872 Audit - Unexpected Overnight Stay After Day-Case Surgery In ENT

Introduction The aim of this audit was to determine the compliance with guidelines regarding patient selection for day-case surgeries in ENT. Method Data was collected retrospectively and included all patients who underwent elective ENT surgeries over a one-year period at an NHS hospital. Factors considered included nature of the operation, timing, surgeon’s preference, as well as social circumstances. Results Out of 1101 intended day cases, 113 (10%) had an unexpected overnight stay. The major factor contributing to these overnight stays was the timing of the operation, where 85 cases had undergone surgery in the afternoon. Other factors included drain siting, saturation monitoring, post-operative complications, and social circumstances. Tonsillectomy-related and nasal procedures formed the majority of the procedures, with 74 cases in total. Conclusions We concluded that most overnight stay cases included in this audit could have been prevented. Careful theatre list planning by prioritizing day cases for morning lists may reduce these numbers significantly. Co-morbidities and social aspects may need to be explored when booking patients for theatres.

The Sensitivity Prediction of Neoadjuvant Chemotherapy for Gastric Cancer

The overall efficacy of neoadjuvant chemoradiotherapy (NACT) for locally advanced gastric cancer (LAGC) has been recognized. However, the response rate of NACT is limited due to tumor heterogeneity. For patients who are resistant to NACT, not only the operation timing will be postponed, patients will also suffer from the side effects of it. Thus, it is important to develop a comprehensive strategy and screen out patients who may be sensitive to NACT. This article summarizes the related research progress on the sensitivity prediction of NACT for GC in the following aspects: microRNAs, metabolic enzymes, exosomes, other biomarkers; inflammatory indicators, and imageological assessments. The results showed that there were many studies on biomarkers, but no unified conclusion has been drawn. The inflammatory indicators are related to the survival and prognosis of patients under NACT. For imageological assessments such as CT, MRI, and PET, with careful integration and optimization, they will have unique advantages in early screening for patients who are sensitive to NACT.

A Way to Reduce the Uncertainties, Optimize and Reduce Time During the Multistage Cut and Retrieve Operations for Surface Plug Placement

Planning and execution of the well plug and abandonment(P&A) requires detailed knowledge of the downhole barrier's integrity status and position of its downhole completion elements.[Maxim Volkov] This input is utilized for the determination of zones for permanent plugs, casing cuts and retrieval procedures. The last one can be significantly optimized if conducted across the zones with minimal total wall thickness. Cutting the casing across casing collars, fins or casing decentralization may extend the operation requiring more time and resources to achieve success. However, the detailed completion information is not always available due to several well handover. This may result in casing cut performed blindly, based on the position of the first casing collars revealed by caliper or ultrasound surveys. This may result in an increase of the RIG operation timing from few hours to few days. The paper shows results of downhole scanning during three subsea wells P&A campaign at the stage of environmental plug deployment. This included cutting and pulling out of casing wellhead elements (casing stumps) after milling works, before setting environmental cement plug in seabed zone. Casing wellhead design may include the first 13 3/8" and 20" casing joint welded fins to centralize casings. Typical casing joint with fins (rigid type) is shown in figure 1. The abandonment program included milling of these casings and the cutting through the minimal or nominal wall thicknesses with avoiding fins and collars of the casings. The depth of the cutting window initially was set from the available well diagrams, which were not available in all the wells. Thus, the main role of the scanning was to verify and optimize the casings cut window depth to perform the process with minimal issues. Figure 1 Casing joint with rigid centralizers-fins.

Energy Management Optimization of Series Hybrid Electric Bus Using an Ultra-Capacitor and Novel Efficiency Improvement Factors

The existing series hybrid electric bus (SHEB) uses an ultra-capacitor (UC) to extend battery life, mitigate vehicle weight, and reduce cost. However, previous studies did not clearly identify the operation timing and load of the UC for efficiency improvement in an SHEB. This paper proposes novel efficiency improvement factors, with their application criteria for the ideal operation timing and load of the UC in an SHEB. The factors are the threshold of the required power of the motor (TRPM), slope of the power split ratio (SPSR), and y-axis intercept of the power split ratio (YPSR). The TRPM determines the duration of using just the battery. The SPSR or YPSR determine the most efficient load ratio between the battery and UC. The criteria for using them are set using particle swarm optimization. Manhattan, Braunschweig, and Orange County driving cycles were used to reflect various road load conditions. The results showed that the proposed factors and their setting criteria guarantee a significant reduction in the fuel consumption and more energy-efficient SHEBs.

DEVICE FOR GEOPHYSICAL EXPLORATION OF THE EARTH'S CRUST BASED ON A DETONATION GENERATOR

The article describes the principle of operation of the device for geophysical exploration, which is based on the action of detonation waves to a limited area of the earth's surface at a shallow depth (up to 100 m), a block diagram and timing diagrams explaining the principle of the device. KEYWORDS: geophysical exploration, device, block diagram, principle of operation, timing diagram, detonation generator, phase shift, harmonic component of echo signals.

Alternative Approaches to Vibration Measurement Due to the Blasting Operation: A Pilot Study

As the infrastructure grows, space on the surface in the urban area is diminishing, and the view of the builders is increasingly moving underground. Implementation of underground structures, however, presents a number of problems during construction. One of the primary side effects of tunnel excavation is vibration. These vibrations need to be monitored for potential damage to structures on the surface, and this monitoring is an integral part of any such structure. This paper brings an original pilot comparative study of standard seismic instrumentation with experimentally developed fiber-optic interferometric and acoustic systems for the purpose of monitoring vibration caused by the blasting operation. The results presented show that systems operating on physical principles (other than those previously used) have the potential to be an alternative that will replace the existing costly seismic equipment. The paper presents waveform images and frequency spectra from experimental measurements of the dynamic response of the rock environment, due to blasting operation performed shallowly during the tunnel excavation of a sewer collector. In the time and frequency domain, there is, by comparison, significant agreement both in the character of the waveform images (recording length, blasting operation timing) and in the spectra (bandwidth, dominant maxima).

Progression of Aortic Regurgitation After Subarterial Ventricular Septal Defect Repair: Optimal Timing of the Operation

In patients with subarterial ventricular septal defect (VSD), the progression of aortic regurgitation (AR) still remains unclear. This review is to identify the incidence of AR progression after VSD repair and to determine the optimal operation timing for subarterial VSD repair with or without aortic valve prolapse or AR. From January 2002 to December 2015, 103 patients who underwent subarterial VSD repair alone at our hospital were reviewed. All patients routinely underwent echocardiography (echo) performed by our pediatric cardiologists. The operative approach was through the pulmonary artery in all patients. The median age of patients at operation was 10 months (range 3 to 16.5 months). Eighty-nine patients (86.4%) underwent subarterial VSD closure before the age of 4 years. In the preoperative evaluation, 27.2% (28 patients) of the patients showed more than faint degree AR. The mean follow-up duration after VSD repair was 6.6 ± 4.0 years. In the latest follow-up echo after VSD repair, four patients had more than mild degree AR owing to aortic valve abnormalities or delayed operation period. Among them, AR progression occurred in only one patient (0.98%). Early and accurate assessment of the anatomical morphology of the aortic valve and optimal operation timing may be important to achieve better outcomes after repair and to prevent the development of aortic valve complications.