Excess Volumes of Mixing of Cl– and Br– with Na+ and K+ at 308.15 K in Aqueous Dioxane Mixed Solvent

Excess volumes of mixing for six possible binary combinations of solutions of NaCl, KCl, NaBr and KBr have been determined at constant ionic strengths of 1.000 and 2.000 mol kg–1 at 308.15 K using a dilatometer in a water +1,4-dioxane mixed solvent system. Pitzer’s ion interaction model has been utilized to obtain binary and triplet interaction parameters, i.e. θV and ψV. The data were also analysed in the light of the Friedman model. Data are dependent on the nature of the common ion and do not support the cross square rule (CSR). The  deviation from the CSR increased with increasing ionic strength and is considered to arise from the appreciable contribution of triplet interactions and preferential solvation of the ions and ion-clusters in the mixed solvent system.KEYWORDS: Excess volumes of mixing, Friedman model, Pitzer model, cross square rule

An Econometric Analysis of Patient Flows in the Cardiac Intensive Care Unit

This paper explores the rationing of bed capacity in a cardiac intensive care unit (ICU). We find that the length of stay for patients admitted to the ICU is influenced by the occupancy level of the ICU. In particular, a patient is likely to be discharged early when the occupancy in the ICU is high. This in turn leads to an increased likelihood of the patient having to be readmitted to the ICU at a later time. Such “bounce-backs” have implications for the overall ICU effective capacity—an early discharge immediately frees up capacity, but at the risk of a (potentially much higher) capacity requirement when the patient needs to be readmitted. We analyze these capacity implications, shedding light on the question of whether an ICU should apply an aggressive discharge strategy or if it should follow the old quality slogan and “do it right the first time.” By comparing the total capacity usage for patients who were discharged early versus those who were not, we show that an aggressive discharge policy applied to patients with lower clinical severity levels frees up capacity in the ICU. However, we find that an increased number of readmissions of patients with high clinical severity levels occur when the ICU is capacity constrained, thereby effectively reducing peak bed capacity

The Effects of Focus on Performance: Evidence from California Hospitals

We use hospital-level discharge data from cardiac patients in California to estimate the effects of focus on operational performance. We examine focus at three distinct levels of the organization—at the firm level, at the operating unit level, and at the process flow level. We find that focus at each of these levels is associated with improved outcomes, namely, faster services at higher levels of quality, as indicated by lower lengths of stay (LOS) and reduced mortality rates. We then analyze the extent to which the superior operational outcome is driven by focused hospitals truly excelling in their operations or by focused hospitals simply “cherry-picking” easy-to-treat patients. To do this, we use an instrumental variables estimation strategy that effectively randomizes the assignment of patients to hospitals. After controlling for selective patient admissions, the previously observed benefits of firm level focus disappear; focused hospitals no longer demonstrate a statistically significant reduction in LOS or mortality rate. However, at more granular measures of focus within the hospital (e.g., operating unit level), we find that more focus leads to a shorter LOS, even after controlling for selective admission effects

Accumulating a Portfolio of Experience: The Effect of Focal and Related Experience on Surgeon Performance

One key driver of improvement in surgical outcomes is a surgeon\u27s prior experience. However, research notes that not all experience provides equal value for performance. How, then, should surgeons accumulate experience to improve quality outcomes? In this paper, we investigate the differential effects of focal and related (i.e., tasks similar to, but not identical to, the focal task) experience. We open up the black box of the volume-outcome relationship by going beyond just dividing experience into focal and related categories, but also considering how subtasks and context (i.e., the organization in which the work takes place) affect performance. To understand these issues, we assemble a novel data set on 71 cardiothoracic surgeons who performed more than 6,500 procedures during a period of 10 years after the introduction of a breakthrough surgical procedure. We find that, as compared to related experience, surgeon focal experience has a greater effect on surgeon performance. We also demonstrate that subtask experience has different, nonlinear performance relationships for focal and related experience. Finally, we find that focal experience is more firm specific than related experience and that nonfirm experience reduces the learning rate for both focal and related experience. We discuss implications of our findings for healthcare delivery and operations management

Excess Enthalpies of Mixing of Binary Mixtures of NaCl, KCl, NaBr and KBr in Mixed Ternary Solvent Systems at 298.15 K

Excess enthalpies of mixing for six possible binary combinations of solutions of NaCl, KCl, NaBr and KBr in mixed ternary solvents composed of formamide, 1,4-dioxane and water have been determined using a flow microcalorimeter at constant ionic strengths of 0.500 and 1.000 mol kg–1 at 298.15 K. Unlike the case of water, the data do not supportYoung’s cross square rule. Pitzer’s virial coefficient theory has been utilized to obtain binary and ternary interaction parameters, i.e. θH and ψH. The data were also analysed in terms of the Friedman model and it was found that interactions between solvated ions are dictated not only by coulombic interactions but also by appreciable asymmetric effects.Keywords: Enthalpy of mixing, ternary solvents, Pitzer theory, Friedman model, cross square rule

Working With Capacity limitations: Operations Management in Critical Care

As your hospital\u27s ICU director, you are approached by the hospital\u27s administration to help solve ongoing problems with ICU bed availability. The ICU seems to be constantly full, and trauma patients in the emergency department sometimes wait up to 24 hours before receiving a bed. Additionally, the cardiac surgeons were forced to cancel several elective coronary-artery bypass graft cases because there was not a bed available for postoperative recovery. The hospital administrators ask whether you can decrease your ICU length of stay, and wonder whether they should expand the ICU to include more beds For help in understanding and optimizing your ICU\u27s throughput, you seek out the operations management researchers at your university

Clinicopathological spectrum of uterine leiomyomas in a state of Northern India: a hospital based study

Background: Myometrial lesions form a diverse group amongst which leiomyoma is the commonest visceral neoplasm affecting females in the reproductive age group. They are noted clinically in 20-30% of women over 30 years of age; are rare prior to the menarche, common in reproductive life and have a tendency to regress after the menopause. Their gross appearances are often altered by various secondary changes. Subtypes of leiomyoma are chiefly of interest as they may mimic malignancy in some cases.Methods: All the hysterectomy and myomectomy specimens which were received in the department of pathology, ASCOMS hospital Jammu, Jammu and Kashmir over a period of one year, out of which 79 cases with leiomyomas were included in the study. The specimens were properly labeled, fixed (in NBF), examined grossly, processed, stained and examined microscopically.Results: Age range of the patients with leiomyoma was18-62 years. Majority of the patients were between 41-50 years (46.84% cases). Menorrhagia was the commonest symptom constituting 37.97% cases and fibroid uterus was the most common clinical diagnosis provided (44%). Most common location of leiomyoma’s was intramural (57.43%) followed by subserosal (30.69%). 56.96% leiomyoma’s were single and 43.04% were multiple. Degenerative changes were observed in 16.46% cases, amongst which hyaline change was the most common (6.33%). 9 types of leiomyoma variants were seen, amongst which cellular leiomyoma (6.33%) was the commonest. Adenomyosis was associated with leiomyoma in 19.23% cases.Conclusions: This study was conducted to analyze the clinic pathologic spectrum of uterine leiomyoma’s in northern India with regards to their clinical presentation, associated changes and variants, and to compare our findings with similar studies from different parts of the world

Clinico-histopathological analysis of orbito-ocular lesions: a hospital-based study

Introductions: Preoperative diagnosis of orbital and ocular lesions is necessary for optimum treatment. The study aims to analyze the histomorphological spectrum of orbito-ocular lesions and to evaluate the need of ancillary techniques for confirmation of diagnosis. Methods: A cross sectional hospital based study of orbito-ocular surgical biopsy samples obtained in the Department of Pathology, at Birat Medical College Teaching Hospital, Nepal during one-year period was analysed for clinical and histopathological findings. Demographic data, site and tissue type, benign or malignant, recommendations for special stains and immunohistochemistry panel study were analysed.    Results: Out of 185 total samples, male to female ratio of 1.1:1, age ranged from ten month to 82 years, 11-20 year age group had 39 (21.1%) orbito-ocular lesions and cornea-conjunctiva was involved in 104 (56.2%). Clinical diagnosis correlated well with histopathological diagnosis, p<0.001. The non-neoplastic, benign and malignant lesions were 36.7%, 33.5% and 29.7% respectively. Squamous cell carcinoma was seen in 28 (50.9%) of malignant lesions followed by sebaceous carcinoma 7 (12.7%). The special stains and immunohistochemistry panel was recommended in 38 (20.5% and 21 (11.3%) cases respectively. Conclusions: Findings suggest the clinical and histopathological diagnosis correlated well in diagnosis of a wide spectrum of orbito-ocular lesions. Keywords: ancillary techniques, clincio-pathological correlation, immunohistochemistry, orbito-ocular lesions, squamous cell carcinom

Changing Climate over Chad: Is the Rainfall over the Major Cities Recovering?

Chad is the largest country of the Sahel region with different climatic zones, varying from arid in the north to tropical in the south. These climatic zones respond differently to climate change signals. Therefore, their detection over major cities, which are scattered within different climatic zones, is of utmost importance. The changes in hydroclimatic fields such as rainfall and temperature were examined over the major cities in various regions for the period 1950 to 2014. Rainfall shows a significant decreasing trend especially over cities close to Lake Chad (Lere, Mondou, Mongo and Sarh), whereas no significant trend is observed for cities farther from the Lake. However, a consistently increasing trend in temperature is found across all cities. The cities in the north (Faya, Abeche, and Ati) receive far less rainfall than those located in southern Chad. All cities (except Faya and Lere) received higher rainfall during 1950 – 1965 (wet period), entering a dry regime between 1966 – 1990 (dry period) and subsequently recovering rainfall totals, toward previous levels, between 1991 – 2014 (recovery phase). A substantial rise in air temperature is observed after 1980 – 1985, reflecting the gradual rise of temperature in recent times. In summary, rainfall is recovering from a dry regime and temperature is rising over all the major cities of Chad. More researches in this region is needed to develop local scale mitigation strategies and adaptation technology

Fermentation process for alcoholic beverage production from mahua (Madhuca indica J. F. Mel.) flowers

Mahua flowers are rich in sugar (68-72%), in addition to a number of minerals and one of the most important raw materials for alcohol fermentation. The present investigation was for the development of a non-distilled alcoholic beverage from Mahua flowers. Eighteen (18) treatment combinations consisting of two temperatures (25 and 30°C), three pH (4.0, 4.5 and 5.0) and three period of fermentation (7, 14 and 21 days) were used in the fermentation conditions. The maximum yield of ethanol (9.51 %) occurred at 25°C with pH 4.5 after 14 days of  fermentation of Mahua flower juice. The fermented non-distilled alcoholic beverage contained total sugar (8.83 mg/ml), reducing sugar (0.82 mg/ml), total soluble solids (6.37°Brix) titrable acidity (0.65 %), and volatile acidity (0.086%). Methanol was not detected at any stage of fermentation. The developed fermented alcoholic beverage had characteristic flavor and aroma of Mahua flowers with about 7 to 9% alcohol.Keywords: Madhuca indica, ethanol, reducing sugar, fermentation.African Journal of Biotechnology Vol. 12(39), pp. 5771-577