Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.

BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major U. S. teaching hospital. METHODS: Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, before and after implementation of an ERAS protocol. Data collected included patient demographics, operative, and perioperative surgical and anesthesia data, need for analgesics, complications, inpatient medical costs, and 30-day readmission rates. RESULTS: There were 99 patients in the traditional care group, and 142 in the ERAS group. The median length of stay (LOS) was 5 days in the ERAS group compared with 7 days in the traditional group (P < 0.001). The reduction in LOS was significant for both open procedures (median 6 vs 7 days, P = 0.01), and laparoscopic procedures (4 vs 6 days, P < 0.0001). ERAS patients had fewer urinary tract infections (13% vs 24%, P = 0.03). Readmission rates were lower in ERAS patients (9.8% vs 20.2%, P = 0.02). DISCUSSION: Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in U.S. hospitals.

Magnetic damping of levitated liquid droplets in AC and DC field

The intense AC magnetic field required to produce levitation in terrestrial conditions, along with the buoyancy and thermo-capillary forces, results in turbulent convective flow within the droplet. The use of a homogenous DC magnetic field allows the convective flow to be damped. However the turbulence properties are affected at the same time, leading to a possibility that the effective turbulent damping is considerably reduced. The MHD modified K-Omega turbulence model allows the investigation of the effect of magnetic field on the turbulence. The model incorporates free surface deformation, the temperature dependent surface tension, turbulent momentum transport, electromagnetic and gravity forces. The model is adapted to incorporate a periodic laser heating at the top of the droplet, which have been used to measure the thermal conductivity of the material by calculating the phase lag between the frequency of the laser heating and the temperature response at the bottom. The numerical simulations show that with the gradual increase of the DC field the fluid flow within the droplet is initially increasing in intensity. Only after a certain threshold magnitude of the field the flow intensity starts to decrease. In order to achieve the flow conditions close to the ‘laminar’ a D.C. magnetic field >4 Tesla is required to measure the thermal conductivity accurately. The reduction in the AC field driven flow in the main body of the drop leads to a noticeable thermo-capillary convection at the edge of the droplet. The uniform vertical DC magnetic field does not stop a translational oscillation of the droplet along the field, which is caused by the variation in total levitation force due to the time-dependent surface deformation.

The application of electrostatic dry powder deposition technology to coat drug-eluting stents

Purpose: A novel methodology has been introduced to effectively coat intravascular stents with sirolimus-loaded polymeric microparticles. Methods: Dry powders of the microparticulate formulation, consisting of non-erodible polymers, were produced by a supercritical, aerosol, solvent extraction system (ASES). A design of experiment (DOE) approach was conducted on the independent variables, such as organic/CO2 phase volume ratio, polymer weight and stirring-rate, while regression analysis was utilized to interpret the influence of all operational parameters on the dependent variable of particle size. The dry powders, so formed, entered an electric field created by corona charging and were sprayed on the earthed metal stent. Furthermore, the thermal stability of sirolimus was investigated to define the optimum conditions for fusion to the metal surfaces. Results: The electrostatic dry powder deposition technology (EDPDT) was used on the metal strut followed by fusion to produce uniform, reproducible and accurate coatings. The coated stents exhibited sustained release profiles over 25 days, similar to commercial products. EDPDT-coated stents displayed significant reduced platelet adhesion. Conclusions: EDPDT appeared to be a robust accurate and reproducible technology to coat eluting stents.

Effect of Rapid Thermal Annealing on the Structure and Magnetic Properties of Chemical Vapour Deposition Cobalt Layers

Future read heads in hard disc storage require high conformal coatings of metal magnetic layers over high aspect ratio profiles. This paper describes pioneering work on the use of MOCVD for the deposition of cobalt layers. While pure cobalt layers could be deposited at 400C their magnetic properties are poor. It was found that the magnetic properties of the layers could be significantly enhanced with an optimised rapid thermal anneal. This work was sponsored by Seagate Technology and led to a follow up PhD studentship on the co-deposition of cobalt and iron by MOCVD.

Diagnostics on an atmospheric pressure plasma jet

The atmospheric pressure plasma jet (APPJ) is a homogeneous non-equilibrium discharge at ambient pressure. It operates with a noble base gas and a percentage-volume admixture of a molecular gas. Applications of the discharge are mainly based on reactive species in the effluent. The effluent region of a discharge operated in helium with an oxygen admixture has been investigated. The optical emission from atomic oxygen decreases with distance from the discharge but can still be observed several centimetres in the effluent. Ground state atomic oxygen, measured using absolutely calibrated two-photon laser induced fluorescence spectroscopy, shows a similar behaviour. Detailed understanding of energy transport mechanisms requires investigations of the discharge volume and the effluent region. An atmospheric pressure plasma jet has been designed providing excellent diagnostics access and a simple geometry ideally suited for modelling and simulation. Laser spectroscopy and optical emission spectroscopy can be applied in the discharge volume and the effluent region.

High-Pressure Densities and Derived Thermodynamic Properties of Imidazolium-Based Ionic Liquids

This work addresses the experimental measurements of the pressure (0.10 <p/MPa <10.0) and temperature (293.15 <T/K <393.15) dependence of the density and derived thermodynamic properties, such as the isothermal compressibility, the isobaric expansivity, the thermal pressure coefficient, and the pressure dependence of the heat capacity of several imidazolium-based ionic liquids (ILs), namely, 1-butyl-3-methylimidazolium tetrafluoroborate, [bmim][BF4]; 3-methyl-1-octylimidazolium tetrafluoroborate, [omim][BF4]; 1-hexyl-3-methylimidazolium hexafluorophosphate, [hmim][PF6]; 3-methyl-1-octylimidazolium hexafluorophosphate, [omim][PF6]; 1-butyl-2,3-dimethylimidazolium hexafluorophosphate, [bmmim][PF6]; and 1-butyl-3-methylimidazolium trifluoromethansulfonate, [bmim][CF3SO3]. These ILs were chosen to provide an understanding of the influence of the cation alkyl chain length, the number of cation substitutions, and the anion influence on the properties under study. The influence of water content in the density was also studied for the most hydrophobic IL used, [omim][PF6]. A simple ideal-volume model was employed for the prediction of the imidazolium molar volumes at ambient conditions, which proved to agree well with the experimental results.

Plasma Ionization in Low-Pressure Radio-Frequency Discharges—Part II: Particle-in-Cell Simulation

Plasma ionization in the low-pressure operation regime ( $«$ 5 Pa) of RF capacitively coupled plasmas (CCPs) is governed by a complex interplay of various mechanisms, such as field reversal, sheath expansion, and wave–particle interactions. In a previous paper, it was shown that experimental observations in a hydrogen CCP operated at 13.56 MHz are qualitatively well described in a 1-D symmetrical particle-in-cell (PIC) simulation. In this paper, a spherical asymmetrical PIC simulation that is closer to the conditions of the highly asymmetrical experimental device is used to simulate a low-pressure neon CCP operated at 2 MHz. The results show a similar behavior, with pronounced ionization through field reversal, sheath expansion, and wave–particle interactions, and can be exploited for more accurate quantitative comparisons with experimental observations.

Spatially resolved diagnostics on a micro atmospheric pressure plasma jet

Despite enormous potential for technological applications, fundamentals of stable non-equilibrium micro-plasmas at ambient pressure are still only partly understood. Micro-plasma jets are one sub-group of these plasma sources. For an understanding it is particularly important to analyse transport phenomena of energy and particles within and between the core and effluent of the discharge. The complexity of the problem requires the combination and correlation of various highly sophisticated diagnostics yielding different information with an extremely high temporal and spatial resolution. A specially designed rf microscale atmospheric pressure plasma jet (µ-APPJ) provides excellent access for optical diagnostics to the discharge volume and the effluent region. This allows detailed investigations of the discharge dynamics and energy transport mechanisms from the discharge to the effluent. Here we present examples for diagnostics applicable to different regions and combine the results. The diagnostics applied are optical emission spectroscopy (OES) in the visible and ultraviolet and two-photon absorption laser-induced fluorescence spectroscopy. By the latter spatially resolved absolutely calibrated density maps of atomic oxygen have been determined for the effluent. OES yields an insight into energy transport mechanisms from the core into the effluent. The first results of spatially and phase-resolved OES measurements of the discharge dynamics of the core are presented.