Introduction of Enhanced Recovery After Surgery for Colorectal Surgical Patients: A Quality Improvement Project

The purpose of this practice project was to develop and introduce an enhanced recovery after surgery (ERAS) protocol for colorectal surgical patients at a tertiary care center in southern Illinois. Project aims included reviewing available literature and study outcomes to develop an evidenced-based ERAS protocol for colorectal surgery and educating anesthesia providers about ERAS to introduce the evidenced-based ERAS protocol for colorectal surgery. An educational presentation and learning assessment tool were developed and subsequently presented to the anesthesia providers at the host facility. The first step toward implementing the protocol is education, as such, the results of the assessment questions suggested the educational posttest positively impacted the participants’ knowledge of ERAS. The staff also indicated on a five-point Likert scale strong support for adopting the introduced protocol. This project can be promoted by replicating it to include interdepartmental education, which would increase awareness of and encourage collaboration for successful implementation of the proposed ERAS protocol. In addition, the ERAS protocol developed is applicable to other similar tertiary care centers, demonstrating generalizability. Ultimately, implementing an ERAS protocol at the facility is aimed at improving patient care in those undergoing colorectal surgery

Combustion of coal gas fuels in a staged combustor

Gaseous fuels produced from coal resources generally have heating values much lower than natural gas; the low heating value could result in unstable or inefficient combustion. Coal gas fuels may contain ammonia which if oxidized in an uncontrolled manner could result in unacceptable nitrogen oxide exhaust emission levels. Previous investigations indicate that staged, rich-lean combustion represents a desirable approach to achieve stable, efficient, low nitrogen oxide emission operation for coal-derived liquid fuels contaning up to 0.8-wt pct nitrogen. An experimental program was conducted to determine whether this fuel tolerance can be extended to include coal-derived gaseous fuels. The results of tests with three nitrogen-free fuels having heating values of 100, 250, and 350 Btu/scf and a 250 Btu/scf heating value doped to contain 0.7 pct ammonia are presented

Conceptualising the impact of information asymmetry on through-life cost: case study of machine tools sector

Information asymmetry (IA) in terms of contextual variety and importance is one of the most challenging aspects of through-life costing in product-service systems (PSS). IA is an imbalance in the information, data and knowledge shared among the parties involved in a contractual agreement. In manufacturing systems under PSS, interaction and effective communication among several parties who are involved in a contractual agreement, rely on the continuity and accuracy of information and context. In such systems, contextual variety exhibits complexity and uncertainty in through-life costing and subsequently in PSS cost assessment. Although the economic aspect of PSS has been studied previously, the impact of IA on through-life cost and for different PSS solutions has not been detailed. Considering manufacturing value chains, this paper introduces a new concept of PSS-hierarchy to perform through-life costing in the presence of IA for various PSS solutions. Moreover, this paper proposes a generic life-cycle model for different PSS solutions to assess the total cost of ownership (TCO). The proposed model has been developed to support decisions on contract design in manufacturing systems. This study considers the manufacturer, service provider and customer perspectives to develop the TCO model using a machine tool manufacturing case study

Preliminary experimental results for a cryogenic brush seal configuration

Preliminary fluid nitrogen flow data are reported for a five-brush, ceramic-coated-rub-runner brush seal system, where the brushes and the rub runner were placed at each end of a centrally pressurized multifunction tester ('back-to-back' set of brushes) and tested at rotor speeds of 0, 10, 18, and 22.5 krpm. After testing, both the brushes and the ceramic-coated rub runner appeared pristine. The coating withstood both the thermomechanical and dynamic loadings with minor wear track scarring. The bristle tips showed some indication of material shearing (smearing) wear. The Ergun porous flow equation was applied to the brush seal data. The Ergun relation, which required heuristic information to characterize the coefficients, fit the gaseous data but was in poor agreement with the fluid results. The brush seal exit conditions were two phase. Two-phase, choked-flow design charts were applied but required one data point at each rotor speed to define the (C(sub f)A x Constant) flow and area coefficients. Reasonable agreement between prediction and data was found, as expected, but such methods are not to be construed as two-phase-flow brush seal analyses

Mutations of penicillin acylase residue B71 extend substrate specificity by decreasing steric constraints for substrate binding

Two mutant forms of penicillin acylase from Escherichia coli strains, selected using directed evolution for the ability to use glutaryl-L-leucine for growth [Forney, Wong and Ferber (1989) Appl. Environ. Microbiol. 55, 2550-2555], are changed within one codon, replacing the B-chain residue Phe(B71) with either Cys or Leu. Increases of up to a factor of ten in k(cat)/K-m values for substrates possessing a phenylacetyl leaving group are consistent with a decrease in K-s. Values of k(cat/)K(m) for glutaryl-L-leucine are increased at least 100-fold. A decrease in k(cat)/K-m for the CySB71 mutant with increased pH is consistent with binding of the uncharged glutaryl group. The mutant proteins are more resistant to urea denaturation monitored by protein fluorescence, to inactivation in the presence of substrate either in the presence of urea or at high pH, and to heat inactivation. The crystal structure of the Leu(B71) mutant protein, solved to 2 X resolution, shows a flip of the side chain of Phe(B256) into the periphery of the catalytic centre, associated with loss of the pi-stacking interactions between Phe(B256) and Phe(B71). Molecular modelling demonstrates that glutaryl-L-leucine may bind with the uncharged glutaryl group in the S-1 subsite of either the wild-type or the Leu(B71) mutant but with greater potential freedom of rotation of the substrate leucine moiety in the complex with the mutant protein. This implies a smaller decrease in the conformational entropy of the substrate on binding to the mutant proteins and consequently greater catalytic activity

Small scale heater tests in argillite of the Eleana Formation at the Nevada Test Site

Near-surface heater tests were run in the Eleana Formation at the Nevada Test Site, in an effort to evaluate argillaceous rock for nuclear waste storage. The main test, which employed a full-scale heater with a thermal output approximating commercial borosilicate waste, was designed to operate for several months. Two smaller, scaled tests were run prior to the full-scale test. This report develops the thermal scaling laws, describes the pretest thermal and thermomechanical analysis conducted for these two tests, and discusses the material properties data used in the analyses. In the first test, scaled to a large heater of 3.5 kW power, computed heater temperatures were within 7% of measured values for the entire 96-hour test run. The second test, scaled to a large heater having 5.0 kW power, experienced periodic water in-flow onto the heater, which tended to damp the temperature. For the second test, the computed temperatures were within 7% of measured for the first 20 hours. After this time, the water effect became significant and the measured temperatures were 15 to 20% below those predicted. On the second test, rock surface spallation was noted in the bore hole above the heater, as predicted. The scaled tests indicated that in-situ argillite would not undergo major thermostructural failure during the follow-on, 3.5 kW, full-scale test. 24 figures, 6 tables

Preparing Catholic Educators to Educate and Evangelize in 21st Century Schools, Action Research of an Analysis of Educator Preparation Program Requirements Including Professional and Pedagogical, Relational, Formational and Evangelistic Education for P-16 Students (PROFEss)

Abstract The preparation of effective, knowledgeable and caring educators whose mission is to serve society through direct contact with and instruction of students, is the topic of this action research. We sought to determine how we as a teacher preparation program within a dynamic Catholic university could ensure that our Catholic identity was truly evident and nurtured in our teacher candidates as they prepare to engage in the extremely important job of offering what is a universal right to an education to PK-12 students, in a variety of learning environments. The analysis of this teacher preparation program included a review of literature specific to Catholic teaching on education, qualitative data collection via interviews, and personal reflection and analysis of curriculum and pedagogy in order to make our Catholic identity explicit. Findings included the need for reinforcing Catholic Identity through professional, pedagogical, relational, formational and evangelistic education for students (PROFEss)

Hypoxia and hyperglycaemia determine why some endometrial tumours fail to respond to metformin

High expression of Ki67, a proliferation marker, is associated with reduced endometrial cancer-specific survival. Pre-surgical metformin reduces tumour Ki-67 expression in some women with endometrial cancer. Metformin's anti-cancer activity may relate to effects on cellular energy metabolism. Since tumour hypoxia and glucose availability are major cellular redox determinants, we evaluated their role in endometrial cancer response to metformin. Endometrial cancer biopsies from women treated with pre-surgical metformin were tested for the hypoxia markers, HIF-1α and CA-9. Endometrial cancer cell lines were treated with metformin in variable glucose concentrations in normoxia or hypoxia and cell viability, mitochondrial biogenesis, function and energy metabolism were assessed. In women treated with metformin (n = 28), Ki-67 response was lower in hypoxic tumours. Metformin showed minimal cytostatic effects towards Ishikawa and HEC1A cells in conventional medium (25 mM glucose). In low glucose (5.5 mM), a dose-dependent cytostatic effect was observed in normoxia but attenuated in hypoxia. Tumours treated with metformin showed increased mitochondrial mass (n = 25), while in cultured cells metformin decreased mitochondrial function. Metformin targets mitochondrial respiration, however, in hypoxic, high glucose conditions, there was a switch to glycolytic metabolism and decreased metformin response. Understanding the metabolic adaptations of endometrial tumours may identify patients likely to derive clinical benefit from metformin

Heme oxygenase (HO)-1 induction prevents Endoplasmic Reticulum stress-mediated endothelial cell death and impaired angiogenic capacity

Most of diabetic cardiovascular complications are attributed to endothelial dysfunction and impaired angiogenesis. Endoplasmic Reticulum (ER) and oxidative stresses were shown to play a pivotal role in the development of endothelial dysfunction in diabetes. Hemeoxygenase-1 (HO-1) was shown to protect against oxidative stress in diabetes; however, its role in alleviating ER stress-induced endothelial dysfunction remains not fully elucidated. We aim here to test the protective role of HO-1 against high glucose-mediated ER stress and endothelial dysfunction and understand the underlying mechanisms with special emphasis on oxidative stress, inflammation and cell death.Human Umbilical Vein Endothelial Cells (HUVECs) were grown in either physiological or intermittent high concentrations of glucose for 5days in the presence or absence of Cobalt (III) Protoporphyrin IX chloride (CoPP, HO-1 inducer) or 4-Phenyl Butyric Acid (PBA, ER stress inhibitor). Using an integrated cellular and molecular approach, we then assessed ER stress and inflammatory responses, in addition to apoptosis and angiogenic capacity in these cells.Our results show that HO-1 induction prevented high glucose-mediated increase of mRNA and protein expression of key ER stress markers. Cells incubated with high glucose exhibited high levels of oxidative stress, activation of major inflammatory and apoptotic responses [nuclear factor (NF)-κB and c-Jun N-terminal kinase (JNK)] and increased rate of apoptosis; however, cells pre-treated with CoPP or PBA were fully protected. In addition, high glucose enhanced caspases 3 and 7 cleavage and activity and augmented cleaved poly ADP ribose polymerase (PARP) expression whereas HO-1 induction prevented these effects. Finally, HO-1 induction and ER stress inhibition prevented high glucose-induced reduction in NO release and impaired the angiogenic capacity of HUVECs, and enhanced vascular endothelial growth factor (VEGF)-A expression.Altogether, we show here the critical role of ER stress-mediated cell death in diabetes-induced endothelial dysfunction and impaired angiogenesis and underscore the role of HO-1 induction as a key therapeutic modulator for ER stress response in ischemic disorders and diabetes. Our results also highlight the complex interplay between ER stress response and oxidative stress.This work was supported with grants to Dr Abdelali Agouni from the Royal Society, the Physiological Society, and Qatar University (grant QUUG-CPH-CPH-15/16-6). Mr Maamoun and Ms. Zachariah are supported by doctoral scholarships from Egyptian cultural bureau and Government of Botswana, respectively