Recycling of waste glass as aggregate in cement-based materials.

Glass is a common material made from natural resources such as sand. Although much of the waste glass is recycled to make new glass products, a large proportion is still being sent to landfill. Glass is a useful resource that is non-biodegradable, occupying valuable landfill space. To combat the waste glass that is heading to landfill, alternative recycling forms need to be investigated. The construction industry is one of the largest CO2 emitters in the world, producing up to 8% of the global CO2 to produce cement. The use of sand largely depletes natural resources for the creation of mortars or concretes. This review explores the possibilities of incorporating waste glass into cement-based materials. It was found waste glass is unsuitable as a raw material replacement to produce clinker and as a coarse aggregate, due to a liquid state being produced in the kiln and the smooth surface area, respectively. Promising results were found when incorporating fine particles of glass in cement-based materials due to the favourable pozzolanic reaction which benefits the mechanical properties. It was found that 20% of cement can be replaced with waste glass of 20 µm without detrimental effects on the mechanical properties. Replacements higher than 30% can cause negative impacts as insufficient amounts of CaCO3 remain to react with the silica from the glass, known as the dilution effect. As the fine aggregate replacement for waste glass increases over 20%, the mechanical properties decrease proportionally; however, up to 20% has similar results to traditionally mixes.

Simultaneous quantification of loxapine, loxapine N-oxide, amoxapine, 8-hydroxyloxapine and 7-hydroxyloxapine in human plasma using LC-MS/MS.

Loxapine is an antipsychotic medication used for the treatment of schizophrenia. In vivo, loxapine is metabolized to multiple metabolites. A high performance liquid chromatographic-tandem mass spectrometry (LC-MS/MS) method has been developed and validated for the determination of loxapine and 4 of its metabolites, loxapine N-oxide, amoxapine (N-desmethyl loxapine), 8-hydroxyloxapine and 7-hydroxyloxapine, in human plasma to support regulated clinical development. During method development, several technical challenges such as poor chromatography, separation of structural isomers, and inadequate sensitivity were met and overcome. The final method utilized micro-elution solid phase extraction (SPE) to extract plasma samples (100µL), and the resulting extracts were analyzed using reversed phase LC-MS/MS using a turbo-ionspray interface in positive ionization mode with selected reaction monitoring (SRM). The method was fully validated according to the current regulatory guidance for bioanalysis over the calibration curve range 0.0500-50.0ng/mL for all analytes using 1/x2-weighted linear regression analysis. Based on three separate runs, the between-run precision and inter-day precision for all five analytes at all concentrations, including the LLOQ (lower limit of quantitation) quality control at 0.0500ng/mL, varied from 0.0% to 13.8%, while the accuracy ranged from 86.4% to 109.3% of nominal. The extraction recoveries of loxapine and the four metabolites were above 80%. Various forms of short-term and long-term stability were established in both solutions and matrix, including the stability of loxapine and the four metabolites in human plasma for up to 260days of storage at -20°C. This method has been used to support a regulated clinical study, which included the successful execution of incurred sample reanalysis (ISR) testing. To the best of our knowledge, this is the first published methodology in which these five analytes were quantified with a single extraction and injection.

Improving the availability of intra-operative images created during trauma operations - a multidisciplinary team collaboration.

Intraoperative x rays are regularly taken on multiple occasions during orthopaedic surgery, especially during the course of planned trauma lists where procedures are performed under x ray guidance. These images have an important role in demonstrating the nature of the operation to clinical staff and in permitting an assessment of the standard of surgery by colleagues at planned metalwork reviews. Furthermore, they represent an important medico-legal record of the fracture configuration at the time of completion of surgery. Various technologies are available for the creation, storage, and presentation of such images. In our hospital, relatively unsophisticated technology is employed to physically print such x rays before they are digitally uploaded to an electronic computer system to be stored. This system also allows the images to be viewed. Unfortunately, many opportunities existed within our systems which created opportunities for images to be lost so that they were not made available to clinical staff. We aimed to evaluate and improve this system with the aim of making all x rays taken intraoperatively available to clinical staff in a timely manner. By examining the processes through which images were handled, we were able to adopt strategies to ensure the prompt production of images.

Barriers to implementation of stroke rehabilitation evidence: findings from a multi-site pilot project.

PURPOSE: To describe the barriers to implementation of evidence-based recommendations (EBRs) for stroke rehabilitation experienced by nurses, occupational therapists, physical therapists, physicians and hospital managers. METHODS: The Stroke Canada Optimization of Rehabilitation by Evidence project developed EBRs for arm and leg rehabilitation after stroke. Five Canadian stroke inpatient rehabilitation centers participated in a pilot implementation study. At each site, a clinician was identified as the "local facilitator" to promote the 6-month implementation. A research coordinator observed the process. Focus groups done at completion were analyzed thematically for barriers by two raters. RESULTS: A total of 79 rehabilitation professionals (23 occupational therapists, 17 physical therapists, 23 nurses and 16 directors/managers) participated in 21 focus groups of three to six participants each. The most commonly noted barrier to implementation was lack of time followed by staffing issues, training/education, therapy selection and prioritization, equipment availability and team functioning/communication. There was variation in perceptions of barriers across stakeholders. Nurses noted more training and staffing issues and managers perceived fewer barriers than frontline clinicians. CONCLUSIONS: Rehabilitation guideline developers should prioritize evidence for implementation and employ user-friendly language. Guideline implementation strategies must be extremely time efficient. Organizational approaches may be required to overcome the barriers. [Box: see text].

Disposition of hydrocodone in hair.

The use of prescription drugs, including synthetic opiates, is increasing in the U.S., with emergency room reports showing a dramatic rise in prescription opiate abuse. As part of an ongoing study, the hair of admitted opiate users was analyzed for hydrocodone and hydromorphone, as well as codeine, morphine, and 6-acetylmorphine in order to determine if there was any correlation between self-reported frequency of opiate intake and the concentration of drug detected in hair. The hairs were confirmed using gas chromatography-mass spectrometry following screening by enzyme linked immunosorbent assay (ELISA). Twenty-four hair specimens collected from volunteers showed the presence of hydrocodone (130-15,933 pg/mg); four of those also contained hydromorphone (59-504 pg/mg). The specimens were also analyzed for morphine, codeine, and 6-acetylmorphine. Hair specimens from five self-reported codeine users showed concentrations of hydrocodone between 592 and 15,933 pg/mg. In addition, codeine was present at concentrations of 575-20,543 pg/mg, but neither morphine nor hydromorphone were present in any of those hair specimens. Though the analysis of some opiates in hair has been previously published, this is the first study where the hydrocodone and hydromorphone concentrations have been measured following self-reported opiate intake.

Implicit motor learning deficits in dyslexic adults.

Children with developmental dyslexia fail to develop age-appropriate reading skills despite adequate intelligence and education. It has been suggested that dyslexics' various literacy, sensory and motor difficulties may be related to impaired cerebellar function. As the cerebellum is involved in motor learning, we measured serial reaction time performance in 40 adults (21 controls, 19 dyslexics). Dyslexic subjects performed comparably to controls during the randomly-ordered reaction time blocks, indicating that the dyslexics were as able as controls to make appropriate stimulus-response associations. However, the dyslexics failed to show the reaction time reduction that the control group showed during the repeated sequences (p = 0.018) and there was a significant group by condition effect when comparing the last two blocks of the sequence condition with the first two blocks of the final random condition (p = 0.008). Furthermore, there was a significant difference between good and poor readers on the degree of learning during the task (p = 0.015). This suggests that some dyslexics may suffer from an implicit motor learning deficit, which could generalize to non-motor learning.

Clinicians' perceptions of the problem of antimicrobial resistance in health care facilities.

BACKGROUND: Many clinicians do not comply with guidelines regarding antimicrobial resistance (AR). In response, the Centers for Disease Control and Prevention developed a national Campaign to Prevent Antimicrobial Resistance in Healthcare Settings that presents 4 strategies and 12 evidence-based steps. METHODS: To assess clinicians' perceptions of AR, barriers and facilitators to preventing AR, and how best to reach clinicians, a questionnaire and 4 focus groups were conducted after presentation of the Campaign at 4 Pittsburgh Regional Healthcare Initiative hospitals. RESULTS: One hundred seventeen clinicians completed the questionnaire; 28 participated in the focus groups. Clinicians were significantly more likely to perceive that AR was a problem nationally than in their own institution (95% vs 77%; P<.001) or practice (95% vs 65%; P =.002), consistent with focus group results (93% nationally vs 46% institution or practice). The 3 Campaign steps with the most barriers to implementation were "Treat infection, not colonization" (35%), "Stop treatment when infection is cured or unlikely" (35%), and "Practice antimicrobial control" (33%). Clinicians in the focus groups cited the additional barriers of the health care culture, lack of knowledge, and the nursing shortage; facilitators included education, information technology, and consults. Computer programs, posters, and local data were suggested for reaching clinicians about AR. CONCLUSIONS: Clinicians perceive AR to be a complex national problem but less relevant to their own institution or practice. Providing clinicians with information and steps for preventing AR, as in the Campaign, may affect their perceptions of the problem and motivate them to take actions to ensure patient safety.

Pittsburgh Regional Healthcare Initiative: a systems approach for achieving perfect patient care.

The Pittsburgh Regional Healthcare Initiative (PRHI) is an innovative model for health system change based on regionwide shared learning. By linking patient outcomes data with processes of care and sharing that information widely, PRHI supports measurable improvements in regionwide clinical practice and patient safety. In addition, through the redesign of problem solving at the front lines of care, PRHI helps health care organizations to evolve toward becoming sustainable systems of perfect patient care. This paper describes PRHI's design for change, reviews the progress and limitations of the shared learning model, and offers a set of broader policy considerations.

A region addresses patient safety.

The Pittsburgh Regional Healthcare Initiative (PRHI) is a coalition of 35 hospitals, 4 major insurers, more than 30 major and small-business health care purchasers, dozens of corporate and civic leaders, organized labor, and partnerships with state and federal government all working together to deliver perfect patient care throughout Southwestern Pennsylvania. PRHI believes that in pursuing perfection, many of the challenges facing today's health care delivery system (eg, waste and error in the delivery of care, rising costs, frustration and shortage among clinicians and workers, financial distress, overcapacity, and lack of access to care) will be addressed. PRHI has identified patient safety (nosocomial infections and medication errors) and 5 clinical areas (obstetrics, orthopedic surgery, cardiac surgery, depression, and diabetes) as ideal starting points. In each of these areas of work, PRHI partners have assembled multifacility/multidisciplinary groups charged with defining perfection, establishing region-wide reporting systems, and devising and implementing recommended improvement strategies and interventions. Many design and conceptual elements of the PRHI strategy are adapted from the Toyota Production System and its Pittsburgh derivative, the Alcoa Business System. PRHI is in the proof-of-concept phase of development.