Proceedings of the Twenty-Sixth Annual Biochemical Engineering Symposium

This volume contains the Proceedings of the Twenty-Sixth Annual Biochemical Engineering Symposium held at Kansas State University on September 21, 1996. The program included 10 oral presentations and 14 posters. Some of the papers describe the progress of ongoing projects, and others contain the results of completed projects. Only brief summaries are given of some of the papers; many of the papers will be published in full elsewhere. A listing of those who attended is given below. ContentsForeign Protein Production from SV40 Early Promoter in Continuous Cultures of Recombinant CHO Cells - Gautam Banik, Paul Todd, and Dhinakar Kampala Enhanced Cell Recruitment Due to Cell-Cell Interactions - Brad Farlow and Matthias Nollert The Recirculation of Hybridoma Suspension Cultures: Effects on Cell Death, Metabolism and Mab Productivity - Peng Jin and Carole A. Heath The Importance of Enzyme Inactivation and Self-Recovery in Cometabolic Biodegradation of Chlorinated Solvents - Xi-Hui Zhang, Shanka Banerji, and Rakesh Bajpai Phytoremediation of VOC contaminated Groundwater using Poplar Trees - Melissa Miller, Jason Dana, L.C. Davis, Murlidharan Narayanan, and L.E. Erickson Biological Treatment of Off-Gases from Aluminum Can Production: Experimental Results and Mathematical Modeling - Adeyma Y. Arroyo, Julio Zimbron, and Kenneth F. Reardon Inertial Migration Based Separation of Chlorella Microalgae in Branched Tubes - N.M. Poflee, A.L. Rakow, D.S. Dandy, M.L. Chappell, and M.N. Pons Contribution of Electrochemical Charge to Protein Partitioning in Aqueous Two-Phase Systems - Weiyu Fan and Charles C. Glatz Biodegradation of Some Commercial Surfactants Used in Bioremediation - Jun Gu, G.W. Preckshot, S.K. Banerji, and Rakesh Bajpai Modeling the Role of Biomass in Heavy Metal Transport Ln Vadose Zone - K.V. Nedunuri, L.E. Erickson, and R.S. Govindaraju Multivariable Statistical Methods for Monitoring Process Quality: Application to Bioinsecticide Production by 73 89 Bacillus Thuringiensis - c. Puente and M.N. Karim The Use of Polymeric Flocculants in Bacterial Lysate Streams - H. Graham, A.S. Cibulskas and E.H. Dunlop Effect of Water Content on transport of Trichloroethylene in a Chamber with Alfalfa Plants - Muralidharan Narayanan, Jiang Hu, Lawrence C. Davis, and Larry E. Erickson Detection of Specific Microorganisms using the Arbitrary Primed PCR in the Bacterial Community of Vegetated Soil - X. Wu and L.C. Davis Flux Enhancement Using Backpulsing - V.T. Kuberkar and R.H. Davis Chromatographic Purification of Oligonucleotides: Comparison with Electrophoresis - Stephen P. Cape, Ching-Yuan Lee, Kevin Petrini, Sean Foree, Micheal G. Sportiello and Paul Todd Determining Singular Arc Control Policies for Bioreactor Systems Using a Modified Iterative Dynamic Programming Algorithm - Arun Tholudur and W. Fred Ramirez Pressure Effect on Subtilisins Measured via FTIR, EPR and Activity Assays, and Its Impact on Crystallizations - J.N. Webb, R.Y. Waghmare, M.G. Bindewald, T.W. Randolph, J.F. Carpenter, C.E. Glatz Intercellular Calcium Changes in Endothelial Cells Exposed to Flow - Laura Worthen and Matthias Nollert Application of Liquid-Liquid Extraction in Propionic Acid Fermentation - Zhong Gu, Bonita A. Glatz, and Charles E. Glatz Purification of Recombinant T4 Lysozyme from E. Coli: Ion-Exchange Chromatography - Weiyu Fan, Matt L. Thatcher, and Charles E. Glatz Recovery and Purification of Recombinant Beta-Glucuronidase from Transgenic Corn - Ann R. Kusnadi, Roque Evangelista, Zivko L. Nikolov, and John Howard Effects of Auxins and cytokinins on Formation of Catharanthus Roseus G. Don Multiple Shoots - Ying-Jin Yuan, Yu-Min Yang, Tsung-Ting Hu, and Jiang Hu Fate and Effect of Trichloroethylene as Nonaqueous Phase Liquid in Chambers with Alfalfa - Qizhi Zhang, Brent Goplen, Sara Vanderhoof, Lawrence c. Davis, and Larry E. Erickson Oxygen Transport and Mixing Considerations for Microcarrier Culture of Mammalian Cells in an Airlift Reactor - Sridhar Sunderam, Frederick R. Souder, and Marylee Southard Effects of Cyclic Shear Stress on Mammalian Cells under Laminar Flow Conditions: Apparatus and Methods - M.L. Rigney, M.H. Liew, and M.Z. Southard

Interconexión monolítica de dispositivos fotovoltaicos basados en a-Si mediante ablación directa con fuentes láser ultravioleta

Resumen En la última década la tecnología láser se ha convertido en una herramienta imprescindible en la fabricación de dispositivos fotovoltaicos, muy especial¬mente en aquellos basados en tecnología de lámina delgada. Independiente¬mente de crisis coyunturales en el sector, la evolución en los próximos años de estas tecnologías seguirá aprovechándose de la flexibilidad y calidad de proceso de la herramienta láser para la consecución de los dos objetivos básicos que harán de la fotovoltaica una opción energética económicamente viable: la reducción de costes de fabricación y el aumento de eficiencia de los dispositivos. Dentro de las tecnologías fotovoltaicas de lámina delgada, la tecnología de dispositivos basados en silicio amorfo ha tenido un gran desarrollo en sistemas estándar en configuración de superestrato, pero su limitada efi¬ciencia hace que su supervivencia futura pase por el desarrollo de formatos en configuración de substrato sobre materiales flexibles de bajo coste. En esta aproximación, las soluciones industriales basadas en láser actualmente disponibles para la interconexión monolítica de dispositivos no son aplica¬bles, y desde hace años se viene investigando en la búsqueda de soluciones apropiadas para el desarrollo de dichos procesos de interconexión de forma que sean transferibles a la industria. En este contexto, esta Tesis propone una aproximación completamente orig¬inal, demostrando la posibilidad de ejecutar una interconexión completa de estos dispositivos irradiando por el lado de la lámina (es decir de forma com¬patible con la opción de configuración de substrato y, valga la redundancia, con el substrato del dispositivo opaco), y con fuentes láser emitiendo en UV. Este resultado, obtenido por primera vez a nivel internacional con este trabajo, aporta un conocimiento revelador del verdadero potencial de estas fuentes en el desarrollo industrial futuro de estas tecnologías. Si bien muy posiblemente la solución industrial final requiera de una solución mixta con el empleo de fuentes en UV y, posiblemente, en otras longitudes de onda, esta Tesis y su planteamiento novedoso aportan un conocimiento de gran valor a la comunidad internacional por la originalidad del planteamiento seguido, los resultados parciales encontrados en su desarrollo (un número importante de los cuales han aparecido en revistas del JCR que recogen en la actualidad un número muy significativo de citas) y porque saca además a la luz, con las consideraciones físicas pertinentes, las limitaciones intrínsecas que el desarrollo de procesos de ablación directa selectiva con láseres UV en parte de los materiales utilizados presenta en el rango temporal de in¬teracción de ns y ps. En este trabajo se han desarrollado y optimizado los tres pasos estándar de interconexión (los habitualmente denominados Pl, P2 y P3 en la industria fotovoltaica) demostrando las ventajas y limitaciones del uso de fuentes en UV tanto con ancho temporal de ns como de ps. En particular destaca, por el éxito en los resultados obtenidos, el estudio de procesos de ablación selectiva de óxidos conductores transparentes (en este trabajo utilizados tanto como contacto frontal así como posterior en los módulos) que ha generado resultados, de excelente acogida científica a nivel internacional, cuya aplicación trasciende el ámbito de las tecnologías de silicio amorfo en lámina delgada. Además en este trabajo de Tesis, en el desarrollo del objetivo citado, se han puesto a punto técnicas de análisis de los procesos láser, basadas en métodos avanzados de caracterización de materiales (como el uso combi¬nado de la espectroscopia dispersiva de rayos X y la microscopía confocal de barrido) que se presentan como auténticos avances en el desarrollo de técnicas específicas de caracterización para el estudio de los procesos con láser de ablación selectiva de materiales en lámina delgada, procesos que no solo tienen impacto en el ámbito de la fotovoltaica, sino también en la microelectrónica, la biotecnología, la microfabricación, etc. Como resultado adicional, parte de los resultados de este trabajo, han sido aplicados exi¬tosamente por el grupo de investigaci´on en la que la autora desarrolla su labor para conseguir desarrollar procesos de enorme inter´es en otras tec-nolog´ıas fotovoltaicas, como las tecnolog´ıas est´andar de silicio amorfo sobre vidrio en configuraci´on de superestrato o el procesado de capas delgadas en tecnolog´ıas convencionales de silicio cristalino. Por u´ltimo decir que este trabajo ha sido posible por una colaboraci´on muy estrecha entre el Centro L´aser de la UPM, en el que la autora de¬sarrolla su labor, y el Grupo de Silicio Depositado del Centro de Inves¬tigaciones Energ´eticas, Medioambientales y Tecnol´ogicas, CIEMAT, que, junto al Grupo de Energ´ıa Fotovoltaica de la Universidad de Barcelona, han preparado la mayor parte de las muestras utilizadas en este estudio. Dichas colaboraciones se han desarrollado en el marco de varios proyectos de investigaci´on aplicada con subvenci´on pu´blica, tales como el proyecto singular estrat´egico PSE-MICROSIL08 (PSE-120000-2006-6), el proyecto INNDISOL (IPT-420000-2010-6), ambos financiados porel Fondo Europeo de Desarrollo Regional FEDER (UE) ”Una manera de hacer Europa y el MICINN, y los proyectos de Plan Nacional AMIC (ENE2010-21384-C04-´ 02) y CLASICO (ENE2007-6772-C04-04), cuya financiaci´on ha permitido en gran parte llevar a t´ermino este trabajo Abstract In the last decade, the laser technology has turned into an indispensable tool in the production of photovoltaic devices, especially of those based on thin film technology. Regardless the current crisis in the sector, the evolution of these technologies in the upcoming years will keep taking advantage of the flexibility and process quality of the laser tool for the accomplishment of the two basic goals that will convert the photovoltaic energy into economically viable: the manufacture cost reduction and the increase in the efficiency of the devices. Amongst the thin film laser technologies, the technology of devices based on amorphous silicon has had a great development in standard systems of superstrate configuration, but its limited efficiency makes its survival de¬pendant on the development of formats in substrate configuration with low cost flexible materials. In this approach, the laser industrial solutions cur¬rently available for the monolithic interconnection are not applicable, and in the last few years the investigations have been focused on the search of appropriate solutions for the development of such interconnection processes in a way that the same are transferable to the industry. In this context, this Thesis proposes a totally original approach, proving the possibility of executing a full interconnection of these devices by means of irradiation from the film side, i.e., compatible with the substrate con¬figuration, and with UV laser sources. This result, obtained for the first time at international level in this work, provides a revealing knowledge of the true potential of these sources in the future industrial development of these technologies. Even though very probably the final industrial solution will require a combination of the use of UV sources along with other wave¬lengths, this Thesis and its novel approach contribute with a high value to the international community because of the originality of the approach, the partial results found throughout its development (out of which, a large number has appeared in JCR journals that currently accumulate a signifi¬cant number of citations) and brings to light, with the pertinent scientific considerations, the intrinsic limitations that the selective direct ablation processes with UV laser present in the temporal range of interaction of ns and ps for part of the materials used in this study. More particularly, the three standard steps of interconnection (usually de¬nominated P1, P2 and P3 in the photovoltaic industry) have been developed and optimized, showing the advantages as well as the limitations of the use of UV sources in both the ns and ps pulse-width ranges. It is highly remark¬able, because of the success in the obtained results, the study of selective ablation processes in transparent conductive oxide (in this work used as a front and back contact), that has generated results, of excellent interna¬tional scientific reception, whose applications go beyond the scope of thin film photovoltaic technologies based on amorphous silicon. Moreover, in this Thesis, with the development of the mentioned goal, differ¬ent techniques of analysis of laser processes have been fine-tuned, basing the same in advanced methods for material characterization (like the combined use of EDX Analysis and Confocal Laser Scanning Microscopy) that can be presented as true breakthroughs in the development of specific techniques for characterization in the study of laser processes of selective ablation of materials in thin film technologies, processes that not only have impact in the photovoltaic field, but also in those of microelectronics, biotechnology, micro-fabrication, etc. As an additional outcome, part of the results of this work has been suc¬cessfully applied, by the investigation group to which the author belongs, to the development of processes of enormous interest within other photo¬voltaic technologies, such as the standard technologies on amorphous silicon over glass in superstrate configuration or the processing of thin layers in conventional technologies using crystalline silicon. Lastly, it is important to mention that this work has been possible thanks to the close cooperation between the Centro L´aser of the UPM, in which the author develops her work, and the Grupo de Silicio Depositado of Centro de Investigaciones Energ´eticas, Medioambientales y Tecnol´ogicas, CIEMAT, which, along with the Grupo de Energ´ıa Fotovoltaica of Univer¬sidad de Barcelona, has prepared the largest part of the samples utilized in this study. Such collaborations have been carried out in the context of several projects of applied investigation with public funding, like Proyecto Singular Estrat´egico PSE-MICROSIL08 (PSE-120000-2006-6), Proyecto IN-NDISOL (IPT-420000-2010-6), both funded by the European Regional De¬velopment Fund (ERDF), ”Una manera de hacer Europa” and MICINN, and the projects of Plan Nacional AMIC (ENE2010-21384-C04-02) and ´ CLASICO (ENE2007-6772-C04-04), whose funds have enabled the devel-opment of large part of this work.

Singularidades da intervenção psicológica nos cuidados paliativos

Relatório de Prática Clínica apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Cuidados Paliativos, realizada sob a orientação científica da Diretora da ESALD Doutora Ana Paula Gonçalves Antunes Sapeta, do Instituto Politécnico de Castelo Branco, e orientação científica do Assistente Convidado pela Escola Superior de Saúde Dr. Lopes Dias, Mestre Eduardo Manuel Neves Oliveira Carqueja.

A decision support system for supplier selection and order allocation in stochastic, multi-stakeholder and multi-criteria environments

Integrated supplier selection and order allocation is an important decision for both designing and operating supply chains. This decision is often influenced by the concerned stakeholders, suppliers, plant operators and customers in different tiers. As firms continue to seek competitive advantage through supply chain design and operations they aim to create optimized supply chains. This calls for on one hand consideration of multiple conflicting criteria and on the other hand consideration of uncertainties of demand and supply. Although there are studies on supplier selection using advanced mathematical models to cover a stochastic approach, multiple criteria decision making techniques and multiple stakeholder requirements separately, according to authors' knowledge there is no work that integrates these three aspects in a common framework. This paper proposes an integrated method for dealing with such problems using a combined Analytic Hierarchy Process-Quality Function Deployment (AHP-QFD) and chance constrained optimization algorithm approach that selects appropriate suppliers and allocates orders optimally between them. The effectiveness of the proposed decision support system has been demonstrated through application and validation in the bioenergy industry.

Periodic nonlinear Fourier transform for fiber-optic communications, Part I:theory and numerical methods

In this work, we introduce the periodic nonlinear Fourier transform (PNFT) method as an alternative and efficacious tool for compensation of the nonlinear transmission effects in optical fiber links. In the Part I, we introduce the algorithmic platform of the technique, describing in details the direct and inverse PNFT operations, also known as the inverse scattering transform for periodic (in time variable) nonlinear Schrödinger equation (NLSE). We pay a special attention to explaining the potential advantages of the PNFT-based processing over the previously studied nonlinear Fourier transform (NFT) based methods. Further, we elucidate the issue of the numerical PNFT computation: we compare the performance of four known numerical methods applicable for the calculation of nonlinear spectral data (the direct PNFT), in particular, taking the main spectrum (utilized further in Part II for the modulation and transmission) associated with some simple example waveforms as the quality indicator for each method. We show that the Ablowitz-Ladik discretization approach for the direct PNFT provides the best performance in terms of the accuracy and computational time consumption.

Information Presentation Features and Comprehensibility of Hospital Report Cards: Design Analysis and Online Survey Among Users

Background: Improving the transparency of information about the quality of health care providers is one way to improve health care quality. It is assumed that Internet information steers patients toward better-performing health care providers and will motivate providers to improve quality. However, the effect of public reporting on hospital quality is still small. One of the reasons is that users find it difficult to understand the formats in which information is presented. Objective: We analyzed the presentation of risk-adjusted mortality rate (RAMR) for coronary angiography in the 10 most commonly used German public report cards to analyze the impact of information presentation features on their comprehensibility. We wanted to determine which information presentation features were utilized, were preferred by users, led to better comprehension, and had similar effects to those reported in evidence-based recommendations described in the literature. Methods: The study consisted of 5 steps: (1) identification of best-practice evidence about the presentation of information on hospital report cards; (2) selection of a single risk-adjusted quality indicator; (3) selection of a sample of designs adopted by German public report cards; (4) identification of the information presentation elements used in public reporting initiatives in Germany; and (5) an online panel completed an online questionnaire that was conducted to determine if respondents were able to identify the hospital with the lowest RAMR and if respondents’ hospital choices were associated with particular information design elements. Results: Evidence-based recommendations were made relating to the following information presentation features relevant to report cards: evaluative table with symbols, tables without symbols, bar charts, bar charts without symbols, bar charts with symbols, symbols, evaluative word labels, highlighting, order of providers, high values to indicate good performance, explicit statements of whether high or low values indicate good performance, and incomplete data (“N/A” as a value). When investigating the RAMR in a sample of 10 hospitals’ report cards, 7 of these information presentation features were identified. Of these, 5 information presentation features improved comprehensibility in a manner reported previously in literature. Conclusions: To our knowledge, this is the first study to systematically analyze the most commonly used public reporting card designs used in Germany. Best-practice evidence identified in international literature was in agreement with 5 findings about German report card designs: (1) avoid tables without symbols, (2) include bar charts with symbols, (3) state explicitly whether high or low values indicate good performance or provide a “good quality” range, (4) avoid incomplete data (N/A given as a value), and (5) rank hospitals by performance. However, these findings are preliminary and should be subject of further evaluation. The implementation of 4 of these recommendations should not present insurmountable obstacles. However, ranking hospitals by performance may present substantial difficulties.

Satisfação profissional versus metodologia de trabalho

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciado em Enfermagem

Consequences of big data on the individual: Interview

The speed with which data has moved from being scarce, expensive and valuable, thus justifying detailed and careful verification and analysis to a situation where the streams of detailed data are almost too large to handle has caused a series of shifts to occur. Legal systems already have severe problems keeping up with, or even in touch with, the rate at which unexpected outcomes flow from information technology. The capacity to harness massive quantities of existing data has driven Big Data applications until recently. Now the data flows in real time are rising swiftly, become more invasive and offer monitoring potential that is eagerly sought by commerce and government alike. The ambiguities as to who own this often quite remarkably intrusive personal data need to be resolved – and rapidly - but are likely to encounter rising resistance from industrial and commercial bodies who see this data flow as ‘theirs’. There have been many changes in ICT that has led to stresses in the resolution of the conflicts between IP exploiters and their customers, but this one is of a different scale due to the wide potential for individual customisation of pricing, identification and the rising commercial value of integrated streams of diverse personal data. A new reconciliation between the parties involved is needed. New business models, and a shift in the current confusions over who owns what data into alignments that are in better accord with the community expectations. After all they are the customers, and the emergence of information monopolies needs to be balanced by appropriate consumer/subject rights. This will be a difficult discussion, but one that is needed to realise the great benefits to all that are clearly available if these issues can be positively resolved. The customers need to make these data flow contestable in some form. These Big data flows are only going to grow and become ever more instructive. A better balance is necessary, For the first time these changes are directly affecting governance of democracies, as the very effective micro targeting tools deployed in recent elections have shown. Yet the data gathered is not available to the subjects. This is not a survivable social model. The Private Data Commons needs our help. Businesses and governments exploit big data without regard for issues of legality, data quality, disparate data meanings, and process quality. This often results in poor decisions, with individuals bearing the greatest risk. The threats harbored by big data extend far beyond the individual, however, and call for new legal structures, business processes, and concepts such as a Private Data Commons. This Web extra is the audio part of a video in which author Marcus Wigan expands on his article "Big Data's Big Unintended Consequences" and discusses how businesses and governments exploit big data without regard for issues of legality, data quality, disparate data meanings, and process quality. This often results in poor decisions, with individuals bearing the greatest risk. The threats harbored by big data extend far beyond the individual, however, and call for new legal structures, business processes, and concepts such as a Private Data Commons.

Avaliação em educação - que desafios?

Neste artigo, começo por questionar-me sobre o que é a avaliação, qual o seu contributo para o mundo da educação, partindo da leitura de alguns teóricos e estudiosos que têm vindo a debruçar-se sobre esta temática / problemática. Num segundo momento, confronto-me com experiências vivenciadas ao longo da minha história de vida pessoal/profissional, para, uma vez retratadas/estudadas/avaliadas, desencadear uma interacção com as teorias convocadas. O questionamento é orientado no sentido de identificar e compreender a avaliação em termos da de estratégias a implementar a nível institucional e de vias a abrir para o sucesso escolar / académico. Estão, pois, em causa, as condições institucionais que viabilizam o processo de ensino, o processo que ao professor cabe organizar para criar condições para o aprimoramento das aprendizagens dos estudantes. A teoria é abordada; dois estudos de caso em tempos e contextos diferentes são focalizados – narrados/estudados/avaliados; a dialéctica é estabelecida – questionando a(s) praxis pela(s) teoria(s) convocadas; surge, então, em consequência, a oportunidade das reflexões e prospecções, para um novo tempo e num contexto outro, sempre orientadas para uma acção/avaliação que leve ao aprimoramento das aprendizagens.

AUTOEVALUACIÓN CON MIRAS A LA ACREDITACIÓN DE LA CARRERA DE BIBLIOTECOLOGÍA Y DOCUMENTACIÓN

En el presente documento se describe la forma en la cual se desarrolló el proceso de autoevaluación con miras a la acreditación de la Carrera de Bibliotecología y Documentación entre 1999-2004, teniendo como base el "Manual de Acreditación" del Sistema Nacional de Acreditación, SINAES. Los criterios que se tomaron en cuenta están relacionados con: Personal académico, Curriculum, Estudiantes, Administración, Infraestructura y Equipo e Impacto y Pertinencia. Se busca con este proceso garantizar calidad a los estudiantes, graduados, empleadores y a la sociedad nacional e internacional.

PM Motors for High Efficiency Applications

PM motors are suitable for nearly all applications, like pumps, elevators, compressors, blowers, extruders, generators, electric vehicles, servodrives, cooling towers, household appliances, etc. This paper will present some applications where the use of PM motors allowed for enhancements in energy efficiency and process quality.

Happiness and victimization in Latin America

In recent decades, studies on economics have identified happiness as a life quality indicator that not only accounts for individuals’ socioeconomic improvement but also accounts for their interactions with institutions and public goods, such as personal safety and protection of life. This study examines the determinants of individual happiness of Latin American citizens by focusing on whether the individual had been a victim of a crime in the last twelve months. To do this, a generalized ordered logit with partial constraints is used to analyze data obtained from the Americas Barometer Survey of 2014. The individual self- reported level of life satisfaction is used to study its relationship with having been a victim of a crime during the previous year. The results suggest the existence of a negative relationship between having been a victim of a crime in the past twelve months and being very satisfied with life.

‘Failure to maintain’: care rationing and the clinical and financial burden of nurse sensitive hospital-acquired complications in complex older patients

Background: The ageing population, with concomitant increase in chronic conditions, is increasing the presence of older people with complex needs in hospital. People with dementia are one of these complex populations and are particularly vulnerable to complications in hospital. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications through their skilled brokerage between patient needs and hospital functions. A range of patient outcome measures that are sensitive to nursing care has been tested in nursing work environments across the world. However, none of these measures have focused on hospitalised older patients. Method: This thesis explores nursing-sensitive complications for older patients with and without dementia using an internationally recognised, risk-adjusted patient outcome approach. Specifically explored are: the differences between rates of complications; the costs of complications; and cost comparisons of patient complexity. A retrospective cohort study of an Australian state’s 2006–07 public hospital discharge data was utilised to identify patient episodes for people over age 50 (N=222,440) where dementia was identified as a primary or secondary diagnosis (N=44,422). Extra costs for patient episodes were estimated based on length of stay (LOS) above the average for each patient’s Diagnosis Related Group (DRG) (N=157,178) and were modelled using linear regression analysis to establish the strongest patient complexity predictors of cost. Results: Hospitalised patients with a primary or secondary diagnosis of dementia had higher rates of complications than did their same-age peers. The highest rates and relative risk for people with dementia were found in four key complications: urinary tract infections; pressure injuries; pneumonia, and delirium. While 21.9% of dementia patients (9,751/44,488, p<0.0001) suffered a complication, only 8.8% of non-dementia patients did so (33,501/381,788, p<0.0001), giving dementia patients a 2.5 relative risk of acquiring a complication (p<0.0001). These four key complications in patients over 50 both with and without dementia were associated with an eightfold increase in length of stay (813%, or 3.6 days/0.4 days) and double the increased estimated mean episode cost (199%, or A$16,403/ A$8,240). These four complications were associated with 24.7% of the estimated cost of additional days spent in hospital in 2006–07 in NSW (A$226million/A$914million). Dementia patients accounted for 22.0% of these costs (A$49million/A$226million) even though they were only 10.4% of the population (44,488/426,276 episodes). Hospital-acquired complications, particularly for people with a comorbidity of dementia, cost more than other kinds of inpatient complexity but admission severity was a better predictor of excess cost. Discussion: Four key complications occur more often in older patients with dementia and the high rate of these complications makes them expensive. These complications are potentially preventable. However, the care that can prevent them (such as mobility, hydration, nutrition and communication) is known to be rationed or left unfinished by nurses. Older hospitalised people who have complex needs, such as those with dementia, are more likely to experience care rationing as their care tends to take longer, be less predictable and less curative in nature. This thesis offers the theoretical proposition that evidence-based nursing practices are rationed for complex older patients and that this rationed care contributes to functional and cognitive decline during hospitalisation. This, in turn, contributes to the high rates of complications observed. Thus four key complications can be seen as a ‘Failure to Maintain’ complex older people in hospital. ‘Failure to Maintain’ is the inadequate delivery of essential functional and cognitive care for a complex older person in hospital resulting in a complication, and is recommended as a useful indicator for hospital quality. Conclusions: When examining extra length of stay in hospital, complications and comorbid dementia are costly. Complications are potentially preventable, and dementia care in hospitals can be improved. Hospitals and governments looking to decrease costs can engage in risk-reduction strategies for common nurse sensitive complications such as healthy nursing work environments that minimise nurses’ rationing of functional and cognitive care. The conceptualisation of complex older patients as ‘business as usual’ rather than a ‘burden’ is likely necessary for sustainable health care services of the future. The use of the ‘Failure to Maintain’ indicators at institution and state levels may aid in embedding this approach for complex older patients into health organisations. Ongoing investigation is warranted into the relationships between the largest health services expense (hospitals), the largest hospital population (complex older patients), and the largest hospital expense (nurses). The ‘Failure to Maintain’ quality indicator makes a useful and substantive contribution to further clinical, administrative and research developments.

Effect of different feed-rate in bone drilling: experimental and numerical study

The behaviour of bone tissue during drilling has been subject of recent studies due to its great importance. Because of thermal nature of the bone drilling, high temperatures and thermal mechanical stresses are developed during drilling that affect the process quality. However, there is still a lack information with regard to the distribution of mechanical and thermal stresses during bone drilling. The present paper describes a sequentially coupled thermal-stress analysis to assess the mechanical and thermal stress distribution during bone drilling. A three-dimensional thermo-mechanical model was developed using the ANSYS/LSDYNA finite element code under different drilling conditions. The model incorporates the dynamic characteristics of drilling process, as well as the thermo-mechanical properties of the involved materials. Experimental tests with polyurethane foam materials were also carried out. It was concluded that the use of higher feed-rates lead to a decrease of normal stresses and strains in the foam materials. The experimental and numerical results were compared and showed good agreement. The proposed numerical model could be used to predict the better drilling parameters and minimize the bone injuries.

Effect of different feed-rate in bone drilling: experimental and numerical study

The behaviour of bone tissue during drilling has been subject of recent studies due to its great importance. Because of thermal nature of the bone drilling, high temperatures and thermal mechanical stresses are developed during drilling that affect the process quality. However, there is still a lack information with regard to the distribution of mechanical and thermal stresses during bone drilling.