Operating room first case start times: a metric to assess systems-based practice milestones?

BACKGROUND: Resident competence in peri-operative care is a reflection on education and cost-efficiency. Inspecting pre-existing operating room metrics for performance outliers may be a potential solution for assessing competence. Statistical correlation of problematic benchmarks may reveal future opportunities for educational intervention. METHODS: Case-log database review yielded 3071 surgical cases involving residents over the course of 5 years. Surgery anticipated and actual start times were evaluated for delays and residents were assessed using the days of resident training performed at the time of each corresponding case. Other variables recorded included day of week, attending anesthesiologist name, attending surgeon name, patient age, sex, American Society of Anesthesiologists physical status classification (ASA PS), and in-patient versus day surgery status. Mixed-effect, multi-variable, linear regression determined independent determinants of delay time. RESULTS: The analysis identified day of the week (F = 25.65, P \u3c 0.0001), days of training (F = 8.39, P = 0.0038), attending surgeon (F = 2.67, P \u3c 0.0001), and anesthesiology resident (F = 1.67, P = 0.0012) as independent predictors of delay time for first-start cases, with an overall regression model F = 3.09, r2 = 0.186, and P \u3c 0.0001. CONCLUSIONS: The day of the week and attending surgeon demonstrated significant impact of case delay compared to resident days trained. If a learning curve for first-case start punctuality exists for anesthesiology residents, it is subtle and irrelevant to operating room efficiency. The regression model accounted for only 19% of the variability in the outcome of delay time, indicating a multitude of additional unidentified factors contributing to operating room efficiency

Hysterectomy for dysfunctional uterine bleeding in women with previous tubal sterilization

Background: Post tubal ligation syndrome has been a topic of debate with various studies concluding contradictory results. Hysterectomy can be considered as a continuum of the post ligation syndrome due to prolonged menstrual complaints. The present study was done to evaluate any association of tubal sterilization with hysterectomy in patients presenting with dysfunctional uterine bleeding.  Methods: The study was conducted in a medical college hospital. Analysis of case files of patients who had undergone hysterectomy for dysfunctional uterine bleeding between May 2012 - May 2013 was done to note the history of prior tubal sterilization. Patients with fibroid uterus, adenomyosis, hypothyroidism, endometrial polyp, cervical polyp and those who had a hysterectomy for nonmenstrual complaints were excluded.Results: 322 patients were hysterectomised during the study period. Among them only 36 patients had a hysterectomy purely for dysfunctional uterine bleeding. Out of the 36 patients, 33 patients (90.9%) had undergone prior tubal sterilization. Hysterectomy was done after a mean duration of 19.31 ± 5.35 years after tubal sterilization. The mean age at onset of menorrhagia was at 42.05 ± 4.71 years.Conclusions: Tubal sterilization is a risk factor for future hysterectomy in patients with dysfunctional uterine bleeding

Assessment of water quality index for the groundwater in Tumkur taluk, Karnataka state, India

The present work is aimed at assessing the water quality index (WQI) for the groundwater of Tumkur taluk. This has been determined by collecting groundwater samples and subjecting the samples to a comprehensive physicochemical analysis. For calculating the WQI, the following 12 parameters have been considered: pH, total hardness, calcium, magnesium, bicarbonate, chloride, nitrate, sulphate, total dissolved solids, iron, manganese and fluorides. The WQI for these samples ranges from 89.21 to 660.56. The high value of WQI has been found to be mainly from the higher values of iron, nitrate, total dissolved solids, hardness, fluorides, bicarbonate and manganese in the groundwater. The results of analyses have been used to suggest models for predicting water quality. The analysis reveals that the groundwater of the area needs some degree of treatment before consumption, and it also needs to be protected from the perils of contamination

On Water Quality Aspects of Manchanabele Reservoir Catchment and Command Area (karnataka)

Reservoirs and lakes occupy a prominent place in the history of irrigation in South India. Tanks are considered to be useful life saving mechanism in the water scarcity areas which are categorized as Arid and Semi-arid zones. The lakes and reservoirs, all over the country without exception, are in varying degrees of environmental degradation. The degradation is due to encroachments, eutrophication (due to the inflow of domestic and industrial effluents) and siltation. There has been a quantum jump in population during the last century without corresponding expansion of civic facilities resulting in deterioration of lakes and reservoirs, especially in urban and semi urban areas becoming sinks for the contaminants. The degradation of reservoir and lake catchments due to deforestation, stone quarrying, sand mining, extensive agricultural use, consequent erosion and increased silt flows have vitiated the quality of water stored in reservoirs and lakes. Infrastructure development, housing projects, and inflow of untreated wastewater into the water bodies have resulted in deterioration of urban and rural lakes and reservoirs. The paper discusses the physico-chemical and bacteriological studies carried out on surface and ground water in the reservoir catchment and the command areas .The results of analyses of water samples reveal that water is polluted at certain locations. The presence of total –Coliform and Faecal-Coliform in ground water and reservoir and lake water at certain locations indicates that water is polluted with waste water. The nitrate level varies between 0.6ppm to 135.8ppm, and exceeds the drinking water standards at 10 locations in the catchment and command area. The suitability of water for irrigation is evaluated based on SAR, %Na, RSC and Salinity hazards. Most of the samples fall in the suitable range for irrigation purpose. The inflow of urban runoff into the surface water bodies has resulted in pollution of reservoir and ground water at certain locations. The paper also discusses the measures proposed to reduce pollution levels in the reservoir, its catchment and command area

Relationship between PPARα activation and NO on proximal tubular Na(+ )transport in the rat

BACKGROUND: Nitric oxide (NO) regulates renal proximal tubular (PT) Na(+ )handling through modulation of Na(+)-K(+ )ATPase. Peroxisome Proliferator Activated Receptorα (PPARα), a nuclear transcription factor, is expressed in PTs and has been reported to influence NO generation/activity in renal tissues. This study tested the hypothesis that PPARα interacts with NO and thereby affects renal tubular Na(+ )transport. Urinary excretion of nitrite (UNO(X)V) and Na(+ )(U(Na)V) and PT Na(+ )transport (Na(+)-K(+ )ATPase activity) were determined in rats treated with clofibrate (250 mg/kg i.p) or WY14643 (45 mg/kg; i.p.), a PPARα ligand, 2% NaCl (orally), clofibrate/NaCl, L-NAME, an inhibitor of NO production (100 mg/kg; orally), L-NAME/Clofibrate. RESULTS: Clofibrate or WY14643 increased PPARα expression by 106 ± 7% (p < 0.05) and 113 ± 8% (p < 0.05), respectively. Similarly, clofibrate and WY14643 increased expression of MCAD, a downstream target protein of PPARα by 123 ± 8% (p < 0.05) and 143 ± 8% (p < 0.05), respectively. L-NAME attenuated clofibrate-induced increase in PPARα expression by 27 ± 2% (p < 0.05) but did not affect MCAD expression. UNO(X)V excretion increased 3–4 fold in rats treated with clofibrate, WY14643 or NaCl from 44 ± 7 to 170 ± 15, 144 ± 18 or 132 ± 11 nmol/24 hr, respectively (p < 0.05). Similarly, clofibrate, WY14643 or NaCl elicited a 2–5 fold increase in U(Na)V. L-NAME significantly reduced basal UNO(X)V and U(Na)V and abolished the clofibrate-induced increase. Clofibrate, WY14643, NaCl or clofibrate + NaCl treatment reduced Na(+)-K(+)-ATPase activity in the PT by 89 ± 23, 62 ± 10, 43 ± 9 and 82 ± 15% (p < 0.05), respectively. On the contrary, L-NAME or ODQ, inhibitor of sGC, abolished the inhibition of Na(+)-K(+)-ATPase activity by clofibrate (p < 0.05). Clofibrate either alone or with NaCl elicited ~2-fold increase in the expression of the α1 subunit of Na(+)-K(+ )ATPase in the PT while L-NAME abolished clofibrate-induced increase in Na(+)-K(+ )ATPase expression. CONCLUSION: These data suggest that PPARα activation, through increased NO generation promotes renal excretion of Na(+ )through reduced Na(+)-K(+ )ATPase activity in the PT probably via post translational modification of Na(+)-K(+)-ATPase

N rf2‐Mediated Resistance to Oxidant‐Induced Redox Disruption in Embryos

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92129/1/bdrb21005.pd

Characterisation of musk lime (Citrus microcarpa) seed oil

BACKGROUND: The seeds of musk lime (Citrus microcarpa) represent a substantial waste product of small‐scale citrus‐processing factories, as they constitute about 100.0 ± 3.2 g kg−1 of the whole fruit and contain a considerable amount of crude fat (338.0 ± 11.3 g kg−1). Thus the aim of the present study was to determine the physicochemical properties of this fat with a view to potential applications. RESULTS: The iodine and saponification values and unsaponifiable matter and free fatty acid contents of the freshly extracted oil were 118.0 g I2 per 100 g oil, 192.6 mg KOH g−1 oil, 22 mg g−1 oil and 18 mg oleic acid g−1 oil respectively. The oil had a Lovibond colour index of 33.1 Y + 1.1 B. Its fatty acid profile indicated that 73.6% of the fatty acids present were unsaturated. Linoleic (L, 31.8%), oleic (O, 29.6%) and palmitic (P, 21.4%) acids were the predominant fatty acids, existing mainly as the triacylglycerols POL (18.9%), PLL (13.7%) and OLL (11.9%). The melting and cooling points of the oil were 10.7 and − 45.2 °C respectively. Electronic nose qualitative analysis of the oil showed the presence of volatile (aroma) compounds, although the concentrations of the more volatile compounds were lower than those present in the seeds. CONCLUSION: Musk lime seeds are a rich source of oil, which is unusual in having linoleic, oleic and palmitic acids dominating the fatty acid composition. This property should make the oil both relatively stable to thermal oxidation owing to the combined presence of oleic and palmitic acids (61.0%) and highly nutritive owing to its high concentration of unsaturated fatty acids (73.6%)