Arctic Marine Terminals -- Some Environmental and Engineering Considerations

Studies are presently underway to determine the technical and economic feasibility of various Arctic marine transportation systems, including ice-breaker super-tankers and submarine tankers. An important consideration in these studies is the design and construction of marine terminal facilities which will be suited to the unique problems of the Arctic. Factors which will significantly affect the design of proposed marine terminals include: 1) bathymetric configuration of the continental shelf;2) influence of moving pack ice on artificial structures, both at the air-water interface and along the bottom;3) lateral and vertical variations in soil conditions, including residual permafrost, which might adversely affect stability of offshore pipelines or structures; and4) instability of existing shoreline. Several basic designs for marine terminals are considered with respect to environmental and engineering problems including:1) nearshore harbor sheltered by a breakwater;2) offshore artificial islands;3) underwater terminals; and4) cone-shaped offshore platforms, either pile supported or gravity-type structures

Project #37: Management Guidelines for Patients with COVID-19: Rapid Cycle Improvement

Project’s purpose is to rapidly devise, continually improve, educate, and implement a live and changing COVID-19 management guideline based upon emerging best available evidence. This project also aims to optimize the care of patients with COVID-19 and improve patient outcomes.https://scholarlycommons.henryford.com/qualityexpo2022/1004/thumbnail.jp

Polyvinylchloride Containers do not Influence the Hemodynamic Response to Intravenous Nitroglycerin

ABSTRACTIn-vitro evidence of sorption of nitroglycerin (NTG) to polyvinylchloride (PVC) containers suggests that these containers may deliver less nitroglycerin to the patient than glass containers. Sorption of NTG to the PVC container may result in hemodynamic changes in the patient when a fresh solution of NTG is prepared and administered from a PVC container. This study was designed as a prospective, randomized trial to measure the hemodynamic response in patients receiving NTG in glass or PVC containers, during the first hour after a container exchange. Patients admitted to the coronary care unit in a University hospital with chest pain considered to be due to unstable angina or acute myocardial infarction were eligible. Patients who received other vasoactive drugs within one hour of container exchanges were excluded. Systolic and diastolic blood pressures, and heart rate were measured at baseline and at intervals for one hour following a container exchange. Twenty patients completed the study. There were no significant changes with time in either group (ANOVA, p>0.05) with respect to systolic, diastolic, or mean arterial blood pressure or heart rate. No chest pain occurred during the 60 minutes following the container exchange in either group. We conclude that NTG can be administered safely and effectively in PVC containers to patients with unstable angina or acute myocardial infarction. However, it remains possible that changes in hemodynamic status could occur in patients on NTG if a change in container type (i.e., from PVC to glass or vice versa) is made during the course of therapy.RÉSUMÉL'adsorption de la nitroglycérine au chlorure de polyvinyle (PVC), comme l'ont démontré les essais in vitro, suggère que les contenants faits de ce matériau peuvent entraîner l'administration d'une plus petite quantité de médicament que les contenants en verre. L'adsorption de la nitroglycérine peut amener des modifications hémodynamiques chez le patient quant on prépare et administre une solution fraîche de nitroglycérine dans un contenant en PVC. La présente étude, un essai prospectif randomisé, devait établir la réaction hémodynamique des malades recevant de la nitroglycérine au cours de la première semaine suivant la substitution des contenants en verre ou en PVC. Ont participé à cet essai des personnes alitées au service de soins coronariens d'un hôpital universitaire à la suite de douleurs à la poitrine attribuables de l'angine instable ou à un infarctus myocardique aigu. Étaient exclus les patients qui avaient reçu d'autres médicaments vasoactifs dans l'heure précédant la substitution des contenants. La pression artérielle systolique et diastolique et le rythme cardiaque ont été établis au départ, puis à intervalles d'une heure après l'échange des contenants. Vingt personnes ont terminé l'étude. On n'a relevé aucune variation significative avec le temps chez les deux groupes (ANOVA, p>0,05) pour ce qui est de la pression artérielle systolique, diastolique ou moyenne, ou le rythme cardiaque. La substitution des contenants n'a entraîné aucune douleur à la poitrine au cours des 60 minutes suivant l'échange. On en conclut que l'administration de nitroglycérine dans des contenants en PVC ne pose aucun danger pour les personnes atteintes d'angine instable ou d'infarctus myocardique aigu. Toutefois, il se peut que l'état hémodynamique des personnes à qui on administre ce médicament subisse des modifications quand on change de contenant au cours du traitement (à savoir quand on passe un contenant en PVC à un contenant en verre, ou vice versa)

Sedimentary reservoir oxidation during geologic CO2 sequestration

Injection of carbon dioxide into subsurface geologic reservoirs during geologic carbon sequestration (GCS) introduces an oxidizing supercritical CO2 phase into a subsurface geologic environment that is typically reducing. The resulting redox disequilibrium provides the chemical potential for the reduction of CO2 to lower free energy organic species. However, redox reactions involving carbon typically require the presence of a catalyst. Iron oxide minerals, including magnetite, are known to catalyze oxidation and reduction reactions of C-bearing species. If the redox conditions in the reservoir are modified by redox transformations involving CO2, such changes could also affect mineral stability, leading to dissolution and precipitation reactions and alteration of the long-term fate of CO2 in GCS reservoirs. We present experimental evidence that reservoirs with reducing redox conditions are favorable environments for the relatively rapid abiotic reduction of CO2 to organic molecules. In these experiments, an aqueous suspension of magnetite nanoparticles was reacted with supercritical CO2 under pressure and temperature conditions relevant to GCS in sedimentary reservoirs (95-210°C and ~100bars of CO2). Hydrogen production was observed in several experiments, likely caused by Fe(II) oxidation either at the surface of magnetite or in the aqueous phase. Heating of the Fe(II)-rich system resulted in elevated PH2 and conditions favorable for the reduction of CO2 to acetic acid. Implications of these results for the long-term fate of CO2 in field-scale systems were explored using reaction path modeling of CO2 injection into reservoirs containing Fe(II)-bearing primary silicate minerals, with kinetic parameters for CO2 reduction obtained experimentally. The results of these calculations suggest that the reaction of CO2 with reservoir constituents will occur in two primary stages (1) equilibration of CO2 with organic acids resulting in mineral-fluid disequilibrium, and (2) gradual dissolution of primary minerals promoting significant CO2 reduction through the release of Fe(II). The reduction of CO2 is identified as a new trapping mechanism that could significantly enhance the long-term stability of GCS reservoirs. Identification of reservoir characteristics that promote CO2 redox transformations could be used as an additional factor in screening geologic reservoirs for GCS

Implementation of indication-based antibiotic order sentences improves antibiotic use in emergency departments

INTRODUCTION: Prior data have suggested that suboptimal antibiotic prescribing in the emergency department (ED) is common for uncomplicated lower respiratory tract infections (LRTI), urinary tract infections (UTI), and acute bacterial skin and skin structure infections (ABSSSI). The objective of this study was to measure the effect of indication-based antibiotic order sentences (AOS) on optimal antibiotic prescribing in the ED. METHODS: This was an IRB-approved quasi-experiment of adults prescribed antibiotics in EDs for uncomplicated LRTI, UTI, or ABSSSI from January to June 2019 (pre-implementation) and September to December 2021 (post-implementation). AOS implementation occurred in July 2021. AOS are lean process, electronic discharge prescriptions retrievable by name or indication within the discharge order field. The primary outcome was optimal prescribing, defined as correct antibiotic selection, dose, and duration per local and national guidelines. Descriptive and bivariate statistics were performed; multivariable logistic regression was used to determine variables associated with optimal prescribing. RESULTS: A total of 294 patients were included: 147 pre-group and 147 post-group. Overall optimal prescribing improved from 12 (8%) to 34 (23%) (P \u3c 0.001). Individual components of optimal prescribing were optimal selection at 90 (61%) vs 117 (80%) (P \u3c 0.001), optimal dose at 99 (67%) vs 115 (78%) (P = 0.036), and optimal duration at 38 (26%) vs 50 (34%) (P = 0.13) for pre- and post-group, respectively. AOS was independently associated with optimal prescribing after multivariable logistic regression analysis (adjOR, 3.6; 95%CI,1.7-7.2). A post-hoc analysis showed low uptake of AOS by ED prescribers. CONCLUSIONS: AOS are an efficient and promising strategy to enhance antimicrobial stewardship in the ED