Effect of Intraoperative Mixed-Reality use on Nonsurgical Team Members in the Neurosurgical Operating Room: An Explorative Study

Objectives: Mixed-reality (MxR) implementation in the neurosurgical operating room (OR) is emerging, but the impact of this technology on the nonsurgical OR staff has not been investigated yet. The purpose of this study is to evaluate the nonsurgical OR team's perception of the impact of intraoperative MxR use. Methods: The evaluation occurred in a neurosurgical institution implementing MxR perioperatively on a daily basis for 15 months. The questionnaire measuring the impact of MxR consisted of 5 binary questions and 4 subquestions measured on a 7-point Likert scale. Results: Fifteen nonsurgical staff members of a neurosurgical OR team were interviewed. Most (85%) of the cohort stated that MxR changed their perception of the surgery, improving understanding of the spatial orientation (median 6, interquartile range 5–7) and of the pathology dimensions (6, 5.5–7). One participant (7%) was of the opinion that MxR disrupted the OR workflow. The majority (60%) stated that use of the holograms improved efficiency in the OR. The participants were neutral about the potential role of MxR to improve communication among different OR team members (4, 2–5) and overall teamwork (4, 2–5). Conclusions: The use of 3-Dimensional interactive holograms of neurosurgical cases in the nonsterile intraoperative phase was not perceived as distractive, and neither was OR flow disruption by members of the nonsurgical OR staff. MxR was considered an adjunct to improve OR efficiency. A thorough understanding of the impact of MxR's implementation on the nonsurgical staff could lead to targeted improvement of the MxR use and, potentially, to increasing the quality of the teamwork

Investigation into the effectiveness of feed spacer configurations for reverse osmosis membrane modules using Computational Fluid Dynamics

© 2016 Elsevier B.V.Reverse osmosis operations for water treatment are usually energy intensive and responsible for most of the product price. Several studies used flow characteristics to compare different geometries of feed spacers, but these cannot completely explain the effectiveness of feed spacers for promoting mass transfer near membranes. A few recent studies introduced a concept (Spacer Configuration Efficacy, SCE) combining mass transfer and energy consumption, but SCE has been applied only to a limited extent. The present study uses 3-dimensional steady state Computational Fluid Dynamics with mass transfer to compare four channels with feed spacer configurations (Ladder-type, Triple, Wavy and Submerged) and an empty plain channel using SCE and other performance measures. In contrast to previous studies, a saturated concentration boundary condition is employed at the membrane surface and optimised meshing of the domain is discussed. Power law correlations for SCE and other performance measures developed from the simulation results enable quick evaluation of the spacers. Results indicated that the assumed saturated solute concentration at the membrane strongly affects the mass transfer coefficient. Based on SCE, the Wavy spacer configuration showed the highest performance for Re>120 among the obstructed geometries considered, while Ladder-type was better for Re<120

Open communication between patients and relatives about illness & death in advanced cancer—results of the eQuiPe Study

Objective: To assess the degree of openness of communication about illness and death between patients with advanced cancer and their relatives during the last three months of the patient’s life, and its association with relatives’ characteristics and bereavement distress. Methods: We used data from bereaved relatives of patients with advanced cancer from the prospective, longitudinal, multicenter, observational eQuipe study. Univariate and multivariable linear regression analyses were used to assess the association between the degree of openness of communication (measured using the validated Caregivers’ Communication with patients about Illness and Death scale), the a priori defined characteristics of the relatives, and the degree of bereavement distress (measured using the Impact of Event Scale). Results: A total of 160 bereaved relatives were included in the analysis. The average degree of open communication about illness and death between patients with advanced cancer and their relatives was 3.86 on a scale of 1 to 5 (SE=0.08). A higher degree of open communication was associated with a lower degree of bereavement distress (p=0.003). No associations were found between the degree of open communication and the relatives’ age (p=0.745), gender (p=0.196), level of education (p>0.773), (religious) worldview (p=0.435), type of relationship with the patient (p>0.548), or level of emotional functioning before the patient’s death (p=0.075). Conclusions: Open communication about illness and death between patients and relatives seems to be important, as it is associated with a lower degree of bereavement distress. Healthcare professionals can play an important role in encouraging the dialogue. However, it is important to keep in mind that some people not feel comfortable talking about illness and death

De restauraties van Jan de Meijer en A.A. Kok

This article is a brief review of the restoration work of the architects Jan de Meijer and Antoon Abel Kok. Both architects worked in Amsterdam in the first half of the twentieth century. De Meijer and Kok each worked in their own way without adhering to the established restoration theories of the so called ‘Basic Principles’, published in 1917. Jan de Meijer mainly reconstructed early seventeenth-century Renaissance buildings which, according to him, had been mutilated by later refurbishments. The premises Oudezijds Voorburgwal 249 and 14 and Nieuwezijds Voorburgwal 75 are examples of this. With his reconstructions he restored these buildings to an ideal seventeenth-century state. In his view the cross-bar windows and the proportions of these Renaissance buildings were the perfect expression of professional skill. Nevertheless De Meijer did not exclusively restore buildings to their original state. Singel 440 and Brouwersgracht 48 show that he, too, sometimes only executed repairs and practical alterations. De Meijer thought that the restoration question was too complicated to be solved by means of dogmas. It was important to him to ask himself the question what should be the approach to each individual restoration. His views on the traditional building methods, the idealisation of Renaissance buildings and the use of the cross-bow window saw to it that he did not adhere to the established restoration theories, but went his own way entirely. A.A. Kok also restored in his own individual way. Sometimes he only repaired, as in the case of Prinsengracht 2, and appeared to adhere completely to the Basic Principles and theories of Ruskin. In other cases, as in Kattegat 4-6, he restored the premises to their original state, abandoning the Basic Principles. Kok was a man with practical know-how; consequently, he looked at each building separately and for each building his point of view on the restoration in question was different. He preferred to take up a position halfway between the views on restoration of Ruskin and Viollet-le-Duc. If it was necessary to demolish part of a building and rebuild it, he carried this out as much as possible with old materials, so as to approach the original state as closely as possible. It was not just the beauty of the individual building that was important to Kok, but also the beauty of the city of Amsterdam. His restoration work should therefore be viewed in connection with the restoration of the city as a whole. A good building only needed repairs, a bad building had to be renewed and improved. So both architects did not adhere to fixed theories and dogmas, but considered each building separately. Kok and De Meijer show a restoration practice that was quite different from the restoration theories at the time. From a review of their work it appears that the restoration practice in the early twentieth century was more complicated as has long been assumed