Using Education to Promote Waste Segregation and Waste Reduction in the Operating Room: A Quality Improvement Initiative

Background: The operating room (OR) is known to be one of the largest producers of medical waste and of the surgical specialties, orthopedic surgery tends to the largest portion of this. Waste from the OR can be mitigated by recycling non-contaminated materials. This reduces the number of raw materials needed to create new products, decreases landfill use, and lowers hospital costs. Local Problem: It was observed that a gap in knowledge existed related to recyclables in the OR of a large medical center in New England. Also, it was observed that there was potential for waste and recycling to be more accurately segregated and for blue wrap to be separated from general recycling. Specific Aims: The aim was to increase circulating nurses’ and surgical technologists’ confidence in knowledge of recyclables in the operating room. Additionally, the aim was to increase the proportion of recycling by 15%, increase the accuracy of recycling to 95%, and increase the accuracy of blue sterilization wrap segregation to 100%. Methods: The Plan-Do-Study-Act (PDSA) model was used for implementation. Pre- and post-education waste audits of primary total knee arthroplasties were performed to assess recycling, blue wrap, and waste. Pre- and post-education surveys were utilized to assess staff confidence. Interventions: An educational presentation was given to orthopedic surgical service circulating nurses and surgical technologists. Additionally, a visual poster board was displayed in the staff breakroom. Results: Survey data indicated an increase between pre- and post-education confidence in staff, which met the specific aim. Waste audit data showed a 26% increase in pre-operative proportions of recycling and an approximate 4% decrease in blue wrap by weight. There was a decrease in recycling accuracy by 6.6% but an increase of about 25% in the accuracy of blue wrap segregation post-intervention. Conclusion: Education for a subset of perioperative staff aided in increased confidence in recycling in the OR. Further improvements in staff confidence, recycling, and blue sterilization wrap segregation throughout surgical specialties may be possible through additional education and physical resources

Aspects of the Mass Distribution of Interstellar Dust Grains in the Solar System from In-Situ Measurements

The in-situ detection of interstellar dust grains in the Solar System by the dust instruments on-board the Ulysses and Galileo spacecraft as well as the recent measurements of hyperbolic radar meteors give information on the properties of the interstellar solid particle population in the solar vicinity. Especially the distribution of grain masses is indicative of growth and destruction mechanisms that govern the grain evolution in the interstellar medium. The mass of an impacting dust grain is derived from its impact velocity and the amount of plasma generated by the impact. Because the initial velocity and the dynamics of interstellar particles in the Solar System are well known, we use an approximated theoretical instead of the measured impact velocity to derive the mass of interstellar grains from the Ulysses and Galileo in-situ data. The revised mass distributions are steeper and thus contain less large grains than the ones that use measured impact velocities, but large grains still contribute significantly to the overall mass of the detected grains. The flux of interstellar grains with masses $> 10^{-14} {\rm kg}$ is determined to be $1\cdot 10^{-6} {\rm m}^{-2} {\rm s}^{-1}$. The comparison of radar data with the extrapolation of the Ulysses and Galileo mass distribution indicates that the very large ($m > 10^{-10} {\rm kg}$) hyperbolic meteoroids detected by the radar are not kinematically related to the interstellar dust population detected by the spacecraft.Comment: 14 pages, 11 figures, to appear in JG

OPTIMIST: A new conflict resolution algorithm for ACT-R.

Several studies have suggested recently that a more dynamic conflict resolution mechanism in the ACT-R cognitive architecture (Anderson & Lebiere, 1998) could improve the decision-making behaviour of cognitive models. This part of ACT-R theory is revisited and a new solution is proposed. The new algorithm (OPTIMIST) has been implemented as an overlay to the ACT-R architecture, and can be used as an alternative mechanism. The operation of the new algorithm is tested in a model of the classical Yerkes and Dodson experiement of animals' learning. When OPTIMIST is used, the resulting model fits the data better than the previous model (e.g. R2 (R squared) increases from .85 to .93 in one example)

Prolactin

During an oral glucose tolerance test (OGTT) glucose and insulin levels were measured in 26 patients with prolactin-producing pituitary tumours without growth hormone excess. Basal glucose and insulin levels did not differ from the values of an age-matched control group. After glucose load the hyperprolactinaemic patients showed a decrease in glucose tolerance and a hyperinsulinaemia. Bromocriptine (CB 154), which suppressed PRL, improved glucose tolerance and decreased insulin towards normal in a second OGTT. — Human PRL or CB 154 had no significant influence on insulin release due to glucose in the perfused rat pancreas. — These findings suggest a diabetogenic effect of PRL. CB 154 might be a useful drug in improving glucose utilization in hormone-active pituitary tumours

Perspectives on Interstellar Dust Inside and Outside of the Heliosphere

Measurements by dust detectors on interplanetary spacecraft appear to indicate a substantial flux of interstellar particles with masses exceeding 10^{-12}gram. The reported abundance of these massive grains cannot be typical of interstellar gas: it is incompatible with both interstellar elemental abundances and the observed extinction properties of the interstellar dust population. We discuss the likelihood that the Solar System is by chance located near an unusual concentration of massive grains and conclude that this is unlikely, unless dynamical processes in the ISM are responsible for such concentrations. Radiation pressure might conceivably drive large grains into "magnetic valleys". If the influx direction of interstellar gas and dust is varying on a ~10 yr timescale, as suggested by some observations, this would have dramatic implications for the small-scale structure of the interstellar medium.Comment: 13 pages. To appear in Space Science Review

A modified band approach for the accurate calculation of online photolysis rates in stratospheric-tropospheric Chemical Transport Models

International audienceHere we present an efficient and accurate method for the online calculation of photolysis rates relevant to both the stratosphere and troposphere for use in global Chemistry Transport Models and General Circulation Models. The method is a modified version of the band model introduced by Landgraf and Crutzen (1998) which has been updated to improve the performance of the approach for solar zenith angles >72° without the use of any implicit parameterisations. For this purpose, additional sets of band parameters have been defined for instances where the incident angle of the light beam is between 72?93°, in conjunction with a scaling component for the far UV region of the spectrum (?=178.6?202.0 nm). For incident angles between 85?93° we introduce a modification for pseudo-sphericity that improves the accuracy of the 2-stream approximation. We show that this modified version of the Practical Improved Flux Method (PIFM) is accurate for angles <93° by comparing the resulting height resolved actinic fluxes with a recently developed full spherical reference model. We also show that the modified band method is more accurate than the original, with errors generally being less than ±10% throughout the atmospheric column for a diverse range of chemical species. Moreover, we perform certain sensitivity studies that indicate it is robust and performs well over a wide range of conditions relevant to the atmosphere

Origins of Solar System Dust Beyond Jupiter

The measurements of cosmic interplanetary dust by the instruments on board the Pioneer 10 and 11 spacecraft contain the dynamical signature of dust generated by Edgeworth-Kuiper Belt objects, as well as short period Oort Cloud comets and short period Jupiter family comets. While the dust concentration detected between Jupiter and Saturn is mainly due to the cometary components, the dust outside Saturn's orbit is dominated by grains originating from the Edgeworth-Kuiper Belt. In order to sustain a dust concentration that accounts for the Pioneer measurements, short period external Jupiter family comets, on orbits similar to comet 29P/Schwassmann-Wachmann-1, have to produce $8\times 10^4:{\rm g}:{\rm s}^{-1}$ of dust grains with sizes between 0.01 and $6:{\rm mm}$. A sustained production rate of $3\times 10^5:{\rm g}:{\rm s}^{-1}$ has to be provided by short period Oort cloud comets on 1P/Halley-like orbits. The comets can not, however, account for the dust flux measured outside Saturn's orbit. The measurements there can only be explained by a generation of dust grains in the Edgeworth-Kuiper belt by mutual collisions of the source objects and by impacts of interstellar dust grains onto the objects' surfaces. These processes have to release in total $5\times 10^7:{\rm g}:{\rm s}^{-1}$ of dust from the Edgeworth Kuiper belt objects in order to account for the amount of dust found by Pioneer beyond Saturn, making the Edgeworth-Kuiper disk the brightest extended feature of the Solar System when observed from afar

X-ray Halos and Large Grains in the Diffuse Interstellar Medium

Recent observations with dust detectors on board the interplanetary spacecraft Ulysses and Galileo have recorded a substantial flux of large interstellar grains with radii between 0.25 and 2.0 mu entering the solar system from the local interstellar cloud. The most commonly used interstellar grain size distribution is characterized by a a^-3.5 power law in grain radii a, and extends to a maximum grain radius of 0.25 mu. The extension of the interstellar grain size distribution to such large radii will have a major effect on the median grain size, and on the amount of mass needed to be tied up in dust for a given visual optical depth. It is therefore important to investigate whether this population of larger dust particles prevails in the general interstellar medium, or if it is merely a local phenomenon. The presence of large interstellar grains can be mainly inferred from their effect on the intensity and radial profiles of scattering halos around X-ray sources. In this paper we examine the grain size distribution that gives rise to the X-ray halo around Nova Cygni 1992. The results of our study confirm the need to extend the interstellar grain size distribution in the direction of this source to and possibly beyond 2.0 mu. The model that gives the best fit to the halo data is characterized by: (1) a grain size distribution that follows an a^-3.5 power law up to 0.50 mu, followed by an a^-4.0 extension from 0.50 mu to 2.0 mu; and (2) silicate and graphite (carbon) dust-to-gas mass ratios of 0.0044 and 0.0022, respectively, consistent with solar abundances constraints. Additional observations of X-ray halos probing other spatial directions are badly needed to test the general validity of this result.Comment: 17 pages, incl. 1 figure, accepted for publ. by ApJ Letter