731 Operation Notes: Is Informal Training Enough?

Aim Operation notes are essential for continuity of patient care, communication between colleagues, medicolegal records and for coding and remuneration. This study aims to assess core surgical trainees (CST’s) understanding of completing accurate and detailed operation notes and their awareness of the RCS England Good Surgical Practice document (GSP 2014). Method Current CST’s who attended regional teaching were surveyed on their knowledge of what an adequate operation notes entails. Trainees then attended a 40-minute lecture on this topic and were then re-surveyed. Results Thirty trainees completed both questionnaires. No trainees had previously received formal teaching on how to complete operation notes. Most had received informal training in the clinical setting, usually by a registrar (93.3%). Operation notes were considered important for medicolegal reasons (53.3%), continuity of care (96.6%) and communication (53.3%). No one identified their importance for coding. Initial assessment showed only 26.6% of CST’s were aware of RCS GSP document. Responses regarding relevant information to be included in operation notes were variable: patient demographics (23.3%), procedure (93.3%) and post-operative instructions (90%). Improvements, between 3 - 70% increase, were noted in all questionnaire domains post teaching session. All trainees found a more formal session to be beneficial. Conclusions Although a small study, this demonstrates global improvements in knowledge after formal teaching session over informal clinical training. We believe this topic should be included in boot camp training at the start of core surgical training. It should include education in coding to ensure CST’s appreciate the significance of health information management.

Operation notes in orthopaedics: Beliefs and practices in a developing country

Maintaining accurate and complete operation notes is an essential metric of the quality of surgical care. While developed countries have implemented electronic health records to improve documentation, financial constraints prevent this realisation in the Caribbean. Somewhat paradoxically, previous studies in this area have focussed on ‘process’ while neglecting the key role of the surgeon. We conducted a 25-item Knowledge, Attitudes and Practices survey of orthopaedic doctors to identify any culturally unique health-related behaviours. Our results indicate that while most doctors understand the importance of operation notes, many are unaware of international note-keeping recommendations. Legibility was identified as a significant issue by 92% of doctors. A disturbing and previously unreported finding from the study revealed that 72% of surgeons would occasionally write the operation notes, although they were not scrubbed in for the procedure. We suggest that future studies examine this peculiar behaviour in greater detail.

Prognostic Value of Intraoperative Pleural Lavage Cytology as an Independent Prognostic Factor in Non-Small Cell Lung Cancer: A Retrospective Study

BackgroundThe aim of this study is to demonstrate that intraoperative PLC has a role in predicting clinical outcomes in NSCLC patients.MethodsIntraoperative PLC was performed in NSCLC patients who had no pleural effusion before the operation. PLC was performed three times for each patient. PLC1 was performed after the thoracotomy; PLC2 was performed immediately after complete operation; and PLC3 was performed after complete operation and washed the pleural cavity with 5,000 ml of normal saline solution. Clinical records of 178 patients in Ramathibodi Hospital from 2012 to 2016 were retrospectively reviewed and analysed for the relevance of intraoperative PLC and clinical outcomes.Results178 patients were included in this study; 67 patients were male (37.6%). Metastatic tumour from primary lung cancer occurred in 56 patients (31.4%). Positive intraoperative PLC was significantly associated with higher metastatic rate (p < 0.05). Survival rate in the positive intraoperative PLC group was significantly worse than that in the negative PLC group (p < 0.05).ConclusionsThis study shows positive intraoperative PLC was statistically significant for increasing metastatic rate and decreasing survival rate in NSCLC patients. Intraoperative PLC could provide important information for the prediction of disease progression and treatment planning.

New Methodology of Slot Recovery Minimizing Milling Operation

Slot recovery operation can be considered as one of the most time consuming operation. Cut and pull casings, or milling casings have been carried out as typical method of slot recovery. However there are a lot of risks with this typical method such as poor progress of milling, damaging top drive due to high vibration while milling or sudden string jumping up while overpulling and possibility of string stuck caused by poor hole cleaning while milling. We have completed slot recovery operations on numbers of wells, but there were a lot of troubles caused by above mentioned adversaries on rig equipment and taking a lot of time to complete operation. There are several kinds of new slot recovery technologies that may save rig time and less harmful than conventional method. Casing Pulling Tool (CPT) is one of the new technologies which eliminates or mitigates risks mentioned above. CPT has piston internally and it is activated by applying pressure inside string. CPT is run with casing spear and drill pipes. Once spear is engaged with casing and apply pressure inside drill string, CPT provides pulling force on casing. Pulling force is varied depend on the applied pressure and maximum available pulling force is more than 1,000 kips. Hence upper part of string is anchored at rotary table by slips, pulling force is applied on casing and drill string below rotary table. This means no pulling force is applied on top drive and minimize the chance of getting damage on it. As an actual case, we could successfully recover 13-3/8" casing by CPT without having any troubles and complete slot recovery operation with saving rig time compared to the conventional methods. This paper introduces the details about the case mentioned above.

The Development and Application of Charitable Trust in China

Charitable trust is a combination of charity and trust industry. The development of charitable trust started earlier in foreign countries and has been widely used. Charitable trust in China is still in its infancy, lacking legal support and a complete operation system. Problems such as unclear boundaries and imperfect tax preference system, and a complete public trust system has not yet been formed. But from a development point of view, charitable trust in China's poverty alleviation, pension and other fields have a high application value and development prospects. In this paper, the development status of charitable trust in China is summarized and considered.

Performance Examination of SEPIC Based Hybrid Cascaded Single-Phase Multilevel Inverter

In the present scenario, reduced part count(RPC) multilevel inverters are become popular compared to traditional multilevel inverters(MLIs). This is mainly due to reduced size and cost and alleviates the issues of more passive components, flying capacitor voltage balancing issues and the requirement of complex switching schemes. Also, the RPC is getting attraction for various industrial and transportation applications. Therefore, in this paper, a novel 17 level inverter is proposed by cascading MLIs with the reduced part count. The complete operation, switching schemes and output are presented to evolve the performance under steady-state conditions using MATLAB software.

Implementation of Protective Device for Lineman Protection in Real Time Operation

this paper is proposed to control an electrical switch with the assistance of OTP based password. A keypad is associated with the task to enter the secret password. During the electric line fixing Lethal electrical accidents to the lineman are increasing because of the lack of communication between the linemen working staff and the electric substation officers. This proposed framework gives an answer, which can guarantee the wellbeing of the lineman. Since the control to turn on/off lies with the lineman. So there is the arrangement in the system and a password is required to operate the electrical switch i.e. on and off. The lineman has to carry the RF-ID tag that will be inserted into RF-ID reader to generate a one-time password. OTP will be received by the lineman. After inserting correct OTP Lineman will trip the supply and after securely repairing it, again he can turn the supply for respective phase. A microcontroller from ARDUINO family is used in the framework for complete operation and control. The microcontroller is interfaced with the matrix keypad to enter the secret one time password. The entered secret OTP is compared with the password stored in the microcontroller’s Read-only memory. If OTP matches with the stored one than only electrical switches can be turned on or off otherwise it will say the wrong password. A light emitting diode is used to intimate the activation and deactivation of the electrical switch. Because of the use of EEPROM, the user does not have to remember the secret password. The microcontroller is interfaced with the Global system of mobile (GSM) to monitor the operation by lineman by the means of SMS. When lineman trip the supply a message will be sent to a higher authority about the Activation and deactivation of the electrical switch.

Outlier Detection in Climatology Time Series with Sliding Window Prediction

It is important to identify outliers for climatology series data. With better quality of data decision capability will improve which in turn will improve the complete operation. An algorithm utilising the sliding window prediction method is being proposed to improve the data decision capability in this paper. The time series are parted in accordance with the size of sliding window. Thereafter a prediction model is rooted with the help of historical data to forecast the new values. There is a pre decided threshold value which will be compared to the difference of predicted and measured value. If the difference is greater than a predefined threshold then the specific point will be treated as an outlier. Results from experiment are showing that the algorithm is identifying the outliers in climatology time series data and also remodeling the correction efficiency.

A Multi-Fidelity Sampling Method for Efficient Design and Optimization of Centrifugal Compressor Impellers

The optimization of a centrifugal compressor impeller is a challenge for established strategies and algorithms, as the interactions between the geometric design parameters and the aerodynamic and structural performance of the system are highly complex. Furthermore many geometrically valid designs are unusable in terms of structure mechanics or flow physics. Due to the complex parameter correlations, a simple limitation of the parametric space is no option, as possibly beneficial parameter combinations could be ruled out. To obtain a meaningful optimization result, the complete operation range of the compressor has to be taken into account which adds further complexities in terms of the optimization process and the computational expense. The combination of these issues leads to a complicated optimization scenario. The aim of the presented work is the reduction of the computational expense required to generate a high quality metamodel for optimization. This goal shall be achieved by the development of a multi-fidelity sampling method. The basic idea is to use preliminary of low-fidelity information from empirical data or fast analytical methods to identify promising regions of the parameter space. Then the samples of the DOE are concentrated in these areas while still maintaining a good coverage of the whole applicable design space. This ensures that no beneficial designs are ruled out which were not recommended by preliminary information. The points of the resulting DOE are computed by CFD and FEA computations and used to generate the metamodel which is used for the optimization. The method is tested by generating a metamodel used for compressor optimization. The results are compared to an optimization using a metamodel based on a conventional Latin hypercube sampling.

Effect of NAFTA, EUMFTA and China addition to WTO on the cucumber world market

Key words: Cucumber world market, international trade, economic integration, quadratic programming, spatial equilibrium models.Abstract. This study empirically analyzed the potential effects of the complete operation of North American Free Trade Agreement (NAFTA), European Union and Mexico Free Trade Agreement (EUMFTA), and the integration of China to the World Trade Organization (WTO), on the cucumber world market. Special emphasis on the impact on Mexico was presented, from a worldwide perspective. A spatial equilibrium model with endogenous prices was constructed for this purpose. Among the findings are: (1) Mexican producers benefited from the complete implementation of NAFTA and EUMFTA. (2) The incorporation of China as a member of the WTO showed a negligible effect on the commercial flows and prices in the cucumber world market. (3) Mexican cucumber production is highly competitive, in the world market, because it has the lowest supply costs.Palabras Clave: Mercado mundial del pepino, integración económica, comercio internacional, programación cuadrática, modelos de equilibro espacial.Resumen. Este estudio analiza empíricamente los efectos potenciales de la operación completa del Tratado de Libre Comercio de América del Norte (TLCAN), Tratado de Libre Comercio de la Unión Europea y México (UMFTA), y la integración de China a la Organización Mundial de Comercio (OMC) en relación al mercado mundial del pepino. Se presentan, con énfasis especial, los impactos sobre México desde una perspectiva mundial.