Geothermal down well pumping system

A key technical problem in the exploitation of hot water geothermal energy resources is down-well pumping to inhibit mineral precipitation, improve thermal efficiency, and enhance flow. A novel approach to this problem involves the use of a small fraction of the thermal energy of the well water to boil and super-heat a clean feedwater flow in a down-hole exchanger adjacent to the pump. This steam powers a high-speed turbine-driven pump. The exhaust steam is brought to the surface through an exhaust pipe, condensed, and recirculated. A small fraction of the high-pressure clean feedwater is diverted to lubricate the turbine pump bearings and prevent leakage of brine into the turbine-pump unit. A project demonstrating the feasibility of this approach by means of both laboratory and down-well tests is discussed

A review of the real-world incidence of major bleeding after anticoagulant use in atrial fibrillation patients in the United States

OBJECTIVE: To comprehensively review real-world database studies in the United States that assess the risk of major bleeding among direct oral anticoagulant (DOAC) therapies or warfarin in a nonvalvular atrial fibrillation (NVAF) population. BACKGROUND: NVAF patients receiving anticoagulant therapy to reduce the risk of stroke or blood clots are at a higher risk of serious bleeding complications with the use of warfarin or other anticoagulant agents. METHODS: Reviewed MEDLINE (via Pubmed) and bibliographies of identified literature for publications and conference abstracts of retrospective observational studies using U.S. data sources from the first available date to June 15th, 2018. RESULTS: A total of 26 real-world database studies were identified and fully reviewed. Most studies utilized data from administrative claims or forms of patient registries (n = 25). Patient populations assessed were generally older and male. Apixaban resulted in statistically significant reductions in bleeding risk compared to warfarin in most studies that assessed the relationship (n = 11). Dabigatran was less consistently shown to exhibit a lower bleeding risk compared to warfarin; nine studies reported lower risk, though only three studies were statistically significant. In a head-to-head comparison, however, apixaban and dabigatran generally showed no significant difference. Bleeding risk for rivaroxaban was similar to warfarin. No studies were found that evaluated the bleeding risk of edoxaban. CONCLUSIONS: Overall, DOACs exhibit a lower risk of major bleeding compared to warfarin, although with significantly different rates. Apixaban most consistently shows reduced risk of bleeding in the real-world compared to warfarin, followed by dabigatran. More evidence is needed to evaluate the recently approved agent edoxaban

We\u27ve Got Time

John Carroll University student Tyrone McBee wrote and directed this play for JCU\u27s Black Theatre. It ran April 22,23,24, 29,30, and May 1 in 1977. The cast included Ralph Robinson, Frank Sheperd, and Sharon Hughes. no program is available. The Carroll News review of this is on page 3 of the April 29, 1977 issue.https://collected.jcu.edu/plays/1077/thumbnail.jp

Development of an Evidence Based Surgical Site Infection Bundle in Patients Undergoing Colorectal Surgery: A Quality Improvement Initiative

BACKGROUND: Surgical site infections (SSI) are among the leading healthcare-acquired infections that negatively impact patient outcomes and increase total cost of healthcare and the patient’s length of stay. At a community hospital in West Virginia, trends in SSI rates and the standardized infection ratio (SIR) increased for patients undergoing colorectal surgery. The purpose of this quality improvement project was to identify and implement permanent evidence-based practice changes to reduce SSI rates in colon surgery patients. METHODS: Baseline rates of SSI and the SIR for the facility was calculated from October 2021 to September 2022. Colon surgery SSI reduction measures were identified based on practice guidelines set forth by the American College of Surgeons (ACS) and the Association of periOperative Registered Nurses (AORN). Measures shown to have the greatest statistical benefit for improving SSI rates were included in a paper bundle checklist. Measures were then divided into three phases including: Preoperative, intra-operative, and post-operative. A baseline assessment of SSI prevention measures was performed for operating room (OR) staff using best practice guidelines by AORN. INTERVENTION: OR staff received education on new SSI reduction measures including the use of a separate closing table and sterile glove change during colon surgery cases. A post-intervention assessment was performed to evaluate learning. The Colon Surgery SSI Bundle checklist was distributed for each colon surgery patient for Registered Nurse (RN) completion during all perioperative phases. Education was performed regarding surgical dressings and documentation for all perioperative departments. RESULTS: Implementation of an evidence-based SSI reduction bundle reduced the rate of colon surgery SSI from 0.06 to 0.03 and reduced the SIR from 1.5 to 0.77. Components of the SSI bundle were successfully integrated into all colon surgery cases utilizing the PDSA cycle. Post-intervention assessment showed a 22% improvement in knowledge scores for OR staff. Low bundle compliance was associated with missing SSI checklist documentation. CONCLUSIONS: Development of a concise, evidence-based SSI reduction bundle is a reasonable method to improve rates of SSI in patients undergoing colon surgery. Specific SSI bundle education for OR staff participating in bundle use improves knowledge of SSI reduction methods and appropriate bundle measures. Completion of paper checklists to document bundle compliance was not conducive to nurse workflow and efforts should be made to integrate SSI bundles into the EMR. The PDSA cycle is a useful quality improvement method to improve patient care and outcomes. Keywords: Colon Surgery, SSI Reduction, Bundle, Quality Improvement, PDSA cycl

Sewing Kit

Kit said to herself, I will not seek him out. But if he finds me, or if I run into him, it can’t be helped. Then one day, as she was reading a magazine and waiting for the bus, he sat beside her on the bench. For a moment she didn’t see him. The morning’s coffee had not kicked in. She was reading the same sentence about the benefits of stevia over and over. Then his scent like Ivory soap and cloves or the low sound of his breathing made her look up to see him smiling at her. His lips curved until it seemed they might split, but they didn’t open. She breathed him. She was glad she was wearing her taupe jacket and neutral knee-length skirt. Drab, asexual work clothes should have been a keen defense. But then he was staring at her little ankles, his green eyes running over her tights. The tights were soft pink. Her heels were a bit higher than necessary