helmet use for all motorcyclists, the burden of the unhelmeted rider is significant with respect to lives lost and healthcare charges incurred. Although the helmet law debate with respect to civil liberties is complex and unsettled, it appears clear that helmet use is strongly associated with both survival and less economic encumbrance on the state.Level of evidenceLevel III, prognostic and epidemiological.

Download Full-text

Impact of the COVID-19 pandemic urology trainees in the West of Scotland

Journal of Clinical Urology ◽

10.1177/2051415820987673 ◽

2021 ◽

pp. 205141582098767

Author(s):

Ashley Carrera ◽

Je Song Shin ◽

Holly Bekarma

Keyword(s):

Multidisciplinary Team ◽

Online Teaching ◽

The West ◽

Level Of Evidence ◽

Team Meetings ◽

Educational Benefit ◽

Teaching Modules ◽

The Impact ◽

Training Opportunities ◽

Multidisciplinary Team Meetings

Hospitals worldwide have taken unprecedented steps to cope with the coronavirus disease 2019 (COVID-19) pandemic. Changes to services created challenges for delivering training in urology. Statutory education bodies implemented processes addressing trainee progression, but the extent of training disruption has not been quantified. To establish the impact on urology trainees in the West of Scotland, online questionnaires were sent to trainees and educational supervisors. Twenty-five trainees working at six hospitals across four health boards responded. Elective operating was significantly reduced, with 64% of trainees having no weekly sessions. Before the pandemic, the majority of trainees (92%) had one or two clinic sessions or more per week, but with new measures, 76% of trainees did not attend clinics. Trainee attendance at multidisciplinary team meetings halved during the pandemic. Sixteen per cent ( n=4) of trainees were redeployed, with 50% ( n=2) reporting no educational benefit. Commonly used alternative educational resources included webinars (52%) and online teaching modules (28%). Thirty-two per cent ( n=8) of trainees had examinations postponed. COVID-19 has impacted urology training in the West of Scotland, with a significant reduction in training opportunities across elective theatre, clinic exposure and education. However, trainees will be more adaptable, learn to work remotely, have opportunities to develop leadership and may help redesign services for the future of urology. Level of evidence: Not applicable.

Download Full-text

Time-jerk optimal trajectory planning of hydraulic robotic excavator

Advances in Mechanical Engineering ◽

10.1177/16878140211034611 ◽

2021 ◽

Vol 13 (7) ◽

pp. 168781402110346

Author(s):

Yunyue Zhang ◽

Zhiyi Sun ◽

Qianlai Sun ◽

Yin Wang ◽

Xiaosong Li ◽

...

Keyword(s):

Angular Velocity ◽

Trajectory Planning ◽

Optimal Trajectory ◽

High Efficiency ◽

Optimal Solution ◽

Optimal Time ◽

Target Point ◽

Robotic Excavator ◽

The Impact ◽

Optimal Trajectory Planning

Due to the fact that intelligent algorithms such as Particle Swarm Optimization (PSO) and Differential Evolution (DE) are susceptible to local optima and the efficiency of solving an optimal solution is low when solving the optimal trajectory, this paper uses the Sequential Quadratic Programming (SQP) algorithm for the optimal trajectory planning of a hydraulic robotic excavator. To achieve high efficiency and stationarity during the operation of the hydraulic robotic excavator, the trade-off between the time and jerk is considered. Cubic splines were used to interpolate in joint space, and the optimal time-jerk trajectory was obtained using the SQP with joint angular velocity, angular acceleration, and jerk as constraints. The optimal angle curves of each joint were obtained, and the optimal time-jerk trajectory planning of the excavator was realized. Experimental results show that the SQP method under the same weight is more efficient in solving the optimal solution and the optimal excavating trajectory is smoother, and each joint can reach the target point with smaller angular velocity, and acceleration change, which avoids the impact of each joint during operation and conserves working time. Finally, the excavator autonomous operation becomes more stable and efficient.

Download Full-text

Evaluation of an environmentally sustainable UV-assisted water treatment system for the removal of Bacillus globigii spores in water

Water Science & Technology Water Supply ◽

10.2166/ws.2017.165 ◽

2017 ◽

Vol 18 (3) ◽

pp. 968-975

Author(s):

R. G. Silva ◽

J. Szabo ◽

V. Namboodiri ◽

E. R. Krishnan ◽

J. Rodriguez ◽

...

Keyword(s):

Water Treatment ◽

High Efficiency ◽

Membrane Filter ◽

Water Security ◽

Disinfection Byproducts ◽

Treatment System ◽

Health Concern ◽

Environmentally Sustainable ◽

Inorganic Substances ◽

The Impact

Abstract Development of greener water treatment technologies is important for the production of safe drinking water and water security applications, such as decontamination. Chlorine assisted disinfection is common and economical, but can generate disinfection byproducts (DBPs) that may be of health concern. DBPs are formed due to the reaction of chlorine with naturally occurring organic and inorganic substances in water. Currently, various innovative technologies are being developed as alternative approaches for preventing DBPs during water treatment. In this study, we evaluated the effectiveness of a novel combination of high efficiency flow filtration and UV disinfection treatment system for the removal of Bacillus globigii (B. globigii) spores in water. The filtration system consists of a charged membrane filter (CMF) that not only helps to remove suspended particles but also reduces the impact of other impurities including bio organisms. In order to get most performance details, the CMF was evaluated at clean, half-life, and end of life (EOL) conditions along with 100% UV transmittance (UVT). In addition, the effectiveness of the UV system was evaluated as a stand alone system at 100% and 70% EOL intensity. The study was conducted at the US EPA's Test and Evaluation (T&E) Facility in Cincinnati, OH, using B. globigii, a surrogate for B. anthracis spores. This non-chemical environmentally-friendly CMF/UV combination system and the stand alone UV unit showed greater than 6.0 log removal of B. globigii during the tests.

Download Full-text