Sodium and Specialty Cyanides Production Facility

Sodium cyanide and specialty cyanide production are essential operations for various industrial processes, with primary applications in mining and mineral processing. Sodium cyanide, despite the high toxicity inherent in the material and its production process, is expected to grow 5% annually, with a projected global demand of 1.1 million tonnes in 2018. This report details a process design for producing sodium cyanide through the use of two intermediate reactions and successive downstream separations. The first major step is the production of hydrogen cyanide gas from ammonia and methane derived from natural gas, via the industry standard Andrussow reaction over a platinum-rhodium gauze catalyst. Aqueous sodium cyanide is produced via a neutralization reaction of absorbed hydrogen cyanide gas with aqueous sodium hydroxide. Downstream processes include the crystallization of solid sodium cyanide from the aqueous product, with the solid product being removed from slurry and brought to low-moisture content through a series of solid-liquid separations. The low-moisture solids are formed into the final briquette product, which is 97.7% sodium cyanide by mass at a capacity of 61.5M tonnes/year, and containing sodium carbonate as the principal impurity. Unconverted ammonia is recovered and recycled back to the feed of the HCN reactor, increasing the molar percent yield of hydrogen cyanide gas on the basis of fed ammonia from 60% to 70.9%. The project requires $35.6MM in Total Capital Investment and produces a Net Present Value of$72.5MM after 15 operating years and presents an Internal Rate of Return of 48.4%. The project will break even in its third operating year when it hits full production capacity. The design is recommended due to its strong return on investment and high resilience to market fluctuations

Cinemeducation: a teaching-learning tool to teach professionalism and ethics in medical undergraduates

Background: The study was undertaken in II year medical students to sensitize and make student competent for professionalism and ethics to maintain respect for patients, colleagues and society and role of Informed Consent in a clinical trial using Cinema-education Methods: A brief lecture about professionalism and ethics and hands-on training to write reflections was conducted. During session, the knowledge gained and attitudes were checked by pre-test questionnaire. In the Session the students were shown short movie clips that portray on professionalism and ethics which highlight doctor patient relationship in context of maintaining respect of patient, colleagues and society and ethical aspects of informed consent in a clinical trial. The Post session was assessed by a role play, post-test, feedback and reflection writing and analyzed using content and narrative analysis.Results: Respect towards patients and co-workers and taking informed consent were the positive reflections while treating patients as a subject and giving incomplete information about the trial were pointed out as negative aspect of the movie clip. Majority of the students agreed that cinemeducation had cleared doubts, gave better understanding, stimulated their interest and motivated to learn about professionalism and Ethics. Through role play as assessment the students were able to correctly pick up the scenario, identify the issues related to the role play and were able to give solution to the problem portrayed.Conclusions: Cinemeducation is an indispensable teaching learning tool to understand about patients feelings, role of communication and to teach empathy, ethical aspects in patient care

M.S. selective enrichment of rare mutations as a new biotechnology to study DNA mismatch repair processes in bacteria

DNA mismatch repair (MMR) is the key process which ensures the incorporation of correct nucleotides during DNA replication by recognizing and removing of incorrectly paired nucleotides from DNA. DNA replication can introduce a mismatched nucleotide at a rate of 10-5 to 10-6 nts per replication cycle. If this mismatch is not corrected, then it becomes a permanent mutation after the next round of replication. Understanding the MMR mechanism can yield important insights into many aspects of human health, like the emergence of cancer and drug resistance in bacteria. To overcome experimental challenges with studying this process in living cells, we have developed a new method to enrich the rare genomic mutations by genotypic selection in a way that allows us to study the mismatch repair process in Escherichia coli, a model organism for MMR. We have shown the maximum 705,000-fold enrichment of DNA with a mutation even after a 10-6 times dilution by DNA with the wild-type sequence in vitro. After further optimization, we could then use this technique to directly measure MMR activity occurring in living E. coli (in vivo). We expect this technique will open up new opportunities and research directions to study MMR-like processes in E. coli as well as different organisms, including Actinobacteria

A Meta-analysis of Standard Versus Ultrasound-Assisted Catheter-Directed Thrombolysis in the Management of Acute Pulmonary Embolism

Background: Standard catheter-directed thrombolysis (SCDT) harnesses the therapeutic benefit of systemic thrombolytics while minimizing bleeding complications in patients presenting with pulmonary embolism (PE). Ultrasound-assisted catheter-directed thrombolysis (USAT) theoretically improves upon SCDT by disrupting fibrin and increasing the surface area exposed to thrombolytic agent. However, it is unclear if this translates into improved outcomes. Methods: A systematic search of prior publications comparing SCDT and USAT in patients with intermediate or high-risk PE was conducted. Primary outcomes of interest were bleeding events, ICU and hospital length of stay. Secondary outcomes included changes in pulmonary artery systolic pressure (PASP), mean pulmonary artery pressure (mPAP), and right ventricle to left ventricle diameter (RV/LV) ratio. Studies that lacked comparison groups were excluded. Bias assessments were performed using the Cochrane tools for randomized and nonrandomized studies. Data was collated utilizing the Cochrane Review Manager software, and all analyses assumed random effects. Results: Our search yielded 7 observational studies and 1 randomized control trial. The studies included a total of 543 patients who underwent either SCDT (n = 273) or USAT (n = 270) for intermediate or high-risk PE. The synthesized analysis showed no significant differences in bleeding between the groups. There were no differences in ICU or hospital lengths of stay, changes in PASP, or mPAP. Reductions in RV/LV ratio were greater with SCDT (mean difference, −0.16; 95% CI, −0.27 to −0.06; P =.003). Conclusions: In comparison to SCDT, USAT did not result in improved clinical or hemodynamic outcomes in patients presenting with PE

Human Tumor Targeted Cytotoxic Mast Cells for Cancer Immunotherapy

The diversity of autologous cells being used and investigated for cancer therapy continues to increase. Mast cells (MCs) are tissue cells that contain a unique set of anti-cancer mediators and are found in and around tumors. We sought to exploit the anti-tumor mediators in MC granules to selectively target them to tumor cells using tumor specific immunoglobin E (IgE) and controllably trigger release of anti-tumor mediators upon tumor cell engagement. We used a human HER2/neu-specific IgE to arm human MCs through the high affinity IgE receptor (FcεRI). The ability of MCs to bind to and induce apoptosis of HER2/neu-positive cancer cells in vitro and in vivo was assessed. The interactions between MCs and cancer cells were investigated in real time using confocal microscopy. The mechanism of action using cytotoxic MCs was examined using gene array profiling. Genetically manipulating autologous MC to assess the effects of MC-specific mediators have on apoptosis of tumor cells was developed using siRNA. We found that HER2/neu tumor-specific IgE-sensitized MCs bound, penetrated, and killed HER2/neu-positive tumor masses in vitro. Tunneling nanotubes formed between MCs and tumor cells are described that parallel tumor cell apoptosis. In solid tumor, human breast cancer (BC) xenograft mouse models, infusion of HER2/neu IgE-sensitized human MCs co-localized to BC cells, decreased tumor burden, and prolonged overall survival without indications of toxicity. Gene microarray of tumor cells suggests a dependence on TNF and TGFβ signaling pathways leading to apoptosis. Knocking down MC-released tryptase did not affect apoptosis of cancer cells. These studies suggest MCs can be polarized from Type I hypersensitivity-mediating cells to cytotoxic cells that selectively target tumor cells and specifically triggered to release anti-tumor mediators. A strategy to investigate which MC mediators are responsible for the observed tumor killing is described so that rational decisions can be made in the future when selecting which mediators to target for deletion or those that could further polarize them to cytotoxic MC by adding other known anti-tumor agents. Using autologous human MC may provide further options for cancer therapeutics that offers a unique anti-cancer mechanism of action using tumor targeted IgE’s

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

FPGA IMPLEMENTATION OF QR DECOMPOSITION ALGORITHMS USING HIGH-LEVEL SYNTHESIS ON ZYNQ SOC

Matrix decomposition and computation constitute an important part of various signal processing, image processing, and communication systems. A better solution in terms of power, performance, and area, can lead to improved performance of the whole system. Designing and testing a new idea is a big challenge due to time limitations. So, a better implementation flow using High-Level Synthesis is discussed. This flow is used to implement QR decomposition algorithms. Three different QR factorization techniques, Gram-Schmidt, Givens Rotation, and Householder Transformation is discussed. These algorithms are compared in terms of area, performance, and precision. All the algorithms are implemented with two different variations in terms of the data type used. A 32-bit floating-point implementation and 16-bit fixed-point implementation are discussed. Results for different designs with various optimization techniques like loop unrolling and pipelining are presented. A scalable architecture is implemented for all the algorithms which are compared for a 10 × 10 matrix architecture. Results for scaled up 100 × 100 matrix architecture are also discussed for the Gram- Schmidt algorithm. Gram-Schmidt had the best performance in all. The performance of Gram Schmidt algorithm was improved by a factor of 3 for 10 × 10 matrix size and by a factor of up to 10 for 100 × 100 matrix size using different optimizations. Givens rotation was close in terms of performance, but the Householder Transformation was four times slower compared to other two algorithms, the reason being the high complexity of the algorithm. All floating-point implementations had nearly 100% precision but varied from 3% to 5% in average error for fixed-point data-type for a 10 × 10 implementation. All the algorithms were coded in C++ and synthesized using High-Level Synthesis using Xilinx Vivado HLS 2016.4 tool. This generated an IP core which was imported to Xilinx Vivado 2016.4 for implementation. The design was targeted for Zedboard, a Zynq – 7020 Extensible Processing Platform (EPP) Development Kit, which has a 7 series Xilinx FPGA architecture and a dual core ARM Cortex A-9 processor.M.S. in Computer Engineering, May 201

Health care and tort reform: an analysis of flaws in the malpractice liability system and reforms to address them

Thesis (M.A.)--Boston University PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.When a patient is bringing a lawsuit, he or she is seeking retributive justice for a harm that they believe was done to them at the hands of a negligent physician. The foundation of malpractice litigation from a legal point of view is that the threat of litigation forces physicians to practice safely and more carefully. Meanwhile physicians believe that malpractice litigation is a punitive approach that seeks to isolate individual cases and assign blame and shame, rather than promote a culture of openness about mistakes and how to avoid them in the future. While the patient safety system relies on transparency and the availability of case information to accomplish its aims, the liability system, as argued by physicians, suppresses the transparency of this information because physicians fear legal retribution in the face of open disclosure. This compromises the foundational dynamic of the physician-patient relationship, and as a result detracts from the quality of care. Studies have found that in punishing the 3 percent of negligent injuries that actually result in malpractice claims, four innocent doctors are punished for every doctor that is actually at fault. Clearly the medical malpractice system is also struggling to maintain an efficient system of corrective justice. If the medical malpractice system seeks to deter negligence, promote patient safety and improve quality and access to medical services in a cost effective manner, then the current system seems to be flawed in meeting these aims. The flaws in this system not only promote a culture of non-disclosure and compromised physician-patient relations but also contribute to a culture of defensive medicine (unnecessary tests) to confirm a diagnosis. With the threat of malpractice litigation ever present, physicians have responded by avoiding high-risk patients and reducing their access to care. Combined, these flaws not only compromise quality and access of care, but also fuel an unjustifiable increase in the costs of care. It is no surprise that studies have found that at least $28 billion is spent each year on an interrelated combination of medical liability litigation and defensive medicine. This statistic, from 2005, compared to total National Health Expenditures from 2005 (1.982 trillion dollars) indicates that this cost was about 1.4% of total National Health Expenditures in 2005. While this may seem like a small percentage of total health care expenditures, at a time when health care costs and declining access are of major public concern, the costs are indefensible because they are not necessarily improving patient safety or health outcomes. As questions linger about waste and inefficiency limiting access and compromising the quality of healthcare, it is necessary to assess the expansive impact that medical malpractice litigation is having on the field of medicine