An Initiative to Improve Performance on a National Transition of Care Measure and to Reduce Readmissions in an Academic Psychiatric Hospital.

Background: Inpatient psychiatry discharge planning through careful transition documentation may reduce adverse patient outcomes and decrease hospital readmissions. In 2017 a national psychiatry reporting program instituted a quality metric called the Transition Record with Specified Elements Received by Discharged Patients (TR-1). At Yale New Haven Psychiatric Hospital, the TR-1 metric had 0% provider compliance when the quality metric was instituted.

Novel Anion Exchange Membrane Based on Poly(Pentafluorostyrene) Substituted with Mercaptotetrazole Pendant Groups and Its Blend with Polybenzimidazole for Vanadium Redox Flow Battery Applications.

In order to evaluate the performance of the anion exchange membranes in a vanadium redox flow battery, a novel anion exchange polymer was synthesized via a three step process. Firstly, 1-(2-dimethylaminoethyl)-5-mercaptotetrazole was grafted onto poly(pentafluorostyrene) by nucleophilic F/S exchange. Secondly, the tertiary amino groups were quaternized by using iodomethane to provide anion exchange sites.

Electrowinning of Iron from Spent Leaching Solutions Using Novel Anion Exchange Membranes.

In the Pyror process, electrowinning (EW) is used to recover acid and iron from spent leaching solutions (SLS), where a porous Terylene membrane acts as a separator between the cathode and anode. In this study, a novel anion exchange membrane (AEM)-based EW process is benchmarked against a process without and with a porous Terylene membrane by comparing the current efficiency, specific energy consumption (SEC), and sulfuric acid generation using an in-house constructed EW flow cell. Using an FAP-PK-130 commercial AEM, it was shown that the AEM-based process was more efficient than the traditional processes.

Performances of Anion-Exchange Blend Membranes on Vanadium Redox Flow Batteries.

Anion exchange blend membranes (AEBMs) were prepared for use in Vanadium Redox Flow Batteries (VRFBs). These AEBMs consisted of 3 polymer components. Firstly, PBI-OO (nonfluorinated PBI) or F6-PBI (partially fluorinated PBI) were used as a matrix polymer.

Density functional theory study with and without COSMO of H SO reactions in an aqueous environment for metal extraction.

In a recent study investigating the suitability of solvent extraction (SX) for the separation of Ta and Nb, it was shown that speciation data would be required to help explain the data obtained. As traditional speciation techniques cannot be readily applied for Ta and Nb, it was decided to determine the suitability of molecular modeling for this purpose. During the SX experiments the aqueous phase consisted of sulfuric acid (H SO ), water, and metal species.

Application of Novel Anion-Exchange Blend Membranes (AEBMs) to Vanadium Redox Flow Batteries.

Both cation-exchange membranes and anion-exchange membranes are used as ion conducting membranes in vanadium redox flow batteries (VRFBs). Anion-exchange membranes (AEMs) are applied in vanadium redox flow batteries due to the high blocking property of vanadium ions via the Donnan exclusion effect. In this study, novel anion-exchange blend membranes (AEBMs) were prepared, characterized, and applied in VRFBs.

Poly(vinylbenzylchloride) Based Anion-Exchange Blend Membranes (AEBMs): Influence of PEG Additive on Conductivity and Stability.

In view of the many possible applications such as fuel cells and electrolysers, recent interest in novel anion exchange membranes (AEMs) has increased significantly. However, their low conductivity and chemical stability limits their current suitability. In this study, the synthesis and characterization of several three- and four-component anion exchange blend membranes (AEBMs) is described, where the compositions have been systematically varied to study the influence of the AEBM's composition on the anion conductivities as well as chemical and thermal stabilities under strongly alkaline conditions.

A dual-channel gas chromatography method for the quantitation of low and high concentrations of NF3 and CF4 to study membrane separation of the two compounds.

A dual-channel gas chromatographic method is described in this paper that can be conveniently used for quantitation of NF3/CF4 mixtures with a thermal conductivity detector (TCD) on one channel for the quantitation of high-concentrations, and a pulsed discharge helium ionization detector (PDHID) on a second channel for the quantitation of low concentrations. It is shown that adequate separation is achieved on both channels with this dual single-column setup in which column switching as used for NF3/CF4 analysis in industrial chromatographic methods are not required, thus yielding an effective analysis method for laboratory-scale investigations. In addition, the use of packed columns with purified divinylbenzene-styrene co-polymers as the sole stationary phase yields satisfactory resolution between NF3 and CF4 at isothermal conditions of 30°C, with elution times of less than 8min on the TCD channel and less than 4min on the PDHID channel.

A consistent and accurate ab initio parametrization of density functional dispersion correction (DFT-D) for the 94 elements H-Pu.

The method of dispersion correction as an add-on to standard Kohn-Sham density functional theory (DFT-D) has been refined regarding higher accuracy, broader range of applicability, and less empiricism. The main new ingredients are atom-pairwise specific dispersion coefficients and cutoff radii that are both computed from first principles. The coefficients for new eighth-order dispersion terms are computed using established recursion relations.

[Process optimization in ENT: clinical pathways and central induction area].

Introduction: Owing to the rising costs in the health care system, it is now important to optimize processes through standardization and process consolidation. A lack of process consolidation in this area of operation or overly long durations of stay of patients in the hospital can lead to increased costs for the ENT department. The aim of this study was to examine whether process optimization could be achieved through close interdisciplinary networking with clinical pathways and central induction (CI).

[Time delay in beginning first OR positions in the morning].

Delayed starts of operation room (OR) processes in the morning lead to suboptimal use of expensive OR personnel and resources. Therefore, the anaesthesiologist has to take care that anaesthesia preparation and induction are finished in time and the patients are ready for the surgical intervention according to the OR time schedule. However, if the anaesthesiologist starts too early, preincision waiting periods occur.

Reduction of restraint and seclusion through collaborative problem solving: a five-year prospective inpatient study.

Objective: This study examined usage patterns of restraint and seclusion before and after the implementation of collaborative problem solving (CPS), a manualized therapeutic program for working with aggressive children and adolescents.

Methods: The clinical setting was a 15-bed psychiatric inpatient unit for school-age children. A total of 755 children were hospitalized for a total of 998 admissions from fiscal years 2003 to 2007 (median age=11 years; 64% boys).

[Central induction area. Reduction of non-operative time without additional costs].

Background: Induction areas (IA) can lead to more efficient operating sessions through shortening the changeover time between patients. To date IAs have always required additional staff members, whose cost was only partly covered by improvements in productivity. The objective of this project was to demonstrate that a reduction in non-operative time through a newly introduced induction area can be achieved without a need for extra personnel.

[Implementation of standard operating procedures for the initial empirical antimicrobial therapy for adults--a new computer program at the University Hospital Charité].

Nowadays 40-50 % of the patients receive inappropriate antibiotic treatment. Evidence based recommendations are not considered and there is an increasing burden of resistant pathogens. Therefore, standard operating procedures (SOPs) should be implemented considering guidelines and resistant species in the specific ICU.

Pilot study on the effects of high cutoff hemofiltration on the need for norepinephrine in septic patients with acute renal failure.

Objective: High cutoff hemofilters are characterized by an increased effective pore size designed to facilitate the elimination of inflammatory mediators in sepsis. Clinical data on this new renal replacement modality are lacking.

Design: Prospective, randomized clinical trial.

Regional citrate anticoagulation in continuous hemodialysis--acid-base and electrolyte balance at an increased dose of dialysis.

Background: Citrate anticoagulation is an excellent alternative to heparin anticoagulation for patients at high risk of bleeding requiring continuous renal replacement therapy. However, citrate anticoagulation has some potential adverse effects such as metabolic alkalosis and acidosis, hypernatremia, hypo- and hypercalcemia. Thus, most citrate anticoagulation protocols use specially designed dialysis fluids to compensate for most of these disarrangements.

Calcium alginate entrapment of the yeast Rhodosporidium toruloides for the kinetic resolution of 1,2-epoxyoctane.

Resting cells of the yeast Rhodosporidium toruloides (UOFS Y-0471) were immobilised in calcium alginate beads for the enantioselective kinetic resolution of racemic-1,2-epoxyoctane. The initial activity exhibited by immobilised cells was almost 50% lower than that of the free counterpart but was extremely stable when compared to the free cells. The concentration of the immobilised biomass had no effect on apparent enzyme activity but did lead to a decrease in single cell activity.

Biocatalysis of nitro substituted styrene oxides by non-conventional yeasts.

Yeast strains (410) from more than 45 different genera were screened for the enantioselective hydrolysis of nitro substituted styrene oxides. These strains included 262 yeasts with known epoxides hydrolase activity for various other epoxides. Epoxide hydrolase activity for p-nitrostyrene oxide (pNSO) (177 strains) and m-nitrostyrene oxide (mNSO) (148 strains) was widespread in the yeasts, while activity for o-nitrostyrene oxide (oNSO) was less ubiquitous (22 strains).

Inhibition of clastogenicity of benzo[a]pyrene and of its trans-7,8-dihydrodiol in mice in vivo by fruits, vegetables, and flavonoids.

In the in vivo mouse bone marrow micronucleus assay, homogenates of spinach, artichoke, peaches, and blue grapes as well as commercial concentrates of these vegetables and fruits reduced induction of micronuclei by benzo[a]pyrene (BaP) by 43-50%. Concentrates of strawberries (31% reduction) and of cauliflower (20% reduction) were less potent. Inhibition of genotoxicity by spinach and peaches was not caused by any delay in maturation of micronucleated erythrocytes as shown by experiments with sampling times of 24, 48, and 72 h after dosing of BaP.

The influence of beta-cyclodextrin on the solubility of chlorthalidone and its enantiomers.

The solubility of chlorthalidone in 16 solvent systems was determined in the absence and presence of different amounts of beta-cyclodextrin (beta-CD). Chlorthalidone (CT) was shown to be more soluble in hydrophilic organic solvents, with the highest solubility in ethylacetate (EtOAc) saturated with water. The solubility of CT in water, butanol, octanol, and dichloromethane (DCM) was enhanced by the addition of beta-cyclodextrin.

[High malignant B-cell non-Hodgkin lymphoma of the heart: intravital diagnosis by transesophageal echocardiography controlled biopsy].

We report about a 66-year old patient with Non-Q-wave infarction in coronary artery two-vessel disease. During an echo- and transesophageal multiplane echocardiography preoperatively before a coronary artery bypass surgery a right atrium septal tumor of unknown form was discovered. The computerized axial tomography (CAT) and nuclear magnetic resonance (NMR) scans did not demonstrate extracardiac pathologic findings.

[Combined lytic and heart surgical therapy of in open foramen ovale incarcerated giant thrombus with pulmonary and cerebral embolization].

A case of phlebothrombosis with recurrent pulmonary and cerebral embolism is presented which occurred in a 42 year old patient two weeks after treatment of a traumatic crural fracture despite of prophylaxis with low molecular heparin. By means of transthoracic echocardiography a large intracardiac thrombus was detected, entrapped in an patent foramen ovale (PFO) and prolapsing through both atrioventricular valves into both ventricles. This was found after systemic thrombolysis with rtPA had been performed because of fulminant pulmonary embolism.

[Form fruste of long QT syndrome].

The long QT syndrome (LQTS) is an inherited disorder associated with recurrent syncope and sudden death from ventricular arrhythmias. It is characterized by a prolonged QT interval on the ECG. A case is discussed in which a patient presented with recurrent syncopal episodes on exertion associated with a slightly prolonged QT interval.

[Prevention of thrombosis in surgery: low molecular weight heparin/standard heparin].

In a randomized study the efficiency of the low molecular weight heparin (LMWH) Fragmin and unfractionated heparin Calciparin in preventing thromboembolic disease was examined. Ninety patients undergoing a herniotomy participated in the study. The LMWH also showed good efficiency in a laboratory test of anti-factor Xa-activity.

[Comments on the induction of anesthesia in arthroscopy of the knee joint].

Anaesthesia was applied to 1,036 patients for diagnostic or therapeutic knee-joint arthroscopy, between 1983 and 1985. Different indications for general and regional anaesthesia, setbacks of spinal anaesthesia, and advantages likely to result from combined use of peridural anaesthesia and peridural analgesia are discussed in some detail.