Evidence Vs. Practice in Early Drain Removal Following Pancreatectomy

Background: Early drain removal when postoperative day (POD) 1 drain fluid amylase (DFA) was ≤ 5000 U/L reduced complications in a previous randomized controlled trial. We hypothesized that most surgeons continue to remove drains late and this is associated with inferior outcomes. Methods: We assessed the practice of surgeons in a prospectively maintained pancreas surgery registry to determine the association between timing of drain removal with demographics, co-morbidities, and complications. We selected patients with POD1 DFA ≤ 5000 U/L and excluded those without drains, and subjects without data on POD1 DFA or timing of drain removal. Early drain removal was defined as ≤ POD5. Results: 244 patients met inclusion criteria. Only 90 (37%) had drains removed early. Estimated blood loss was greater in the late removal group (190 mL vs 100 mL, p = 0.005) and pathological findings associated with soft gland texture were more frequent (97(63%) vs 35(39%), p < 0.0001). Patients in the late drain removal group had more complications (84(55%) vs 30(33%), p = 0.001) including pancreatic fistula (55(36%) vs 4(4%), p < 0.0001), delayed gastric emptying (27(18%) vs 3(3%), p = 0.002), and longer length of stay (7 days vs 5 days, p < 0.0001). In subset analysis for procedure type, complications and pancreatic fistula remained significant for both pancreatoduodenectomy and distal pancreatectomy. Conclusion: Despite level 1 data suggesting improved outcomes with early removal when POD1 DFA is ≤ 5000 U/L, experienced pancreas surgeons more frequently removed drains late. This practice was associated with known risk factors (EBL, soft pancreas) and may be associated with inferior outcomes suggesting potential for improvement

Life After Succession in the Family Business: Is It Really the End of Problems?

The succession processes in family business are well chronicled in the business literature. Most of the research focuses on the process of transferring power within the business-family. What has not been as closely examined is the after-succession environment that exists when the management and leadership of the family business are passed on to the next generation. This article addresses that organizational climate and the potential for additional problems in the business-family if post-succession issues are not identified and addressed and suggests some steps that will be helpful in producing complete succession success.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

The Impact of Timing and Mode of Entry on Successor Development and Successful Succession

Family businesses frequently are disrupted by the process of succession of leadership and ownership. This article focuses on causes of conflict and how to manage success after siblings have entered the business.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Review on VSI switch fault tolerant control systems for electric vehicle drivetrains

Electric Vehicles (EVs) are an effective solution for reducing greenhouse gas emissions to the atmosphere. Safety is the most crucial issue in the automotive industry and any fault in the EV drivetrain may results in a fatal accident. This paper discusses the dynamic performance of EVs under drivetrain Voltage Source Inverter (VSI) switch faults and presents the suitable Fault Diagnosis Algorithm (FDA) and remedial strategy for EV applications. Physical testing of drivetrain faults in EVs is both expensive and extremely difficult; therefore the Nissan Leaf and the Lightning GT EVs are simulated using a validated model of the Permanent-Magnet Synchronous Motor (PMSM) and their performances investigated under faulty drivetrain conditions. Simulation results show the necessity of implementing Fault Tolerant Control Systems (FTCSs) in EV drivetrain electric motor drives. Various fault diagnosis algorithms of the VSI switch faults in PMSM drives are reviewed and their merits and demerits are discussed. Existing fault tolerant control inverter topologies are also reviewed and compared based on EV application requirements. Finally, suitable FDA and fault tolerant control inverter topology for EV drivetrain application are recommended to maintain safe and optimal vehicle performance in the postfault condition

Investigation of the relationship between family mental functioning and the level of education among the staff of three hospitals

The family is considered as one of the most important institutions that affect people's physical and mental health and is able to provide people with physical, emotional and social balance. Family is the most important institution of society; and many social science researches are based on this institution. This is the first study to investigate the relationship between family mental functioning and the level of education. This is a descriptive-analytical, epidemiological study conducted on 232 employees of three hospitals. The sampling was done randomly. In this study, first, the subjects were asked to complete a demographic questionnaire, and then the McMaster questionnaire was used to assess family functioning. The family functioning score was higher in samples having MSc and PhD (12.194) than other levels of education (p-value= 0.0001), in addition, family functioning score in samples whose head of household had PhD (79.195), was higher than the other samples (p-value= 0.0001). In this study, an increase in family level of education led to an increase in family mental functioning as well, that is likely because people who have a higher level of education use better problem-solving techniques, higher communication skills, and verbal level and employ it in the challenges of life, and maybe people with fewer psychological problems had the ability to achieve a higher level of education