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The performance of a pilot-scale horizontal sedimentation tank was characterised utilising computational fluid dynamics (CFD) and a bespoke ultrasonic backscatter array, for both spherical glass and flocculated calcite separation. The CFD simulation was developed in OpenFOAM, using algebraic slip and hindered settling models, in order to solve the transport of multiple particle size classes, enabled through a population balance approach. Simulations of concentration compared closely to samples for the glass dispersions, but under-predicted concentration with flocculated calcite (likely due to complexities from modelling floc break-up in the mixer). In comparison, the acoustic array measured the calcite concentration with a high degree of resolution, where in particular, evidence suspension mobilisation near the outlet was observed, due to recirculation. Overall, we demonstrate the performance and current limitations of large-scale CFD for complex floc systems, as well as the use of ultrasonics to significantly aid process understanding, through online monitoring of solid-liquid separations.

The National Health Service (NHS) in England has a capital budget of approximately £4bn per year to spend on the construction and refurbishment of new and existing buildings. The majority of capital costs are committed by early stage design decisions, which have a large impact on operations, costs and performance. It is necessary to incorporate a sociotechnical approach to design as healthcare is a service environment in which patients are part of the system. The design of facilities determines the allocation of space and the interacting flows including: patients, clinicians, visitors, medication, supplies, equipment, and information. The design requires many trade-offs and has a major impact on the patient experience and the quality and efficiency of care. This paper evaluates the application of the Lean 3P (production, preparation, process) participative design method as part of a pilot project to design a new endoscopy unit at Gateshead Health NHS Foundation Trust. The research, which was funded by the Health Foundation, used participant observation, and an analysis of the layout drawings and the 7 flows of medicine to appraise 3P. The existing and proposed designs were compared. The results show that 3P is an effective tool that can develop designs that meet the requirements of multiple stakeholders. A framework was developed that positions 3P within the overall design process. The seven flows of medicine classification was extended to include subcategories and to identify interrelationships between the flows. This will help inform the design of healthcare facilities.

A healthy 55-year-old man without known medical problems presented for a routine physical examination and was found to have an abnormal ECG. He denied chest pain, dyspnea, palpitations, dizziness, or syncopal episodes. He also denied orthopnea, paroxysmal nocturnal dyspnea, and lower-extremity edema. His exercise capacity had been excellent. He was a lifelong nonsmoker and never had lung problems.

Amiodarone pulmonary toxicity represents the most serious adverse reaction from amiodarone use. It remains underdiagnosed and can have a variable presentation. The elderly population is at increased risk for amiodarone pulmonary toxicity. Thus, clinicians should prescribe the lowest dosage possible in the elderly and have a low threshold to discontinue the amiodarone for anyone with unexplained fatigue, dyspnea, cough, or weight loss. We present the case of an 89-year-old female who presented with a several month history of fatigue and recent development of dyspnea on exertion and a dry cough. She had been taking amiodarone for 1 year secondary to atrial fibrillation. Chest x-ray and chest CT revealed multilobar airway opacities. An infectious work-up was negative and a transbronchial biopsy revealed prominent intra-alveolar foamy macrophages, consistent with amiodarone pulmonary toxicity. Despite the prompt discontinuation of her amiodarone and a trial of intravenous steroids, the patient succumbed to respiratory failure. The risk factors, clinical presentation, diagnosis, treatment, and prevention of amiodarone pulmonary toxicity are discussed.

Musculoskeletal injuries secondary to seizures are well documented and have a variable incidence. Meperidine (Demerol [Abbott, Abbott Park, IL]) has been used for many years in the postoperative setting for pain control; however, in high doses, it has been associated with seizure. We report the case of patient who experienced a tonic-clonic seizure 5 days after hip revision surgery, resulting in dissociation of the socket from the acetabulum with an associated acetabular fracture. In this patient, meperidine administered for patient-controlled analgesia within recommended range caused the seizure.