The Implementation of Laser Shaft Alignment System on Rotating Machines in the Bulla Field, Platform 6

Shaft misalignment is a common fault in rotating machines in the industry. Inadequate coupling alignment of rotating shafts often results in serious vibration problems and premature machine component failure. This article introduces the concept of using a laser shaft alignment system to improve equipment reliability, maintenance efficiency, and reduce rotating component wear. This paper explores the concept of implementation of laser shaft alignment system on rotating machines in the Bulla field, Platform 6. For this purpose, an appropriate tool has been selected for further implementation. As compared to a traditional mechanical method, the proposed electronic approach has more accurate results and optimize the performance gained via the previous techniques. Additionally, the application of the proposed system is user friendly and faster compared to the previous method. The measurement procedure is issued as per system manufacturer recommendation, and manufacturer video training will be submitted to appropriate maintenance staff. The novelty of the approach is to increase the reliability of rotating machines on Platform 6 in the Bulla field and develop Company maintenance processes by implementing a new laser measurement system.

Mechanical Ventilation Guided by Uncalibrated Esophageal Pressure May Be Potentially Harmful

Background Esophageal balloon calibration was proposed in acute respiratory failure patients to improve esophageal pressure assessment. In a clinical setting characterized by a high variability of abdominal load and intrathoracic pressure (i.e., pelvic robotic surgery), the authors hypothesized that esophageal balloon calibration could improve esophageal pressure measurements. Accordingly, the authors assessed the impact of esophageal balloon calibration compared to conventional uncalibrated approach during pelvic robotic surgery. Methods In 30 adult patients, scheduled for elective pelvic robotic surgery, calibrated end-expiratory and end-inspiratory esophageal pressure, and the associated respiratory variations were obtained at baseline, after pneumoperitoneum–Trendelenburg application, and with positive end-expiratory pressure (PEEP) administration and compared to uncalibrated values measured at 4-ml filling volume, as per manufacturer recommendation. Data are expressed as median and [25th, 75th percentile]. Results Ninety calibrations were successfully performed. Chest wall elastance worsened with pneumoperitoneum–Trendelenburg and PEEP (19.0 [15.5, 24.6] and 16.7 [11.4, 21.7] cm H2O/l) compared to baseline (8.8 [6.3, 9.8] cm H2O/l; P < 0.0001 for both comparisons). End-expiratory and end-inspiratory calibrated esophageal pressure progressively increased from baseline (3.7 [2.2, 6.0] and 7.7 [5.9, 10.2] cm H2O) to pneumoperitoneum–Trendelenburg (6.2 [3.8, 10.2] and 16.1 [13.1, 20.6] cm H2O; P = 0.014 and P < 0.001) and PEEP (8.8 [7.7, 15.6] and 18.9 [16.3, 22.0] cm H2O; P < 0.0001 vs. baseline for both comparison; P < 0.001 and P = 0.002 vs. pneumoperitoneum–Trendelenburg) and, at each study step, they were persistently lower than uncalibrated esophageal pressure (P < 0.0001 for all comparisons). Overall, difference among uncalibrated and calibrated esophageal pressure was 5.1 [3.8, 8.4] cm H2O at end-expiration and 3.8 [3.0, 6.3] cm H2O at end-inspiration. Uncalibrated esophageal pressure swing was always lower than calibrated one (P < 0.0001 for all comparisons) with a difference of −1.0 [−1.8, −0.4] cm H2O. Conclusions In a clinical setting with variable chest wall mechanics, uncalibrated measurements substantially overestimated absolute values and underestimated respiratory variations of esophageal pressure. Calibration could substantially improve mechanical ventilation guided by esophageal pressure. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Utilization of a Dextrose-Only Purge Solution for an LVAD in Patients With Suspected HIT: A Case Series

The Impella devices are percutaneous intravascular ventricular assist devices indicated for use in patients with cardiogenic shock that occurs following acute myocardial infarction (MI) or open heart surgery. These devices must be used with a purge solution that contains heparin per manufacturer recommendation, which will prevent blood from reaching the motor causing pump thrombosis and mechanical failure. We describe the utilization of a dextrose-only purge solution plus systemic argatroban in 2 patients with suspected heparin-induced thrombocytopenia (HIT). Each case describes a patient with suspected HIT following Impella placement for cardiogenic shock post-MI that had an increased bleeding risk. In each case, pharmacy monitored and adjusted the patients’ argatroban, resulting in therapeutic anticoagulation without major bleeding or thrombotic events. These case reports demonstrate that use of a dextrose-only purge solution in the Impella device may be a safe and effective option when combined with systemic argatroban in patients with suspected or confirmed HIT who exhibit increased bleeding risk. Further research is needed to determine the optimal concentrations and duration of anticoagulation-free purge solution in these patients.

Effects of SOP Lagoon Additive on Gaseous Emissions from Stored Liquid Dairy Manure

Animal manure is a source of greenhouse gas (GHG) emissions and other pollutants and nuisances such as ammonia and odors. There are several technologies to reduce emissions on animal farms including manure additives; however, few have been proven effective and easy to apply to dairy lagoon systems. The present research aimed at testing the ability of the commercial additive “SOP LAGOON” to reduce emissions of GHGs (i.e., carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O)), as well as ammonia (NH3) and odors from lagoon stored liquid manure. Emissions of GHGs, NH3 and odors were measured in the laboratory from barrels filled with 65 L of manure treated with SOP LAGOON or left untreated as a control. Manure was collected from a commercial dairy that is located in Solano County, California. Emissions of GHGs and NH3 were continuously measured for one week using flux chambers placed on top of the barrels and connected to a mobile air emissions laboratory. The effects of the untreated control, versus the two respective treatment additive doses of 30.8 and 61.6 g/m3 of manure were compared to each other. The low dose was selected based on the manufacturer recommendation and the high dose was selected by doubling the low dose. Results showed that SOP LAGOON applied at the high dose (61.6 g of SOP LAGOON per m3 of manure) versus the control greatly reduced (p < 0.05) emissions of CO2, CH4, N2O and NH3 by 14.7%, 22.7%, 45.4% and 45.9%, respectively. Furthermore, the high dose of SOP LAGOON treated samples versus the control samples showed less odor intensity (p < 0.05). There was no significant effect of the low dose of SOP LAGOON on the emissions of different gases. The HIGH dose of SOP LAGOON might decrease the number of methanogens and hydrolytic microorganisms and their excreted enzymes during manure storage. Further studies are needed to investigate the mechanism of emission reduction using SOP LAGOON.

A microscopic analysis of single-use versus multi-use phacoemulsification tubing in maintaining sterility and patient safety

Background: The Pietermaritzburg (PMB) complex in South Africa does not have a uniform protocol regarding reuse of phacoemulsification tubing. Each hospital in the complex has its own guideline, based on manufacturer recommendation and cost-saving measures. There is no definitive scientific evidence proving that reusing phaco tubing will harm patients.Aim: To assess if phacoemulsification tubing remains sterile during sequential phacoemulsification.Setting: The study was conducted at Edendale Hospital and Greys Hospital in PMB. Greys Hospital has a single-use policy and at Edendale policy, multi-use of tubings is allowed.Methods: This was an observational descriptive prospective study observed over 4 months. Routine phacoemulsification was carried out at each hospital as per hospital guidelines. At the end of the surgery, the tips of the tubing were cut off, placed in a standard specimen container and sent to the laboratory for culture and microscopy. Results were compared and two unused tubings were also analysed as controls.Results: A total of 26 single-use tubings were analysed and it was found that 46.2% grew no organisms; 19.2% grew Bacillus species; other microorganisms were in less than 1% of tubings. A total of 41 multiple-use tubings were sent for analysis. Forty one and a half percent grew no organisms; 17.1% tubings grew Bacillus species. Other microorganisms were found in less than 5% of tubings. Unused tubings did not grow any microorganism.Conclusion: A p value less than 0.05% was accepted as statistically significant. Comparing the two hospitals, tubings which grew no organisms were 46.2% (single-use) versus 41.5% (multiple-use). This gives a statistically non-significant p value of 0.70. Tubings which grew Bacillus species were 19.2% (single-use) versus 17.1% (multiple-use) (p = 0.83). Other microorganisms also showed a p value of 0.76. This implies that phacoemulsification tubing is significantly contaminated after just one use. Although no statistical difference was found between the two groups, a contamination rate of over 40% is of great concern. There are contributing factors which may have influenced this result. In our setting, phaco tubing does not seem to remain sterile after cataract surgery. Further research needs to be carried out in order to gain more insight into patient safety.

Safe Mechanical Preparation with Reciprocation Movement without Glide Path Creation: Result from a Pool of 673 Root Canals

The aim of the present study was to prospectively assess the frequency of teeth in which the Reciproc instruments were able to reach the full working length (WL). This case series study enrolled 277 consecutive teeth requiring primary endodontic treatment performed with the Reciproc system (VDW) without a previous glide path by 3 experienced endodontists. Instruments R25, R40 or R50 were selected, respectively, for narrow, medium and large canals, according to the preoperative radiographs, as per manufacturer recommendation. Canals were instrumented and classified as reaching the full WL (RFWL) and not reaching the full WL (NRFWL), according to the ability of the Reciproc instrument to reach without a glide path the full electronically determined WL. Finally, canals were filled using a single matched cone technique. Pearson's squared-chi test compared the frequency distributions of canals classified as RFWL and NRFWL. From a total pool of 673 root canals, Reciproc instruments reached the FWL in 96.28% of cases and 3 fractures occurred. For narrow canals the percentage of RFWL was 95.37% with 3 fractures. For medium and large canals, the R40 or R50 instruments reached the FWL in 98.51% and 97.62% of the cases respectively, with no fracture. Enlarging of root canals using the Reciproc instruments up to the FWL without a glide path is successful in a great percentage of cases. This case series suggests the possibility of using a single instrument to enlarge the root canal space of teeth by a simpler approach without an a prioriglide path procedure.