Dielectric characterization and molecular interaction behaviour in binary mixtures of methyl acetate with 1-butanol and 1-pentanol

900-910The dielectric constant (ɛs) and relaxation time () of binary mixtures of methyl acetate with alcohols (1-butanol and 1-pentanol) have been investigated at fifteen molar concentrations over the entire mixing range at 288 K, 298 K, 308 K and 318 K using time domain reflectometery technique over the frequency range from 10 MHz to 10 GHz. The relaxation in these mixtures can be described by a single relaxation time using the Debye model. The concentration dependent plots of excess dielectric constant (ɛE), excess inverse relaxation time (1/)E, Kirkwood correlation factor (geff), thermodynamic parameters such as enthalpy of activation (H) and Gibbs free energy (G) of activation and Bruggman factor (fB) have been used to explore the complexes formed between unlike molecules, dipolar ordering, hydrogen bond molecular connectivity’s and their strength in the binary mixtures. Results confirm that there are strong hydrogen-bond interactions between unlike molecules of ester-alcohol mixtures

Integration of robotic surgery into routine practice and impacts on communication, collaboration, and decision making: A realist process evaluation protocol

Background: Robotic surgery offers many potential benefits for patients. While an increasing number of healthcare providers are purchasing surgical robots, there are reports that the technology is failing to be introduced into routine practice. Additionally, in robotic surgery, the surgeon is physically separated from the patient and the rest of the team, with the potential to negatively impact teamwork in the operating theatre. The aim of this study is to ascertain: how and under what circumstances robotic surgery is effectively introduced into routine practice; and how and under what circumstances robotic surgery impacts teamwork, communication and decision making, and subsequent patient outcomes. Methods and design: We will undertake a process evaluation alongside a randomised controlled trial comparing laparoscopic and robotic surgery for the curative treatment of rectal cancer. Realist evaluation provides an overall framework for the study. The study will be in three phases. In Phase I, grey literature will be reviewed to identify stakeholders' theories concerning how robotic surgery becomes embedded into surgical practice and its impacts. These theories will be refined and added to through interviews conducted across English hospitals that are using robotic surgery for rectal cancer resection with staff at different levels of the organisation, along with a review of documentation associated with the introduction of robotic surgery. In Phase II, a multi-site case study will be conducted across four English hospitals to test and refine the candidate theories. Data will be collected using multiple methods: the structured observation tool OTAS (Observational Teamwork Assessment for Surgery); video recordings of operations; ethnographic observation; and interviews. In Phase III, interviews will be conducted at the four case sites with staff representing a range of surgical disciplines, to assess the extent to which the results of Phase II are generalisable and to refine the resulting theories to reflect the experience of a broader range of surgical disciplines. The study will provide (i) guidance to healthcare organisations on factors likely to facilitate successful implementation and integration of robotic surgery, and (ii) guidance on how to ensure effective communication and teamwork when undertaking robotic surgery

Influence of soil chemical composition on electrical conductivity

156-161This paper presents the influences of soil chemical composition on electrical conductivity. Electrical conductivity of 150 samples from different locations of Pune district of Maharashtra State was measured. Chemical compositions such as organic carbon, nitrogen, potassium, phosphorous, sodium, calcium carbonate, iron, manganese, zinc and copper were measured. Pearson’s correlation coefficients studies were employed to highlight the influence of the chemical composition on the electrical conductivity. It had been observed that nitrogen, phosphorous, potassium, sodium and calcium carbonate have a significant influence on measured electrical conductivity values. Whereas there had een very low correlation with the organic carbon, iron, manganese, zinc and copper

Discrepant perceptions of communication, teamwork and situation awareness among surgical team members

Objective To assess surgical team members’ differences in perception of non-technical skills. Design Questionnaire design. Setting Operating theatres (OTs) at one university hospital, three teaching hospitals and one general hospital in the Netherlands. Participants Sixty-six surgeons, 97 OT nurses, 18 anaesthetists and 40 nurse anaesthetists. Methods All surgical team members, of five hospitals, were asked to complete a questionnaire and state their opinion on the current state of communication, teamwork and situation awareness at the OT. Results Ratings for ‘communication’ were significantly different, particularly between surgeons and all other team members (P ? 0.001). The ratings for ‘teamwork’ differed significantly between all team members (P ? 0.005). Within ‘situation awareness’ significant differences were mainly observed for ‘gathering information’ between surgeons and other team members (P < 0.001). Finally, 72–90% of anaesthetists, OT nurses and nurse anaesthetists rated routine team briefings and debriefings as inadequate. Conclusions This study shows discrepancies on many aspects in perception between surgeons and other surgical team members concerning communication, teamwork and situation awareness. Future research needs to ascertain whether these discrepancies are linked to greater risk of adverse events or to process as well as systems failures. Establishing this link would support implementation and use of complex team interventions that intervene at multiple levels of the healthcare systemIndustrial Design Engineerin

Evaluation of Protocol Uniformity Concerning Laparoscopic Cholecystectomy in The Netherlands

Background: Iatrogenic bile duct injury remains a current complication of laparoscopic cholecystectomy. One uniform and standardized protocol, based on the "critical view of safety" concept of Strasberg, should red

A BURST‐BAUS consensus document for best practice in the conduct of scrotal exploration for suspected testicular torsion: the Finding Consensus for Orchidopexy in Torsion (FIX‐IT) study

Objectives To produce a best practice consensus guideline for the conduct of scrotal exploration for suspected testicular torsion using formal consensus methodology. Materials and Methods A panel of 16 expert urologists, representing adult, paediatric, general and andrological urology used the RAND Corporation / University of California, Los Angeles (RAND/UCLA) Appropriateness Consensus Methodology to score a 184-statement pre-meeting questionnaire on the conduct of scrotal exploration for suspected testicular torsion. The collated responses were presented at a face-to-face online meeting and each item was rescored anonymously after a group discussion, facilitated by an independent chair with expertise in consensus methodology. Items were scored for agreement and consensus and the items scored with consensus were used to derive a set of best practice guidelines. Results Statements scored with consensus increased from Round 1 (122/184, 66.3%) to Round 2 (149/200, 74.5%). Recommendations were generated in 10 categories: consent; assessment under anaesthetic; initial incision; intra-operative decision making; fixation; medical photography; closure; operation note; logistics; and follow-up after scrotal exploration. Our statements assume that the decision to operate has already been made. Key recommendations in the consent process included discussion of the possibility of orchidectomy and the possibility of subsequent infection of the affected testis or wound requiring antibiotic therapy. If after the examination under anaesthesia, the index of suspicion of testicular torsion is lower than previously thought, then the surgeon should still proceed to scrotal exploration as planned. A flow chart guiding decision making dependent on intra-operative findings has been designed. If no torsion is present on exploration and bell clapper deformity is absent, the testis should not be fixed. When fixing a testis using sutures, a three- or four-point method is acceptable and non-absorbable sutures are preferred. Conclusions We have produced consensus recommendations to inform best practice in the conduct of scrotal exploration for suspected testicular torsion

Changes in safety climate and teamwork in the operating room after implementation of a revised WHO checklist: a prospective interventional study

BACKGROUND: Inter-professional teamwork in the operating room is important for patient safety. The World Health Organization (WHO) checklist was introduced to improve intraoperative teamwork. The aim of this study was to evaluate the safety climate in a Swedish operating room setting before and after an intervention, using a revised version of the WHO checklist to improve teamwork. METHODS: This study is a single center prospective interventional study. Participants were personnel working in operating room teams including surgeons, anesthesiologists, scrub nurses, nurse anaesthetists and nurse assistants. The study started with pre-interventional observations of the WHO checklist use followed by education on safety climate, the WHO checklist, and non-technical skills in the operating room. Thereafter a revised version of the WHO checklist was introduced. Post-interventional observations regarding the performance of the WHO checklist were carried out. The Safety Attitude Questionnaire was used to assess safety climate at baseline and post-intervention. RESULTS: At baseline we discovered a need for improved teamwork and communication. The participants considered teamwork to be important for patient safety, but had different perceptions of good teamwork between professions. The intervention, a revised version of the WHO checklist, did not affect teamwork climate. Adherence to the revision of the checklist was insufficient, dominated by a lack of structure. CONCLUSIONS: There was no significant change in teamwork climate by use of the revised WHO checklist, which may be due to insufficient implementation, as a lack of adherence to the WHO checklist was detected. We found deficiencies in teamwork and communication. Further studies exploring how to improve safety climate are needed. TRIAL REGISTRATION: NCT02329691