Mass Spectrometric Determination of Uranium and Thorium in High Radiopurity Polymers Using Ultra Low Background Electroformed Copper Crucibles for Dry Ashing.

A rapid new method for determining the U and Th mass concentrations in high radiopurity plastics is described, consisting of (1) dry ashing the plastic sample and tracers in low mass crucibles made of ultra low background electroformed copper (ULB EF-Cu) foil cut and folded into boats, (2) dissolving both the ash and the boat in acid, (3) performing a column separation to remove copper, and (4) determining the elements of interest by isotope dilution mass spectrometry. This method was demonstrated on both unfluorinated and fluorinated plastics, demonstrating high tracer recoveries and detection limits to pg/g (i.e., parts per trillion) levels or below, corresponding to µBq/kg of material. Samples of biomedical polyester (Max-Prene 955) and a fluoropolymer (polyvinylidene fluoride, PVDF) were analyzed in powder raw material forms as well as solids in the form of pellets or injection molded parts. The polyester powder contained 6 pg/g and 2 pg/g for 232Th and 238U, respectively. These levels correspond to 25 and 25 µBq/kg radioactivity, respectively. Determinations on samples of PVDF powder were typically below 1 pg/g for 232Th and 2 pg/g for 238U, corresponding to 4 and 25 µBq/kg radioactivity, respectively. The use of low mass ULB EF-Cu boats for dry ashing successfully overcame the problem of crucible-generated contaminants in the analysis; absolute detection limits, calculated as 3 × standard deviation of the process blanks, were typically 20-100 fg within a sample set. Complete dissolution of the ash and low mass boat provided high tracer recoveries and provides a convincing method to recover both the tracer and sample isotopes when full equilibration of tracer isotopes with sample isotopes is not possible prior to beginning chemical sample processing on solids.

Improving recording accuracy, transparency, and performance for obstetric quality measures in a community hospital-based obstetrics department.

BACKGROUND: The obstetric arena has been typically ignored in the race to determine hospital quality measures due primarily to the fact that a large majority of patients do not have Medicare federal insurance, which has been the focus of hospital measures of quality. With "normal vaginal delivery" being the number one hospital discharge diagnosis and cesarean sections rates varying greatly between hospitals, national organizations are taking greater interest in determining differences in quality. METHODS: Sutter Medical Center, Sacramento (California) chartered a multidisciplinary Perinatal Data Committee to improve and simplify data capture for six obstetric quality measures. RESULTS: All six quality measures showed significantly improved trends from 2010 through 2012, with elective delivery < 39 weeks decreasing (15.3% to 2.3%, p < .001), nulliparous term singleton vertex cesarean (NTSV) delivery rate decreasing (31.3% to 24.7%, p < .001), episiotomy rates decreasing (4.7% to 2.3%, p < .001), antenatal steroid documentation increasing (80.0% to 100%, p <.01), exclusive breastfeeding at hospital discharge increasing (57.9% to 69.9%, p <.001), and deep vein prophylaxis at cesarean increasing (95.4% to 98.2%,p < .001). CONCLUSION: That performance on all six quality measures improved suggests that the improvement approach was effective and perhaps reproducible in other clinical situations to improve hospital quality outcomes. A key contributor to success was that the dashboard of results was shared with the department's physicians and the hospital administration on a monthly basis. Reinforcement of good results helped keep the project front and center with the hospital, particularly more recently, given that data reporting for four of the six measures is soon to be required.

Radiological HEPA Filter 10-year Lifetime Evaluation in Research Facilities.

ABSTRACT: High-efficiency particulate air (HEPA) filters are widely employed by nuclear facilities to remove radiological particulate matter from their effluent exhaust streams. The purpose of this study is to evaluate the relationships between the 10-y HEPA filter lifetime deployment and its other performance indicators. This 10-y-long endeavor to collect and analyze data regarding the service life of HEPA filters at the Pacific Northwest National Laboratory began in 2010. A set of HEPA filters was selected, and the filters have been surveyed and analyzed at least annually to verify compliance with permit conditions. The study suggests the frequency of filter replacement should be based on the actual operational requirements, such as fume hood face velocity and/or efficiency test results, instead of on the prescribed filter "age limit" of 10 y from the date of manufacture (e.g., birth date) when operating under dry conditions. The study has now been completed, and over the past decade, all the HEPA filters have been replaced due to either technical issues as listed in this report or the previously recommended filter "age limit" of 10 y as prescribed by the oversight bodies. Experimentally determined failure rates are also determined from the data set and can be used to estimate the chances of HEPA filters surviving 15, 20, or even 30 y.

Is there a useful cesarean birth measure? Assessment of the nulliparous term singleton vertex cesarean birth rate as a tool for obstetric quality improvement.

OBJECTIVE: This study was undertaken to assess the utility of the nulliparous term singleton vertex cesarean birth (NTSV CB) measure as a quality improvement tool for use at the hospital level. STUDY DESIGN: We prospectively collected data on all NTSV births in Sutter Health's 20 birthing units over a 3-year period, 2001 through 2003, totaling 41,416 births. Hospital rates of NTSV CB, obstetric practices, and infant outcomes were calculated and compared by using weighted logistic analyses. In addition, we examined the effect of maternal age on the NTSV CB measure by using direct standardization with US norms for nulliparous women. RESULTS: There was large variation noted in the NTSV CB rate among the 20 hospitals, with unadjusted rates ranging from 10.5% to 30.2%. Strong correlations were found between CB rates and labor induction rates (r = 0.57, P < .0001) and with early labor admission rates (r = 0.62, P < .0001). The strongest correlation was found between NTSV CB rates and a combined measure of induction and early labor admission (r = 0.73, P < .0001). Rates of term 5-minute Apgar score below 7 were not correlated with the NTSV CB rate. Hospital nulliparous maternal age distribution varied markedly and direct standardization led to significant changes in the NTSV CB rate. CONCLUSION: NTSV CB rate is strongly influenced by elective obstetric practices. The addition of an easily performed maternal age adjustment makes it the most promising CB quality measure for use at the hospital level.

The rationale for sitting elderly patients in hospital out of bed for long periods is medically unsubstantiated and detrimental to their recovery.

The notorious statement by Asher about the dangers of bed rest [Brit Med J 1947; ii: 967-8] which continues to be quoted out of context in leading medical journals today is inapplicable to modern short stay elderly hospital patients and has little medical foundation. 'Blood clotting in the veins' is more likely to result from venous stasis during sitting than from lying down. 'Lime draining from the bones' refers to subjects' spending weeks, not hours, in the horizontal position and similar losses have been shown to occur in healthy people immobilised in chairs for long periods during the day. Constipation is common in sick old people and there is no evidence that 'scybala stacking up the colon' is more likely to occur in bed than in a chair. The 'flesh rotting from the seat', or pressure sores, occur as frequently or more frequently, in sick patients nursed in chairs as in bed. 'Urine leaking from the distended bladder' may be reduced in very debilitated old people sitting in chairs, but at the expense of impaired renal function associated with reduced perfusion in the upright posture and exacerbated incontinence due to a compensatory diuresis at night. The 'spirit evaporating from the soul' today is more likely to afflict old patients who are exhausted by prolonged chair nursing and orthostatic hypotension due to age or illness. Recent studies in intensive care patients have highlighted the hypotension due to vasodilatation which can occur in infection and trauma. There is no evidence that nosocomial pneumonia is reduced by sitting patients out of bed, and lack of sleep is likely to exacerbate infection and delay recovery. Preventing patients from lying down when they feel the need is a violation of their rights and has been shown to be probably as injurious as the Victorian practice of preventing healthy patients from getting up. Physiotherapy is obviously important but patients should be allowed to decide for themselves how long they spend in or out of bed.

Letters.

COMMUNITY GUIDELINES ON PRESSURE AREA CARE NECROTISING FASCIITIS INTERNET SOURCES MEPITEL: A 'STICKY' SUBJECT.

Medical pathology in patients with leg ulcers: a study carried out in a leg ulcer clinic in a day hospital for the elderly.

This study was undertaken to see if the multiple pathology previously found in elderly patients with leg ulcers (other than the ulcer) differed in older and younger patients. A retrospective survey of the case notes of 42 consecutive patients (19 males, 23 females) admitted to a medically staffed leg ulcer clinic based in a geriatric day hospital was carried out. Twenty one patients were aged < or = 74 years (including seven aged < or = 59 years) and 21 aged > or = 75 years. Medical conditions known on referral and illnesses diagnosed during attendance were identified. The high incidence of disease in both age groups was identical, with 57% of patients with four or more diagnoses. No patient had no medical illness in addition to their ulcer. The commonest was cardiovascular disease followed by arthritis, obesity and endocrine disease. Nineteen per cent of all diagnoses were made at the clinic. Medical treatment, including drug reviews, in addition to compression bandaging and other local treatment, was found to be helpful for healing the ulcer. Medical input to leg ulcer clinics is therefore important.

Social and economic benefits of flexible intramedullary nails in the treatment of pediatric femoral shaft fractures.

All patients between the ages of 5 and 15 years with isolated femoral shaft fractures treated at our institution with flexible intramedullary nails between 1996 and 1998 were examined and compared to an age-matched group of patients treated with spica casting. All fractures healed well with no significant complications. Patients treated with flexible intramedullary nails achieved earlier independent ambulation, at an average of 19 days, compared to 106 in the control group (P<.0001). They also attained earlier independent bathroom use (21 versus 79 days, P<.0001). Hospital stays were significantly shorter as well (6 versus 29 days, P<.0001). These patients also returned to school earlier, at 28 days postinjury, compared to 120 days for patients in spica casts (P<.0001). The use of flexible intramedullaty nails allowed patients and their families to achieve independence months earlier than the spica cast patients. Earlier return to school, independent ambulation, and independent bathroom use are advantages of this treatment modality.