Poor Cleaning Research Articles

Modeling and Analysis of Drillstring Vibration in Riserless Environment

Riserless drilling poses numerous operational challenges that adversely affect the efficiency of the drilling process. These challenges include increased torque and drag, buckling, increased vibration, poor hole cleaning, tubular failures, poor cement jobs, and associated problems during tripping operations. These challenges are closely associated with complex bottomhole assemblies (BHAs) and the vibration of the drillstring when the topholes are drilled directionally. Current methods lack proper modeling to predict drillstring vibration. This paper presents and validates a modified model to predict severe damaging vibrations, analysis techniques, and guidelines to avoid the vibration damage to BHAs and their associated downhole tools in the riserless highly deviated wells. The dynamic analysis model is based on forced frequency response (FFR) to solve for resonant frequencies. In addition, a mathematical formulation includes viscous, axial, torsional, and structural damping mechanisms. With careful consideration of input parameters and judicious analysis of the results, the author demonstrates that drillstring vibration can be avoided by determining the 3D vibrational response at selected excitations that are likely to cause them. The analysis also provides an estimate of relative bending stresses, shear forces, and lateral displacements for the assembly used. Based on the study, severe vibrations causing potentially damaging operating conditions were avoided, which posed a major problem in the nearby wells. The study indicates that the results are influenced by various parameters, including depth of the mud line, offset of the wellhead from the rig center, wellbore inclination, curvature, wellbore torsion, and angle of entry into the wellhead. This study compares simulated predictions with actual well data and describes the applicability of the model. Simple guidelines are provided to estimate the operating range of the drilling parameter to mitigate and avoid downhole tool failures.

Cleaning and decontamination efficacy of wiping cloths and silver dihydrogen citrate on food contact surfaces

To test the efficacy of four wipe cloth types (cotton bar towel, nonwoven, microfibre and blended cellulose/cotton) with either quaternary ammonia cleaning solution or silver dihydrogen citrate (SDC) in cleaning food contact surfaces. Swab samples collected from untreated, cloth-treated and cloth disinfectant-treated surfaces were subjected to hygiene monitoring using adenosine triphosphate (ATP) bioluminescence and aerobic total plate counting (TPC) assays. Adenosine triphosphate measurements taken after wiping the surfaces showed poor cleaning by nonwoven cloths (2·89 RLU 100 cm(-2) ) than the microfibre (2·30 RLU 100 cm(-2) ), cotton terry bar (2·26 RLU 100 cm(-2) ) and blended cellulose/cotton cloth types (2·20 RLU 100 cm(-2) ). The cellulose/cotton cloth showed highest log reduction in ATP-B RLU values (95%) and CFU values (98·03%) when used in combination with SDC disinfectant. Cleaning effect of wiping cloths on food contact surfaces can be enhanced by dipping them in SDC disinfectant. ATP-B measurements can be used for real-time hygiene monitoring in public sector, and testing microbial contamination provides more reliable measure of cleanliness. Contaminated food contact surfaces need regular hygiene monitoring. This study could help to estimate and establish contamination thresholds for surfaces at public sector facilities and to base the effectiveness of cleaning methods.

More-Effective Plug-and-Abandonment Cementing Technique

This article, written by Senior Technology Editor Dennis Denney, contains highlights of paper SPE 148640, ’Novel Approach to More-Effective Plug-and-Abandonment Cementing Techniques,’ by Thomas E. Ferg, Hans-Jacob Lund, and Dan Mueller, ConocoPhillips; Morten Myhre, Arne Larsen, and Patrick Andersen, SPE, HydraWell Intervention; Gunnar Lende, SPE, Halliburton; Charlie Hudson, SPE, M-I Swaco; and Cato Prestegaard, SPE, and David Field, Halliburton, prepared for the 2011 SPE Arctic and Extreme Environments Conference & Exhibition, Moscow, 18-20 October. The paper has not been peer reviewed. The effectiveness of a permanent abandonment plug is measured by its ability to bridge the wellbore cross section, both vertically and horizontally, including all annuli, with a plugging medium that can withstand the harsh environment to which it is exposed (Fig. 1). A new method is presented that creates a permanent abandonment plug by use of a system that perforates uncemented casing, washes the annular space, and then mechanically places the cement across the wellbore cross section in a single run. Introduction Traditional methods of creating an annulus barrier in uncemented casing require removal of a section of casing by milling, cleaning the created open hole to remove swarf (i.e., metal filings or shavings produced by a cutting tool) and other debris, underreaming the section to expose new formation, and then setting a balanced cement plug. These operations can be time consuming and difficult to execute safely and effectively. Fluids for use in section milling must have sufficient weight to keep the open hole stable and sufficient viscosity to suspend and transport swarf and debris to surface. The required fluid-viscosity profile for milling operations can generate equivalent circulating densities that exceed the fracture gradient of the exposed open hole, leading to losses while circulating, swabbing and well-control problems, poor hole cleaning, and packing off of the bottomhole assembly (BHA). The problems occur because not all swarf and skimmed casing remnants can be cleared from the wellbore. Swarf and casing debris can become strung out along the wellbore, lodging in the annular and ram blowout-preventer equipment, seriously effecting function. At the surface, handling equipment must be positioned and installed within the return flowline beyond the bell nipple and in front of the shakers to separate and capture the generated metal returns from the active mud system. An example of metal brought to surface during milling operations is shown in Fig. 2.

The Haitian Connection in Connie May Fowler’s Sugar Cage

SUZANNE W. JONES University of Richmond The Haitian Connection in Connie May Fowler’s Sugar Cage IN HER FIRST NOVEL, SUGAR CAGE (1992), CONNIE MAY FOWLER, A WHITE Floridian with Cherokee ancestry and an early exposure to Voodoo, employs some of the narrative conventions of magical realism as a way around the impasse of Southern race relations in Florida in the 1960s. Her otherwise modernist narrative technique of nine first-person narrators emphasizes the isolation of her characters at the same time that the variety of viewpoints encourages readers to see both the interracial and international connections that elude or confuse her characters. The culturalandtransnationalcomplexitiessheexplores,especiallyasregards the importation of African and Haitian belief systems and Florida’s reliance on Haitian migrant workers, make magical realism an interesting, if perhaps contested, connective tissue between black and white worlds in Florida.1 In exploring the historical circumstances that produced South American magical realism, circumstances similar to those in the US South, Antonio Benítez-Rojo argues that Caribbean revolutionary discourses, which reacted to slavery, colonialism, and the plantation economy, inform the genre. He believes that such discourses when “passing into the genres of literature” attempt “to decenter the 1 Differing views, such as those by Arnold Krupat and Richard Fleck, about whether the term “magical realism” should be applied to Native American fiction are pertinent to Fowler’s depiction of Voodoo rituals in Sugar Cage. At the root of the debate is a question about whether the term “magical realism” devalues what westerners would identify as “magic” in such texts, thereby denying what constitutes a nonwestern reality (and so making realism a more accurate descriptor for such fiction) or whether magical realism functions as Lois Zamora and Wendy Faris argue, “as a cultural corrective, requiring readers to scrutinize accepted realistic conventions of causality, materiality, motivation” (3). Lee Schweninger presents a helpful overview of the debate in “Myth Launching and Moon Landings.” He focuses on whether the alternative “realities” in Native American fiction should be seen as parallel (and so in keeping with the conventions of realism), braided, or fused. Applying these categories to Fowler’s Sugar Cage, the answer seems to vary: her presentation of Voodoo rituals suggests a parallel coexisting reality, the clairvoyance of Inez and Soleil Marie hints at braided natural and supernatural aspects of reality, while the fantastic ending of the novel represents a fused reality employed as a “cultural corrective.” 84 Suzanne W. Jones violence of their origins with their own excess, looking for legitimation in their own illegitimacy” (212-13). In a large cast of characters, Fowler’s most compelling focus is on a young interracial couple and an old African American cleaning woman, but the novel’s many subplots manifest a palpable desire to reach a sphere of “effective equality” which Benítez-Rojo attributes to creole cultures, “where the racial, social, and cultural differences that conquest, colonization, and slavery created would coexist without violence” (52). This is just the place that several of Fowler’s characters reach by the conclusion of Sugar Cage, crossing color lines, belief systems, and national boundaries to make personal connections, although hardly to effect institutional changes. Set in the seedy central Florida town of Tiama, “Prison Capital of the World,” the novel begins in 1945, spans more than two decades, and examines the race relations of two generations of Southerners. By including a migrant worker of mixed Haitian and Seminole Indian ancestry in her story of Southern race relations, Fowler complicates the received biracial history of the South and presents the interracial romance between Soleil Marie BeauvoirandEmoryLooneyasamodelforinterpersonaltransformation. At the same time, she shows how agribusiness has produced a neo-plantation system that exploits migrant workers of color and lingers to the present day. At one time or another all nine narrators of Sugar Cage are imprisoned within their own narrow perspectives, and their individual stories are about moving beyond these “cages.” Fowler creates two exceptions, characters who because of their prescience and supernatural powers take the novel into the realm of magical realism: Soleil Marie Beauvoir, a racially mixed Haitian-Seminole cane field worker, and Inez Temple, a poor African American cleaning woman. Voodoo provides a spiritual and cultural link...

Nano-Enhanced Drilling Fluids: Pioneering Approach to Overcome Uncompromising Drilling Problems

The idea of pushing the limits of drilling oil and gas wells by improving drilling fluids for undemanding and cost efficient drilling operations by extracting advantage from the wonders of nanotechnology forms the basis of the work presented here. Foremost, in order to highlight the significance of reducing the size distribution of particles, new clay ATR which has a chain like structure and offers enormous surface area and increased reactivity was tested in different sizes that were chemically and mechanically milled. Bentonite which is a commonly used drilling fluid additive was also tested in different particle size distribution (PSD) and rheological properties were tested. Significant reduction in viscosity with small sized particles was recorded. The tested material called ATR throughout this paper is shown to offer better functionality than bentonite without the requirement of other expensive additives. Experiments were performed with different size distributions and compositions and drastic changes in rheological properties are observed. A detailed investigation of the shear thinning behavior was also carried out with ATR samples in order to confirm its functionality for eliminating the problem of mechanical and differential pipe sticking, while retaining suitable viscosity and density for avoidance of problems like lost circulation, poor hole cleaning and inappropriate operating hydrostatic pressures.

Assessment of clients' satisfaction with health service deliveries at jimma university specialized hospital.

Client satisfaction is considered as one of the desired outcomes of health care and it is directly related with utilization of health services. Nonetheless, there is no adequate information on users' perception about the service provided in the hospital after the implementation of Business process re-engineering reform. Hence, the objective of this study was to assess the perceived levels of clients' satisfaction with health services rendered at Jimma University Specialized Hospital. A cross sectional study was conducted from March 1-8, 2010 on a sample of 422 service users of the hospital using systematic random sampling technique. Data was collected using structured questionnaire and analyzed by SPSS for windows version 16.0. Statistical tests were employed where necessary at 0.05 level of significance. The questionnaire was administered to a total of 422 clients , of which, 51.7 % were male, about 33.4% of the respondents were between the age group 25-34, 41.% of the clients were illiterates, 60% were from the rural areas and 57.8 % received the service free of charge. The findings of the study showed that the overall client satisfaction level with the health services rendered at the hospital was 77%. Satisfaction was reported to be highest (82.7%) with the way the doctors examined them and on the other hand dissatisfaction was reported to be highest (46.9%) by respondents with the time spent to see a doctor. Furthermore, satisfaction with the health care was found to have a significant association with the age of the respondents (p=0.034) and educational level of the respondents (p=0.003). This study showed higher clients' satisfaction level in the University Specialized Hospital when compared to previous studies in the same hospital as well as other similar studies in the country. Lack of drugs and supplies, poor information provision, long waiting time, poor cleanliness, lack of privacy and inadequate visiting hours, were found to be the major causes of dissatisfaction. Therefore, the Hospital management should understand these weak service areas and plan for a better service delivery.

Dutch surveys bedpan management (1990 & 2010): progress in correct use of washer disinfectors

In the Netherlands bedpans are regarded as semi-critical items unlike Spauldings scheme (1968), where bedpans are categorized as non-critical items. Washer-disinfectors (WD) were used incorrect for a long time. A survey in 1990 showed poor final cleaning and disinfection results. The Dutch Working Party Infection Prevention made guidelines for WD (1998), and in 2006 the International Organization for Standardization (ISO) introduced the Standard 15883 for WD:Part 3 specifies requirements intended to be used for emptying, flushing, cleaning and thermal disinfection of bedpans. I repeated the survey in the Netherlands in 2010.

Surveys Bedpan Management in the Netherlands (1990 & 2010) Progress in Correct Use of Washer Disinfectors

Bedpans are frequently used items and potential carriers of (MDR) organisms. In the Netherlands bedpans are regarded as semi-critical items unlike Spauldings scheme (1968), where bedpans are categorized as non-critical items. Washer-disinfectors (WD) were used incorrectly for a long time. A Dutch survey in 1990 showed poor final cleaning and disinfection results. The Dutch Working Party Infection Prevention made guidelines for WD in 1998, and in 2006 the International Organization for Standardization (ISO) introduced the Standard 15883 for WD: Parts 1-6. Part 3 specifies requirements intended to be used for emptying, flushing, cleaning and thermal disinfection of bedpans. To get insight in the current status I repeated the survey in 2010.

Environmental factors in drinking venues and alcohol‐related harm: the evidence base for European intervention

Reducing alcohol-related harm in young people is a major priority across Europe. Much alcohol use and associated harm in young people occurs in public drinking environments. This review aims to identity environmental factors in drinking establishements that are associated with increased alcohol consumption and associated harm and to understand the extent of study in this area across Europe. A systematic literature search identified studies that had explored associations between physical, staffing and social factors in drinking environments and increased alcohol use or alcohol-related harm. Fifty-three papers were identified, covering 34 studies implemented in nine countries. Most studies had been implemented in non-European countries and many had collected data more than a decade prior to the review. The majority had used observational research techniques. Throughout the studies, a wide range of physical, staffing and social factors had been associated with higher levels of alcohol use and related harm in drinking environments. Factors that appeared particularly important in contributing to alcohol-related problems included a permissive environment, cheap alcohol availability, poor cleanliness, crowding, loud music, a focus on dancing and poor staff practice. However, findings were not always consistent across studies. Drinking establishments, their management and the behaviours of the young people who use them vary widely across Europe. While international research shows that environmental factors in drinking settings can have an important influence on alcohol-related harm, there is currently a scarcity of knowledge on the relevance and impacts of such factors in modern European settings. Developing this knowledge will support the implementation of strategies to create drinking environments in Europe that are less conducive to risky drinking and alcohol-related harm.

Patient satisfaction regarding eye care services at tertiary hospital of central India

Purpose:To evaluate patients’ satisfaction regarding eye care services and suggest policy changes accordingly.Study Design:Descriptive study.Materials and Methods:This study was conducted between September 2005 and June 2006. Patients attending the eye clinic of Sadguru Netra Chikitsalaya, Chitrakoot, Madhya Pradesh, India, and admitted as in-patients in this hospital were our study population. Randomly selected patients were interviewed by trained staff. Close-ended questionnaire was used to conduct these structured interviews. Their responses were grouped into one of five categories and evaluated to determine satisfaction for different components of eye care services.Results:Three hundred and twenty persons were interviewed. The satisfaction was of excellent grade among 77 (48.1%) patients attending clinic and 156 (97.5%) patients who were admitted in the hospital. The participants expressed dissatisfaction for the long waiting period in clinics, poor cleanliness, and insufficient toilet facilities. Those admitted in the hospital felt that food facilities were less than the expected quality. Child-friendly facilities received high satisfaction scores.Conclusion:Although eye care services both in clinics and in the wards were satisfactory according to the end-users, there are scopes for improvement. Patient satisfaction surveys should be encouraged in hospitals for better accountability and also for strengthening the quality of eye care services.

Efficacy of Bolus Lukewarm Saline and Yoga (Shankh Prakhshalana) as Colonoscopy Preparation-Interim Analysis of Randomized, Endoscopist Blinded Study

Purpose: Bolus lukewarm saline and Yoga (Shankh Prakhshalana) was as efficacious as Halflytely®+Dulcolax® for colonoscopy preparation. We report the interim analysis of this study with an emphasis on efficacy and adverse events. Methods: The protocol was approved by the IRB at WHMC. Patients with salt-sensitivity, arthritis limiting Yoga postures, hypertension, congestive heart failure and renal dysfunction were excluded. Group A (n=55) drank 0.9N lukewarm saline in bolus form (16 oz. in 1-2 minutes or 8 oz. in less than a minute) and performed a defined set of yoga exercises (known as “Shankh prakshalana”) as described on a provided DVD. Group B (n=53) followed Halflytely® with Dulcolax® prep as suggested by the manufacturer. All patients were directed to take only clear liquids after 12 pm the day before colonoscopy. All colonoscopies were performed by a single, blinded endoscopist at a JCAHO certified outpatient GI clinic. Colon prep was assessed on a 4 point grading scale; a score of 1 was given to a poor preparation, 2 to suboptimum preparation, 3 to optimum prep, and 4 to excellent prep. Colon cleansing was scored in six regions - rectum, sigmoid, left colon, transverse colon, right colon, and cecum - for a minimum score of 6 and a maximum of 24. Scores of 1-6 corresponded with poor cleaning, 7-12 with suboptimum, 13-18 with optimum, and 19-24 with excellent. Photographs were taken to substantiate the grading system. Blood was drawn before and after prep to check for electrolyte imbalance. Weight and vitals were also documented. All patients reported the amount of solution drank and evaluated their preps regarding palatability, ease of prep, willingness to repeat prep, side effects. Results: Group A and B total scores did not differ significantly (p<0.13), Mean (SD) 17.73 (5.92) and 19.53 (3.52), respectively). In Group A, 48 of 55 patients (87.27%) had excellent or optimum preparation, compared to 50 of 53 patients (94.34%) in Group B (p<0.25). None of the patients in both groups had any clinically significant electrolyte imbalance. Minor side effects, predominantly nausea and abdominal cramps were reported in 69.1% of patients in group A and 56.6% of patients in group B. A trend towards weight loss (0.57lbs on average) was observed in group A. Conclusion: In this interim analysis, Bolus lukewarm saline and Yoga (Shankh Prakhshalana/Shudh) was no different from Halflytely® + Dulcolax® in the quality of bowel preparation, judged by total colon prep score. In contrary to the previous studies of normal saline colon preps, Bolus lukewarm saline and Yoga colon prep is associated with weight loss rather than weight gain. More precise estimates of efficacy and adverse event rates will be obtained at the final analysis. Disclosure: Vijaypal Arya MD - President, Vikalp Inc. Kalpana A Gupta MD - Vice President, Vikalp Inc.

Hand Contamination of Anesthesia Providers Is an Important Risk Factor for Intraoperative Bacterial Transmission

We have recently shown that intraoperative bacterial transmission to patient IV stopcock sets is associated with increased patient mortality. In this study, we hypothesized that bacterial contamination of anesthesia provider hands before patient contact is a risk factor for direct intraoperative bacterial transmission. Dartmouth-Hitchcock Medical Center is a tertiary care and level 1 trauma center with 400 inpatient beds and 28 operating suites. The first and second operative cases in each of 92 operating rooms were randomly selected for analysis. Eighty-two paired samples were analyzed. Ten pairs of cases were excluded because of broken or missing sampling protocol and lost samples. We identified cases of intraoperative bacterial transmission to the patient IV stopcock set and the anesthesia environment (adjustable pressure-limiting valve and agent dial) in each operating room pair by using a previously validated protocol. We then used biotype analysis to compare these transmitted organisms to those organisms isolated from the hands of anesthesia providers obtained before the start of each case. Provider-origin transmission was defined as potential pathogens isolated in the patient stopcock set or environment that had an identical biotype to the same organism isolated from hands of providers. We also assessed the efficacy of the current intraoperative cleaning protocol by evaluating isolated potential pathogens identified at the start of case 2. Poor intraoperative cleaning was defined as 1 or more potential pathogens found in the anesthesia environment at the start of case 2 that were not there at the beginning of case 1. We collected clinical and epidemiological data on all the cases to identify risk factors for contamination. One hundred sixty-four cases (82 case pairs) were studied. We identified intraoperative bacterial transmission to the IV stopcock set in 11.5 % (19/164) of cases, 47% (9/19) of which were of provider origin. We identified intraoperative bacterial transmission to the anesthesia environment in 89% (146/164) of cases, 12% (17/146) of which were of provider origin. The number of rooms that an attending anesthesiologist supervised simultaneously, the age of the patient, and patient discharge from the operating room to an intensive care unit were independent predictors of bacterial transmission events not directly linked to providers. The contaminated hands of anesthesia providers serve as a significant source of patient environmental and stopcock set contamination in the operating room. Additional sources of intraoperative bacterial transmission, including postoperative environmental cleaning practices, should be further studied.

A New Well-Path Design Using Clothoid Spiral Curvature Bridging for Ultra-Extended-Reach Drilling

Summary Drilling ultra-extended-reach (UERD) wells and extending their reach to greater depths requires both improved models and comprehensive analysis. Wellbore friction is an important factor in drilling ultralong wells, and optimizing the well-path design is an effective means for reducing torque and drag. This paper describes a new well-path design that will enable extending the reach of a well to a greater depth. Usually, well trajectories are designed with constant curvature with well-defined arcs connecting the transition between the tangent sections. Even though the transition between the tangent and build sections or tangent and drop sections appears to be smooth, there will be some discontinuity that will result in high stresses on the tubulars, will increase torque and drag, and will result in poor hole cleaning and other problems. To avoid curvature and geometrical torsion discontinuities between sections, curvature-bridge curves, or transition curves called clothoid spirals, can be used. This paper presents a new mathematical formulation for well-path designs using curvature bridges. Results show that the essential elements in planning a proposed well path are determining the shape and position of the bridged section, the characteristic parameter describing its shape, and its position in the well profile. To provide a quantitative means for measuring the complexity of well-path designs, a coupled analytical criterion based on the minimum energy of the curve is proposed. The proposed approach is a superior method and a more effective tool for describing and comparing the minimum energies used in well-path designs. This paper compares simulated well-path designs created with the new method with actual conventional well-path designs and describes the accuracy and applicability of the new well-path model. The results of this study demonstrate that well-path designs using curvature bridges are superior to the existing well-path designs used for drilling extended-reach-drilling (ERD) and UERD wells.

Evaluation of common cleaning and disinfection programmes in battery cage and on-floor layer houses in France

1. The aim in this study was to evaluate cleaning and disinfection programmes in battery cage and on-floor layer houses in France. 2. Cleaning and disinfection efficiency was assessed by a visual evaluation of cleaning and a bacteriological monitoring of surface contamination from counts of thermotolerant streptococci on contact agar plates. 3. In battery cage houses, dropping belts, manure conveyors, and house floors remained highly contaminated due to poor cleaning in half of the buildings examined. 4. In on-floor houses, a high standard of cleaning was achieved but errors in the planning of cleaning and disinfection operations sometimes led to a high residual contamination of nest boxes and egg sorting tables.

Technology Focus: Drilling Technology (February 2010)

Technology Focus Many discussions have taken place recently about the excessive nonproductive time (NPT) incurred in the drilling industry today and about the use of cutting-edge technology. From these discussions, it is believed that the drilling industry relies much more on cutting-edge technology than optimized-drilling practice to address downhole problems. Indeed, too many failures or dysfunctions still happen and are unexplained, even in supposedly simple wells, because of the lack of knowledge of what is happening downhole. Without having identified and understood the real cause of a given problem, one solution is to use a new technology that may overcome the problem without curing it. For economic reasons, cutting-edge technology often is used in complex and high-cost-environment drilling operations. For example, high-end rotary-steerable systems combined with downhole vibration measurements transmitted at high-speed along wired pipes enable achieving very complex and accurate drilling trajectories in geosteering. However, this accuracy is achieved as a result of the measurements but without necessarily understanding the drilling fundamentals and the physical phenomena involved. This method is a costly trial-and-error procedure. Indeed, in this complex-drilling operation, drillstring mechanics and hydraulics are very complicated, and physical models sometimes fail to predict and reproduce the actual drilling process. The solution to reduce NPT could be to use instrumentation and new technology in allegedly simple or basic wells to: Understand the new-technology function and performance Validate the physical models (mechanics and hydraulics) Improve fundamental drilling practices Even though this high-end technology used in low-cost environments sounds contradictory, it should clarify our understanding of what is happening downhole to improve the overall drilling efficiency. Once fundamental drilling mechanics and processes are completely understood, one can go further in complex-drilling operations with the same technology and validated models. And as the proverb says, “Don’t put the cart before the horse!” Drilling Technology additional reading available at OnePetro: www.onepetro.org SPE 124142 • “Comprehensive Drilling Model Analyzes BHT Parameters” by A.W. Iyoho, SPE, Shell, et al. SPE 123374 • “Statistical Method for Detection of Poor Hole Cleaning and Stuck Pipe” by Thor O. Gulsrud, SINTEF Petroleum Research, et al. SPE 124631 • “Advanced Automatic Control for Dual-Gradient Drilling” by øyvind Breyholtz, International Research Institute of Stavanger, et al. SPE 121752 • “Modeling the Effect of a Downhole Vibrator” by Ken Newman, NOV CTES, et al.

Efficacy of Lukewarm Saline Water and Exercise as Colonoscopy Preparation—A Randomized, Endoscopist Blinded Study

Purpose: Normal Saline (7 litres) has been used in the past for colonoscopy preparation but did not become common because of marked weight gain and salt retention. In our pilot study, 0.9N lukewarm saline water (LWSW) (3 litres) and exercise (EXE) were used as preparation for colonoscopy. Results were very encouraging, and we were inspired to conduct this randomized, endoscopist blinded study. Methods: After IRB approval, 53 patients were randomized into two groups. Patients with salt-sensitivity, hypertension, congestive heart failure and renal dysfunction were excluded. Group A (n=26) drank 0.9N LWSW and performed a defined set of yoga exercises (known as “Shankh prakshalana”) as described on a provided DVD. Group B (n=27) followed Halflytely® with Dulcolax® prep as suggested by the manufacturer. All patients were directed to take only clear liquids after 12 pm the day before colonoscopy. All colonoscopies were performed by a single, blinded endoscopist at a JCAHO certified outpatient GI clinic. Colon prep was assessed on a 4 point grading scale; a score of 1 was given to a poor preparation, 2 to suboptimum preparation, 3 to optimum prep, and 4 to excellent prep. Colon cleansing was scored in six regions-rectum, sigmoid, left colon, transverse colon, right colon, and cecum-for a minimum score of 6 and a maximum of 24. Scores of 1-6 corresponded with poor cleaning, 7-12 with suboptimum, 13-18 with optimum, and 19-24 with excellent. Photographs were taken to substantiate the grading system. Blood was drawn before and after prep to check for electrolyte imbalance. All patients reported the amount of solution drank and evaluated their preps regarding palatability, ease of prep, willingness to repeat prep, side effects and time required to complete the prep. Total scores were compared via the Mann-Whitney (MW) test. Results: Group A and B total scores did not differ significantly (Mann-Whitney test p<0.13, Mean (SD) 15.8 (6.5) and 18.9 (3.7), respectively). In Group A, 21 of 26 patients (81%) had excellent or optimum preparation, compared to 25 of 27 patients (93%) in Group B (p<0.25, Fisher exact test). None of the patients had any electrolyte imbalance. 72% of patients in group A and 62% of patients in group B reported minor side effects, predominantly nausea and abdominal cramps. There were no differences in palatability ratings and willingness to repeat prep. Conclusion: In this prelilminary study, LWSW and exercise was no different from Halflytely® + Dulcolax® in the quality of bowel preparation, whether judged by total colon prep score or by the rate of excellent/optimum preps. More precise estimates of efficacy and adverse event rates will be obtained in a larger scale randomized clinical trial of 200 patients. Disclosure: Dr Vijaypal Arya - President Vikalp Inc, Dr Kalpana Arya Gupta - no financial relationship, Swarn Arya - no financial relationship.

Poor cleaning puts patients at risk

Poor cleaning puts patients at risk

HACCP 적용을 중심으로 본 해외 식품운반 관리체계의 특징과 우리나라 축산물 유통단계 안전관리 현황 조사 연구

HACCP is a scientific and systematic program that identifies specific hazards and gives measures for their control to ensure the safety of foods. Based on the Livestock Products Processing Act, the HACCP system is now being applied to Korean livestock products since December 1997, and Korea is accelerating its application from farm to table, including in farms, slaughterhouses, livestock product industries, retail markets, and transportation. The transport of livestock and its products is one of the vulnerable sectors in terms of food safety in Korea. Meats are transported in trucks in the form of carcasses or packaged meats in boxes. Carcasses may be exposed to microbiological, physical, and chemical hazards from the environment or through cross-contamination from other meats. Poor cleaning or maintenance of vehicles and tools may also raise the exposure of carcasses to microbiological or chemical hazards. HACCP application and its acceleration in distribution, particularly in transport, is regarded as critical to the provision to consumers of ultimately safe livestock products. To achieve this goal, steady efforts to develop practical tools for HACCP application should be carried out.

Assessment of quality of care in maternal and newborn health services available in public health care facilities in Bangladesh

The study was conducted using the exit interview with patients (n=120), in depth interview with health care providers (n=87) and focus group discussion (n=16) with stakeholders to assess the perceived level of quality of care in maternal and newborn health at public facilities in Bangladesh. Both clients and providers expressed dissatisfaction for inadequate quality of care represented by poor cleanliness, long waiting time with less consultation time, poor compassion by providers, inadequate supply of drugs and unnoticed cost for services varied by level of facilities. Inadequacy in human resource and absenteeism and poor laboratory service were reported to worsen the condition especially at lower level of service delivery. Thus this study explored some important factors like poor quality of care, inadequate technical competencies, information exchange and follow-up services. A deficit in supplies and logistics are strong barrier in regards to quality of care at various levels which needs to be addressed immediately.

Assessment of risk behaviours and factors associated with oral and peri-oral lesions in adult HIV patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background: HIV patients have several habits that can produce oral lesions. However the association of oral habits and risk behaviors with oral and peri-oral lesions in HIV patients has not been studied in Ethiopia to date. Objective: To assess the relationship of oral and peri-oral lesions with oral habits risk behaviors socio-demographic factors and clinical stages of disease among HIV infected adult Ethiopians. Methodology A cross-sectional study was conducted on consecutive adult ART naive HIV patients at ART clinic of Tikur Anbessa Specialized University Hospital Addis Ababa Ethiopia during December 2005 to July 2006. The EC-clearing houses classification and diagnostic criteria for oral lesions in HIV infection was used. Written informed consent was obtained before enrollment to the study. Results A total of 384 patients 126 (33%) males and 258 (67%) females were evaluated. The mean + SD age of males was 39.9 +10.56 and females was 33.17 + 8.85 years. Fifty seven (15%) of the unit of analysis were smokers 178 (46%) alcohol consumers and 217(57.1%) khat chewers use tooth sticks for dental cleaning. Of which 132 (34.7%) clean their teeth at least once a day and 302 (79%) gave history of recent significant weight loss. Linear regression analysis showed association of oral and peri-oral lesions with less frequent cleaning (p=0.038 p=0.03 respectively) means of cleaning (p=0.004; p=0.001) broad-spectrum antibiotic use (p=0.019 p=0.008) advanced stage of HIV (p=0.016 p=0.001) and CD4 level below 200 Cells/mm3 (p=0.001 p=0.01). The oral lesions were seen more frequently among smokers (p=0.028) heavy alcohol consumers (p=0.041) those with age above 40 years (p=0.016) and recent weight loss (p=0.001). At the level of binary logistic regression analysis smoking (p=0.005) CD4 count less than 200 (p=0.039) and stage 3 (p=0.022) and stage 4 disease (p=0.046) were found to be independent risks while daily dental cleaning habit was found to be protective (p=0.021). Conclusion Oral and peri-oral diseases among HIV/AIDS patients and are significantly associated with correctable risk factors like smoking and poor oral cleaning habits. Lesions are also frequent with evidence of advanced HIV disease and low CD4 count. These findings demonstrate the need for oral health examination and education to improve on risk behaviors and oral care in HIV/AIDS patients.