Advanced electrical current measurements of microdischarges: evidence of sub-critical pulses and ion currents in barrier discharge in air

NASA Astrophysics Data System (ADS)

Synek, Petr; Zemánek, Miroslav; Kudrle, Vít; Hoder, Tomáš

2018-04-01

Electrical current measurements in corona or barrier microdischarges are a challenge as they require both high temporal resolution and a large dynamic range of the current probe used. In this article, we apply a simple self-assembled current probe and compare it to commercial ones. An analysis in the time and frequency domain is carried out. Moreover, an improved methodology is presented, enabling both temporal resolution in sub-nanosecond times and current sensitivity in the order of tens of micro-amperes. Combining this methodology with a high-tech oscilloscope and self-developed software, a unique statistical analysis of currents in volume barrier discharge driven in atmospheric-pressure air is made for over 80 consecutive periods of a 15 kHz applied voltage. We reveal the presence of repetitive sub-critical current pulses and conclude that these can be identified with the discharging of surface charge microdomains. Moreover, extremely low, long-lasting microsecond currents were detected which are caused by ion flow, and are analysed in detail. The statistical behaviour presented gives deeper insight into the discharge physics of these usually undetectable current signals.

Estimating extreme river discharges in Europe through a Bayesian network

NASA Astrophysics Data System (ADS)

Paprotny, Dominik; Morales-Nápoles, Oswaldo

2017-06-01

Large-scale hydrological modelling of flood hazards requires adequate extreme discharge data. In practise, models based on physics are applied alongside those utilizing only statistical analysis. The former require enormous computational power, while the latter are mostly limited in accuracy and spatial coverage. In this paper we introduce an alternate, statistical approach based on Bayesian networks (BNs), a graphical model for dependent random variables. We use a non-parametric BN to describe the joint distribution of extreme discharges in European rivers and variables representing the geographical characteristics of their catchments. Annual maxima of daily discharges from more than 1800 river gauges (stations with catchment areas ranging from 1.4 to 807 000 km2) were collected, together with information on terrain, land use and local climate. The (conditional) correlations between the variables are modelled through copulas, with the dependency structure defined in the network. The results show that using this method, mean annual maxima and return periods of discharges could be estimated with an accuracy similar to existing studies using physical models for Europe and better than a comparable global statistical model. Performance of the model varies slightly between regions of Europe, but is consistent between different time periods, and remains the same in a split-sample validation. Though discharge prediction under climate change is not the main scope of this paper, the BN was applied to a large domain covering all sizes of rivers in the continent both for present and future climate, as an example. Results show substantial variation in the influence of climate change on river discharges. The model can be used to provide quick estimates of extreme discharges at any location for the purpose of obtaining input information for hydraulic modelling.

Global hospital bed utilization crisis. A different approach.

PubMed

Waness, Abdelkarim; Akbar, Jalal U; Kharal, Mubashar; BinSalih, Salih; Harakati, Mohammed

2010-04-01

To test the effect of improved physician availability on hospital bed utilization. A prospective cohort study was conducted from 1st January 2009 to 31st March 2009 in the Division of Internal Medicine (DIM), King Abdul-Aziz Medical City (KAMC), Riyadh, Kingdom of Saudi Arabia. Two clinical teaching units (CTU) were compared head-to-head. Each CTU has 3 consultants. The CTU-control provides standard care, while the CTU-intervention was designed to provide better physician-consultant availability. Three outcomes were evaluated: patient outsourcing to another hospital, patient discharge during weekends, and overall admissions. Statistical analysis was carried out by electronic statistics calculator from the Center for Evidence-Based Medicine. Three hundred and thirty-four patients were evaluated for admission at the Emergency Room by both CTU's. One hundred and eighty-three patients were seen by the CTU-control, 6 patients were outsourced, and 177 were admitted. One hundred fifty-one patients were seen by the CTU-intervention: 39 of them were outsourced, and 112 were admitted. Forty-eight weekend patient discharges occurred during this period of time: 21 by CTU-control, and 27 by CTU-intervention. Analysis for odds ratio in both the rate of outsourcing, and weekend discharges, showed statistical significance in favor of the intervention group. The continuous availability of a physician-consultant for patient admission evaluation, outsourcing, or discharge during regular weekdays and weekends at DIM, KAMC proved to have a positive impact on bed utilization.

Measuring hospital efficiency--comparing four European countries.

PubMed

Mateus, Céu; Joaquim, Inês; Nunes, Carla

2015-02-01

Performing international comparisons on efficiency usually has two main drawbacks: the lack of comparability of data from different countries and the appropriateness and adequacy of data selected for efficiency measurement. With inpatient discharges for four countries, some of the problems of data comparability usually found in international comparisons were mitigated. The objectives are to assess and compare hospital efficiency levels within and between countries, using stochastic frontier analysis with both cross-sectional and panel data. Data from English (2005-2008), Portuguese (2002-2009), Spanish (2003-2009) and Slovenian (2005-2009) hospital discharges and characteristics are used. Weighted hospital discharges were considered as outputs while the number of employees, physicians, nurses and beds were selected as inputs of the production function. Stochastic frontier analysis using both cross-sectional and panel data were performed, as well as ordinary least squares (OLS) analysis. The adequacy of the data was assessed with Kolmogorov-Smirnov and Breusch-Pagan/Cook-Weisberg tests. Data available results were redundant to perform efficiency measurements using stochastic frontier analysis with cross-sectional data. The likelihood ratio test reveals that in cross-sectional data stochastic frontier analysis (SFA) is not statistically different from OLS in Portuguese data, while SFA and OLS estimates are statistically different for Spanish, Slovenian and English data. In the panel data, the inefficiency term is statistically different from 0 in the four countries in analysis, though for Portugal it is still close to 0. Panel data are preferred over cross-section analysis because results are more robust. For all countries except Slovenia, beds and employees are relevant inputs for the production process. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Trends in selected streamflow statistics at 19 long-term streamflow-gaging stations indicative of outflows from Texas to Arkansas, Louisiana, Galveston Bay, and the Gulf of Mexico, 1922-2009

USGS Publications Warehouse

Barbie, Dana L.; Wehmeyer, Loren L.

2012-01-01

Trends in selected streamflow statistics during 1922-2009 were evaluated at 19 long-term streamflow-gaging stations considered indicative of outflows from Texas to Arkansas, Louisiana, Galveston Bay, and the Gulf of Mexico. The U.S. Geological Survey, in cooperation with the Texas Water Development Board, evaluated streamflow data from streamflow-gaging stations with more than 50 years of record that were active as of 2009. The outflows into Arkansas and Louisiana were represented by 3 streamflow-gaging stations, and outflows into the Gulf of Mexico, including Galveston Bay, were represented by 16 streamflow-gaging stations. Monotonic trend analyses were done using the following three streamflow statistics generated from daily mean values of streamflow: (1) annual mean daily discharge, (2) annual maximum daily discharge, and (3) annual minimum daily discharge. The trend analyses were based on the nonparametric Kendall's Tau test, which is useful for the detection of monotonic upward or downward trends with time. A total of 69 trend analyses by Kendall's Tau were computed - 19 periods of streamflow multiplied by the 3 streamflow statistics plus 12 additional trend analyses because the periods of record for 2 streamflow-gaging stations were divided into periods representing pre- and post-reservoir impoundment. Unless otherwise described, each trend analysis used the entire period of record for each streamflow-gaging station. The monotonic trend analysis detected 11 statistically significant downward trends, 37 instances of no trend, and 21 statistically significant upward trends. One general region studied, which seemingly has relatively more upward trends for many of the streamflow statistics analyzed, includes the rivers and associated creeks and bayous to Galveston Bay in the Houston metropolitan area. Lastly, the most western river basins considered (the Nueces and Rio Grande) had statistically significant downward trends for many of the streamflow statistics analyzed.

Hair Mineral Analysis and Disruptive Behavior in Clinically Normal Young Men.

ERIC Educational Resources Information Center

Struempler, Richard E.; And Others

1985-01-01

Forty young navy recruits were selected for hair mineral analysis on the basis of three criteria: mental test scores, demerits during training, and premature discharge from the navy. Statistical analysis revealed several significant relationships between behavioral criteria and mineral measures. Findings confirmed, in a nonclinical sample, hair…

[Continuity of hospital identifiers in hospital discharge data - Analysis of the nationwide German DRG Statistics from 2005 to 2013].

PubMed

Nimptsch, Ulrike; Wengler, Annelene; Mansky, Thomas

2016-11-01

In Germany, nationwide hospital discharge data (DRG statistics provided by the research data centers of the Federal Statistical Office and the Statistical Offices of the 'Länder') are increasingly used as data source for health services research. Within this data hospitals can be separated via their hospital identifier ([Institutionskennzeichen] IK). However, this hospital identifier primarily designates the invoicing unit and is not necessarily equivalent to one hospital location. Aiming to investigate direction and extent of possible bias in hospital-level analyses this study examines the continuity of the hospital identifier within a cross-sectional and longitudinal approach and compares the results to official hospital census statistics. Within the DRG statistics from 2005 to 2013 the annual number of hospitals as classified by hospital identifiers was counted for each year of observation. The annual number of hospitals derived from DRG statistics was compared to the number of hospitals in the official census statistics 'Grunddaten der Krankenhäuser'. Subsequently, the temporal continuity of hospital identifiers in the DRG statistics was analyzed within cohorts of hospitals. Until 2013, the annual number of hospital identifiers in the DRG statistics fell by 175 (from 1,725 to 1,550). This decline affected only providers with small or medium case volume. The number of hospitals identified in the DRG statistics was lower than the number given in the census statistics (e.g., in 2013 1,550 IK vs. 1,668 hospitals in the census statistics). The longitudinal analyses revealed that the majority of hospital identifiers persisted in the years of observation, while one fifth of hospital identifiers changed. In cross-sectional studies of German hospital discharge data the separation of hospitals via the hospital identifier might lead to underestimating the number of hospitals and consequential overestimation of caseload per hospital. Discontinuities of hospital identifiers over time might impair the follow-up of hospital cohorts. These limitations must be taken into account in analyses of German hospital discharge data focusing on the hospital level. Copyright © 2016. Published by Elsevier GmbH.

Use of the Oxford Handicap Scale at hospital discharge to predict Glasgow Outcome Scale at 6 months in patients with traumatic brain injury.

PubMed

Perel, Pablo; Edwards, Phil; Shakur, Haleema; Roberts, Ian

2008-11-06

Traumatic brain injury (TBI) is an important cause of acquired disability. In evaluating the effectiveness of clinical interventions for TBI it is important to measure disability accurately. The Glasgow Outcome Scale (GOS) is the most widely used outcome measure in randomised controlled trials (RCTs) in TBI patients. However GOS measurement is generally collected at 6 months after discharge when loss to follow up could have occurred. The objectives of this study were to evaluate the association and predictive validity between a simple disability scale at hospital discharge, the Oxford Handicap Scale (OHS), and the GOS at 6 months among TBI patients. The study was a secondary analysis of a randomised clinical trial among TBI patients (MRC CRASH Trial). A Spearman correlation was estimated to evaluate the association between the OHS and GOS. The validity of different dichotomies of the OHS for predicting GOS at 6 months was assessed by calculating sensitivity, specificity and the C statistic. Uni and multivariate logistic regression models were fitted including OHS as explanatory variable. For each model we analysed its discrimination and calibration. We found that the OHS is highly correlated with GOS at 6 months (spearman correlation 0.75) with evidence of a linear relationship between the two scales. The OHS dichotomy that separates patients with severe dependency or death showed the greatest discrimination (C statistic: 84.3). Among survivors at hospital discharge the OHS showed a very good discrimination (C statistic 0.78) and excellent calibration when used to predict GOS outcome at 6 months. We have shown that the OHS, a simple disability scale available at hospital discharge can predict disability accurately, according to the GOS, at 6 months. OHS could be used to improve the design and analysis of clinical trials in TBI patients and may also provide a valuable clinical tool for physicians to improve communication with patients and relatives when assessing a patient's prognosis at hospital discharge.

Maintenance of improved lipid levels following attendance at a cardiovascular risk reduction clinic: a 10-year experience

PubMed Central

Pearson, Glen J; Olson, Kari L; Panich, Nicole E; Majumdar, Sumit R; Tsuyuki, Ross T; Gilchrist, Dawna M; Damani, Ali; Francis, Gordon A

2008-01-01

Background: Specialty cardiovascular risk reduction clinics (CRRC) increase the proportion of patients attaining recommended lipid targets; however, it is not known if the benefits are sustained after discharge. We evaluated the impact of a CRRC on lipid levels and assessed the long-term effect of a CRRC in maintaining improved lipid levels following discharge. Methods: The medical records of consecutive dyslipidemic patients discharged ×6 months from a tertiary hospital CRRC from January 1991 to January 2001 were retrospectively reviewed. The primary outcome was the change in patients’ lipid levels between the final CRRC visit and the most recent primary care follow-up. A worst-case analysis was conducted to evaluate the potential impact of the patients in whom the follow-up lipid profiles post-discharge from the CRRC were not obtained. Results: Within the CRRC (median follow-up = 1.28 years in 1064 patients), we observed statistically significant improvements in all lipid parameters. In the 411 patients for whom post-discharge lipid profiles were available (median follow-up = 2.41 years), there were no significant differences observed in low-density lipoprotein-cholesterol, total cholesterol (TC), or triglycerides since CRRC discharge; however, there were small improvements in high-density lipoprotein-cholesterol (HDL-C) and TC:HDL ratio (p < 0.05 for both). The unadjusted worst-case analysis (653 patients with no follow-up lipid profiles) demonstrated statistically significant worsening of all lipid parameters between CRRC discharge and the most recent follow-up. However, when the change in lipid parameters between the baseline and the most recent follow-up was assessed in this analysis, the changes in all lipid parameters were significantly improved (p < 0.05). Conclusions: This study demonstrates that a CRRC can improve lipid levels and suggests that these benefits are sustained once patients are returned to the care of their primary physician. PMID:19183763

STATISTICS ON PUBLIC INSTITUTIONS FOR DELINQUENT CHILDREN, 1964. CHILDREN'S BUREAU STATISTICAL SERIES 81.

ERIC Educational Resources Information Center

TOWNSEND, ALAIR A.

AN ANALYSIS OF 245 UNITED STATES PUBLIC INSTITUTIONS FOR DELINQUENT CHILDREN FOR FISCAL YEAR JULY 1963 TO JUNE 1964 PROVIDES DATA ON NUMBERS OF CHILDREN IN PUBLIC TRAINING SCHOOLS, NUMBERS OF CHILDREN COMMITTED AND DISCHARGED, SEX OF CHILDREN, RETURNEES, RUNAWAYS, LENGTH OF STAY, INSTITUTION CAPACITY, AND OCCUPANCY RATE. PER CAPITA OPERATING…

Do regional methods really help reduce uncertainties in flood frequency analyses?

NASA Astrophysics Data System (ADS)

Cong Nguyen, Chi; Payrastre, Olivier; Gaume, Eric

2013-04-01

Flood frequency analyses are often based on continuous measured series at gauge sites. However, the length of the available data sets is usually too short to provide reliable estimates of extreme design floods. To reduce the estimation uncertainties, the analyzed data sets have to be extended either in time, making use of historical and paleoflood data, or in space, merging data sets considered as statistically homogeneous to build large regional data samples. Nevertheless, the advantage of the regional analyses, the important increase of the size of the studied data sets, may be counterbalanced by the possible heterogeneities of the merged sets. The application and comparison of four different flood frequency analysis methods to two regions affected by flash floods in the south of France (Ardèche and Var) illustrates how this balance between the number of records and possible heterogeneities plays in real-world applications. The four tested methods are: (1) a local statistical analysis based on the existing series of measured discharges, (2) a local analysis valuating the existing information on historical floods, (3) a standard regional flood frequency analysis based on existing measured series at gauged sites and (4) a modified regional analysis including estimated extreme peak discharges at ungauged sites. Monte Carlo simulations are conducted to simulate a large number of discharge series with characteristics similar to the observed ones (type of statistical distributions, number of sites and records) to evaluate to which extent the results obtained on these case studies can be generalized. These two case studies indicate that even small statistical heterogeneities, which are not detected by the standard homogeneity tests implemented in regional flood frequency studies, may drastically limit the usefulness of such approaches. On the other hand, these result show that the valuation of information on extreme events, either historical flood events at gauged sites or estimated extremes at ungauged sites in the considered region, is an efficient way to reduce uncertainties in flood frequency studies.

Study on ion energy distribution in low-frequency oscillation time scale of Hall thrusters

NASA Astrophysics Data System (ADS)

Wei, Liqiu; Li, Wenbo; Ding, Yongjie; Han, Liang; Yu, Daren; Cao, Yong

2017-11-01

This paper reports on the dynamic characteristics of the distribution of ion energy during Hall thruster discharge in the low-frequency oscillation time scale through experimental studies, and a statistical analysis of the time-varying peak and width of ion energy and the ratio of high-energy ions during the low-frequency oscillation. The results show that the ion energy distribution exhibits a periodic change during the low-frequency oscillation. Moreover, the variation in the ion energy peak is opposite to that of the discharge current, and the variations in width of the ion energy distribution and the ratio of high-energy ions are consistent with that of the discharge current. The variation characteristics of the ion density and discharge potential were simulated by one-dimensional hybrid-direct kinetic simulations; the simulation results and analysis indicate that the periodic change in the distribution of ion energy during the low-frequency oscillation depends on the relationship between the ionization source term and discharge potential distribution during ionization in the discharge channel.

The classification of gunshot residue using laser electrospray mass spectrometry and offline multivariate statistical analysis

USDA-ARS?s Scientific Manuscript database

Nonresonant laser vaporization combined with high-resolution electrospray time-of-flight mass spectrometry enables analysis of a casing after discharge of a firearm revealing organic signature molecules including methyl centralite (MC), diphenylamine (DPA), N-nitrosodiphenylamine (N-NO-DPA), 4-nitro...

Streamflow statistics for selected streams in North Dakota, Minnesota, Manitoba, and Saskatchewan

USGS Publications Warehouse

Williams-Sether, Tara

2012-01-01

Statistical summaries of streamflow data for the periods of record through water year 2009 for selected active and discontinued U.S. Geological Survey streamflow-gaging stations in North Dakota, Minnesota, Manitoba, and Saskatchewan were compiled. The summaries for each streamflow-gaging station include a brief station description, a graph of the annual peak and annual mean discharge for the period of record, statistics of monthly and annual mean discharges, monthly and annual flow durations, probability of occurrence of annual high discharges, annual peak discharge and corresponding gage height for the period of record, and monthly and annual mean discharges for the period of record.

Estimates of Flow Duration, Mean Flow, and Peak-Discharge Frequency Values for Kansas Stream Locations

USGS Publications Warehouse

Perry, Charles A.; Wolock, David M.; Artman, Joshua C.

2004-01-01

Streamflow statistics of flow duration and peak-discharge frequency were estimated for 4,771 individual locations on streams listed on the 1999 Kansas Surface Water Register. These statistics included the flow-duration values of 90, 75, 50, 25, and 10 percent, as well as the mean flow value. Peak-discharge frequency values were estimated for the 2-, 5-, 10-, 25-, 50-, and 100-year floods. Least-squares multiple regression techniques were used, along with Tobit analyses, to develop equations for estimating flow-duration values of 90, 75, 50, 25, and 10 percent and the mean flow for uncontrolled flow stream locations. The contributing-drainage areas of 149 U.S. Geological Survey streamflow-gaging stations in Kansas and parts of surrounding States that had flow uncontrolled by Federal reservoirs and used in the regression analyses ranged from 2.06 to 12,004 square miles. Logarithmic transformations of climatic and basin data were performed to yield the best linear relation for developing equations to compute flow durations and mean flow. In the regression analyses, the significant climatic and basin characteristics, in order of importance, were contributing-drainage area, mean annual precipitation, mean basin permeability, and mean basin slope. The analyses yielded a model standard error of prediction range of 0.43 logarithmic units for the 90-percent duration analysis to 0.15 logarithmic units for the 10-percent duration analysis. The model standard error of prediction was 0.14 logarithmic units for the mean flow. Regression equations used to estimate peak-discharge frequency values were obtained from a previous report, and estimates for the 2-, 5-, 10-, 25-, 50-, and 100-year floods were determined for this report. The regression equations and an interpolation procedure were used to compute flow durations, mean flow, and estimates of peak-discharge frequency for locations along uncontrolled flow streams on the 1999 Kansas Surface Water Register. Flow durations, mean flow, and peak-discharge frequency values determined at available gaging stations were used to interpolate the regression-estimated flows for the stream locations where available. Streamflow statistics for locations that had uncontrolled flow were interpolated using data from gaging stations weighted according to the drainage area and the bias between the regression-estimated and gaged flow information. On controlled reaches of Kansas streams, the streamflow statistics were interpolated between gaging stations using only gaged data weighted by drainage area.

Linear error analysis of slope-area discharge determinations

USGS Publications Warehouse

Kirby, W.H.

1987-01-01

The slope-area method can be used to calculate peak flood discharges when current-meter measurements are not possible. This calculation depends on several quantities, such as water-surface fall, that are subject to large measurement errors. Other critical quantities, such as Manning's n, are not even amenable to direct measurement but can only be estimated. Finally, scour and fill may cause gross discrepancies between the observed condition of the channel and the hydraulic conditions during the flood peak. The effects of these potential errors on the accuracy of the computed discharge have been estimated by statistical error analysis using a Taylor-series approximation of the discharge formula and the well-known formula for the variance of a sum of correlated random variates. The resultant error variance of the computed discharge is a weighted sum of covariances of the various observational errors. The weights depend on the hydraulic and geometric configuration of the channel. The mathematical analysis confirms the rule of thumb that relative errors in computed discharge increase rapidly when velocity heads exceed the water-surface fall, when the flow field is expanding and when lateral velocity variation (alpha) is large. It also confirms the extreme importance of accurately assessing the presence of scour or fill. ?? 1987.

Oscillations and trends of river discharge in the southern Central Andes and linkages with climate variability

NASA Astrophysics Data System (ADS)

Castino, Fabiana; Bookhagen, Bodo; Strecker, Manfred R.

2017-12-01

This study analyzes the discharge variability of small to medium drainage basins (102-104 km2) in the southern Central Andes of NW Argentina. The Hilbert-Huang Transform (HHT) was applied to evaluate non-stationary oscillatory modes of variability and trends, based on four time series of monthly-normalized discharge anomaly between 1940 and 2015. Statistically significant trends reveal increasing discharge during the past decades and document an intensification of the hydrological cycle during this period. An Ensemble Empirical Mode Decomposition (EEMD) analysis revealed that discharge variability in this region can be best described by five quasi-periodic statistically significant oscillatory modes, with mean periods varying from 1 to ∼20 y. Moreover, we show that discharge variability is most likely linked to the phases of the Pacific Decadal Oscillation (PDO) at multi-decadal timescales (∼20 y) and, to a lesser degree, to the Tropical South Atlantic SST anomaly (TSA) variability at shorter timescales (∼2-5 y). Previous studies highlighted a rapid increase in discharge in the southern Central Andes during the 1970s, inferred to have been associated with the global 1976-77 climate shift. Our results suggest that the rapid discharge increase in the NW Argentine Andes coincides with the periodic enhancement of discharge, which is mainly linked to a negative to positive transition of the PDO phase and TSA variability associated with a long-term increasing trend. We therefore suggest that variations in discharge in this region are largely driven by both natural variability and the effects of global climate change. We furthermore posit that the links between atmospheric and hydrologic processes result from a combination of forcings that operate on different spatiotemporal scales.

Integrated environmental monitoring and multivariate data analysis-A case study.

PubMed

Eide, Ingvar; Westad, Frank; Nilssen, Ingunn; de Freitas, Felipe Sales; Dos Santos, Natalia Gomes; Dos Santos, Francisco; Cabral, Marcelo Montenegro; Bicego, Marcia Caruso; Figueira, Rubens; Johnsen, Ståle

2017-03-01

The present article describes integration of environmental monitoring and discharge data and interpretation using multivariate statistics, principal component analysis (PCA), and partial least squares (PLS) regression. The monitoring was carried out at the Peregrino oil field off the coast of Brazil. One sensor platform and 3 sediment traps were placed on the seabed. The sensors measured current speed and direction, turbidity, temperature, and conductivity. The sediment trap samples were used to determine suspended particulate matter that was characterized with respect to a number of chemical parameters (26 alkanes, 16 PAHs, N, C, calcium carbonate, and Ba). Data on discharges of drill cuttings and water-based drilling fluid were provided on a daily basis. The monitoring was carried out during 7 campaigns from June 2010 to October 2012, each lasting 2 to 3 months due to the capacity of the sediment traps. The data from the campaigns were preprocessed, combined, and interpreted using multivariate statistics. No systematic difference could be observed between campaigns or traps despite the fact that the first campaign was carried out before drilling, and 1 of 3 sediment traps was located in an area not expected to be influenced by the discharges. There was a strong covariation between suspended particulate matter and total N and organic C suggesting that the majority of the sediment samples had a natural and biogenic origin. Furthermore, the multivariate regression showed no correlation between discharges of drill cuttings and sediment trap or turbidity data taking current speed and direction into consideration. Because of this lack of correlation with discharges from the drilling location, a more detailed evaluation of chemical indicators providing information about origin was carried out in addition to numerical modeling of dispersion and deposition. The chemical indicators and the modeling of dispersion and deposition support the conclusions from the multivariate statistics. Integr Environ Assess Manag 2017;13:387-395. © 2016 SETAC. © 2016 SETAC.

Statistical analysis of storm electrical discharges reconstituted from a lightning mapping system, a lightning location system, and an acoustic array

NASA Astrophysics Data System (ADS)

Gallin, Louis-Jonardan; Farges, Thomas; Marchiano, Régis; Coulouvrat, François; Defer, Eric; Rison, William; Schulz, Wolfgang; Nuret, Mathieu

2016-04-01

In the framework of the European Hydrological Cycle in the Mediterranean Experiment project, a field campaign devoted to the study of electrical activity during storms took place in the south of France in 2012. An acoustic station composed of four microphones and four microbarometers was deployed within the coverage of a Lightning Mapping Array network. On the 26 October 2012, a thunderstorm passed just over the acoustic station. Fifty-six natural thunder events, due to cloud-to-ground and intracloud flashes, were recorded. This paper studies the acoustic reconstruction, in the low frequency range from 1 to 40 Hz, of the recorded flashes and their comparison with detections from electromagnetic networks. Concurrent detections from the European Cooperation for Lightning Detection lightning location system were also used. Some case studies show clearly that acoustic signal from thunder comes from the return stroke but also from the horizontal discharges which occur inside the clouds. The huge amount of observation data leads to a statistical analysis of lightning discharges acoustically recorded. Especially, the distributions of altitudes of reconstructed acoustic detections are explored in detail. The impact of the distance to the source on these distributions is established. The capacity of the acoustic method to describe precisely the lower part of nearby cloud-to-ground discharges, where the Lightning Mapping Array network is not effective, is also highlighted.

Effect of a Dedicated Orthopaedic Advanced Practice Provider in a Level I Trauma Center: Analysis of Length of Stay and Cost.

PubMed

Hiza, Elise A; Gottschalk, Michael B; Umpierrez, Erica; Bush, Patricia; Reisman, William M

2015-07-01

The objective of this study is to analyze the effect of an orthopaedic trauma advanced practice provider on length of stay (LOS) and cost in a level I trauma center. The hypothesis of this study is that the addition of a single full-time nurse practitioner (NP) to the orthopaedic trauma team at a level I Trauma center would decrease overall LOS and hospital cost. A retrospective chart review of all patients discharged from the orthopaedic surgery service 1 year before the addition of a NP (pre-NP) and 1 year after the hiring of a NP (post-NP) were reviewed. Chart review included age, gender, LOS, discharge destination, intravenous antibiotic use, wound VAC therapy, admission location, and length of time to surgery. Statistical analysis was performed using the Wilcoxon/Kruskal-Wallis test. The hiring of a NP yielded a statistically significant decrease in the LOS across the following patient subgroups: patients transferred from the trauma service (13.56 compared with 7.02 days, P < 0.001), patients aged 60 years and older (7.34 compared with 5.04 days, P = 0.037), patients discharged to a rehabilitation facility (10.84 compared with 8.31 days, P = 0.002), and patients discharged on antibiotics/wound VAC therapy (15.16 compared with 11.24 days, P = 0.017). Length of time to surgery was also decreased (1.48 compared with 1.31 days, P = 0.37). The addition of a dedicated orthopaedic trauma advanced practice provider at a county level I trauma center resulted in a statistically significant decrease in LOS and thus reduced indirect costs to the hospital. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Multivariate analysis for stormwater quality characteristics identification from different urban surface types in macau.

PubMed

Huang, J; Du, P; Ao, C; Ho, M; Lei, M; Zhao, D; Wang, Z

2007-12-01

Statistical analysis of stormwater runoff data enables general identification of runoff characteristics. Six catchments with different urban surface type including roofs, roadway, park, and residential/commercial in Macau were selected for sampling and study during the period from June 2005 to September 2006. Based on univariate statistical analysis of data sampled, major pollutants discharged from different urban surface type were identified. As for iron roof runoff, Zn is the most significant pollutant. The major pollutants from urban roadway runoff are TSS and COD. Stormwater runoff from commercial/residential and Park catchments show high level of COD, TN, and TP concentration. Principal component analysis was further done for identification of linkages between stormwater quality and urban surface types. Two potential pollution sources were identified for study catchments with different urban surface types. The first one is referred as nutrients losses, soil losses and organic pollutants discharges, the second is related to heavy metals losses. PCA was proved to be a viable tool to explain the type of pollution sources and its mechanism for different urban surface type catchments.

The effect of funding policy on day of week admissions and discharges in hospitals: the cases of Austria and Canada.

PubMed

Leonard, Kevin J; Rauner, Marion S; Schaffhauser-Linzatti, Michaela Maria; Yap, Richard

2003-03-01

This paper compares two different funding policies for inpatients, the case-based approach in Austria versus the global budgeting approach in Canada. It examines the impact of these funding policies on length of stay of inpatients as one key measure of health outcome. In our study, six major clinical categories for inpatients are selected in which the day of the week for admission is matched to the particular day of the week of discharge for each individual case. The strategic statistical analysis proves that funding policies have a significant impact on the expected length of stay of inpatients. For all six clinical categories, Austrian inpatients stayed longer in hospitals compared to Canadian inpatients. Moreover, inpatients were not admitted and discharged equally throughout the week. We also statistically prove for certain clinical categories that more inpatients are discharged on certain days such as Mondays or Fridays depending on the funding policy. Our study is unique in the literature and our conclusions indicate that, with the right incentives in place, the length of stay can be decreased and discharge anomalies can be eliminated, which ultimately leads to a decrease in healthcare expenditures and an increase in healthcare effectiveness.

Streamflow characteristics at streamgages in northern Afghanistan and selected locations

USGS Publications Warehouse

Olson, Scott A.; Williams-Sether, Tara

2010-01-01

Statistical summaries of streamflow data for 79 historical streamgages in Northern Afghanistan and other selected historical streamgages are presented in this report. The summaries for each streamgage include (1) station description, (2) graph of the annual mean discharge for the period of record, (3) statistics of monthly and annual mean discharges, (4) monthly and annual flow duration, (5) probability of occurrence of annual high discharges, (6) probability of occurrence of annual low discharges, (7) probability of occurrence of seasonal low discharges, (8) annual peak discharges for the period of record, and (9) monthly and annual mean discharges for the period of record.

Extracting Prior Distributions from a Large Dataset of In-Situ Measurements to Support SWOT-based Estimation of River Discharge

NASA Astrophysics Data System (ADS)

Hagemann, M.; Gleason, C. J.

2017-12-01

The upcoming (2021) Surface Water and Ocean Topography (SWOT) NASA satellite mission aims, in part, to estimate discharge on major rivers worldwide using reach-scale measurements of stream width, slope, and height. Current formalizations of channel and floodplain hydraulics are insufficient to fully constrain this problem mathematically, resulting in an infinitely large solution set for any set of satellite observations. Recent work has reformulated this problem in a Bayesian statistical setting, in which the likelihood distributions derive directly from hydraulic flow-law equations. When coupled with prior distributions on unknown flow-law parameters, this formulation probabilistically constrains the parameter space, and results in a computationally tractable description of discharge. Using a curated dataset of over 200,000 in-situ acoustic Doppler current profiler (ADCP) discharge measurements from over 10,000 USGS gaging stations throughout the United States, we developed empirical prior distributions for flow-law parameters that are not observable by SWOT, but that are required in order to estimate discharge. This analysis quantified prior uncertainties on quantities including cross-sectional area, at-a-station hydraulic geometry width exponent, and discharge variability, that are dependent on SWOT-observable variables including reach-scale statistics of width and height. When compared against discharge estimation approaches that do not use this prior information, the Bayesian approach using ADCP-derived priors demonstrated consistently improved performance across a range of performance metrics. This Bayesian approach formally transfers information from in-situ gaging stations to remote-sensed estimation of discharge, in which the desired quantities are not directly observable. Further investigation using large in-situ datasets is therefore a promising way forward in improving satellite-based estimates of river discharge.

Statistical analysis of an inter-laboratory comparison of small-scale safety and thermal testing of RDX

DOE PAGES

Brown, Geoffrey W.; Sandstrom, Mary M.; Preston, Daniel N.; ...

2014-11-17

In this study, the Integrated Data Collection Analysis (IDCA) program has conducted a proficiency test for small-scale safety and thermal (SSST) testing of homemade explosives (HMEs). Described here are statistical analyses of the results from this test for impact, friction, electrostatic discharge, and differential scanning calorimetry analysis of the RDX Class 5 Type II standard. The material was tested as a well-characterized standard several times during the proficiency test to assess differences among participants and the range of results that may arise for well-behaved explosive materials.

Variance of discharge estimates sampled using acoustic Doppler current profilers from moving boats

USGS Publications Warehouse

Garcia, Carlos M.; Tarrab, Leticia; Oberg, Kevin; Szupiany, Ricardo; Cantero, Mariano I.

2012-01-01

This paper presents a model for quantifying the random errors (i.e., variance) of acoustic Doppler current profiler (ADCP) discharge measurements from moving boats for different sampling times. The model focuses on the random processes in the sampled flow field and has been developed using statistical methods currently available for uncertainty analysis of velocity time series. Analysis of field data collected using ADCP from moving boats from three natural rivers of varying sizes and flow conditions shows that, even though the estimate of the integral time scale of the actual turbulent flow field is larger than the sampling interval, the integral time scale of the sampled flow field is on the order of the sampling interval. Thus, an equation for computing the variance error in discharge measurements associated with different sampling times, assuming uncorrelated flow fields is appropriate. The approach is used to help define optimal sampling strategies by choosing the exposure time required for ADCPs to accurately measure flow discharge.

Multifactorial analysis of factors affecting recurrence of stroke in Japan.

PubMed

Omori, Toyonori; Kawagoe, Masahiro; Moriyama, Michiko; Yasuda, Takeshi; Ito, Yasuhiro; Hyakuta, Takeshi; Nagatsuka, Kazuyuki; Matsumoto, Masayasu

2015-03-01

Data on factors affecting stroke recurrence are relatively limited. The authors examined potential factors affecting stroke recurrence, retrospectively. The study participants were 1087 patients who were admitted to stroke centers suffering from first-ever ischemic stroke and returned questionnaires with usable information after discharge. The authors analyzed the association between clinical parameters of the patients and their prognosis. Recurrence rate of during an average of 2 years after discharge was 21.3%, and there were differences among stroke subtypes. It was found that the disability level of the patients after discharge correlated well with the level at discharge (r s = 0.66). Multivariate logistic regression analysis of the data shows that modified Rankin Scale score, National Institute of Health Stroke Scale score, gender, age, and family history had statistically significant impacts on stroke recurrence, and the impact was different depending on subtypes. These findings suggest that aggressive and persistent health education for poststroke patients and management of risk factors are essential to reduce stroke recurrence. © 2012 APJPH.

Lifetime assessment analysis of Galileo Li/SO2 cells: Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Levy, S.C.; Jaeger, C.D.; Bouchard, D.A.

Galileo Li/SO2 cells from five lots and five storage temperatures were studied to establish a database from which the performance of flight modules may be predicted. Nondestructive tests consisting of complex impedance analysis and a 15-s pulse were performed on all cells. Chemical analysis was performed on one cell from each lot/storage group, and the remaining cells were discharged at Galileo mission loads. An additional number of cells were placed on high-temperature accelerated aging storage for 6 months and then discharged. All data were statistically analyzed. Results indicate that the present Galileo design Li/SO2 cell will satisfy electrical requirements formore » a 10-year mission. 10 figs., 4 tabs.« less

SWToolbox: A surface-water tool-box for statistical analysis of streamflow time series

USGS Publications Warehouse

Kiang, Julie E.; Flynn, Kate; Zhai, Tong; Hummel, Paul; Granato, Gregory

2018-03-07

This report is a user guide for the low-flow analysis methods provided with version 1.0 of the Surface Water Toolbox (SWToolbox) computer program. The software combines functionality from two software programs—U.S. Geological Survey (USGS) SWSTAT and U.S. Environmental Protection Agency (EPA) DFLOW. Both of these programs have been used primarily for computation of critical low-flow statistics. The main analysis methods are the computation of hydrologic frequency statistics such as the 7-day minimum flow that occurs on average only once every 10 years (7Q10), computation of design flows including biologically based flows, and computation of flow-duration curves and duration hydrographs. Other annual, monthly, and seasonal statistics can also be computed. The interface facilitates retrieval of streamflow discharge data from the USGS National Water Information System and outputs text reports for a record of the analysis. Tools for graphing data and screening tests are available to assist the analyst in conducting the analysis.

Feasibility of Estimating Constituent Concentrations and Loads Based on Data Recorded by Acoustic Instrumentation

USGS Publications Warehouse

Lietz, A.C.

2002-01-01

The acoustic Doppler current profiler (ADCP) and acoustic Doppler velocity meter (ADVM) were used to estimate constituent concentrations and loads at a sampling site along the Hendry-Collier County boundary in southwestern Florida. The sampling site is strategically placed within a highly managed canal system that exhibits low and rapidly changing water conditions. With the ADCP and ADVM, flow can be gaged more accurately rather than by conventional field-data collection methods. An ADVM velocity rating relates measured velocity determined by the ADCP (dependent variable) with the ADVM velocity (independent variable) by means of regression analysis techniques. The coefficient of determination (R2) for this rating is 0.99 at the sampling site. Concentrations and loads of total phosphorus, total Kjeldahl nitrogen, and total nitrogen (dependent variables) were related to instantaneous discharge, acoustic backscatter, stage, or water temperature (independent variables) recorded at the time of sampling. Only positive discharges were used for this analysis. Discharges less than 100 cubic feet per second generally are considered inaccurate (probably as a result of acoustic ray bending and vertical temperature gradients in the water column). Of the concentration models, only total phosphorus was statistically significant at the 95-percent confidence level (p-value less than 0.05). Total phosphorus had an adjusted R2 of 0.93, indicating most of the variation in the concentration can be explained by the discharge. All of the load models for total phosphorus, total Kjeldahl nitrogen, and total nitrogen were statistically significant. Most of the variation in load can be explained by the discharge as reflected in the adjusted R2 for total phosphorus (0.98), total Kjeldahl nitrogen (0.99), and total nitrogen (0.99).

Streamflow Characteristics of Streams in the Helmand Basin, Afghanistan

USGS Publications Warehouse

Williams-Sether, Tara

2008-01-01

Statistical summaries of streamflow data for all historical streamflow-gaging stations for the Helmand Basin upstream from the Sistan Wetlands are presented in this report. The summaries for each streamflow-gaging station include (1) manuscript (station description), (2) graph of the annual mean discharge for the period of record, (3) statistics of monthly and annual mean discharges, (4) graph of the annual flow duration, (5) monthly and annual flow duration, (6) probability of occurrence of annual high discharges, (7) probability of occurrence of annual low discharges, (8) probability of occurrence of seasonal low discharges, (9) annual peak discharge and corresponding gage height for the period of record, and (10) monthly and annual mean discharges for the period of record.

A cost-effectiveness evaluation of hospital discharge counseling by pharmacists.

PubMed

Chinthammit, Chanadda; Armstrong, Edward P; Warholak, Terri L

2012-04-01

This study estimated the cost-effectiveness of pharmacist discharge counseling on medication-related morbidity in both the high-risk elderly and general US population. A cost-effectiveness decision analytic model was developed using a health care system perspective based on published clinical trials. Costs included direct medical costs, and the effectiveness unit was patients discharged without suffering a subsequent adverse drug event. A systematic review of published studies was conducted to estimate variable probabilities in the cost-effectiveness model. To test the robustness of the results, a second-order probabilistic sensitivity analysis (Monte Carlo simulation) was used to run 10 000 cases through the model sampling across all distributions simultaneously. Pharmacist counseling at hospital discharge provided a small, but statistically significant, clinical improvement at a similar overall cost. Pharmacist counseling was cost saving in approximately 48% of scenarios and in the remaining scenarios had a low willingness-to-pay threshold for all scenarios being cost-effective. In addition, discharge counseling was more cost-effective in the high-risk elderly population compared to the general population. This cost-effectiveness analysis suggests that discharge counseling by pharmacists is quite cost-effective and estimated to be cost saving in over 48% of cases. High-risk elderly patients appear to especially benefit from these pharmacist services.

Same-Day Discharge after Laparoscopic Roux-en-Y Gastric Bypass: An Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database.

PubMed

Inaba, Colette S; Koh, Christina Y; Sujatha-Bhaskar, Sarath; Zhang, Lishi; Nguyen, Ninh T

2018-05-01

Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been performed with successful discharge on postoperative day 1 (POD1). There are limited studies on same-day discharge after LRYGB. The objective of this study was to examine the frequency and outcomes of same-day discharge after LRYGB. The 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was analyzed for adult patients who underwent elective LRYGB cases with same-day vs POD1 discharge. Open and revisional cases were excluded. Multivariate analysis was performed to compare risk-adjusted 30-day mortality, overall morbidity, readmission, and reoperation. There were 354 (0.9%) patients who were discharged on the same day as surgery after LRYGB. After exclusion criteria, 319 patients with same-day discharge and 9,402 patients with POD1 discharge were examined. For same-day vs POD1 discharge groups, mean ages were 45.0 and 44.5 years, respectively, and mean BMIs were 47.3 kg/m 2 and 45.9 kg/m 2 , respectively. The unadjusted mortality rate was significantly higher for same-day compared with POD1 discharge (0.94% vs. 0.05%, respectively; p = 0.0017). Compared with POD1 discharge, same-day discharge had higher overall morbidity (3.76% vs 1.54%; adjusted odds ratio [AOR] 2.41; p = 0.0216), but no statistically significant differences for readmissions (3.45% vs. 3.66%; AOR 0.85; p = 0.9999) or reoperations (1.88% vs. 0.89%; AOR 2.33; p = 0.2428). Same-day discharge after LRYGB is associated with increased morbidity and mortality compared with POD1 discharge. The practice of same-day discharge after LRYGB should be considered experimental until further studies confirm which patient characteristics will ensure safe same-day discharge. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Water quality responses to the interaction between surface water and groundwater along the Songhua River, NE China

NASA Astrophysics Data System (ADS)

Teng, Yanguo; Hu, Bin; Zheng, Jieqiong; Wang, Jinsheng; Zhai, Yuanzheng; Zhu, Chen

2018-03-01

Investigation of surface water and groundwater interaction (SW-GW interaction) provides basic information for regional water-resource protection, management, and development. In this survey of a 10-km-wide area along both sides of the Songhua River, northeast China, the hydrogeochemical responses to different SW-GW interactions were studied. Three types of SW-GW interactions were identified—"recharge", "discharge", and "flow-through"—according to the hydraulic connection between the surface water and groundwater. The single factor index, principal component analysis, and hierarchical cluster analysis of the hydrogeochemistry and pollutant data illuminated the hydrogeochemical response to the various SW-GW interactions. Clear SW-GW interactions along the Songhua River were revealed: (1) upstream in the study area, groundwater usually discharges into the surface water, (2) groundwater is recharged by surface water downstream, and (3) discharge and flow-through coexist in between. Statistical analysis indicated that the degree of hydrogeochemical response in different types of hydraulic connection varied, being clear in recharge and flow-through modes, and less obvious in discharge mode. During the interaction process, dilution, adsorption, redox reactions, nitrification, denitrification, and biodegradation contributed to the pollutant concentration and affected hydrogeochemical response in the hyporheic zone.

Stream gage descriptions and streamflow statistics for sites in the Tigris River and Euphrates River Basins, Iraq

USGS Publications Warehouse

Saleh, Dina K.

2010-01-01

Statistical summaries of streamflow data for all long-term streamflow-gaging stations in the Tigris River and Euphrates River Basins in Iraq are presented in this report. The summaries for each streamflow-gaging station include (1) a station description, (2) a graph showing annual mean discharge for the period of record, (3) a table of extremes and statistics for monthly and annual mean discharge, (4) a graph showing monthly maximum, minimum, and mean discharge, (5) a table of monthly and annual mean discharges for the period of record, (6) a graph showing annual flow duration, (7) a table of monthly and annual flow duration, (8) a table of high-flow frequency data (maximum mean discharge for 3-, 7-, 15-, and 30-day periods for selected exceedance probabilities), and (9) a table of low-flow frequency data (minimum mean discharge for 3-, 7-, 15-, 30-, 60-, 90-, and 183-day periods for selected non-exceedance probabilities).

Water-resources investigations in Wisconsin, 1993

USGS Publications Warehouse

Maertz, D.E.

1993-01-01

OBJECTIVE: The objectives of this study are to provide continuous discharge records for selected rivers at specific sites to supply the needs for: regulation, analytical studies, definition of statistical properties, trends analysis, determination of the occurrence, and distribution of water in streams for planning. The project is also designed to determine lake levels and to provide discharge for floods, low-flow conditions, and for water-quality investigations. Requests for streamflow data and information relating to streamflow in Wisconsin are answered. Basic data are published annually in "Water Resources Data Wisconsin."

Partial discharge detection and analysis in low pressure environments

NASA Astrophysics Data System (ADS)

Liu, Xin

Typical aerospace vehicles (aircraft and spacecraft) experience a wide range of operating pressures during ascending and returning to earth. Compared to the sea-level atmospheric pressure (760 Torr), the pressure at about 60 km altitude is 2 Torr. The performance of the electric power system components of the aerospace vehicles must remain reliable even under such sub-atmospheric operating conditions. It is well known that the dielectric strength of gaseous insulators, while the electrode arrangement remains unchanged, is pressure dependent. Therefore, characterization of the performance and behavior of the electrical insulation in flight vehicles in low-pressure environments is extremely important. Partial discharge testing is one of the practical methods for evaluating the integrity of electrical insulation in aerospace vehicles. This dissertation describes partial discharge (PD) measurements performed mainly with 60 Hz ac energization in air, argon and helium, for pressures between 2 and 760 Torr. Two main electrode arrangements were used. One was a needle-plane electrode arrangement with a Teflon insulating barrier. The other one was a twisted pair of insulated conductors taken from a standard aircraft wiring harness. The measurement results are presented in terms of typical PD current pulse waveforms and waveform analysis for both main electrode arrangements. The evaluation criteria are the waveform polarity, magnitude, shape, rise time, and phase angle (temporal location) relative to the source voltage. Two-variable histograms and statistical averages of the PD parameters are presented. The PD physical mechanisms are analyzed. For PD pattern recognition, both statistical methods (such as discharge parameter dot pattern representation, discharge parameter phase distribution, statistical operator calculations, and PD fingerprint development) and wavelet transform applications are investigated. The main conclusions of the dissertation include: (1) The PD current pulse waveforms are dependent on the pressure. (2) The rise time of the waveform is another effective PD current pulse characteristic indicator. (3) PD fingerprint patterns that are already available for atmospheric pressure (760 Torr) conditions are inadequate for the evaluation of PD pulses at low pressures. (4) Various wavelet transform techniques can be used effectively for PD pulse signal denoising purposes, and for PD pulse waveform transient feature recognition.

Streamflow characteristics of streams in southeastern Afghanistan

USGS Publications Warehouse

Vining, Kevin C.

2010-01-01

Statistical summaries of streamflow data for all historical streamgaging stations that have available data in the southeastern Afghanistan provinces of Ghazni, Khost, Logar, Paktya, and Wardak, and a portion of Kabul Province are presented in this report. The summaries for each streamgaging station include a station desciption, table of statistics of monthly and annual mean discharges, table of monthly and annual flow duration, table of probability of occurrence of annual high discharges, table of probability of occurrence of annual low discharges, table of annual peak discharge and corresponding gage height for the period of record, and table of monthly and annual mean discharges for the period of record.

Potentiometric surfaces of the upper glacial and Magothy aquifers and selected streamflow statistics, 1943-72, on Long Island, New York

USGS Publications Warehouse

Vaupel, Donald E.; Prince, K.R.; Koehler, A.J.; Runco, Mario

1977-01-01

A brief text describes the two major aquifers and the discharge pattern of major streams on Long Island. Four water-table maps for the years 1943, 1959, 1966, and 1972, an average water-table map for the period 1943-72 supplemented by five well hydrographs representing Kings, Queens, western Nassau, eastern Nassau, and Suffolk Counties, and three potentiometric- surface maps of the Magothy aquifer for the years 1959, 1966, and 1972 are included. A statistical summary of stream discharge presents average annual discharges, annual average discharges, and average 7-day, 10-year low-flow discharges for major streams.

Laboratory Measurements of X-Ray Emissions From Centimeter-Long Streamer Corona Discharges

NASA Astrophysics Data System (ADS)

da Silva, C. L.; Millan, R. M.; McGaw, D. G.; Yu, C. T.; Putter, A. S.; LaBelle, J.; Dwyer, J.

2017-11-01

We provide extensive evidence that runaway electron acceleration and subsequent bremsstrahlung X-ray emission are a common feature in negative electrical discharges with voltages as low as 100 kV, indicating that all negative lightning could potentially produce runaway electrons. Centimeter long streamer corona discharges produce bursts of X-ray radiation, emitted by a source highly compact in space and time, leading to photon pileup. Median photon burst energies vary between 33 and 96 keV in 100 kV discharges. Statistical analysis of 5,000+ discharges shows that X-rays are observed in as many as 60% of the triggers, depending on the configuration. X-ray detection is more frequent when streamers are not followed by a spark, the detector is oriented perpendicular to the gap, and a thicker anode is used. In an 8-cm-long gap, X-rays are produced when runaway electrons hit the anode, and the electron acceleration is not necessarily correlated with streamer collisions.

Agreement between admission and discharge diagnoses: Analysis by the groups of international classification of diseases, 10th revision.

PubMed

Mihailović, Nataša; Trajković, Goran; Simić-Vukomanović, Ivana; Ristić, Svetlana; Kocić, Sanja

2016-12-01

Admission diagnosis represents the diagnosis of an illness, injury or condition due to which a patient is referred to hospital to be admitted. Discharge diagnosis represents the main reason of illness or condition due to which a patient is admitted. The aim of this study was to analyze the agreement between admission diagnostic groups and discharge diagnostic groups of patients in the Clinical Center Kragujevac in the period from January 1, 2006 to December 31, 2013 on the basis of the hospitalization report. From the basic set of reports, 5% of random samples were singled out and they contained 20,422 reports. Out of the given number of reports, 18,173 hospitalization reports were complete and then further analyzed in the paper. Admission diagnostic groups given by the primary care doctor were compared with discharge diagnostic groups filled out by the practicing physician in the hospital ward from which a patient was discharged. The agreement of these two diagnostic groups was an indication of the high-quality performance of the primary care doctor. Agreement analysis was conducted using Cohen’s Kappa statistics. Agreement analysis showed that the values of the Kappa coefficient for the five leading admission diagnostic groups were in the range of κ = 0.61 to κ = 0.94. The values of the Kappa coefficient for the five most common discharge diagnostic groups were in the range of κ = 0.55 to κ = 0.81. Hospitalization report is a reliable individual report on inpatient care, so it could be used in determining the degree of agreement between admission diagnostic groups and discharge diagnostic groups.

Nutrient-enriched formula versus standard term formula for preterm infants following hospital discharge.

PubMed

Henderson, G; Fahey, T; McGuire, W

2007-10-17

Preterm infants are often growth-restricted at hospital discharge. Feeding infants after hospital discharge with nutrient-enriched formula rather than standard term formula might facilitate "catch-up" growth and improve development. To determine the effect of feeding nutrient-enriched formula compared with standard term formula on growth and development for preterm infants following hospital discharge. The standard search strategy of the Cochrane Neonatal Review Group were used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2007), MEDLINE (1966 - May 2007), EMBASE (1980 - May 2007), CINAHL (1982 - May 2007), conference proceedings, and previous reviews. Randomised or quasi-randomised controlled trials that compared the effect of feeding preterm infants following hospital discharge with nutrient-enriched formula compared with standard term formula. Data was extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two authors, and synthesis of data using weighted mean difference and a fixed effects model for meta-analysis. Seven trials were found that were eligible for inclusion. These recruited a total of 631 infants and were generally of good methodological quality. The trials found little evidence that feeding with nutrient-enriched formula milk affected growth and development. Because of differences in the way individual trials measured and presented outcomes, data synthesis was limited. Growth data from two trials found that, at six months post-term, infants fed with nutrient-enriched formula had statistically significantly lower weights [weighted mean difference: -601 (95% confidence interval -1028, -174) grams], lengths [-18.8 (-30.0, -7.6) millimetres], and head circumferences [-10.2 ( -18.0, -2.4) millimetres], than infants fed standard term formula. At 12 to 18 months post-term, meta-analyses of data from three trials did not find any statistically significant differences in growth parameters. However, examination of these meta-analyses demonstrated statistical heterogeneity. Meta-analyses of data from two trials did not reveal a statistically significant difference in Bayley Mental Development or Psychomotor Development Indices. There are not yet any data on growth or development through later childhood. The available data do not provide strong evidence that feeding preterm infants following hospital discharge with nutrient-enriched formula compared with standard term formula affects growth rates or development up to 18 months post-term.

Correspondence analysis to evaluate the transmission of Staphylococcus aureus strains in two New York State maximum-security prisons.

PubMed

Befus, M; Mukherjee, D V; Herzig, C T A; Lowy, F D; Larson, E

2017-07-01

Prisons/jails are thought to amplify the transmission of Staphylococcus aureus (SA) particularly methicillin-resistant SA infection and colonisation. Two independently pooled cross-sectional samples of detainees being admitted or discharged from two New York State maximum-security prisons were used to explore this concept. Private interviews of participants were conducted, during which the anterior nares and oropharynx were sampled and assessed for SA colonisation. Log-binomial regression and correspondence analysis (CA) were used to evaluate the prevalence of colonisation at entry as compared with discharge. Approximately 51% of admitted (N = 404) and 41% of discharged (N = 439) female detainees were colonised with SA. Among males, 59% of those admitted (N = 427) and 49% of those discharged (N = 393) were colonised. Females had a statistically significant higher prevalence (1·26: P = 0·003) whereas males showed no significant difference (1·06; P = 0·003) in SA prevalence between entry and discharge. CA demonstrated that some strains, such as spa types t571 and t002, might have an affinity for certain mucosal sites. Contrary to our hypothesis, the prison setting did not amplify SA transmission, and CA proved to be a useful tool in describing the population structure of strains according to time and/or mucosal site.

Water-resources investigations in Wisconsin: Programs and activities of the U.S. Geological Survey, 1991-92

USGS Publications Warehouse

Maertz, D.E.

1992-01-01

OBJECTIVE: The objectives of this study are to provide continuous discharge records for selected rivers at specific sites to supply the needs for: regulation, analytical studies, definition of statistical properties, trends analysis, determination of the occurrence, and distribution of water in streams for planning. The project is also designed to determine lake levels and to provide discharge for floods, low-flow conditions, and for water-quality investigations. Requests for streamflow data and information relating to streamflow in Wisconsin are answered. Basic data are published annually in "Water Resources Data Wisconsin."

Water-resources investigations in Wisconsin

USGS Publications Warehouse

Maertz, D.E.

1996-01-01

OBJECTIVE: The objectives of this study are to provide continuous discharge records for selected rivers at specific sites to supply the needs for regulation, analytical studies, definition of statistical properties, trends analysis, determination of the occurrence, and distribution of water in streams for planning. The project is also LOCATION: Statewide PROJECT CHIEF: Barry K. Holmstrom PERIOD OF PROJECT: July 1913-Continuing designed to determine lake levels and to provide discharge for floods, low-flow conditions, and for waterquality investigations. Requests for streamflow data and information relating to streamflow in Wisconsin are answered. Basic data are published annually in the report "Water Resources Data-Wisconsin."

Spectral Analysis; Applications in Water Pollution Control.

ERIC Educational Resources Information Center

Wastler, T. A.

The statistical technique of analyzing data collected at regular intervals to reveal periodic components of the data is described by reference to actual records. The data chosen for illustration include tide height in a river; biochemical oxygen demand and dissolved oxygen in the same river; discharged salt into a river system and its relation to…

Bankfull discharge and channel characteristics of streams in New York State

USGS Publications Warehouse

Mulvihill, Christiane I.; Baldigo, Barry P.; Miller, Sarah J.; DeKoskie, Douglas; DuBois, Joel

2009-01-01

Equations that relate drainage area to bankfull discharge and channel characteristics (such as width, depth, and cross-sectional area) at gaged sites are needed to help define bankfull discharge and channel characteristics at ungaged sites and can be used in stream-restoration and protection projects, stream-channel classification, and channel assessments. These equations are intended to serve as a guide for streams in areas of similar hydrologic, climatic, and physiographic conditions. New York State contains eight hydrologic regions that were previously delineated on the basis of high-flow (flood) characteristics. This report seeks to increase understanding of the factors affecting bankfull discharge and channel characteristics to drainage-area size relations in New York State by providing an in-depth analysis of seven previously published regional bankfull-discharge and channel-characteristics curves.Stream-survey data and discharge records from 281 cross sections at 82 streamflow-gaging stations were used in regression analyses to relate drainage area to bankfull discharge and bankfull-channel width, depth, and cross-sectional area. The R2 and standard errors of estimate of each regional equation were compared to the R2 and standard errors of estimate for the statewide (pooled) model to determine if regionalizing data reduced model variability. It was found that regional models typically yield less variable results than those obtained using pooled statewide equations, which indicates statistically significant regional differences in bankfull-discharge and channel-characteristics relations.Statistical analysis of bankfull-discharge relations found that curves for regions 4 and 7 fell outside the 95-percent confidence interval bands of the statewide model and had intercepts that were significantly diferent (p≤0.10) from the other five hydrologic regions.Analysis of channel-characteristics relations found that the bankfull width, depth, and cross-sectional area curves for region 3 were significantly different p(≤0.05) from the other six regions.It was hypothesized that some regional variability could be reduced by creating models for streams with similar physiographic and climatic characteristics. Available data on streamflow patterns and previous regional-curve research suggested that mean annual runoff, Rosgen stream type, and water-surface slope were the variables most likely to influence regional bankfull discharge and channel characteristics to drainage-area size relations. Results showed that although all of these factors had an influence on regional relations, most stratified models have lower 2 values and higher standard errors of estimate than the regional models.The New York statewide (pooled) bankfull-discharge equation and equations for regions 4 and 7 were compared with equations for four other regions in the Northeast to evaluate region-to-region differences, and assess the ability of individual curves to produce results more accurate than those that would be obtained from one model of the northeastern United States. Results indicated that model slopes lack significant diferences, though intercepts are significantly different. Comparison of bankfull-discharge estimates using different models shows that results could vary by as much as 100 percent depending on which model was used and indicated that regionalization improved model accuracy.

Stage-discharge relationship in tidal channels

NASA Astrophysics Data System (ADS)

Kearney, W. S.; Mariotti, G.; Deegan, L.; Fagherazzi, S.

2016-12-01

Long-term records of the flow of water through tidal channels are essential to constrain the budgets of sediments and biogeochemical compounds in salt marshes. Statistical models which relate discharge to water level allow the estimation of such records from more easily obtained records of water stage in the channel. While there is clearly structure in the stage-discharge relationship, nonlinearity and nonstationarity of the relationship complicates the construction of statistical stage-discharge models with adequate performance for discharge estimation and uncertainty quantification. Here we compare four different types of stage-discharge models, each of which is designed to capture different characteristics of the stage-discharge relationship. We estimate and validate each of these models on a two-month long time series of stage and discharge obtained with an Acoustic Doppler Current Profiler in a salt marsh channel. We find that the best performance is obtained by models which account for the nonlinear and time-varying nature of the stage-discharge relationship. Good performance can also be obtained from a simplified version of these models which approximates the fully nonlinear and time-varying models with a piecewise linear formulation.

Redesigning the ICU nursing discharge process: a quality improvement study.

PubMed

Chaboyer, Wendy; Lin, Frances; Foster, Michelle; Retallick, Lorraine; Panuwatwanich, Kriengsak; Richards, Brent

2012-02-01

To evaluate the impact of a redesigned intensive care unit (ICU) nursing discharge process on ICU discharge delay, hospital mortality, and ICU readmission within 72 hours. A quality improvement study using a time series design and statistical process control analysis was conducted in one Australian general ICU. The primary outcome measure was hours of discharge delay per patient discharged alive per month, measured for 15 months prior to, and for 12 months after the redesigned process was implemented. The redesign process included appointing a change agent to facilitate process improvement, developing a patient handover sheet, requesting ward staff to nominate an estimated transfer time, and designing a daily ICU discharge alert sheet that included an expected date of discharge. A total of 1,787 ICU discharges were included in this study, 1,001 in the 15 months before and 786 in the 12 months after the implementation of the new discharge processes. There was no difference in in-hospital mortality after discharge from ICU or ICU readmission within 72 hours during the study period. However, process improvement was demonstrated by a reduction in the average patient discharge delay time of 3.2 hours (from 4.6 hour baseline to 1.0 hours post-intervention). Involving both ward and ICU staff in the redesign process may have contributed to a shared situational awareness of the problems, which led to more timely and effective ICU discharge processes. The use of a change agent, whose ongoing role involved follow-up of patients discharged from ICU, may have helped to embed the new process into practice. ©2011 Sigma Theta Tau International.

Robust multiscale prediction of Po River discharge using a twofold AR-NN approach

NASA Astrophysics Data System (ADS)

Alessio, Silvia; Taricco, Carla; Rubinetti, Sara; Zanchettin, Davide; Rubino, Angelo; Mancuso, Salvatore

2017-04-01

The Mediterranean area is among the regions most exposed to hydroclimatic changes, with a likely increase of frequency and duration of droughts in the last decades and potentially substantial future drying according to climate projections. However, significant decadal variability is often superposed or even dominates these long-term hydrological trend as observed, for instance, in North Italian precipitation and river discharge records. The capability to accurately predict such decadal changes is, therefore, of utmost environmental and social importance. In order to forecast short and noisy hydroclimatic time series, we apply a twofold statistical approach that we improved with respect to previous works [1]. Our prediction strategy consists in the application of two independent methods that use autoregressive models and feed-forward neural networks. Since all prediction methods work better on clean signals, the predictions are not performed directly on the series, but rather on each significant variability components extracted with Singular Spectrum Analysis (SSA). In this contribution, we will illustrate the multiscale prediction approach and its application to the case of decadal prediction of annual-average Po River discharges (Italy). The discharge record is available for the last 209 years and allows to work with both interannual and decadal time-scale components. Fifteen-year forecasts obtained with both methods robustly indicate a prominent dry period in the second half of the 2020s. We will discuss advantages and limitations of the proposed statistical approach in the light of the current capabilities of decadal climate prediction systems based on numerical climate models, toward an integrated dynamical and statistical approach for the interannual-to-decadal prediction of hydroclimate variability in medium-size river basins. [1] Alessio et. al., Natural variability and anthropogenic effects in a Central Mediterranean core, Clim. of the Past, 8, 831-839, 2012.

Special Flood Hazard Evaluation Report, Maumee River, Defiance and Paulding Counties, Ohio

DTIC Science & Technology

1988-01-01

into the Flood Flow Frequency Analysis (FFFA) computer program (Reference 3) to determine the discharge-frequency relationship for the Maumee River...although the flood may occur in any year. It is based on statistical analysis of streamflow records available for the watershed and analysis of rainfall...C) K) K4 10 ERFODBUDR .S ryEgne itit ufI N - FODA ONAYSEIA LO AADEAUTO 6 ? -F -C )I= ~ - %E )tvXJ. AE LO LVTO MAMERVE CROS SECIONLOCAION DEFINCEAND

Automatic location of L/H transition times for physical studies with a large statistical basis

NASA Astrophysics Data System (ADS)

González, S.; Vega, J.; Murari, A.; Pereira, A.; Dormido-Canto, S.; Ramírez, J. M.; contributors, JET-EFDA

2012-06-01

Completely automatic techniques to estimate and validate L/H transition times can be essential in L/H transition analyses. The generation of databases with hundreds of transition times and without human intervention is an important step to accomplish (a) L/H transition physics analysis, (b) validation of L/H theoretical models and (c) creation of L/H scaling laws. An entirely unattended methodology is presented in this paper to build large databases of transition times in JET using time series. The proposed technique has been applied to a dataset of 551 JET discharges between campaigns C21 and C26. A prediction with discharges that show a clear signature in time series is made through the locating properties of the wavelet transform. It is an accurate prediction and the uncertainty interval is ±3.2 ms. The discharges with a non-clear pattern in the time series use an L/H mode classifier based on discharges with a clear signature. In this case, the estimation error shows a distribution with mean and standard deviation of 27.9 ms and 37.62 ms, respectively. Two different regression methods have been applied to the measurements acquired at the transition times identified by the automatic system. The obtained scaling laws for the threshold power are not significantly different from those obtained using the data at the transition times determined manually by the experts. The automatic methods allow performing physical studies with a large number of discharges, showing, for example, that there are statistically different types of transitions characterized by different scaling laws.

32 CFR 865.122 - Summary of statistics for Discharge Review Board.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Summary of statistics for Discharge Review Board. 865.122 Section 865.122 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE... Deputy Assistant Secretary of Defense (Military Personnel and Force Management) DASD(MP&FM), Office of...

32 CFR 865.122 - Summary of statistics for Discharge Review Board.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false Summary of statistics for Discharge Review Board. 865.122 Section 865.122 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE... Deputy Assistant Secretary of Defense (Military Personnel and Force Management) DASD(MP&FM), Office of...

Attenuated total reflectance-FT-IR spectroscopy for gunshot residue analysis: potential for ammunition determination.

PubMed

Bueno, Justin; Sikirzhytski, Vitali; Lednev, Igor K

2013-08-06

The ability to link a suspect to a particular shooting incident is a principal task for many forensic investigators. Here, we attempt to achieve this goal by analysis of gunshot residue (GSR) through the use of attenuated total reflectance (ATR) Fourier transform infrared spectroscopy (FT-IR) combined with statistical analysis. The firearm discharge process is analogous to a complex chemical process. Therefore, the products of this process (GSR) will vary based upon numerous factors, including the specific combination of the firearm and ammunition which was discharged. Differentiation of FT-IR data, collected from GSR particles originating from three different firearm-ammunition combinations (0.38 in., 0.40 in., and 9 mm calibers), was achieved using projection to latent structures discriminant analysis (PLS-DA). The technique was cross (leave-one-out), both internally and externally, validated. External validation was achieved via assignment (caliber identification) of unknown FT-IR spectra from unknown GSR particles. The results demonstrate great potential for ATR-FT-IR spectroscopic analysis of GSR for forensic purposes.

Application of acoustic doppler velocimeters for streamflow measurements

USGS Publications Warehouse

Rehmel, M.

2007-01-01

The U.S. Geological Survey (USGS) principally has used Price AA and Price pygmy mechanical current meters for measurement of discharge. New technologies have resulted in the introduction of alternatives to the Price meters. One alternative, the FlowTracker acoustic Doppler velocimeter, was designed by SonTek/YSI to make streamflow measurements in wadeable conditions. The device measures a point velocity and can be used with standard midsection method algorithms to compute streamflow. The USGS collected 55 quality-assurance measurements with the FlowTracker at 43 different USGS streamflow-gaging stations across the United States, with mean depths from 0.05to0.67m, mean velocities from 13 to 60 cm/s, and discharges from 0.02 to 12.4m3/s. These measurements were compared with Price mechanical current meter measurements. Analysis of the comparisons shows that the FlowTracker discharges were not statistically different from the Price meter discharges at a 95% confidence level. ?? 2007 ASCE.

Analysis of potential errors in real-time streamflow data and methods of data verification by digital computer

USGS Publications Warehouse

Lystrom, David J.

1972-01-01

Various methods of verifying real-time streamflow data are outlined in part II. Relatively large errors (those greater than 20-30 percent) can be detected readily by use of well-designed verification programs for a digital computer, and smaller errors can be detected only by discharge measurements and field observations. The capability to substitute a simulated discharge value for missing or erroneous data is incorporated in some of the verification routines described. The routines represent concepts ranging from basic statistical comparisons to complex watershed modeling and provide a selection from which real-time data users can choose a suitable level of verification.

Evaluation of related factors and the outcome in cardiac arrest resuscitation at Thammasat Emergency Department.

PubMed

Amnuaypattanapon, Kumpol; Udomsubpayakul, Umaporn

2010-12-01

In the present study, we aimed to define the factors contributing to patient survival after treatment by cardiopulmonary resuscitation (CPR) following cardiac arrest. Retrospective analysis was performed on cardiac arrest patients (n=138) who had CPR in the emergency department (ED) at Thammasat University hospital from 2007-2009. Logistic regression was used to analyze factors that related to the sustained return of spontaneous circulation (ROSC) for 20 minutes, survival until discharge, and survival up to 1 month post discharge. The sustained ROSC was 22.5%, survival to discharge 5.6%, and survival from discharge to 1 month 3.6%. Significant factors related to sustained ROSC was the location of cardiac arrest, the cause of arrest, shockable rhythm with defibrillation, the time until chest compression, and CPR duration. The factor influencing survival to discharge was chest compression performed within 15 minutes after cardiac arrest (p = 0.048). No factor however could be attributed to survivability up to 1 month following discharge. Our findings attribute six factors associated to ROSC including the location of arrest, the cause of cardiac arrest, initial cardiac rhythm, shockable rhythm with defibrillation, the time until chest compression and CPR duration. Statistically, resuscitation performed within 15 minutes of cardiac arrest increases the survivability of patients until discharge. However no factors could be related to the percentage of patients surviving up to 1 month post discharge.

[Computer-supported patient history: a workplace analysis].

PubMed

Schubiger, G; Weber, D; Winiker, H; Desgrandchamps, D; Imahorn, P

1995-04-29

Since 1991, an extensive computer network has been developed and implemented at the Cantonal Hospital of Lucerne. The medical applications include computer aided management of patient charts, medical correspondence, and compilation of diagnosis statistics according to the ICD-9 code. In 1992, the system was introduced as a pilot project in the departments of pediatrics and pediatric surgery of the Lucerne Children's Hospital. This new system has been prospectively evaluated using a workplace analysis. The time taken to complete patient charts and surgical reports was recorded for 14 days before and after the introduction of the computerized system. This analysis was performed for both physicians and secretarial staff. The time delay between the discharge of the patient and the mailing of the discharge letter to the family doctor was also recorded. By conventional means, the average time for the physician to generate a patient chart (26 minutes, n = 119) was slightly lower than the time needed with the computer system (28 minutes, n = 177). However, for a discharge letter, the time needed by the physician was reduced by one third with the computer system and by more than one half for the secretarial staff (32 and 66 minutes conventionally; 22 and 24 minutes respectively with the computer system; p < 0.0001). The time required for the generation of surgical reports was reduced from 17 to 13 minutes per patient and the processing time by secretaries from 37 to 14 minutes. The time delay between the discharge of the patient and the mailing of the discharge letter was reduced by 50% from 7.6 to 3.9 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Analysis and assessment on heavy metal sources in the coastal soils developed from alluvial deposits using multivariate statistical methods.

PubMed

Li, Jinling; He, Ming; Han, Wei; Gu, Yifan

2009-05-30

An investigation on heavy metal sources, i.e., Cu, Zn, Ni, Pb, Cr, and Cd in the coastal soils of Shanghai, China, was conducted using multivariate statistical methods (principal component analysis, clustering analysis, and correlation analysis). All the results of the multivariate analysis showed that: (i) Cu, Ni, Pb, and Cd had anthropogenic sources (e.g., overuse of chemical fertilizers and pesticides, industrial and municipal discharges, animal wastes, sewage irrigation, etc.); (ii) Zn and Cr were associated with parent materials and therefore had natural sources (e.g., the weathering process of parent materials and subsequent pedo-genesis due to the alluvial deposits). The effect of heavy metals in the soils was greatly affected by soil formation, atmospheric deposition, and human activities. These findings provided essential information on the possible sources of heavy metals, which would contribute to the monitoring and assessment process of agricultural soils in worldwide regions.

[A functional statistical analysis of the action potentials in the brain multineuronal activity of waking cats].

PubMed

Merzhanova, G Kh; Porada, I

1990-01-01

In the present work a method is substantiated of the correction of singled out impulses series by identification of parameters of neurones discharges (PD) during a long period of recording (up to 120 days) of the neuronal activity by means of chronically implanted nichrome semimicroelectrode in different brain part of alert cats.

Exploring dangerous neighborhoods: Latent Semantic Analysis and computing beyond the bounds of the familiar

PubMed Central

Cohen, Trevor; Blatter, Brett; Patel, Vimla

2005-01-01

Certain applications require computer systems to approximate intended human meaning. This is achievable in constrained domains with a finite number of concepts. Areas such as psychiatry, however, draw on concepts from the world-at-large. A knowledge structure with broad scope is required to comprehend such domains. Latent Semantic Analysis (LSA) is an unsupervised corpus-based statistical method that derives quantitative estimates of the similarity between words and documents from their contextual usage statistics. The aim of this research was to evaluate the ability of LSA to derive meaningful associations between concepts relevant to the assessment of dangerousness in psychiatry. An expert reference model of dangerousness was used to guide the construction of a relevant corpus. Derived associations between words in the corpus were evaluated qualitatively. A similarity-based scoring function was used to assign dangerousness categories to discharge summaries. LSA was shown to derive intuitive relationships between concepts and correlated significantly better than random with human categorization of psychiatric discharge summaries according to dangerousness. The use of LSA to derive a simulated knowledge structure can extend the scope of computer systems beyond the boundaries of constrained conceptual domains. PMID:16779020

Cervical cytopathological changes among women with vaginal discharge attending teaching hospital.

PubMed

Salih, Magdi M; AlHag, Fatma Tage El Sir; Khalifa, Mohammed Ahmed; El Nabi, Abdulla H

2017-01-01

To find cytology changes among women attending obstetrics and gynaecology clinic with complaints of vaginal discharges. This descriptive hospital-based cytological study was conducted at the outpatient clinic of the obstetrics and gynaecology department. Two hundred women with complaints of vaginal discharge were selected. Their detailed histories were documented on a special request form. Pap smears were then obtained and sent for cytological examination to the cytopathology department. All low-grade squamous intraepithelial lesion (LSIL) cases were advised to follow-up with Pap smears in the next 6-12 months. Those with high-grade squamous intraepithelial lesion (HSIL) were further investigated by a cervical biopsy and managed accordingly. The statistical analysis was performed using, the Statistical Package for Social Science (SPSS). Chi-square and cross-tabulation were used in this study. The cytological examination of Pap smears showed no changes (i.e. negative findings) in 88 (44%) cases, while Candida species infection was the most prevalent, which was found in 67 (33.5%) of the cases. Bacterial vaginosis was found in 39 women (19.5%); 6 women (3%) were reported with dyskaryotic changes. Two cases were found to have LSIL and 4 women had HSIL. Infection is common among the illiterate group of women. Women with vaginal discharges should undergo screening tests for evaluation by cervical smear for the early detection of cervical precancer conditions. There is an urgent need to establish a screening program for cervical cancer in Sudan.

Effects of Inaccurate Identification of Interictal Epileptiform Discharges in Concurrent EEG-fMRI

NASA Astrophysics Data System (ADS)

Gkiatis, K.; Bromis, K.; Kakkos, I.; Karanasiou, I. S.; Matsopoulos, G. K.; Garganis, K.

2017-11-01

Concurrent continuous EEG-fMRI is a novel multimodal technique that is finding its way into clinical practice in epilepsy. EEG timeseries are used to identify the timing of interictal epileptiform discharges (IEDs) which is then included in a GLM analysis in fMRI to localize the epileptic onset zone. Nevertheless, there are still some concerns about its reliability concerning BOLD changes correlated with IEDs. Even though IEDs are identified by an experienced neurologist-epiliptologist, the reliability and concordance of the mark-ups is depending on many factors including the level of fatigue, the amount of time that he spent or, in some cases, even the screen that is being used for the display of timeseries. This investigation is aiming to unravel the effect of misidentification or inaccuracy in the mark-ups of IEDs in the fMRI statistical parametric maps. Concurrent EEG-fMRI was conducted in six subjects with various types of epilepsy. IEDs were identified by an experienced neurologist-epiliptologist. Analysis of EEG was performed with EEGLAB and analysis of fMRI was conducted in FSL. Preliminary results revealed lower statistical significance for missing events or larger period of IEDs than the actual ones and the introduction of false positives and false negatives in statistical parametric maps when random events were included in the GLM on top of the IEDs. Our results suggest that mark-ups in EEG for simultaneous EEG-fMRI should be done with caution from an experienced and restful neurologist as it affects the fMRI results in various and unpredicted ways.

How do clinicians with different training backgrounds manage walk-in patients in the ED setting?

PubMed

Harris, Tim; McDonald, Keith

2014-12-01

To compare the initial assessment and management of walk-in emergency department (ED) patients between different types of healthcare providers. A large teaching hospital with an annual ED census of 140 000 adult patients. A random sample of 384 patients who self-presented to the ED was obtained. A detailed analysis of each patient record was performed by two clinicians. Data were obtained on the presenting condition, and disposition of each patient, either into the ED for further assessment, or discharge. GPs were significantly more likely to discharge patients home as compared to emergency nurses. ED senior nurses were more likely than GPs to stream patients into the ED for further assessment. Of the patients referred into the ED for further assessment by senior ED nurses, the majority were discharged home. There were insufficient numbers of emergency physician assessments for meaningful statistical analysis. The clinician groups studied here demonstrated different patterns of discharge and referral, reflecting their training and experience. When planning operational procedures, the training and background of the staff allocated to each area should be considered. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Necessary storage as a signature of discharge variability: towards global maps

NASA Astrophysics Data System (ADS)

Takeuchi, Kuniyoshi; Masood, Muhammad

2017-09-01

This paper proposes the use of necessary storage to smooth out discharge variability to meet a discharge target as a signature of discharge variability in time. Such a signature has a distinct advantage over other statistical indicators such as standard deviation (SD) or coefficient of variation (CV) as it expresses hydrological variability in human terms, which directly indicates the difficulty and ease of managing discharge variation for water resource management. The signature is presented in the form of geographical distribution, in terms of both necessary storage (km3) and normalized necessary storage (months), and is related to the basin characteristics of hydrological heterogeneity. The signature is analyzed in different basins considering the Hurst equation of range as a reference. The slope of such a relation and the scatter of departures from the average relation are analyzed in terms of their relationship with basin characteristics. As a method of calculating necessary storage, the flood duration curve (FDC) and drought duration curve (DDC) methods are employed in view of their relative advantage over other methods to repeat the analysis over many grid points. The Ganges-Brahmaputra-Meghna (GBM) basin is selected as the case study and the BTOPMC hydrological model with Water and Global Change (WATCH) Forcing Data (WFD) is used for estimating FDC and DDC. It is concluded that the necessary storage serves as a useful signature of discharge variability, and its analysis could be extended to the entire globe and in this way seek new insights into hydrological variability in the storage domain at a larger range of scales.

Survival in Malnourished Older Patients Receiving Post-Discharge Nutritional Support; Long-Term Results of a Randomized Controlled Trial.

PubMed

Neelemaat, F; van Keeken, S; Langius, J A E; de van der Schueren, M A E; Thijs, A; Bosmans, J E

2017-01-01

Previous analyses have shown that a post-discharge individualized nutritional intervention had positive effects on body weight, lean body mass, functional limitations and fall incidents in malnourished older patients. However, the impact of this intervention on survival has not yet been studied. The objective of this randomized controlled study was to examine the effect of a post-discharge individualized nutritional intervention on survival in malnourished older patients. Malnourished older patients, aged ≥ 60 years, were randomized during hospitalization to a three-months post-discharge nutritional intervention group (protein and energy enriched diet, oral nutritional supplements, vitamin D3/calcium supplement and telephone counseling by a dietitian) or to a usual care regimen (control group). Survival data were collected 4 years after enrollment. Survival analyses were performed using intention-to-treat analysis by Log-rank tests and Cox regression adjusted for confounders. The study population consisted of 94 men (45%) and 116 women with a mean age of 74.5 (SD 9.5) years. There were no statistically significant differences in baseline characteristics. Survival data was available in 208 out of 210 patients. After 1 and 4 years of follow-up, survival rates were respectively 66% and 29% in the intervention group (n=104) and 73% and 30% in the control group (n=104). There were no statistically significant differences in survival between the two groups 1 year (HR= 0.933, 95% CI=0.675-1.289) and 4 years after enrollment (HR=0.928, 95% CI=0.671-1.283). The current study failed to show an effect of a three-months post-discharge multi-component nutritional intervention in malnourished older patients on long-term survival, despite the positive effects on short-term outcome such as functional limitations and falls.

Influence of cerebral white matter lesions on the activities of daily living of older patients with mild stroke.

PubMed

Yamashita, Yutaka; Wada, Ikuo; Horiba, Mitsuya; Sahashi, Kento

2016-08-01

Neurological symptom severity is a prognostic factor for post-stroke activities of daily living (ADL). Recently, it has been reported that white matter lesions indicate poor functional prognosis in patients with stroke. The present study investigated the influence of white matter lesions on the ADL of older patients with stroke who have mild neurological symptoms. We investigated ADL at discharge in 44 patients with stroke (men, n = 27; women, n = 17; mean age 78 years [range 71-85 years]) aged ≥65 years with National Institutes of Health Stroke Scale scores of ≤5 (cerebral infarction, n = 37; cerebral hemorrhage, n = 7). We used single correlation analysis and multiple regression analysis to investigate factors that correlated with ADL at discharge. ADL at discharge was also evaluated on the basis of white matter lesion severity (Fazekas classification, grades 0-3). Single correlation analysis showed that age (r = -0.36, P = 0.016), male sex (r = 0.362, P = 0.016), neurological symptom severity (r = -0.361, P = 0.016), ADL on starting rehabilitation (r = 0.685, P < 0.001) and white matter lesion severity (r = -0.361, P = 0.016) significantly correlated with ADL at discharge. Multiple regression analysis showed that ADL on starting rehabilitation (β = 0.519, t = 4.723, P < 0.001) and white matter lesion severity (β = -0.309, t = -3.057, P < 0.01) were statistically significant prognostic factors for ADL at discharge. ADL at discharge score was significantly lower in the group with high white matter lesion severity (Fazekas, grade 2) than in the other two groups (Fazekas, grade 0, P < 0.01; Fazekas, grade 1, P < 0.05). Severe white matter lesions are a prognostic factor for poor ADL at discharge in older patients with stroke who have mild neurological symptoms. Geriatr Gerontol Int 2016; 16: 942-947. © 2015 Japan Geriatrics Society.

Hydrologic drivers and controls of stream biofilm-grazer interactions

NASA Astrophysics Data System (ADS)

Ceola, S.; Bertuzzo, E.; Mari, L.; Botter, G.; Hödl, I.; Battin, T.; Rinaldo, A.

2012-04-01

Understanding the dynamics of fluvial ecosystems linked to hydrology is one of the most important challenges of ecohydrology. In fact, streamflow, which chiefly relies on rainfall, climate, land use and geomorphologic properties, plays a fundamental role in sustaining and regulating fluvial ecosystem integrity. To analyze possible implications of hydrological fluctuations on the biofilm-grazer interaction, an experimental campaign has been conducted between June and September 2011 at the Wasser Cluster Lunz, in Lunz am See (AU). 36 flumes have been used to perform biofilm growth and grazing activity under two distinct discharge conditions (i.e., constant and stochastic discharge regimes) and four different light regimes (from natural light conditions to nearly 70% attenuation). Experimental results concerning (i) dynamics of biofilm growth, (ii) grazing effect, and (iii) grazing rate will be presented. Results of performed statistical analysis for testing the effects of discharge treatment and light regime on the grazing rate will be also discussed.

Climate and floods still govern California levee breaks

USGS Publications Warehouse

Florsheim, J.L.; Dettinger, M.D.

2007-01-01

Even in heavily engineered river systems, climate still governs flood variability and thus still drives many levee breaks and geomorphic changes. We assemble a 155-year record of levee breaks for a major California river system to find that breaks occurred in 25% of years during the 20th Century. A relation between levee breaks and river discharge is present that sets a discharge threshold above which most levee breaks occurred. That threshold corresponds to small floods with recurrence intervals of ???2-3 years. Statistical analysis illustrates that levee breaks and peak discharges cycle (broadly) on a 12-15 year time scale, in time with warm-wet storm patterns in California, but more slowly or more quickly than ENSO and PDO climate phenomena, respectively. Notably, these variations and thresholds persist through the 20th Century, suggesting that historical flood-control effects have not reduced the occurrence or frequency of levee breaks. Copyright 2007 by the American Geophysical Union.

The impact of climate change on river discharges in Eastern Romania

NASA Astrophysics Data System (ADS)

Croitoru, Adina-Eliza; Minea, Ionut

2014-05-01

Climate changes imply many changes in different socioeconomic and environmental fields. Among the most important impacts are changes in water resources. Long- and mid-term river discharge flow analysis is essential for the effective management of water resources. In this work, the changes in two climatic parameters (temperature and precipitation) and river discharges and the connections between precipitation and river discharges were investigated. Seasonal and annual climatic and hydrological data collected at six weather stations and 17 hydrological stations were employed. The data sets cover 57 years (1950-2006). The modified Mann-Kendall test was used to calculate trends, and the Bravais-Pearson correlation index was chosen to detect the connections between precipitation and river discharge data series. The main findings are as follows: A general increase was identified in all the three parameters. The air temperature data series showed the highest frequency of statistically significant slopes, mainly in annual and spring series. All data series, except the series for winter, showed an increase in precipitation; in winter, a significant decrease in precipitation was observed at most of the stations. The increase in precipitation is reflected in the upward trends of the river discharge flows, as verified by the good Bravais-Pearson correlations, mainly for annual, summer, and autumn series

The impact of climate changes on rivers discharge in Eastern Romania

NASA Astrophysics Data System (ADS)

Croitoru, Adina-Eliza; Minea, Ionus

2015-05-01

Climate changes imply many changes in different socioeconomic and environmental fields. Among the most important impacts are changes in water resources. Long- and mid-term river discharge flow analysis is essential for the effective management of water resources. In this work, the changes in temperature, precipitation, and river discharges as well as the connections between precipitation and river discharges were investigated. Seasonal and annual climatic and hydrological data collected at 6 weather stations and 17 hydrological stations were employed. The data sets cover 57 years (1950-2006). The modified Mann-Kendall test and Sen's slope were used to calculate trends and their slopes, whereas the Bravais-Pearson correlation index was chosen to detect the connections between precipitation and river discharge data series. The main findings are as follows: a general increase was identified in all the three variables; the air temperature data series showed the highest frequency of statistically significant slopes, mainly in annual and spring series; all data series, except the series for winter, showed an increase in precipitation, and in winter, a significant decrease in precipitation was observed at most of the stations. The increase in precipitation is reflected in the upward trends of the river discharge flows, as verified by the good Bravais-Pearson correlations, mainly for annual, summer, and autumn series.

Fast surface temperature measurement of Teflon propellant-in-pulsed ablative discharges using HgCdTe photovoltaic cells

NASA Astrophysics Data System (ADS)

Antonsen, Erik L.; Burton, Rodney L.; Reed, Garrett A.; Spanjers, Gregory G.

2006-10-01

High-speed mercury cadmium telluride photovoltaic detectors, sensitive to infrared emission, are investigated as a means of measuring surface temperature on a microsecond time frame during pulsed ablative discharges with Teflon™ as the ablated material. Analysis is used to derive a governing equation for detector output voltage for materials with wavelength dependent emissivity. The detector output voltage is experimentally calibrated against thermocouples embedded in heated Teflon. Experimental calibration is performed with Teflon that has been exposed to ˜200 pulsed discharges and non-plasma-exposed Teflon and is compared to theoretical predictions to analyze emissivity differences. The diagnostic capability is evaluated with measurements of surface temperature from the Teflon propellant of electric micropulsed plasma thrusters. During the pulsed current discharge, there is insufficient information to claim that the surface temperature is accurately measured. However, immediately following the discharge, the postpulse cooling curve is measured. The statistical spread of postpulse surface temperature from shot to shot, most likely due to arc constriction and localization, is investigated to determine an operational envelope for postpulse temperature and mass ablation. This information is useful for determining postpulse ablation contributions to mass loss as well as evaluation of theoretical discharge models currently under development.

Calorie and protein-enriched formula versus standard term formula for improving growth and development in preterm or low birth weight infants following hospital discharge.

PubMed

Henderson, G; Fahey, T; McGuire, W

2005-04-18

Preterm and low birth weight infants are often growth-restricted at hospital discharge. Feeding infants post-hospital discharge with calorie and protein-enriched formula milk might facilitate "catch-up" growth and improve development. To review the evidence from randomised controlled trials that feeding following hospital discharge with calorie and protein-enriched formula compared with standard term formula improves growth and development for preterm or low birth weight infants. We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2004), MEDLINE (1966 - December 2004), EMBASE (1980 - December 2004), CINAHL (1982 - December 2004), conference proceedings, and previous reviews. Randomised or quasi-randomised controlled trials that compared the effect of feeding preterm or low birth weight infants post-hospital discharge with calorie and protein-enriched formula compared with standard term formula. We extracted data using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by two authors, and synthesis of data using weighted mean difference and a fixed effects model for meta-analysis. We found six trials that were eligible for inclusion. These recruited a total of 424 infants and were generally of good methodological quality. These trials found little evidence that feeding with calorie and protein-enriched formula milk affected growth and development. Because of differences in the way individual trials measured and presented outcomes, data synthesis was limited. Meta-analysis of data from two trials found a statistically significant effect on crown-heel length at 18 months post-term (weighted mean difference 9.7 millimetres (95% confidence interval 3.2 to 16.2)), but not on weight or head circumference. Meta-analysis of data from the two trials that assessed neurodevelopment at 18 months post-term did not reveal a statistically significant difference in either Bayley Mental Development Index (weighted mean difference 0.23 (95% confidence interval -2.99 to 3.45)) or Psychomotor Development Index (weighted mean difference 0.56 (95% confidence interval -1.95 to 3.07)). There are not yet any data on growth or development through later childhood. The limited available data do not provide strong evidence that feeding preterm or low birth weight infants following hospital discharge with calorie and protein-enriched formula compared with standard term formula affects growth rates or development up to 18 months post-term.

Early discharge after total thyroidectomy: a retrospective feasibility study.

PubMed

Tartaglia, F; Giuliani, A; Sorrenti, S; Tromba, L; Carbotta, S; Maturo, A; Carbotta, G; De Anna, L; Merola, R; Livadoti, G; Pelle, F; Ulisse, S

2016-01-01

The continued hospitalization after total thyroidectomy is often due to the onset of hypocalcemic complications more than 24 hours after surgery. So it would be important to predict which patients will not develop the hypocalcemic complication to discharge them early. This was the aim of our study. Our retrospective study was conducted on 327 consecutive thyroidectomized patients, operated on for benign and malignant diseases. We evaluated the values of preoperative serum calcium levels (Cal0) and of the first postoperative day (Cal1) and two new variables were calculated (dCal and dCaln). The same thing was made on a subgroup of 111 patients in whom also parathiroyd hormone (PTH) values were detected. Statistical analysis was performed with the goal of determining if we could establish a safe criterion for discharge at 24 hours after surgery and if there is a correlation between suitability for discharge and diagnosis. As to discharge, the predictive power of the discriminant function applied was significant both on the total of patients and in the subgroup of 111 patients, but it was clinically unacceptable because it would expose us to a 21% to 27% error rate. It is not possible to identify a threshold, below which to consider patients surely dischargeable. The diagnosis does not appear correlated with the suitability for discharge. On the basis of serum calcium and PTH levels in the first postoperative day, it is impossible to predict which patients can be discharged 24 hours after surgery without incurring in hypocalcemic complications.

Use of Principal Components Analysis to Explain Controls on Nutrient Fluxes to the Chesapeake Bay

NASA Astrophysics Data System (ADS)

Rice, K. C.; Mills, A. L.

2017-12-01

The Chesapeake Bay watershed, on the east coast of the United States, encompasses about 166,000-square kilometers (km2) of diverse land use, which includes a mixture of forested, agricultural, and developed land. The watershed is now managed under a Total Daily Maximum Load (TMDL), which requires implementation of management actions by 2025 that are sufficient to reduce nitrogen, phosphorus, and suspended-sediment fluxes to the Chesapeake Bay and restore the bay's water quality. We analyzed nutrient and sediment data along with land-use and climatic variables in nine sub watersheds to better understand the drivers of flux within the watershed and to provide relevant management implications. The nine sub watersheds range in area from 300 to 30,000 km2, and the analysis period was 1985-2014. The 31 variables specific to each sub watershed were highly statistically significantly correlated, so Principal Components Analysis was used to reduce the dimensionality of the dataset. The analysis revealed that about 80% of the variability in the whole dataset can be explained by discharge, flux, and concentration of nutrients and sediment. The first two principal components (PCs) explained about 68% of the total variance. PC1 loaded strongly on discharge and flux, and PC2 loaded on concentration. The PC scores of both PC1 and PC2 varied by season. Subsequent analysis of PC1 scores versus PC2 scores, broken out by sub watershed, revealed management implications. Some of the largest sub watersheds are largely driven by discharge, and consequently large fluxes. In contrast, some of the smaller sub watersheds are more variable in nutrient concentrations than discharge and flux. Our results suggest that, given no change in discharge, a reduction in nutrient flux to the streams in the smaller watersheds could result in a proportionately larger decrease in fluxes of nutrients down the river to the bay, than in the larger watersheds.

Effectiveness of community-based rehabilitation after traumatic brain injury for 489 program completers compared with those precipitously discharged.

PubMed

Altman, Irwin M; Swick, Shannon; Parrot, Devan; Malec, James F

2010-11-01

To evaluate outcomes of home- and community-based postacute brain injury rehabilitation (PABIR). Retrospective analysis of program evaluation data for treatment completers and noncompleters. Home- and community-based PABIR conducted in 7 geographically distinct U.S. cities. Patients (N=489) with traumatic brain injury who completed the prescribed course of rehabilitation (completed-course-of-treatment [CCT] group) compared with 114 who were discharged precipitously before program completion (precipitous-discharge [PD] group). PABIR delivered in home and community settings by certified professional staff on an individualized basis. Mayo-Portland Adaptability Inventory (MPAI-4) completed by means of professional consensus on admission and at discharge; MPAI-4 Participation Index at 3- and 12-month follow-up through telephone contact. Analysis of covariance (CCT vs PD group as between-subjects variable, admission MPAI-4 score as covariate) showed significant differences between groups at discharge on the full MPAI-4 (F=82.25; P<.001), Ability Index (F=50.24; P<.001), Adjustment Index (F=81.20; P<.001), and Participation Index (F=59.48; P<.001). A large portion of the sample was lost to follow-up; however, available data showed that group differences remained statistically significant at follow-up. Results provided evidence of the effectiveness of home- and community-based PABIR and that treatment effects were maintained at follow-up. Copyright © 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Statistical analysis of lightning electric field measured under Malaysian condition

NASA Astrophysics Data System (ADS)

Salimi, Behnam; Mehranzamir, Kamyar; Abdul-Malek, Zulkurnain

2014-02-01

Lightning is an electrical discharge during thunderstorms that can be either within clouds (Inter-Cloud), or between clouds and ground (Cloud-Ground). The Lightning characteristics and their statistical information are the foundation for the design of lightning protection system as well as for the calculation of lightning radiated fields. Nowadays, there are various techniques to detect lightning signals and to determine various parameters produced by a lightning flash. Each technique provides its own claimed performances. In this paper, the characteristics of captured broadband electric fields generated by cloud-to-ground lightning discharges in South of Malaysia are analyzed. A total of 130 cloud-to-ground lightning flashes from 3 separate thunderstorm events (each event lasts for about 4-5 hours) were examined. Statistical analyses of the following signal parameters were presented: preliminary breakdown pulse train time duration, time interval between preliminary breakdowns and return stroke, multiplicity of stroke, and percentages of single stroke only. The BIL model is also introduced to characterize the lightning signature patterns. Observations on the statistical analyses show that about 79% of lightning signals fit well with the BIL model. The maximum and minimum of preliminary breakdown time duration of the observed lightning signals are 84 ms and 560 us, respectively. The findings of the statistical results show that 7.6% of the flashes were single stroke flashes, and the maximum number of strokes recorded was 14 multiple strokes per flash. A preliminary breakdown signature in more than 95% of the flashes can be identified.

Treatment outcomes in patients with migraine: an ex-post-facto comparison of two in-patient facilities.

PubMed

Weidenhammer, W; Linde, K; Melchart, D

2004-08-01

In two hospitals we performed an open, prospective observational study on patients with chronic headache as a measure of internal quality assurance using identical methods. Available data were subordinately analysed in order to compare both studies. Are the patient samples of both hospitals comparable? If not, which form of statistical adjustment is recommended? Are there differences in the outcome measures of both facilities? The outcomes were defined as differences between baseline values and values at discharge from hospital, respectively 6 months after. Frequency of headache attacks, intensity of pain, intensity of general complaints as well as of concomitant symptoms, and quality of life were determined in advance as dependent variables. To compare both patient groups univariate analysis of variance without and with inclusion of covariates were used. For calculating propensity scores (conditional probability of belonging to one of two groups) a logistic regression with the same covariates serving as independent variables was performed. 426 patients with the main diagnosis "Migraine" and complete data sets concerning the covariates were selected for analysis. 87% of patients are female, the mean age is 45.5 +/- 11.7 years (range 14-73 yrs). 4 out of 11 potential covariates show statistically significant differences between the patients of both hospitals. Correct classification of patients by means of the propensity score succeeds in 67%. Comparing the outcomes at discharge from hospital, significant differences between both groups exist which are, with one exception, not affected by controlling for covariates. 6 months after discharge two of the initial differences between both patient groups are no longer present. These findings are independent from the statistical technique of risk adjustment. Because of the observed differences between both patient groups it is recommended to adjust data by regression analysis in order to enhance comparability. The choice for one of the two proposed techniques is secondary. With respect to the analyses clear differences between both hospitals exist in short-term outcomes, disappearing 6 months later. Copyright 2004 S. Karger GmbH, Freiburg

Impact of a COPD discharge care bundle on readmissions following admission with acute exacerbation: interrupted time series analysis.

PubMed

Laverty, Anthony A; Elkin, Sarah L; Watt, Hilary C; Millett, Christopher; Restrick, Louise J; Williams, Sian; Bell, Derek; Hopkinson, Nicholas S

2015-01-01

We evaluated the impact of a COPD discharge care bundle on readmission rates following hospitalisation with an acute exacerbation. Interrupted time series analysis, comparing readmission rates for COPD exacerbations at nine trusts that introduced the bundle, to two comparison groups; (1) other NHS trusts in London and (2) all other NHS trusts in England. Care bundles were implemented at different times for different NHS trusts, ranging from October 2009 to April 2011. Nine NHS acute trusts in the London, England. Patients aged 45 years and older admitted to an NHS acute hospital in England for acute exacerbation of COPD. Data come from Hospital Episode Statistics, April 2002 to March 2012. Annual trend readmission rates (and in total bed days) within 7, 28 and 90 days, before and after implementation. In hospitals introducing the bundle readmission rates were rising before implementation and falling afterwards (e.g. readmissions within 28 days +2.13% per annum (pa) pre and -5.32% pa post (p for difference in trends = 0.012)). Following implementation, readmission rates within 7 and 28 day were falling faster than among other trusts in London, although this was not statistically significant (e.g. readmissions within 28 days -4.6% pa vs. -3.2% pa, p = 0.44). Comparisons with a national control group were similar. The COPD discharge care bundle appeared to be associated with a reduction in readmission rate among hospitals using it. The significance of this is unclear because of changes to background trends in London and nationally.

A numerical model of acoustic wave caused by a single positive corona source

NASA Astrophysics Data System (ADS)

Zhang, Bo; Li, Zhen; He, Jinliang

2017-10-01

Audible noise accompanies corona discharge, which is one of the most important electromagnetic environment issues of high voltage transmission lines. Most of the studies on the audible noise generated by corona discharge focused on statistical analysis of the experimental results and a series of empirical formulas were derived to predict the audible noise. However, few of them interpreted the generating mechanism of the audible noise. Sound wave in the air is actually the fluctuation of the air, which lead to the hypothesis that the sound wave is generated by the interaction of the charged particles and the air molecules in the discharge progress. To validate this hypothesis, experiments were carried out in this paper to study the relationship between the audible noise and the corona current, including the correlation both in time domain and in frequency domain. Based on the experimental results, the fluid equations of the particles in the air were introduced to study the interactions among the electrons, ions, and neutral molecules in the discharge, and a numerical model for the amplitude of corona acoustic emission was developed and validated.

Effects of Out-of-hospital Continuing Nursing on Schizophrenia Patients’ Rehabilitation and Quality of Life

PubMed Central

Ye, Maoting; Guo, Jia; Song, Caiping; Zheng, Feiyu

2017-01-01

Abstract Objective This paper aims to explore specific effects of out-of-hospital continuing nursing on schizophrenia patients’ health rehabilitation and quality of life, and further improve application and popularization of out-of-hospital continuing nursing. Methods The 180 schizophrenia patients discharged from our hospital from March 2014 to March 2016 were selected as the subjects. The patients were divided into two groups according to the randomized double-blind method. Both groups received routine discharge guidance, and the observation group received out-of-hospital continuing nursing on this basis. Questionnaires and scales were used to compare differences of the two groups after discharge from hospital, such as medication compliance, recurrence rate of schizophrenia, awareness of health knowledge and quality of life. Results After 6 months of nursing for the observation group, complete medication compliance rate was 71.11% (64/90), awareness rate of schizophrenia-related health knowledge was 96.67% (87/90), and recurrence rate was 8.89% (8/90). For the control group, complete medication compliance rate was 45.56% (41/90), awareness rate of schizophrenia-related knowledge was 46.67% (42/90) and the recurrence rate of disease was 26.67% (24/90). Hence, the observation group enjoys significant advantages compared with the control group. Statistical analysis (P <0.05) showed statistical significance; In addition, life quality scores showed that the quality of life of the observation group was obviously better than the control group; the difference was statistically significant (P <0.05). Conclusion Out-of-hospital continuing nursing for schizophrenia patients after discharge can effectively improve medication compliance, awareness rate of health knowledge, effectively reduce incidence of schizophrenia and improve the quality of life of patients. Thus, the nursing concept and related methods are worthy of publicity and application in a wider range. PMID:29423451

Evolution of the use of noninvasive mechanical ventilation in chronic obstructive pulmonary disease in a Spanish region, 1997-2010.

PubMed

Carpe-Carpe, Bienvenida; Hernando-Arizaleta, Lauro; Ibáñez-Pérez, M Carmen; Palomar-Rodríguez, Joaquín A; Esquinas-Rodríguez, Antonio M

2013-08-01

Noninvasive mechanical ventilation (NIV) appeared in the 1980s as an alternative to invasive mechanical ventilation (IMV) in patients with acute respiratory failure. We evaluated the introduction of NIV and the results in patients with acute exacerbation of chronic obstructive pulmonary disease in the Region of Murcia (Spain). A retrospective observational study based on the minimum basic hospital discharge data of all patients hospitalised for this pathology in all public hospitals in the region between 1997 and 2010. We performed a time trend analysis on hospital attendance, the use of each ventilatory intervention and hospital mortality through joinpoint regression. We identified 30.027 hospital discharges. Joinpoint analysis: downward trend in attendance (annual percentage change [APC]=-3.4, 95% CI: - 4.8; -2.0, P <.05) and in the group without ventilatory intervention (APC=-4.2%, -5.6; -2.8, P <.05); upward trend in the use of NIV (APC=16.4, 12.0; 20. 9, P <.05), and downward trend that was not statistically significant in IMV (APC=-4.5%, -10.3; 1.7). We observed an upward trend without statistical significance in overall mortality (APC=0.5, -1.3; 2.4) and in the group without intervention (APC=0.1, -1.6; 1.9); downward trend with statistical significance in the NIV group (APC=-7.1, -11.7; -2.2, P <.05) and not statistically significant in the IMV group (APC=-0,8, -6, 1; 4.8). The mean stay did not change substantially. The introduction of NIV has reduced the group of patients not receiving assisted ventilation. No improvement in results was found in terms of mortality or length of stay. Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.

Characteristics of Lake Chad Level Variability and Links to ENSO, Precipitation, and River Discharge

PubMed Central

Demoz, Belay; Gebremariam, Sium

2014-01-01

This study used trend, correlation, and wavelet analysis to characterize Lake Chad (LC) level fluctuations, river discharge, El Niño Southern Oscillation (ENSO), and precipitation regimes and their interrelationships. Linear correlation results indicate a negative association between ENSO and LC level, river discharge and precipitation. Trend analysis shows increasing precipitation in the Lake Chad Basin (LCB) but decreasing LC level. The mode of interannual variability in LC level, rainfall, and ENSO analyzed using wavelet analysis is dominated by 3-4-year periods. Results show that variability in ENSO could explain only 31% and 13% of variations in LC level at Kindjeria and precipitation in the northern LCB, respectively. The wavelet transform coherency (WTC) between LC level of the southern pool at Kalom and ENSO is statistically significant at the 95% confidence level and phase-locked, implying a cause-and-effect association. These strong coherencies coincide with the La Niña years with the exception of 1997-1998 El Niño events. The WTC shows strong covariance between increasing precipitation and LC level in the northern pool at a 2- to 4-year band and 3- to 4-year band localized from 1996 to 2010. Implications for water resource planning and management are discussed. PMID:25538946

[Effects of an early psychological intervention on parents of children with cleft lip/palate].

PubMed

Wang, Yangyang; Xin, Yanhua; Ma, Jian; Xin, Xiuhong; Shi, Bing; Huang, Yongqing

2013-08-01

To provide basis for effects of an early psychological intervention on parents of children with cleft lip/palate, and investigate the effects of an early psychological intervention to them. One self-administered questionnaire (SCL-90) was applied in 102 parents of children with cleft lip/palate, compared to 126 parents of healthy individuals on the day of admission. They were given the psychological intervention during hospitalization and 3 months after discharge. The questionnaire (SCL-90) was again applied to them on the day of discharge and 3 months after discharge. Using the questionnaire (SCL-90), the answer scores of somatization, obsessive-compulsive, depression and anxiety etc. were significantly higher than those of the control group (P < 0.05). There were no statistical differences during 3 subgroups in the case group (P > 0.05). There were no statistical differences on the day of admission and on the day of discharge (P > 0.05), but there were statistical difference on the day of admission and 3 months after discharge (P < 0.05). In this study, the psychosomatic states of parents of children with cleft lip/palate is poor. It's important and greatly significant that we conduct early psychological intervention to parents of children with cleft lip/palate and to the children's psychosomatic health.

Methods for estimating annual exceedance probability discharges for streams in Arkansas, based on data through water year 2013

USGS Publications Warehouse

Wagner, Daniel M.; Krieger, Joshua D.; Veilleux, Andrea G.

2016-08-04

In 2013, the U.S. Geological Survey initiated a study to update regional skew, annual exceedance probability discharges, and regional regression equations used to estimate annual exceedance probability discharges for ungaged locations on streams in the study area with the use of recent geospatial data, new analytical methods, and available annual peak-discharge data through the 2013 water year. An analysis of regional skew using Bayesian weighted least-squares/Bayesian generalized-least squares regression was performed for Arkansas, Louisiana, and parts of Missouri and Oklahoma. The newly developed constant regional skew of -0.17 was used in the computation of annual exceedance probability discharges for 281 streamgages used in the regional regression analysis. Based on analysis of covariance, four flood regions were identified for use in the generation of regional regression models. Thirty-nine basin characteristics were considered as potential explanatory variables, and ordinary least-squares regression techniques were used to determine the optimum combinations of basin characteristics for each of the four regions. Basin characteristics in candidate models were evaluated based on multicollinearity with other basin characteristics (variance inflation factor < 2.5) and statistical significance at the 95-percent confidence level (p ≤ 0.05). Generalized least-squares regression was used to develop the final regression models for each flood region. Average standard errors of prediction of the generalized least-squares models ranged from 32.76 to 59.53 percent, with the largest range in flood region D. Pseudo coefficients of determination of the generalized least-squares models ranged from 90.29 to 97.28 percent, with the largest range also in flood region D. The regional regression equations apply only to locations on streams in Arkansas where annual peak discharges are not substantially affected by regulation, diversion, channelization, backwater, or urbanization. The applicability and accuracy of the regional regression equations depend on the basin characteristics measured for an ungaged location on a stream being within range of those used to develop the equations.

Usefulness of combining admission brain natriuretic peptide (BNP) plus hospital discharge bioelectrical impedance vector analysis (BIVA) in predicting 90 days cardiovascular mortality in patients with acute heart failure.

PubMed

Santarelli, Simona; Russo, Veronica; Lalle, Irene; De Berardinis, Benedetta; Navarin, Silvia; Magrini, Laura; Piccoli, Antonio; Codognotto, Marta; Castello, Luigi Maria; Avanzi, Gian Carlo; Villacorta, Humberto; Precht, Bernardo Luiz Campanário; de Araújo Porto, Pilar Barreto; Villacorta, Aline Sterque; Di Somma, Salvatore

2017-06-01

Heart failure is a disease characterized by high prevalence and mortality, and frequent rehospitalizations. The aim of this study is to investigate the prognostic power of combining brain natriuretic peptide (BNP) and congestion status detected by bioelectrical impedance vector analysis (BIVA) in acute heart failure patients. This is an observational, prospective, and a multicentre study. BNP assessment was measured upon hospital arrival, while BIVA analysis was obtained at the time of discharge. Cardiovascular deaths were evaluated at 90 days by a follow up phone call. 292 patients were enrolled. Compared to survivors, BNP was higher in the non-survivors group (mean value 838 vs 515 pg/ml, p < 0.001). At discharge, BIVA shows a statistically significant difference in hydration status between survivors and non-survivors [respectively, hydration index (HI) 85 vs 74, p < 0.001; reactance (Xc) 26.7 vs 37, p < 0.001; resistance (R) 445 vs 503, p < 0.01)]. Discharge BIVA shows a prognostic value in predicting cardiovascular death [HI: area under the curve (AUC) 0.715, 95% confidence interval (95% CI) 0.65-0.76; p < 0.004; Xc: AUC 0.712, 95% CI 0.655-0.76, p < 0.007; R: AUC 0.65, 95% CI 0.29-0.706, p < 0.0247]. The combination of BIVA with BNP gives a greater prognostic power for cardiovascular mortality [combined receiving operating characteristic (ROC): AUC 0.74; 95% CI 0.68-0.79; p < 0.001]. In acute heart failure patients, higher BNP levels upon hospital admission, and congestion detected by BIVA at discharge have a significant predictive value for 90 days cardiovascular mortality. The combined use of admission BNP and BIVA discharge seems to be a useful tool for increasing prognostic power in these patients.

Low-flow characteristics and flow-duration statistics for selected USGS continuous-record streamgaging stations in North Carolina through 2012

USGS Publications Warehouse

Weaver, J. Curtis

2015-03-12

In 2013, the U.S. Geological Survey, in cooperation with the North Carolina Division of Water Resources, compiled updated low-flow characteristics and flow-duration statistics for selected continuous-record streamgages in North Carolina. The compilation of updated streamflow statistics provides regulators and planners with relevant hydrologic information reflective of the recent droughts, which can be used to better manage the quantity and quality of streams in North Carolina. Streamflow records available through the 2012 water year1 were used to determine the annual (based on climatic year2) and winter 7-day, 10-year (7Q10, W7Q10) low-flow discharges, the 30-day, 2-year (30Q2) low-flow discharge, and the 7-day, 2-year (7Q2) low-flow discharge. Consequently, streamflow records available through March 31, 2012 (or the 2011 climatic year) were used to determine the updated low-flow characteristics. Low-flow characteristics were published for 177 unregulated sites, 56 regulated sites, and 33 sites known or considered to be affected by varying degrees of minor regulation and (or) diversions upstream from the streamgages (266 sites total). The updated 7Q10 discharges were compared for 63 streamgages across North Carolina where (1) long-term streamflow record consisted of 30 or more climatic years of data available as of the 1998 climatic year, and (2) streamflows were not known to be regulated. The 7Q10 discharges did not change for 3 sites, whereas increases and decreases were noted at 5 and 55 sites, respectively. Positive changes (increases) ranged from 4.3 percent (site 362) to 34.1 percent (site 112) with a median of 13.2 percent. Negative percentage changes (decreases) ranged from –3.3 percent (site 514) to –80.0 percent (site 308) with a median of –22.2 percent. The median percentage change for all 63 streamgages was –18.4 percent. Streamflow statistics determined as a part of this compilation included minimum, mean, maximum, and flow-duration statistics of daily mean discharges for categorical periods. Flow-duration statistics based on the daily mean discharge records were compiled in this study for the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles. Flow-duration statistics were determined for each complete water year of record at a streamgage as well as the available period of record (or selected periods if flows were regulated) and selected seasonal, monthly, and calendar day periods. In addition to the streamflow statistics compiled for each of the water years, the number of days the daily mean discharge was at or below the 10th percentile was summed for each water year as well as the number of events during the water year when streamflow was consistently at or below the 10th percentile. All low-flow characteristics for the streamgages were added into the StreamStatsDB, which is a database accessible to users through the recently released USGS StreamStats application for North Carolina. The minimum, mean, maximum, and flow-duration statistics of daily mean discharges based on the available (or selected if regulated flows) period of record were updated in the North Carolina StreamStatsDB. However, for the selected seasonal, monthly, calendar day, and annual water year periods, tab-delimited American Standard Code for Information Interchange (ASCII) tables of the streamflow statistics are available online to users from a link provided in the StreamStats application. 1The annual period from October 1 through September 30, designated by the year in which the period ends. 2The annual period from April 1 through March 31, designated by the year in which the period begins.

Improved communication in post-ICU care by improving writing of ICU discharge letters: a longitudinal before-after study.

PubMed

Medlock, Stephanie; Eslami, Saeid; Askari, Marjan; van Lieshout, Erik Jan; Dongelmans, Dave A; Abu-Hanna, Ameen

2011-11-01

The discharge letter is the primary means of communication at patient discharge, yet discharge letters are often not completed on time. A multifaceted intervention was performed to improve communication in patient hand-off from the intensive care unit (ICU) to the wards by improving the timeliness of discharge letters. A management directive was operationalised by a working group of ICU staff in a longitudinal before-after study. The intervention consisted of (a) changing policy to require a letter for use as a transfer note at the time of ICU discharge, (b) changing the assignment of responsibility to an automatic process, (c) leveraging positive peer pressure by making the list of patients in need of letters visible to colleagues and (d) provision of decision support, through automatic copying of important content from the patient record to the letter and email reminders if letters were not written on time. Statistical process control charts were used to monitor the longitudinal effect of the intervention. The intervention resulted in a 77.9% absolute improvement in the proportion of patients with a complete transfer note at the time of discharge, and an 85.2% absolute improvement in the number of discharge letters written. Statistical process control shows that the effect was sustained over time. A multifaceted intervention can be highly effective for improving discharge communication from the ICU.

Effect of the South Bay Ocean Outfall (SBOO) on ocean beach water quality near the USA-Mexico border.

PubMed

Gersberg, Richard; Tiedge, Jürgen; Gottstein, Dana; Altmann, Sophie; Watanabe, Kayo; Lüderitz, Volker

2008-04-01

In early 1999, primary treatment and discharge of sewage from Tijuana, Mexico (approximately 95 million liters per day) began through South Bay Ocean Outfall (SBOO) into the ocean 4.3 km offshore. In this study, statistical comparisons were made of the bacterial water quality (total and fecal coliforms and enterococci densities) of the ocean, both before and after discharge of sewage to the SBOO began, so that the effect of this ocean discharge on nearshore ocean water quality could be quantitatively assessed. The frequency of exceedence of bacterial indicator thresholds was statistically analyzed for 11 shore (surfzone) stations throughout US and Mexico using the Fisher's exact test, for the years before (1995-1998) as compared to after the SBOO discharge began (1999-2003). Only four of the 11 shoreline stations (S2, S3, S11, and S12) showed significant improvement (decreased frequency of exceedence of bacterial indicator thresholds) after SBOO discharge began.

Active compression-decompression cardiopulmonary resuscitation (CPR) versus standard CPR for cardiac arrest patients: a meta-analysis

PubMed Central

Luo, Xu-rui; Zhang, Hui-li; Chen, Geng-jin; Ding, Wen-shu; Huang, Liang

2013-01-01

BACKGROUND: Active compression-decompression cardiopulmonary resuscitation (ACDCPR) has been popular in the treatment of patients with cardiac arrest (CA). However, the effect of ACD-CPR versus conventional standard CPR (S-CRP) is contriversial. This study was to analyze the efficacy and safety of ACD-CPR versus S-CRP in treating CA patients. METHODS: Randomized or quasi-randomized controlled trials published from January 1990 to March 2011 were searched with the phrase “active compression-decompression cardiopulmonary resuscitation and cardiac arrest” in PubMed, EmBASE, and China Biomedical Document Databases. The Cochrane Library was searched for papers of meta-analysis. Restoration of spontaneous circulation (ROSC) rate, survival rate to hospital admission, survival rate at 24 hours, and survival rate to hospital discharge were considered primary outcomes, and complications after CPR were viewed as secondary outcomes. Included studies were critically appraised and estimates of effects were calculated according to the model of fixed or random effects. Inconsistency across the studies was evaluated using the I2 statistic method. Sensitivity analysis was made to determine statistical heterogeneity. RESULTS: Thirteen studies met the criteria for this meta-analysis. The studies included 396 adult CA patients treated by ACD-CPR and 391 patients by S-CRP. Totally 234 CA patients were found out hospitals, while the other 333 CA patients were in hospitals. Two studies were evaluated with high-quality methodology and the rest 11 studies were of poor quality. ROSC rate, survival rate at 24 hours and survival rate to hospital discharge with favorable neurological function indicated that ACD-CPR is superior to S-CRP, with relative risk (RR) values of 1.39 (95% CI 0.99–1.97), 1.94 (95% CI 1.45–2.59) and 2.80 (95% CI 1.60–5.24). No significant differences were found in survival rate to hospital admission and survival rate to hospital discharge for ACD-CPR versus S-CRP with RR values of 1.06 (95% CI 0.76–1.60) and 1.00 (95% CI 0.73–1.38). CONCLUSION: Quality controlled studies confirmed the superiority of ACD-CPR to S-CRP in terms of ROSC rate and survival rate at 24 hours. Compared with S-CRP, ACD-CPR could not improve survival rate to hospital admission or survival rate to hospital discharge. PMID:25215130

X-ray emissions from centimeter-long streamer corona discharges

NASA Astrophysics Data System (ADS)

da Silva, C. L.; Millan, R. M.; McGaw, D. G.; Yu, C. T.; Putter, A. S.; Labelle, J. W.; Dwyer, J. R.

2017-12-01

In this work we provide extensive evidence that runaway electron acceleration and subsequent bremsstrahlung X-ray emission are a common feature in electrical discharges of negative polarity. They can be easily detected at voltages as low as 100 kV, indicating that all negative lightning could potentially produce runaway electrons. We show that centimeter-long streamer corona discharges produce bursts of X-ray radiation that are emitted by a source that is highly compact in space and time. Therefore, the emitted X-ray photons arrive together at the detector and pile up. Median burst energies vary between 33-96% of the total 100 keV available electrostatic energy that an electron can acquire in the gap. We present detailed statistical analysis of 5000+ discharges, showing that X-rays are observed in as many as 60% of the triggers, depending on the configuration. X-ray detection is more frequent when: the streamer corona discharge is not followed by a spark, the detector is oriented perpendicular to the gap, and a thicker anode is used. We show that for an 8-cm-long gap, X-rays are produced when runaway electrons hit the anode, and that the runaway electron acceleration is not correlated with streamer collisions, as inferred in meter-long discharges. The described experiment is a promising way for measuring the runaway electron distribution very close to the source and its dependence on the applied voltage.

Factors That Influence Human Milk Feeding at Hospital Discharge for Preterm Infants in a Tertiary Neonatal Care Center in Taiwan.

PubMed

Pai, Chia-Ming; Jim, Wai-Tim; Lin, Hsiang-Yu; Hsu, Chyong-Hsin; Kao, Hsin-An; Hung, Han-Yang; Peng, Chun-Chih; Chang, Jui-Hsing

Human milk is considered optimal nutrition for newborn infants, especially preterm infants, and it can lessen morbidity in this population. Human milk feeding at hospital discharge may encourage breastfeeding at home. This study evaluated the incidence and predictive factors of human milk feeding of preterm infants at discharge. It included all preterm infants with gestational age of less than 37 weeks who were admitted to the Mackay Memorial Hospital in Taiwan from January to December 2010 who survived to discharge. Infants were classified into a human milk group or a formula milk group. Gestational age, birth weight, length of hospital stay, maternal age, maternal educational status, and morbidity of prematurity were compared between the groups. Of the 290 preterm infants, 153 (52.8%) were being fed human milk at hospital discharge. Compared with the formula milk group, the human milk group had lower birth weights, younger gestational age, higher rates of ventilator use, and longer hospital stays. These differences were not statistically significant for very low-birth-weight (birth weight of <1500 g) infants (n = 66). Multivariate analysis indicated that 2 factors, longer hospital stay and neonatal intensive care unit admission, were associated with human milk feeding at hospital discharge. These findings highlight the need for encouraging and helping all mothers, even those with relatively mature and healthy infants, to provide human milk for their infants.

Emergency department discharge prescription errors in an academic medical center

PubMed Central

Belanger, April; Devine, Lauren T.; Lane, Aaron; Condren, Michelle E.

2017-01-01

This study described discharge prescription medication errors written for emergency department patients. This study used content analysis in a cross-sectional design to systematically categorize prescription errors found in a report of 1000 discharge prescriptions submitted in the electronic medical record in February 2015. Two pharmacy team members reviewed the discharge prescription list for errors. Open-ended data were coded by an additional rater for agreement on coding categories. Coding was based upon majority rule. Descriptive statistics were used to address the study objective. Categories evaluated were patient age, provider type, drug class, and type and time of error. The discharge prescription error rate out of 1000 prescriptions was 13.4%, with “incomplete or inadequate prescription” being the most commonly detected error (58.2%). The adult and pediatric error rates were 11.7% and 22.7%, respectively. The antibiotics reviewed had the highest number of errors. The highest within-class error rates were with antianginal medications, antiparasitic medications, antacids, appetite stimulants, and probiotics. Emergency medicine residents wrote the highest percentage of prescriptions (46.7%) and had an error rate of 9.2%. Residents of other specialties wrote 340 prescriptions and had an error rate of 20.9%. Errors occurred most often between 10:00 am and 6:00 pm. PMID:28405061

Renewed growth in hospital inpatient cost since 1998: variation across metropolitan areas and leading clinical conditions.

PubMed

Friedman, Bernard S; Wong, Herbert S; Steiner, Claudia A

2006-03-01

To use disaggregated data about metropolitan statistical areas (MSAs) and clinical conditions to better describe the variation in cost increases and explore some of the hypothesized influences. The study uses the state inpatient databases from the Healthcare Cost and Utilization Project, containing all discharges from hospitals in 172 MSAs in 1998 and 2001. The discharge summary information was combined with standardized hospital accounting files, surveys of managed care plans, MSA demographics, and state data pertaining to caps on medical malpractice awards. The analysis used descriptive comparisons and multivariate regressions of admission rate and cost per case in 9 leading disease categories across the MSAs. The increase in hospital input prices and changes in severity of illness were controlled. Metropolitan statistical areas with higher HMO market penetration continued to show lower admission rates, no less so in 2001 than in 1998. A cap on malpractice awards appeared to restrain admissions, but the net effect on hospital cost per adult eroded for those states with the most experience with award caps. Higher admission rates and increase in cost were found in several disease categories.

Kinetics of fast short-term depression are matched to spike train statistics to reduce noise.

PubMed

Khanbabaie, Reza; Nesse, William H; Longtin, Andre; Maler, Leonard

2010-06-01

Short-term depression (STD) is observed at many synapses of the CNS and is important for diverse computations. We have discovered a form of fast STD (FSTD) in the synaptic responses of pyramidal cells evoked by stimulation of their electrosensory afferent fibers (P-units). The dynamics of the FSTD are matched to the mean and variance of natural P-unit discharge. FSTD exhibits switch-like behavior in that it is immediately activated with stimulus intervals near the mean interspike interval (ISI) of P-units (approximately 5 ms) and recovers immediately after stimulation with the slightly longer intervals (>7.5 ms) that also occur during P-unit natural and evoked discharge patterns. Remarkably, the magnitude of evoked excitatory postsynaptic potentials appear to depend only on the duration of the previous ISI. Our theoretical analysis suggests that FSTD can serve as a mechanism for noise reduction. Because the kinetics of depression are as fast as the natural spike statistics, this role is distinct from previously ascribed functional roles of STD in gain modulation, synchrony detection or as a temporal filter.

Prediction of TARANIS Observations of TGF's and Optical Emissions from Red Sprites

NASA Astrophysics Data System (ADS)

Nelson, M. A.

2006-12-01

TARANIS (Tool for the Analysis of Radiation from Lightning and Sprites) is a French (CNES, Centre National D'Etudes Spatiales) micro-satellite that is scheduled for launch in 2009. This will be the first satellite that will measure coincident gamma-rays and optical emissions from atmospheric discharges. These measurements will provide important clues concerning the physics of discharges that produce gamma-rays and will provide more definitive evidence of the role of conventional breakdown versus runaway breakdown than is currently available. While a variety of discharges may be associated with Transient Gamma Ray Flashes (TGF's), this study will focus on emissions expected from red sprites. Future studies will focus on other types of discharges (for example, gigantic jets or blue jets) to see whether they should produce detectable signal levels at both gamma-ray and optical frequencies. The source of terrestrial TGF's is a matter of debate at this time. Many experts in the field have interpreted the data associated with the RHESSI (Reuven Ramaty High Energy Solar Spectroscopic Imager) satellite to be indicative that the discharges associated with terrestrial gamma-rays are not associated with sprites. However, RHESSI was not designed for the purpose of collecting gamma-ray measurements from terrestrial discharges; does not possess a coincident optical measurement capability; and must average data over many events to predict a spectrum. We will present a statistical analysis of the relative efficiencies of the RHESSI and TARANIS satellite designs for the detection of TGF's associated with sprites. We will show results from a fully 2-D electromagnetic model (UNIMAX, the Unified Maxwell code) and an optical model (POEM, the Physics Based Optical Emission Model) to demonstrate the level of agreement between the simulations and the gamma-ray spectrum measurements and optical measurements (camera, photometer, and spectral measurements) for several different classes of discharges (halos, streamers, and runaway breakdown.) We will distinguish which measurements and model results are indicative of conventional breakdown and which are indicative of runaway breakdown.

Mars: Noachian hydrology by its statistics and topology

NASA Technical Reports Server (NTRS)

Cabrol, N. A.; Grin, E. A.

1993-01-01

Discrimination between fluvial features generated by surface drainage and subsurface aquifer discharges will provide clues to the understanding of early Mars' climatic history. Our approach is to define the process of formation of the oldest fluvial valleys by statistical and topological analyses. Formation of fluvial valley systems reached its highest statistical concentration during the Noachian Period. Nevertheless, they are a scarce phenomenom in Martian history, localized on the craterized upland, and subject to latitudinal distribution. They occur sparsely on Noachian geological units with a weak distribution density, and appear in reduced isolated surface (around 5 x 10(exp 3)(sq km)), filled by short streams (100-300 km length). Topological analysis of the internal organization of 71 surveyed Noachian fluvial valley networks also provides information on the mechanisms of formation.

Counting at low concentrations: the statistical challenges of verifying ballast water discharge standards

USGS Publications Warehouse

Frazier, Melanie; Miller, A. Whitman; Lee, Henry; Reusser, Deborah A.

2013-01-01

Discharge from the ballast tanks of ships is one of the primary vectors of nonindigenous species in marine environments. To mitigate this environmental and economic threat, international, national, and state entities are establishing regulations to limit the concentration of living organisms that may be discharged from the ballast tanks of ships. The proposed discharge standards have ranged from zero detectable organisms to 3. If standard sampling methods are used, verifying whether ballast discharge complies with these stringent standards will be challenging due to the inherent stochasticity of sampling. Furthermore, at low concentrations, very large volumes of water must be sampled to find enough organisms to accurately estimate concentration. Despite these challenges, adequate sampling protocols comprise a critical aspect of establishing standards because they help define the actual risk level associated with a standard. A standard that appears very stringent may be effectively lax if it is paired with an inadequate sampling protocol. We describe some of the statistical issues associated with sampling at low concentrations to help regulators understand the uncertainties of sampling as well as to inform the development of sampling protocols that ensure discharge standards are adequately implemented.

Selected Streamflow Statistics for Streamgaging Stations in Delaware, 2003

USGS Publications Warehouse

Ries, Kernell G.

2004-01-01

Flow-duration and low-flow frequency statistics were calculated for 15 streamgaging stations in Delaware, in cooperation with the Delaware Geological Survey. The flow-duration statistics include the 1-, 2-, 5-, 10-, 20-, 30-, 40-, 50-, 60-, 70-, 80-, 90-, 95-, 98-, and 99-percent duration discharges. The low-flow frequency statistics include the average discharges for 1, 7, 14, 30, 60, 90, and 120 days that recur, on average, once in 1.01, 2, 5, 10, 20, 50, and 100 years. The statistics were computed using U.S. Geological Survey computer programs that can be downloaded from the World Wide Web at no cost. The computer programs automate standard U.S. Geological Survey methods for computing the statistics. Documentation is provided at the Web sites for the individual programs. The computed statistics are presented in tabular format on a separate page for each station, along with the station name, station number, the location, the period of record, and remarks.

Discharge Planning in Chronic Conditions

PubMed Central

McMartin, K

2013-01-01

Background Chronically ill people experience frequent changes in health status accompanied by multiple transitions between care settings and care providers. Discharge planning provides support services, follow-up activities, and other interventions that span pre-hospital discharge to post-hospital settings. Objective To determine if discharge planning is effective at reducing health resource utilization and improving patient outcomes compared with standard care alone. Data Sources A standard systematic literature search was conducted for studies published from January 1, 2004, until December 13, 2011. Review Methods Reports, randomized controlled trials, systematic reviews, and meta-analyses with 1 month or more of follow-up and limited to specified chronic conditions were examined. Outcomes included mortality/survival, readmissions and emergency department (ED) visits, hospital length of stay (LOS), health-related quality of life (HRQOL), and patient satisfaction. Results One meta-analysis compared individualized discharge planning to usual care and found a significant reduction in readmissions favouring individualized discharge planning. A second meta-analysis compared comprehensive discharge planning with postdischarge support to usual care. There was a significant reduction in readmissions favouring discharge planning with postdischarge support. However, there was significant statistical heterogeneity. For both meta-analyses there was a nonsignificant reduction in mortality between the study arms. Limitations There was difficulty in distinguishing the relative contribution of each element within the terms “discharge planning” and “postdischarge support.” For most studies, “usual care” was not explicitly described. Conclusions Compared with usual care, there was moderate quality evidence that individualized discharge planning is more effective at reducing readmissions or hospital LOS but not mortality, and very low quality evidence that it is more effective at improving HRQOL or patient satisfaction. Compared with usual care, there was low quality evidence that the discharge planning plus postdischarge support is more effective at reducing readmissions but not more effective at reducing hospital LOS or mortality. There was very low quality evidence that it is more effective at improving HRQOL or patient satisfaction. Plain Language Summary Chronically ill people experience frequent changes in their health status and multiple transitions between care settings and care providers (e.g., hospital to home). Discharge planning provides support services, follow-up activities and other interventions that span pre-hospital discharge to post-hospital settings. A review of the effects of different discharge plans was conducted. After searching for relevant studies, 11 studies were found that compared discharge planning with routine discharge care. This review indicates that: Individualized discharge planning reduces initial hospital length of stay and subsequent readmission to hospital but does not reduce mortality. The effect on health-related quality of life (HRQOL) or patient satisfaction is uncertain. Discharge planning plus postdischarge support reduces readmissions but does not reduce the initial hospital length of stay or mortality after discharge. The effect on HRQOL or patient satisfaction is uncertain. PMID:24167538

Statistical considerations in estimating organism concentrations in ballast water discharges

EPA Science Inventory

Sampling probabilities may affect the practical use of different ballast water performance standards which establish the acceptable concentration of organisms in ballast discharges. The International Maritime Organization (IMO) has initiated a ballast water standard of <10 viabl...

Impact of a Post-Discharge Integrated Disease Management Program on COPD Hospital Readmissions.

PubMed

Russo, Ashlee N; Sathiyamoorthy, Gayathri; Lau, Chris; Saygin, Didem; Han, Xiaozhen; Wang, Xiao-Feng; Rice, Richard; Aboussouan, Loutfi S; Stoller, James K; Hatipoğlu, Umur

2017-11-01

Readmission following a hospitalization for COPD is associated with significant health-care expenditure. A multicomponent COPD post-discharge integrated disease management program was implemented at the Cleveland Clinic to improve the care of patients with COPD and reduce readmissions. This retrospective study reports our experience with the program. Groups of subjects who were exposed to different components of the program were compared regarding their readmission rates. Multivariate logistic regression analysis was performed to build predictive models for 30- and 90-d readmission. One hundred sixty subjects completed a 90-d follow-up, of which, 67 attended the exacerbation clinic, 16 subjects received care coordination, 51 subjects completed both, and 26 subjects did not participate in any component despite referral. Thirty- and 90-d readmission rates for the entire group were 18.1 and 46.2%, respectively. Thirty- and 90-d readmission rates for the individual groups were: exacerbation clinic, 11.9 and 35.8%; care coordination, 25.0 and 50.0%; both, 19.6 and 41.2%; and neither, 26.9 and 80.8%, respectively. The model with the best predictive ability for 30-d readmission risk included the number of hospitalizations within the previous year and use of noninvasive ventilation (C statistic of 0.84). The model for 90-d readmission risk included receiving any component of the post-discharge integrated disease management program, the number of hospitalizations, and primary care physician visits within the previous year (C statistic of 0.87). Receiving any component of a post-discharge integrated disease management program was associated with reduced 90-d readmission rate. Previous health-care utilization and lung function impairment were strong predictors of readmission. Copyright © 2017 by Daedalus Enterprises.

q-triplet for Brazos River discharge: The edge of chaos?

NASA Astrophysics Data System (ADS)

Stosic, Tatijana; Stosic, Borko; Singh, Vijay P.

2018-04-01

We study the daily discharge data of Brazos River in Texas, USA, from 1900 to 2017, in terms of concepts drawn from the non-extensive statistics recently introduced by Tsallis. We find that the Brazos River discharge indeed follows non-extensive statistics regarding equilibrium, relaxation and sensitivity. Besides being the first such finding of a full-fledged q-triplet in hydrological data with possible future impact on water resources management, the fact that all three Tsallis q-triplet values are remarkably close to those of the logistic map at the onset of chaos opens up new questions towards a deeper understanding of the Brazos River dynamics, that may prove relevant for hydrological research in a more general sense.

Mobility scores as a predictor of length of stay in general surgery: a prospective cohort study.

PubMed

Carroll, Georgia M; Hampton, Jacob; Carroll, Rosemary; Smith, Stephen R

2018-05-22

Post-operative length of stay (LOS) is an increasingly important clinical indicator in general surgery. Despite this, no tool has been validated to predict LOS or readiness for discharge in general surgical patients. The de Morton Mobility Index (DEMMI) is a functional mobility assessment tool that has been validated in rehabilitation patient populations. In this prospective cohort study, we aimed to identify if trends in DEMMI scores were associated with discharge within 1 week and overall LOS in general surgical patients. A total of 161 patients who underwent elective gastrointestinal resections were included. DEMMI scores were performed preoperatively, on days 1, 2, 3 and 30 post-operative. Statistical analysis was performed to identify any association between DEMMI scores and discharge within 1 week and LOS. Functional recovery (measured by achieving 80% of baseline DEMMI score by post-operative day 1) was significantly associated with discharge within 1 week. Presence of a stoma was associated with longer LOS. The area under the receiver operating characteristic curve using functional recovery on post-operative day 1 as a predictor of discharge within 1 week is 0.772. The DEMMI score is a fast, easy and useful tool to, on post-operative day 1, predict discharge within 1 week. The utility of this is to act as an anticipatory trigger for more proactive and efficient discharge planning in the early post-operative period, and there is potential to use the DEMMI as a comparator in clinical trials to assess functional recovery. © 2018 Royal Australasian College of Surgeons.

Evaluating the combined effects of source zone mass release rates and aquifer heterogeneity on solute discharge uncertainty

NASA Astrophysics Data System (ADS)

de Barros, Felipe P. J.

2018-07-01

Quantifying the uncertainty in solute mass discharge at an environmentally sensitive location is key to assess the risks due to groundwater contamination. Solute mass fluxes are strongly affected by the spatial variability of hydrogeological properties as well as release conditions at the source zone. This paper provides a methodological framework to investigate the interaction between the ubiquitous heterogeneity of the hydraulic conductivity and the mass release rate at the source zone on the uncertainty of mass discharge. Through the use of perturbation theory, we derive analytical and semi-analytical expressions for the statistics of the solute mass discharge at a control plane in a three-dimensional aquifer while accounting for the solute mass release rates at the source. The derived solutions are limited to aquifers displaying low-to-mild heterogeneity. Results illustrate the significance of the source zone mass release rate in controlling the mass discharge uncertainty. The relative importance of the mass release rate on the mean solute discharge depends on the distance between the source and the control plane. On the other hand, we find that the solute release rate at the source zone has a strong impact on the variance of the mass discharge. Within a risk context, we also compute the peak mean discharge as a function of the parameters governing the spatial heterogeneity of the hydraulic conductivity field and mass release rates at the source zone. The proposed physically-based framework is application-oriented, computationally efficient and capable of propagating uncertainty from different parameters onto risk metrics. Furthermore, it can be used for preliminary screening purposes to guide site managers to perform system-level sensitivity analysis and better allocate resources.

Analysis of spike-wave discharges in rats using discrete wavelet transform.

PubMed

Ubeyli, Elif Derya; Ilbay, Gül; Sahin, Deniz; Ateş, Nurbay

2009-03-01

A feature is a distinctive or characteristic measurement, transform, structural component extracted from a segment of a pattern. Features are used to represent patterns with the goal of minimizing the loss of important information. The discrete wavelet transform (DWT) as a feature extraction method was used in representing the spike-wave discharges (SWDs) records of Wistar Albino Glaxo/Rijswijk (WAG/Rij) rats. The SWD records of WAG/Rij rats were decomposed into time-frequency representations using the DWT and the statistical features were calculated to depict their distribution. The obtained wavelet coefficients were used to identify characteristics of the signal that were not apparent from the original time domain signal. The present study demonstrates that the wavelet coefficients are useful in determining the dynamics in the time-frequency domain of SWD records.

Estimation of streamflow for selected sites on the Carson and Truckee rivers in California and Nevada, 1944-80

USGS Publications Warehouse

Blodgett, J.C.; Oltmann, R.N.; Poeschel, K.R.

1984-01-01

Daily mean and monthly discharges were estimated for 10 sites on the Carson and Truckee Rivers for periods of incomplete records and for tributary sites affected by reservoir regulation. On the basis of the hydrologic characteristics, stream-flow data for a water year were grouped by month or season for subsequent regression analysis. In most cases, simple linear regressions adequately defined a relation of streamflow between gaging stations, but in some instances a nonlinear relation for several months of the water year was derived. Statistical data are presented to indicate the reliability of the estimated streamflow data. Records of discharges including historical and estimated data for the gaging stations for the water years 1944-80 are presented. (USGS)

Burn Injuries and Their Impact on Cognitive-Communication Skills in the Inpatient Rehabilitation Setting.

PubMed

Hendricks, Carla Tierney; Camara, Kristin; Violick Boole, Kathryn; Napoli, Maureen F; Goldstein, Richard; Ryan, Colleen M; Schneider, Jeffrey C

The prevalence and extent of cognitive-communication disorders and factors that have impact on outcomes are examined in the burn population within an inpatient rehabilitation facility. A retrospective data analysis was conducted on adults diagnosed with burn injury (n = 144). Descriptive statistics were used to identify the prevalence of cognitive-communication deficits on admission and discharge. The main outcomes were cognitive-communication ratings on discharge from inpatient rehabilitation as measured by the memory and problem-solving domains of the Functional Independence Measure (FIM) and composite score of the Functional Communication Measure (FCM). Medical, demographic and rehabilitation predictors of the main outcomes were assessed using regression analyses. On admission to inpatient rehabilitation, 79% of the total population presented with cognitive-communication impairments, and of them, 27% presented with persistent deficits on discharge. Admission FIM memory score, marital status, and age were significant predictors of discharge FIM memory score. Admission FIM problem-solving score, age, marital status, and prehospital living-with were significant predictors of discharge FIM problem-solving score. Admission FCM score and age were significant predictors of discharge FCM cognitive score. Persons with burn injuries are at risk for cognitive-communication impairments, which may persist after inpatient rehabilitation. FIM data obtained on admission can be used as a screening tool to identify these at-risk patients. Future work is needed to assess the efficacy of speech-language pathologist intervention for cognitive-communication deficits within the burn injury population.

[Benefit of clinical and laboratory parameters for the diagnosis of endometritis in dairy cows].

PubMed

Hässig, M; Steinmann, B; Wittenbrink, M M

2010-09-01

The goal of this work was to answer the question of whether or not there are significant differences between cows with abnormal vaginal discharge and cows with the diagnosis of puerperal or chronic endometritis, using blood and urine parameters. In addition, cows with and without vaginal discharge were examined for significant bacteriological differences in uterine mucous samples. The question of false positive and false negatives from the diagnosis of endometritis was also investigated. A total of 35 matched-pairs (+/-vaginal discharge) from 27 stables was examined 21 to 63 days post partum. The examination consisted of a rectal and vaginal exam, urine and blood samples as well as vaginal swab from the corpus uteri using a Folmer-Nielsen-Catheter. Based on the history vaginal discharge occurred more frequently in dystocia and retentio secundinarium. Cows with a history of distocia and retentio secundinarium showed significantly more vaginal discharge. Gammaglutamyltransferase (GGT; p=0.01) and cholesterine (p=0.04) were different in cows with endometritis. The bacteriology results showed a statistically significant difference (p<0.01) only for Escherichia coli and Arcanobacterium pyogenes. The Folmer-Nielsen smears/endometritis showed a significant difference between the two groups (p<0.01). In a multivariate analysis with final step-back procedure regarding endometritis Gammaglutamyltransferase (GGT) and Betahydroxybutteracid (BHB) were significant different (p=0.02). The hypothesis vaginal discharge alike endometritis showed that 34 % of the clinical suspicious cases were recorded as false negatives. In the non-suspicious cases 20 % were diagnosed as false negative.

Information analysis of posterior canal afferents in the turtle, Trachemys scripta elegans.

PubMed

Rowe, Michael H; Neiman, Alexander B

2012-01-24

We have used sinusoidal and band-limited Gaussian noise stimuli along with information measures to characterize the linear and non-linear responses of morpho-physiologically identified posterior canal (PC) afferents and to examine the relationship between mutual information rate and other physiological parameters. Our major findings are: 1) spike generation in most PC afferents is effectively a stochastic renewal process, and spontaneous discharges are fully characterized by their first order statistics; 2) a regular discharge, as measured by normalized coefficient of variation (cv*), reduces intrinsic noise in afferent discharges at frequencies below the mean firing rate; 3) coherence and mutual information rates, calculated from responses to band-limited Gaussian noise, are jointly determined by gain and intrinsic noise (discharge regularity), the two major determinants of signal to noise ratio in the afferent response; 4) measures of optimal non-linear encoding were only moderately greater than optimal linear encoding, indicating that linear stimulus encoding is limited primarily by internal noise rather than by non-linearities; and 5) a leaky integrate and fire model reproduces these results and supports the suggestion that the combination of high discharge regularity and high discharge rates serves to extend the linear encoding range of afferents to higher frequencies. These results provide a framework for future assessments of afferent encoding of signals generated during natural head movements and for comparison with coding strategies used by other sensory systems. This article is part of a Special Issue entitled: Neural Coding. Copyright © 2011 Elsevier B.V. All rights reserved.

Cost-effectiveness of the U.S. Geological Survey stream-gaging program in Indiana

USGS Publications Warehouse

Stewart, J.A.; Miller, R.L.; Butch, G.K.

1986-01-01

Analysis of the stream gaging program in Indiana was divided into three phases. The first phase involved collecting information concerning the data need and the funding source for each of the 173 surface water stations in Indiana. The second phase used alternate methods to produce streamflow records at selected sites. Statistical models were used to generate stream flow data for three gaging stations. In addition, flow routing models were used at two of the sites. Daily discharges produced from models did not meet the established accuracy criteria and, therefore, these methods should not replace stream gaging procedures at those gaging stations. The third phase of the study determined the uncertainty of the rating and the error at individual gaging stations, and optimized travel routes and frequency of visits to gaging stations. The annual budget, in 1983 dollars, for operating the stream gaging program in Indiana is $823,000. The average standard error of instantaneous discharge for all continuous record gaging stations is 25.3%. A budget of $800,000 could maintain this level of accuracy if stream gaging stations were visited according to phase III results. A minimum budget of $790,000 is required to operate the gaging network. At this budget, the average standard error of instantaneous discharge would be 27.7%. A maximum budget of $1 ,000,000 was simulated in the analysis and the average standard error of instantaneous discharge was reduced to 16.8%. (Author 's abstract)

High turnover stays for pediatric asthma in the United States: analysis of the 2006 Kids' Inpatient Database.

PubMed

Macy, Michelle L; Stanley, Rachel M; Sasson, Comilla; Gebremariam, Achamyeleh; Davis, Matthew M

2010-09-01

Pediatric observation units provide an alternative to traditional hospitalization. The extent to which observation units could replace inpatient care for asthmatic children is unknown. To describe brief inpatient ("high-turnover," HTO) stays for US children hospitalized with a principal discharge diagnosis of asthma, to characterize cases that may be appropriate for observation. We analyzed the 2006 Kids' Inpatient Database, a nationally representative sample of hospital discharges. HTO stays were defined as hospitalizations of 0 or 1 night in duration. We conducted descriptive statistics and case-mix adjusted, sample-weighted regression analysis of HTO stays, and associated hospital charges. Discharges among children aged 2 to 20 years with a principal discharge diagnosis of asthma. HTO stays and total charges. Overall, 34,592 (34%) pediatric asthma hospitalizations were HTO, accounting for 66,278 hospital days in 2006. HTO stays were associated with younger age, uncomplicated asthma, and private insurance. Freestanding children's hospitals had the highest proportion of HTO stays, 38% (95% CI: 34%-42%) compared with 32% (95% CI: 28%-36%) for children's units and 33% (95% CI: 31%-34%) for general hospitals. In multivariate regression analyses, charges were significantly higher across hospital types when HTO stays begin in the emergency department. The presence of a large number of HTO stays for children hospitalized for asthma suggests the need to explore opportunities to restructure care for this condition, perhaps through the development of physically or operationally distinct observation units.

Meteorological situations that generated exceptional discharges along the Danube River

NASA Astrophysics Data System (ADS)

Bocioaca, Mihai; Marinica, Ion; Rusu, Simona

2010-05-01

For Europe, the undisputed importance of the Danube can be rendered by some general data: Its hydrographic basin surface exceeds 817,000 km2, i.e. about 10% of that of the continent, its length is 2857 km and its mean multiannual discharge is about 6500 m3/s, thus ranking second to Volga river. Romania is the country with the largest surface situated within Danube's basin (97.4%), representing 29% of Danube's hydrographic basin. The water resources of the Danube in Bazias section amount to 205 billion m3, 30 billion m3 of which are technically usable resources. Our analysis aimed at determining those complex meteorological situations at the European continent level that triggered exceptional discharges along the Danube, resulting in severe flooding, causing in turn heavy damages, fatalities, population evacuations and considerable rehabilitation costs. A complex analysis was performed, of statistical-synoptic type and those complex meteorological situations were identified that determined the occurrence of such disasters. Discharges and levels of the Danube were used along the whole measuring period, data from the archive of the National Meteorological Administration, and data, map and image archives from Wetterzentrale (Kartenarchiv, NCEP, NCAR, AVN etc.). The complex meteorological situations at the level of the European continent that triggered exceptional discharges along the Danube correlate with intense cyclonic activity, of both the Icelandic and the Mediterranean cyclones, with the negative phase of the North-Atlantic Oscillation and with decreasing or minimum solar activity (according to data from NOAA's Space Environment Center). The most disastrous floods occurred in the spring of 2006. The paper is important for meteorologists, in their weather forecasting activity, for hydrologists, in their hydrological forecasting and for the institutions involved in flood management.

Psychological aptitude evaluation of the special forces candidate.

PubMed

Genoni, Luca; Jelmini, F; Lang, M; Muggli, F

2017-02-01

Changes in recruitment procedures reduced early dismissal rates from Swiss military basic recruitment schools; however, such improvements were not reflected in premature discharge rates from the special forces (SF) (Grenadier) recruitment school. A six-item questionnaire designed to identify recruits likely to be subject to premature dismissal on psychological or psychiatric grounds was developed and prospectively validated. The questionnaire was based on an analysis of medical and psychiatric/psychological records of 26 recruits dismissed from a SF recruitment school. Six items were identified that appeared to have prognostic value for early discharge. These six questions were submitted to the remaining applicants in the recruitment school by a suitably qualified psychologist or psychiatrist and effectively identified candidates who would be discharged early. Based on these results a 0-6 scale was developed and applied prospectively to subsequent Grenadier recruitment courses. Statistical analysis showed that 75% of candidates with the lowest scores would eventually complete the course and that no candidates with highest scores would subsequently complete the recruitment course. Prospective studies in subsequent recruitment courses candidates with high scores were classified as not qualified to enter the course, and those with intermediate scores were subject to additional in-depth interviews with a psychologist or psychiatrist to determine their suitability. In the following courses a correlation was established between the questionnaire score and week of discharge for those discharged. Application of this method during subsequent recruitment courses has reduced early dismissal from Swiss SF recruitment schools. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Impact of a standardized nurse observation protocol including MEWS after Intensive Care Unit discharge.

PubMed

De Meester, K; Das, T; Hellemans, K; Verbrugghe, W; Jorens, P G; Verpooten, G A; Van Bogaert, P

2013-02-01

Analysis of in-hospital mortality after serious adverse events (SAE's) in our hospital showed the need for more frequent observation in medical and surgical wards. We hypothesized that the incidence of SAE's could be decreased by introducing a standard nurse observation protocol. To investigate the effect of a standard nurse observation protocol implementing the Modified Early Warning Score (MEWS) and a color graphic observation chart. Pre- and post-intervention study by analysis of patients records for a 5-day period after Intensive Care Unit (ICU) discharge to 14 medical and surgical wards before (n=530) and after (n=509) the intervention. For the total study population the mean Patient Observation Frequency Per Nursing Shift (POFPNS) during the 5-day period after ICU discharge increased from .9993 (95% C.I. .9637-1.0350) in the pre-intervention period to 1.0732 (95% C.I. 1.0362-1.1101) (p=.005) in the post-intervention period. There was an increased risk of a SAE in patients with MEWS 4 or higher in the present nursing shift (HR 8.25; 95% C.I. 2.88-23.62) and the previous nursing shift (HR 12.83;95% C.I. 4.45-36.99). There was an absolute risk reduction for SAE's within 120h after ICU discharge of 2.2% (95% C.I. -0.4-4.67%) from 5.7% to 3.5%. The intervention had a positive impact on the observation frequency. MEWS had a predictive value for SAE's in patients after ICU discharge. The drop in SAE's was substantial but did not reach statistical significance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Elevation of B-Type Natriuretic Peptide at Discharge is Associated With 2-Year Mortality After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis: Insights From a Multicenter Prospective OCEAN-TAVI (Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation) Registry.

PubMed

Mizutani, Kazuki; Hara, Masahiko; Iwata, Shinichi; Murakami, Takashi; Shibata, Toshihiko; Yoshiyama, Minoru; Naganuma, Toru; Yamanaka, Futoshi; Higashimori, Akihiro; Tada, Norio; Takagi, Kensuke; Araki, Motoharu; Ueno, Hiroshi; Tabata, Minoru; Shirai, Shinichi; Watanabe, Yusuke; Yamamoto, Masanori; Hayashida, Kentaro

2017-07-14

In this study, we sought to investigate the 2-year prognostic impact of B-type natriuretic peptide (BNP) levels at discharge, following transcatheter aortic valve replacement. We enrolled 1094 consecutive patients who underwent transcatheter aortic valve replacement between 2013 and 2016. Study patients were stratified into 2 groups according to survival classification and regression tree analysis (high versus low BNP groups). We evaluated the impact of high BNP on 2-year mortality compared with that of low BNP using a multivariable Cox model, and assessed whether this stratification would improve predictive accuracy for determining 2-year mortality by assessing time-dependent net reclassification improvement and integrated discrimination improvement. The median age of patients was 85 years (quartile 82-88), and 29.2% of the study population were men. The median Society of Thoracic Surgeons score was 6.8 (4.7-9.5), and BNP at discharge was 186 (93-378) pg/mL. All-cause mortality following discharge was 7.9% (95% CI, 5.8-9.9%) at 1 year and 15.4% (95% CI, 11.6-19.0%) at 2 years. The survival classification and regression tree analysis revealed that the discriminating BNP level to discern 2-year mortality was 202 pg/mL, and that elevated BNP had a statistically significant impact on outcomes, with an adjusted hazard ratio of 2.28 (1.36-3.82, P =0.002). The time-dependent net reclassification improvement ( P =0.047) and integrated discrimination improvement ( P =0.029) analysis revealed that the incorporation of BNP stratification with other clinical variables significantly improved predictive accuracy for 2-year mortality. Elevation of BNP at discharge is associated with 2-year mortality after transcatheter aortic valve replacement. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Biocompatibility Analysis of an Electrically-Activated Silver-Based Antibacterial Surface System for Medical Device Applications

DTIC Science & Technology

2012-12-16

sterilizing without causing toxicity in vivo. 1 Introduction As reported to the Centers for Disease Control and Pre- vention (CDC) between 2006 and...Owings MF. National Hospital Discharge Survey. Advance Data from Vital and Health Statistics. United States: Centers for Disease Control and Prevention...10.1007/s10856-012-4730-3. 19. Shirwaiker RA, Wysk RA, Kariyawasam S, Carrion H, Voigt RC. Micro-scale fabrication and characterization of a silver–polymer

Theoretical investigations on plasma processes in the Kaufman thruster. [electron and ion velocity distribution

NASA Technical Reports Server (NTRS)

Wilhelm, H. E.

1974-01-01

An analysis of the sputtering of metal surfaces and grids by ions of medium energies is given and it is shown that an exact, nonlinear, hyperbolic wave equation for the temperature field describes the transient transport of heat in metals. Quantum statistical and perturbation theoretical analysis of surface sputtering by low energy ions are used to develop the same expression for the sputtering rate. A transport model is formulated for the deposition of sputtered atoms on system components. Theoretical efforts in determining the potential distribution and the particle velocity distributions in low pressure discharges are briefly discussed.

Basin characteristics, history of stream gaging, and statistical summary of selected streamflow records for the Rapid Creek basin, western South Dakota

USGS Publications Warehouse

Driscoll, Daniel G.; Zogorski, John S.

1990-01-01

The report presents a summary of basin characteristics affecting streamflow, a history of the U.S. Geological Survey 's stream-gaging program, and a compilation of discharge records and statistical summaries for selected sites within the Rapid Creek basin. It is the first in a series which will investigate surface-water/groundwater relations along Rapid Creek. The summary of basin characteristics includes descriptions of the geology and hydrogeology, physiography and climate, land use and vegetation, reservoirs, and water use within the basin. A recounting of the U.S. Geological Survey 's stream-gaging program and a tabulation of historic stream-gaging stations within the basin are furnished. A compilation of monthly and annual mean discharge values for nine currently operated, long-term, continuous-record, streamflow-gaging stations on Rapid Creek is presented. The statistical summary for each site includes summary statistics on monthly and annual mean values, correlation matrix for monthly values, serial correlation for 1 year lag for monthly values, percentile rankings for monthly and annual mean values, low and high value tables, duration curves, and peak-discharge tables. Records of monthend contents for two reservoirs within the basin also are presented. (USGS)

Correlation between audible noise and corona current generated by AC corona discharge in time and frequency domains

NASA Astrophysics Data System (ADS)

Li, Xuebao; Wang, Jing; Li, Yinfei; Zhang, Qian; Lu, Tiebing; Cui, Xiang

2018-06-01

Corona-generated audible noise is induced by the collisions between space charges and air molecules. It has been proven that there is a close correlation between audible noise and corona current from DC corona discharge. Analysis on the correlation between audible noise and corona current can promote the cognition of the generation mechanism of corona discharge. In this paper, time-domain waveforms of AC corona-generated audible noise and corona current are measured simultaneously. The one-to-one relationship between sound pressure pulses and corona current pulses can be found and is used to remove the interferences from background noise. After the interferences are removed, the linear correlated relationships between sound pressure pulse amplitude and corona current pulse amplitude are obtained through statistical analysis. Besides, frequency components at the harmonics of power frequency (50 Hz) can be found both in the frequency spectrums of audible noise and corona current through frequency analysis. Furthermore, the self-correlation relationships between harmonic components below 400 Hz with the 50 Hz component are analyzed for audible noise and corona current and corresponding empirical formulas are proposed to calculate the harmonic components based on the 50 Hz component. Finally, based on the AC corona discharge process and generation mechanism of audible noise and corona current, the correlation between audible noise and corona current in time domain and frequency domain are interpreted qualitatively. Besides, with the aid of analytical expressions of periodic square waves, sound pressure pulses, and corona current pulses, the modulation effects from the AC voltage on the pulse trains are used to interpret the generation of the harmonic components of audible noise and corona current.

Factors associated with infant feeding practices after hospital discharge.

PubMed

Audi, Celene Aparecida Ferrari; Corrêa, A M S; Latorre, M R D O; Pérez-Escamilla, Rafael

2005-06-01

To assess factors associated with infant feeding practices on the first day at home after hospital discharge. A total of 209 women, who had a child aged four months or less and were living in Itapira, Brazil, were interviewed during the National Immunization Campaign Day in 1999. Statistical analysis was performed using the Chi-square test and a logistic regression model was used for verifying an association between dependent and independent variables. Women aged 25.5 years on average and 18.2% were teenagers. Fifty-three percent of the women delivered vaginally and most vaginal deliveries (78.5%) took place in the public hospital. The prevalence of exclusive breastfeeding on the first day at home was 78.1% and 11.6% of the infants were receiving formula at this time. The only factor associated with EBF on the first day at home was being a teenaged-primiparous mother (OR=9.40; 95% CI: 1.24-71.27). This association remained statistically significant even after controlling for type of delivery and hospital where the birth took place. Feeding formula on the first day at home was only significantly associated with the hospital (i.e., birth at the city hospital was a protective factor (OR=0.33; 95% CI: 0.13-0.86), even after controlling for vaginal delivery. On the first day at home after hospital discharge, teenaged-primiparous mothers were more likely to exclusive breastfeeding as well as those infants born in the municipal public hospital. Further studies are needed from a multidisciplinary approach.

Relationship Between Satellite-Derived Snow Cover and Snowmelt-Runoff Timing and Stream Power in the Wind River Range, Wyoming

NASA Technical Reports Server (NTRS)

Hall, Dorothy K.; Foster, James L.; DiGirolamo, Nicolo E.; Riggs, George A.

2010-01-01

Earlier onset of springtime weather including earlier snowmelt has been documented in the western United States over at least the last 50 years. Because the majority (>70%) of the water supply in the western U.S. comes from snowmelt, analysis of the declining spring snowpack (and shrinking glaciers) has important implications for streamflow management. The amount of water in a snowpack influences stream discharge which can also influence erosion and sediment transport by changing stream power, or the rate at which a stream can do work such as move sediment and erode the stream bed. The focus of this work is the Wind River Range (WRR) in west-central Wyoming. Ten years of Moderate-Resolution Imaging Spectroradiometer (MODIS) snow-cover, cloud- gap-filled (CGF) map products and 30 years of discharge and meteorological station data are studied. Streamflow data from six streams in the WRR drainage basins show lower annual discharge and earlier snowmelt in the decade of the 2000s than in the previous three decades, though no trend of either lower streamflow or earlier snowmelt was observed using MODIS snow-cover maps within the decade of the 2000s. Results show a statistically-significant trend at the 95% confidence level (or higher) of increasing weekly maximum air temperature (for three out of the five meteorological stations studied) in the decade of the 1970s, and also for the 40-year study period. MODIS-derived snow cover (percent of basin covered) measured on 30 April explains over 89% of the variance in discharge for maximum monthly streamflow in the decade of the 2000s using Spearman rank correlation analysis. We also investigated stream power for Bull Lake Creek Above Bull Lake from 1970 to 2009; a statistically-significant end toward reduced stream power was found (significant at the 90% confidence level). Observed changes in streamflow and stream power may be related to increasing weekly maximum air temperature measured during the 40-year study period. The strong relationship between percent of basin covered and streamflow indicates that MODIS data is useful for predicting streamflow, leading to improved reservoir management

Relationship Between Satellite-Derived Snow Cover and Snowmelt-Runoff Timing and Stream Power in the Wind River Range, Wyoming

NASA Technical Reports Server (NTRS)

Hall, Dorothy K.; Foster, James L.; Riggs, George A.; DiGirolano, Nocolo E.

2010-01-01

Earlier onset of springtime weather including earlier snowmelt has been documented in the western United States over at least the last 50 years. Because the majority (>70%) of the water supply in the western U.S. comes from snowmelt, analysis of the declining spring snowpack (and shrinking glaciers) has important implications for streamflow management. The amount of water in a snowpack influences stream discharge which can also influence erosion and sediment transport by changing stream power, or the rate at which a stream can do work such as move sediment and erode the stream bed. The focus of this work is the Wind River Range (WRR) in west-central Wyoming. Ten years of Moderate-Resolution Imaging Spectroradiometer (MODIS) snow-cover, cloud- gap-filled (CGF) map products and 30 years of discharge and meteorological station a are studied. Streamflow data from six streams in the WRR drainage basins show lower annual discharge and earlier snowmelt in the decade of the 2000s than in the previous three decades, though no trend of either lower streamflow or earlier snowmelt was observed using MODIS snow-cover maps within the decade of the 2000s. Results show a statistically-significant trend at the 95% confidence level (or higher) of increasing weekly maximum air temperature (for three out of the five meteorological stations studied) in the decade of the 1970s, and also for the 40-year study period. MODIS- derived snow cover (percent of basin covered) measured on 30 April explains over 89% of the variance in discharge for maximum monthly streamflow in the decade of the 2000s using Spearman rank correlation analysis. We also investigated stream power for Bull Lake Creek Above Bull Lake from 1970 to 2009; a statistically-significant trend toward reduced stream power was found (significant at the 90% confidence level). Observed changes in streamflow and stream power may be related to increasing weekly maximum air temperature measured during the 40-year study period. The strong relationship between percent of basin covered and streamflow indicates that MODIS data is useful for predicting streamflow, leading to improved reservoir management.

Low-flow characteristics for streams on the Islands of Kauaʻi, Oʻahu, Molokaʻi, Maui, and Hawaiʻi, State of Hawaiʻi

USGS Publications Warehouse

Cheng, Chui Ling

2016-08-03

Statistical models were developed to estimate natural streamflow under low-flow conditions for streams with existing streamflow data at measurement sites on the Islands of Kauaʻi, Oʻahu, Molokaʻi, Maui, and Hawaiʻi. Streamflow statistics used to describe the low-flow characteristics are flow-duration discharges that are equaled or exceeded between 50 and 95 percent of the time during the 30-year base period 1984–2013. Record-augmentation techniques were applied to develop statistical models relating concurrent streamflow data at the measurement sites and long-term data from nearby continuous-record streamflow-gaging stations that were in operation during the base period and were selected as index stations. Existing data and subsequent low-flow analyses of the available data help to identify streams in under-represented geographic areas and hydrogeologic settings where additional data collection is suggested.Low-flow duration discharges were estimated for 107 measurement sites (including long-term and short-term continuous-record streamflow-gaging stations, and partial-record stations) and 27 index stations. The adequacy of statistical models was evaluated with correlation coefficients and modified Nash-Sutcliff coefficients of efficiency, and a majority of the low-flow duration-discharge estimates are satisfactory based on these regression statistics.Molokaʻi and Hawaiʻi have the fewest number of measurement sites (that are not located on ephemeral stream reaches) at which flow-duration discharges were estimated, which can be partially explained by the limited number of index stations available on these islands that could be used for record augmentation. At measurement sites on some tributary streams, low-flow duration discharges could not be estimated because no adequate correlations could be developed with the index stations. These measurement sites are located on streams where duration-discharge estimates are available at long-term stations at other locations on the main stream channel to provide at least some definition of low-flow characteristics on that stream. In terms of general natural streamflow data availability, data are scarce in the leeward areas for all five islands as many leeward streams are dry or have minimal flow. Other under-represented areas include central Oʻahu, central Maui, and southeastern Maui.

Critical elements of clinical follow-up after hospital discharge for heart failure: insights from the EVEREST trial

PubMed Central

Dunlay, Shannon M.; Gheorghiade, Mihai; Reid, Kimberly J.; Allen, Larry A.; Chan, Paul S.; Hauptman, Paul J.; Zannad, Faiez; Maggioni, Aldo P.; Swedberg, Karl; Konstam, Marvin A.; Spertus, John A.

2010-01-01

Aims Hospitalized heart failure (HF) patients are at high risk for death and readmission. We examined the incremental value of data obtained 1 week after HF hospital discharge in predicting mortality and readmission. Methods and results In the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with tolvaptan, 1528 hospitalized patients (ejection fraction ≤40%) with a physical examination, laboratories, and health status [Kansas City Cardiomyopathy Questionnaire (KCCQ)] assessments 1 week after discharge were included. The ability to predict 1 year cardiovascular rehospitalization and mortality was assessed with Cox models, c-statistics, and the integrated discrimination improvement (IDI). Not using a beta-blocker, rales, pedal oedema, hyponatraemia, lower creatinine clearance, higher brain natriuretic peptide, and worse health status were independent risk factors for rehospitalization and death. The c-statistic for the base model (history and medications) was 0.657. The model improved with physical examination, laboratory, and KCCQ results, with IDI increases of 4.9, 7.0, and 3.2%, respectively (P < 0.001 each). The combination of all three offered the greatest incremental gain (c-statistic 0.749; IDI increase 10.8%). Conclusion Physical examination, laboratories, and KCCQ assessed 1 week after discharge offer important prognostic information, suggesting that all are critical components of outpatient evaluation after HF hospitalization. PMID:20197265

Statistical Characteristics of the Gaussian-Noise Spikes Exceeding the Specified Threshold as Applied to Discharges in a Thundercloud

NASA Astrophysics Data System (ADS)

Klimenko, V. V.

2017-12-01

We obtain expressions for the probabilities of the normal-noise spikes with the Gaussian correlation function and for the probability density of the inter-spike intervals. As distinct from the delta-correlated noise, in which the intervals are distributed by the exponential law, the probability of the subsequent spike depends on the previous spike and the interval-distribution law deviates from the exponential one for a finite noise-correlation time (frequency-bandwidth restriction). This deviation is the most pronounced for a low detection threshold. Similarity of the behaviors of the distributions of the inter-discharge intervals in a thundercloud and the noise spikes for the varying repetition rate of the discharges/spikes, which is determined by the ratio of the detection threshold to the root-mean-square value of noise, is observed. The results of this work can be useful for the quantitative description of the statistical characteristics of the noise spikes and studying the role of fluctuations for the discharge emergence in a thundercloud.

Numerical and Qualitative Contrasts of Two Statistical Models for Water Quality Change in Tidal Waters

EPA Science Inventory

Two statistical approaches, weighted regression on time, discharge, and season and generalized additive models, have recently been used to evaluate water quality trends in estuaries. Both models have been used in similar contexts despite differences in statistical foundations and...

Daily Suspended Sediment Discharge Prediction Using Multiple Linear Regression and Artificial Neural Network

NASA Astrophysics Data System (ADS)

Uca; Toriman, Ekhwan; Jaafar, Othman; Maru, Rosmini; Arfan, Amal; Saleh Ahmar, Ansari

2018-01-01

Prediction of suspended sediment discharge in a catchments area is very important because it can be used to evaluation the erosion hazard, management of its water resources, water quality, hydrology project management (dams, reservoirs, and irrigation) and to determine the extent of the damage that occurred in the catchments. Multiple Linear Regression analysis and artificial neural network can be used to predict the amount of daily suspended sediment discharge. Regression analysis using the least square method, whereas artificial neural networks using Radial Basis Function (RBF) and feedforward multilayer perceptron with three learning algorithms namely Levenberg-Marquardt (LM), Scaled Conjugate Descent (SCD) and Broyden-Fletcher-Goldfarb-Shanno Quasi-Newton (BFGS). The number neuron of hidden layer is three to sixteen, while in output layer only one neuron because only one output target. The mean absolute error (MAE), root mean square error (RMSE), coefficient of determination (R2 ) and coefficient of efficiency (CE) of the multiple linear regression (MLRg) value Model 2 (6 input variable independent) has the lowest the value of MAE and RMSE (0.0000002 and 13.6039) and highest R2 and CE (0.9971 and 0.9971). When compared between LM, SCG and RBF, the BFGS model structure 3-7-1 is the better and more accurate to prediction suspended sediment discharge in Jenderam catchment. The performance value in testing process, MAE and RMSE (13.5769 and 17.9011) is smallest, meanwhile R2 and CE (0.9999 and 0.9998) is the highest if it compared with the another BFGS Quasi-Newton model (6-3-1, 9-10-1 and 12-12-1). Based on the performance statistics value, MLRg, LM, SCG, BFGS and RBF suitable and accurately for prediction by modeling the non-linear complex behavior of suspended sediment responses to rainfall, water depth and discharge. The comparison between artificial neural network (ANN) and MLRg, the MLRg Model 2 accurately for to prediction suspended sediment discharge (kg/day) in Jenderan catchment area.

Current Risk Adjustment and Comorbidity Index Underperformance in Predicting Post-Acute Utilization and Hospital Readmissions After Joint Replacements: Implications for Comprehensive Care for Joint Replacement Model.

PubMed

Kumar, Amit; Karmarkar, Amol; Downer, Brian; Vashist, Amit; Adhikari, Deepak; Al Snih, Soham; Ottenbacher, Kenneth

2017-11-01

To compare the performances of 3 comorbidity indices, the Charlson Comorbidity Index, the Elixhauser Comorbidity Index, and the Centers for Medicare & Medicaid Services (CMS) risk adjustment model, Hierarchical Condition Category (HCC), in predicting post-acute discharge settings and hospital readmission for patients after joint replacement. A retrospective study of Medicare beneficiaries with total knee replacement (TKR) or total hip replacement (THR) discharged from hospitals in 2009-2011 (n = 607,349) was performed. Study outcomes were post-acute discharge setting and unplanned 30-, 60-, and 90-day hospital readmissions. Logistic regression models were built to compare the performance of the 3 comorbidity indices using C statistics. The base model included patient demographics and hospital use. Subsequent models included 1 of the 3 comorbidity indices. Additional multivariable logistic regression models were built to identify individual comorbid conditions associated with high risk of hospital readmissions. The 30-, 60-, and 90-day unplanned hospital readmission rates were 5.3%, 7.2%, and 8.5%, respectively. Patients were most frequently discharged to home health (46.3%), followed by skilled nursing facility (40.9%) and inpatient rehabilitation facility (12.7%). The C statistics for the base model in predicting post-acute discharge setting and 30-, 60-, and 90-day readmission in TKR and THR were between 0.63 and 0.67. Adding the Charlson Comorbidity Index, the Elixhauser Comorbidity Index, or HCC increased the C statistic minimally from the base model for predicting both discharge settings and hospital readmission. The health conditions most frequently associated with hospital readmission were diabetes mellitus, pulmonary disease, arrhythmias, and heart disease. The comorbidity indices and CMS-HCC demonstrated weak discriminatory ability to predict post-acute discharge settings and hospital readmission following joint replacement. © 2017, American College of Rheumatology.

History of irrigation and characteristics of streamflow in Nebraska, part of the North and South Platte River basins

USGS Publications Warehouse

Shaffer, F. Butler

1976-01-01

Statistics on streamflow for selected periods of time are presented for 28 gaging sites in the Nebraska part of the North and South Platte River basins. Monthly mean discharges, monthly means in percent of annual runoff, standard deviations, coefficients of variation, and monthly extremes are given. Also tabulated are probabilities of high discharges for 1 day and for 3, 7, 15, 30, and 60 consecutive days and of low discharges for 1 day and for 3, 7, 14, 30, and 60 consecutive days. All statistics are based on records that are representative of 1973 conditions of streamflow. Brief historical data are given for 27 of the principal irrigation canals diverting from the North and South Platte Rivers. (Woodard-USGS)

Chronic lung disease in very low birth weight infants: Persistence and improvement of a quality improvement process in a tertiary level neonatal intensive care unit.

PubMed

Birenbaum, H J; Pfoh, E R; Helou, S; Pane, M A; Marinkovich, G A; Dentry, A; Yeh, Hsin-Chieh; Updegraff, L; Arnold, C; Liverman, S; Cawman, H

2016-05-19

We previously demonstrated a significant reduction in our incidence of chronic lung disease in our NICU using potentially better practices of avoiding delivery room endotracheal intubation and using early nasal CPAP. We sought to demonstrate whether these improvements were sustained and or improved over time. We conducted a retrospective, cross-sectional analysis of infants 501-1500 grams born at our hospital between 2005 and 2013. Infants born during the 2005-2007, 2008-2010 and 2011-2013 epochs were grouped together, respectively. Descriptive analysis was conducted to determine the number and percent of maternal and neonatal characteristics by year grouping. Chi-squared tests were used to determine whether there were any statistically significant changes in characteristics across year groupings.. Two outcome variables were assessed: a diagnosis of chronic lung disease based on the Vermont Oxford Network definition and being discharged home on supplemental oxygen. There was a statistically significant improvement in the incidence of chronic lung disease in infants below 27 weeks' gestation in the three year period in the 2011-2013 cohort compared with those in the 2005-2007 cohort. We also found a statistically significant improvement in the number of infants discharged on home oxygen with birth weights 751-1000 grams and infants with gestational age less than 27 weeks in the 2011-2013 cohort compared to the 2005-2007 cohort. We demonstrated sustained improvement in our incidence of CLD between 2005 and 2013. We speculate that a multifaceted strategy of avoiding intubation and excessive oxygen in the delivery room, the early use of CPAP, as well as the use of volume targeted ventilation, when needed, may help significantly reduce the incidence of CLD.

Variation of Water Quality Parameters with Siltation Depth for River Ichamati Along International Border with Bangladesh Using Multivariate Statistical Techniques

NASA Astrophysics Data System (ADS)

Roy, P. K.; Pal, S.; Banerjee, G.; Biswas Roy, M.; Ray, D.; Majumder, A.

2014-12-01

River is considered as one of the main sources of freshwater all over the world. Hence analysis and maintenance of this water resource is globally considered a matter of major concern. This paper deals with the assessment of surface water quality of the Ichamati river using multivariate statistical techniques. Eight distinct surface water quality observation stations were located and samples were collected. For the samples collected statistical techniques were applied to the physico-chemical parameters and depth of siltation. In this paper cluster analysis is done to determine the relations between surface water quality and siltation depth of river Ichamati. Multiple regressions and mathematical equation modeling have been done to characterize surface water quality of Ichamati river on the basis of physico-chemical parameters. It was found that surface water quality of the downstream river was different from the water quality of the upstream. The analysis of the water quality parameters of the Ichamati river clearly indicate high pollution load on the river water which can be accounted to agricultural discharge, tidal effect and soil erosion. The results further reveal that with the increase in depth of siltation, water quality degraded.

Attempting to physically explain space-time correlation of extremes

NASA Astrophysics Data System (ADS)

Bernardara, Pietro; Gailhard, Joel

2010-05-01

Spatial and temporal clustering of hydro-meteorological extreme events is scientific evidence. Moreover, the statistical parameters characterizing their local frequencies of occurrence show clear spatial patterns. Thus, in order to robustly assess the hydro-meteorological hazard, statistical models need to be able to take into account spatial and temporal dependencies. Statistical models considering long term correlation for quantifying and qualifying temporal and spatial dependencies are available, such as multifractal approach. Furthermore, the development of regional frequency analysis techniques allows estimating the frequency of occurrence of extreme events taking into account spatial patterns on the extreme quantiles behaviour. However, in order to understand the origin of spatio-temporal clustering, an attempt to find physical explanation should be done. Here, some statistical evidences of spatio-temporal correlation and spatial patterns of extreme behaviour are given on a large database of more than 400 rainfall and discharge series in France. In particular, the spatial distribution of multifractal and Generalized Pareto distribution parameters shows evident correlation patterns in the behaviour of frequency of occurrence of extremes. It is then shown that the identification of atmospheric circulation pattern (weather types) can physically explain the temporal clustering of extreme rainfall events (seasonality) and the spatial pattern of the frequency of occurrence. Moreover, coupling this information with the hydrological modelization of a watershed (as in the Schadex approach) an explanation of spatio-temporal distribution of extreme discharge can also be provided. We finally show that a hydro-meteorological approach (as the Schadex approach) can explain and take into account space and time dependencies of hydro-meteorological extreme events.

FISH TISSUE QUALITY IN NEAR-COASTAL AREAS OF THE GULF OF MEXICO RECEIVING POINT SOURCE DISCHARGES

EPA Science Inventory

The objective of this study was to determine inorganic and organic contaminant concentrations in edible tissue of fish collected from eight coastal areas receiving wastewater discharges and from two reference locations. Trace metal residues were statistically similar regardless o...

Environmental Data-Driven Inquiry and Exploration (EDDIE)- Water Focused Modules for interacting with Big Hydrologic Data

NASA Astrophysics Data System (ADS)

Meixner, T.; Gougis, R.; O'Reilly, C.; Klug, J.; Richardson, D.; Castendyk, D.; Carey, C.; Bader, N.; Stomberg, J.; Soule, D. C.

2016-12-01

High-frequency sensor data are driving a shift in the Earth and environmental sciences. The availability of high-frequency data creates an engagement opportunity for undergraduate students in primary research by using large, long-term, and sensor-based, data directly in the scientific curriculum. Project EDDIE (Environmental Data-Driven Inquiry & Exploration) has developed flexible classroom activity modules designed to meet a series of pedagogical goals that include (1) developing skills required to manipulate large datasets at different scales to conduct inquiry-based investigations; (2) developing students' reasoning about statistical variation; and (3) fostering accurate student conceptions about the nature of environmental science. The modules cover a wide range of topics, including lake physics and metabolism, stream discharge, water quality, soil respiration, seismology, and climate change. In this presentation we will focus on a sequence of modules of particular interest to hydrologists - stream discharge, water quality and nutrient loading. Assessment results show that our modules are effective at making students more comfortable analyzing data, improved understanding of statistical concepts, and stronger data analysis capability. This project is funded by an NSF TUES grant (NSF DEB 1245707).

Acoustic firearm discharge detection and classification in an enclosed environment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Luzi, Lorenzo; Gonzalez, Eric; Bruillard, Paul

2016-05-01

Two different signal processing algorithms are described for detection and classification of acoustic signals generated by firearm discharges in small enclosed spaces. The first is based on the logarithm of the signal energy. The second is a joint entropy. The current study indicates that a system using both signal energy and joint entropy would be able to both detect weapon discharges and classify weapon type, in small spaces, with high statistical certainty.

Determinants of health after hospital discharge: rationale and design of the Vanderbilt Inpatient Cohort Study (VICS)

PubMed Central

2014-01-01

Background The period following hospital discharge is a vulnerable time for patients when errors and poorly coordinated care are common. Suboptimal care transitions for patients admitted with cardiovascular conditions can contribute to readmission and other adverse health outcomes. Little research has examined the role of health literacy and other social determinants of health in predicting post-discharge outcomes. Methods The Vanderbilt Inpatient Cohort Study (VICS), funded by the National Institutes of Health, is a prospective longitudinal study of 3,000 patients hospitalized with acute coronary syndromes or acute decompensated heart failure. Enrollment began in October 2011 and is planned through October 2015. During hospitalization, a set of validated demographic, cognitive, psychological, social, behavioral, and functional measures are administered, and health status and comorbidities are assessed. Patients are interviewed by phone during the first week after discharge to assess the quality of hospital discharge, communication, and initial medication management. At approximately 30 and 90 days post-discharge, interviewers collect additional data on medication adherence, social support, functional status, quality of life, and health care utilization. Mortality will be determined with up to 3.5 years follow-up. Statistical models will examine hypothesized relationships of health literacy and other social determinants on medication management, functional status, quality of life, utilization, and mortality. In this paper, we describe recruitment, eligibility, follow-up, data collection, and analysis plans for VICS, as well as characteristics of the accruing patient cohort. Discussion This research will enhance understanding of how health literacy and other patient factors affect the quality of care transitions and outcomes after hospitalization. Findings will help inform the design of interventions to improve care transitions and post-discharge outcomes. PMID:24397292

Quantifying the distribution of tracer discharge from boreal catchments under transient flow using the kinematic pathway approach

NASA Astrophysics Data System (ADS)

Soltani, S. S.; Cvetkovic, V.

2017-07-01

This focuses on solute discharge from boreal catchments with relatively shallow groundwater table and topography-driven groundwater flow. We explore whether a simplified semianalytical approach can be used for predictive modeling of the statistical distribution of tracer discharge. The approach is referred to as the "kinematic pathways approach" (KPA). This approach uses hydrological and tracer inputs and topographical and hydrogeological information; the latter regards average aquifer depth to the less permeable bedrock. A characteristic velocity of water flow through the catchment is further obtained from the overall water balance in the catchment. For the waterborne tracer transport through the catchment, morphological dispersion is accounted for by topographical analysis of the distribution of pathway lengths to the catchment outlet. Macrodispersion is accounted for heuristically by assuming an effective Péclet number. Distribution of water travel times through the catchment reflect the dispersion on both levels and are derived in both a forward mode (transit time from input to outlet) and a backward mode (water age when arriving at outlet arrival). The forward distribution of water travel times is further used for the tracer discharge modeling by convolution. The approach is applied to modeling of a 23 year long chloride data series for a specific catchment Kringlan (Sweden), and for generic modeling to better understand the dependence of the tracer discharge distribution on different dispersion aspects. The KPA is found to provide reasonable estimates of tracer discharge distribution, and particularly of extreme values, depending on method for determining the pathway length distribution. As a possible alternative analytical model of tracer transport through a catchment, the reservoir approach generally results in large tracer dispersion. This implies that tracer discharge distributions obtained from a mixed reservoir approach and from KPA are only compatible under large dispersion conditions.

Estimation of stream conditions in tributaries of the Klamath River, northern California

USGS Publications Warehouse

Manhard, Christopher V.; Som, Nicholas A.; Jones, Edward C.; Perry, Russell W.

2018-01-01

Because of their critical ecological role, stream temperature and discharge are requisite inputs for models of salmonid population dynamics. Coho Salmon inhabiting the Klamath Basin spend much of their freshwater life cycle inhabiting tributaries, but environmental data are often absent or only seasonally available at these locations. To address this information gap, we constructed daily averaged water temperature models that used simulated meteorological data to estimate daily tributary temperatures, and we used flow differentials recorded on the mainstem Klamath River to estimate daily tributary discharge. Observed temperature data were available for fourteen of the major salmon bearing tributaries, which enabled estimation of tributary-specific model parameters at those locations. Water temperature data from six mid-Klamath Basin tributaries were used to estimate a global set of parameters for predicting water temperatures in the remaining tributaries. The resulting parameter sets were used to simulate water temperatures for each of 75 tributaries from 1980-2015. Goodness-of-fit statistics computed from a cross-validation analysis demonstrated a high precision of the tributary-specific models in predicting temperature in unobserved years and of the global model in predicting temperatures in unobserved streams. Klamath River discharge has been monitored by four gages that broadly intersperse the 292 kilometers from the Iron Gate Dam to the Klamath River mouth. These gages defined the upstream and downstream margins of three reaches. Daily discharge of tributaries within a reach was estimated from 1980-2015 based on drainage-area proportionate allocations of the discharge differential between the upstream and downstream margin. Comparisons with measured discharge on Indian Creek, a moderate-sized tributary with naturally regulated flows, revealed that the estimates effectively approximated both the variability and magnitude of discharge.

Inpatient burden of constipation in the United States: an analysis of national trends in the United States from 1997 to 2010.

PubMed

Sethi, Saurabh; Mikami, Sage; Leclair, John; Park, Richard; Jones, Mike; Wadhwa, Vaibhav; Sethi, Nidhi; Cheng, Vivian; Friedlander, Elizabeth; Bollom, Andrea; Lembo, Anthony

2014-02-01

Constipation is one of the most common outpatient diagnoses in primary care and gastroenterology clinics; however, there is limited data on the inpatient burden of constipation in the United States. The aim of this study was to evaluate inpatient admission rates, length of stay, and associated costs related to constipation from 1997 to 2010. We analyzed the National Inpatient Sample Database for all patients in which constipation (ICD-9 codes: 564.0-564.09) was the principal discharge diagnosis from 1997 to 2010. The statistical significance of the difference in the number of hospital discharges, length of stay, and hospital costs over the study period was determined by utilizing the Spearman's coefficient to describe various trends. Between 1997 and 2010, the number of hospitalizations for patients with a primary discharge diagnosis of constipation increased from 21,190 patients to 48,450 (P<0.001, GoF test), whereas the mean length of hospital stay increased only slightly from 3.0 days to 3.1 days (b=0.008 (0.003-0.014); P=0.004). The mean charges per hospital discharge for constipation increased from $8869 in 1997 (adjusted for long-term inflation) to $17,518 in 2010 (b=745.4 (685.3-805.6); P<0.001)), whereas the total costs increased from $188,109,249 (adjusted for inflation) in 1997 to $851,713,263 in 2010. Although the elderly (65-84 years) accounted for the largest percentage of constipation discharges, patients in the 1-17 years age group had the highest frequency of constipation per 10,000 discharges. The number of inpatient discharges for constipation and associated costs has significantly increased between 1997 and 2010.

Spatiotemporal interpolation of discharge across a river network by using synthetic SWOT satellite data

NASA Astrophysics Data System (ADS)

Paiva, Rodrigo C. D.; Durand, Michael T.; Hossain, Faisal

2015-01-01

Recent efforts have sought to estimate river discharge and other surface water-related quantities using spaceborne sensors, with better spatial coverage but worse temporal sampling as compared with in situ measurements. The Surface Water and Ocean Topography (SWOT) mission will provide river discharge estimates globally from space. However, questions on how to optimally use the spatially distributed but asynchronous satellite observations to generate continuous fields still exist. This paper presents a statistical model (River Kriging-RK), for estimating discharge time series in a river network in the context of the SWOT mission. RK uses discharge estimates at different locations and times to produce a continuous field using spatiotemporal kriging. A key component of RK is the space-time river discharge covariance, which was derived analytically from the diffusive wave approximation of Saint Venant's equations. The RK covariance also accounts for the loss of correlation at confluences. The model performed well in a case study on Ganges-Brahmaputra-Meghna (GBM) River system in Bangladesh using synthetic SWOT observations. The correlation model reproduced empirically derived values. RK (R2=0.83) outperformed other kriging-based methods (R2=0.80), as well as a simple time series linear interpolation (R2=0.72). RK was used to combine discharge from SWOT and in situ observations, improving estimates when the latter is included (R2=0.91). The proposed statistical concepts may eventually provide a feasible framework to estimate continuous discharge time series across a river network based on SWOT data, other altimetry missions, and/or in situ data.

Influence of early variables in traumatic brain injury on functional independence measure scores and rehabilitation length of stay and charges.

PubMed

Cowen, T D; Meythaler, J M; DeVivo, M J; Ivie, C S; Lebow, J; Novack, T A

1995-09-01

To determine the relationship between early variables (initial Glasgow Coma Scale [GCS] scores, computed tomography [CT] findings, presence of skeletal trauma, age, length of acute hospitalization) and outcome variables (Functional Independence Measure [FIM] scores, rehabilitation length of stay [LOS], rehabilitation charges) in traumatic brain injury (TBI). Inception cohort. University tertiary care rehabilitation center. 91 patients with TBI. Inpatient rehabilitation. FIM, rehabilitation LOS, and rehabilitation charges. Patients in the severely impaired (GCS = 3 to 7) group showed significantly lower (p = .01) mean admission and discharge motor scores (21.26, 39.83) than patients in the mildly impaired (GCS = 13 to 15) group (38.86, 55.29). Cognitive scores were also significantly lower (p < .01) in the severely impaired group on admission (26.73 vs 54.14) and discharge (42.28 vs 66.48). These findings continued to be statistically significant (p < .01) after regression analysis accounted for the other early variables previously listed. Regression analysis also illustrated that longer acute hospitalization LOS was independently associated with significantly lower admission motor (p < .01) and cognitive (p = .05) scores, and significantly higher (p = .01) rehabilitation charges. Patients with CT findings of intracranial bleed with skull fracture had longer total LOS (70.88 vs 43.08 days; p < .05), rehabilitation LOS (30.01 vs 19.68 days; p < .10), and higher rehabilitation charges ($43,346 vs $25,780; p < .05). Paradoxically, those patients in a motor vehicle crash with an extremity bone fracture had significantly higher (p = .002; p = .04 after regression analysis) FIM cognitive scores on admission (48.30 vs 27.28) and discharge (64.74 vs 45.78) than those without a fracture. Finally, data available on rehabilitation admission were used to predict discharge outcomes. The percentage of explained variance for each outcome variable is as follows: discharge FIM motor score, 69.5%; discharge FIM cognitive score, 71.2%; rehabilitation LOS, 54.1%; rehabilitation charges, 61.1%. The most powerful predictor of LOS and charges was the admission FIM motor score (p < .001), followed by CT findings (p = .02) and age (p = .04). Information readily available on rehabilitation admission, particularly the FIM motor score, may be useful in predicting discharge FIM scores as well as utilization of medical rehabilitation resources. Earlier transfer to rehabilitation may result in higher functional status and lower rehabilitation charges, as well as lower acute hospitalization charges. The presence of extremity fractures encountered during a motor vehicle crash is associated with a more favorable outcome in TBI as evidenced by higher discharge FIM cognitive scores.

Analysis of the NASA/MSFC Airborne Doppler Lidar results from San Gorgonio Pass, California

NASA Technical Reports Server (NTRS)

Cliff, W. C.; Skarda, J. R.; Renne, D. S.; Sandusky, W. F.

1984-01-01

Two days during July of 1981 the NASA/MSFC Airborne Doppler Lidar System (ADLS) was flown aboard the NASA/AMES Convair 990 on the east side of San Gorgonio Pass California, near Palm Springs, to measure and investigate the accelerated atmospheric wind field discharging from the pass. The vertical and horizontal extent of the fast moving atmospheric flow discharging from the San Gorgonio Pass were examined. Conventional ground measurements were also taken during the tests to assist in validating the ADLS results. This particular region is recognized as a high wind resource region and, as such, a knowledge of the horizontal and vertical extent of this flow was of interest for wind energy applications. The statistics of the atmospheric flow field itself as it discharges from the pass and then spreads out over the desert were also of scientific interests. This data provided the first spatial data for ensemble averaging of spatial correlations to compute longitudinal and lateral integral length scales in the longitudinal and lateral directions for both components.

Environmental Health Practice: Statistically Based Performance Measurement

PubMed Central

Enander, Richard T.; Gagnon, Ronald N.; Hanumara, R. Choudary; Park, Eugene; Armstrong, Thomas; Gute, David M.

2007-01-01

Objectives. State environmental and health protection agencies have traditionally relied on a facility-by-facility inspection-enforcement paradigm to achieve compliance with government regulations. We evaluated the effectiveness of a new approach that uses a self-certification random sampling design. Methods. Comprehensive environmental and occupational health data from a 3-year statewide industry self-certification initiative were collected from representative automotive refinishing facilities located in Rhode Island. Statistical comparisons between baseline and postintervention data facilitated a quantitative evaluation of statewide performance. Results. The analysis of field data collected from 82 randomly selected automotive refinishing facilities showed statistically significant improvements (P<.05, Fisher exact test) in 4 major performance categories: occupational health and safety, air pollution control, hazardous waste management, and wastewater discharge. Statistical significance was also shown when a modified Bonferroni adjustment for multiple comparisons was performed. Conclusions. Our findings suggest that the new self-certification approach to environmental and worker protection is effective and can be used as an adjunct to further enhance state and federal enforcement programs. PMID:17267709

Analysis of the statistic al properties of pulses in atmospheric corona discharge

NASA Astrophysics Data System (ADS)

Aubrecht, L.; Koller, J.; Plocek, J.; Stanék, Z.

2000-03-01

The properties of the negative corona current pulses in a single point-to-plane configuration have been extensively studied by many investigators. The amplitude and the interval of these pulses are not generally constant and depend on many variables. The repetition rate and the amplitude of the pulses fluctuate in time. Since these fluctuations are subject to a certain probability distribution, the statistical processing was used for the analysis of the pulse fluctuations. The behavior of the pulses has been also investigated in a multipoint geometry configuration. The dependence of the behavior of the corona pulses on the gap lengths, the material, the shape of the point electrode, the number and separation of electrodes (in the multiple-point mode) has been investigated, too. No detailed study has been carried out up to now for this case. The attention has been devoted also to the study of the pulses on the points of live materials (needles of coniferous trees). This contribution describes recent studies of the statistical properties of the pulses for various conditions.

Predicting nonstationary flood frequencies: Evidence supports an updated stationarity thesis in the United States

NASA Astrophysics Data System (ADS)

Luke, Adam; Vrugt, Jasper A.; AghaKouchak, Amir; Matthew, Richard; Sanders, Brett F.

2017-07-01

Nonstationary extreme value analysis (NEVA) can improve the statistical representation of observed flood peak distributions compared to stationary (ST) analysis, but management of flood risk relies on predictions of out-of-sample distributions for which NEVA has not been comprehensively evaluated. In this study, we apply split-sample testing to 1250 annual maximum discharge records in the United States and compare the predictive capabilities of NEVA relative to ST extreme value analysis using a log-Pearson Type III (LPIII) distribution. The parameters of the LPIII distribution in the ST and nonstationary (NS) models are estimated from the first half of each record using Bayesian inference. The second half of each record is reserved to evaluate the predictions under the ST and NS models. The NS model is applied for prediction by (1) extrapolating the trend of the NS model parameters throughout the evaluation period and (2) using the NS model parameter values at the end of the fitting period to predict with an updated ST model (uST). Our analysis shows that the ST predictions are preferred, overall. NS model parameter extrapolation is rarely preferred. However, if fitting period discharges are influenced by physical changes in the watershed, for example from anthropogenic activity, the uST model is strongly preferred relative to ST and NS predictions. The uST model is therefore recommended for evaluation of current flood risk in watersheds that have undergone physical changes. Supporting information includes a MATLAB® program that estimates the (ST/NS/uST) LPIII parameters from annual peak discharge data through Bayesian inference.

Experimental evidence of intermittent chaos in a glow discharge plasma without external forcing and its numerical modelling

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ghosh, S., E-mail: sabuj.ghosh@saha.ac.in; Kumar Shaw, Pankaj; Sekar Iyengar, A. N.

Intermittent chaos was observed in a glow discharge plasma as the system evolved from regular type of relaxation oscillations (of larger amplitude) to an irregular type of oscillations (of smaller amplitude) as the discharge voltage was increased. Floating potential fluctuations were analyzed by different statistical and spectral methods. Features like a gradual change in the normal variance of the interpeak time intervals, a dip in the skewness, and a hump in the kurtosis with variation in the control parameter have been seen, which are strongly indicative of intermittent behavior in the system. Detailed analysis also suggests that the intrinsic noisemore » level in the experiment increases with the increasing discharge voltage. An attempt has been made to model the experimental observations by a second order nonlinear ordinary differential equation derived from the fluid equations for an unmagnetized plasma. Though the experiment had no external forcing, it was conjectured that the intrinsic noise in the experiment could be playing a vital role in the dynamics of the system. Hence, a constant bias and noise as forcing terms were included in the model. Results from the theoretical model are in close qualitative agreement with the experimental results.« less

Evaluation of the Ott Hydromet Qliner for measuring discharge in laboratory and field conditions

USGS Publications Warehouse

McVay, Jason C.

2015-01-01

The U.S. Geological Survey, in collaboration with the University of Iowa IIHR – Hydroscience and Engineering, evaluated the use of the Ott Hydromet Qliner using laboratory flume tests along with field validation tests. Analysis of the flume testing indicates the velocities measured by the Qliner at a 40-second exposure time results in higher dispersion of velocities from the mean velocity of data collected with a 5-minute exposure time. The percent data spread from the mean of a 100-minute mean of Qliner velocities for a 40-second exposure time averaged 16.6 percent for the entire vertical, and a 5-minute mean produced a 6.2 percent data spread from the 100-minute mean. This 16.6 percent variation in measured velocity would result in a 3.32 percent variation in computed discharge assuming 25 verticals while averaging 4 bins in each vertical. The flume testing also provided results that indicate the blanking distance of 0.20 meters is acceptable when using beams 1 and 2, however beam 3 is negatively biased near the transducer and the 0.20-meter blanking distance is not sufficient. Field testing included comparing the measured discharge by the Qliner to the discharge measured by a Price AA mechanical current meter and a Teledyne RDI Rio Grande 1200 kilohertz acoustic Doppler current profiler. The field tests indicated a difference between the discharges measured with the Qliner and the field reference discharge between -14.0 and 8.0 percent; however the average percent difference for all 22 field comparisons was 0.22, which was not statistically significant.

Analysis of river pollution data from low-flow period by means of multivariate techniques: a case study from the oil-shale industry region, northeastern Estonia.

PubMed

Truu, Jaak; Heinaru, Eeva; Talpsep, Ene; Heinaru, Ain

2002-01-01

The oil-shale industry has created serious pollution problems in northeastern Estonia. Untreated, phenol-rich leachate from semi-coke mounds formed as a by-product of oil-shale processing is discharged into the Baltic Sea via channels and rivers. An exploratory analysis of water chemical and microbiological data sets from the low-flow period was carried out using different multivariate analysis techniques. Principal component analysis allowed us to distinguish different locations in the river system. The riverine microbial community response to water chemical parameters was assessed by co-inertia analysis. Water pH, COD and total nitrogen were negatively related to the number of biodegradative bacteria, while oxygen concentration promoted the abundance of these bacteria. The results demonstrate the utility of multivariate statistical techniques as tools for estimating the magnitude and extent of pollution based on river water chemical and microbiological parameters. An evaluation of river chemical and microbiological data suggests that the ambient natural attenuation mechanisms only partly eliminate pollutants from river water, and that a sufficient reduction of more recalcitrant compounds could be achieved through the reduction of wastewater discharge from the oil-shale chemical industry into the rivers.

Counting at low concentrations: the statistical challenges of verifying ballast water discharge standards

EPA Science Inventory

Discharge from the ballast tanks of ships is one of the primary vectors of nonindigenous species in marine environments. To mitigate this environmental and economic threat, the U.S. Coast Guard and the U.S. Environmental Protection Agency will regulate the concentration of livin...

Evaluating simulations of daily discharge from large watersheds using autoregression and an index of flashiness

USDA-ARS?s Scientific Manuscript database

Watershed models are calibrated to simulate stream discharge as accurately as possible. Modelers will often calculate model validation statistics on aggregate (often monthly) time periods, rather than the daily step at which models typically operate. This is because daily hydrologic data exhibit lar...

The 1993 Mississippi river flood: A one hundred or a one thousand year event?

USGS Publications Warehouse

Malamud, B.D.; Turcotte, D.L.; Barton, C.C.

1996-01-01

Power-law (fractal) extreme-value statistics are applicable to many natural phenomena under a wide variety of circumstances. Data from a hydrologic station in Keokuk, Iowa, shows the great flood of the Mississippi River in 1993 has a recurrence interval on the order of 100 years using power-law statistics applied to partial-duration flood series and on the order of 1,000 years using a log-Pearson type 3 (LP3) distribution applied to annual series. The LP3 analysis is the federally adopted probability distribution for flood-frequency estimation of extreme events. We suggest that power-law statistics are preferable to LP3 analysis. As a further test of the power-law approach we consider paleoflood data from the Colorado River. We compare power-law and LP3 extrapolations of historical data with these paleo-floods. The results are remarkably similar to those obtained for the Mississippi River: Recurrence intervals from power-law statistics applied to Lees Ferry discharge data are generally consistent with inferred 100- and 1,000-year paleofloods, whereas LP3 analysis gives recurrence intervals that are orders of magnitude longer. For both the Keokuk and Lees Ferry gauges, the use of an annual series introduces an artificial curvature in log-log space that leads to an underestimate of severe floods. Power-law statistics are predicting much shorter recurrence intervals than the federally adopted LP3 statistics. We suggest that if power-law behavior is applicable, then the likelihood of severe floods is much higher. More conservative dam designs and land-use restrictions Nay be required.

Methods for estimating annual exceedance-probability discharges for streams in Iowa, based on data through water year 2010

USGS Publications Warehouse

Eash, David A.; Barnes, Kimberlee K.; Veilleux, Andrea G.

2013-01-01

A statewide study was performed to develop regional regression equations for estimating selected annual exceedance-probability statistics for ungaged stream sites in Iowa. The study area comprises streamgages located within Iowa and 50 miles beyond the State’s borders. Annual exceedance-probability estimates were computed for 518 streamgages by using the expected moments algorithm to fit a Pearson Type III distribution to the logarithms of annual peak discharges for each streamgage using annual peak-discharge data through 2010. The estimation of the selected statistics included a Bayesian weighted least-squares/generalized least-squares regression analysis to update regional skew coefficients for the 518 streamgages. Low-outlier and historic information were incorporated into the annual exceedance-probability analyses, and a generalized Grubbs-Beck test was used to detect multiple potentially influential low flows. Also, geographic information system software was used to measure 59 selected basin characteristics for each streamgage. Regional regression analysis, using generalized least-squares regression, was used to develop a set of equations for each flood region in Iowa for estimating discharges for ungaged stream sites with 50-, 20-, 10-, 4-, 2-, 1-, 0.5-, and 0.2-percent annual exceedance probabilities, which are equivalent to annual flood-frequency recurrence intervals of 2, 5, 10, 25, 50, 100, 200, and 500 years, respectively. A total of 394 streamgages were included in the development of regional regression equations for three flood regions (regions 1, 2, and 3) that were defined for Iowa based on landform regions and soil regions. Average standard errors of prediction range from 31.8 to 45.2 percent for flood region 1, 19.4 to 46.8 percent for flood region 2, and 26.5 to 43.1 percent for flood region 3. The pseudo coefficients of determination for the generalized least-squares equations range from 90.8 to 96.2 percent for flood region 1, 91.5 to 97.9 percent for flood region 2, and 92.4 to 96.0 percent for flood region 3. The regression equations are applicable only to stream sites in Iowa with flows not significantly affected by regulation, diversion, channelization, backwater, or urbanization and with basin characteristics within the range of those used to develop the equations. These regression equations will be implemented within the U.S. Geological Survey StreamStats Web-based geographic information system tool. StreamStats allows users to click on any ungaged site on a river and compute estimates of the eight selected statistics; in addition, 90-percent prediction intervals and the measured basin characteristics for the ungaged sites also are provided by the Web-based tool. StreamStats also allows users to click on any streamgage in Iowa and estimates computed for these eight selected statistics are provided for the streamgage.

Ward mortality after ICU discharge: a multicenter validation of the Sabadell score.

PubMed

Fernandez, Rafael; Serrano, Jose Manuel; Umaran, Isabel; Abizanda, Ricard; Carrillo, Andres; Lopez-Pueyo, Maria Jesus; Rascado, Pedro; Balerdi, Begoña; Suberviola, Borja; Hernandez, Gonzalo

2010-07-01

Tools for predicting post-ICU patients' outcomes are scarce. A single-center study showed that the Sabadell score classified patients into four groups with clear-cut differences in ward mortality. To validate the Sabadell score using a prospective multicenter approach. Thirty-one ICUs in Spain. All patients admitted in the 3-month study period. We recorded variables at ICU admission (age, sex, severity of illness, and do-not-resuscitate orders), during the ICU stay (ICU-specific treatments, ICU-acquired infection, and acute renal failure), and at ICU discharge (Sabadell score). Statistical analyses included one-way ANOVA and multiple regression analysis with ward mortality as the dependent variable. We admitted 4,132 patients (mean age 61.5 +/- 16.7 years) with mean predicted mortality of 23.8 +/- 22.7%; 545 patients (13%) died in the ICU and 3,587 (87%) were discharged to the ward. Overall ward mortality was 6.7%; ward mortality was 1.5% (36/2,422) in patients with score 0 (good prognosis), 9% (64/725) in patients with score 1 (long-term poor prognosis), 23% (79/341) in patients with score 2 (short-term poor prognosis), and 64% (63/99) in patients with score 3 (expected hospital death). Variables associated with ward mortality in the multivariate analysis were predicted risk of death (OR 1.016), ICU readmission (OR 5.9), Sabadell score 1 (OR 4.7), Sabadell score 2 (OR 15.7), and Sabadell score 3 (OR 107.2). We confirm the ability of the Sabadell score at ICU discharge to define four groups of patients with very different likelihoods of hospital survival.

Characterization and statistical modeling of bacterial (Escherichia coli) outflows from watersheds that discharge into Southern Lake Michigan

USGS Publications Warehouse

Olyphant, G.A.; Thomas, Joan; Whitman, R.L.; Harper, D.

2003-01-01

Two watersheds in northwestern Indiana were selected for detailed monitoring of bacterially contaminated discharges (Escherichia coli) into Lake Michigan. A large watershed that drains an urbanized area with treatment plants that release raw sewage during storms discharges into Lake Michigan at the outlet of Burns Ditch. A small watershed drains part of the Great Marsh, a wetland complex that has been disrupted by ditching and limited residential development, at the outlet of Derby Ditch. Monitoring at the outlet of Burns Ditch in 1999 and 2000 indicated that E. coli concentrations vary over two orders of magnitude during storms. During one storm, sewage overflows caused concentrations to increase to more than 10,000 cfu/100 mL for several hours. Monitoring at Derby Ditch from 1997 to 2000 also indicated that E. coli concentrations increase during storms with the highest concentrations generally occurring during rising streamflow. Multiple regression analysis indicated that 60% of the variability in measured outflows of E. coli from Derby Ditch (n = 88) could be accounted for by a model that utilizes continuously measured rainfall, stream discharge, soil temperature and depth to water table in the Great Marsh. A similar analysis indicated that 90% of the variability in measured E. coli concentrations at the outlet of Burns Ditch (n = 43) during storms could be accounted for by a combination of continuously measured water-quality variables including nitrate and ammonium. These models, which utilize data that can be collected on a real-time basis, could form part of an Early Warning System for predicting beach closures.

The stroke impairment assessment set: its internal consistency and predictive validity.

PubMed

Tsuji, T; Liu, M; Sonoda, S; Domen, K; Chino, N

2000-07-01

To study the scale quality and predictive validity of the Stroke Impairment Assessment Set (SIAS) developed for stroke outcome research. Rasch analysis of the SIAS; stepwise multiple regression analysis to predict discharge functional independence measure (FIM) raw scores from demographic data, the SIAS scores, and the admission FIM scores; cross-validation of the prediction rule. Tertiary rehabilitation center in Japan. One hundred ninety stroke inpatients for the study of the scale quality and the predictive validity; a second sample of 116 stroke inpatients for the cross-validation study. Mean square fit statistics to study the degree of fit to the unidimensional model; logits to express item difficulties; discharge FIM scores for the study of predictive validity. The degree of misfit was acceptable except for the shoulder range of motion (ROM), pain, visuospatial function, and speech items; and the SIAS items could be arranged on a common unidimensional scale. The difficulty patterns were identical at admission and at discharge except for the deep tendon reflexes, ROM, and pain items. They were also similar for the right- and left-sided brain lesion groups except for the speech and visuospatial items. For the prediction of the discharge FIM scores, the independent variables selected were age, the SIAS total scores, and the admission FIM scores; and the adjusted R2 was .64 (p < .0001). Stability of the predictive equation was confirmed in the cross-validation sample (R2 = .68, p < .001). The unidimensionality of the SIAS was confirmed, and the SIAS total scores proved useful for stroke outcome prediction.

Improving patient comprehension and recall of discharge instructions by supplementing free texts with pictographs.

PubMed

Zeng-Treitler, Qing; Kim, Hyeoneui; Hunter, Martha

2008-11-06

Inpatient discharge instructions provide critical information for patients to manage their own care. These instructions are typically free-text and not easy for patients to understand and remember. In this pilot study, we developed a set of pictographs through a participatory design process and used them to enhance two mock-up discharge instructions. Tested on 13 healthy volunteers, the pictograph enhancement resulted in statistically significant better recall rates (p<0.001). This suggests that patient comprehension and recall of discharge instructions could be improved by supplementing free texts with pictographs.

[Morbidity among mothers and infants after ambulatory deliveries].

PubMed

Kierkegaard, O

1991-07-29

Postpartum early discharge programs are reviewed. Few programs were mandatory and both primi- and multiparae were included. Discharge varied from two to 72 hours after delivery. Nearly all programs had prenatal preparation and all patients had postpartum follow-up at home. Approximately one per cent of the infants were readmitted mostly on account of hyperbilirubinemia and infections, and half as many mothers were readmitted mostly for hemorrhage and endometritis. Infants discharged very early were readmitted more frequently than others. There were no statistical significant difference in mortality or morbidity between mothers or infants in early discharge groups and control groups.

Spatio-temporal analysis of prodelta dynamics by means of new satellite generation: the case of Po river by Landsat-8 data

NASA Astrophysics Data System (ADS)

Manzo, Ciro; Braga, Federica; Zaggia, Luca; Brando, Vittorio Ernesto; Giardino, Claudia; Bresciani, Mariano; Bassani, Cristiana

2018-04-01

This paper describes a procedure to perform spatio-temporal analysis of river plume dispersion in prodelta areas by multi-temporal Landsat-8-derived products for identifying zones sensitive to water discharge and for providing geostatistical patterns of turbidity linked to different meteo-marine forcings. In particular, we characterized the temporal and spatial variability of turbidity and sea surface temperature (SST) in the Po River prodelta (Northern Adriatic Sea, Italy) during the period 2013-2016. To perform this analysis, a two-pronged processing methodology was implemented and the resulting outputs were analysed through a series of statistical tools. A pixel-based spatial correlation analysis was carried out by comparing temporal curves of turbidity and SST hypercubes with in situ time series of wind speed and water discharge, providing correlation coefficient maps. A geostatistical analysis was performed to determine the spatial dependency of the turbidity datasets per each satellite image, providing maps of correlation and variograms. The results show a linear correlation between water discharge and turbidity variations in the points more affected by the buoyant plumes and along the southern coast of Po River delta. Better inverse correlation was found between turbidity and SST during floods rather than other periods. The correlation maps of wind speed with turbidity show different spatial patterns depending on local or basin-scale wind effects. Variogram maps identify different spatial anisotropy structures of turbidity in response to ambient conditions (i.e. strong Bora or Scirocco winds, floods). Since the implemented processing methodology is based on open source software and free satellite data, it represents a promising tool for the monitoring of maritime ecosystems and to address water quality analyses and the investigations of sediment dynamics in estuarine and coastal waters.

Concomitant ion effects on isotope ratio measurements with liquid sampling – atmospheric pressure glow discharge ion source Orbitrap mass spectrometry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoegg, Edward D.; Marcus, R. Kenneth; Hager, George J.

RATIONALE: The field of highly accurate and precise isotope ratio (IR) analysis has been dominated by inductively coupled plasma and thermal ionization mass spectrometers. While these instruments are considered the gold standard for IR analysis, the International Atomic Energy Agency desires a field deployable instrument capable of accurately and precisely measuring U isotope ratios. METHODS: The proposed system interfaces the liquid sampling – atmospheric pressure glow discharge (LS-APGD) ion source with a high resolution Exactive Orbitrap mass spectrometer. With this experimental setup certified U isotope standards and unknown samples were analyzed. The accuracy and precision of the system were thenmore » determined. RESULTS: The LS-APGD /Exactive instrument measures a certified reference material of natural U (235U/238U = 0.007258) as 0.007041 with a relative standard deviation of 0.158% meeting the International Target Values for Uncertainty for the destructive analysis of U. Additionally, when three unknowns measured and compared to the results from an ICP multi collector instrument, there is no statistical difference between the two instruments.CONCLUSIONS: The LS-APGD / Orbitrap system, while still in the preliminary stages of development, offers highly accurate and precise IR analysis that suggest a paradigm shift in the world of IR analysis. Furthermore, the portability of the LS-APGD as an elemental ion source combined with the low overhead and small size of the Orbitrap suggest that the instrumentation is capable of being field deployable.With liquid sampling glow discharge-Orbitrap MS, isotope ratio and precision performance improves with rejection of concomitant ion species.« less

Impact of structural and economic factors on hospitalization costs, inpatient mortality, and treatment type of traumatic hip fractures in Switzerland.

PubMed

Mehra, Tarun; Moos, Rudolf M; Seifert, Burkhardt; Bopp, Matthias; Senn, Oliver; Simmen, Hans-Peter; Neuhaus, Valentin; Ciritsis, Bernhard

2017-12-01

The assessment of structural and potentially economic factors determining cost, treatment type, and inpatient mortality of traumatic hip fractures are important health policy issues. We showed that insurance status and treatment in university hospitals were significantly associated with treatment type (i.e., primary hip replacement), cost, and lower inpatient mortality respectively. The purpose of this study was to determine the influence of the structural level of hospital care and patient insurance type on treatment, hospitalization cost, and inpatient mortality in cases with traumatic hip fractures in Switzerland. The Swiss national medical statistic 2011-2012 was screened for adults with hip fracture as primary diagnosis. Gender, age, insurance type, year of discharge, hospital infrastructure level, length-of-stay, case weight, reason for discharge, and all coded diagnoses and procedures were extracted. Descriptive statistics and multivariate logistic regression with treatment by primary hip replacement as well as inpatient mortality as dependent variables were performed. We obtained 24,678 inpatient case records from the medical statistic. Hospitalization costs were calculated from a second dataset, the Swiss national cost statistic (7528 cases with hip fractures, discharged in 2012). Average inpatient costs per case were the highest for discharges from university hospitals (US$21,471, SD US$17,015) and the lowest in basic coverage hospitals (US$18,291, SD US$12,635). Controlling for other variables, higher costs for hip fracture treatment at university hospitals were significant in multivariate regression (p < 0.001). University hospitals had a lower inpatient mortality rate than full and basic care providers (2.8% vs. both 4.0%); results confirmed in our multivariate logistic regression analysis (odds ratio (OR) 1.434, 95% CI 1.127-1.824 and OR 1.459, 95% confidence interval (CI) 1.139-1.870 for full and basic coverage hospitals vs. university hospitals respectively). The proportion of privately insured varied between 16.0% in university hospitals and 38.9% in specialized hospitals. Private insurance had an OR of 1.419 (95% CI 1.306-1.542) in predicting treatment of a hip fracture with primary hip replacement. The seeming importance of insurance type on hip fracture treatment and the large inequity in the distribution of privately insured between provider types would be worth a closer look by the regulatory authorities. Better outcomes, i.e., lower mortality rates for hip fracture treatment in hospitals with a higher structural care level advocate centralization of care.

RP and RQA Analysis for Floating Potential Fluctuations in a DC Magnetron Sputtering Plasma

NASA Astrophysics Data System (ADS)

Sabavath, Gopikishan; Banerjee, I.; Mahapatra, S. K.

2016-04-01

The nonlinear dynamics of a direct current magnetron sputtering plasma is visualized using recurrence plot (RP) technique. RP comprises the recurrence quantification analysis (RQA) which is an efficient method to observe critical regime transitions in dynamics. Further, RQA provides insight information about the system’s behavior. We observed the floating potential fluctuations of the plasma as a function of discharge voltage by using Langmuir probe. The system exhibits quasi-periodic-chaotic-quasi-periodic-chaotic transitions. These transitions are quantified from determinism, Lmax, and entropy of RQA. Statistical investigations like kurtosis and skewness also studied for these transitions which are in well agreement with RQA results.

Tendencia de los egresos hospitalarios por enfermedades infecciosas intestinales en niños en Argentina, 2005-2013.

PubMed

Degiuseppe, Juan I

2017-08-01

Acute diarrhea is one of the most serious public health problems in developing countries because it is generally associated with unfavorable living conditions. The objective of this study was to analyze trends in hospital discharges for intestinal infectious disease in children under age 5 recorded in official public hospitals from Argentina in the 2005-2013 period. This was an ecological, time-series study based on data provided by the Health Statistics and Information Department, at a national and regional level. Specific hospital discharge rates were estimated, and seasonal behavior and trends were analyzed in relation to this event. In Argentina, 2 521 729 patients under age 5 were discharged in this period; of these, 9.0% were diagnosed with intestinal infectious disease. Children under age 1 accounted for a third of hospitalizations; two annual peaks (summer and winter) were observed in the seasonality analysis. Overall, a downward trend was observed, with a mild increase in the 2007-2009 period. Rates were up to 3 or 4 times higher in Northwest and Northeast Argentina than in the Pampa region. Hospital discharges for intestinal infectious disease in the public subsector account for approximately 10% of all discharges of children under age 5. This event shows a seasonal pattern, with a slightly downward trend over the past years in spite of its heterogeneous distribution across the different Argentine regions. Sociedad Argentina de Pediatría

Nursing diagnoses, diagnosis-related group, and hospital outcomes.

PubMed

Welton, John M; Halloran, Edward J

2005-12-01

There are no nursing centric data in the hospital discharge abstract. This study investigates whether adding nursing data in the form of nursing diagnoses to medical diagnostic data in the discharge abstract can improve overall explanation of variance in commonly studied hospital outcomes. A retrospective analyses of 123,241 sequential patient admissions to a university hospital in a Midwestern city was performed. Two data sets were combined: (1) a daily collection of patient assessments by nurses using nursing diagnosis terminology (NDX); and (2) the summary discharge information from the hospital discharge abstract including diagnosis-related group (DRG) and all payer refined DRG (APR-DRG). Each of 61 daily NDX observations were collapsed as frequency of occurrence for the hospital stay and inserted into the discharge abstract. NDX was then compared to both DRG and APR-DRG across 5 hospital outcome variables using multivariate regression or logistic regression. In all statistical models, DRG, APR-DRG, and NDX were significantly associated with the 5 hospital outcome variables (P <.0001). When NDX was added to models containing either the DRG or the APR-DRG, explanatory power (R2) and model discrimination (c statistic) improved by 30% to 146% across the outcome variables of hospital length of stay, ICU length of stay, total charges, probably of death, and discharge to a nursing home (P <.0001). The findings support the contention that nursing care is an independent predictor of patient hospital outcomes. These nursing data are not redundant with the medical diagnosis, in particular, the DRG. The findings support the argument for including nursing care data in the hospital discharge abstract. Further study is needed to clarify which nursing data are the best fit for the current hospital discharge abstract data collection scheme.

Online monitoring and conditional regression tree test: Useful tools for a better understanding of combined sewer network behavior.

PubMed

Bersinger, T; Bareille, G; Pigot, T; Bru, N; Le Hécho, I

2018-06-01

A good knowledge of the dynamic of pollutant concentration and flux in a combined sewer network is necessary when considering solutions to limit the pollutants discharged by combined sewer overflow (CSO) into receiving water during wet weather. Identification of the parameters that influence pollutant concentration and flux is important. Nevertheless, few studies have obtained satisfactory results for the identification of these parameters using statistical tools. Thus, this work uses a large database of rain events (116 over one year) obtained via continuous measurement of rainfall, discharge flow and chemical oxygen demand (COD) estimated using online turbidity for the identification of these parameters. We carried out a statistical study of the parameters influencing the maximum COD concentration, the discharge flow and the discharge COD flux. In this study a new test was used that has never been used in this field: the conditional regression tree test. We have demonstrated that the antecedent dry weather period, the rain event average intensity and the flow before the event are the three main factors influencing the maximum COD concentration during a rainfall event. Regarding the discharge flow, it is mainly influenced by the overall rainfall height but not by the maximum rainfall intensity. Finally, COD discharge flux is influenced by the discharge volume and the maximum COD concentration. Regression trees seem much more appropriate than common tests like PCA and PLS for this type of study as they take into account the thresholds and cumulative effects of various parameters as a function of the target variable. These results could help to improve sewer and CSO management in order to decrease the discharge of pollutants into receiving waters. Copyright © 2017 Elsevier B.V. All rights reserved.

Comparative growth outcome of preterm neonate fed post-discharge formula and breast milk after discharge.

PubMed

Chotigeat, Uraiwan; Vongpakorn, Jarinthorn

2014-06-01

To evaluate the post-discharge growth, laboratory outcome, neurodevelopment and safety of post-discharge formula in comparison to breast milk. A prospective cohort of preterm infants, who were discharged on breast milk or post-discharge formula (PDF) were studied. Demographic data, post-discharge growth, laboratory outcome, neurodevelopment and complications were recorded. These infants were followed-up at 40 weeks' postmenstrual age (PMA) 2, 4 and 6 months' corrected age. The present study was conducted for 22 months (from September 1, 2011-May 31, 2013). Seventeen infants were enrolled in the study, 7 in the breastfed group and 10 in the PDF group. Mean maternal age in breastfed group were significantly younger compared with PDF-fed group. PDF-fed infants were longer with statistical significantly at 40 weeks PMA and 4 months' corrected age (p < 0.05). At 2 months' corrected age, babies in breast milk group were significantly heavier compared to those in PDF group. Conversely, those in PDF group were heavier than the breastfed group at 4 months' corrected age (p < 0.05). There was no difference of head circumference between groups at follow-up. A higher serum phosphorus and lower serum alkaline phosphatase were related to improve suspected osteopenia of prematurity at 2 months' corrected age in PDF group (p = 0.007). Hematocrit was higher in the PDF group than breastfed group, which was statistically significant at 40 weeks' postmenstrual age and 6 months' corrected age. There were no significant diferences in developmental screening in both groups. Post-discharge formula may improve growth, hematocrit and reduce suspected osteopenia of prematurity. However neurodevelopment outcome and complications were similar to both groups.

Effects of botulinum toxin A therapy and multidisciplinary rehabilitation on upper and lower limb spasticity in post-stroke patients.

PubMed

Hara, Takatoshi; Abo, Masahiro; Hara, Hiroyoshi; Kobayashi, Kazushige; Shimamoto, Yusuke; Samizo, Yuta; Sasaki, Nobuyuki; Yamada, Naoki; Niimi, Masachika

2017-06-01

The purpose of this study was to examine the effects of combined botulinum toxin type A (BoNT-A) and inpatient multidisciplinary (MD) rehabilitation therapy on the improvement of upper and lower limb function in post-stroke patients. In this retrospective study, a 12-day inpatient treatment protocol was implemented on 51 post-stroke patients with spasticity. Assessments were performed on the day of admission, at discharge, and at 3 months following discharge. At the time of discharge, all of the evaluated items showed a statistically significant improvement. Only the Functional Reach Test (FRT) showed a statistically significant improvement at 3 months. In subgroup analyses, the slowest walking speed group showed a significantly greater change ratio of the 10 Meter Walk Test relative to the other groups, from the time of admission to discharge. This group showed a greater FRT change ratio than the other groups from the time of admission to the 3-month follow-up. Inpatient combined therapy of simultaneous injections of BoNT-A to the upper and lower limbs and MD may improve motor function.

Spatio-temporal variation of water flow and sediment discharge in the Mahanadi River, India

NASA Astrophysics Data System (ADS)

Bastia, Fakira; Equeenuddin, Sk. Md.

2016-09-01

The transport of sediments by rivers to the oceans represents an important link between the terrestrial and marine ecosystem. Therefore, this work aims to study spatio-temporal variation of the sediment discharge and erosion rate in the Mahanadi river, one of the biggest rivers in India, over past three decades vis-à-vis their controlling factors. To understand the sediment load variation, the trend analysis in the time series data of rainfall, water and sediment discharge of the Mahanadi river were also attempted. The non-parametric Mann-Kendall and Sen's methods were used to determine whether there was a positive or negative trend in the time series data with their statistical significance. The occurrence of abrupt changes was detected using Pettitt test. The trend test result represents that sediment load delivered from the Mahanadi river to the global ocean has decreased sharply at the rate of 0.515 × 106 tons/year between 1980 and 2010. Water discharge and rainfall in the basin showed no significant decreasing trend except at only one tributary. The decline in sediment discharge from the basin to the Bay of Bengal is mainly due to the increase in the number of dams, which has recorded the increase from 70 to 253 during the period of 1980 to 2010. Over the past 30 years the Mahanadi river has discharged about 49.0 ± 20.5 km3 of water and 17.4 ± 12.7 × 106 tons of sediment annually to the Bay of Bengal whereas the mean erosional rate is 265 ± 125 tons/km2/year over the period of 30 years in the basin. Based on the current data (2000-2001 to 2009-2010), sediment flux and water discharge to the ocean are 12 ± 5 × 106 tons/year and 49 ± 16 km3/year respectively; and ranking Mahanadi river second in terms of water discharge and sediment flux to the ocean among the peninsular rivers in India.

Spatial variability of mountain stream dynamics along the Ethiopian Rift Valley escarpment

NASA Astrophysics Data System (ADS)

Asfaha, Tesfaalem-Ghebreyohannes; Frankl, Amaury; Zenebe, Amanuel; Haile, Mitiku; Nyssen, Jan

2014-05-01

Changes in hydrogeomorphic characteristics of mountain streams are generally deemed to be controlled mainly by land use/cover changes and rainfall variability. This study investigates the spatial variability of peak discharge in relation to land cover, rainfall and topographic variables in eleven catchments of the Ethiopian Rift Valley escarpment (average slope gradient = 48% (± 13%). Rapid deforestation of the escarpment in the second half of the 20th century resulted in the occurrence of strong flash floods, transporting large amounts of discharge and sediment to the lower graben bottom. Due to integrated reforestation interventions as of the 1980s, many of these catchments do show improvement in vegetation cover at various degrees. Daily rainfall was measured using seven non-recording rain gauges, while peak stage discharges were measured after floods using crest stage gauges installed at eleven stream reaches. Peak discharges were calculated using the Manning's equation. Daily area-weighted rainfall was computed for each catchment using the Thiessen Polygon method. To estimate the vegetation cover of each catchment, the Normalized Difference Vegetation Index was calculated from Landsat TM imagery (mean = 0.14 ± 0.05). In the rainy season of 2012, there was a positive correlation between daily rainfall and peak discharge in each of the monitored catchments. In a multiple linear regression analysis (R² = 0.83; P<0.01), average daily peak discharge in all rivers was positively related with rainfall depth and catchment size and negatively with vegetation cover (as represented by average NDVI values). Average slope gradient of the catchments and Gravelius's compactness index did not show a statistically significant relation with peak discharge. This study shows that though the average vegetation cover of the catchments is still relatively low, differences in vegetation cover, together with rainfall variability plays a determining role in the amount of peak discharges in flashy mountain streams.

An analysis of potential water availability from the Atwood, Leesville, and Tappan Lakes in the Muskingum River Watershed, Ohio

USGS Publications Warehouse

Koltun, G.F.

2013-01-01

This report presents the results of a study to assess potential water availability from the Atwood, Leesville, and Tappan Lakes, located within the Muskingum River Watershed, Ohio. The assessment was based on the criterion that water withdrawals should not appreciably affect maintenance of recreation-season pool levels in current use. To facilitate and simplify the assessment, it was assumed that historical lake operations were successful in maintaining seasonal pool levels, and that any discharges from lakes constituted either water that was discharged to prevent exceeding seasonal pool levels or discharges intended to meet minimum in-stream flow targets downstream from the lakes. It further was assumed that the volume of water discharged in excess of the minimum in-stream flow target is available for use without negatively impacting seasonal pool levels or downstream water uses and that all or part of it is subject to withdrawal. Historical daily outflow data for the lakes were used to determine the quantity of water that potentially could be withdrawn and the resulting quantity of water that would flow downstream (referred to as “flow-by”) on a daily basis as a function of all combinations of three hypothetical target minimum flow-by amounts (1, 2, and 3 times current minimum in-stream flow targets) and three pumping capacities (1, 2, and 3 million gallons per day). Using both U.S. Geological Survey streamgage data and lake-outflow data provided by the U.S. Army Corps of Engineers resulted in analytical periods ranging from 51 calendar years for the Atwood Lake to 73 calendar years for the Leesville and Tappan Lakes. The observed outflow time series and the computed time series of daily flow-by amounts and potential withdrawals were analyzed to compute and report order statistics (95th, 75th, 50th, 25th, 10th, and 5th percentiles) and means for the analytical period, in aggregate, and broken down by calendar month. In addition, surplus-water mass curve data were tabulated for each of the lakes. Monthly order statistics of computed withdrawals indicated that, for the three pumping capacities considered, increasing the target minimum flow-by amount tended to reduce the amount of water that can be withdrawn. The reduction was greatest in the lower percentiles of withdrawal; however, increasing the flow-by amount had no impact on potential withdrawals during high flow. In addition, for a given target minimum flow-by amount, increasing the pumping rate increased the total amount of water that could be withdrawn; however, that increase was less than a direct multiple of the increase in pumping rate for most flow statistics. Potential monthly withdrawals were observed to be more variable and more limited in some calendar months than others. Monthly order statistics and means of computed daily mean flow-by amounts indicated that flow-by amounts generally tended to be lowest during June–October and February. Increasing the target minimum flow-by amount for a given pumping rate resulted in some small increases in the magnitudes of the mean and 50th percentile and lower order statistics of computed mean flow-by, but had no effect on the magnitudes of the higher percentile statistics. Increasing the pumping rate for a given target minimum flow-by amount resulted in decreases in magnitudes of higher-percentile flow-by statistics by an amount equal to the flow equivalent of the increase in pumping rate; however, some lower percentile statistics remained unchanged.

Going with the flow: using species-discharge relationships to forecast losses in fish biodiversity.

PubMed

Xenopoulos, Marguerite A; Lodge, David M

2006-08-01

In response to the scarcity of tools to make quantitative forecasts of the loss of aquatic species from anthropogenic effects, we present a statistical model that relates fish species richness to river discharge. Fish richness increases logarithmically with discharge, an index of habitat space, similar to a species-area curve in terrestrial systems. We apply the species-discharge model as a forecasting tool to build scenarios of changes in riverine fish richness from climate change, water consumption, and other anthropogenic drivers that reduce river discharge. Using hypothetical reductions in discharges (of magnitudes that have been observed in other rivers), we predict that reductions of 20-90% in discharge would result in losses of 2-38% of the fish species in two biogeographical regions in the United States (Lower Ohio-Upper Mississippi and Southeastern). Additional data on the occurrence of specific species relative to specific discharge regimes suggests that fishes found exclusively in high discharge environments (e.g., Shovelnose sturgeon) would be most vulnerable to reductions in discharge. Lag times in species extinctions after discharge reduction provide a window of opportunity for conservation efforts. Applications of the species-discharge model can help prioritize such management efforts among species and rivers.

Premature mortality in a national cohort of people recently discharged from their first psychiatric inpatient treatment episode

PubMed Central

Walter, Florian; Carr, Matthew J.; Mok, Pearl L.H.; Astrup, Aske; Antonsen, Sussie; Pedersen, Carsten B.; Shaw, Jenny; Webb, Roger T.

2017-01-01

Importance Patients recently discharged from psychiatric inpatient services are at elevated risk of dying prematurely. National cohorts provide sufficient statistical power for examining cause-specific mortality in this population. Objective To comprehensively investigate premature mortality in a national cohort of recently discharged psychiatric patients at 15-44 years of age. Design, setting, and participants Cohort study of all persons born in Denmark during 1967-1996 (N=1,683,385). Participants were followed up from their 15th birthday until their date of death, emigration or December 31st 2011, whichever came first. Exposures First discharge from inpatient psychiatric care. Main outcome measures Incidence rates and incidence rate ratios (IRRs) for all-cause mortality and for an array of unnatural and natural causes among discharged patients versus persons not admitted for psychiatric care. Our primary analysis considered risk within a year of first discharge. Results Compared to persons not admitted, discharged patients had an elevated risk for all-cause mortality within a year (IRR 16.2, 95% CI 14.5-18.0). Relative risk for unnatural death (IRR 25.0, 95% CI 22.0- 28.4) was much higher than for natural death (IRR 8.6, 95% CI 7.0-10.7). The highest IRR found was for suicide: IRR 66.9, 95% CI 56.4-79.4; the IRR for alcohol-related deaths was the second highest observed: IRR 42.0, 95% CI 26.6-66.1. Among the psychiatric diagnostic categories assessed, psychoactive substance abuse conferred the highest risk for all-cause mortality (IRR 24.8, 95% CI 21.0-29.4). Across the array of cause-specific outcomes examined, risk of premature death during the first year post-discharge was markedly elevated compared to longer term follow up. Conclusions and relevance Enhanced liaison between primary and secondary health services post-discharge, as well as early intervention programs for drug and alcohol misuse could substantially decrease the greatly elevated mortality risk among recently discharged psychiatric patients. PMID:28296989

Using Simulation to Model Improvements in Pediatric Bed Placement in an Acute Care Hospital.

PubMed

Lambton, Judith; Roeder, Theresa; Saltzman, Robert; Param, Lila; Fernandes, Roxanne

2017-02-01

The objective of this project was to use an interdisciplinary approach to analyze strategies through simulation technology for improving patient flow in a pediatric hospital. Various statistics have been offered on the number of children admitted annually to hospitals. For administrators, particularly in smaller systems, the financial burden of equipping and staffing pediatric units often outweighs the moral desire to maintain a pediatric unit as a viable option for patients and pediatricians. Discrete event simulation was used to model current operations of a pediatric unit. Cost analysis was conducted using simulation reflecting various percentages of patients being referred to a discharge holding area (DHA) upon discharge and of the use of all private rooms. Both DHA and private rooms resulted in increased patient volumes. Administrators should consider the use of a DHA and/or private rooms to ease the census strains of pediatric units and the resultant revenue of this service.

Low-flow characteristics for selected streams in Indiana

USGS Publications Warehouse

Fowler, Kathleen K.; Wilson, John T.

2015-01-01

The management and availability of Indiana’s water resources increase in importance every year. Specifically, information on low-flow characteristics of streams is essential to State water-management agencies. These agencies need low-flow information when working with issues related to irrigation, municipal and industrial water supplies, fish and wildlife protection, and the dilution of waste. Industrial, municipal, and other facilities must obtain National Pollutant Discharge Elimination System (NPDES) permits if their discharges go directly to surface waters. The Indiana Department of Environmental Management (IDEM) requires low-flow statistics in order to administer the NPDES permit program. Low-flow-frequency characteristics were computed for 272 continuous-record stations. The information includes low-flow-frequency analysis, flow-duration analysis, and harmonic mean for the continuous-record stations. For those stations affected by some form of regulation, low-flow frequency curves are based on the longest period of homogeneous record under current conditions. Low-flow-frequency values and harmonic mean flow (if sufficient data were available) were estimated for the 166 partial-record stations. Partial-record stations are ungaged sites where streamflow measurements were made at base flow.

Variation in the Mississippi River Plume from Data Synthesis of Model Outputs and MODIS Imagery

NASA Astrophysics Data System (ADS)

Fitzpatrick, C.; Kolker, A.; Chu, P. Y.

2017-12-01

Understanding the Mississippi River (MR) plume's interaction with the open ocean is crucial for understanding many processes in the Gulf of Mexico. Though the Mississippi River and its delta and plume have been studied extensively, recent archives of model products and satellite imagery have allowed us to highlight patterns in plume behavior over the last two decades through large scale data synthesis. Using 8 years of USGS discharge data and Landsat imagery, we identified the spatial extent, geographic patterns, depth, and freshwater concentration of the MR plume across seasons and years. Using 20 years of HYCOM (HYbrid Coordinate Ocean Model) analysis and reanalysis model output, and several years of NGOFS FVCOM model outputs, we mapped the minimum and maximum spatial area of the MR plume, and its varied extent east and west. From the synthesis and analysis of these data, the statistical probability of the MR plume's spatial area and geographical extent were computed. Measurements of the MR plume and its response to river discharge may predict future behavior and provide a path forward to understanding MR plume influence on nearby ecosystems.

U.S. Geological Survey applied research studies of the Cheyenne River system, South Dakota; description and collation of data, water years 1985-86

USGS Publications Warehouse

Goddard, Kimball E.

1988-01-01

The Cheyenne River system in Western South Dakota has been impacted by the discharge of about 100 million metric tons of gold-mill tailings to Whitewood Creek near Lead, South Dakota. In April 1985, the U.S. Geological Survey initiated an extensive series of research studies to investigate the magnitude of the impact and to define important processes acting on the contaminated sediments present in the system. The report presents all data collected during the 1985 and 1986 water years for these research studies. Some of the data included have been published previously. Hydrologic, geochemical, and biologic data are available for sites on Whitewood Creek, the Belle Fourche and Cheyenne Rivers, and for the Cheyenne River arm of Lake Oahe. Data complexity varies from routine discharge and water quality to very complex photon-correlation spectroscopy and energy-dispersive x-ray analysis. Methods for sample collection, handling and preservation, and laboratory analysis are also presented. No interpretations or complex statistical summaries are included. (USGS)

The role of baseflow in dissolved solids delivery to streams in the Upper Colorado River Basin

NASA Astrophysics Data System (ADS)

Rumsey, C.; Miller, M. P.; Schwarz, G. E.; Susong, D.

2017-12-01

Salinity has a major effect on water users in the Colorado River Basin, estimated to cause almost $300 million per year in economic damages. The Colorado River Basin Salinity Control Program implements and manages projects to reduce salinity (dissolved solids) loads, investing millions of dollars per year in irrigation upgrades, canal projects, and other mitigation strategies. To inform and improve mitigation efforts, there is a need to better understand sources of salinity to streams and how salinity has changed over time. This study explores salinity in baseflow, or groundwater discharge to streams, to assess whether groundwater is a significant contributor of dissolved solids to streams in the Upper Colorado River Basin (UCRB). Chemical hydrograph separation was used to estimate long-term mean annual baseflow discharge and baseflow dissolved solids loads at stream gages (n=69) across the UCRB. On average, it is estimated that 89% of dissolved solids loads originate from the baseflow fraction of streamflow. Additionally, a statistical trend analysis using weighted regressions on time, discharge, and season was used to evaluate changes in baseflow dissolved solids loads in streams with data from 1987 to 2011 (n=29). About two-thirds (62%) of these streams showed statistically significant decreasing trends in baseflow dissolved solids loads. At the two most downstream sites, Green River at Green River, UT and Colorado River at Cisco, UT, baseflow dissolved solids loads decreased by a combined 780,000 metric tons, which is approximately 65% of the estimated basin-scale decrease in total dissolved solids loads in the UCRB attributed to salinity control efforts. Results indicate that groundwater discharged to streams, and therefore subsurface transport processes, play a large role in delivering dissolved solids to streams in the UCRB. Decreasing trends in baseflow dissolved solids loads suggest that salinity mitigation projects, changes in land use, and/or climate are decreasing salinity in groundwater transported to streams.

Statistical data of X-ray emission from laboratory sparks

NASA Astrophysics Data System (ADS)

Kochkin, P.; Deursen, D. V.

2011-12-01

In this study we present a summary of the data of 1331 long laboratory sparks in atmospheric pressure intended for a statistical analysis. A 2 MV, 17kJ Marx generator were used to generate 1.2/52μs shape pulses positive and negative polarity. The generator was connected to a spark gap with cone-shaped electrodes. The distance between high-voltage and grounded electrodes was 1.08 meters. Breakdown voltage between electrodes was about 1MV. X-rays have been detected during the development of the discharge channel. The currents through the grounded electrode and through the high-voltage electrode were recorded separately and simultaneously with the voltage and the X-ray signal. X-rays were registered by two LaBr3(Ce+) scintillation detectors in different positions with respect to the forming discharge channel. Detector D1 was placed immediately under the grounded electrode at 15cm distance. Detector D2 was placed at horizontal distances of 143cm and 210cm, at mid-gap height. We also used lead shields of 1.5, 3, and 4 mm thickness for radiation attenuation measurements. For detector collimation we used shields up to 2 cm thickness. Also no metallic objects with pointed surfaces were present within 2 m from the spark gap. Typical plot of positive discharge presented in Figure 1a. Table 1 shows the summary of the X-ray registrations. Signal detection occurred significantly more for positive polarity discharges than for negative. This dependence was observed for both detectors. For detector D2 the probability of X-ray registration decreased proportional to 1/d2 with increasing the distance d to the breakdown gap from 1m43 to 2m10. Detailed energy spectra and time distribution of X-ray emission were obtained; see for example Fig. 1b. For both polarities of the high voltage, the X-rays only occurred when there was a current at the cathode.

Measuring the degradation level of polymer films subjected to partial discharges

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bozzo, R.; Gemme, C.; Guastavino, F.

1996-12-31

Polymer films have been subjected to partial discharge (PD) aging. It is shown that statistical quantities derived from partial discharges patterns can be related to test conditions, film characteristics and degradation level. PDs have been measured by means of a digital system. Several resulting PD patterns have been elaborated and about 50 derived and statistical quantities have been obtained for each pattern. The effects of the test conditions on the derived quantities has been studied with relevance to the following items: To recognize the kind of film under test; to correlate the value of quantities with the degradation level ofmore » the film (i.e., to focus at the quantities which change with time); to find a link between the quantities values and the test ambient conditions (i.e., relative humidity); to determine the influence of the film thickness; and to evidence the effect of the voltage level.« less

Feasibility of corona discharge ion mobility spectrometry for direct analysis of samples extracted by dispersive liquid-liquid microextraction.

PubMed

Jafari, Mohammad T; Riahi, Farhad

2014-05-23

The capability of corona discharge ionization ion mobility spectrometry (CD-IMS) for direct analysis of the samples extracted by dispersive liquid-liquid microextraction (DLLME) was investigated and evaluated, for the first time. To that end, an appropriate new injection port was designed and constructed, resulting in possibility of direct injection of the known sample volume, without tedious sample preparation steps (e.g. derivatization, solvent evaporation, and re-solving in another solvent…). Malathion as a test compound was extracted from different matrices by a rapid and convenient DLLME method. The positive ion mobility spectra of the extracted malathion were obtained after direct injection of carbon tetrachloride or methanol solutions. The analyte responses were compared and the statistical results revealed the feasibility of direct analysis of the extracted samples in carbon tetrachloride, resulting in a convenient methodology. The coupled method of DLLME-CD-IMS was exhaustively validated in terms of sensitivity, dynamic range, recovery, and enrichment factor. Finally, various real samples of apple, river and underground water were analyzed, all verifying the feasibility and success of the proposed method for the easy extraction of the analyte using DLLME separation before the direct analysis by CD-IMS. Copyright © 2014 Elsevier B.V. All rights reserved.

Mortality Trends in Pediatric and Congenital Heart Surgery: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database.

PubMed

Jacobs, Jeffrey P; He, Xia; Mayer, John E; Austin, Erle H; Quintessenza, James A; Karl, Tom R; Vricella, Luca; Mavroudis, Constantine; O'Brien, Sean M; Pasquali, Sara K; Hill, Kevin D; Husain, S Adil; Overman, David M; St Louis, James D; Han, Jane M; Shahian, David M; Cameron, Duke; Jacobs, Marshall L

2016-10-01

Previous analyses of The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database have demonstrated a reduction over time of risk-adjusted operative mortality after coronary artery bypass grafting. The STS Congenital Heart Surgery Database (STS CHSD) was queried to assess multiinstitutional trends over time in discharge mortality and postoperative length of stay (PLOS). Since 2009, operations in the STS CHSD have been classified according to STAT (The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery) Congenital Heart Surgery Mortality Categories. The five STAT Mortality Categories were chosen to be optimal with respect to minimizing variation within categories and maximizing variation between categories. For this study, all index cardiac operations from 1998 to 2014, inclusive, were grouped by STAT Mortality Category (exclusions: patent ductus arteriosus ligation in patients weighing less than or equal to 2.5 kg and operations that could not be assigned to a STAT Mortality Category). End points were discharge mortality and PLOS in survivors for the entire period and for 4-year epochs. The Cochran-Armitage trend test was used to test the null hypothesis that the mortality was the same across epochs, by STAT Mortality Category. The analysis encompassed 202,895 index operations at 118 centers. The number of centers participating in STS CHSD increased in each epoch. Overall discharge mortality was 3.4% (6,959 of 202,895) for 1998 to 2014 and 3.1% (2,308 of 75,337) for 2011 to 2014. Statistically significant improvement in discharge mortality was seen in STAT Mortality Categories 2, 3, 4, and 5 (p values for STAT Mortality Categories 1 through 5 are 0.060, <0.001, 0.015, <0.001, and <0.001, respectively). PLOS in survivors was relatively unchanged over the same time intervals. Sensitivity analyses reveal that the finding of declining risk-stratified rates of discharge mortality over time is not simply attributable to the addition of more centers to the cohort over time. This 16-year analysis of STS CHSD reveals declining discharge mortality over time, especially for more complex operations. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Adult sports-related traumatic brain injury in United States trauma centers.

PubMed

Winkler, Ethan A; Yue, John K; Burke, John F; Chan, Andrew K; Dhall, Sanjay S; Berger, Mitchel S; Manley, Geoffrey T; Tarapore, Phiroz E

2016-04-01

OBJECTIVE Sports-related traumatic brain injury (TBI) is an important public health concern estimated to affect 300,000 to 3.8 million people annually in the United States. Although injuries to professional athletes dominate the media, this group represents only a small proportion of the overall population. Here, the authors characterize the demographics of sports-related TBI in adults from a community-based trauma population and identify predictors of prolonged hospitalization and increased morbidity and mortality rates. METHODS Utilizing the National Sample Program of the National Trauma Data Bank (NTDB), the authors retrospectively analyzed sports-related TBI data from adults (age ≥ 18 years) across 5 sporting categories-fall or interpersonal contact (FIC), roller sports, skiing/snowboarding, equestrian sports, and aquatic sports. Multivariable regression analysis was used to identify predictors of prolonged hospital length of stay (LOS), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis. RESULTS From 2003 to 2012, in total, 4788 adult sports-related TBIs were documented in the NTDB, which represented 18,310 incidents nationally. Equestrian sports were the greatest contributors to sports-related TBI (45.2%). Mild TBI represented nearly 86% of injuries overall. Mean (± SEM) LOSs in the hospital or intensive care unit (ICU) were 4.25 ± 0.09 days and 1.60 ± 0.06 days, respectively. The mortality rate was 3.0% across all patients, but was statistically higher in TBI from roller sports (4.1%) and aquatic sports (7.7%). Age, hypotension on admission to the emergency department (ED), and the severity of head and extracranial injuries were statistically significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Traumatic brain injury during aquatic sports was similarly associated with prolonged ICU and hospital LOSs, medical complications, and failure to be discharged to home. CONCLUSIONS Age, hypotension on ED admission, severity of head and extracranial injuries, and sports mechanism of injury are important prognostic variables in adult sports-related TBI. Increasing TBI awareness and helmet use-particularly in equestrian and roller sports-are critical elements for decreasing sports-related TBI events in adults.

Photogrammetric discharge monitoring of small tropical mountain rivers - A case study at Rivière des Pluies, Réunion island

NASA Astrophysics Data System (ADS)

Stumpf, André; Augereau, Emmanuel; Delacourt, Christophe; Bonnier, Julien

2016-04-01

Reliable discharge measurements are indispensable for an effective management of natural water resources and floods. Limitations of classical current meter profiling and stage-discharge ratings have stimulated the development of more accurate and efficient gauging techniques. While new discharge measurements technologies such as acoustic doppler current profilers and large-scale image particle velocimetry (LSPIV) have been developed and tested in numerous studies, the continuous monitoring of small mountain rivers and discharge dynamics during strong meteorological events remains challenging. More specifically LSPIV studies are often focused on short-term measurements during flood events and there are still very few studies that address its use for long-term monitoring of small mountain rivers. To fill this gap this study targets the development and testing of largely autonomous photogrammetric discharge measurement system with a special focus on the application to small mountain river with high discharge variability and a mobile riverbed in the tropics. It proposes several enhancements among previous LSPIV methods regarding camera calibration, more efficient processing in image geometry, the automatic detection of the water level as well as the statistical calibration and estimation of the discharge from multiple profiles. To account for changes in the bed topography the riverbed is surveyed repeatedly during the dry seasons using multi-view photogrammetry or terrestrial laser scanners. The presented case study comprises the analysis of several thousand videos spanning over two and a half year (2013-2015) to test the robustness and accuracy of different processing steps. An analysis of the obtained results suggests that the quality of the camera calibration reaches a sub-pixel accuracy. The median accuracy of the watermask detections is F1=0.82, whereas the precision is systematically higher than the recall. The resulting underestimation of the water surface area and level leads to a systematic underestimation of the discharge and error rates of up to 25 %. However, the bias can be effectively removed using a least-square cross-calibration which reduces the error to a MAE of 6.39% and a maximum error of 16.18%. Those error rates are significantly lower than the uncertainties among multiple profiles (30%) and illustrate the importance of the spatial averaging from multiple measurements. The study suggests that LSPIV can already be considered as a valuable tool for the monitoring of torrential flows, whereas further research is still needed to fully integrate night-time observation and stereo-photogrammetric capabilities.

Predictors of formal home health care use in elderly patients after hospitalization.

PubMed

Solomon, D H; Wagner, D R; Marenberg, M E; Acampora, D; Cooney, L M; Inouye, S K

1993-09-01

To prospectively study the incidence of and risk factors for home health care (HHC) use in a cohort of elderly medical and surgical patients discharged from acute care. Although HHC is commonly received by patients in this group, its predictors have not been well studied. Prospective cohort study. Medical and surgical wards at a university teaching hospital, followed by 23 Medicare-certified HHC agencies in the study catchment area. 226 medical and surgical patients aged 70 years and older immediately after discharge from acute care. HHC initiated within 14 days after hospital discharge, measured by direct review of HHC agency records. The incidence of HHC initiated within 2 weeks post-discharge was 75/226 (34%). The median duration of service was 30 days (range 3-483) with a median of 3 visits per week. Four independent predictors of HHC were identified through multivariate analysis: educational level < or = 12 years (relative risk (RR) 3.3; 95% confidence interval (CI) 1.6 to 6.6); less accessible social support (RR, 1.7; CI 0.9 to 3.1); impairment in at least one instrumental activity of daily living (RR, 1.9; CI, 1.0, 3.4); and prior HHC use (RR, 2.1; CI, 1.2 to 3.6). Risk strata were created by adding one point for each risk factor present: with 0-1 risk factors, 8% used HHC; with two risk factors, 28%; with three risk factors, 45%, with four risk factors, 76%. This trend was statistically significant (P < 0.001). HHC use is common among elderly patients after discharge from acute care. A simple predictive model based on four risk factors can be used on admission to predict HHC use. This model may be useful for discharge planning and health care utilization planning for the elderly population.

Nitrate transport and supply limitations quantified using high-frequency stream monitoring and turning point analysis

NASA Astrophysics Data System (ADS)

Jones, Christopher S.; Wang, Bo; Schilling, Keith E.; Chan, Kung-sik

2017-06-01

Agricultural landscapes often leak inorganic nitrogen to the stream network, usually in the form of nitrate-nitrite (NOx-N), degrading downstream water quality on both the local and regional scales. While the spatial distribution of nitrate sources has been delineated in many watersheds, less is known about the complicated temporal dynamics that drive stream NOx-N because traditional methods of stream grab sampling are often conducted at a low frequency. Deployment of accurate real-time, continuous measurement devices that have been developed in recent years enables high-frequency sampling that provides detailed information on the concentration-discharge relation and the timing of NOx-N delivery to streams. We aggregated 15-min interval NOx-N and discharge data over a nine-year period into daily averages and then used robust statistical methods to identify how the discharge regime within an artificially-drained agricultural watershed reflected catchment hydrology and NOx-N delivery pathways. We then quantified how transport and supply limitations varied from year-to-year and how dependence of these limitations varied with climate, especially drought. Our results show NOx-N concentrations increased linearly with discharge up to an average "turning point" of 1.42 mm of area-normalized discharge, after which concentrations decline with increasing discharge. We estimate transport and supply limitations to govern 57 and 43 percent, respectively, of the NOx-N flux over the nine-year period. Drought effects on the NOx-N flux linger for multiple years and this is reflected in a greater tendency toward supply limitations in the three years following drought. How the turning point varies with climate may aid in prediction of NOx-N loading in future climate regimes.

Modelling the impacts of global change on concentrations of Escherichia coli in an urban river

NASA Astrophysics Data System (ADS)

Jalliffier-Verne, Isabelle; Leconte, Robert; Huaringa-Alvarez, Uriel; Heniche, Mourad; Madoux-Humery, Anne-Sophie; Autixier, Laurène; Galarneau, Martine; Servais, Pierre; Prévost, Michèle; Dorner, Sarah

2017-10-01

Discharges of combined sewer system overflows (CSOs) affect water quality in drinking water sources despite increasing regulation and discharge restrictions. A hydrodynamic model was applied to simulate the transport and dispersion of fecal contaminants from CSO discharges and to quantify the impacts of climate and population changes on the water quality of the river used as a drinking water source in Québec, Canada. The dispersion model was used to quantify Escherichia coli (E. coli) concentrations at drinking water intakes. Extreme flows during high and low water events were based on a frequency analysis in current and future climate scenarios. The increase of the number of discharges was quantified in current and future climate scenarios with regards to the frequency of overflows observed between 2009 and 2012. For future climate scenarios, effects of an increase of population were estimated according to current population growth statistics, independently of local changes in precipitation that are more difficult to predict than changes to regional scale hydrology. Under ;business-as-usual; scenarios restricting increases in CSO discharge frequency, mean E. coli concentrations at downstream drinking water intakes are expected to increase by up to 87% depending on the future climate scenario and could lead to changes in drinking water treatment requirements for the worst case scenarios. The greatest uncertainties are related to future local discharge loads. Climate change adaptation with regards to drinking water quality must focus on characterizing the impacts of global change at a local scale. Source water protection planning must consider the impacts of climate and population change to avoid further degradation of water quality.

Interrelationship of sleep and juvenile myoclonic epilepsy (JME): a sleep questionnaire-, EEG-, and polysomnography (PSG)-based prospective case-control study.

PubMed

Ramachandraiah, C T; Sinha, S; Taly, A B; Rao, S; Satishchandra, P

2012-11-01

We studied the effects of 'epilepsy on sleep and its architecture' and 'sleep on the occurrence and distribution of interictal epileptiform discharges (ED)' using 'sleep questionnaires', 'EEG', and 'PSG' in patients with JME. Forty patients with JME [20 on valproate (Group I - 20.8±4.0 years; M: F=9:11) and 20 drug-naïve (Group II - 24.4±6.7 years; M: F=9:11)] and 20 controls (M: F=9:11; age: 23.5±4.7 years) underwent assessment with Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), overnight PSG, and scalp-EEG. Epileptiform discharges (EDs) were quantified in different sleep stages. The 'ED Index' was derived as number of EDs/min per stage. Statistical Package for the Social Sciences (SPSS) vs. 11 was used for statistical analysis. A 'p' <0.05 was considered as statistically significant. There was poor sleep quality in patients compared to controls (p=0.02), while there was no significant difference in ESS scores between the groups. The PSG parameters were comparable in both groups. Routine EEG revealed EDs in 22/40 (Group I: 7 and Group II: 15) patients. Thirty-five patients had EDs in various sleep stages during PSG (Group I: 17 and Group II: 18): N1 - Group I: 9 and Group II: 14, N2 - Group I: 14 and Group II: 14, N3 - Group I: 14 and Group II: 10, and REM - Group I: 9 and Group II: 11. The ED Index was higher during N2/N3 in Group I and N1/REM in Group II. The epileptiform discharges were frequently associated with arousals in N1/REM and K-complexes in N2. There was no other significant difference between Groups I and II. In conclusion, there was poor sleep quality in patients with JME compared to controls, especially those on valproate who had altered sleep architecture. Epileptiform activity was observed more often in sleep than wakefulness. Sleep stages had variable effect on epileptiform discharges with light sleep having a facilitatory effect in the drug-naïve group and slow wave sleep having a facilitatory effect in the valproate group. Copyright © 2012 Elsevier Inc. All rights reserved.

Detection of changes of high-frequency activity by statistical time-frequency analysis in epileptic spikes

PubMed Central

Kobayashi, Katsuhiro; Jacobs, Julia; Gotman, Jean

2013-01-01

Objective A novel type of statistical time-frequency analysis was developed to elucidate changes of high-frequency EEG activity associated with epileptic spikes. Methods The method uses the Gabor Transform and detects changes of power in comparison to background activity using t-statistics that are controlled by the false discovery rate (FDR) to correct type I error of multiple testing. The analysis was applied to EEGs recorded at 2000 Hz from three patients with mesial temporal lobe epilepsy. Results Spike-related increase of high-frequency oscillations (HFOs) was clearly shown in the FDR-controlled t-spectra: it was most dramatic in spikes recorded from the hippocampus when the hippocampus was the seizure onset zone (SOZ). Depression of fast activity was observed immediately after the spikes, especially consistently in the discharges from the hippocampal SOZ. It corresponded to the slow wave part in case of spike-and-slow-wave complexes, but it was noted even in spikes without apparent slow waves. In one patient, a gradual increase of power above 200 Hz preceded spikes. Conclusions FDR-controlled t-spectra clearly detected the spike-related changes of HFOs that were unclear in standard power spectra. Significance We developed a promising tool to study the HFOs that may be closely linked to the pathophysiology of epileptogenesis. PMID:19394892

Control of Laser Plasma Based Accelerators up to 1 GeV

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nakamura, Kei

2007-12-01

This dissertation documents the development of a broadband electron spectrometer (ESM) for GeV class Laser Wakefield Accelerators (LWFA), the production of high quality GeV electron beams (e-beams) for the first time in a LWFA by using a capillary discharge guide (CDG), and a statistical analysis of CDG-LWFAs. An ESM specialized for CDG-LWFAs with an unprecedented wide momentum acceptance, from 0.01 to 1.1 GeV in a single shot, has been developed. Simultaneous measurement of e-beam spectra and output laser properties as well as a large angular acceptance (> ± 10 mrad) were realized by employing a slitless scheme. A scintillating screenmore » (LANEX Fast back, LANEX-FB)--camera system allowed faster than 1 Hz operation and evaluation of the spatial properties of e-beams. The design provided sufficient resolution for the whole range of the ESM (below 5% for beams with 2 mrad divergence). The calibration between light yield from LANEX-FB and total charge, and a study on the electron energy dependence (0.071 to 1.23 GeV) of LANEX-FB were performed at the Advanced light source (ALS), Lawrence Berkeley National Laboratory (LBNL). Using this calibration data, the developed ESM provided a charge measurement as well. The production of high quality electron beams up to 1 GeV from a centimeter-scale accelerator was demonstrated. The experiment used a 310 μm diameter gas-filled capillary discharge waveguide that channeled relativistically-intense laser pulses (42 TW, 4.5 x 10 18 W/cm 2) over 3.3 centimeters of sufficiently low density (≃ 4.3 x 10 18/cm 3) plasma. Also demonstrated was stable self-injection and acceleration at a beam energy of ≃ 0.5 GeV by using a 225 μm diameter capillary. Relativistically-intense laser pulses (12 TW, 1.3 x 10 18W/cm 2) were guided over 3.3 centimeters of low density (≃ 3.5 x 10 18/cm 3) plasma in this experiment. A statistical analysis of the CDG-LWFAs performance was carried out. By taking advantage of the high repetition rate experimental system, several thousands of shots were taken in a broad range of the laser and plasma parameters. An analysis program was developed to sort and select the data by specified parameters, and then to evaluate performance statistically. The analysis suggested that the generation of GeV-level beams comes from a highly unstable and regime. By having the plasma density slightly above the threshold density for self injection, (1) the longest dephasing length possible was provided, which led to the generation of high energy e-beams, and (2) the number of electrons injected into the wakefield was kept small, which led to the generation of high quality (low energy spread) e-beams by minimizing the beam loading effect on the wake. The analysis of the stable half-GeV beam regime showed the requirements for stable self injection and acceleration. A small change of discharge delay t dsc, and input energy E in, significantly affected performance. The statistical analysis provided information for future optimization, and suggested possible schemes for improvement of the stability and higher quality beam generation. A CDG-LWFA is envisioned as a construction block for the next generation accelerator, enabling significant cost and size reductions.« less

Performance of bed-load transport equations relative to geomorphic significance: Predicting effective discharge and its transport rate

Treesearch

Jeffrey J. Barry; John M. Buffington; Peter Goodwin; John .G. King; William W. Emmett

2008-01-01

Previous studies assessing the accuracy of bed-load transport equations have considered equation performance statistically based on paired observations of measured and predicted bed-load transport rates. However, transport measurements were typically taken during low flows, biasing the assessment of equation performance toward low discharges, and because equation...

Study on the Measurement and Calculation of Environmental Pollution Bearing Index of China’s Pig Scale

NASA Astrophysics Data System (ADS)

Leng, Bi-Bin; Gong, Jian; Zhang, Wen-bo; Ji, Xue-Qiang

2017-11-01

According to the environmental pollution caused by large-scale pig breeding, the SPSS statistical software and factor analysis method were used to calculate the environmental pollution bearing index of China’s breeding scale from 2006 to 2015. The results showed that with the increase of scale the density of live pig farming and the amount of fertilizer application in agricultural production increased. However, due to the improvement of national environmental awareness, industrial waste water discharge is greatly reduced. China's hog farming environmental pollution load index is rising.

Study on Standard Fatigue Vehicle Load Model

NASA Astrophysics Data System (ADS)

Huang, H. Y.; Zhang, J. P.; Li, Y. H.

2018-02-01

Based on the measured data of truck from three artery expressways in Guangdong Province, the statistical analysis of truck weight was conducted according to axle number. The standard fatigue vehicle model applied to industrial areas in the middle and late was obtained, which adopted equivalence damage principle, Miner linear accumulation law, water discharge method and damage ratio theory. Compared with the fatigue vehicle model Specified by the current bridge design code, the proposed model has better applicability. It is of certain reference value for the fatigue design of bridge in China.

Building electronic forms for elderly program: integrated care model for high risk elders in Hong Kong.

PubMed

Yiu, Rex; Fung, Vicky; Szeto, Karen; Hung, Veronica; Siu, Ricky; Lam, Johnny; Lai, Daniel; Maw, Christina; Cheung, Adah; Shea, Raman; Choy, Anna

2013-01-01

In Hong Kong, elderly patients discharged from hospital are at high risk of unplanned readmission. The Integrated Care Model (ICM) program is introduced to provide continuous and coordinated care for high risk elders from hospital to community to prevent unplanned readmission. A multidisciplinary working group was set up to address the requirements on developing the electronic forms for ICM program. Six (6) forms were developed. These forms can support ICM service delivery for the high risk elders, clinical documentation, statistical analysis and information sharing.

Long-Term Predictive and Feedback Encoding of Motor Signals in the Simple Spike Discharge of Purkinje Cells

PubMed Central

Popa, Laurentiu S.; Streng, Martha L.

2017-01-01

Abstract Most hypotheses of cerebellar function emphasize a role in real-time control of movements. However, the cerebellum’s use of current information to adjust future movements and its involvement in sequencing, working memory, and attention argues for predicting and maintaining information over extended time windows. The present study examines the time course of Purkinje cell discharge modulation in the monkey (Macaca mulatta) during manual, pseudo-random tracking. Analysis of the simple spike firing from 183 Purkinje cells during tracking reveals modulation up to 2 s before and after kinematics and position error. Modulation significance was assessed against trial shuffled firing, which decoupled simple spike activity from behavior and abolished long-range encoding while preserving data statistics. Position, velocity, and position errors have the most frequent and strongest long-range feedforward and feedback modulations, with less common, weaker long-term correlations for speed and radial error. Position, velocity, and position errors can be decoded from the population simple spike firing with considerable accuracy for even the longest predictive (-2000 to -1500 ms) and feedback (1500 to 2000 ms) epochs. Separate analysis of the simple spike firing in the initial hold period preceding tracking shows similar long-range feedforward encoding of the upcoming movement and in the final hold period feedback encoding of the just completed movement, respectively. Complex spike analysis reveals little long-term modulation with behavior. We conclude that Purkinje cell simple spike discharge includes short- and long-range representations of both upcoming and preceding behavior that could underlie cerebellar involvement in error correction, working memory, and sequencing. PMID:28413823

Designing an 'expert knowledge' based approach for the quantification of historical floods - the case study of the Kinzig catchment in Southwest Germany

NASA Astrophysics Data System (ADS)

Bösmeier, Annette; Glaser, Rüdiger; Stahl, Kerstin; Himmelsbach, Iso; Schönbein, Johannes

2017-04-01

Future estimations of flood hazard and risk for developing optimal coping and adaption strategies inevitably include considerations of the frequency and magnitude of past events. Methods of historical climatology represent one way of assessing flood occurrences beyond the period of instrumental measurements and can thereby substantially help to extend the view into the past and to improve modern risk analysis. Such historical information can be of additional value and has been used in statistical approaches like Bayesian flood frequency analyses during recent years. However, the derivation of quantitative values from vague descriptive information of historical sources remains a crucial challenge. We explored possibilities of parametrization of descriptive flood related data specifically for the assessment of historical floods in a framework that combines a hermeneutical approach with mathematical and statistical methods. This study forms part of the transnational, Franco-German research project TRANSRISK2 (2014 - 2017), funded by ANR and DFG, with the focus on exploring the floods history of the last 300 years for the regions of Upper and Middle Rhine. A broad data base of flood events had been compiled, dating back to AD 1500. The events had been classified based on hermeneutical methods, depending on intensity, spatial dimension, temporal structure, damages and mitigation measures associated with the specific events. This indexed database allowed the exploration of a link between descriptive data and quantitative information for the overlapping time period of classified floods and instrumental measurements since the end of the 19th century. Thereby, flood peak discharges as a quantitative measure of the severity of a flood were used to assess the discharge intervals for flood classes (upper and lower thresholds) within different time intervals for validating the flood classification, as well as examining the trend in the perception threshold over time. Furthermore, within a suitable time period, flood classes and other quantifiable indicators of flood intensity (number of damaged locations mentioned in historical sources, general availability of reports associated with a specific event) were combined with available peak discharges measurements. We argue that this information can be considered as 'expert knowledge' and used it to develop a fuzzy rule based model for deriving peak discharge estimates of pre-instrumental events that can finally be introduced into a flood frequency analysis.

Low free triiodothyronine levels are related to symptomatic intracranial hemorrhage and poor functional outcomes after intravenous thrombolysis in acute ischemic stroke patients.

PubMed

Liu, Junfeng; Wang, Deren; Xiong, Yao; Yuan, Ruozhen; Tao, Wendan; Liu, Ming

2016-05-01

Low free triiodothyronine (fT3) levels have been associated with increased mortality and poor functional outcomes in patients with stroke. However, the research of relationship between fT3 levels and acute ischemic stroke (AIS) patients with intravenous thrombolysis (IVT) is scarce. We aimed to investigate the association of fT3 levels with symptomatic intracranial hemorrhage (sICH) and functional outcomes at discharge in AIS patients with IVT. Patients with AIS admitted to West China hospital, Sichuan University, who had underwent IVT treatment, were consecutively and retrospectively included. Demographic and clinical information were collected and analyzed according to the levels of fT3. We used logistic regression analysis to estimate the multivariable adjusted association of fT3 levels and post-IVT sICH, and functional outcomes at discharge. Among the 46 patients (26 males; mean age, 63.6 years) in the final analysis, 17 patients (37.0%) had fT3 levels lower than the reference range. After adjustment for age, gender, and statistically important variables (NIHSS on admission, urea levels and creatinine levels), low fT3 levels were significantly associated with post-IVT sICH (p = 0.01, OR = 0.27, 95% CI 0.10-0.77) and poor functional outcomes at discharge (p = 0.04 OR = 2.58, 95% CI 1.05-6.35). We found that lower free T3 levels are independently related to post-IVT sICH and poor functional outcomes at discharge in AIS patients with IVT, which should be verified and extended in large cohorts in the future.

Estimation of flood-frequency characteristics of small urban streams in North Carolina

USGS Publications Warehouse

Robbins, J.C.; Pope, B.F.

1996-01-01

A statewide study was conducted to develop methods for estimating the magnitude and frequency of floods of small urban streams in North Carolina. This type of information is critical in the design of bridges, culverts and water-control structures, establishment of flood-insurance rates and flood-plain regulation, and for other uses by urban planners and engineers. Concurrent records of rainfall and runoff data collected in small urban basins were used to calibrate rainfall-runoff models. Historic rain- fall records were used with the calibrated models to synthesize a long- term record of annual peak discharges. The synthesized record of annual peak discharges were used in a statistical analysis to determine flood- frequency distributions. These frequency distributions were used with distributions from previous investigations to develop a database for 32 small urban basins in the Blue Ridge-Piedmont, Sand Hills, and Coastal Plain hydrologic areas. The study basins ranged in size from 0.04 to 41.0 square miles. Data describing the size and shape of the basin, level of urban development, and climate and rural flood charac- teristics also were included in the database. Estimation equations were developed by relating flood-frequency char- acteristics to basin characteristics in a generalized least-squares regression analysis. The most significant basin characteristics are drainage area, impervious area, and rural flood discharge. The model error and prediction errors for the estimating equations were less than those for the national flood-frequency equations previously reported. Resulting equations, which have prediction errors generally less than 40 percent, can be used to estimate flood-peak discharges for 2-, 5-, 10-, 25-, 50-, and 100-year recurrence intervals for small urban basins across the State assuming negligible, sustainable, in- channel detention or basin storage.

The effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare) on readmission rates in a multicultural population of internal medicine patients.

PubMed

Karapinar-Carkit, Fatma; Borgsteede, Sander D; Zoer, Jan; Siegert, Carl; van Tulder, Maurits; Egberts, Antoine C G; van den Bemt, Patricia M L A

2010-02-16

Medication errors occur frequently at points of transition in care. The key problems causing these medication errors are: incomplete and inappropriate medication reconciliation at hospital discharge (partly arising from inadequate medication reconciliation at admission), insufficient patient information (especially within a multicultural patient population) and insufficient communication to the next health care provider. Whether interventions aimed at the combination of these aspects indeed result in less discontinuity and associated harm is uncertain. Therefore the main objective of this study is to determine the effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare) on readmission rates in patients discharged from the internal medicine department. An experimental study is performed at the internal medicine ward of a general teaching hospital in Amsterdam, which serves a multicultural population. In this study the effects of the COACH program is compared with usual care using a pre-post study design. All patients being admitted with at least one prescribed drug intended for chronic use are included in the study unless they meet one of the following exclusion criteria: no informed consent, no medication intended for chronic use prescribed at discharge, death, transfer to another ward or hospital, discharge within 24 hours or out of office hours, discharge to a nursing home and no possibility to counsel the patient.The intervention consists of medication reconciliation, patient counselling and communication between the hospital and primary care healthcare providers.The following outcomes are measured: the primary outcome readmissions within six months after discharge and the secondary outcomes number of interventions, adherence, patient's attitude towards medicines, patient's satisfaction with medication information, costs, quality of life and finally satisfaction of general practitioners and community pharmacists.Interrupted time series analysis is used for data-analysis of the primary outcome. Descriptive statistics is performed for the secondary outcomes. An economic evaluation is performed according to the intention-to-treat principle. This study will be able to evaluate the clinical and cost impact of a comprehensive program on continuity of care and associated patient safety. Dutch trial register: NTR1519.

Statistical analysis of fires and explosions attributed to static electricity over the last 50 years in Japanese industry

NASA Astrophysics Data System (ADS)

Ohsawa, A.

2011-06-01

This paper presents a statistical analysis of 153 accidents attributable to static electricity in Japanese industry over the last 50 years. A more thorough understanding of their causes could help prevent similar incidents and identify hazards that could assist in the task of risk assessment. Most of the incidents occurred during operations performed by workers. In addition, more than 70% of the flammable atmospheres resulted from the presence of vapours. A noteworthy finding is that at least 70% of the ignitions were caused by isolated conductors including operators' bodies leading to spark discharges, which could have easily been prevented with earthing. These tendencies indicate that, when operators handle flammable liquids with any conductors, the ignition risk is significantly high. A serious lack of information regarding fundamental countermeasures for static electricity seems to be the main cause of such hazards. Only organised management, including education and risk communication, would prevent them.

Predictability of current and future multi-river discharges: Ganges, Brahmaputra, Yangtze, Blue Nile, and Murray-Darling rivers

NASA Astrophysics Data System (ADS)

Jian, Jun

2007-12-01

Determining river discharge is of critical importance to many societies as they struggle with fresh water supply and risk of flooding. In Bangladesh, floods occur almost every year but with sufficient irregularity to have adverse social and economical consequences. Important goals are to predict the discharge to be used for the optimization of agricultural practices, disaster mitigation and water resource management. The aim of this study is to determine the predictability of river discharge in a number of major rivers on time scale varying from weeks to a century. We investigated predictability considering relationship between SST and discharge. Next, we consider IPCC model projections of river discharge while the models are statistically adjusted against observed discharges. In this study, we consider five rivers, the Ganges, the Brahmaputra, the Yangtze, the Blue Nile, and the Murray-Darling Rivers. On seasonal time scales, statistically significant correlations are found between mean monthly equatorial Pacific sea surface temperature (SST) and the summer Ganges discharge with lead times of 2-3 months due to oscillations of the El Nino-Southern Oscillation (ENSO) phenomena. In addition, there are strong correlations in the southwest and northeast Pacific. These, too, appear to be tied to the ENSO cycle. The Brahmaputra discharge, on the other hand, shows somewhat weaker relationships with tropical SST. Strong lagged correlations relationships are found with SST in the Bay of Bengal but these are the result of very warm SSTs and exceptional Brahmaputra discharge during the summer of 1998. When this year is removed from the time series, relationships weaken everywhere except in the northwestern Pacific for the June discharge and in areas of the central Pacific straddling the equator for the July discharge. The relationships are relative strong, but they are persistent from month to month and suggest that two different and sequential factors influence Brahmaputra river flow. Second goal is to project the behavior of future river discharge forced by the increasing greenhouse gases (GHGs) and aerosols from natural and anthropogenic sources. Three more rivers, the Yangtze, Blue Nile, and Murray-Darling rivers are considered. It is meaningful to people living within the watershed, which would experience flooding or drought in the next 100-years. The original precipitation output from the third phase of Coupled Model Inter-comparison Project (CMIP3) project has large inter-model variability, which limits the ability to quantify the regional precipitation or runoff trends. With a basic statistical Quantile-to-Quantile (Q-Q) technique, a mapping index was built to link each modeled precipitation averaged over river catchment and observational discharge measured close to the mouth. Using the climatological annual cycle to choose the "good" models, the observational river discharges are well reproduced from the 20th century run (20C3M) model results. Furthermore, with the same indices, the future 21st century river discharge of the Yangtze, the Ganges, the Brahmaputra, and the Blue Nile are simulated under different SRES scenarios. The Murray-Darling River basin does not have the similar seasonal cycle of discharge with modeled precipitations. So we choose to build the link between satellite imaged and modeled precipitations and use it to simulate the future precipitation. The Yangtze, Ganges, Brahmaputra River mean wet season discharges are projected to increase up to 15-25% at the end of the 21st century under the most abundant GHGs scenarios (SRESA1B and SRESA2). The risks of flooding also reach to a high level throughout the time. Inter-model deviations increase dramatically under all scenarios except for the fixed-2000 level concentration (COMMIT). With large uncertainty, the Blue Nile River discharge and Murray-Darling River basin annual precipitation do not suggest a sign of change on multi-model mean.

[A study of home care needs of patients at discharge and effects of home care--centered on patients discharged from a rural general hospital].

PubMed

Choi, Y S; Kim, D H; Storey, M; Kim, C J; Kang, K S

1992-01-01

The study was carried out at W. hospital, an affiliated hospital of Y university, involved a total of 163 patients who were discharged from the hospital between May 1990 and March 1991. Data collection was twice, just prior to discharge and a minimum of three months post discharge. Thirty patients who lived within a hour travel time of the hospital received home care during the three months post discharge. Nursing diagnoses and nursing interventions for these patients were analyzed in this study. The results of the study are summarized as follows: 1. Discharge needs for the subjects of the study were analyzed using Gordon's eleven functional categories and it was found that 48.3% of the total sample had identified nursing needs. Of these, the needs most frequently identified were in the categories of sexuality, 79.3%, health perception, 68.2% self concept, 62.5%, and sleep and rest 62.5%. Looking at the nursing diagnosis that were made for the 30 patients receiving home care, the following diagnoses were the most frequently given; alteration in sexual pattern 79.3%, alterations in health maintenance, 72.6%, alteration in comfort, 68.0%, depression, 64.0%, noncompliance with diet therapy, 63.7%, alteration in self concept, 55.6%, and alteration in sleep pattern, 53%. 2. In looking at the effects of home nursing care as demonstrated by changes in the functional categories over the three month period, it was found that of the 11 functional categories, the need level for health perception, nutrition, activity and self concept decreased slightly over the three month period. On the average sleep patterns improved, but restfulness was slightly less and bowel elimination patterns improved but satisfaction with urinary elimination was slightly less. On the other hand, role enactment, sexuality, stress management and spirituality decreased slightly. The only results that were statistically significant at the 0.05 level were improvement in digestion and decrease in pain. No statistically significant changes were found in ability related to ADL, the total ADL score at discharge was 19.78 +/- 8.23, and after 3 months 19.01 +/- 8.12. Considering that a majority of the patients were over 60 years of age and that many had brain or spinal cord injuries, the fact that their ADL ability did not deteriorate after discharge can be interpreted as related to a positive impact by the home health care nurses. Similarly there was a slight but not statistically significant decrease in the quality of life scores between the two test times (147.83 at discharge and 143.02 at the three month period).(ABSTRACT TRUNCATED AT 400 WORDS)

Physiotherapists' Perceptions of and Experiences with the Discharge Planning Process in Acute-Care General Internal Medicine Units in Ontario

PubMed Central

Uyeno, Jennifer; Heck, Carol S.

2014-01-01

ABSTRACT Purpose: To examine discharge planning of patients in general internal medicine units in Ontario acute-care hospitals from the perspective of physiotherapists. Methods: A cross-sectional study using an online questionnaire was sent to participants in November 2011. Respondents' demographic characteristics and ranking of factors were analyzed using descriptive statistics; t-tests were performed to determine between-group differences (based on demographic characteristics). Responses to open-ended questions were coded to identify themes. Results: Mobility status was identified as the key factor in determining discharge readiness; other factors included the availability of social support and community resources. While inter-professional communication was identified as important, processes were often informal. Discharge policies, timely availability of other discharge options, and pressure for early discharge were identified as affecting discharge planning. Respondents also noted a lack of training in discharge planning; accounts of ethical dilemmas experienced by respondents supported these themes. Conclusions: Physiotherapists consider many factors beyond the patient's physical function during the discharge planning process. The improvement of team communication and resource allocation should be considered to deal with the realities of discharge planning. PMID:25125778

Estimating river discharge uncertainty by applying the Rating Curve Model

NASA Astrophysics Data System (ADS)

Barbetta, S.; Melone, F.; Franchini, M.; Moramarco, T.

2012-04-01

The knowledge of the flow discharge at a river site is necessary for planning and management of water resources as well as for monitoring and real-time forecasting purposes when significant flood events occur. In the hydrological practice, the operational discharge measurement in medium and large rivers is mostly based on indirect approaches by converting the observed stage into discharge values using steady-flow rating curves. However, the stage-discharge relationship can be unknown for hydrometric sections where flow velocity measurements, particularly during high floods, are not available. To overcome this issue, a simplified approach named Rating Curve Model (RCM) and proposed by Moramarco et al. (Moramarco, T., Barbetta, S., F. Melone, F. & Singh, V.P., Relating local stage and remote discharge with significant lateral inflow, J. Hydrol. Engng ASCE, 10[1], 58?69, 2005) can be conveniently used. RCM turned out able to assess, with a high level of accuracy, the discharge hydrograph at a river site where only the stage is monitored while the flow is recorded at a different section along the river, even when significant lateral flows occur. The simple structure of the model is depending on three parameters of which two can be considered characteristic of the river reach and one of the wave travel time of floods. Considering that RCM well lends itself to predict the stage-discharge relationship at a river site wherein only stages are recorded, an uncertainty analysis on river discharge estimate is of interest for the hydrological practice definitely. To this aim, the uncertainty characterizing the RCM outcomes is addressed in this work by considering two different procedures based on the Monte Carlo approach and the Generalized Likelihood Uncertainty Estimation (GLUE) method, respectively. The statistical distribution of parameters is found and a random re-sampling of parameters is done for assessing the 90% confidence interval (CI) of discharge estimates. In particular, for the latter approach the Nash-Sutcliffe coefficient is used as likelihood measure. Two equipped river reaches of the Upper-Middle Tiber River basin, central Italy, are investigated as case studies. The results provided by the selected methodologies are discussed and compared showing that all the computed CIs are satisfied in term of percentage of included observed discharges with similar percentages characterizing the bands assessed by both Monte Carlo approach and GLUE procedure.

Inpatient Rehabilitation Volume and Functional Outcomes in Stroke, Lower Extremity Fracture, and Lower Extremity Joint Replacement

PubMed Central

Graham, James E.; Deutsch, Anne; O’Connell, Ann A.; Karmarkar, Amol M.; Granger, Carl V.; Ottenbacher, Kenneth J.

2013-01-01

Background It is unclear if volume-outcome relationships exist in inpatient rehabilitation. Objectives Assess associations between facility volumes and two patient-centered outcomes in the three most common diagnostic groups in inpatient rehabilitation. Research Design We used hierarchical linear and generalized linear models to analyze administrative assessment data from patients receiving inpatient rehabilitation services for stroke (n=202,423), lower extremity fracture (n=132,194), or lower extremity joint replacement (n=148,068) between 2006 and 2008 in 717 rehabilitation facilities across the U.S. Facilities were assigned to quintiles based on average annual diagnosis-specific patient volumes. Measures Discharge functional status (FIM instrument) and probability of home discharge. Results Facility-level factors accounted for 6–15% of the variance in discharge FIM total scores and 3–5% of the variance in home discharge probability across the 3 diagnostic groups. We used the middle volume quintile (Q3) as the reference group for all analyses and detected small, but statistically significant (p < .01) associations with discharge functional status in all three diagnosis groups. Only the highest volume quintile (Q5) reached statistical significance, displaying higher functional status ratings than Q3 each time. The largest effect was observed in FIM total scores among fracture patients, with only a 3.6-point difference in Q5 and Q3 group means. Volume was not independently related to home discharge. Conclusions Outcome-specific volume effects ranged from small (functional status) to none (home discharge) in all three diagnostic groups. Patients with these conditions can be treated locally rather than at higher-volume regional centers. Further regionalization of inpatient rehabilitation services is not needed for these conditions. PMID:23579350

Multivariate regression methods for estimating velocity of ictal discharges from human microelectrode recordings

NASA Astrophysics Data System (ADS)

Liou, Jyun-you; Smith, Elliot H.; Bateman, Lisa M.; McKhann, Guy M., II; Goodman, Robert R.; Greger, Bradley; Davis, Tyler S.; Kellis, Spencer S.; House, Paul A.; Schevon, Catherine A.

2017-08-01

Objective. Epileptiform discharges, an electrophysiological hallmark of seizures, can propagate across cortical tissue in a manner similar to traveling waves. Recent work has focused attention on the origination and propagation patterns of these discharges, yielding important clues to their source location and mechanism of travel. However, systematic studies of methods for measuring propagation are lacking. Approach. We analyzed epileptiform discharges in microelectrode array recordings of human seizures. The array records multiunit activity and local field potentials at 400 micron spatial resolution, from a small cortical site free of obstructions. We evaluated several computationally efficient statistical methods for calculating traveling wave velocity, benchmarking them to analyses of associated neuronal burst firing. Main results. Over 90% of discharges met statistical criteria for propagation across the sampled cortical territory. Detection rate, direction and speed estimates derived from a multiunit estimator were compared to four field potential-based estimators: negative peak, maximum descent, high gamma power, and cross-correlation. Interestingly, the methods that were computationally simplest and most efficient (negative peak and maximal descent) offer non-inferior results in predicting neuronal traveling wave velocities compared to the other two, more complex methods. Moreover, the negative peak and maximal descent methods proved to be more robust against reduced spatial sampling challenges. Using least absolute deviation in place of least squares error minimized the impact of outliers, and reduced the discrepancies between local field potential-based and multiunit estimators. Significance. Our findings suggest that ictal epileptiform discharges typically take the form of exceptionally strong, rapidly traveling waves, with propagation detectable across millimeter distances. The sequential activation of neurons in space can be inferred from clinically-observable EEG data, with a variety of straightforward computation methods available. This opens possibilities for systematic assessments of ictal discharge propagation in clinical and research settings.

Inpatient rehabilitation volume and functional outcomes in stroke, lower extremity fracture, and lower extremity joint replacement.

PubMed

Graham, James E; Deutsch, Anne; O'Connell, Ann A; Karmarkar, Amol M; Granger, Carl V; Ottenbacher, Kenneth J

2013-05-01

It is unclear if volume-outcome relationships exist in inpatient rehabilitation. Assess associations between facility volumes and 2 patient-centered outcomes in the 3 most common diagnostic groups in inpatient rehabilitation. We used hierarchical linear and generalized linear models to analyze administrative assessment data from patients receiving inpatient rehabilitation services for stroke (n=202,423), lower extremity fracture (n=132,194), or lower extremity joint replacement (n=148,068) between 2006 and 2008 in 717 rehabilitation facilities across the United States. Facilities were assigned to quintiles based on average annual diagnosis-specific patient volumes. Discharge functional status (FIM instrument) and probability of home discharge. Facility-level factors accounted for 6%-15% of the variance in discharge FIM total scores and 3%-5% of the variance in home discharge probability across the 3 diagnostic groups. We used the middle volume quintile (Q3) as the reference group for all analyses and detected small, but statistically significant (P<0.01) associations with discharge functional status in all 3 diagnosis groups. Only the highest volume quintile (Q5) reached statistical significance, displaying higher functional status ratings than Q3 each time. The largest effect was observed in FIM total scores among fracture patients, with only a 3.6-point difference in Q5 and Q3 group means. Volume was not independently related to home discharge. Outcome-specific volume effects ranged from small (functional status) to none (home discharge) in all 3 diagnostic groups. Patients with these conditions can be treated locally rather than at higher volume regional centers. Further regionalization of inpatient rehabilitation services is not needed for these conditions.

Exploring storage and runoff generation processes for urban flooding through a physically based watershed model

NASA Astrophysics Data System (ADS)

Smith, B. K.; Smith, J. A.; Baeck, M. L.; Miller, A. J.

2015-03-01

A physically based model of the 14 km2 Dead Run watershed in Baltimore County, MD was created to test the impacts of detention basin storage and soil storage on the hydrologic response of a small urban watershed during flood events. The Dead Run model was created using the Gridded Surface Subsurface Hydrologic Analysis (GSSHA) algorithms and validated using U.S. Geological Survey stream gaging observations for the Dead Run watershed and 5 subbasins over the largest 21 warm season flood events during 2008-2012. Removal of the model detention basins resulted in a median peak discharge increase of 11% and a detention efficiency of 0.5, which was defined as the percent decrease in peak discharge divided by percent detention controlled area. Detention efficiencies generally decreased with increasing basin size. We tested the efficiency of detention basin networks by focusing on the "drainage network order," akin to the stream order but including storm drains, streams, and culverts. The detention efficiency increased dramatically between first-order detention and second-order detention but was similar for second and third-order detention scenarios. Removal of the soil compacted layer, a common feature in urban soils, resulted in a 7% decrease in flood peak discharges. This decrease was statistically similar to the flood peak decrease caused by existing detention. Current soil storage within the Dead Run watershed decreased flood peak discharges by a median of 60%. Numerical experiment results suggested that detention basin storage and increased soil storage have the potential to substantially decrease flood peak discharges.

Synthesis of monthly and annual streamflow records (water years 1950-2003) for Big Sandy, Clear, Peoples, and Beaver Creeks in the Milk River basin, Montana

USGS Publications Warehouse

Parrett, Charles

2006-01-01

To address concerns expressed by the State of Montana about the apportionment of water in the St. Mary and Milk River basins between Canada and the United States, the International Joint Commission requested information from the United States government about water that originates in the United States but does not cross the border into Canada. In response to this request, the U.S. Geological Survey synthesized monthly and annual streamflow records for Big Sandy, Clear, Peoples, and Beaver Creeks, all of which are in the Milk River basin in Montana, for water years 1950-2003. This report presents the synthesized values of monthly and annual streamflow for Big Sandy, Clear, Peoples, and Beaver Creeks in Montana. Synthesized values were derived from recorded and estimated streamflows. Statistics, including long-term medians and averages and flows for various exceedance probabilities, were computed from the synthesized data. Beaver Creek had the largest median annual discharge (19,490 acre-feet), and Clear Creek had the smallest median annual discharge (6,680 acre-feet). Big Sandy Creek, the stream with the largest drainage area, had the second smallest median annual discharge (9,640 acre-feet), whereas Peoples Creek, the stream with the second smallest drainage area, had the second largest median annual discharge (11,700 acre-feet). The combined median annual discharge for the four streams was 45,400 acre-feet. The largest combined median monthly discharge for the four creeks was 6,930 acre-feet in March, and the smallest combined median monthly discharge was 48 acre-feet in January. The combined median monthly values were substantially smaller than the average monthly values. Overall, synthesized flow records for the four creeks are considered to be reasonable given the prevailing climatic conditions in the region during the 1950-2003 base period. Individual estimates of monthly streamflow may have large errors, however. Linear regression was used to relate logarithms of combined annual streamflow to water years 1950-2003. The results of the regression analysis indicated a significant downward trend (regression line slope was -0.00977) for combined annual streamflow. A regression analysis using data from 1956-2003 indicated a slight, but not significant, downward trend for combined annual streamflow.

Results of chopper-controlled discharge life cycling studies on lead acid batteries

NASA Technical Reports Server (NTRS)

Ewashinka, J. G.; Sidik, S. M.

1982-01-01

A group of 108 state of the art nominally 6 volt lead acid batteries were tested in a program of one charge/discharge cycle per day for over two years or to ultimate battery failure. The primary objective was to determine battery cycle life as a function of depth of discharge (25 to 75 percent), chopper frequency (100 to 1000 Hz), duty cycle (25 to 87.5 percent), and average discharge current (20 to 260 A). The secondary objective was to determine the types of battery failure modes, if any, were due to the above parameters. The four parameters above were incorporated in a statistically designed test program.

Prediction of mean monthly river discharges in Colombia through Empirical Mode Decomposition

NASA Astrophysics Data System (ADS)

Carmona, A. M.; Poveda, G.

2015-04-01

The hydro-climatology of Colombia exhibits strong natural variability at a broad range of time scales including: inter-decadal, decadal, inter-annual, annual, intra-annual, intra-seasonal, and diurnal. Diverse applied sectors rely on quantitative predictions of river discharges for operational purposes including hydropower generation, agriculture, human health, fluvial navigation, territorial planning and management, risk preparedness and mitigation, among others. Various methodologies have been used to predict monthly mean river discharges that are based on "Predictive Analytics", an area of statistical analysis that studies the extraction of information from historical data to infer future trends and patterns. Our study couples the Empirical Mode Decomposition (EMD) with traditional methods, e.g. Autoregressive Model of Order 1 (AR1) and Neural Networks (NN), to predict mean monthly river discharges in Colombia, South America. The EMD allows us to decompose the historical time series of river discharges into a finite number of intrinsic mode functions (IMF) that capture the different oscillatory modes of different frequencies associated with the inherent time scales coexisting simultaneously in the signal (Huang et al. 1998, Huang and Wu 2008, Rao and Hsu, 2008). Our predictive method states that it is easier and simpler to predict each IMF at a time and then add them up together to obtain the predicted river discharge for a certain month, than predicting the full signal. This method is applied to 10 series of monthly mean river discharges in Colombia, using calibration periods of more than 25 years, and validation periods of about 12 years. Predictions are performed for time horizons spanning from 1 to 12 months. Our results show that predictions obtained through the traditional methods improve when the EMD is used as a previous step, since errors decrease by up to 13% when the AR1 model is used, and by up to 18% when using Neural Networks is combined with the EMD.

Approaches to setting organism-based ballast water discharge standards

USGS Publications Warehouse

Lee, Henry; Reusser, Deborah A.; Frazier, Melanie

2013-01-01

As a vector by which foreign species invade coastal and freshwater waterbodies, ballast water discharge from ships is recognized as a major environmental threat. The International Maritime Organization (IMO) drafted an international treaty establishing ballast water discharge standards based on the number of viable organisms per volume of ballast discharge for different organism size classes. Concerns that the IMO standards are not sufficiently protective have initiated several state and national efforts in the United States to develop more stringent standards. We evaluated seven approaches to establishing discharge standards for the >50-μm size class: (1) expert opinion/management consensus, (2) zero detectable living organisms, (3) natural invasion rates, (4) reaction–diffusion models, (5) population viability analysis (PVA) models, (6) per capita invasion probabilities (PCIP), and (7) experimental studies. Because of the difficulty in synthesizing scientific knowledge in an unbiased and transparent fashion, we recommend the use of quantitative models instead of expert opinion. The actual organism concentration associated with a “zero detectable organisms” standard is defined by the statistical rigor of its monitoring program; thus it is not clear whether such a standard is as stringent as other standards. For several reasons, the natural invasion rate, reaction–diffusion, and experimental approaches are not considered suitable for generating discharge standards. PVA models can be used to predict the likelihood of establishment of introduced species but are limited by a lack of population vital rates for species characteristic of ballast water discharges. Until such rates become available, PVA models are better suited to evaluate relative efficiency of proposed standards rather than predicting probabilities of invasion. The PCIP approach, which is based on historical invasion rates at a regional scale, appears to circumvent many of the indicated problems, although it may underestimate invasions by asexual and parthenogenic species. Further research is needed to better define propagule dose–responses, densities at which Allee effects occur, approaches to predicting the likelihood of invasion from multi-species introductions, and generation of formal comparisons of approaches using standardized scenarios.

An Approach to Industrial Stormwater Benchmarks: Establishing and Using Site-Specific Threshold Criteria at Lawrence Livermore National Laboratory

DOE Office of Scientific and Technical Information (OSTI.GOV)

Campbell, C G; Mathews, S

2006-09-07

Current regulatory schemes use generic or industrial sector specific benchmarks to evaluate the quality of industrial stormwater discharges. While benchmarks can be a useful tool for facility stormwater managers in evaluating the quality stormwater runoff, benchmarks typically do not take into account site-specific conditions, such as: soil chemistry, atmospheric deposition, seasonal changes in water source, and upstream land use. Failing to account for these factors may lead to unnecessary costs to trace a source of natural variation, or potentially missing a significant local water quality problem. Site-specific water quality thresholds, established upon the statistical evaluation of historic data take intomore » account these factors, are a better tool for the direct evaluation of runoff quality, and a more cost-effective trigger to investigate anomalous results. Lawrence Livermore National Laboratory (LLNL), a federal facility, established stormwater monitoring programs to comply with the requirements of the industrial stormwater permit and Department of Energy orders, which require the evaluation of the impact of effluent discharges on the environment. LLNL recognized the need to create a tool to evaluate and manage stormwater quality that would allow analysts to identify trends in stormwater quality and recognize anomalous results so that trace-back and corrective actions could be initiated. LLNL created the site-specific water quality threshold tool to better understand the nature of the stormwater influent and effluent, to establish a technical basis for determining when facility operations might be impacting the quality of stormwater discharges, and to provide ''action levels'' to initiate follow-up to analytical results. The threshold criteria were based on a statistical analysis of the historic stormwater monitoring data and a review of relevant water quality objectives.« less

A new casemix adjustment index for hospital mortality among patients with congestive heart failure.

PubMed

Polanczyk, C A; Rohde, L E; Philbin, E A; Di Salvo, T G

1998-10-01

Comparative analysis of hospital outcomes requires reliable adjustment for casemix. Although congestive heart failure is one of the most common indications for hospitalization, congestive heart failure casemix adjustment has not been widely studied. The purposes of this study were (1) to describe and validate a new congestive heart failure-specific casemix adjustment index to predict in-hospital mortality and (2) to compare its performance to the Charlson comorbidity index. Data from all 4,608 admissions to the Massachusetts General Hospital from January 1990 to July 1996 with a principal ICD-9-CM discharge diagnosis of congestive heart failure were evaluated. Massachusetts General Hospital patients were randomly divided in a derivation and a validation set. By logistic regression, odds ratios for in-hospital death were computed and weights were assigned to construct a new predictive index in the derivation set. The performance of the index was tested in an internal Massachusetts General Hospital validation set and in a non-Massachusetts General Hospital external validation set incorporating data from all 1995 New York state hospital discharges with a primary discharge diagnosis of congestive heart failure. Overall in-hospital mortality was 6.4%. Based on the new index, patients were assigned to six categories with incrementally increasing hospital mortality rates ranging from 0.5% to 31%. By logistic regression, "c" statistics of the congestive heart failure-specific index (0.83 and 0.78, derivation and validation set) were significantly superior to the Charlson index (0.66). Similar incrementally increasing hospital mortality rates were observed in the New York database with the congestive heart failure-specific index ("c" statistics 0.75). In an administrative database, this congestive heart failure-specific index may be a more adequate casemix adjustment tool to predict hospital mortality in patients hospitalized for congestive heart failure.

Low-flow characteristics of streams under natural and diversion conditions, Waipiʻo Valley, Island of Hawaiʻi, Hawaiʻi

USGS Publications Warehouse

Fontaine, Richard A.

2012-01-01

Over the past 100 years, natural streamflow in Waipiʻo Valley has been reduced by the transfer of water out of the valley by Upper and Lower Hāmākua Ditches. The physical condition and diversion practices along the two ditch systems have varied widely over the years, and as a result, so have their effects on natural streamflow in Waipiʻo Valley. Recent renovation and improvements to Lower Hāmākua Ditch system, along with proposals for its future operation and water-diversion strategies, have unknown implications. The purpose of this report is to quantify the availability of streamflow and to determine the effects of current and proposed diversion strategies on the low-flow hydrology in Waipiʻo Valley. In this report, the low-flow hydrology of Waipiʻo Valley is described in terms of flow-duration statistics. Flow-duration statistics were computed for three locations in the Waipiʻo Valley study area where long-term surface-water gaging stations have been operated. Using a variety of streamflow record-extension techniques, flow-duration statistics were estimated at an additional 13 locations where only few historical data are available or where discharge measurements were made as part of this study. Flow-duration statistics were computed to reflect natural conditions, current (2000-2005) diversion conditions, and proposed future diversion conditions at the 16 locations. At the downstream limit of the study area, on Wailoa Stream at an altitude of 190 feet, a baseline for evaluating the availability of streamflow is provided by computed flow-duration statistics that are representative of natural, no-diversion conditions. At the Wailoa gaging station, 95- and 50-percentile discharges under natural conditions were determined to be 86 and 112 cubic feet per second, respectively. Under 1965-1969 diversion conditions, natural 95- and 50-percentile discharges were reduced by 52 and 53 percent, to 41 and 53 cubic feet per second, respectively. Under current (2000-2005) diversion conditions, natural 95- and 50-percentile discharges were reduced by 21 and 24 percent, to 68 and 85 cubic feet per second, respectively. Under proposed future diversion conditions, natural 95- and 50-percentile discharges would be reduced by 33 and 24 percent, to 58 and 85 cubic feet per second, respectively. Compared to discharges that reflect current (2000-2005) diversion conditions, proposed future diversion conditions would reduce 95-percentile discharges, which are representative of moderate drought levels in the stream, by 15 percent. No change would be expected in 50-percentile discharges, which are representative of normal conditions. The effects of current (2000-2005) and proposed future diversion conditions on the natural flow of streams in the Waipiʻo Valley study area differ, depending on the location. Under current (2000-2005) diversion conditions, reductions in natural 95- or 50-percentile discharges of greater than 30 percent were found in Kawainui Stream downstream from Upper Hamakua Ditch to an altitude of about 1,435 feet and in the reach of Waimā Stream between Upper and Lower Hāmākua Ditches. Under proposed future diversion conditions, reductions in natural 95- or 50-percentile discharges of greater than 30 percent were found in Kawainui Stream downstream from Upper Hamakua Ditch to an altitude of about 1,435 feet, in the reach of Waimā Stream between Upper and Lower Hāmākua Ditches, and along most stream reaches downstream from Lower Hāmākua Ditch, except for Waimā Stream.

On the radiated EMI current extraction of dc transmission line based on corona current statistical measurements

NASA Astrophysics Data System (ADS)

Yi, Yong; Chen, Zhengying; Wang, Liming

2018-05-01

Corona-originated discharge of DC transmission lines is the main reason for the radiated electromagnetic interference (EMI) field in the vicinity of transmission lines. A joint time-frequency analysis technique was proposed to extract the radiated EMI current (excitation current) of DC corona based on corona current statistical measurements. A reduced-scale experimental platform was setup to measure the statistical distributions of current waveform parameters of aluminum conductor steel reinforced. Based on the measured results, the peak value, root-mean-square value and average value with 9 kHz and 200 Hz band-with of 0.5 MHz radiated EMI current were calculated by the technique proposed and validated with conventional excitation function method. Radio interference (RI) was calculated based on the radiated EMI current and a wire-to-plate platform was built for the validity of the RI computation results. The reason for the certain deviation between the computations and measurements was detailed analyzed.

Selected Streamflow Statistics for Streamgaging Stationsin Northeastern Maryland, 2006

USGS Publications Warehouse

Ries, Kernell G.

2006-01-01

Streamflow statistics were calculated for 47 U.S. Geological Survey (USGS) streamgaging stations in northeastern Maryland, in cooperation with (1) the University of Maryland, Baltimore County, Center for Urban Environmental Research and Education; (2) the Baltimore City Department of Public Works; and (3) the Baltimore County Department of Environmental Protection and Resource Management. The statistics include the mean, minimum, maximum, and standard deviation of the daily mean discharges for the periods of record at the stations, as well as flow-duration and low-flow frequency statistics. The flow-duration statistics include the 1-, 2-, 5-, 10-, 15-, 20-, 25-, 30-, 40-, 50-, 60-, 70-, 75-, 80-, 85-, 90-, 95-, 98-, and 99-percent duration discharges. The low-flow frequency statistics include the average discharges for 1, 7, 14, and 30 days that recur, on average, once in 1.01, 2, 5, 10, 20, 50, and 100 years. The statistics were computed only for the 25 stations with periods of record of 10 years or more. The statistics were computed from records available through September 30, 2004 using standard methods and computer software developed by the USGS. A comparison between low-flow frequency statistics computed for this study and for a previous study that used data available through September 30, 1989 was done for seven stations. The comparison indicated that, for the 7-day mean low flow, the newer values were 19.8 and 15.3 percent lower for the 20- and 10-year recurrence intervals, respectively, and 2.1 percent higher for the 2-year recurrence interval, than the older values. For the 14-day mean low flow, the newer 20- and 10-year values were 25.2 and 15.5 percent lower, respectively, and the 2-year value was 2.9 percent higher than the older values. For the 30-day mean low flow, the newer 20-, 10-, and 2-year values were 10.8, 7.9, and 0.8 percent lower, respectively, than the older values. The newer values are generally lower than the older ones most likely because two major droughts have occurred since the older study was completed.

Validation of a Delirium Risk Assessment Using Electronic Medical Record Information.

PubMed

Rudolph, James L; Doherty, Kelly; Kelly, Brittany; Driver, Jane A; Archambault, Elizabeth

2016-03-01

Identifying patients at risk for delirium allows prompt application of prevention, diagnostic, and treatment strategies; but is rarely done. Once delirium develops, patients are more likely to need posthospitalization skilled care. This study developed an a priori electronic prediction rule using independent risk factors identified in a National Center of Clinical Excellence meta-analysis and validated the ability to predict delirium in 2 cohorts. Retrospective analysis followed by prospective validation. Tertiary VA Hospital in New England. A total of 27,625 medical records of hospitalized patients and 246 prospectively enrolled patients admitted to the hospital. The electronic delirium risk prediction rule was created using data obtained from the patient electronic medical record (EMR). The primary outcome, delirium, was identified 2 ways: (1) from the EMR (retrospective cohort) and (2) clinical assessment on enrollment and daily thereafter (prospective participants). We assessed discrimination of the delirium prediction rule with the C-statistic. Secondary outcomes were length of stay and discharge to rehabilitation. Retrospectively, delirium was identified in 8% of medical records (n = 2343); prospectively, delirium during hospitalization was present in 26% of participants (n = 64). In the retrospective cohort, medical record delirium was identified in 2%, 3%, 11%, and 38% of the low, intermediate, high, and very high-risk groups, respectively (C-statistic = 0.81; 95% confidence interval 0.80-0.82). Prospectively, the electronic prediction rule identified delirium in 15%, 18%, 31%, and 55% of these groups (C-statistic = 0.69; 95% confidence interval 0.61-0.77). Compared with low-risk patients, those at high- or very high delirium risk had increased length of stay (5.7 ± 5.6 vs 3.7 ± 2.7 days; P = .001) and higher rates of discharge to rehabilitation (8.9% vs 20.8%; P = .02). Automatic calculation of delirium risk using an EMR algorithm identifies patients at risk for delirium, which creates a critical opportunity for gaining clinical efficiencies and improving delirium identification, including those needing skilled care. Published by Elsevier Inc.

Effects of land use and sample location on nitrate-stream flow hysteresis descriptors during storm events

USGS Publications Warehouse

Feinson, Lawrence S.; Gibs, Jacob; Imbrigiotta, Thomas E.; Garrett, Jessica D.

2016-01-01

The U.S. Geological Survey's New Jersey and Iowa Water Science Centers deployed ultraviolet-visible spectrophotometric sensors at water-quality monitoring sites on the Passaic and Pompton Rivers at Two Bridges, New Jersey, on Toms River at Toms River, New Jersey, and on the North Raccoon River near Jefferson, Iowa to continuously measure in-stream nitrate plus nitrite as nitrogen (NO3 + NO2) concentrations in conjunction with continuous stream flow measurements. Statistical analysis of NO3 + NO2 vs. stream discharge during storm events found statistically significant links between land use types and sampling site with the normalized area and rotational direction of NO3 + NO2-stream discharge (N-Q) hysteresis patterns. Statistically significant relations were also found between the normalized area of a hysteresis pattern and several flow parameters as well as the normalized area adjusted for rotational direction and minimum NO3 + NO2 concentrations. The mean normalized hysteresis area for forested land use was smaller than that of urban and agricultural land uses. The hysteresis rotational direction of the agricultural land use was opposite of that of the urban and undeveloped land uses. An r2 of 0.81 for the relation between the minimum normalized NO3 + NO2 concentration during a storm vs. the normalized NO3 + NO2 concentration at peak flow suggested that dilution was the dominant process controlling NO3 + NO2 concentrations over the course of most storm events.

The Relationship Between Hospital Construction and High-Risk Infant Auditory Function at NICU Discharge: A Retrospective Descriptive Cohort Study.

PubMed

Willis, Valerie

2018-04-01

To describe the difference in auditory function at neonatal intensive care unit (NICU) discharge between high-risk infant cases exposed to hospital construction during NICU stay and those not exposed. Noise produced by routine NICU caregiving exceeds recommended intensity. As California hospitals undergo construction to meet seismic safety regulations, vulnerable neonates are potentially exposed to even higher levels of noise. Ramifications are unknown. Retrospective data-based descriptive cohort design was used to compare high-risk infant auditory function at NICU discharge between hospital construction exposed and unexposed groups. N = 540 infant cases (243 construction exposed and 297 unexposed controls). Infant cases born and discharged from the study site NICU in the year 2010 (unexposed) and year 2015 (exposed) and received a newborn hearing screening by automated auditory brainstem evoked response (ABER) prior to discharge with results reported. Infant cases excluded: hearing screen results by ABER unavailable, potentially confounding characteristics (congenital infection, major anomalies including cleft lip and/or palate), and transferred into or out of the study site. ABER. descriptive statistics (SPSS Version 24.0), hypothesis testing, correlation, and logistic regression. The difference in auditory function at NICU discharge between high-risk infant cases exposed to hospital construction noise and those unexposed was statistically insignificant, χ 2 = 1.666, df = 4, p = .1968, 95% confidence interval [-0.635, 2.570]. More research is needed to better understand whether hospital construction exposure during NICU admission negatively affects high-risk infant auditory function. Findings may catalyze theory development, future research, and child health policy.

ICD Social Codes: An Underutilized Resource for Tracking Social Needs.

PubMed

Torres, Jacqueline M; Lawlor, John; Colvin, Jeffrey D; Sills, Marion R; Bettenhausen, Jessica L; Davidson, Amber; Cutler, Gretchen J; Hall, Matt; Gottlieb, Laura M

2017-09-01

Social determinants of health (SDH) data collected in health care settings could have important applications for clinical decision-making, population health strategies, and the design of performance-based incentives and penalties. One source for cataloging SDH data is the International Statistical Classification of Diseases and Related Health Problems (ICD). To explore how SDH are captured with ICD Ninth revision SDH V codes in a national inpatient discharge database. Data come from the 2013 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, a national stratified sample of discharges from 4363 hospitals from 44 US states. We estimate the rate of ICD-9 SDH V code utilization overall and by patient demographics and payer categories. We additionally estimate the rate of SDH V code utilization for: (a) the 5 most common reasons for hospitalization; and (b) the 5 conditions with the highest rates of SDH V code utilization. Fewer than 2% of overall discharges in the National Inpatient Sample were assigned an SDH V code. There were statistically significant differences in the rate of overall SDH V code utilization by age categories, race/ethnicity, sex, and payer (all P<0.001). Nevertheless, SDH V codes were assigned to <7% of discharges in any demographic or payer subgroup. SDH V code utilization was highest for major diagnostic categories related to mental health and alcohol/substance use-related discharges. SDH V codes are infrequently utilized in inpatient settings for discharges other than those related to mental health and alcohol/substance use. Utilization incentives will likely need to be developed to realize the potential benefits of cataloging SDH information.

Statistical validation of predictive TRANSP simulations of baseline discharges in preparation for extrapolation to JET D-T

NASA Astrophysics Data System (ADS)

Kim, Hyun-Tae; Romanelli, M.; Yuan, X.; Kaye, S.; Sips, A. C. C.; Frassinetti, L.; Buchanan, J.; Contributors, JET

2017-06-01

This paper presents for the first time a statistical validation of predictive TRANSP simulations of plasma temperature using two transport models, GLF23 and TGLF, over a database of 80 baseline H-mode discharges in JET-ILW. While the accuracy of the predicted T e with TRANSP-GLF23 is affected by plasma collisionality, the dependency of predictions on collisionality is less significant when using TRANSP-TGLF, indicating that the latter model has a broader applicability across plasma regimes. TRANSP-TGLF also shows a good matching of predicted T i with experimental measurements allowing for a more accurate prediction of the neutron yields. The impact of input data and assumptions prescribed in the simulations are also investigated in this paper. The statistical validation and the assessment of uncertainty level in predictive TRANSP simulations for JET-ILW-DD will constitute the basis for the extrapolation to JET-ILW-DT experiments.

Citizen Hydrology and Compressed-Air Hydropower for Rural Electrification in Haiti

NASA Astrophysics Data System (ADS)

Allen, S. M.

2015-12-01

At the present time, only one in eight residents of Haiti has access to electricity. Two recent engineering and statistical innovations have the potential for vastly reducing the cost of installation of hydropower in Haiti and the rest of the developing world. The engineering innovation is that wind, solar and fluvial energy have been used to compress air for generation of electricity for only 20 per megawatt-hour, in contrast to the conventional World Bank practice of funding photovoltaic cells for 156 per megawatt-hour. The installation of hydropower requires a record of stream discharge, which is conventionally obtained by installing a gaging station that automatically monitors gage height (height of the water surface above a fixed datum). An empirical rating curve is then used to convert gage height to stream discharge. The multiple field measurements of gage height and discharge over a wide range of discharge values that are required to develop and maintain a rating curve require a manpower of hydrologic technicians that is prohibitive in remote and impoverished areas of the world. The statistical innovation is that machine learning has been applied to the USGS database of nearly four million simultaneous measurements of gage height and discharge to develop a new classification of rivers so that a rating curve can be developed solely from the stream slope, channel geometry, horizontal and vertical distances to the nearest upstream and downstream confluences, and two pairs of discharge - gage height measurements. The objective of this study is to organize local residents to monitor gage height at ten stream sites in the northern peninsula of Haiti over a one-year period in preparation for installation of hydropower at one of the sites. The necessary baseline discharge measurements and channel surveying are being carried out for conversion of gage height to discharge. Results will be reported at the meeting.

The Application of the Specific Gage Technique and Aerial Photographs in Kaskaskia River Degradation Studies

NASA Astrophysics Data System (ADS)

Du, X.

2008-12-01

The Kaskaskia River basin contains 136,000 acres of bottomland forest, the largest contiguous tract of bottomland forest remaining in the state of Illinois. Since the 1960's, the Carlyle Lake Dam impoundment and channelization activities have altered the natural hydrologic and ecological equilibrium of the Kaskaskia River. Morphological changes of the river channel have necessitated conservation and restoration efforts to create and maintain the sustainability, diversity, health, and connectivity of the river watershed. This study utilized the specific gage technique and historical aerial photographs to investigate the spatial and temporal changes of the river. Historical daily discharge and daily stage data from the Carlyle (1966 to 2002) and Venedy Station gages (1984 to 2003) were analyzed. Logs of daily discharge data were used to generate annual rating curves. The best fit equations were produced from annual rating regressions. A stage associated with a chosen reference discharge, the minimum available discharge (MAD), was calculated. A stage decreasing/increasing trend was used as a primary indicator of channel bed incision/aggradation. Pseudo specific gage analysis (PSGA) was used to model channel cross sectional geometry changes over time. PSGA applied similar procedures as compared to the specific gage technique. Instead of using the stage variable, PSGA utilized cross sectional width, cross-sectional area, mean velocity and gage height individually. At each gage, the historical change of each cross sectional parameter was plotted against the log of discharge. Ratings of specific stages, specific cross sectional width, specific depth, specific area, and specific velocity associated with the chosen discharge, MAD, were produced. The decreasing/increasing trend of each parameter mentioned above corresponded with changes of channel cross sectional geometries over time. Historical aerial photographs were also used to assess the bankfull channel width changing rates during the pre and post modification period. The statistical significance of the regression trendlines from the specific gage analyses and PSGA was tested. Results suggested that there was no significant channel bed incision trend near the river gages within the studied time period. A statistically significant increase in channel width changing rates was found during post-modification period. Following the channelization and dam construction on the Kaskaskia River, substantial channel bed widening has accelerated bank erosion and associated channel morphology change, which has consequently resulted in a net loss of riparian habitat in this important bottomland forest corridor in southern Illinois, USA.

Statistical analysis of long-term hydrologic records for selection of drought-monitoring sites on Long Island, New York

USGS Publications Warehouse

Busciolano, Ronald J.

2005-01-01

Ground water is the sole source of water supply for more than 3 million people on Long Island, New York. Large-scale ground-water pumpage, sewering systems, and prolonged periods of below-normal precipitation have lowered ground-water levels and decreased stream-discharge in western and central Long Island. No method is currently (2004) available on Long Island that can assess data from the ground-water-monitoring network to enable water managers and suppliers with the ability to give timely warning of severe water-level declines.This report (1) quantifies past drought- and human-induced changes in the ground-water system underlying Long Island by applying statistical and graphical methods to precipitation, stream-discharge, and ground-water-level data from selected monitoring sites; (2) evaluates the relation between water levels in the upper glacial aquifer and those in the underlying Magothy aquifer; (3) defines trends in stream discharge and ground-water levels that might indicate the onset of drought conditions or the effects of excessive pumping; and (4) discusses the long-term records that were used to select sites for a Long Island drought-monitoring network.Long Island’s long-term hydrologic records indicated that the available data provide a basis for development of a drought-monitoring network. The data from 36 stations that were selected as possible drought-monitoring sites—8 precipitation-monitoring stations, 8 streamflow-gaging (discharge) stations, 15 monitoring wells screened in the upper glacial aquifer under water-table (unconfined) conditions, and 5 monitoring wells screened in the underlying Magothy aquifer under semi-confined conditions—indicate that water levels in western parts of Long Island have fallen and risen markedly (more than 15 ft) in response to fluctuations in pumpage, and have declined from the increased use of sanitary- and storm-sewer systems. Water levels in the central and eastern parts, in contrast, remain relatively unaffected compared to the western parts, although the effects of human activity are discernible in the records.The value of each site as a drought-monitoring indicator was assessed through an analysis of trends in the records. Fifty-year annual and monthly data sets were created and combined into three composite-average hydrographs—precipitation, stream discharge, and ground-water levels. Three zones representing the range of human effect on ground-water levels were delineated to help evaluate islandwide hydrologic conditions and to quantify the indices. Data from the three indices can be used to assess current conditions in the ground-water system underlying Long Island and evaluate water-level declines during periods of drought.

Evaluation and statistical judgement of neural responses to sinusoidal stimulation in cases with superimposed drift and noise.

PubMed

Jastreboff, P W

1979-06-01

Time histograms of neural responses evoked by sinuosidal stimulation often contain a slow drifting and an irregular noise which disturb Fourier analysis of these responses. Section 2 of this paper evaluates the extent to which a linear drift influences the Fourier analysis, and develops a combined Fourier and linear regression analysis for detecting and correcting for such a linear drift. Usefulness of this correcting method is demonstrated for the time histograms of actual eye movements and Purkinje cell discharges evoked by sinusoidal rotation of rabbits in the horizontal plane. In Sect. 3, the analysis of variance is adopted for estimating the probability of the random occurrence of the response curve extracted by Fourier analysis from noise. This method proved to be useful for avoiding false judgements as to whether the response curve was meaningful, particularly when the response was small relative to the contaminating noise.

Effective discharge analysis of ecological processes in streams

USGS Publications Warehouse

Doyle, Martin W.; Stanley, Emily H.; Strayer, David L.; Jacobson, Robert B.; Schmidt, John C.

2005-01-01

Discharge is a master variable that controls many processes in stream ecosystems. However, there is uncertainty of which discharges are most important for driving particular ecological processes and thus how flow regime may influence entire stream ecosystems. Here the analytical method of effective discharge from fluvial geomorphology is used to analyze the interaction between frequency and magnitude of discharge events that drive organic matter transport, algal growth, nutrient retention, macroinvertebrate disturbance, and habitat availability. We quantify the ecological effective discharge using a synthesis of previously published studies and modeling from a range of study sites. An analytical expression is then developed for a particular case of ecological effective discharge and is used to explore how effective discharge varies within variable hydrologic regimes. Our results suggest that a range of discharges is important for different ecological processes in an individual stream. Discharges are not equally important; instead, effective discharge values exist that correspond to near modal flows and moderate floods for the variable sets examined. We suggest four types of ecological response to discharge variability: discharge as a transport mechanism, regulator of habitat, process modulator, and disturbance. Effective discharge analysis will perform well when there is a unique, essentially instantaneous relationship between discharge and an ecological process and poorly when effects of discharge are delayed or confounded by legacy effects. Despite some limitations the conceptual and analytical utility of the effective discharge analysis allows exploring general questions about how hydrologic variability influences various ecological processes in streams.

The influence of major rivers discharges on physical and biological state of the Baltic Sea

NASA Astrophysics Data System (ADS)

Dudkowska, Aleksandra; Cieszyńska, Agata

2017-04-01

River discharges are one of very important factors affecting the marine ecosystem functioning. Land-originated inflows, carrying fresh, nutrient-rich water can be often defined as the factor responsible for creating new physical and biochemical conditions, which in turn can create more or less favorable medium for many marine organisms to run their biological cycles within. In some basins, the Baltic Sea including, land-originated water inflows are usually associated with the eutrophication and are the factors, which trigger this process. It is clear that not only because of the riverine discharges, the nutrients levels in the sea increase. To exemplify in the case of phosphorus, the nutrient concentration can be raised by 'internal re-loading', which is caused by phosphorus pools accumulated in the sediments of the sea bed being released back to the water under anoxic conditions. In the present study, we focused on the major Baltic rivers inflows and their impact on the environmental state of the basin. We have examined river discharges (expressed as volumetric inflow in m3 s-1) and the nutrient load (phosphorus, nitrogen) accompanied by these inflows. Data for our investigation were derived from EHype model (Swedish Meteorological Institute Server, http://hypeweb.smhi.se/europehype/time-series/). From the river discharge model data set spanned over 1981 - 2010, we have calculated long-term trends and the basic statistics: annual and monthly means, percentiles (10th, 50th, 90th). The trends were defined to be statistically significant at the confidence level of 95% (p < 0.05). What is more, we have estimated the inflows extent and related to tributaries changes in three-dimensional distribution of seawater physical properties on the basis of hydrodynamic model. Land-sea interface comprise an important link in the water body state analysis. This research comprises a discussion of river runoffs significance evaluation in the Baltic Sea area. This work has been funded by the National Centre of Science project (contract number: 2012/07/N/ST10/03485) entitled: "Improved understanding of phytoplankton blooms in the Baltic Sea based on numerical models and existing data sets". The Author (AC) received funding from National Centre of Sciences in doctoral scholarship program (contract number: 2016/20/T/ST10/00214).

Inpatient Addiction Consultation for Hospitalized Patients Increases Post-Discharge Abstinence and Reduces Addiction Severity.

PubMed

Wakeman, Sarah E; Metlay, Joshua P; Chang, Yuchiao; Herman, Grace E; Rigotti, Nancy A

2017-08-01

Alcohol and drug use results in substantial morbidity, mortality, and cost. Individuals with alcohol and drug use disorders are overrepresented in general medical settings. Hospital-based interventions offer an opportunity to engage with a vulnerable population that may not otherwise seek treatment. To determine whether inpatient addiction consultation improves substance use outcomes 1 month after discharge. Prospective quasi-experimental evaluation comparing 30-day post-discharge outcomes between participants who were and were not seen by an addiction consult team during hospitalization at an urban academic hospital. Three hundred ninety-nine hospitalized adults who screened as high risk for having an alcohol or drug use disorder or who were clinically identified by the primary nurse as having a substance use disorder. Addiction consultation from a multidisciplinary specialty team offering pharmacotherapy initiation, motivational counseling, treatment planning, and direct linkage to ongoing addiction treatment. Addiction Severity Index (ASI) composite score for alcohol and drug use and self-reported abstinence at 30 days post-discharge. Secondary outcomes included 90-day substance use measures and self-reported hospital and ED utilization. Among 265 participants with 30-day follow-up, a greater reduction in the ASI composite score for drug or alcohol use was seen in the intervention group than in the control group (mean ASI-alcohol decreased by 0.24 vs. 0.08, p < 0.001; mean ASI-drug decreased by 0.05 vs. 0.02, p = 0.003.) There was also a greater increase in the number of days of abstinence in the intervention group versus the control group (+12.7 days vs. +5.6, p < 0.001). The differences in ASI-alcohol, ASI-drug, and days abstinent all remained statistically significant after controlling for age, gender, employment status, smoking status, and baseline addiction severity (p = 0.018, 0.018, and 0.02, respectively). In a sensitivity analysis, assuming that patients who were lost to follow-up had no change from baseline severity, the differences remained statistically significant. In a non-randomized cohort of medical inpatients, addiction consultation reduced addiction severity for alcohol and drug use and increased the number of days of abstinence in the first month after hospital discharge.

Combinatorial approach toward high-throughput analysis of direct methanol fuel cells.

PubMed

Jiang, Rongzhong; Rong, Charles; Chu, Deryn

2005-01-01

A 40-member array of direct methanol fuel cells (with stationary fuel and convective air supplies) was generated by electrically connecting the fuel cells in series. High-throughput analysis of these fuel cells was realized by fast screening of voltages between the two terminals of a fuel cell at constant current discharge. A large number of voltage-current curves (200) were obtained by screening the voltages through multiple small-current steps. Gaussian distribution was used to statistically analyze the large number of experimental data. The standard deviation (sigma) of voltages of these fuel cells increased linearly with discharge current. The voltage-current curves at various fuel concentrations were simulated with an empirical equation of voltage versus current and a linear equation of sigma versus current. The simulated voltage-current curves fitted the experimental data well. With increasing methanol concentration from 0.5 to 4.0 M, the Tafel slope of the voltage-current curves (at sigma=0.0), changed from 28 to 91 mV.dec-1, the cell resistance from 2.91 to 0.18 Omega, and the power output from 3 to 18 mW.cm-2.

U.S. Geological Survey applied research studies of the Cheyenne River System, South Dakota; description and collation of data, water years 1987-88

USGS Publications Warehouse

Goddard, K. E.

1990-01-01

The Cheyenne River System in western South Dakota has been impacted by the discharge of about 100 million metric tons of gold-mill tailings to Whitewood Creek near Lead, South Dakota. In April 1985, the U.S. Geological Survey initiated an extensive series of research studies to investigate the magnitude of the impact and to define important processes acting on the contaminated sediments present in the system. The report presents all data collected during the 1987 and 1988 water years for these research studies. Some of the data included have been published previously. Data collected in the 1985 and 1986 water years have been published in a companion report (U.S. Geological Survey Open-File Report 88-484). Hydrologic, geochemical, and biologic data are available for sites on Whitewood Creek, and the Belle Fourche and Cheyenne Rivers. Data complexity varies from routine discharge and water-quality to very complex energy-dispersive x-ray analysis. Methods for sample collection, handling and preservation, and laboratory analysis are also presented. No interpretations or complex statistical summaries are included. (See also W89-08390) (USGS)

Secondary analysis of data can inform care delivery for Indigenous women in an acute mental health inpatient unit.

PubMed

Bradley, Pat; Cunningham, Teresa; Lowell, Anne; Nagel, Tricia; Dunn, Sandra

2017-02-01

There is a paucity of research exploring Indigenous women's experiences in acute mental health inpatient services in Australia. Even less is known of Indigenous women's experience of seclusion events, as published data are rarely disaggregated by both indigeneity and gender. This research used secondary analysis of pre-existing datasets to identify any quantifiable difference in recorded experience between Indigenous and non-Indigenous women, and between Indigenous women and Indigenous men in an acute mental health inpatient unit. Standard separation data of age, length of stay, legal status, and discharge diagnosis were analysed, as were seclusion register data of age, seclusion grounds, and number of seclusion events. Descriptive statistics were used to summarize the data, and where warranted, inferential statistical methods used SPSS software to apply analysis of variance/multivariate analysis of variance testing. The results showed evidence that secondary analysis of existing datasets can provide a rich source of information to describe the experience of target groups, and to guide service planning and delivery of individualized, culturally-secure mental health care at a local level. The results are discussed, service and policy development implications are explored, and suggestions for further research are offered. © 2016 Australian College of Mental Health Nurses Inc.

Comparing extracorporeal cardiopulmonary resuscitation with conventional cardiopulmonary resuscitation: A meta-analysis.

PubMed

Kim, Su Jin; Kim, Hyun Jung; Lee, Hee Young; Ahn, Hyeong Sik; Lee, Sung Woo

2016-06-01

The objective was to determine whether extracorporeal cardiopulmonary resuscitation (ECPR), when compared with conventional cardiopulmonary resuscitation (CCPR), improves outcomes in adult patients, and to determine appropriate conditions that can predict good survival outcome in ECPR patients through a meta-analysis. We searched the relevant literature of comparative studies between ECPR and CCPR in adults, from the MEDLINE, EMBASE, and Cochrane databases. The baseline information and outcome data (survival, good neurologic outcome at discharge, at 3-6 months, and at 1 year after arrest) were extracted. Beneficial effect of ECPR on outcome was analyzed according to time interval, location of arrest (out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA)), and pre-defined population inclusion criteria (witnessed arrest, initial shockable rhythm, cardiac etiology of arrest and CPR duration) by using Review Manager 5.3. Cochran's Q test and I(2) were calculated. 10 of 1583 publications were included. Although survival to discharge did not show clear superiority in OHCA, ECPR showed statistically improved survival and good neurologic outcome as compared to CCPR, especially at 3-6 months after arrest. In the subgroup of patients with pre-defined inclusion criteria, the pooled meta-analysis found similar results in studies with pre-defined criteria. Survival and good neurologic outcome tended to be superior in the ECPR group at 3-6 months after arrest. The effect of ECPR on survival to discharge in OHCA was not clearly shown. As ECPR showed better outcomes than CCPR in studies with pre-defined criteria, strict indications criteria should be considered when implementation of ECPR. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg: analysis of shunt type, size, and surgical approach.

PubMed

Myers, John W; Ghanayem, Nancy S; Cao, Yumei; Simpson, Pippa; Trapp, Katie; Mitchell, Michael E; Tweddell, James S; Woods, Ronald K

2014-02-01

To evaluate outcomes of systemic to pulmonary artery shunts (SPS) in patients weighing less than 3 kg with regard to shunt type, shunt size, and surgical approach. Patients weighing less than 3 kg who underwent modified Blalock-Taussig or central shunts with polytetrafluoroethylene grafts at our institution from January 1, 2000, to May 31, 2011, were reviewed. Patients who had undergone other major concomitant procedures were excluded from the analysis. Primary outcomes included mortality (discharge mortality and mortality before next planned palliative procedure or definitive repair), cardiac arrest and/or extracorporeal membrane oxygenation (ECMO), and shunt reintervention. In this cohort of 80 patients, discharge survival was 96% (77/80). Postoperative cardiac arrest or ECMO occurred in 6/80 (7.5%), and shunt reintervention was required in 14/80 (17%). On univariate analysis, shunt reintervention was more common in patients with 3-mm shunts (11/30, 37%) compared with 3.5-mm (2/36, 6%) or 4-mm shunts (1/14, 7%) (P < .003). There were no statistically significant associations between shunt type, shunt size, or surgical approach and cardiac arrest/ECMO or mortality. Multiple logistic regression demonstrated that a shunt size of 3 mm (P = .019) and extracardiac anomaly (P = .047) were associated with shunt reintervention, whereas no variable was associated with cardiac arrest/ECMO or mortality. In this high-risk group of neonates weighing less than 3 kg at the time of SPS, survival to discharge and the next planned surgical procedure was high. Outcomes were good with the 3.5- and 4-mm shunts; however, shunt reintervention was common with 3-mm shunts. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Water-quality assessment of the Trinity River Basin, Texas - Analysis of available information on nutrients and suspended sediment, 1974-91

USGS Publications Warehouse

Van Metre, Peter C.; Reutter, David C.

1995-01-01

Only limited suspended-sediment data were available. Four sites had daily sediment-discharge records for three or more water years (October 1 to September 30) between 1974 and 1985. An additional three sites had periodic measurements of suspended-sediment concentrations. There are differences in concentrations and yields among sites; however, the limited amount of data precludes developing statistical or cause-and-effect relations with environmental factors such as land use, soil, and geology. Data are sufficient, and the relation is pronounced enough, to indicate trapping of suspended sediment by Livingston Reservoir.

Plasma Discharge Process in a Pulsed Diaphragm Discharge System

NASA Astrophysics Data System (ADS)

Duan, Jianjin; Hu, Jue; Zhang, Chao; Wen, Yuanbin; Meng, Yuedong; Zhang, Chengxu

2014-12-01

As one of the most important steps in wastewater treatment, limited study on plasma discharge process is a key challenge in the development of plasma applications. In this study, we focus on the plasma discharge process of a pulsed diaphragm discharge system. According to the analysis, the pulsed diaphragm discharge proceeds in seven stages: (1) Joule heating and heat exchange stage; (2) nucleated site formation; (3) plasma generation (initiation of the breakdown stage); (4) avalanche growth and plasma expansion; (5) plasma contraction; (6) termination of the plasma discharge; and (7) heat exchange stage. From this analysis, a critical voltage criterion for breakdown is obtained. We anticipate this finding will provide guidance for a better application of plasma discharges, especially diaphragm plasma discharges.

The ADHF/NT-proBNP risk score to predict 1-year mortality in hospitalized patients with advanced decompensated heart failure.

PubMed

Scrutinio, Domenico; Ammirati, Enrico; Guida, Pietro; Passantino, Andrea; Raimondo, Rosa; Guida, Valentina; Sarzi Braga, Simona; Canova, Paolo; Mastropasqua, Filippo; Frigerio, Maria; Lagioia, Rocco; Oliva, Fabrizio

2014-04-01

The acute decompensated heart failure/N-terminal pro-B-type natriuretic peptide (ADHF/NT-proBNP) score is a validated risk scoring system that predicts mortality in hospitalized heart failure patients with a wide range of left ventricular ejection fractions (LVEFs). We sought to assess discrimination and calibration of the score when applied to patients with advanced decompensated heart failure (AHF). We studied 445 patients hospitalized for AHF, defined by the presence of severe symptoms of worsening HF at admission, severely depressed LVEF, and the need for intravenous diuretic and/or inotropic drugs. The primary outcome was cumulative (in-hospital and post-discharge) mortality and post-discharge 1-year mortality. Separate analyses were performed for patients aged ≤ 70 years. A Seattle Heart Failure Score (SHFS) was calculated for each patient discharged alive. During follow-up, 144 patients (32.4%) died, and 69 (15.5%) underwent heart transplantation (HT) or ventricular assist device (VAD) implantation. After accounting for the competing events (VAD/HT), the ADHF/NT-proBNP score's C-statistic for cumulative mortality was 0.738 in the overall cohort and 0.771 in patients aged ≤ 70 years. The C-statistic for post-discharge mortality was 0.741 and 0.751, respectively. Adding prior (≤6 months) hospitalizations for HF to the score increased the C-statistic for post-discharge mortality to 0.759 in the overall cohort and to 0.774 in patients aged ≤ 70 years. Predicted and observed mortality rates by quartiles of score were highly correlated. The SHFS demonstrated adequate discrimination but underestimated the risk. The ADHF/NT-proBNP risk calculator is available at http://www.fsm.it/fsm/file/NTproBNPscore.zip. Our data suggest that the ADHF/NT-proBNP score may efficiently predict mortality in patients hospitalized with AHF. Copyright © 2014 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Determination of dilution factors for discharge of aluminum-containing wastes by public water-supply treatment facilities into lakes and reservoirs in Massachusetts

USGS Publications Warehouse

Colman, John A.; Massey, Andrew J.; Brandt, Sara L.

2011-09-16

Dilution of aluminum discharged to reservoirs in filter-backwash effluents at water-treatment facilities in Massachusetts was investigated by a field study and computer simulation. Determination of dilution is needed so that permits for discharge ensure compliance with water-quality standards for aquatic life. The U.S. Environmental Protection Agency chronic standard for aluminum, 87 micrograms per liter (μg/L), rather than the acute standard, 750 μg/L, was used in this investigation because the time scales of chronic exposure (days) more nearly match rates of change in reservoir concentrations than do the time scales of acute exposure (hours).Whereas dilution factors are routinely computed for effluents discharged to streams solely on the basis of flow of the effluent and flow of the receiving stream, dilution determination for effluents discharged to reservoirs is more complex because (1), compared to streams, additional water is available for dilution in reservoirs during low flows as a result of reservoir flushing and storage during higher flows, and (2) aluminum removal in reservoirs occurs by aluminum sedimentation during the residence time of water in the reservoir. Possible resuspension of settled aluminum was not considered in this investigation. An additional concern for setting discharge standards is the substantial concentration of aluminum that can be naturally present in ambient surface waters, usually in association with dissolved organic carbon (DOC), which can bind aluminum and keep it in solution.A method for dilution determination was developed using a mass-balance equation for aluminum and considering sources of aluminum from groundwater, surface water, and filter-backwash effluents and losses caused by sedimentation, water withdrawal, and spill discharge from the reservoir. The method was applied to 13 reservoirs. Data on aluminum and DOC concentrations in reservoirs and influent water were collected during the fall of 2009. Complete reservoir volume was determined to be available for mixing on the basis of vertical and horizontal aluminum-concentration profiling. Losses caused by settling of aluminum were assumed to be proportional to aluminum concentration and reservoir area. The constant of proportionality, as a function of DOC concentration, was established by simulations in each of five reservoirs that differed in DOC concentration.In addition to computing dilution factors, the project determined dilution factors that would be protective with the same statistical basis (frequency of exceedance of the chronic standard) as dilutions computed for streams at the 7-day-average 10-year-recurrence annual low flow (the 7Q10). Low-flow dilutions are used for permitting so that receiving waters are protected even at the worst-case flow levels. The low-flow dilution factors that give the same statistical protection are the lowest annual 7-day-average dilution factors with a recurrence of 10 years, termed 7DF10s. Determination of 7DF10 values for reservoirs required that long periods of record be simulated so that dilution statistics could be determined. Dilution statistics were simulated for 13 reservoirs from 1960 to 2004 using U.S. Geological Survey Firm-Yield Estimator software to model reservoir inputs and outputs and present-day values of filter-effluent discharge and aluminum concentration.Computed settling velocities ranged from 0 centimeters per day (cm/d) at DOC concentrations of 15.5 milligrams per liter (mg/L) to 21.5 cm/d at DOC concentrations of 2.7 mg/L. The 7DF10 values were a function of aluminum effluent discharged. At current (2009) effluent discharge rates, the 7DF10 values varied from 1.8 to 115 among the 13 reservoirs. In most cases, the present-day (2009) discharge resulted in receiving water concentrations that did not exceed the standard at the 7DF10. Exceptions were one reservoir with a very small area and three reservoirs with high concentrations of DOC. Maximum permissible discharges were determined for water-treatment plants by adjusting discharges upward in simulations until the 7DF10 resulted in reservoir concentrations that just met the standard. In terms of aluminum flux, these discharges ranged from 0 to 28 kilograms of aluminum per day.

Consolidation of materials by pulse-discharge processes

NASA Astrophysics Data System (ADS)

Strizhakov, E. L.; Nescoromniy, S. V.

2017-07-01

The article presents the research and the analysis of the pulse-discharge processes of capacitor discharge sintering: CD Stud Welding, capacitor discharge percussion welding (CDPW), high-voltage capacitor welding with an inductive-dynamic drive (HVCW with IDD), pulse electric current sintering (PECS) of powders. The comparative analysis of the impact parameter is presented.

User's manual for computer program BASEPLOT

USGS Publications Warehouse

Sanders, Curtis L.

2002-01-01

The checking and reviewing of daily records of streamflow within the U.S. Geological Survey is traditionally accomplished by hand-plotting and mentally collating tables of data. The process is time consuming, difficult to standardize, and subject to errors in computation, data entry, and logic. In addition, the presentation of flow data on the internet requires more timely and accurate computation of daily flow records. BASEPLOT was developed for checking and review of primary streamflow records within the U.S. Geological Survey. Use of BASEPLOT enables users to (1) provide efficiencies during the record checking and review process, (2) improve quality control, (3) achieve uniformity of checking and review techniques of simple stage-discharge relations, and (4) provide a tool for teaching streamflow computation techniques. The BASEPLOT program produces tables of quality control checks and produces plots of rating curves and discharge measurements; variable shift (V-shift) diagrams; and V-shifts converted to stage-discharge plots, using data stored in the U.S. Geological Survey Automatic Data Processing System database. In addition, the program plots unit-value hydrographs that show unit-value stages, shifts, and datum corrections; input shifts, datum corrections, and effective dates; discharge measurements; effective dates for rating tables; and numeric quality control checks. Checklist/tutorial forms are provided for reviewers to ensure completeness of review and standardize the review process. The program was written for the U.S. Geological Survey SUN computer using the Statistical Analysis System (SAS) software produced by SAS Institute, Incorporated.

An Application of a Stochastic Semi-Continuous Simulation Method for Flood Frequency Analysis: A Case Study in Slovakia

NASA Astrophysics Data System (ADS)

Valent, Peter; Paquet, Emmanuel

2017-09-01

A reliable estimate of extreme flood characteristics has always been an active topic in hydrological research. Over the decades a large number of approaches and their modifications have been proposed and used, with various methods utilizing continuous simulation of catchment runoff, being the subject of the most intensive research in the last decade. In this paper a new and promising stochastic semi-continuous method is used to estimate extreme discharges in two mountainous Slovak catchments of the rivers Váh and Hron, in which snow-melt processes need to be taken into account. The SCHADEX method used, couples a precipitation probabilistic model with a rainfall-runoff model used to both continuously simulate catchment hydrological conditions and to transform generated synthetic rainfall events into corresponding discharges. The stochastic nature of the method means that a wide range of synthetic rainfall events were simulated on various historical catchment conditions, taking into account not only the saturation of soil, but also the amount of snow accumulated in the catchment. The results showed that the SCHADEX extreme discharge estimates with return periods of up to 100 years were comparable to those estimated by statistical approaches. In addition, two reconstructed historical floods with corresponding return periods of 100 and 1000 years were compared to the SCHADEX estimates. The results confirmed the usability of the method for estimating design discharges with a recurrence interval of more than 100 years and its applicability in Slovak conditions.

Gastric bypass surgery - discharge

MedlinePlus

... bypass - discharge; Gastric bypass - Roux-en-Y - discharge; Obesity gastric bypass discharge; Weight loss - gastric bypass discharge ... al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised ...

Readiness for hospital discharge: A concept analysis.

PubMed

Galvin, Eileen Catherine; Wills, Teresa; Coffey, Alice

2017-11-01

To report on an analysis on the concept of 'readiness for hospital discharge'. No uniform operational definition of 'readiness for hospital discharge' exists in the literature; therefore, a concept analysis is required to clarify the concept and identify an up-to-date understanding of readiness for hospital discharge. Clarity of the concept will identify all uses of the concept; provide conceptual clarity, an operational definition and direction for further research. Literature review and concept analysis. A review of literature was conducted in 2016. Databases searched were: Academic Search Complete, CINAHL Plus with Full Text, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycINFO, Social Sciences Full Text (H.W. Wilson) and SocINDEX with Full Text. No date limits were applied. Identification of the attributes, antecedents and consequences of readiness for hospital discharge led to an operational definition of the concept. The following attributes belonging to 'readiness for hospital discharge' were extracted from the literature: physical stability, adequate support, psychological ability, and adequate information and knowledge. This analysis contributes to the advancement of knowledge in the area of hospital discharge, by proposing an operational definition of readiness for hospital discharge, derived from the literature. A better understanding of the phenomenon will assist healthcare professionals to recognize, measure and implement interventions where necessary, to ensure patients are ready for hospital discharge and assist in the advancement of knowledge for all professionals involved in patient discharge from hospital. © 2017 John Wiley & Sons Ltd.

Nonlinear, discrete flood event models, 1. Bayesian estimation of parameters

NASA Astrophysics Data System (ADS)

Bates, Bryson C.; Townley, Lloyd R.

1988-05-01

In this paper (Part 1), a Bayesian procedure for parameter estimation is applied to discrete flood event models. The essence of the procedure is the minimisation of a sum of squares function for models in which the computed peak discharge is nonlinear in terms of the parameters. This objective function is dependent on the observed and computed peak discharges for several storms on the catchment, information on the structure of observation error, and prior information on parameter values. The posterior covariance matrix gives a measure of the precision of the estimated parameters. The procedure is demonstrated using rainfall and runoff data from seven Australian catchments. It is concluded that the procedure is a powerful alternative to conventional parameter estimation techniques in situations where a number of floods are available for parameter estimation. Parts 2 and 3 will discuss the application of statistical nonlinearity measures and prediction uncertainty analysis to calibrated flood models. Bates (this volume) and Bates and Townley (this volume).

Barriers to primary care hospital follow-up among older adults in rural or semi-rural communities.

PubMed

Hardman, Bobbi; Newcomb, Patricia

2016-02-01

Failure to follow-up with a primary care provider (PCP) following discharge from an acute care setting is strongly associated with readmission within 90 days among elderly patients. The purpose of this study was to identify barriers to primary care follow-up among older adults in rural communities. This was an explanatory mixed methods study which included scaled survey and interview techniques. Descriptive and inferential statistics were calculated for scaled concepts. Standard content analysis was performed on the qualitative items. Correlation between intention to follow-up with a PCP and actual follow-up was poor (r=0.20). Patients encountered substantial obstacles to the PCP follow-up visit. Obstacles clustered into two groups: 1) healthcare or social system barriers and 2) personal characteristics of patients. Individualized discharge planning that reflects the complexities of post-hospitalization adaptation for elders is most likely to be useful for ensuring PCP follow-up. Copyright © 2015 Elsevier Inc. All rights reserved.

Weber's law implies neural discharge more regular than a Poisson process.

PubMed

Kang, Jing; Wu, Jianhua; Smerieri, Anteo; Feng, Jianfeng

2010-03-01

Weber's law is one of the basic laws in psychophysics, but the link between this psychophysical behavior and the neuronal response has not yet been established. In this paper, we carried out an analysis on the spike train statistics when Weber's law holds, and found that the efferent spike train of a single neuron is less variable than a Poisson process. For population neurons, Weber's law is satisfied only when the population size is small (< 10 neurons). However, if the population neurons share a weak correlation in their discharges and individual neuronal spike train is more regular than a Poisson process, Weber's law is true without any restriction on the population size. Biased competition attractor network also demonstrates that the coefficient of variation of interspike interval in the winning pool should be less than one for the validity of Weber's law. Our work links Weber's law with neural firing property quantitatively, shedding light on the relation between psychophysical behavior and neuronal responses.

Reducing Readmissions among Heart Failure Patients Discharged to Home Health Care: Effectiveness of Early and Intensive Nursing Services and Early Physician Follow-Up.

PubMed

Murtaugh, Christopher M; Deb, Partha; Zhu, Carolyn; Peng, Timothy R; Barrón, Yolanda; Shah, Shivani; Moore, Stanley M; Bowles, Kathryn H; Kalman, Jill; Feldman, Penny H; Siu, Albert L

2017-08-01

To compare the effectiveness of two "treatments"-early, intensive home health nursing and physician follow-up within a week-versus less intense and later postacute care in reducing readmissions among heart failure (HF) patients discharged to home health care. National Medicare administrative, claims, and patient assessment data. Patients with a full week of potential exposure to the treatments were followed for 30 days to determine exposure status, 30-day all-cause hospital readmission, other health care use, and mortality. An extension of instrumental variables methods for nonlinear statistical models corrects for nonrandom selection of patients into treatment categories. Our instruments are the index hospital's rate of early aftercare for non-HF patients and hospital discharge day of the week. All hospitalizations for a HF principal diagnosis with discharge to home health care between July 2009 and June 2010 were identified from source files. Neither treatment by itself has a statistically significant effect on hospital readmission. In combination, however, they reduce the probability of readmission by roughly 8 percentage points (p < .001; confidence interval = -12.3, -4.1). Results are robust to changes in implementation of the nonlinear IV estimator, sample, outcome measure, and length of follow-up. Our results call for closer coordination between home health and medical providers in the clinical management of HF patients immediately after hospital discharge. © Health Research and Educational Trust.

Hospital Discharge Within 1 Day After Total Joint Arthroplasty From a Veterans Affairs Hospital Does Not Increase Complication and Readmission Rates.

PubMed

Kiskaddon, Eric M; Lee, Jessica H; Meeks, Brett D; Barnhill, Spencer W; Froehle, Andrew W; Krishnamurthy, Anil

2018-05-01

Attempts to control costs associated with total joint arthroplasty have included efforts to shorten hospital length of stay (LOS). Concerns related to patient outcomes and safety with decreased LOS persist. The purpose of this study was to investigate whether discharge on postoperative day (POD) 1 after joint replacement is associated with increased rates of 90-day return to the operating room, and 30-day readmissions and emergency department (ED) visits. After chart review, 447 patients admitted between January 2, 2013 and September 16, 2016 met inclusion criteria. All patients underwent one total joint arthroplasty. Patients were either discharged on POD 1 (subgroup 1) or POD 2 or 3 (subgroup 2). Statistical evaluation was performed using Wilcoxon-Mann-Whitney tests for continuous variables, and Fisher exact tests for categorical and frequency data. Statistical significance was established at P ≤ .05. Subgroup 1 had significantly fewer return trips to the operating room (P = .043) and significantly fewer 30-day readmissions (P = .033). ED visits were not significantly different between groups (P = .901). Early discharge after joint arthroplasty appears to be a viable practice and did not result in increased rates of reoperation within the 90-day global period, or rates of 30-day readmission and ED visits. Our results support the utilization of an early discharge protocol on POD 1, with no evidence that shorter LOS results in higher rates of short-term complications. Copyright © 2017 Elsevier Inc. All rights reserved.

Effect of duty-cycles on the air plasma gas-phase of dielectric barrier discharges

NASA Astrophysics Data System (ADS)

Barni, R.; Biganzoli, I.; Dell'Orto, E. C.; Riccardi, C.

2015-10-01

An experimental investigation concerning the effects of a duty-cycle in the supply of a dielectric barrier discharge in atmospheric pressure air has been performed. Electrical characteristics of the discharge have been measured, focusing mainly on the statistical properties of the current filaments and on dielectric surface charging, both affected by the frequent repetition of breakdown imposed by the duty-cycle. Information on the gas-phase composition was gathered too. In particular, a strong enhancement in the ozone formation rate is observed when suitable long pauses separate the active discharge phases. A simulation of the chemical kinetics in the gas-phase, based on a simplified discharge modeling, is briefly described in order to shed light on the observed increase in ozone production. The effect of a duty-cycle on surface modification of polymeric films in order to increase their wettability has been investigated too.

Estimating discharge measurement uncertainty using the interpolated variance estimator

USGS Publications Warehouse

Cohn, T.; Kiang, J.; Mason, R.

2012-01-01

Methods for quantifying the uncertainty in discharge measurements typically identify various sources of uncertainty and then estimate the uncertainty from each of these sources by applying the results of empirical or laboratory studies. If actual measurement conditions are not consistent with those encountered in the empirical or laboratory studies, these methods may give poor estimates of discharge uncertainty. This paper presents an alternative method for estimating discharge measurement uncertainty that uses statistical techniques and at-site observations. This Interpolated Variance Estimator (IVE) estimates uncertainty based on the data collected during the streamflow measurement and therefore reflects the conditions encountered at the site. The IVE has the additional advantage of capturing all sources of random uncertainty in the velocity and depth measurements. It can be applied to velocity-area discharge measurements that use a velocity meter to measure point velocities at multiple vertical sections in a channel cross section.

Survival Outcomes Following the Use of Extracorporeal Membrane Oxygenation as a Rescue Technology in Critically Ill Patients: Results From Pennsylvania 2007-2015.

PubMed

Huesch, Marco D; Foy, Andrew; Brehm, Christoph

2018-01-01

To examine real-world outcomes of survival, length of stay, and discharge destination, among all adult extracorporeal membrane oxygenation admissions in one state over nearly a decade. Retrospective analysis of administrative discharge data. State-wide administrative discharge data from Pennsylvania between 2007 and 2015. All 2,948 consecutive patients billed under a Diagnosis-Related Grouper 3 grouper and in whom a procedural code for extracorporeal membrane oxygenation was present, admitted between the beginning of 2007 and the end of 2015 to hospitals regulated by the state of Pennsylvania. Admitting diagnoses were coded as respiratory, cardiac, cardiac arrest, or uncategorized based on administrative data. Unadjusted in-hospital mortality, length of stay, and discharge destination. Summary statistics and tests of differences by age 65 years or older and by admitting diagnosis were performed. Outcomes by age were plotted using running-mean smoothed graphs. Over the 9-year period, the average observed death rate was 51.7%. Among all survivors, 14.6% went home to self-care and a further 15.2% to home health care. Of all survivors, 43.8% were readmitted within 1 month, and 60.6% within 1 year. Among elderly survivors, readmission rates were 52.3% and 65.5% within 1 month and 1 year, respectively. The likelihood of dying in-hospital increased with age that of being discharged home or to postacute care decreased. In a "usual clinical practice" setting, short-term outcomes are similar to those observed in clinical trials such as Conventional Ventilation or ECMO for Severe Adult Respiratory Failure, in registries such as extracorporeal life support organization, and in smaller single-site studies. More data on longer term follow-up are needed to allow clinicians to better inform patient selection and care.

Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score.

PubMed

Raposeiras-Roubín, Sergio; Abu-Assi, Emad; Cambeiro-González, Cristina; Álvarez-Álvarez, Belén; Pereira-López, Eva; Gestal-Romaní, Santiago; Pedreira-López, Milagros; Rigueiro-Veloso, Pedro; Virgós-Lamela, Alejandro; García-Acuña, José María; González-Juanatey, José Ramón

2015-06-01

Given the increasing focus on early mortality and readmission rates among patients with acute coronary syndrome (ACS), this study was designed to evaluate the accuracy of the GRACE risk score for identifying patients at high risk of 30-day post-discharge mortality and cardiovascular readmission. This was a retrospective study carried out in a single center with 4229 ACS patients discharged between 2004 and 2010. The study endpoint was the combination of 30-day post-discharge mortality and readmission due to reinfarction, heart failure or stroke. One hundred and fourteen patients had 30-day events: 0.7% mortality, 1% reinfarction, 1.3% heart failure, and 0.2% stroke. After multivariate analysis, the six-month GRACE risk score was associated with an increased risk of 30-day events (HR 1.03, 95% CI 1.02-1.04; p<0.001), demonstrating good discrimination (C-statistic: 0.79 ± 0.02) and optimal fit (Hosmer-Lemeshow p=0.83). The sensitivity and specificity were adequate (78.1% and 63.3%, respectively), and negative predictive value was excellent (99.1%). In separate analyses for each event of interest (all-cause mortality, reinfarction, heart failure and stroke), assessment of the six-month GRACE risk score also demonstrated good discrimination and fit, as well as adequate predictive values. The six-month GRACE risk score is a useful tool to predict 30-day post-discharge death and early cardiovascular readmission. Clinicians may find it simple to use with the online and mobile app score calculator and applicable to clinical daily practice. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

The effects of drainage basin geomorphometry on minimum low flow discharge: the study of small watershed in Kelang River Valley in Peninsular Malaysia.

PubMed

Yunus, Ahmad Jailani Muhamed; Nakagoshi, Nobukazu; Salleh, Khairulmaini Osman

2003-03-01

This study investigate the relationships between geomorphometric properties and the minimum low flow discharge of undisturbed drainage basins in the Taman Bukit Cahaya Seri Alam Forest Reserve, Peninsular Malaysia. The drainage basins selected were third-order basins so as to facilitate a common base for sampling and performing an unbiased statistical analyses. Three levels of relationships were observed in the study. Significant relationships existed between the geomorphometric properties as shown by the correlation network analysis; secondly, individual geomorphometric properties were observed to influence minimum flow discharge; and finally, the multiple regression model set up showed that minimum flow discharge (Q min) was dependent of basin area (AU), stream length (LS), maximum relief (Hmax), average relief (HAV) and stream frequency (SF). These findings further enforced other studies of this nature that drainage basins were dynamic and functional entities whose operations were governed by complex interrelationships occurring within the basins. Changes to any of the geomorphometric properties would influence their role as basin regulators thus influencing a change in basin response. In the case of the basin's minimum low flow, a change in any of the properties considered in the regression model influenced the "time to peak" of flow. A shorter time period would mean higher discharge, which is generally considered the prerequisite to flooding. This research also conclude that the role of geomorphometric properties to control the water supply within the stream through out the year even though during the drought and less precipitations months. Drainage basins are sensitive entities and any deteriorations involve will generate reciprocals and response to the water supply as well as the habitat within the areas.

Microplastic pollution is widely detected in US municipal wastewater treatment plant effluent.

PubMed

Mason, Sherri A; Garneau, Danielle; Sutton, Rebecca; Chu, Yvonne; Ehmann, Karyn; Barnes, Jason; Fink, Parker; Papazissimos, Daniel; Rogers, Darrin L

2016-11-01

Municipal wastewater effluent has been proposed as one pathway for microplastics to enter the aquatic environment. Here we present a broad study of municipal wastewater treatment plant effluent as a pathway for microplastic pollution to enter receiving waters. A total of 90 samples were analyzed from 17 different facilities across the United States. Averaging all facilities and sampling dates, 0.05 ± 0.024 microparticles were found per liter of effluent. Though a small value on a per liter basis, even minor municipal wastewater treatment facilities process millions of liters of wastewater each day, yielding daily discharges that ranged from ∼50,000 up to nearly 15 million particles. Averaging across the 17 facilities tested, our results indicate that wastewater treatment facilities are releasing over 4 million microparticles per facility per day. Fibers and fragments were found to be the most common type of particle within the effluent; however, some fibers may be derived from non-plastic sources. Considerable inter- and intra-facility variation in discharge concentrations, as well as the relative proportions of particle types, was observed. Statistical analysis suggested facilities serving larger populations discharged more particles. Results did not suggest tertiary filtration treatments were an effective means of reducing discharge. Assuming that fragments and pellets found in the effluent arise from the 'microbeads' found in many cosmetics and personal care products, it is estimated that between 3 and 23 billion (with an average of 13 billion) of these microplastic particles are being released into US waterways every day via municipal wastewater. This estimate can be used to evaluate the contribution of microbeads to microplastic pollution relative to other sources (e.g., plastic litter and debris) and pathways (e.g., stormwater) of discharge. Published by Elsevier Ltd.

Consumer perspectives of medication-related problems following discharge from hospital in Australia: a quantitative study.

PubMed

Eassey, Daniela; Smith, Lorraine; Krass, Ines; McLAchlan, Andrew; Brien, Jo-Anne

2016-06-01

The aim of this study was to investigate the consumer's perspectives and experiences regarding medication related problems (MRPs) following discharge from hospital. A cross-sectional study was conducted using an online 80-question survey. Survey participants were recruited through an online market research company. Five hundred and six participants completed the survey. Participants were included if they were aged 50 years or older, taking 5 or more prescription medicines, had been admitted to hospital with a minimum stay of 24 h, admitted to hospital within the last 4 months and discharged from hospital within the last 1 month. The survey comprised questions measuring: health literacy, health status, medication safety (measured by reported MRPs), missed dose(s), role of health professionals, health services and cost, and socio-demographic status. Descriptive and univariate statistics and logistic regression analysis was performed to examine the predictors of experiencing MRPs. Four main risk factors of MRPs emerged as significant: health literacy (P < 0.05), health status (P < 0.05), consumer engagement (P < 0.05) and cost of medicines (P = 0.001). Participants reporting a lack of perceived control over their medicines (OR 6.3; 95% CI: 3.4-11.8) or those who played less of a role in follow-up discussions with their healthcare professionals (OR 7.6; 95% CI: 1.3-45.7) were more likely to experience a self-reported MRP. This study provides insight into consumers' experiences and perceptions of self-reported MRPs following hospital discharge. Results highlight novel findings demonstrating the importance of consumer engagement in developing processes to ensure medication safety on patient discharge. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Identifying predictors of hospital readmission following congenital heart surgery through analysis of a multiinstitutional administrative Database.

PubMed

Smith, Andrew H; Doyle, Thomas P; Mettler, Bret A; Bichell, David P; Gay, James C

2015-01-01

Despite resource burdens associated with hospital readmission, there remains little multiinstitutional data available to identify children at risk for readmission following congenital heart surgery. Children undergoing congenital heart surgery and discharged home between January of 2011 and December 2012 were identified within the Pediatric Health Information System database, a multiinstitutional collection of clinical and administrative data. Patient discharges were assigned to derivation and validation cohorts for the purposes of predictive model design, with 17 871 discharges meeting inclusion criteria. Readmission within 30 days was noted following 956 (11%) of discharges within the derivation cohort (n = 9104), with a median time to readmission of 9 days (interquartile range [IQR] 5-18 days). Readmissions resulted in a rehospitalization length of stay of 4 days (IQR 2-8 days) and were associated with an intensive care unit (ICU) admission in 36% of cases. Independent perioperative predictors of readmission included Risk Adjustment in Congenital Heart Surgery score of 6 (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.8-3.7, P < .001) and ICU length of stay of at least 7 days (OR 1.9 95% CI 1.6-2.2, P < .001). Demographic predictors included Hispanic ethnicity (OR 1.2, 95% CI 1.1-1.4, P = .014) and government payor status (OR 1.2, 95% CI 1.1-1.4, P = .007). Predictive model performance was modest among validation cohort (c statistic 0.68, 95% CI 0.66-0.69, P < .001). Readmissions following congenital heart surgery are common and associated with significant resource consumption. While we describe independent predictors that may identify patients at risk for readmission prior to hospital discharge, there likely remains other unreported factors that may contribute to readmission following congenital heart surgery. © 2014 Wiley Periodicals, Inc.

Geochemical and statistical evidence of recharge, mixing, and controls on spring discharge in an eogenetic karst aquifer

NASA Astrophysics Data System (ADS)

Moore, Paul J.; Martin, Jonathan B.; Screaton, Elizabeth J.

2009-10-01

SummaryInformation about sources of recharge, distributions of flow paths, and the extent of water-rock reactions in karst aquifers commonly result from monitoring spring chemistry and discharge. To investigate the relationship between spring characteristics and the complexities of karst aquifers, we couple variations in surface- and groundwater chemistry to physical conditions including river stage, precipitation, and evapotranspiration (ET) within a sink-rise system through a 6-km portion of the Upper Floridan aquifer (UFA) in north-central Florida. Principal component analysis (PCA) of time series major-element compositions suggests that at least three sources of water affect spring discharge, including allogenic recharge into a swallet, diffuse recharge through a thin vadose zone, and water upwelling from deep within the aquifer. The deep-water source exerts the strongest influence on water chemistry by providing a majority of Na +, Mg 2+, K +, Cl -, and SO42- to the system. Anomalously high temperature at one of several monitoring wells reflects vertical flow of about 1 m/year. Mass-balance calculations suggest diffuse recharge and deep-water upwelling can provide up to 50% of the spring discharge; however, their contributions depend on head gradients between the conduit and surrounding aquifer matrix, which are influenced by variations in precipitation, ET, and river stage. Our results indicate that upwelling from deep flow paths may provide significant contributions of water to spring discharge, and that monitoring only springs limits interpretations of karst systems by masking critical components of the aquifer, such as water sources and flow paths. These results also suggest the matrix in eogenetic aquifers is a major pathway for flow even in a system dominated by conduits.

Enumerating Sparse Organisms in Ships’ Ballast Water: Why Counting to 10 Is Not So Easy

PubMed Central

2011-01-01

To reduce ballast water-borne aquatic invasions worldwide, the International Maritime Organization and United States Coast Guard have each proposed discharge standards specifying maximum concentrations of living biota that may be released in ships’ ballast water (BW), but these regulations still lack guidance for standardized type approval and compliance testing of treatment systems. Verifying whether BW meets a discharge standard poses significant challenges. Properly treated BW will contain extremely sparse numbers of live organisms, and robust estimates of rare events require extensive sampling efforts. A balance of analytical rigor and practicality is essential to determine the volume of BW that can be reasonably sampled and processed, yet yield accurate live counts. We applied statistical modeling to a range of sample volumes, plankton concentrations, and regulatory scenarios (i.e., levels of type I and type II errors), and calculated the statistical power of each combination to detect noncompliant discharge concentrations. The model expressly addresses the roles of sampling error, BW volume, and burden of proof on the detection of noncompliant discharges in order to establish a rigorous lower limit of sampling volume. The potential effects of recovery errors (i.e., incomplete recovery and detection of live biota) in relation to sample volume are also discussed. PMID:21434685

Enumerating sparse organisms in ships' ballast water: why counting to 10 is not so easy.

PubMed

Miller, A Whitman; Frazier, Melanie; Smith, George E; Perry, Elgin S; Ruiz, Gregory M; Tamburri, Mario N

2011-04-15

To reduce ballast water-borne aquatic invasions worldwide, the International Maritime Organization and United States Coast Guard have each proposed discharge standards specifying maximum concentrations of living biota that may be released in ships' ballast water (BW), but these regulations still lack guidance for standardized type approval and compliance testing of treatment systems. Verifying whether BW meets a discharge standard poses significant challenges. Properly treated BW will contain extremely sparse numbers of live organisms, and robust estimates of rare events require extensive sampling efforts. A balance of analytical rigor and practicality is essential to determine the volume of BW that can be reasonably sampled and processed, yet yield accurate live counts. We applied statistical modeling to a range of sample volumes, plankton concentrations, and regulatory scenarios (i.e., levels of type I and type II errors), and calculated the statistical power of each combination to detect noncompliant discharge concentrations. The model expressly addresses the roles of sampling error, BW volume, and burden of proof on the detection of noncompliant discharges in order to establish a rigorous lower limit of sampling volume. The potential effects of recovery errors (i.e., incomplete recovery and detection of live biota) in relation to sample volume are also discussed.

Temporal and spatial assessment of river surface water quality using multivariate statistical techniques: a study in Can Tho City, a Mekong Delta area, Vietnam.

PubMed

Phung, Dung; Huang, Cunrui; Rutherford, Shannon; Dwirahmadi, Febi; Chu, Cordia; Wang, Xiaoming; Nguyen, Minh; Nguyen, Nga Huy; Do, Cuong Manh; Nguyen, Trung Hieu; Dinh, Tuan Anh Diep

2015-05-01

The present study is an evaluation of temporal/spatial variations of surface water quality using multivariate statistical techniques, comprising cluster analysis (CA), principal component analysis (PCA), factor analysis (FA) and discriminant analysis (DA). Eleven water quality parameters were monitored at 38 different sites in Can Tho City, a Mekong Delta area of Vietnam from 2008 to 2012. Hierarchical cluster analysis grouped the 38 sampling sites into three clusters, representing mixed urban-rural areas, agricultural areas and industrial zone. FA/PCA resulted in three latent factors for the entire research location, three for cluster 1, four for cluster 2, and four for cluster 3 explaining 60, 60.2, 80.9, and 70% of the total variance in the respective water quality. The varifactors from FA indicated that the parameters responsible for water quality variations are related to erosion from disturbed land or inflow of effluent from sewage plants and industry, discharges from wastewater treatment plants and domestic wastewater, agricultural activities and industrial effluents, and contamination by sewage waste with faecal coliform bacteria through sewer and septic systems. Discriminant analysis (DA) revealed that nephelometric turbidity units (NTU), chemical oxygen demand (COD) and NH₃ are the discriminating parameters in space, affording 67% correct assignation in spatial analysis; pH and NO₂ are the discriminating parameters according to season, assigning approximately 60% of cases correctly. The findings suggest a possible revised sampling strategy that can reduce the number of sampling sites and the indicator parameters responsible for large variations in water quality. This study demonstrates the usefulness of multivariate statistical techniques for evaluation of temporal/spatial variations in water quality assessment and management.

Pertinent spatio-temporal scale of observation to understand suspended sediment yield control factors in the Andean region: the case of the Santa River (Peru)

NASA Astrophysics Data System (ADS)

Morera, S. B.; Condom, T.; Vauchel, P.; Guyot, J.-L.; Galvez, C.; Crave, A.

2013-11-01

Hydro-sedimentology development is a great challenge in Peru due to limited data as well as sparse and confidential information. This study aimed to quantify and to understand the suspended sediment yield from the west-central Andes Mountains and to identify the main erosion-control factors and their relevance. The Tablachaca River (3132 km2) and the Santa River (6815 km2), located in two adjacent Andes catchments, showed similar statistical daily rainfall and discharge variability but large differences in specific suspended-sediment yield (SSY). In order to investigate the main erosion factors, daily water discharge and suspended sediment concentration (SSC) datasets of the Santa and Tablachaca rivers were analysed. Mining activity in specific lithologies was identified as the major factor that controls the high SSY of the Tablachaca (2204 t km2 yr-1), which is four times greater than the Santa's SSY. These results show that the analysis of control factors of regional SSY at the Andes scale should be done carefully. Indeed, spatial data at kilometric scale and also daily water discharge and SSC time series are needed to define the main erosion factors along the entire Andean range.

Historical channel-planform change of the Little Colorado River near Winslow, Arizona

USGS Publications Warehouse

Block, Debra L.

2014-01-01

This study evaluates channel-planform adjustment on an alluvial reach of the Little Colorado River and documents the geomorphic evolution of the channel through an analysis of aerial photographs and orthophotographs for the period 1936–2010. The Little Colorado River has adjusted to the effects of an extreme flood in 1923 and a subsequent decline in peak discharge and mean annual flow by channel narrowing: the channel width and area of the river have decreased by approximately 90 percent over the study period. Although deposition historically exceeds erosion, lateral migration exacerbates localized erosion, particularly near hydraulic controls. Despite repeated cutoff and avulsion, the Little Colorado River has steadily increased in length and sinuosity over a period of 74 years. Changes in temperature and precipitation are likely affecting the discharge of the Little Colorado River near and downstream of Winslow, Ariz. Nonparametric methods of trend detection determine whether the probability distribution of temperature, precipitation, and peak streamflow has changed over time. Time-series plots of temperature and precipitation show statistically significant trends at the 99-percent-confidence level when evaluated with a Mann-Kendall test. An increasing trend was indicated in mean daily minimum air temperature (Tmin), whereas decreasing trends were indicated in both annual precipitation (Pann) and monsoon-seasonal precipitation (Pjas), as well as in peak discharge.

Classification of Partial Discharge Measured under Different Levels of Noise Contamination.

PubMed

Jee Keen Raymond, Wong; Illias, Hazlee Azil; Abu Bakar, Ab Halim

2017-01-01

Cable joint insulation breakdown may cause a huge loss to power companies. Therefore, it is vital to diagnose the insulation quality to detect early signs of insulation failure. It is well known that there is a correlation between Partial discharge (PD) and the insulation quality. Although many works have been done on PD pattern recognition, it is usually performed in a noise free environment. Also, works on PD pattern recognition in actual cable joint are less likely to be found in literature. Therefore, in this work, classifications of actual cable joint defect types from partial discharge data contaminated by noise were performed. Five cross-linked polyethylene (XLPE) cable joints with artificially created defects were prepared based on the defects commonly encountered on site. Three different types of input feature were extracted from the PD pattern under artificially created noisy environment. These include statistical features, fractal features and principal component analysis (PCA) features. These input features were used to train the classifiers to classify each PD defect types. Classifications were performed using three different artificial intelligence classifiers, which include Artificial Neural Networks (ANN), Adaptive Neuro-Fuzzy Inference System (ANFIS) and Support Vector Machine (SVM). It was found that the classification accuracy decreases with higher noise level but PCA features used in SVM and ANN showed the strongest tolerance against noise contamination.

Plasma mixing glow discharge device for analytical applications

DOEpatents

Pinnaduwage, Lal A.

1999-01-01

An instrument for analyzing a sample has an enclosure that forms a chamber containing an anode which divides the chamber into a discharge region and an analysis region. A gas inlet and outlet are provided to introduce and exhaust a rare gas into the discharge region. A cathode within the discharge region has a plurality of pins projecting in a geometric pattern toward the anode for exciting the gas and producing a plasma discharge between the cathode and the anode. Low energy electrons (e.g. <0.5 eV) pass into the analysis region through an aperture. The sample to be analyzed is placed into the analysis region and bombarded by the metastable rare gas atoms and the low energy electrons extracted into from the discharge region. A mass or optical spectrometer can be coupled to a port of the analysis region to analyze the resulting ions and light emission.

Plasma mixing glow discharge device for analytical applications

DOEpatents

Pinnaduwage, L.A.

1999-04-20

An instrument for analyzing a sample has an enclosure that forms a chamber containing an anode which divides the chamber into a discharge region and an analysis region. A gas inlet and outlet are provided to introduce and exhaust a rare gas into the discharge region. A cathode within the discharge region has a plurality of pins projecting in a geometric pattern toward the anode for exciting the gas and producing a plasma discharge between the cathode and the anode. Low energy electrons (e.g. <0.5 eV) pass into the analysis region through an aperture. The sample to be analyzed is placed into the analysis region and bombarded by the metastable rare gas atoms and the low energy electrons extracted into from the discharge region. A mass or optical spectrometer can be coupled to a port of the analysis region to analyze the resulting ions and light emission. 3 figs.

Time-lag properties of corona streamer discharges between impulse sphere and dc needle electrodes under atmospheric air conditions.

PubMed

Okano, Daisuke

2013-02-01

In this study of corona streamer discharges from an impulse generator using a dc power supply, the relationship of the discharge time-lag with the dc bias voltage between the sphere-to-needle electrodes under atmospheric conditions is investigated. Devices utilizing corona discharges have been used to purify air or water, destroy bacteria, and to remove undesirable substances, and in order to achieve fast response times and high power efficiencies in such devices, it is important to minimize the time-lag of the corona discharge. Our experimental results show that (a) the discharge path of a negatively biased needle electrode will be straighter than that of a positively biased needle and (b) the discharge threshold voltage in both the positive and the negative needle electrodes is nearly equal to 33 kV. By expressing the discharge voltage as a power function of time-lag, the extent of corona generation can be quantitatively specified using the exponent of this power function. The observed behavior of a corona streamer discharge between the negative spherical and the positive needle electrodes indicates that the largest power exponent is associated with the shortest time-lag, owing to the reduction in the statistical time-lag in the absence of a formative time-lag.

Time-lag properties of corona streamer discharges between impulse sphere and dc needle electrodes under atmospheric air conditions

NASA Astrophysics Data System (ADS)

Okano, Daisuke

2013-02-01

In this study of corona streamer discharges from an impulse generator using a dc power supply, the relationship of the discharge time-lag with the dc bias voltage between the sphere-to-needle electrodes under atmospheric conditions is investigated. Devices utilizing corona discharges have been used to purify air or water, destroy bacteria, and to remove undesirable substances, and in order to achieve fast response times and high power efficiencies in such devices, it is important to minimize the time-lag of the corona discharge. Our experimental results show that (a) the discharge path of a negatively biased needle electrode will be straighter than that of a positively biased needle and (b) the discharge threshold voltage in both the positive and the negative needle electrodes is nearly equal to 33 kV. By expressing the discharge voltage as a power function of time-lag, the extent of corona generation can be quantitatively specified using the exponent of this power function. The observed behavior of a corona streamer discharge between the negative spherical and the positive needle electrodes indicates that the largest power exponent is associated with the shortest time-lag, owing to the reduction in the statistical time-lag in the absence of a formative time-lag.

Characteristics and dispersity of a two gap capillary discharge applied for long spark gap ignition in air

NASA Astrophysics Data System (ADS)

Huang, Dong; Yang, Lanjun; Guo, Haishan; Zhang, Zhiyuan; Jiang, Hongqiu; Xu, Haipeng

2017-07-01

In this paper, the characteristics and dispersity of a two gap capillary (TGC) discharge applied for long spark gap ignition are studied. Under the same discharge condition, 30 repetitive discharges are done to get a certain number of data samples. Accordingly, the change trend of the characteristics and the dispersity with the charging voltage of C1 are analyzed statistically. The delay of soft capillary discharge is determined by the saturation rate of the magnetic core of the pulse transformer and decreases with the increase in the charging voltage. The main discharge delay decreases from 1.0 kV to 2.0 kV and stops the decreasing trend when the charging voltage increases to 2.5 kV. In contrast, the current amplitude of soft capillary discharge and main discharge increases with charging voltage. Long tail extinction is witnessed at the charging voltage of 1.0 kV and the major cause is the insufficient pressure in the post discharge. The waveform of the capillary arc resistivity is U-like shape and the minimum resistivity decreases with the increase in the charging voltage. Meanwhile, the arc resistivity in the ascending stage is much higher than that in the descending stage with the same value of the discharge current. The energy consumption of the TGC discharge can be mainly divided into four parts and more than 70% of the energy is consumed in main discharge.

Observatory enabled discovery of diffuse discharge temperature structure

NASA Astrophysics Data System (ADS)

Bemis, K. G.; Lee, R.; Ivakin, A. N.

2016-12-01

Underwater cabled observatories provide long term but short time and spatial scale measurements of hydrothermal discharge properties. For the first time, an intricate picture of diffuse discharge has been captured at both Axial Volcano (Axial) and the Main Endeavour Field (MEF) on the Juan de Fuca Ridge. This study combines thermistor (3D array, 2D array and spot) and acoustic data to compare the statistical and distribution characteristics of diffuse discharge for narrow crack flow (at ASHES field on Axial) and distributive flow out of a sulfide structure (at Grotto vent in MEF). Two surprising observations seem to apply to both styles of diffuse discharge: (1) thermal variance scales with the mean temperature suggesting coherent flow structures exist in the form of plumes, wakes or boundary layers, and (2) thermal hot spots are persistently localized in space, despite tidal current disruption. Thermal variance was measured at ASHES using a 3D thermistor array (TMPSF) with 10 s sampling over two years and at Grotto using 2D thermistor arrays with 1 hr sampling over several years and a ROV-held CTD (Seabird 39plus) with 0.5 second sampling over several minutes. For locations with temperatures greater than ambient, the variance in temperature scales with the mean temperature. This unusual statistical property is characteristic of self-similar flows like plumes, wakes, and boundary layers and arises from the bounded mixing of a cooling high temperature fluid with a cold ambient fluid. Thus this observation implies an underlying coherence to the diffuse discharge that has not yet been adequately captured or described. A coherent flow like a plume should have a discoverable spatial pattern, albeit one that may vary with the influence of tides. Acoustic observations ( 1m diameter footprint) of the Grotto sulfide edifice found stable local hot spots of diffuse discharge that sway with tides. In contrast, the 3D thermistor array at ASHES sees very localized (single thermistor) hot spots that persist for months. Is this a fundamental difference between two styles of diffuse discharge? Alternate conceptual models of diffuse discharge are used to place localized observations in a spatial context and develop a rigorous understanding of the spatial and temporal pattern of diffuse discharge for both crack and distributive styles.

Survival factors of hospitalized out-of-hospital cardiac arrest patients in Taiwan: A retrospective study.

PubMed

Lai, Chung-Yu; Lin, Fu-Huang; Chu, Hsin; Ku, Chih-Hung; Tsai, Shih-Hung; Chung, Chi-Hsiang; Chien, Wu-Chien; Wu, Chun-Hsien; Chu, Chi-Ming; Chang, Chi-Wen

2018-01-01

The chain of survival has been shown to improve the chances of survival for victims of cardiac arrest. Post-cardiac arrest care has been demonstrated to significantly impact the survival of out-of-hospital cardiac arrest (OHCA). How post-cardiac arrest care influences the survival of OHCA patients has been a main concern in recent years. The objective of this study was to assess the survival outcome of hospitalized OHCA patients and determine the factors associated with improved survival in terms of survival to discharge. We conducted a retrospective observational study by analyzing records from the National Health Insurance Research Database of Taiwan from 2007 to 2013. We collected cases with an International Classification of Disease Clinical Modification, 9th revision primary diagnosis codes of 427.41 (ventricular fibrillation, VF) or 427.5 (cardiac arrest) and excluded patients less than 18 years old, as well as cases with an unknown outcome or a combination of traumatic comorbidities. We then calculated the proportion of survival to discharge among hospitalized OHCA patients. Factors associated with the dependent variable were examined by logistic regression. Statistical analysis was conducted using SPSS 22 (IBM, Armonk, NY). Of the 11,000 cases, 2,499 patients (22.7%) survived to hospital discharge. The mean age of subjects who survived to hospital discharge and those who did not was 66.7±16.7 and 71.7±15.2 years, respectively. After adjusting for covariates, neurological failure, cardiac comorbidities, hospital level, intensive care unit beds, transfer to another hospital, and length of hospital stay were independent predictors of improved survival. Cardiac rhythm on admission was a strong factor associated with survival to discharge (VF vs. non-VF: adjusted odds ratio: 3.51; 95% confidence interval: 3.06-4.01). In conclusion, cardiac comorbidities, hospital volume, cardiac rhythm on admission, transfer to another hospital and length of hospital stay had a significant positive association with survival to discharge in hospitalized OHCA patients in Taiwan.

The effects of the distribution pattern of multiple voids within LDPE on partial discharge characteristics

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shin, D.S.; Han, M.K.; Lee, J.H.

1996-12-31

In this paper, the authors have investigated effects of the arrangement of the voids in LDPE samples on PD characteristics, such as phase-related magnitude of PD, number of discharges. The differences of the PD patterns may be attributed to the arrangements of the voids. They have also employed available statistical operators, such as discharge factor and cross correlation factor in order to analyze the PD characteristics. The authors could conclude that partial discharge characteristics show quite different patterns due to the arrangements of voids in spite of the same size. The experimental results suggest that it is important to knowmore » the arrangements of the multiple voids as well as to obtain the information about the number of defects in the insulators.« less

HV discharge acceleration by sequences of UV laser filaments with visible and near-infrared pulses

NASA Astrophysics Data System (ADS)

Schubert, Elise; Rastegari, Ali; Feng, Chengyong; Mongin, Denis; Kamer, Brian; Kasparian, Jérôme; Wolf, Jean-Pierre; Arissian, Ladan; Diels, Jean-Claude

2017-12-01

We investigate the triggering and guiding of DC high-voltage discharges over a distance of 37 cm by filaments produced by ultraviolet (266 nm) laser pulses of 200 ps duration. The latter reduce the breakdown electric field by half and allow up to 80% discharge probability in an electric field of 920 kV m–1. This high efficiency is not further increased by adding nanosecond pulses in the Joule range at 532 and at 1064 nm. However, the latter statistically increases the guiding length, thereby accelerating the discharge by a factor of 2. This effect is due both to photodetachment and to the heating of the plasma channel, that increases the efficiency of avalanche ionization and reduces electron attachment and recombination.

Predicting two-year mortality from discharge after acute coronary syndrome: An internationally-based risk score.

PubMed

Pocock, Stuart J; Huo, Yong; Van de Werf, Frans; Newsome, Simon; Chin, Chee Tang; Vega, Ana Maria; Medina, Jesús; Bueno, Héctor

2017-08-01

Long-term risk of post-discharge mortality associated with acute coronary syndrome remains a concern. The development of a model to reliably estimate two-year mortality risk from hospital discharge post-acute coronary syndrome will help guide treatment strategies. EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients, NCT01171404) and EPICOR Asia (EPICOR Asia, NCT01361386) are prospective observational studies of 23,489 patients hospitalized for an acute coronary syndrome event, who survived to discharge and were then followed up for two years. Patients were enrolled from 28 countries across Europe, Latin America and Asia. Risk scoring for two-year all-cause mortality risk was developed using identified predictive variables and forward stepwise Cox regression. Goodness-of-fit and discriminatory power was estimated. Within two years of discharge 5.5% of patients died. We identified 17 independent mortality predictors: age, low ejection fraction, no coronary revascularization/thrombolysis, elevated serum creatinine, poor EQ-5D score, low haemoglobin, previous cardiac or chronic obstructive pulmonary disease, elevated blood glucose, on diuretics or an aldosterone inhibitor at discharge, male sex, low educational level, in-hospital cardiac complications, low body mass index, ST-segment elevation myocardial infarction diagnosis, and Killip class. Geographic variation in mortality risk was seen following adjustment for other predictive variables. The developed risk-scoring system provided excellent discrimination ( c-statistic=0.80, 95% confidence interval=0.79-0.82) with a steep gradient in two-year mortality risk: >25% (top decile) vs. ~1% (bottom quintile). A simplified risk model with 11 predictors gave only slightly weaker discrimination ( c-statistic=0.79, 95% confidence interval =0.78-0.81). This risk score for two-year post-discharge mortality in acute coronary syndrome patients ( www.acsrisk.org ) can facilitate identification of high-risk patients and help guide tailored secondary prevention measures.

An analysis of potential water availability from the Charles Mill, Clendening, Piedmont, Pleasant Hill, Senecaville, and Wills Creek Lakes in the Muskingum River Watershed, Ohio

USGS Publications Warehouse

Koltun, G.F.

2014-01-01

This report presents the results of a study to assess potential water availability from the Charles Mill, Clendening, Piedmont, Pleasant Hill, Senecaville, and Wills Creek Lakes, located within the Muskingum River Watershed, Ohio. The assessment was based on the criterion that water withdrawals should not appreciably affect maintenance of recreation-season pool levels in current use. To facilitate and simplify the assessment, it was assumed that historical lake operations were successful in maintaining seasonal pool levels, and that any discharges from lakes constituted either water that was discharged to prevent exceeding seasonal pool levels or discharges intended to meet minimum in-stream flow targets downstream from the lakes. It further was assumed that the volume of water discharged in excess of the minimum in-stream flow target is available for use without negatively impacting seasonal pool levels or downstream water uses and that all or part of it is subject to withdrawal. Historical daily outflow data for the lakes were used to determine the quantity of water that potentially could be withdrawn and the resulting quantity of water that would flow downstream (referred to as “flow-by”) on a daily basis as a function of all combinations of three hypothetical target minimum flow-by amounts (1, 2, and 3 times current minimum in-stream flow targets) and three pumping capacities (1, 2, and 3 million gallons per day). Using both U.S. Geological Survey streamgage data (where available) and lake-outflow data provided by the U.S. Army Corps of Engineers resulted in analytical periods ranging from 51 calendar years for Charles Mill, Clendening, and Piedmont Lakes to 74 calendar years for Pleasant Hill, Senecaville, and Wills Creek Lakes. The observed outflow time series and the computed time series of daily flow-by amounts and potential withdrawals were analyzed to compute and report order statistics (95th, 75th, 50th, 25th, 10th, and 5th percentiles) and means for the analytical period, in aggregate, and broken down by calendar month. In addition, surplus-water mass curve data were tabulated for each of the lakes. Monthly order statistics of computed withdrawals indicated that, for the three pumping capacities considered, increasing the target minimum flow-by amount tended to reduce the amount of water that can be withdrawn. The reduction was greatest in the lower percentiles of withdrawal; however, increasing the flow-by amount had no impact on potential withdrawals during high flow. In addition, for a given target minimum flow-by amount, increasing the pumping rate typically increased the total amount of water that could be withdrawn; however, that increase was less than a direct multiple of the increase in pumping rate for most flow statistics. Potential monthly withdrawals were observed to be more variable and more limited in some calendar months than others. Monthly order statistics and means of computed daily mean flow-by amounts indicated that flow-by amounts generally tended to be lowest during June–October. Increasing the target minimum flow-by amount for a given pumping rate resulted in some small increases in the magnitudes of the mean and 50th percentile and lower order statistics of computed mean flow-by, but had no effect on the magnitudes of the higher percentile statistics. Increasing the pumping rate for a given target minimum flow-by amount resulted in decreases in magnitudes of higher-percentile flow-by statistics by an amount equal to the flow equivalent of the increase in pumping rate; however, some lower percentile statistics remained unchanged.

Impacts of climate change on precipitation and discharge extremes through the use of statistical downscaling approaches in a Mediterranean basin.

PubMed

Piras, Monica; Mascaro, Giuseppe; Deidda, Roberto; Vivoni, Enrique R

2016-02-01

Mediterranean region is characterized by high precipitation variability often enhanced by orography, with strong seasonality and large inter-annual fluctuations, and by high heterogeneity of terrain and land surface properties. As a consequence, catchments in this area are often prone to the occurrence of hydrometeorological extremes, including storms, floods and flash-floods. A number of climate studies focused in the Mediterranean region predict that extreme events will occur with higher intensity and frequency, thus requiring further analyses to assess their effect at the land surface, particularly in small- and medium-sized watersheds. In this study, climate and hydrologic simulations produced within the Climate Induced Changes on the Hydrology of Mediterranean Basins (CLIMB) EU FP7 research project were used to analyze how precipitation extremes propagate into discharge extremes in the Rio Mannu basin (472.5km(2)), located in Sardinia, Italy. The basin hydrologic response to climate forcings in a reference (1971-2000) and a future (2041-2070) period was simulated through the combined use of a set of global and regional climate models, statistical downscaling techniques, and a process based distributed hydrologic model. We analyzed and compared the distribution of annual maxima extracted from hourly and daily precipitation and peak discharge time series, simulated by the hydrologic model under climate forcing. For this aim, yearly maxima were fit by the Generalized Extreme Value (GEV) distribution using a regional approach. Next, we discussed commonality and contrasting behaviors of precipitation and discharge maxima distributions to better understand how hydrological transformations impact propagation of extremes. Finally, we show how rainfall statistical downscaling algorithms produce more reliable forcings for hydrological models than coarse climate model outputs. Copyright © 2015 Elsevier B.V. All rights reserved.

[Does improvement of symptoms four weeks after the begin of psychodynamic inpatient psychotherapy correspond to long term outcome?].

PubMed

Franke, Gabriele Helga; Hoffmann, Thilo; Frommer, Jörg

2005-01-01

This study was conducted to explore differentiated aspects of outcome throughout and one year after psychodynamic inpatient psychotherapy with special regard to symptomatic distress and interpersonal behaviour. Sixty-four patients of the Department of Psychotherapeutic Medicine of the Jerichow Hospital (Saxonia-Anhaltina) were investigated with the SCL-90-R and the IIP-D four times: at the beginning of inpatient psychotherapy (t0), four weeks after (t1), at the end (t2), and one year after discharge (t3). The improvement of symptoms four weeks after the beginning of psychodynamic inpatient psychotherapy is equivalent with long term outcome. The Global Severity Index of SCL-90-R demonstrated a statistically significant change from markedly psychological distress to lack of distress after four weeks psychodynamic inpatient psychotherapy (effect-size d(GSI) = 0.82). At the end of psychotherapy, three weeks later, the effect-size was d = 1.11, and one year after discharge the effect-size decreased again to d = 0.85. Major improvements demonstrated the SCL-90-R subscales Depression, Anxiety, and Obsessive/Compulsive. Regarding interpersonal problems, the subscales Dominance, and Competitive demonstrated statistically significant changes from low Stanine-scores at t0 to higher scores one year after discharge. The subscales Socially avoidant, Nonassertive, and Exploitable demonstrated statistical significant changes from high levels at t0 to lower scores after one year. In conclusion the first four weeks of psychodynamic psychotherapy are not sufficient to demonstrate an optimum level of low psychological distress as well as an optimum change in interpersonal problems. Regarding stability of the effects of psychodynamic inpatient psychotherapy it was demonstrated that the first four weeks initiated changes which improved at the end of psychotherapy until one year after discharge.

Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions.

PubMed

Fleming, Lisa M; Zhao, Xin; DeVore, Adam D; Heidenreich, Paul A; Yancy, Clyde W; Fonarow, Gregg C; Hernandez, Adrian F; Kociol, Robb D

2018-04-01

Early ambulation (EA) is associated with improved outcomes for mechanically ventilated and stroke patients. Whether the same association exists for patients hospitalized with acute heart failure is unknown. We sought to determine whether EA among patients hospitalized with heart failure is associated with length of stay, discharge disposition, 30-day post discharge readmissions, and mortality. The study population included 369 hospitals and 285 653 patients with heart failure enrolled in the Get With The Guidelines-Heart Failure registry. We used multivariate logistic regression with generalized estimating equations at the hospital level to identify predictors of EA and determine the association between EA and outcomes. Sixty-five percent of patients ambulated by day 2 of the hospital admission. Patient-level predictors of EA included younger age, male sex, and hospitalization outside of the Northeast ( P <0.01 for all). Hospital size and academic status were not predictive. Hospital-level analysis revealed that those hospitals with EA rates in the top 25% were less likely to have a long length of stay (defined as >4 days) compared with those in the bottom 25% (odds ratio, 0.83; confidence interval, 0.73-0.94; P =0.004). Among a subgroup of fee-for-service Medicare beneficiaries, we found that hospitals in the highest quartile of rates of EA demonstrated a statistically significant 24% lower 30-day readmission rates ( P <0.0001). Both end points demonstrated a dose-response association and statistically significant P for trend test. Multivariable-adjusted hospital-level analysis suggests an association between EA and both shorter length of stay and lower 30-day readmissions. Further prospective studies are needed to validate these findings. © 2018 American Heart Association, Inc.

The spatio-temporal mapping of epileptic networks: Combination of EEG–fMRI and EEG source imaging

PubMed Central

Vulliemoz, S.; Thornton, R.; Rodionov, R.; Carmichael, D.W.; Guye, M.; Lhatoo, S.; McEvoy, A.W.; Spinelli, L.; Michel, C.M.; Duncan, J.S.; Lemieux, L.

2009-01-01

Simultaneous EEG–fMRI acquisitions in patients with epilepsy often reveal distributed patterns of Blood Oxygen Level Dependant (BOLD) change correlated with epileptiform discharges. We investigated if electrical source imaging (ESI) performed on the interictal epileptiform discharges (IED) acquired during fMRI acquisition could be used to study the dynamics of the networks identified by the BOLD effect, thereby avoiding the limitations of combining results from separate recordings. Nine selected patients (13 IED types identified) with focal epilepsy underwent EEG–fMRI. Statistical analysis was performed using SPM5 to create BOLD maps. ESI was performed on the IED recorded during fMRI acquisition using a realistic head model (SMAC) and a distributed linear inverse solution (LAURA). ESI could not be performed in one case. In 10/12 remaining studies, ESI at IED onset (ESIo) was anatomically close to one BOLD cluster. Interestingly, ESIo was closest to the positive BOLD cluster with maximal statistical significance in only 4/12 cases and closest to negative BOLD responses in 4/12 cases. Very small BOLD clusters could also have clinical relevance in some cases. ESI at later time frame (ESIp) showed propagation to remote sources co-localised with other BOLD clusters in half of cases. In concordant cases, the distance between maxima of ESI and the closest EEG–fMRI cluster was less than 33 mm, in agreement with previous studies. We conclude that simultaneous ESI and EEG–fMRI analysis may be able to distinguish areas of BOLD response related to initiation of IED from propagation areas. This combination provides new opportunities for investigating epileptic networks. PMID:19408351

Time-Varying Networks of Inter-Ictal Discharging Reveal Epileptogenic Zone.

PubMed

Zhang, Luyan; Liang, Yi; Li, Fali; Sun, Hongbin; Peng, Wenjing; Du, Peishan; Si, Yajing; Song, Limeng; Yu, Liang; Xu, Peng

2017-01-01

The neuronal synchronous discharging may cause an epileptic seizure. Currently, most of the studies conducted to investigate the mechanism of epilepsy are based on EEGs or functional magnetic resonance imaging (fMRI) recorded during the ictal discharging or the resting-state, and few studies have probed into the dynamic patterns during the inter-ictal discharging that are much easier to record in clinical applications. Here, we propose a time-varying network analysis based on adaptive directed transfer function to uncover the dynamic brain network patterns during the inter-ictal discharging. In addition, an algorithm based on the time-varying outflow of information derived from the network analysis is developed to detect the epileptogenic zone. The analysis performed revealed the time-varying network patterns during different stages of inter-ictal discharging; the epileptogenic zone was activated prior to the discharge onset then worked as the source to propagate the activity to other brain regions. Consistence between the epileptogenic zones detected by our proposed approach and the actual epileptogenic zones proved that time-varying network analysis could not only reveal the underlying neural mechanism of epilepsy, but also function as a useful tool in detecting the epileptogenic zone based on the EEGs in the inter-ictal discharging.

A Retrospective Analysis of Hemostatic Techniques in Primary Total Knee Arthroplasty: Traditional Electrocautery, Bipolar Sealer, and Argon Beam Coagulation.

PubMed

Rosenthal, Brett D; Haughom, Bryan D; Levine, Brett R

2016-01-01

In this retrospective cohort study of 280 primary total knee arthroplasties, clinical outcomes relevant to hemostasis were compared by electrocautery type: traditional electrocautery (TE), bipolar sealer (BS), and argon beam coagulation (ABC). Age, sex, and preoperative diagnosis were not significantly different among the TE, BS, and ABC cohorts. The 3 hemostasis systems were statistically equivalent with respect to estimated blood loss. Wound drainage during the first 48 hours after surgery was equivalent between the BS and ABC cohorts but less for the TE cohort. Transfusion requirements were not significantly different among the cohorts. The 3 hemostasis systems were statistically equivalent with respect to mean change in hemoglobin level during the early postoperative period (levels were measured on postoperative day 1 and on discharge). As BS and ABC are clinically equivalent to TE, their increased cost may not be justified.

A statistical model for water quality predictions from a river discharge using coastal observations

NASA Astrophysics Data System (ADS)

Kim, S.; Terrill, E. J.

2007-12-01

Understanding and predicting coastal ocean water quality has benefits for reducing human health risks, protecting the environment, and improving local economies which depend on clean beaches. Continuous observations of coastal physical oceanography increase the understanding of the processes which control the fate and transport of a riverine plume which potentially contains high levels of contaminants from the upstream watershed. A data-driven model of the fate and transport of river plume water from the Tijuana River has been developed using surface current observations provided by a network of HF radar operated as part of a local coastal observatory that has been in place since 2002. The model outputs are compared with water quality sampling of shoreline indicator bacteria, and the skill of an alarm for low water quality is evaluated using the receiver operating characteristic (ROC) curve. In addition, statistical analysis of beach closures in comparison with environmental variables is also discussed.

Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis.

PubMed

Rodakowski, Juleen; Rocco, Philip B; Ortiz, Maqui; Folb, Barbara; Schulz, Richard; Morton, Sally C; Leathers, Sally Caine; Hu, Lu; James, A Everette

2017-08-01

To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all English-language articles published between 1990 and April 2016. Hospital or skilled nursing facility. Older adults with informal caregivers discharged to a community setting. Readmission rates, length of and time to post-discharge rehospitalizations, costs of postdischarge care. Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62-0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64-0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

Patients discharged against medical advice from a psychiatric hospital in Iran: a prospective study.

PubMed

Sheikhmoonesi, Fatemeh; Khademloo, Mohammad; Pazhuheshgar, Samaneh

2014-03-30

Self- discharged patients are at high risk for readmission and ultimately higher cost for care.We intended to find the proportion of patients who leave hospital against medical advice and explore some of their characteristics. This prospective study of discharge against medical advice was conducted in psychiatric wards of Zare hospital in Iran, 2011. A psychologist recorded some information on a checklist based on the documented information about the patient who wanted to leave against medical advice. The psychologist interviewed these patients and recorded the reasons for discharge against medical advice. Descriptive statistics were calculated for the variables. The rate of premature discharge was 34.4%. Compared to patients with regular discharges, patients with premature discharge were significantly more likely to be male, self-employed, to have co morbid substance abuse and first admission and positive family history of psychiatric disorder. Disappearance of symptoms was the most frequent reason for premature discharge. The 34.4% rate of premature discharge observed in our study is higher than rate reported in other studies. One possible explanation is our teaching hospital serves a low-income urban area and most patients had low socioeconomic status. Further studies are needed to compare teaching and non-teaching hospital about the rate of premature discharge and the reasons of patients who want to leave against medical advice.

Argonne National Laboratory Li-alloy/FeS cell testing and R and D programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gay, E.C.

1982-01-01

Groups of 12 or more identical Li-alloy/FeS cells fabricated by Eagle-Picher Industries, Inc. and Gould Inc. were operated at Argonne National Laboratory (ANL) in the status cell test program to obtain data for statistical analysis of cell cycle life and failure modes. The cells were full-size electric vehicle battery cells (150 to 350 Ah capacity) and they were cycled at the 4-h discharge rate and 8-h charge rate. The end of life was defined as a 20% loss of capacity or a decrease in the coulombic efficiency to less than 95%. Seventy-four cells (six groups of identical cells) were cycle-lifemore » tested and the results were analyzed statistically. The ultimate goal of this analysis was to predict cell and battery reliability. Testing of groups of identical cells also provided a means of identifying common failure modes which were eliminated by cell design changes. Mean time to failure (MTTF) for the cells based on the Weibull distribution is presented.« less

Factors affecting breastfeeding adherence among Chinese mothers

PubMed Central

Huang, Pan; Ren, Jianhua; Liu, Yi; Luo, Biru; Zhao, Xiufang

2017-01-01

Abstract Breastfeeding is beneficial for both infant and mother, but discontinuation of breastfeeding is very common. To investigate maternal breastfeeding intention and the rate of breastfeeding based on the theory of reasoned action, and analyze the predominant factors associated with breastfeeding and breastfeeding problems. This observational study was conducted in 3 hospitals. Three researchers recruited women at 3 time points in the hospitals: initial documentation of pregnancy at the outpatient department, prenatal admission, and postpartum discharge. SPSS version 21 was used for statistical analyses. Significance was set at P < .05. In the multivariate analysis, binary logistic regression was used and odds ratios (ORs) with 95% confidence intervals (CI) were calculated. We recruited 1260 women, with 420 pregnant women at each time point. 55.1% of the infants were exclusively breastfed, 40.6% were mixed fed, and 4.3% were formula fed when discharged from hospital. A total of 53.8% of the mothers declared having breastfeeding problems. The multivariate analysis showed that nonsuccessful breastfeeding was associated with neonatal birth length, food intake before breastfeeding, infrequent sucking, the intention of breastfeeding, understanding level of the benefits of breastfeeding and that breastfeeding problems were related with the understanding level of the benefits of breastfeeding, neonatal birth length, normal vaginal delivery, breast size, the experience of breastfeeding, use of pacifier and the needs of family member's support in breastfeeding. Most mothers who intended to practice exclusive breastfeeding initially chose to add formula and had breastfeeding problems when discharged from hospital. Successful breastfeeding depends on antenatal and postnatal breastfeeding education and on support provided by healthcare professionals. PMID:28930818

Advances in the regionalization approach: geostatistical techniques for estimating flood quantiles

NASA Astrophysics Data System (ADS)

Chiarello, Valentina; Caporali, Enrica; Matthies, Hermann G.

2015-04-01

The knowledge of peak flow discharges and associated floods is of primary importance in engineering practice for planning of water resources and risk assessment. Streamflow characteristics are usually estimated starting from measurements of river discharges at stream gauging stations. However, the lack of observations at site of interest as well as the measurement inaccuracies, bring inevitably to the necessity of developing predictive models. Regional analysis is a classical approach to estimate river flow characteristics at sites where little or no data exists. Specific techniques are needed to regionalize the hydrological variables over the considered area. Top-kriging or topological kriging, is a kriging interpolation procedure that takes into account the geometric organization and structure of hydrographic network, the catchment area and the nested nature of catchments. The continuous processes in space defined for the point variables are represented by a variogram. In Top-kriging, the measurements are not point values but are defined over a non-zero catchment area. Top-kriging is applied here over the geographical space of Tuscany Region, in Central Italy. The analysis is carried out on the discharge data of 57 consistent runoff gauges, recorded from 1923 to 2014. Top-kriging give also an estimation of the prediction uncertainty in addition to the prediction itself. The results are validated using a cross-validation procedure implemented in the package rtop of the open source statistical environment R The results are compared through different error measurement methods. Top-kriging seems to perform better in nested catchments and larger scale catchments but no for headwater or where there is a high variability for neighbouring catchments.

JPRS Report Environmental Issues.

DTIC Science & Technology

1990-04-10

set of government regulations covering their Far East are to be guaranteed the territories of tradi- extraction on a goal-oriented scientific-technical...700 [Table by USSR State Committee for Statistics] metric tons of nitrates were discharged into Baykal; of [Text] Discharges of Harmful Substances Into...Previous the siting of new sources of electric power on the oblast’s Item": "From a Sea of Lies to a Field of Rye "] periphery, it being impermissible to

Statistical Patterns in Natural Lightning

NASA Astrophysics Data System (ADS)

Zoghzoghy, F. G.; Cohen, M.; Said, R.; Inan, U. S.

2011-12-01

Every day millions of lightning flashes occur around the globe but the understanding of this natural phenomenon is still lacking. Fundamentally, lightning is nature's way of destroying charge separation in clouds and restoring electric neutrality. Thus, statistical patterns of lightning activity indicate the scope of these electric discharges and offer a surrogate measure of timescales for charge buildup in thunderclouds. We present a statistical method to investigate spatio-temporal correlations among lightning flashes using National Lightning Detection Network (NLDN) stroke data. By monitoring the distribution of lightning activity, we can observe the charging and discharging processes in a given thunderstorm. In particular, within a given storm, the flashes do not occur as a memoryless random process. We introduce the No Flash Zone (NFZ) which results from the suppressed probability of two consecutive neighboring flashes. This effect lasts for tens of seconds and can extend up to 15 km around the location of the initial flash, decaying with time. This suppression effect may be a function of variables such as storm location, storm phase, and stroke peak current. We develop a clustering algorithm, Storm-Locator, which groups strokes into flashes, storm cells, and thunderstorms, and enables us to study lightning and the NFZ in different geographical regions, and for different storms. The recursive algorithm also helps monitor the interaction among spatially displaced storm cells, and can provide more insight into the spatial and temporal impacts of lightning discharges.

The 7Q10 in South Carolina water-quality regulation: Nearly fifty years later

USGS Publications Warehouse

Feaster, Toby D.; Cantrell, Wade M.

2010-01-01

The annual minimum 7-day average streamflow with a 10-year recurrence interval, often referred to as the 7Q10, has a long history of being an important low-flow statistic used in water-quality management in South Carolina as evidenced by its adoption into South Carolina law in 1967. State agencies, such as the South Carolina Department of Health and Environmental Control and the South Carolina Department of Natural Resources, use such lowflow statistics to determine Wasteload Allocations for National Pollutant Discharge Elimination System discharges, develop Total Maximum Daily Loads for streams, prepare the State Water Plan, and restrict the quantity of water that can be transferred out of basin. The U.S. Geological Survey, working cooperatively with the South Carolina Department of Health and Environmental Control, is updating low-flow statistics at continuous-record streamflow gages in South Carolina on a basin-by-basin approach. Such statistics are influenced by length of record and hydrologic conditions under which the record was collected. Statewide low-flow statistics in South Carolina were last updated in 1987. Since that time several droughts have occurred with the most severe occurring from 1998-2002 and the most recent occurring from 2006-2009. The low-flow statistics for the Pee Dee River basin were the first to be completed in this ongoing investigation.

Using Technology to Enhance Discharge Teaching and Improve Coping for Patients After Stroke.

PubMed

Schneider, Melissa A; Howard, Katrina A

2017-06-01

A diagnosis of stroke is a life-changing event. Effective discharge teaching after a stroke is crucial for recovery, but the overload of information can be overwhelming for patients and caregivers. The purpose of this study was to examine differences in discharge readiness and postdischarge coping in patients admitted for stroke after the use of individualized postdischarge information/education provided via a technology package (including patient online portal access, e-mail/secure messaging) compared with current standard discharge teaching methods (verbal/written instructions). This study used a descriptive comparative design to evaluate the difference between the nonintervention group A and the intervention group B. Patients in group B received additional discharge information via secured e-mail messaging at postdischarge days 2, 6, and 10. Two validated tools, Readiness for Hospital Discharge Form and Post-Discharge Coping Difficulty Scale, were used. One hundred patients were recruited for the study, but the final number of complete data sets collected was 86-42 in group A and 44 in group B. There was no statistically significant difference between the groups in discharge readiness. There was a significant difference in coping scores between the 2 groups, with the technology group exhibiting higher coping. New technology affords new options to improve discharge readiness and contribute to positive patient coping after stroke. The researchers hope that this study will contribute to the growing body of evidence showing success using aspects of technology to enhance discharge teaching and follow-up after discharge.

Analysis of the influence of rainfall variables on urban effluents concentrations and fluxes in wet weather

NASA Astrophysics Data System (ADS)

Gooré Bi, Eustache; Monette, Frédéric; Gasperi, Johnny

2015-04-01

Urban rainfall runoff has been a topic of increasing importance over the past years, a result of both the increase in impervious land area arising from constant urban growth and the effects of climate change on urban drainage. The main goal of the present study is to assess and analyze the correlations between rainfall variables and common indicators of urban water quality, namely event mean concentrations (EMCs) and event fluxes (EFs), in order to identify and explain the impacts of each of the main rainfall variables on the generation process of urban pollutants during wet periods. To perform this analysis, runoff from eight summer rainfall events that resulted in combined sewer overflow (CSO) was sampled simultaneously from two distinct catchment areas in order to quantify discharges at the respective outfalls. Pearson statistical analysis of total suspended solids (TSS), chemical oxygen demand (COD), carbonaceous biochemical oxygen demand at 5 days (CBOD5), total phosphorus (Ptot) and total kedjal nitrogen (N-TKN) showed significant correlations (ρ = 0.05) between dry antecedent time (DAT) and EMCs on one hand, and between total rainfall (TR) and the volume discharged (VD) during EFs, on the other. These results show that individual rainfall variables strongly affect either EMCs or EFs and are good predictors to consider when selecting variables for statistical modeling of urban runoff quality. The results also show that in a combined sewer network, there is a linear relationship between TSS event fluxes and COD, CBOD5, Ptot, and N-TKN event fluxes; this explains 97% of the variability of these pollutants which adsorb onto TSS during wet weather, which therefore act as tracers. Consequently, the technological solution selected for TSS removal will also lead to a reduction of these pollutants. Given the huge volumes involved, urban runoffs contribute substantially to pollutant levels in receiving water bodies, a situation which, in a climate change context, may get much worse as a result of more frequent, shorter, but more intense rainfall events.

Interprofessional Communication Patterns During Patient Discharges: A Social Network Analysis.

PubMed

Pinelli, Vincent A; Papp, Klara K; Gonzalo, Jed D

2015-09-01

Optimal care delivery requires timely, efficient, and accurate communication among numerous providers and their patients, especially during hospital discharge. Little is known about communication patterns during this process. Our aim was to assess the frequency and patterns of communication between patients and providers during patient discharges from a hospital-based medicine unit. On the day of the patient's discharge, the patient and all healthcare providers involved in the discharge were interviewed using structured questions related to information exchange during the discharge process. Each interview identified the frequency and method of communication between participants, including synchronous (e.g., face-to-face) and asynchronous (e.g., through electronic medical record) routes. Communication patterns were visually diagramed using social network analysis. Forty-six patients were screened for inclusion in the network analysis. Of those, seven patients who were fully oriented and able to complete an interview and all providers who participated in their care during the discharge were selected for inclusion in the analysis. In all, 72 healthcare professionals contributing to the discharge process were interviewed, including physicians, nurses, therapists, pharmacists, care coordinators, social workers, and nutritionists. Patients' mean age was 63, length-of-stay was 7.8 days, and most (86 %) were discharged to home. On average, 11 roles were involved with each discharge. The majority of communication was synchronous (562 events vs. 469 asynchronous events, p = 0.004). Most communication events occurred between the primary nurse and patient and the care coordinator and primary nurse (mean 3.9 and 2.3 events/discharge, respectively). Participants identified intern physicians as most important in the discharge process, followed by primary nurses and care coordinators. In patients being discharged from the medicine service, communication was more frequently synchronous, and occurred between intern physicians, primary nurses, and patients. Potential improvements in coordinating patients' discharges are possible by reorganizing systems to optimize efficient communication.

Benthic foraminiferal assemblages as bio-indicators of metals contamination in sediments, Qarun Lake as a case study, Egypt

NASA Astrophysics Data System (ADS)

Abd El Naby, Ahmed; Al Menoufy, Safia; Gad, Ahmed

2018-03-01

Qarun Lake, in the Fayoum Depression of the Western Desert of Egypt, lies within the deepest area in the River Nile flood plain. The drainage water in the Qarun Lake is derived from the discharge of the natural and artificial drainage systems in the Fayoum. Mixed domestic and agricultural pollutants, including heavy metals, nitrates, phosphates, sulfates and pesticides, are discharged into Qarun Lake. Forty-six samples, collected from the undisturbed layer of sediments were used for benthic foraminiferal analysis. Concentrations of some selected trace metal elements (Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, Sr, V, and Zn) were also determined. Statistical analysis of the abiotic variables (Texture distribution of sediments, Physico-chemical parameters, and metals concentrations) and of the biotic variables (distribution of benthic foraminiferal species) were also performed. The Q-mode cluster analysis of benthic foraminiferal distribution has provided evidence that the Qarun Lake can be subdivided into two cluster groups (A and B), reflecting environmental changes in the lake ecosystem. Cluster B can also be subdivided into two sub-clusters (B1 and B2). The presence of only pollution tolerant taxa with higher faunal density and lower diversity and the absence of the other foraminiferal assemblages in cluster A were attributed to the high concentration of trace metal elements and the strong environmental stress at the eastern and central parts of the Qarun Lake.

Daily GRACE storage anomaly data for characterization of dynamic storage-discharge relationships of natural drainage basins

NASA Astrophysics Data System (ADS)

Sharma, D.; Patnaik, S.; Reager, J. T., II; Biswal, B.

2017-12-01

Despite the fact that streamflow occurs mainly due to depletion of storage, our knowledge on how a drainage basin stores and releases water is very limited because of measurement limitations. As a result storage has largely remained an elusive entity in hydrological analysis and modelling. A window of opportunity, however, is given to us by GRACE satellite mission that provides storage anomaly (TWSA) data for the entire globe. Many studies have used TWSA data for storage-discharge analysis, uncovering a range of potential applications of TWSA data. Here we argue that the capability of GRACE satellite mission has not been fully explored as most of the studies in the past have performed storage-discharge analysis using monthly TWSA data for large river basins. With such coarse data we are quite unlikely to fully understand variation of storage and discharge in space and time. In this study, we therefore use daily TWSA data for several mid-sized catchments and perform storage-discharge analysis. Daily storage-discharge relationship is highly dynamic, which generates large amount of scatter in storage-discharge plots. Yet a careful analysis of those scatter plots reveals interesting information on storage-discharge relationships of basins, particularly by looking at the relationships during individual recession events. It is observed that storage-discharge relationship is exponential in nature, contrary to the general assumption that the relationship is linear. We find that there is a strong relationship between power-law recession coefficient and initial storage (TWSA at the beginning of recession event). Furthermore, appreciable relationships are observed between recession coefficient and past TWSA values implying that storage takes time to deplete completely. Overall, insights drawn from this study expands our knowledge on how discharge is dynamically linked to storage.

Building a database for statistical characterization of ELMs on DIII-D

NASA Astrophysics Data System (ADS)

Fritch, B. J.; Marinoni, A.; Bortolon, A.

2017-10-01

Edge localized modes (ELMs) are bursty instabilities which occur in the edge region of H-mode plasmas and have the potential to damage in-vessel components of future fusion machines by exposing the divertor region to large energy and particle fluxes during each ELM event. While most ELM studies focus on average quantities (e.g. energy loss per ELM), this work investigates the statistical distributions of ELM characteristics, as a function of plasma parameters. A semi-automatic algorithm is being used to create a database documenting trigger times of the tens of thousands of ELMs for DIII-D discharges in scenarios relevant to ITER, thus allowing statistically significant analysis. Probability distributions of inter-ELM periods and energy losses will be determined and related to relevant plasma parameters such as density, stored energy, and current in order to constrain models and improve estimates of the expected inter-ELM periods and sizes, both of which must be controlled in future reactors. Work supported in part by US DoE under the Science Undergraduate Laboratory Internships (SULI) program, DE-FC02-04ER54698 and DE-FG02- 94ER54235.

Smolt Monitoring at the Head of Lower Granite Reservoir and Lower Granite Dam, 2004 Annual Report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Buettner, Edwin W.; Putnam, Scott A.

This project monitored the daily passage of Chinook salmon Oncorhynchus tshawytscha, steelhead trout O. mykiss, and sockeye salmon O. nerka smolts during the 2004 spring out-migration at migrant traps on the Snake River and Salmon River. In 2004 fish management agencies released significant numbers of hatchery Chinook salmon and steelhead trout above Lower Granite Dam that were not marked with a fin clip or coded-wire tag. Generally, these fish were distinguishable from wild fish by the occurrence of fin erosion. Total annual hatchery Chinook salmon catch at the Snake River trap was 1.1 times greater in 2004 than in 2003.more » The wild Chinook catch was 1.1 times greater than the previous year. Hatchery steelhead trout catch was 1.2 times greater than in 2003. Wild steelhead trout catch was 1.6 times greater than the previous year. The Snake River trap collected 978 age-0 Chinook salmon of unknown rearing. During 2004, the Snake River trap captured 23 hatchery and 18 wild/natural sockeye salmon and 60 coho salmon O. kisutch of unknown rearing. Differences in trap catch between years are due to fluctuations not only in smolt production, but also differences in trap efficiency and duration of trap operation associated with flow. Trap operations began on March 7 and were terminated on June 4. The trap was out of operation for a total of zero days due to mechanical failure or debris. Hatchery Chinook salmon catch at the Salmon River trap was 10.8% less and wild Chinook salmon catch was 19.0% less than in 2003. The hatchery steelhead trout collection in 2004 was 20.0% less and wild steelhead trout collection was 22.3% less than the previous year. Trap operations began on March 7 and were terminated on May 28 due to high flows. There were two days when the trap was taken out of service because wild Chinook catch was very low, hatchery Chinook catch was very high, and the weekly quota of PIT tagged hatchery Chinook had been met. Travel time (d) and migration rate (km/d) through Lower Granite Reservoir for PIT-tagged Chinook salmon and steelhead trout marked at the Snake River trap were affected by discharge. Statistical analysis of 2004 data detected a relation between migration rate and discharge for wild Chinook salmon but was unable to detect a relation for hatchery Chinook. The inability to detect a migration rate discharge relation for hatchery Chinook salmon was caused by age-0 fall Chinook being mixed in with the age 1 Chinook. Age-0 fall Chinook migrate much slower than age-1 Chinook, which would confuse the ability to detect the migration rate discharge relation. When several groups, which consisted of significant numbers of age-0 Chinook salmon, were removed from the analysis a relation was detected. For hatchery and wild Chinook salmon there was a 2.8-fold and a 2.4-fold increase in migration rate, respectively, between 50 and 100 kcfs. For steelhead trout tagged at the Snake River trap, statistical analysis detected a significant relation between migration rate and Lower Granite Reservoir inflow discharge. For hatchery and wild steelhead trout, there was a 2.3-fold and a 2.0-fold increase in migration rate, respectively, between 50 and 100 kcfs. Travel time and migration rate to Lower Granite Dam for fish marked at the Salmon River trap were calculated. Statistical analysis of the 2004 data detected a significant relation between migration rate and Lower Granite Reservoir inflow discharge for hatchery Chinook salmon, wild Chinook salmon and hatchery steelhead trout. Not enough data were available to perform the analysis for wild steelhead trout. Migration rate increased 7.0-fold for hatchery Chinook salmon, 4.7-fold for wild Chinook salmon and 3.8-fold for hatchery steelhead as discharge increased between 50 kcfs and 100 kcfs. Fish tagged with passive integrated transponder (PIT) tags at the Snake River and Salmon River traps were interrogated at four dams with PIT tag detection systems (Lower Granite, Little Goose, Lower Monumental, and McNary dams). Because of the addition of the fourth interrogation site (Lower Monumental) in 1993 and the installation of the Removable Spillway Weir at Lower Granite Dam in 2001, caution must be used in comparing cumulative interrogation data. Cumulative interrogations at the four dams for fish marked at the Snake River trap were 82% for hatchery Chinook, 77% for wild Chinook, 90% for hatchery steelhead, and 90% for wild steelhead. Cumulative interrogations at the four dams for fish marked at the Salmon River trap were 68% for hatchery Chinook, 70% for wild Chinook salmon, 80% for hatchery steelhead trout, and 79% for wild steelhead trout.« less

Estimating the magnitude and frequency of floods for streams in west-central Florida, 2001

USGS Publications Warehouse

Hammett, Kathleen M.; DelCharco, Michael J.

2005-01-01

Flood discharges were estimated for recurrence intervals of 2, 5, 10, 25, 50, 100, 200, and 500 years for 94 streamflow stations in west-central Florida. Most of the stations are located within the 10,000 square-mile, 16-county area that forms the Southwest Florida Water Management District. All stations had at least 10 years of homogeneous record, and none have flood discharges that are significantly affected by regulation or urbanization. Guidelines established by the U.S. Water Resources Council in Bulletin 17B were used to estimate flood discharges from gaging station records. Multiple linear regression analysis was then used to mathematically relate estimates of flood discharge for selected recurrence intervals to explanatory basin characteristics. Contributing drainage area, channel slope, and the percent of total drainage area covered by lakes (percent lake area) were the basin characteristics that provided the best regression estimates. The study area was subdivided into four geographic regions to further refine the regression equations. Region 1 at the northern end of the study area includes large rivers that are characteristic of the rolling karst terrain of northern Florida. Only a small part of Region 1 lies within the boundaries of the Southwest Florida Water Management District. Contributing drainage area and percent lake area were the most statistically significant basin characteristics in Region 1; the prediction error of the regression equations varied with the recurrence interval and ranged from 57 to 69 percent. In the three other regions of the study area, contributing drainage area, channel slope, and percent lake area were the most statistically significant basin characteristics, and are the three characteristics that can be used to best estimate the magnitude and frequency of floods on most streams within the Southwest Florida Water Management District. The Withlacoochee River Basin dominates Region 2; the prediction error of the regression models in the region ranged from 65 to 68 percent. The basins that drain into the northern part of Tampa Bay and the upper reaches of the Peace River Basin are in Region 3, which had prediction errors ranging from 54 to 74 percent. Region 4, at the southern end of the study area, had prediction errors that ranged from 40 to 56 percent. Estimates of flood discharge become more accurate as longer periods of record are used for analyses; results of this study should be used in lieu of results from earlier U.S. Geological Survey studies of flood magnitude and frequency in west-central Florida. A comparison of current results with earlier studies indicates that use of a longer period of record with additional high-water events produces substantially higher flood-discharge estimates for many gaging stations. Another comparison indicates that the use of a computed, generalized skew in a previous study in 1979 tended to overestimate flood discharges.

Impact of ED management on hospital quality measures: the negative case of atrial fibrillation.

PubMed

Piela, Nicole E; Sacchetti, Alfred; Sholevar, Darius; Blaber, Reginald; Levi, Steven

2013-05-01

Emergency department (ED) cardioversion and discharge of atrial fibrillation (AF) is an evolving treatment. Emergency department cardioversion patients have few comorbidities, and their discharge directly from the ED leads to a sicker in-patient population of AF patients. This study examines whether the quality care markers, hospital charges (HC) and length of stay (LOS), negatively reflect the practice of ED cardioversion. Median HC and LOS were determined for 2 different quality assessment reporting models. In a standard model (SM), patients discharged from the ED were not included in any hospital statistics and only admitted, or observation patients were used to calculate the HC and LOS of AF patients. In an inclusive model (IM), patients discharged from the ED were also included in the hospital statistics but given the same LOS as observation patients. Differences across medians were analyzed using Wilcoxon rank sum tests. A total of 312 patients were evaluated for AF over an 18-month period. Of these, 197 (62%) were admitted, 21 (7%) were placed in observation status, and 95 (31%) were discharged from the ED. Median values for LOS were 3 days (interquartile range [IQR], 1-5) for the SM and 1 day (IQR, 0-4) for the IM. Median values for HC were $33062 (IQR, $19267-$60614) for the SM and $20059 (IQR, $4249-$47195) for the IM. Emergency department cardioversion selects out a less sick cohort of patients whose removal from a hospital's admission numbers negatively skews quality performance profiles. Copyright © 2013 Elsevier Inc. All rights reserved.

A method for extending stage-discharge relationships using a hydrodynamic model and quantifying the associated uncertainty

NASA Astrophysics Data System (ADS)

Shao, Quanxi; Dutta, Dushmanta; Karim, Fazlul; Petheram, Cuan

2018-01-01

Streamflow discharge is a fundamental dataset required to effectively manage water and land resources. However, developing robust stage - discharge relationships called rating curves, from which streamflow discharge is derived, is time consuming and costly, particularly in remote areas and especially at high stage levels. As a result stage - discharge relationships are often heavily extrapolated. Hydrodynamic (HD) models are physically based models used to simulate the flow of water along river channels and over adjacent floodplains. In this paper we demonstrate a method by which a HD model can be used to generate a 'synthetic' stage - discharge relationship at high stages. The method uses a both-side Box-Cox transformation to calibrate the synthetic rating curve such that the regression residuals are as close to the normal distribution as possible. By doing this both-side transformation, the statistical uncertainty in the synthetically derived stage - discharge relationship can be calculated. This enables people trying to make decisions to determine whether the uncertainty in the synthetically generated rating curve at high stage levels is acceptable for their decision. The proposed method is demonstrated in two streamflow gauging stations in north Queensland, Australia.

Diagnosis of Nipple Discharge: Value of Magnetic Resonance Imaging and Ultrasonography in Comparison with Ductoscopy.

PubMed

Yılmaz, Ravza; Bender, Ömer; Çelik Yabul, Fatma; Dursun, Menduh; Tunacı, Mehtap; Acunas, Gülden

2017-04-05

Pathologic nipple discharge, which is a common reason for referral to the breast imaging service, refers to spontaneous or bloody nipple discharge that arises from a single duct. The most common cause of nipple discharge is benign breast lesions, such as solitary intraductal papilloma and papillomatosis. Nevertheless, in rare cases, a malignant cause of nipple discharge can be found. To study the diagnostic value of ultrasonography, magnetic resonance imaging, and ductoscopy in patients with pathologic nipple discharge, compare their efficacy, and investigate the importance of magnetic resonance imaging in the diagnosis of intraductal pathologies. Diagnostic accuracy study. Fifty patients with pathologic nipple discharge were evaluated by ultrasonography and magnetic resonance imaging. Of these, 44 ductoscopic investigations were made. The patients were classified according to magnetic resonance imaging, ultrasonography, and ductoscopy findings. A total of 25 patients, whose findings were reported as intraductal masses, underwent surgery oincluding endoscopic excision for two endoscopic excision. Findings were compared with the pathology results that were accepted as the gold standard in the description of the aetiology of nipple discharge. In addition, magnetic resonance imaging, ultrasonography and ductoscopy findings were analysed comparatively in patients who had no surgery. Intraductal masses were reported in 26 patients, 20 of whom operated and established accurate diagnosis of 18 patients on magnetic resonance imaging. According to the ultrasonography, intraductal masses were identified in 22 patients, 17 of whom underwent surgery. Ultrasonography established accurate diagnoses in 15 patients. Intraductal mass was identified in 22 patients and ductoscopy established accurate diagnoses based on histopathologic results in 16 patients. The sensitivities of methods were 75% in ultrasonography, 90% in magnetic resonance imaging, and 94.6% in ductoscopy. The specificities were 66.7% in ultrasonography, 66.7% in magnetic resonance imaging, and 40% in ductoscopy. Intraductal papillomas were mostly observed as oval nodules with well-circumscribed smooth margins within dilated ducts and persistant in the dynamic analysis. Lesions that protruded into the lumen of the ducts, either solitary or multiple, were characteristic ductoscopy findings of our patients who were diagnosed as having papilloma/papillomatosis. Magnetic resonance imaging and ductoscopy had no statistical superiority over each other, however they were superior to ultrasonography in the diagnosis of pathologic nipple discharge. Magnetic resonance imaging may be highly sensitive for diagnosing nipple discharge with new techniques and sequences and a non-invasive method that more advantageous for showing ductal tree visualization and is able to detect completely obstructed intraductal lesions.

The Effect of Mississippi River Discharge on the Concentration and Composition of Particulate Matter along the Texas-Louisiana Shelf during Summers 2012 and 2013

NASA Astrophysics Data System (ADS)

Richardson, M. J.; Zuck, N.; Gardner, W. D.

2016-02-01

Flow from the Mississippi-Atchafalaya River System generally peaks during the spring freshet, discharging nutrient-rich fresh water and sediment into the northern Gulf of Mexico. The peak discharge varies year to year as a result of varying drought or flood conditions in the Mississippi watershed. When compared to an 8-year climatological average, summer 2012 is characterized by low discharge into the northern Gulf of Mexico, whereas summer 2013 is characterized by average discharge conditions. Water samples were collected during four cruises during June and August of 2012 and 2013 to assess the changes in concentration and composition of bulk particulate matter. While no consistent relationship between particulate matter composition and hypoxia was observed, there are several statistically significant seasonal and inter-annual changes in the concentration and composition of particulate matter associated with varying river discharge. There is also evidence that some sub-pycnocline turbidity and chlorophyll-a may be due to in situ primary productivity, rather than settled plankton containing chlorophyll-a.

Density matters: Review of approaches to setting organism-based ballast water discharge standards

USGS Publications Warehouse

Lee II,; Frazier,; Ruiz,

2010-01-01

As part of their effort to develop national ballast water discharge standards under NPDES permitting, the Office of Water requested that WED scientists identify and review existing approaches to generating organism-based discharge standards for ballast water. Six potential approaches were identified and the utility and uncertainties of each approach was evaluated. During the process of reviewing the existing approaches, the WED scientists, in conjunction with scientists at the USGS and Smithsonian Institution, developed a new approach (per capita invasion probability or "PCIP") that addresses many of the limitations of the previous methodologies. THE PCIP approach allows risk managers to generate quantitative discharge standards using historical invasion rates, ballast water discharge volumes, and ballast water organism concentrations. The statistical power of sampling ballast water for both the validation of ballast water treatment systems and ship-board compliance monitoring with the existing methods, though it should be possible to obtain sufficient samples during treatment validation. The report will go to a National Academy of Sciences expert panel that will use it in their evaluation of approaches to developing ballast water discharge standards for the Office of Water.

Latent topic discovery of clinical concepts from hospital discharge summaries of a heterogeneous patient cohort.

PubMed

Lehman, Li-Wei; Long, William; Saeed, Mohammed; Mark, Roger

2014-01-01

Patients in critical care often exhibit complex disease patterns. A fundamental challenge in clinical research is to identify clinical features that may be characteristic of adverse patient outcomes. In this work, we propose a data-driven approach for phenotype discovery of patients in critical care. We used Hierarchical Dirichlet Process (HDP) as a non-parametric topic modeling technique to automatically discover the latent "topic" structure of diseases, symptoms, and findings documented in hospital discharge summaries. We show that the latent topic structure can be used to reveal phenotypic patterns of diseases and symptoms shared across subgroups of a patient cohort, and may contain prognostic value in stratifying patients' post hospital discharge mortality risks. Using discharge summaries of a large patient cohort from the MIMIC II database, we evaluate the clinical utility of the discovered topic structure in identifying patients who are at high risk of mortality within one year post hospital discharge. We demonstrate that the learned topic structure has statistically significant associations with mortality post hospital discharge, and may provide valuable insights in defining new feature sets for predicting patient outcomes.

Prevalence of vaginal candidiasis among pregnant women with abnormal vaginal discharge in Maiduguri.

PubMed

Ibrahim, S M; Bukar, M; Mohammed, Y; Mohammed, B; Yahaya, M; Audu, B M; Ibrahim, H M; Ibrahim, H A

2013-01-01

Pregnancy represents a risk factor in the occurrence of vaginal candidiasis. To determine the prevalence and clinical features associated with abnormal vaginal discharge and C. albicans infection in pregnant women. High vaginal swab samples and data on epidemiological characteristics were collected from 400 pregnant women with complaints of abnormal vaginal discharge at booking clinic of University of Maiduguri Teaching Hospital. The data was analysed using SPSS 16.0 statistical software. The prevalence of abnormal vaginal discharge in pregnancy was 31.5%. The frequency of abnormal vaginal discharge was 183 (45.8%) among those aged 20-24 years, 291 (72.8%) in multipara, 223 (55.8%) in those with Primary education and 293 (73.2%) in unemployed. Vulval pruritus 300 (75.0%) was significantly related to abnormal vaginal discharge (P < 0.001). The prevalence of C. albicans was 41%. The frequencies of Vulval itching, Dyspareunia and vulval excoriation among those with candidiasis were 151 (50.3%), 14 (56.0%) and 75 (75.0%) respectively (P < 0.001). The prevalence of abnormal vaginal discharge in pregnancy was high in this study and C. albicans was the commonest cause. It is recommended that a pregnant woman complaining of abnormal vaginal discharge be assessed and Laboratory diagnosis done in order to give appropriate treatment.

Society of vascular surgery vascular registry comparison of carotid artery stenting outcomes for atherosclerotic vs nonatherosclerotic carotid artery disease.

PubMed

White, Rodney A; Sicard, Gregorio A; Zwolak, Robert M; Sidawy, Anton N; Schermerhorn, Marc L; Shackelton, Rebecca J; Siami, Flora Sandra

2010-05-01

The Vascular Registry (VR) on carotid procedures collects long-term outcomes on carotid artery stenting (CAS) and carotid endarterectomy (CEA) patients. The purpose of this report is to describe in-hospital and 30-day CAS outcomes in patients with atherosclerotic carotid artery disease (CAD; atherosclerosis [ATH]) compared to recurrent carotid stenosis (RES) and radiation-induced stenosis (RAD). The VR collects provider-reported data on CAS using a Web-based data management system. For this report, data were analyzed at the preprocedure, procedure, predischarge, and 30-day intervals. As of November 20, 2008, there were 4017 patients with CAS with discharge data, of which 72% were due to ATH. A total of 2321 patients were available for 30-day outcomes analysis (1623 ATH, 529 restenosis, 119 radiation, 17 dissection, 3 trauma, and 30 other). Baseline demographics showed that ATH occurred in older patients (72-years-old), had the greatest history of coronary artery disease (CAD; 62%), myocardial infarction (MI; 24%), valvular heart disease (8%), arrhythmia (16%), congestive heart failure (CHF; 16%), diabetes mellitus (DM; 35%), and chronic obstructive pulmonary disease (COPD; 20%). RES had a higher degree of baseline stenosis (87.0 vs 85.8 ATH; P = .010), were less likely to be symptomatic (35.5% vs 46.3% ATH; P < .001), but had a greater history of hypertension, peripheral vascular disease (PVD), and smoking. RAD was seen in younger patients (66.6 vs 71.7 ATH; P < .001), were more likely to be male (78.2% vs 60.9% ATH; P < .001), and had less comorbidities overall, with the exception of amaurosis fugax, smoking, and cancer. The only statistically significant difference in perioperative rates was in transient ischemic attack (TIA; 2.7% ATH vs 0.9% RES; P = .02). There were no statistically significant differences in in-hospital death/stroke/MI (ATH 5.4%, RES 3.8%, RAD 4.2%) or at 30 days (ATH 7.1%, RES 5.1%, RAD 5.0%). Even after adjusting for age, gender, symptomatology, CHF, and renal failure, the only statistically significant difference at 30 days was amaurosis fugax between ATH and RAD (odds ratio [OR] 0.13; P = .01). Although patients with ATH have statistically significant comorbidities, they did not have statistically significant increased rates of death/stroke/MI during hospitalization or within 30 days after discharge when compared to RES or RAD. The CAS event rates for ATH vs RES and RAD are similar, despite prior published reports. Symptomatic ATH have statistically significant higher rates of death/stroke/MI compared to asymptomatic cohort. Finally, consistent and accurate entry of long-term data beyond initial hospitalization is essential to fully assess CAS outcomes since a significant number of adverse events occur in the interval from hospital discharge to 30 days. Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

A Method of Calculating Functional Independence Measure at Discharge from Functional Independence Measure Effectiveness Predicted by Multiple Regression Analysis Has a High Degree of Predictive Accuracy.

PubMed

Tokunaga, Makoto; Watanabe, Susumu; Sonoda, Shigeru

2017-09-01

Multiple linear regression analysis is often used to predict the outcome of stroke rehabilitation. However, the predictive accuracy may not be satisfactory. The objective of this study was to elucidate the predictive accuracy of a method of calculating motor Functional Independence Measure (mFIM) at discharge from mFIM effectiveness predicted by multiple regression analysis. The subjects were 505 patients with stroke who were hospitalized in a convalescent rehabilitation hospital. The formula "mFIM at discharge = mFIM effectiveness × (91 points - mFIM at admission) + mFIM at admission" was used. By including the predicted mFIM effectiveness obtained through multiple regression analysis in this formula, we obtained the predicted mFIM at discharge (A). We also used multiple regression analysis to directly predict mFIM at discharge (B). The correlation between the predicted and the measured values of mFIM at discharge was compared between A and B. The correlation coefficients were .916 for A and .878 for B. Calculating mFIM at discharge from mFIM effectiveness predicted by multiple regression analysis had a higher degree of predictive accuracy of mFIM at discharge than that directly predicted. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

[A cross-correlational analysis of the background neuronal pulse trains in surviving slices of the guinea pig neocortex].

PubMed

Bortnik, A T; Iakupova, L P

1991-01-01

Cross-correlation analysis of interdependence of the background spike activity was carried out for pairs of adjacent neurons simultaneously recorded in the incubated slices of the neocortex of guinea-pig. Statistical correlation of spike discharges was detected in 16 out of 26 recorded pairs of the neurons. Significant correlation was observed mainly in the range of +/- 100 ms from the null point. Cross-correlation had symmetric or asymmetric maxima up to 150 ms long and negative shifts up to 200 ms long. More complex positive-negative types of cross-correlations were also obtained. The data were compared to those known from other authors for the intact brain. The contribution of intrinsic intracortical interactions and extrinsic afferent influences in these correlations of activity is discussed.

Intervening to promote early initiation of breastfeeding in the LDR.

PubMed

Komara, Carol; Simpson, Diana; Teasdale, Carla; Whalen, Gaye; Bell, Shay; Giovanetto, Laurie

2007-01-01

To evaluate the effectiveness of an interventional protocol for the early initiation of breastfeeding that would remove barriers in the labor, delivery, recovery (LDR) unit. Descriptive design using 100 postpartum mothers who were interviewed before discharge at a large university hospital in the south-central United States. Descriptive statistics were used for analysis. The protocol was effective for initiating breastfeeding, and breastfeeding increased from 53% to 66%. When barriers to breastfeeding are reduced in the LDR setting, women will breastfeed. It is possible that reducing hospital barriers to breastfeeding in the LDR can also set the stage for sustained breastfeeding during hospitalization and for less supplementation with formula.

Statistical analysis of water-level, springflow, and streamflow data for the Edwards Aquifer in south-central Texas

USGS Publications Warehouse

Puente, Celso

1976-01-01

Water-level, springflow, and streamflow data were used to develop simple and multiple linear-regression equations for use in estimating water levels in wells and the flow of three major springs in the Edwards aquifer in the eastern San Antonio area. The equations provide daily, monthly, and annual estimates that compare very favorably with observed data. Analyses of geologic and hydrologic data indicate that the water discharged by the major springs is supplied primarily by regional underflow from the west and southwest and by local recharge in the infiltration area in northern Bexar, Comal, and Hays Counties.

Risks of atrial fibrillation and death at discharge after thrombolysis in stroke patients: Northumbrian Sentinel Stroke Audit, 2013-2015.

PubMed

Shiue, I

2017-02-01

The aim of this study was to examine risks of atrial fibrillation and death at discharge in stroke patients treated with thrombolysis in a subregional setting covering full calendar years with a clear study catchment drawn serving as a confirmatory statistical analysis from the northeast of England in the last 2 years. Data between 16 June, 2013 and 15 June, 2015 were extracted from Sentinel Stroke National Audit Programme in Northumbria Healthcare NHS Foundation Trust that has covered health service for Northumberland and North Tyneside. The very old people aged 80 and above were less likely to have thrombolysis treatment, while there was no sex difference observed. Moreover, thrombolysis treatment was more likely to be given in ischemic patients with severe stroke symptoms. There was no difference in comorbidities including atrial fibrillation, congestive heart failure, diabetes, hypertension, and stroke/TIA as well. Those who received thrombolysis treatment were more likely to have atrial fibrillation or die at discharge. The ORs were higher after additionally adjusting for comorbidities. Similarly, these patients also had poorer scoring in modified Rankin scale than those who did not receive thrombolysis treatment. However, there was no difference at 6 months after survival. For future research, clinical outcomes in addition to atrial fibrillation and quality of life both at discharge and 6 months after thrombolysis treatment should be included for examination as well. For clinical practice, giving thrombolysis treatment in hospitals might need to be reconsidered if clinical outcomes were actually worse than not. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Examining patient comprehension of emergency department discharge instructions: Who says they understand when they do not?

PubMed

Lin, Margaret Jane; Tirosh, Adva Gutman; Landry, Alden

2015-12-01

Patient comprehension of emergency department (ED) discharge instructions is important for ensuring that patients understand their diagnosis, recommendations for treatment, appropriate follow-up, and reasons to return. However, many patients may not fully understand their instructions. Furthermore, some patients may state they understand their instructions even when they do not. We surveyed 75 patients on their perception of their understanding of their ED discharge instructions, and asked them specific questions about the instructions. We also performed a chart review, and examined patients' answers for correlation with the written instructions and medical chart. We then performed a statistical analysis evaluating which patients claimed understanding but who were found to have poor understanding on chart review. Overall, there was no significant correlation between patient self-reported understanding and physician evaluation of their understanding (ρ = 0.221, p = 0.08). However, among female patients and patients with less than 4 years of college, there was significant positive correlation between self-report and physician evaluation of comprehension (ρ = 0.326, p = 0.04 and ρ = 0.344, p = 0.04, respectively), whereas there was no correlation for male patients and those with more than 16 years of education (ρ = 0.008, p = 0.9, ρ = -0.041, p = 0.84, respectively). Patients' perception of their understanding may not be accurate, especially among men, and those with greater than college education. Identifying which patients say they understand their discharge instructions, but may actually have poor comprehension could help focus future interventions on improving comprehension.

Randomized clinical trial of hydrocodone/acetaminophen versus codeine/acetaminophen in the treatment of acute extremity pain after emergency department discharge.

PubMed

Chang, Andrew K; Bijur, Polly E; Munjal, Kevin G; John Gallagher, E

2014-03-01

The objective was to test the hypothesis that hydrocodone/acetaminophen (Vicodin [5/500]) provides more efficacious analgesia than codeine/acetaminophen (Tylenol #3 [30/300]) in patients discharged from the emergency department (ED). Both are currently Drug Enforcement Administration (DEA) Schedule III narcotics. This was a prospective, randomized, double-blind, clinical trial of patients with acute extremity pain who were discharged home from the ED, comparing a 3-day supply of oral hydrocodone/acetaminophen (5 mg/500 mg) to oral codeine/acetaminophen (30 mg/300 mg). Pain was measured on a valid and reproducible verbal numeric rating scale (NRS) ranging from 0 to 10, and patients were contacted by telephone approximately 24 hours after being discharged. The primary outcome was the between-group difference in improvement in pain at 2 hours following the most recent ingestion of the study drug, relative to the time of phone contact after ED discharge. Secondary outcomes compared side-effect profiles and patient satisfaction. The median time from ED discharge to follow-up was 26 hours (interquartile range [IQR] = 24 to 39 hours). The mean NRS pain score before the most recent dose of pain medication after ED discharge was 7.6 NRS units for both groups. The mean decrease in pain scores 2 hours after pain medications were taken were 3.9 NRS units in the hydrocodone/acetaminophen group versus 3.5 NRS units in the codeine/acetaminophen group, for a difference of 0.4 NRS units (95% confidence interval [CI] = -0.3 to 1.2 NRS units). No differences were found in side effects or patient satisfaction. Both medications decreased NRS pain scores by approximately 50%. However, the oral hydrocodone/acetaminophen failed to provide clinically or statistically superior pain relief compared to oral codeine/acetaminophen when prescribed to patients discharged from the ED with acute extremity pain. Similarly, there were no clinically or statistically important differences in side-effect profiles or patient satisfaction. If the DEA reclassifies hydrocodone as a Schedule II narcotic, as recently recommended by its advisory board, our data suggest that the codeine/acetaminophen may be a clinically reasonable Schedule III substitute for hydrocodone/acetaminophen at ED discharge. These findings should be regarded as tentative and require independent validation in similar and other acute pain models. © 2014 by the Society for Academic Emergency Medicine.

Peak discharge, flood frequency, and peak stage of floods on Big Cottonwood Creek at U.S. Highway 50 near Coaldale, Colorado, and Fountain Creek below U.S. Highway 24 in Colorado Springs, Colorado, 2016

USGS Publications Warehouse

Kohn, Michael S.; Stevens, Michael R.; Mommandi, Amanullah; Khan, Aziz R.

2017-12-14

The U.S. Geological Survey (USGS), in cooperation with the Colorado Department of Transportation, determined the peak discharge, annual exceedance probability (flood frequency), and peak stage of two floods that took place on Big Cottonwood Creek at U.S. Highway 50 near Coaldale, Colorado (hereafter referred to as “Big Cottonwood Creek site”), on August 23, 2016, and on Fountain Creek below U.S. Highway 24 in Colorado Springs, Colorado (hereafter referred to as “Fountain Creek site”), on August 29, 2016. A one-dimensional hydraulic model was used to estimate the peak discharge. To define the flood frequency of each flood, peak-streamflow regional-regression equations or statistical analyses of USGS streamgage records were used to estimate annual exceedance probability of the peak discharge. A survey of the high-water mark profile was used to determine the peak stage, and the limitations and accuracy of each component also are presented in this report. Collection and computation of flood data, such as peak discharge, annual exceedance probability, and peak stage at structures critical to Colorado’s infrastructure are an important addition to the flood data collected annually by the USGS.The peak discharge of the August 23, 2016, flood at the Big Cottonwood Creek site was 917 cubic feet per second (ft3/s) with a measurement quality of poor (uncertainty plus or minus 25 percent or greater). The peak discharge of the August 29, 2016, flood at the Fountain Creek site was 5,970 ft3/s with a measurement quality of poor (uncertainty plus or minus 25 percent or greater).The August 23, 2016, flood at the Big Cottonwood Creek site had an annual exceedance probability of less than 0.01 (return period greater than the 100-year flood) and had an annual exceedance probability of greater than 0.005 (return period less than the 200-year flood). The August 23, 2016, flood event was caused by a precipitation event having an annual exceedance probability of 1.0 (return period of 1 year, or the 1-year storm), which is a statistically common (high probability) storm. The Big Cottonwood Creek site is downstream from the Hayden Pass Fire burn area, which dramatically altered the hydrology of the watershed and caused this statistically rare (low probability) flood from a statistically common (high probability) storm. The peak flood stage at the cross section closest to the U.S. Highway 50 culvert was 6,438.32 feet (ft) above the North American Datum of 1988 (NAVD 88).The August 29, 2016, flood at the Fountain Creek site had an estimated annual exceedance probability of 0.5505 (return period equal to the 1.8-year flood). The August 29, 2016, flood event was caused by a precipitation event having an annual exceedance probability of 1.0 (return period of 1 year, or the 1-year storm). The peak stage during this flood at the cross section closest to the U.S. Highway 24 bridge was 5,832.89 ft (NAVD 88).Slope-area indirect discharge measurements were carried out at the Big Cottonwood Creek and Fountain Creek sites to estimate peak discharge of the August 23, 2016, flood and August 29, 2016, flood, respectively. The USGS computer program Slope-Area Computation Graphical User Interface was used to compute the peak discharge by adding the surveyed cross sections with Manning roughness coefficient assignments to the high-water marks. The Manning roughness coefficients for each cross section were estimated in the field using the Cowan method.

Statistical properties of gravity-driven granular discharge flow under the influence of an obstacle

NASA Astrophysics Data System (ADS)

Endo, Keita; Katsuragi, Hiroaki

2017-06-01

Two-dimensional granular discharge flow driven by gravity under the influence of an obstacle is experimentally investigated. A horizontal exit of width W is opened at the bottom of vertical Hele-Shaw cell filled with stainless-steel particles to start the discharge flow. In this experiment, a circular obstacle is placed in front of the exit. Thus, the distance between the exit and obstacle L is also an important parameter. During the discharge, granular-flow state is acquired by a high-speed camera. The bulk discharge-flow rate is also measured by load cell sensors. The obtained high-speed-image data are analyzed to clarify the particle-level granular-flow dynamics. Using the measured data, we find that the obstacle above the exit affects the granular- flow field. Specifically, the existence of obstacle results in large horizontal granular temperature and small packing fraction. This tendency becomes significant when L is smaller than approximately 6Dg when W ≃ 4Dg, where Dg is diameter of particles.

Risk factors for superficial surgical site infection after elective rectal cancer resection: a multivariate analysis of 8880 patients from the American College of Surgeons National Surgical Quality Improvement Program database.

PubMed

Sutton, Elie; Miyagaki, Hiromichi; Bellini, Geoffrey; Shantha Kumara, H M C; Yan, Xiaohong; Howe, Brett; Feigel, Amanda; Whelan, Richard L

2017-01-01

Superficial surgical site infection (sSSI) is one of the most common complications after colorectal resection. The goal of this study was to determine the comorbidities and operative characteristics that place patients at risk for sSSI in patients who underwent rectal cancer resection. The American College of Surgeons National Surgical Quality Improvement Program database was queried (via diagnosis and Current Procedural Terminology codes) for patients with rectal cancer who underwent elective resection between 2005 and 2012. Patients for whom data concerning 27 demographic factors, comorbidities, and operative characteristics were available were eligible. A univariate and multivariate analysis was performed to identify possible risk factors for sSSI. A total of 8880 patients met the entry criteria and were included. sSSIs were diagnosed in 861 (9.7%) patients. Univariate analysis found 14 patients statistically significant risk factors for sSSI. Multivariate analysis revealed the following risk factors: male gender, body mass index (BMI) >30, current smoking, history of chronic obstructive pulmonary disease (COPD), American Society of Anesthesiologists III/IV, abdominoperineal resection (APR), stoma formation, open surgery (versus laparoscopic), and operative time >217 min. The greatest difference in sSSI rates was noted in patients with COPD (18.9 versus 9.5%). Of note, 54.2% of sSSIs was noted after hospital discharge. With regard to the timing of presentation, univariate analysis revealed a statistically significant delay in sSSI presentation in patients with the following factors and/or characteristics: BMI <30, previous radiation therapy (RT), APR, minimally invasive surgery, and stoma formation. Multivariate analysis suggested that only laparoscopic surgery (versus open) and preoperative RT were risk factors for delay. Rectal cancer resections are associated with a high incidence of sSSIs, over half of which are noted after discharge. Nine patient and operative characteristics, including smoking, BMI, COPD, APR, and open surgery were found to be significant risk factors for SSI on multivariate analysis. Furthermore, sSSI presentation in patients who had laparoscopic surgery and those who had preoperative RT is significantly delayed for unclear reasons. Copyright © 2016 Elsevier Inc. All rights reserved.

Hydrological similarity approach and rainfall satellite utilization for mini hydro power dam basic design (case study on the ungauged catchment at West Borneo, Indonesia)

NASA Astrophysics Data System (ADS)

Prakoso, W. G.; Murtilaksono, K.; Tarigan, S. D.; Purwanto, Y. J.

2018-05-01

An approach on flow duration and flood design estimation on the ungauged catchment with no rainfall and discharge data availability was been being develop with hydrological modelling including rainfall run off model implemented with watershed characteristic dataset. Near real time Rainfall data from multi satellite platform e.g. TRMM can be utilized for regionalization approach on the ungauged catchment. Watershed hydrologically similarity analysis were conducted including all of the major watershed in Borneo which was predicted to be similar with the Nanga Raun Watershed. It was found that a satisfactory hydrological model calibration could be achieved using catchment weighted time series of TRMM daily rainfall data, performed on nearby catchment deemed to be sufficiently similar to Nanga Raun catchment in hydrological terms. Based on this calibration, rainfall runoff parameters were then transferred to a model. Relatively reliable flow duration curve and extreme discharge value estimation were produced with reasonable several limitation. Further approach may be performed in order to deal with the primary limitations inherent in the hydrological and statistical analysis, especially to give prolongation to the availability of the rainfall and climate data with some novel approach like downscaling of global climate model.

Spatial distribution, enrichment, and source of environmentally important elements in Batticaloa lagoon, Sri Lanka.

PubMed

Adikaram, Madurya; Pitawala, Amarasooriya; Ishiga, Hiroaki; Jayawardana, Daham

2017-01-01

The present paper is the first documentation of distribution and contamination status of environmentally important elements of superficial sediments in the Batticaloa lagoon that is connected to the largest bay of the world. Surface sediment samples were collected from 34 sites covering all over the lagoon. Concentrations of elements such as As, Cr, Cu, Fe, Nb, Ni, Pb, Sc, Sr, Th, V, Y, Zn, and Zr were measured by X-ray florescence analysis. Geochemically, the lagoon has three different zones that were influenced mainly by fresh water sources, marine fronts, and intermediate mixing zones. The marine sediment quality standards indicate that Zr and Th values are exceeded throughout the lagoon. According to the freshwater sediment quality standards, Cr levels of all sampling sites exceed the threshold effect level (TEL) and 17 % of them are even above the probable effect level (PEL). Most sampling sites of the channel discharging areas show minor enrichment of Cu, Ni, and Zn with respect to the TEL. Contamination indices show that the lagoon mouth area is enriched with As. Statistical analysis implies that discharges from agricultural channel and marine fluxes of the lagoon effects on the spatial distribution of measured elements. Further research is required to understand the rate of contamination in the studied marine system.

Statistical properties of edge plasma turbulence in the Large Helical Device

NASA Astrophysics Data System (ADS)

Dewhurst, J. M.; Hnat, B.; Ohno, N.; Dendy, R. O.; Masuzaki, S.; Morisaki, T.; Komori, A.

2008-09-01

Ion saturation current (Isat) measurements made by three tips of a Langmuir probe array in the Large Helical Device are analysed for two plasma discharges. Absolute moment analysis is used to quantify properties on different temporal scales of the measured signals, which are bursty and intermittent. Strong coherent modes in some datasets are found to distort this analysis and are consequently removed from the time series by applying bandstop filters. Absolute moment analysis of the filtered data reveals two regions of power-law scaling, with the temporal scale τ ≈ 40 µs separating the two regimes. A comparison is made with similar results from the Mega-Amp Spherical Tokamak. The probability density function is studied and a monotonic relationship between connection length and skewness is found. Conditional averaging is used to characterize the average temporal shape of the largest intermittent bursts.

Experiences of patients undergoing pulmonary rehabilitation during an exacerbation of chronic respiratory disease.

PubMed

Vincent, Emma E; Chaplin, Emma J; Williams, Johanna Ea; Harvey-Dunstan, Theresa; Greening, Neil J; Steiner, Michael C; Morgan, Mike D; Singh, Sally J

2017-08-01

Chronic obstructive pulmonary disease (COPD) is characterized in the later stages by acute exacerbations that often require hospitalization. Pulmonary rehabilitation is recommended for patients with COPD to aid symptom control, improve quality of life and increase physical activity. We have previously reported a large intervention trial commenced during a hospital admission. The aim of this sub-study was to evaluate the patients' experiences of discharge following the hospitalization for an acute exacerbation of COPD. During a programme of early rehabilitation (ER) patient perceptions, experiences and healthcare use were collated during the month that followed their discharge. ER (started during their admission) was comprised of exercise training techniques that were modified to suit the environment of acute illness, together with an education and self-management programme. Each patient was then supported on the programme by telephone contact, following their discharge home, at 48 hours, 2 weeks and 4 weeks. We collected information in relation to the walking and exercise progression; we monitored patient recall of healthcare use, compliance/understanding of medical therapy, as well as their wider perceptions that may have influenced the recovery process. Healthcare use was captured using GP records and data analysis. Of the 100 patients, 47 males, (mean (standard deviation)) 71 (9.3) years, FEV 1 1.14 L (0.6), BMI 26.6 (6.9), pack smoked years 45.8 (29.6), ethnicity White British 97%, were discharged home following an acute exacerbation of their respiratory symptoms, to an ER programme. At 48 hours following discharge, a minority (20%) of patients stated their symptoms were 'feeling better'; 15% highlighted that they found the prescribed 'exercise difficult'; 44% of patients felt at the end of the month that prescribed exercise programme had a 'positive effect' on their recovery from their exacerbation; 38% of patients felt their family had a positive effect on their recovery; 11% felt their family hindered. Patients reported a mean confidence score of 8.21 (2.1) for exercise that did not vary over the three contacts ( p = 0.166). A similar mean confidence score of 7.76 (2.6) was reported for walking with a non-statistical change also noted ( p = 0.223). When patient recall of primary health care contact was compared with actual use, there was statistical significance shown ( p = 0.002); patients underestimated the amount of care they received. The data indicate that patients do recover at home within the support of an early intervention. Patients are positive about the benefit of ER in the process of recovery; however, this is uncontrolled data.

Transfer of preterm infants from incubator to open cot at lower versus higher body weight.

PubMed

New, Karen; Flenady, Vicki; Davies, Mark W

2011-09-07

A key criterion for discharging preterm infants home from nurseries is their ability to maintain temperature once transferred from incubators to open cots. The timing of transfer is important given the preterm infant's immature thermoregulatory mechanisms. To determine the effects of body weight in transferring preterm infants from incubators to unheated open cots. Electronic databases, the Cochrane Central Register of Controlled Trials, clinical trials registers and the abstracts of the Society for Pediatric Research were searched. Randomised and quasi-randomised controlled trials comparing transfer of preterm infants from incubators to unheated open cots at lower and higher body weights. Data collection and analysis was performed in accordance with the methods of the Cochrane Neonatal Review Group. Four eligible studies were identified. Two of the identified trials were assessed as having good methodological quality. Two studies reported daily weight gain (calculated as growth velocity); the lower body weight group had a significantly greater daily weight gain [pooled mean difference (MD) 2.66 (95% confidence interval (CI)1.37 to 3.95). One study reported a larger proportion of infants transferred at the higher body weight had an episode of low temperature in the first 72 hours; while no difference between the two groups was found in the proportion of infants experiencing cold stress post-transfer to discharge. Two studies report no difference between the two groups in requiring an overhead heater for temperature maintenance [pooled RR 1.43 (95% CI 0.35 to 1.18). No statistically significant difference was shown for proportion of infants returning to an incubator [three studies (N = 336) [pooled RR 1.78 (95% CI 0.77 to 4.08].Two studies report there was no statistically significant difference in time spent in an open cot post transfer to discharge; while one study found infants transferred at lower weights had a significantly reduced length of stay [MD -9.00 (95% CI -13.29 to -4.71), a second study found no differences between the two groups [MD 0.30 (95% CI -5.11 to 5.71). In these two studies not breastfeeding at discharge was not significantly different between the lower and higher body weight groups [pooled RR 1.02 (95% CI 0.69 to 1.51). Medically stable preterm infants can be transferred to unheated open cots at a lower body weight of 1600 grams without adverse effects on temperature stability or weight gain. Earlier transfer does not necessarily result in earlier discharge.

Characterization of spatial and temporal variability in hydrochemistry of Johor Straits, Malaysia.

PubMed

Abdullah, Pauzi; Abdullah, Sharifah Mastura Syed; Jaafar, Othman; Mahmud, Mastura; Khalik, Wan Mohd Afiq Wan Mohd

2015-12-15

Characterization of hydrochemistry changes in Johor Straits within 5 years of monitoring works was successfully carried out. Water quality data sets (27 stations and 19 parameters) collected in this area were interpreted subject to multivariate statistical analysis. Cluster analysis grouped all the stations into four clusters ((Dlink/Dmax) × 100<90) and two clusters ((Dlink/Dmax) × 100<80) for site and period similarities. Principal component analysis rendered six significant components (eigenvalue>1) that explained 82.6% of the total variance of the data set. Classification matrix of discriminant analysis assigned 88.9-92.6% and 83.3-100% correctness in spatial and temporal variability, respectively. Times series analysis then confirmed that only four parameters were not significant over time change. Therefore, it is imperative that the environmental impact of reclamation and dredging works, municipal or industrial discharge, marine aquaculture and shipping activities in this area be effectively controlled and managed. Copyright © 2015 Elsevier Ltd. All rights reserved.

Impact of Deforestation and Recovery on Streamflow Recession Statistics

NASA Astrophysics Data System (ADS)

Krapu, C.; Kumar, M.

2016-12-01

Deforestation is known to influence streamflow and baseflow in particular in sub-humid environments. Baseflow contributions to the recession limb of a flood hydrograph convey information about subsurface stores from which trees also draw water. Recent works based on the assumptions outlined by Brutsaert and Nieber (1977) have proposed analyzing streamflow recession curves on a per-event basis. In this framework, each event's recession curve is governed by a power law relation with per-event scale and shape coefficients. As streamflow recession depends in part upon evapotranspiration demand from trees, these coefficients are hypothesized to contain useful information about catchment vegetation. Analysis was conducted of 13 small experimental catchments in the eastern United States with known forest treatment histories to determine whether or not streamflow recession behavior as observed from daily discharge records could serve as an indicator of deforestation in the drainage basin. Power-law scale coefficients were calculated for each major stormflow event at each test site and a statistical comparison of distribution of fitted coefficients was made between pre-treatment and post-treatment events as well as between pre-treatment and post-recovery events. A second method using these fitted coefficients in conjunction with Gaussian process regression was employed to track the change in the scale coefficient in the 13 catchments described previously as well as two medium-sized catchments in the North Carolina portion of the American Piedmont which did not have extensive records of forest cover. A linear trend analysis of precipitation was performed to determine whether nonstationarity in rainfall could be a confounding cause of changes in event scale coefficients. These results show a statistically significant difference in scale coefficient values in 5/8 treatment catchments and 0/5 control catchments. This suggests that lesser alterations to forest cover may not be detectable but that this method is robust against changes in precipitation. Additionally, we found clear evidence that forest regrowth in the Piedmont sites continued from 1940-1970. As a proof-of-concept, this work suggests that major alterations to forest cover can be inferred from daily data of stream discharge.

Recherche d'une politique de gestion des stocks d'eau de barrages-réservoirs en vue de soutenir les étiages. 1. Élaboration d'un modèle alterné annuel apports-déficits

NASA Astrophysics Data System (ADS)

Bocquillon, C.; Masson, J. M.

1983-01-01

Lack of water supply during periods of deficient flow affects the economic potentiality of the great river valleys which are the most developed areas in the country. Reservoir dams built in the upper stream catchments store excess flow and provide controlled release in the dry season. Capital costs of construction and the consequences of failures justify a thorough study of operating rules. The low flows and conditional variability of availability of water call for carry-over procedures (reservoir capacity is sometimes greater than the mean available water). It is not possible to predict future sequence of flows, thus the carry-over rule is a statistical decision-making tool. The flow data are only one of the very many possible sources of information. But the analysis of flow data provides us with statistical measures to generate long series of synthetic inflows associated with summer deficits. A simplification has been introduced by choosing only the values which are absolutely necessary for optimal management research: available water volumes and reserve volumes for a flow threshold. Yearly alternate periods of excess and deficiency of water are defined by the values above and below a threshold of flow discharge at a location gage named "objective point", where the reservoir effects are to be estimated. Yearly periods are described by water volumes, either inflows into reservoirs, or deficits below various thresholds of summer flow discharges. Marginal and conditional probability distributions of these volumes and the physical laws which mark their bounds and relationships were estimated on the basis of 31 years of daily flow records. The synthetic simulated series for 1000 years was compared to records of historical levels (since 1863). Extreme events such as sequences of dry years, have return periods of comparable magnitude. This synthetic series has a similar statistical character of short historical series and makes the analysis of operating rules possible.

Effects of corticosteroids on hyposmia in persistent allergic rhinitis.

PubMed

Catana, Iuliu V; Chirila, Magdalena; Negoias, Simona; Bologa, Ramona; Cosgarea, Marcel

2013-01-01

To asses the effects of two topical nasal corticosteroids sprays on hyposmia in patients with persistent allergic rhinitis. The study was a prospective clinical trial and it included twenty four patients with persistent allergic rhinitis (PER) and hyposmia (H). The patients were divided into two groups depending on the type of corticosteroid topical nasal spray treatment: group A, 200 micrograms dose of mometasone furoate (MF) and group B, 110 micrograms dose of fluticasone furoate (FF) both administered in the morning for 4 weeks. The olfactory function of the patients was evaluated with the extended Test battery "Sniffin' Sticks". The visual analogue scale (VAS) was used for the assessment of hyposmia, nasal discharge. The level of the nasal obstruction, before and after the treatment, was evaluated through the anterior rhinomanometry. The comparisons between the two types of topical corticosteroids showed a significant improvement separately between scores of the odor threshold (OT), odor discrimination (OD) and odor identification (OI) and also on the final olfactory score (SDI) before and after 4 weeks of the treatment. The comparisons of the VAS scores pre and post treatment showed a significant improvement in hyposmia and nasal obstruction. The nasal airflow and the nasal discharge scores were improved, but the differences were not statistically significant between the groups. The final statistical analysis found no significant differences between the two patients groups. The study concludes that fluticasone furoate and mometasone furoate have quite the same effects on hyposmia and on the classical symptoms from PER.

Walking Performance: Correlation between Energy Cost of Walking and Walking Participation. New Statistical Approach Concerning Outcome Measurement

PubMed Central

Franceschini, Marco; Rampello, Anais; Agosti, Maurizio; Massucci, Maurizio; Bovolenta, Federica; Sale, Patrizio

2013-01-01

Walking ability, though important for quality of life and participation in social and economic activities, can be adversely affected by neurological disorders, such as Spinal Cord Injury, Stroke, Multiple Sclerosis or Traumatic Brain Injury. The aim of this study is to evaluate if the energy cost of walking (CW), in a mixed group of chronic patients with neurological diseases almost 6 months after discharge from rehabilitation wards, can predict the walking performance and any walking restriction on community activities, as indicated by Walking Handicap Scale categories (WHS). One hundred and seven subjects were included in the study, 31 suffering from Stroke, 26 from Spinal Cord Injury and 50 from Multiple Sclerosis. The multivariable binary logistical regression analysis has produced a statistical model with good characteristics of fit and good predictability. This model generated a cut-off value of.40, which enabled us to classify correctly the cases with a percentage of 85.0%. Our research reveal that, in our subjects, CW is the only predictor of the walking performance of in the community, to be compared with the score of WHS. We have been also identifying a cut-off value of CW cost, which makes a distinction between those who can walk in the community and those who cannot do it. In particular, these values could be used to predict the ability to walk in the community when discharged from the rehabilitation units, and to adjust the rehabilitative treatment to improve the performance. PMID:23468871

Inclusion of historical information in flood frequency analysis using a Bayesian MCMC technique: a case study for the power dam Orlík, Czech Republic

NASA Astrophysics Data System (ADS)

Gaál, Ladislav; Szolgay, Ján; Kohnová, Silvia; Hlavčová, Kamila; Viglione, Alberto

2010-01-01

The paper deals with at-site flood frequency estimation in the case when also information on hydrological events from the past with extraordinary magnitude are available. For the joint frequency analysis of systematic observations and historical data, respectively, the Bayesian framework is chosen, which, through adequately defined likelihood functions, allows for incorporation of different sources of hydrological information, e.g., maximum annual flood peaks, historical events as well as measurement errors. The distribution of the parameters of the fitted distribution function and the confidence intervals of the flood quantiles are derived by means of the Markov chain Monte Carlo simulation (MCMC) technique. The paper presents a sensitivity analysis related to the choice of the most influential parameters of the statistical model, which are the length of the historical period h and the perception threshold X0. These are involved in the statistical model under the assumption that except for the events termed as ‘historical’ ones, none of the (unknown) peak discharges from the historical period h should have exceeded the threshold X0. Both higher values of h and lower values of X0 lead to narrower confidence intervals of the estimated flood quantiles; however, it is emphasized that one should be prudent of selecting those parameters, in order to avoid making inferences with wrong assumptions on the unknown hydrological events having occurred in the past. The Bayesian MCMC methodology is presented on the example of the maximum discharges observed during the warm half year at the station Vltava-Kamýk (Czech Republic) in the period 1877-2002. Although the 2002 flood peak, which is related to the vast flooding that affected a large part of Central Europe at that time, occurred in the near past, in the analysis it is treated virtually as a ‘historical’ event in order to illustrate some crucial aspects of including information on extreme historical floods into at-site flood frequency analyses.

Clinical prediction of Gardnerella vaginalis in general practice

PubMed Central

O'Dowd, T.C.; West, R.R.

1987-01-01

In a study of 162 women with vaginal symptoms the clinical features of increased discharge, yellow discharge, 'high cheese' odour and pH greater than 5 were statistically strongly associated with the presence of Gardnerella vaginalis, confirmed by microbiological culture. The sensitivities and specificities of these clinical tests, although not as high as those of previously described sideroom tests using the amine test and microscopy for 'clue cells' nevertheless allow the clinician to predict G. vaginalis reliably and initiate treatment at first consultation. PMID:3499508

Rehabilitation activities, out-patient visits and employment in patients and partners the first year after ICU: a descriptive study.

PubMed

Agård, A S; Lomborg, K; Tønnesen, E; Egerod, I

2014-04-01

To describe the influence of critical illness on patients and their partners in relation to rehabilitation, healthcare consumption and employment during the first year after Intensive Care Unit discharge. Longitudinal, observational and descriptive. Five Danish Intensive Care Units. Data were collected from hospital charts, population registers and interviews with 18 patients and their partners at 3 and 12 months after intensive care discharge. Descriptive statistical analysis was performed. Post-discharge inpatient rehabilitation was median (range) 52 (15-174) days (n=10). Community-based training was 12 (3-34) weeks (n=15). Neuropsychological rehabilitation following brain damage was 13-20 weeks (n=3). Number of out-patient visits 1 year before and 1 year after were mean 3 versus 8, and General Practitioner visits were 12 versus 18. Three patients resumed work at pre-hospitalisation employment rates after 12 months. After the patients' stay in intensive care, partners' mean full-time sick leave was 17 (range 0-124) days and 21 (range 0-106) days part time. Partners often had long commutes. Most patients had comprehensive recovery needs requiring months of rehabilitation. Some partners needed extensive sick leave. The study reveals the human cost of critical illness and intensive care for patients and partners in the Danish welfare system. Copyright © 2013 Elsevier Ltd. All rights reserved.

Quantifying opportunities for hospital cost control: medical device purchasing and patient discharge planning.

PubMed

Robinson, James C; Brown, Timothy T

2014-09-01

To quantify the potential reduction in hospital costs from adoption of best local practices in supply chain management and discharge planning. We performed multivariate statistical analyses of the association between total variable cost per procedure and medical device price and length of stay, controlling for patient and hospital characteristics. Ten hospitals in 1 major metropolitan area supplied patient-level administrative data on 9778 patients undergoing joint replacement, spine fusion, or cardiac rhythm management (CRM) procedures in 2008 and 2010. The impact on each hospital of matching lowest local market device prices and lowest patient length of stay (LOS) was calculated using multivariate regression analysis controlling for patient demographics, diagnoses, comorbidities, and implications. Average variable costs ranged from $11,315 for joint replacement to $16,087 for CRM and $18,413 for spine fusion. Implantable medical devices accounted for a large share of each procedure's variable costs: 44% for joint replacement, 39% for spine fusion, and 59% for CRM. Device prices and patient length-of-stay exhibited wide variation across hospitals. Total potential hospital cost savings from achieving best local practices in device prices and patient length of stay are 14.5% for joint replacement, 18.8% for spine fusion;,and 29.1% for CRM. Hospitals have opportunities for cost reduction from adoption of best local practices in supply chain management and discharge planning.

A comparison of alcohol positive and alcohol negative trauma patients requiring an emergency laparotomy.

PubMed

Benson, Cedric; Weinberg, Janice; Narsule, Chaitan K; Brahmbhatt, Tejal S

2018-07-01

The effect of alcohol exposure on patients undergoing a laparotomy for trauma is unknown. The purpose of this study was to compare outcomes of morbidity and mortality between alcohol positive and alcohol negative trauma patients who required emergent laparotomies using the National Trauma Data Bank (NTDB). A retrospective database analysis was performed using 28,354 NTDB incident trauma cases, from 2007 through 2012, who had been tested for alcohol and who required abdominal operations (using ICD-9-CM procedure codes) within 24h of presentation. Variables used: age, gender, admission year, alcohol presence, ISS, GCS, injury type & mechanism, discharge status, hospital LOS, ICU stay, ventilator use, and hospital complications. In adjusted analyses, there were no statistically significant differences between the alcohol positive and alcohol negative cohorts when evaluating in-hospital mortality (OR, 0.93; 95% CI: 0.84-1.03), likelihood of earlier hospital discharge (HR, 1.02; 95% CI: 0.99-1.05), and the all-inclusive category of in-hospital complications (OR, 1.04; 95% CI: 0.97-1.12). After adjusting for age, gender, admission year, ISS, GCS, and injury mechanism, there were no major differences between the alcohol positive and alcohol negative cohorts when it came to in-hospital mortality, likelihood of earlier hospital discharge, and most of the in-hospital complications measured among adult trauma patients requiring emergency laparotomies. Copyright © 2017 Elsevier Inc. All rights reserved.

Polishing of treated palm oil mill effluent (POME) from ponding system by electrocoagulation process.

PubMed

Bashir, Mohammed J K; Mau Han, Tham; Jun Wei, Lim; Choon Aun, Ng; Abu Amr, Salem S

2016-01-01

As the ponding system used to treat palm oil mill effluent (POME) frequently fails to satisfy the discharge standard in Malaysia, the present study aimed to resolve this problem using an optimized electrocoagulation process. Thus, a central composite design (CCD) module in response surface methodology was employed to optimize the interactions of process variables, namely current density, contact time and initial pH targeted on maximum removal of chemical oxygen demand (COD), colour and turbidity with satisfactory pH of discharge POME. The batch study was initially designed by CCD and statistical models of responses were subsequently derived to indicate the significant terms of interactive process variables. All models were verified by analysis of variance showing model significances with Prob > F < 0.01. The optimum performance was obtained at the current density of 56 mA/cm(2), contact time of 65 min and initial pH of 4.5, rendering complete removal of colour and turbidity with COD removal of 75.4%. The pH of post-treated POME of 7.6 was achieved, which is suitable for direct discharge. These predicted outputs were subsequently confirmed by insignificant standard deviation readings between predicted and actual values. This optimum condition also permitted the simultaneous removal of NH3-N, and various metal ions, signifying the superiority of the electrocoagulation process optimized by CCD.

Classification of Partial Discharge Measured under Different Levels of Noise Contamination

PubMed Central

2017-01-01

Cable joint insulation breakdown may cause a huge loss to power companies. Therefore, it is vital to diagnose the insulation quality to detect early signs of insulation failure. It is well known that there is a correlation between Partial discharge (PD) and the insulation quality. Although many works have been done on PD pattern recognition, it is usually performed in a noise free environment. Also, works on PD pattern recognition in actual cable joint are less likely to be found in literature. Therefore, in this work, classifications of actual cable joint defect types from partial discharge data contaminated by noise were performed. Five cross-linked polyethylene (XLPE) cable joints with artificially created defects were prepared based on the defects commonly encountered on site. Three different types of input feature were extracted from the PD pattern under artificially created noisy environment. These include statistical features, fractal features and principal component analysis (PCA) features. These input features were used to train the classifiers to classify each PD defect types. Classifications were performed using three different artificial intelligence classifiers, which include Artificial Neural Networks (ANN), Adaptive Neuro-Fuzzy Inference System (ANFIS) and Support Vector Machine (SVM). It was found that the classification accuracy decreases with higher noise level but PCA features used in SVM and ANN showed the strongest tolerance against noise contamination. PMID:28085953

Recognition of psychiatric disorders in musculoskeletal and cardiovascular rehabilitation patients.

PubMed

Härter, Martin; Woll, Sonja; Reuter, Katrin; Wunsch, Alexandra; Bengel, Jürgen

2004-07-01

To investigate the detection rate of psychiatric disorders in rehabilitation inpatients with musculoskeletal and cardiovascular diseases (CVDs). Cross-sectional survey; analysis of medical charts and discharge reports, combined with standardized diagnostic interviews. Four orthopedic and 6 cardiovascular rehabilitation hospitals in southwest Germany. More than 1700 inpatients with different musculoskeletal disorders and CVDs participated in the survey. On the basis of their General Health Questionnaire score, 205 patients with musculoskeletal diseases and 164 patients with CVDs were selected randomly for standardized interviews. Discharge reports of interviewed patients were analyzed. Not applicable. Clinical interview (Composite International Diagnostic Interview [CIDI]) to obtain diagnoses of psychiatric disorders as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Assessment of psychosocial burden and diagnoses of mental disorders, as well as admission to psychologic treatments, based on discharge reports of the attending physicians. The detection rate (sensitivity) of mental disorders was 48% in the orthopedic rehabilitation patients and 32% in the cardiovascular patients. Specificity was 80% in musculoskeletal patients and 87% in cardiovascular patients. Differential diagnostic competencies were lacking, and only half of the physicians' diagnoses corresponded to the CIDI diagnoses. The results showed a need for current DSM-IV or International Classification of Diseases, 10th edition, psychodiagnostics in medical rehabilitation to detect mental disorders in patients in the rehabilitation process at an earlier stage and to refer patients with comorbid mental disorders to adequate treatment.

Alcohol craving as a predictor of relapse.

PubMed

Schneekloth, Terry D; Biernacka, Joanna M; Hall-Flavin, Daniel K; Karpyak, Victor M; Frye, Mark A; Loukianova, Larissa L; Stevens, Susanna R; Drews, Maureen S; Geske, Jennifer R; Mrazek, David A

2012-11-01

Alcoholism treatment interventions, both psychosocial and pharmacologic, aim to reduce cravings to drink. Yet, the role of craving in treatment outcomes remains unclear. This study evaluated craving intensity measured with the Penn Alcohol Craving Scale (PACS) at admission and discharge from residential treatment as a predictive factor of relapse after treatment. The study cohort included 314 alcohol-dependent subjects. Associations between relapse after discharge, PACS score, and clinical variables were investigated using time-to-event analyses. The primary analysis, based on the intent-to-treat principle, presumed relapse in those declining follow-up or not responding to contact attempts. Secondary analysis utilized data from 226 subjects successfully contacted after discharge with a median follow-up time of 365 days. The intent-to-treat analysis demonstrated that relapse was associated with higher level of craving at admission (p= .002) and discharge (p < .001). The analysis of data from patients successfully contacted after discharge led to similar results. A multivariable analysis indicated that relapse rates increased as PACS scores increased, and a higher discharge PACS score was significantly associated with relapse (p= .006) even after adjusting for covariates. This study demonstrates that higher PACS scores at the time of admission and discharge are associated with relapse following residential addiction treatment. These data support the role of craving in relapse and the utility of craving measurement as a clinical guide in assessing relapse risk. Copyright © American Academy of Addiction Psychiatry.

Institutional Discharges and Subsequent Shelter Use among Unaccompanied Adults in New York City

ERIC Educational Resources Information Center

Metraux, Stephen; Byrne, Thomas; Culhane, Dennis P.

2010-01-01

This study empirically examines the link between homelessness and discharges from other institutions. An administrative record match was undertaken to determine rates of discharge from institutional care for 9,247 unaccompanied adult shelter users in New York City. Cluster analysis and multinomial logistic regression analysis was then used to…

CONTAMINANTS IN FISH

EPA Science Inventory

The objective of this study was to determine inorganic and organic contaminant concentrations in edible tissue of fish collected from eight coastal areas receiving wastewater discharges and from two reference locations. Trace metal residues were statistically similar regardless ...

Morphological Processing of Ultraviolet Emissions of Electrical Corona Discharge for Analysis and Diagnostic Use

NASA Technical Reports Server (NTRS)

Schubert, Matthew R.; Moore, Andrew J.

2015-01-01

Electron cascades from electrical discharge produce secondary emissions from atmospheric plasma in the ultraviolet band. For a single point of discharge, these emissions exhibit a stereotypical discharge morphology, with latent information about the discharge location. Morphological processing can uncover the location and therefore can have diagnostic utility.

Morphological processing of ultraviolet emissions of electrical corona discharge for analysis and diagnostic use.

PubMed

Schubert, Matthew; Moore, Andrew J

2016-03-01

Electron cascades from electrical discharge produce secondary emissions from atmospheric plasma in the ultraviolet band. For a single point of discharge, these emissions exhibit a stereotypical discharge morphology, with latent information about the discharge location. Morphological processing can uncover the location and therefore have diagnostic utility.

Improvement of MRR and surface roughness during electrical discharge machining (EDM) using aluminum oxide powder mixed dielectric fluid

NASA Astrophysics Data System (ADS)

Khan, A. A.; Mohiuddin, A. K. M.; Latif, M. A. A.

2018-01-01

This paper discusses the effect of aluminium oxide (Al203) addition to dielectric fluid during electrical discharge machining (EDM). Aluminium oxide was added to the dielectric used in the EDM process to improve its performance when machining the stainless steel AISI 304, while copper was used as the electrode. Effect of the concentration of Al203 (0.3 mg/L) in dielectric fluid was compared with EDM without any addition of Al203. Surface quality of stainless steel and the material removal rate were investigated. Design of the experiment (DOE) was used for the experimental plan. Statistical analysis was done using ANOVA and then appropriate model was designated. The experimental results show that with dispersing of aluminium oxide in dielectric fluid surface roughness was improved while the material removal rate (MRR) was increased to some extent. These indicate the improvement of EDM performance using aluminium oxide in dielectric fluid. It was also found that with increase in pulse on time both MRR and surface roughness increase sharply.

Outcome prediction in home- and community-based brain injury rehabilitation using the Mayo-Portland Adaptability Inventory.

PubMed

Malec, James F; Parrot, Devan; Altman, Irwin M; Swick, Shannon

2015-01-01

The objective of the study was to develop statistical formulas to predict levels of community participation on discharge from post-hospital brain injury rehabilitation using retrospective data analysis. Data were collected from seven geographically distinct programmes in a home- and community-based brain injury rehabilitation provider network. Participants were 642 individuals with post-traumatic brain injury. Interventions consisted of home- and community-based brain injury rehabilitation. The main outcome measure was the Mayo-Portland Adaptability Inventory (MPAI-4) Participation Index. Linear discriminant models using admission MPAI-4 Participation Index score and log chronicity correctly predicted excellent (no to minimal participation limitations), very good (very mild participation limitations), good (mild participation limitations), and limited (significant participation limitations) outcome levels at discharge. Predicting broad outcome categories for post-hospital rehabilitation programmes based on admission assessment data appears feasible and valid. Equations to provide patients and families with probability statements on admission about expected levels of outcome are provided. It is unknown to what degree these prediction equations can be reliably applied and valid in other settings.

Streamflow characteristics related to channel geometry of streams in western United States

USGS Publications Warehouse

Hedman, E.R.; Osterkamp, W.R.

1982-01-01

Assessment of surface-mining and reclamation activities generally requires extensive hydrologic data. Adequate streamflow data from instrumented gaging stations rarely are available, and estimates of surface- water discharge based on rainfall-runoff models, drainage area, and basin characteristics sometimes have proven unreliable. Channel-geometry measurements offer an alternative method of quickly and inexpensively estimating stream-flow characteristics for ungaged streams. The method uses the empirical development of equations to yield a discharge value from channel-geometry and channel-material data. The equations are developed by collecting data at numerous streamflow-gaging sites and statistically relating those data to selected discharge characteristics. Mean annual runoff and flood discharges with selected recurrence intervals can be estimated for perennial, intermittent, and ephemeral streams. The equations were developed from data collected in the western one-half of the conterminous United States. The effect of the channel-material and runoff characteristics are accounted for with the equations.

Using Soluble Reactive Phosphorus and Ammonia to Identify Point Source Discharge from Large Livestock Facilities

NASA Astrophysics Data System (ADS)

Borrello, M. C.; Scribner, M.; Chessin, K.

2013-12-01

A growing body of research draws attention to the negative environmental impacts on surface water from large livestock facilities. These impacts are mostly in the form of excessive nutrient loading resulting in significantly decreased oxygen levels. Over-application of animal waste on fields as well as direct discharge into surface water from facilities themselves has been identified as the main contributor to the development of hypoxic zones in Lake Erie, Chesapeake Bay and the Gulf of Mexico. Some regulators claim enforcement of water quality laws is problematic because of the nature and pervasiveness of non-point source impacts. Any direct discharge by a facility is a violation of permits governed by the Clean Water Act, unless the facility has special dispensation for discharge. Previous research by the principal author and others has shown runoff and underdrain transport are the main mechanisms by which nutrients enter surface water. This study utilized previous work to determine if the effects of non-point source discharge can be distinguished from direct (point-source) discharge using simple nutrient analysis and dissolved oxygen (DO) parameters. Nutrient and DO parameters were measured from three sites: 1. A stream adjacent to a field receiving manure, upstream of a large livestock facility with a history of direct discharge, 2. The same stream downstream of the facility and 3. A stream in an area relatively unimpacted by large-scale agriculture (control site). Results show that calculating a simple Pearson correlation coefficient (r) of soluble reactive phosphorus (SRP) and ammonia over time as well as temperature and DO, distinguishes non-point source from point source discharge into surface water. The r value for SRP and ammonia for the upstream site was 0.01 while the r value for the downstream site was 0.92. The control site had an r value of 0.20. Likewise, r values were calculated on temperature and DO for each site. High negative correlations between temperature and DO are indicative of a relatively unimpacted stream. Results from this study are commensurate with nutrient correlations and are: r = -0.97 for the upstream site, r = -0.21 for the downstream site and r = -0.89 for the control site. Results from every site tested were statistically significant (p ≤ 0.05). These results support previous studies and demonstrate that the simple analytical techniques mentioned provide an effective means for regulatory agencies and community groups to monitor and identify point source discharge from large livestock facilities.

CURB-65 Performance Among Admitted and Discharged Emergency Department Patients With Community-acquired Pneumonia.

PubMed

Sharp, Adam L; Jones, Jason P; Wu, Ivan; Huynh, Dan; Kocher, Keith E; Shah, Nirav R; Gould, Michael K

2016-04-01

Pneumonia severity tools were primarily developed in cohorts of hospitalized patients, limiting their applicability to the emergency department (ED). We describe current community ED admission practices and examine the accuracy of the CURB-65 to predict 30-day mortality for patients, either discharged or admitted with community-acquired pneumonia (CAP). A retrospective, observational study of adult CAP encounters in 14 community EDs within an integrated healthcare system. We calculated CURB-65 scores for all encounters and described the use of hospitalization, stratified by each score (0-5). We then used each score as a cutoff to calculate sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratios, and negative likelihood ratios for predicting 30-day mortality. The sample included 21,183 ED encounters for CAP (7,952 discharged and 13,231 admitted). The C-statistic describing the accuracy of CURB-65 for predicting 30-day mortality in the full sample was 0.761 (95% confidence interval [CI], 0.747-0.774). The C-statistic was 0.864 (95% CI, 0.821-0.906) among patients discharged from the ED compared with 0.689 (95% CI, 0.672-0.705) among patients who were admitted. Among all ED encounters a CURB-65 threshold of ≥1 was 92.8% sensitive and 38.0% specific for predicting mortality, with a 99.9% NPV. Among all encounters, 62.5% were admitted, including 36.2% of those at lowest risk (CURB-65 = 0). CURB-65 had very good accuracy for predicting 30-day mortality among patients discharged from the ED. This severity tool may help ED providers risk stratify patients to assist with disposition decisions and identify unwarranted variation in patient care. © 2016 by the Society for Academic Emergency Medicine.

TECNOB Study: Ad Interim Results of a Randomized Controlled Trial of a Multidisciplinary Telecare Intervention for Obese Patients with Type-2 Diabetes.

PubMed

Castelnuovo, Gianluca; Manzoni, Gian Mauro; Cuzziol, Paola; Cesa, Gian Luca; Corti, Stefania; Tuzzi, Cristina; Villa, Valentina; Liuzzi, Antonio; Petroni, Maria Letizia; Molinari, Enrico

2011-03-04

Obesity increases the risk of many health complications such as hypertension, coronary heart disease and type 2 diabetes, needs long-lasting treatment for effective results and involves high public and private care-costs. Therefore, it is imperative that enduring and low-cost clinical programs for obesity and related co-morbidities are developed and evaluated. Information and communication technologies (ICT) can help clinicians to deliver treatment in a cost-effective and time-saving manner to a large number of obese individuals with co-morbidities. To examine ad interim effectiveness of a 12-month multidisciplinary telecare intervention for weight loss provided to obese patients with type 2 diabetes. A single-center randomized controlled trial (TECNOB study) started in December 2008. At present, 72 obese patients with type 2 diabetes have been recruited and randomly allocated to the TECNOB program (n=37) or to a control condition (n=39). However, only 34 participants have completed at least the 3-month follow-up and have been included in this ad interim analysis. 21 out of them have reached also the 6-month follow-up and 13 have achieved the end of the program. Study is still on-going. All participants attended 1-month inpatient intensive program that involved individualized medical care, diet therapy, physical training and brief psychological counseling. At discharge, participants allocated to the TECNOB program were instructed to use a weight-loss web-site, a web-based videoconference tool, a dietary software installed into their cellular phones and an electronic armband measuring daily steps and energy expenditure. Weight and disordered eating-related behaviors and cognitions (EDI-2) at entry to hospital, at discharge from hospital, at 3,6 and 12 months. Ad interim analysis of data from 34 participants showed no statistically significant difference between groups in weight change at any time-point. However, within-group analysis revealed significant reductions of initial weight at discharge from hospital, at 3 months, at 6 months but not at 12 months. Control group had higher scores in Interpersonal distrust at 12 months. This ad interim findings revealed that the effect of the inpatient treatment was high and probably overwhelmed the effect of the TECNOB intervention. Much statistical power and long-term follow-up may enhance the probability to detect the TECNOB effect over and above the great one exerted by the inpatient program.

Mapping interictal epileptic discharges using mutual information between concurrent EEG and fMRI.

PubMed

Caballero-Gaudes, César; Van de Ville, Dimitri; Grouiller, Frédéric; Thornton, Rachel; Lemieux, Louis; Seeck, Margitta; Lazeyras, François; Vulliemoz, Serge

2013-03-01

The mapping of haemodynamic changes related to interictal epileptic discharges (IED) in simultaneous electroencephalography (EEG) and functional MRI (fMRI) studies is usually carried out by means of EEG-correlated fMRI analyses where the EEG information specifies the model to test on the fMRI signal. The sensitivity and specificity critically depend on the accuracy of EEG detection and the validity of the haemodynamic model. In this study we investigated whether an information theoretic analysis based on the mutual information (MI) between the presence of epileptic activity on EEG and the fMRI data can provide further insights into the haemodynamic changes related to interictal epileptic activity. The important features of MI are that: 1) both recording modalities are treated symmetrically; 2) no requirement for a-priori models for the haemodynamic response function, or assumption of a linear relationship between the spiking activity and BOLD responses, and 3) no parametric model for the type of noise or its probability distribution is necessary for the computation of MI. Fourteen patients with pharmaco-resistant focal epilepsy underwent EEG-fMRI and intracranial EEG and/or surgical resection with positive postoperative outcome (seizure freedom or considerable reduction in seizure frequency) was available in 7/14 patients. We used nonparametric statistical assessment of the MI maps based on a four-dimensional wavelet packet resampling method. The results of MI were compared to the statistical parametric maps obtained with two conventional General Linear Model (GLM) analyses based on the informed basis set (canonical HRF and its temporal and dispersion derivatives) and the Finite Impulse Response (FIR) models. The MI results were concordant with the electro-clinically or surgically defined epileptogenic area in 8/14 patients and showed the same degree of concordance as the results obtained with the GLM-based methods in 12 patients (7 concordant and 5 discordant). In one patient, the information theoretic analysis improved the delineation of the irritative zone compared with the GLM-based methods. Our findings suggest that an information theoretic analysis can provide clinically relevant information about the BOLD signal changes associated with the generation and propagation of interictal epileptic discharges. The concordance between the MI, GLM and FIR maps support the validity of the assumptions adopted in GLM-based analyses of interictal epileptic activity with EEG-fMRI in such a manner that they do not significantly constrain the localization of the epileptogenic zone. Copyright © 2012 Elsevier Inc. All rights reserved.

Semi-Competing Risks Data Analysis: Accounting for Death as a Competing Risk When the Outcome of Interest Is Nonterminal.

PubMed

Haneuse, Sebastien; Lee, Kyu Ha

2016-05-01

Hospital readmission is a key marker of quality of health care. Notwithstanding its widespread use, however, it remains controversial in part because statistical methods used to analyze readmission, primarily logistic regression and related models, may not appropriately account for patients who die before experiencing a readmission event within the time frame of interest. Toward resolving this, we describe and illustrate the semi-competing risks framework, which refers to the general setting where scientific interest lies with some nonterminal event (eg, readmission), the occurrence of which is subject to a terminal event (eg, death). Although several statistical analysis methods have been proposed for semi-competing risks data, we describe in detail the use of illness-death models primarily because of their relation to well-known methods for survival analysis and the availability of software. We also describe and consider in detail several existing approaches that could, in principle, be used to analyze semi-competing risks data, including composite end point and competing risks analyses. Throughout we illustrate the ideas and methods using data on N=49 763 Medicare beneficiaries hospitalized between 2011 and 2013 with a principle discharge diagnosis of heart failure. © 2016 American Heart Association, Inc.

Semi-Competing Risks Data Analysis: Accounting for Death as a Competing Risk When the Outcome of Interest is Non-Terminal

PubMed Central

Haneuse, Sebastien; Lee, Kyu Ha

2016-01-01

Hospital readmission is a key marker of quality of health care. Notwithstanding its widespread use, however, it remains controversial in part because statistical methods used to analyze readmission, primarily logistic regression and related models, may not appropriately account for patients who die prior to experiencing a readmission event within the timeframe of interest. Towards resolving this, we describe and illustrate the semi-competing risks framework, which refers to the general setting where scientific interest lies with some non-terminal event (e.g. readmission), the occurrence of which is subject to a terminal event (e.g. death). Although a number of statistical analysis methods have been proposed for semi-competing risks data, we describe in detail the use of illness-death models primarily because of their relation to well-known methods for survival analysis and the availability of software. We also describe and consider in detail a number of existing approaches that could, in principle, be used to analyze semi-competing risks data including composite endpoint and competing risks analyses. Throughout we illustrate the ideas and methods using data on N=49,763 Medicare beneficiaries hospitalized between 2011–2013 with a principle discharge diagnosis of heart failure. PMID:27072677

A coupled stochastic rainfall-evapotranspiration model for hydrological impact analysis

NASA Astrophysics Data System (ADS)

Pham, Minh Tu; Vernieuwe, Hilde; De Baets, Bernard; Verhoest, Niko E. C.

2018-02-01

A hydrological impact analysis concerns the study of the consequences of certain scenarios on one or more variables or fluxes in the hydrological cycle. In such an exercise, discharge is often considered, as floods originating from extremely high discharges often cause damage. Investigating the impact of extreme discharges generally requires long time series of precipitation and evapotranspiration to be used to force a rainfall-runoff model. However, such kinds of data may not be available and one should resort to stochastically generated time series, even though the impact of using such data on the overall discharge, and especially on the extreme discharge events, is not well studied. In this paper, stochastically generated rainfall and corresponding evapotranspiration time series, generated by means of vine copulas, are used to force a simple conceptual hydrological model. The results obtained are comparable to the modelled discharge using observed forcing data. Yet, uncertainties in the modelled discharge increase with an increasing number of stochastically generated time series used. Notwithstanding this finding, it can be concluded that using a coupled stochastic rainfall-evapotranspiration model has great potential for hydrological impact analysis.

Male anorexia and bulimia nervosa: Disorder symptoms and impulsive behaviour during hospital treatment and one year follow-up period.

PubMed

Sernec, Karin; Mrevlje, Gorazd V; Čarapič, Jadranka; Weber, Urška; Zalar, Bojan

2015-09-01

The study aimed to evaluate treatment efficacy in male patients with anorexia (AN) and bulimia nervosa (BN) treated at the Eating Disorder Unit, University Psychiatric Clinic Ljubljana, Slovenia (EDU UPCL), using longitudinal assessments of eating disorder (ED) symptoms and selected impulsive behaviours highly correlated with these entities from hospital admission till twelve months after. 35 male AN and 35 male BN patients were included. Participants were aged 17 or more and somatically stable with the BMI>12 kg/m(2). Patients with psychiatric comorbidity, mental disorder due to a general medical condition, or serious somatic or neurological disease were excluded. Intensity of ED symptoms and presence of selected impulsive behaviours were evaluated at hospital admission and discharge, and three, six and twelve months after, using an internal Eating Disorder Unit Questionnaire. For statistical analysis multivariate analysis of variance was used. Throughout the research period the appropriate changes in BMI were observed in both patient groups. In both, AN and BN patient groups, the evaluation of longitudinal differences regarding the intensity of all ED symptoms and the presence of studied impulsive behaviours showed a significant decline at discharge and all subsequent assessments compared to the results obtained upon admission to the hospital. The re-hospitalization rates of patients with AN and BN in the first year after discharge from the hospital were 3.84% vs. 3.7% respectively. In male patients with AN and BN treated at the EDU UPCL, ED symptoms, BMI, and studied impulsive behaviours show a substantial improvement during hospital treatment. These changes seem to be long lasting, still being effective through one-year post-hospitalization follow-up.

Relative importance of P and N in macrophyte and epilithic algae biomass in a wastewater-impacted oligotrophic river.

PubMed

Taube, Nadine; He, Jianxun; Ryan, M Cathryn; Valeo, Caterina

2016-08-01

The role of nutrient loading on biomass growth in wastewater-impacted rivers is important in order to effectively optimize wastewater treatment to avoid excessive biomass growth in the receiving water body. This paper directly relates wastewater treatment plant (WWTP) effluent nutrients (including ammonia (NH3-N), nitrate (NO3-N) and total phosphorus (TP)) to the temporal and spatial distribution of epilithic algae and macrophyte biomass in an oligotrophic river. Annual macrophyte biomass, epilithic algae data and WWTP effluent nutrient data from 1980 to 2012 were statistically analysed. Because discharge can affect aquatic biomass growth, locally weighted scatterplot smoothing (LOWESS) was used to remove the influence of river discharge from the aquatic biomass (macrophytes and algae) data before further analysis was conducted. The results from LOWESS indicated that aquatic biomass did not increase beyond site-specific threshold discharge values in the river. The LOWESS-estimated biomass residuals showed a variable response to different nutrients. Macrophyte biomass residuals showed a decreasing trend concurrent with enhanced nutrient removal at the WWTP and decreased effluent P loading, whereas epilithic algae biomass residuals showed greater response to enhanced N removal. Correlation analysis between effluent nutrient concentrations and the biomass residuals (both epilithic algae and macrophytes) suggested that aquatic biomass is nitrogen limited, especially by NH3-N, at most sampling sites. The response of aquatic biomass residuals to effluent nutrient concentrations did not change with increasing distance to the WWTP but was different for P and N, allowing for additional conclusions about nutrient limitation in specific river reaches. The data further showed that the mixing process between the effluent and the river has an influence on the spatial distribution of biomass growth.

Worsening renal function is not associated with response to treatment in acute heart failure

PubMed Central

Ather, Sameer; Bavishi, Chirag; McCauley, Mark D; Dhaliwal, Amandeep; Deswal, Anita; Johnson, Sarah; Chan, Wenyaw; Aguilar, David; Pritchett, Allison M; Ramasubbu, Kumudha; Wehrens, Xander HT; Bozkurt, Biykem

2015-01-01

Background About a fourth of acute decompensated heart failure (ADHF) patients develop renal dysfunction during their admission. To date, the association of ADHF treatment with the development of worsening renal function (WRF) remains contentious. Thus, we examined the association of WRF with changes in BNP levels and with mortality. Methods We performed retrospective chart review of patients admitted with ADHF who had BNP, eGFR, creatinine and blood urea nitrogen (BUN) values measured both on admission and discharge. Survival analysis was conducted using Cox proportional hazards model and correlation was measured using Spearman's rank correlation test. Results 358 patients admitted for ADHF were evaluated. WRF was defined as >20% reduction in eGFR from admission to discharge and response to treatment was assessed by ΔBNP. There was a statistically significant reduction in BNP and increase in BUN during the admission. ΔBNP did not correlate with either ΔGFR or ΔBUN. Patients who developed WRF and those who did not, had a similar reduction in BNP. On univariate survival analysis, ΔBUN, but not ΔeGFR, was associated with 1-year mortality. In multivariate Cox proportional hazards model, BUN at discharge was associated with 1-year mortality (HR: 1.02, p<0.001), but ΔeGFR and ΔBUN were not associated with the primary endpoint. Conclusion During ADHF treatment, ΔBNP was not associated with changes in renal function. Development of WRF during ADHF treatment was not associated with mortality. Our study suggests that development of WRF should not preclude diuresis in ADHF patients in the absence of volume depletion. PMID:22633437

Difference in Composite End Point of Readmission and Death Between Malnourished and Nonmalnourished Veterans Assessed Using Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Clinical Characteristics.

PubMed

Hiller, Lynn D; Shaw, Robert F; Fabri, Peter J

2017-11-01

Previous studies have demonstrated an association between malnutrition and poor outcomes. The primary objective of this study was to explore the difference in the composite end point of readmission rate or mortality rate between hospitalized veterans with and without malnutrition. This was a retrospective chart review comparing veterans with malnutrition based on a modified version of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition consensus characteristics that used 5 of the 6 clinical characteristics to a matched control group of nonmalnourished veterans based on age, admitting service, and date of admission who were admitted between August 1, 2012, and December 1, 2014. Data were extracted from the medical record. Multivariate analysis was used to identify predictors of outcomes. In total, 404 patients were included in the final analysis. All end points were found to be statistically significant. The malnourished group was more likely to meet the composite end point (odds ratio [OR], 5.3), more likely to be readmitted within 30 days (OR, 3.4), more likely to die within 90 days of discharge (OR, 5.5), and more likely to have a length of stay >7 days (OR, 4.3) compared with the nonmalnourished group. Length of stay was significantly longer in the malnourished group, 9.80 (11.5) vs 4.38 (4.5) days. Malnutrition was an independent risk factor for readmission within 30 days or death within 90 days of discharge. Malnourished patients had higher rates of readmission, higher mortality rates, and longer lengths of stay and were more likely to be discharged to nursing homes.

Comparative analysis of effluent water quality from a municipal treatment plant and two on-site wastewater treatment systems.

PubMed

Garcia, Santos N; Clubbs, Rebekah L; Stanley, Jacob K; Scheffe, Brian; Yelderman, Joe C; Brooks, Bryan W

2013-06-01

Though decentralized on-site technologies are extensively employed for wastewater treatment around the globe, an understanding of effluent water quality impairments associated with these systems remain less understood than effluent discharges from centralized municipal wastewater treatment facilities. Using a unique experimental facility, a novel comparative analysis of effluent water quality was performed from model decentralized aerobic (ATS) and septic (STS) on-site wastewater treatment systems and a centralized municipal wastewater treatment plant (MTP). The ATS and STS units did not benefit from further soil treatment. Each system received common influent wastewater from the Waco, Texas, USA Metropolitan Area Regional Sewerage System. We tested the hypothesis that MTP effluent would exhibit higher water quality than on-site effluents, based on parameters selected for study. A tiered testing approach was employed to assess the three effluent discharges: select routine water quality parameters (Tier I), whole effluent toxicity (Tier II), and select endocrine-active compounds (Tier III). Contrary to our hypothesis, ATS effluent was not statistically different from MTP effluents, based on Tier I and III parameters, but reproductive responses of Daphnia magna were slightly more sensitive to ATS than MTP effluents. STS effluent water quality was identified as most degraded of the three wastewater treatment systems. Parameters used to assess centralized wastewater treatment plant effluent water quality such as whole effluent toxicity and endocrine active substances appear useful for water quality assessments of decentralized discharges. Aerobic on-site wastewater treatment systems may represent more robust options than traditional septic systems for on-site wastewater treatment in watersheds with appreciable groundwater - surface water exchange. Copyright © 2013 Elsevier Ltd. All rights reserved.

Provider-Hospital “Fit” and Patient Outcomes: Evidence from Massachusetts Cardiac Surgeons, 2002–2004

PubMed Central

Huesch, Marco D

2011-01-01

Objective To examine whether the “fit” of a surgeon with hospital resources impacts cardiac surgery outcomes, separately from hospital or surgeon effects. Data Sources Retrospective secondary data from the Massachusetts Department of Public Health's Data Analysis Center, on all 12,983 adult isolated coronary artery bypass surgical admissions in state-regulated hospitals from 2002 through 2004. Clinically audited chart data was collected using Society of Thoracic Surgeons National Cardiac Surgery Database tools and cross-referenced with administrative discharge data in the Division of Health Care Finance and Policy. Mortality was followed up through 2007 via the state vital statistics registry. Study Design Analysis was at the patient level for those receiving isolated coronary artery bypass surgery (CABG). Sixteen outcomes included 30-day mortality, major morbidity, indicators of perioperative, and predischarge processes of care. Hierarchical crossed mixed models were used to estimate fixed covariate and random effects at hospital, surgeon, and hospital × surgeon level. Principal Findings Hospital volume was associated with significantly reduced intraoperative durations and significantly increased probability of aspirin, β-blocker, and lipid-lowering discharge medication use. The proportion of outcome variability due to unobserved hospital × surgeon interaction effects was small but meaningful for intraoperative practices, discharge destination, and medication use. For readmissions and mortality within 30 days or 1 year, unobserved patient and hospital factors drove almost all variability in outcomes. Conclusions Among Massachusetts patients receiving isolated CABG, consistent evidence was found that the hospital × surgeon combination independently impacted patient outcomes, beyond hospital or surgeon effects. Such distinct local interactions between a surgeon and hospital resources may play an important part in moderating quality improvement efforts, although residual patient-level factors generally contributed the most to outcome variability. PMID:20849555

Combination of physico-chemical analysis, Allium cepa test system and Oreochromis niloticus erythrocyte based comet assay/nuclear abnormalities tests for cyto-genotoxicity assessments of treated effluents discharged from textile industries.

PubMed

Hemachandra, Chamini K; Pathiratne, Asoka

2016-09-01

Bioassays for cyto-genotoxicity assessments are generally not required in current textile industry effluent discharge management regulations. The present study applied in vivo plant and fish based toxicity tests viz. Allium cepa test system and Oreochromis niloticus erythrocyte based comet assay and nuclear abnormalities tests in combination with physico-chemical analysis for assessing potential cytotoxic/genotoxic impacts of treated textile industry effluents reaching a major river (Kelani River) in Sri Lanka. Of the treated effluents tested from two textile industries, color in the Textile industry 1 effluents occasionally and color, biochemical oxygen demand and chemical oxygen demand in the Textile industry 2 effluents frequently exceeded the specified Sri Lankan tolerance limits for discharge of industrial effluents into inland surface waters. Exposure of A. cepa bulbs to 100% and 12.5% treated effluents from both industries resulted in statistically significant root growth retardation, mito-depression, and induction of chromosomal abnormalities in root meristematic cells in comparison to the dilution water in all cases demonstrating cyto-genotoxicity associated with the treated effluents. Exposure of O. niloticus to the 100% and 12.5% effluents, resulted in erythrocytic genetic damage as shown by elevated total comet scores and induction of nuclear abnormalities confirming the genotoxicity of the treated effluents even with 1:8 dilution. The results provide strong scientific evidence for the crucial necessity of incorporating cyto-genotoxicity impact assessment tools in textile industry effluent management regulations considering human health and ecological health of the receiving water course under chronic exposure. Copyright © 2016 Elsevier Inc. All rights reserved.

a Combination of Geospatial and Clinical Analysis in Predicting Disability Outcome after Road Traffic Injury (rti) in a District in Malaysia

NASA Astrophysics Data System (ADS)

Nik Hisamuddin, R.; Ruslan, R.; Syed Hatim, N.; Sharifah Mastura, S. M.

2016-09-01

This was a Prospective Cohort Study commencing from July 2011 until June 2013 involving all injuries related to motor vehicle crashes (MVC) attended Emergency Departments (ED) of two tertiary centers in a district in Malaysia. Selected attributes were geospatially analyzed by using ARCGIS (by ESRI) software version 10.1 licensed to the institution and Google Map free software and multiple logistic regression was performed by using SPSS version 22.0. A total of 439 cases were recruited. The mean age (SD) of the MVC victims was 26.04 years (s.d 15.26). Male comprised of 302 (71.7%) of the cases. Motorcyclists were the commonest type of victims involved [351(80.0%)]. Hotspot MVC locations occurred at certain intersections and on roads within borough of Kenali and Binjai. The number of severely injured and polytrauma are mostly on the road network within speed limit of 60 km/hour. A person with an increase in ISS of one score had a 37 % higher odd to have disability at hospital discharge (95% CI: 1.253, 1.499, p-value < 0.001). Pediatric age group (less than 19 years of age) had 52.1% lesser odds to have disability at discharge from hospital (95% CI: 0.258, 0.889, p-value < 0.001) and patients who underwent operation for definitive management had 4.14 times odds to have disability at discharge from hospital (95% CI: 1.681, 10.218, p-value = 0.002). Overall this study has proven that GIS with a combination of traditional statistical analysis is still a powerful tool in road traffic injury (RTI) related research.

Off-label use of recombinant factor VIIa in U.S. hospitals: analysis of hospital records.

PubMed

Logan, Aaron C; Yank, Veronica; Stafford, Randall S

2011-04-19

Recombinant factor VIIa (rFVIIa) is approved for treatment of bleeding in patients who have hemophilia with inhibitors but has been applied to a wide range of off-label indications. To estimate patterns of off-label rFVIIa use in U.S. hospitals. Retrospective database analysis. Data were extracted from the Premier Perspectives database (Premier, Charlotte, North Carolina), which contains discharge records from a sample of academic and nonacademic U.S. hospitals. 12 644 hospitalizations for patients who received rFVIIa during a hospital stay. Hospital diagnoses and patient dispositions from 1 January 2000 to 31 December 2008. Statistical weights for each hospital were used to provide national estimates of rFVIIa use. From 2000 to 2008, off-label use of rFVIIa in hospitals increased more than 140-fold, such that in 2008, 97% (95% CI, 96% to 98%) of 18 311 in-hospital uses were off-label. In contrast, in-hospital use for hemophilia increased less than 4-fold and accounted for 2.7% (CI, 1.9% to 3.5%) of use in 2008. Adult and pediatric cardiovascular surgery (29% [CI, 21% to 33%]), body and brain trauma (29% [CI, 19% to 38%]), and intracranial hemorrhage (11% [CI, 7.7% to 14%]) were the most common indications for rFVIIa use. Across all indications, in-hospital mortality was 27% (CI, 19% to 34%) and 43% (CI, 26% to 59%) of patients were discharged to home. Accuracy and completeness of the discharge diagnoses and patient medication records in the database sample cannot be verified. Off-label use of rFVIIa in the hospital setting far exceeds use for approved indications. These patterns raise concern about the application of rFVIIa to conditions for which strong supporting evidence is lacking.

A proactive outreach intervention that decreases readmission after hepatectomy.

PubMed

Narula, Nisha; Kim, Bradford J; Davis, Catherine H; Dewhurst, Whitney L; Samp, Leigh A; Aloia, Thomas A

2018-04-01

After hepatectomy, 7%-19% of patients are readmitted within 30 days, accounting for substantial cost and poor patient experience. The purpose of this study was to analyze the impact of a proactive outreach intervention on readmissions. Consecutive patients undergoing hepatectomy by a single surgeon 2012-2016 were identified in a prospectively maintained database. In August 2013 a postoperative intervention was implemented; an advanced practice provider called each patient within 72 hours of discharge. Readmission rates were compared pre- and postintervention using standard statistics. Two hundred thirty-one patients met the inclusion criteria and major hepatectomy was performed in 45.5% of patients. Although the complication rate was similar (25.0% preintervention and 19.4% postintervention, P = .324), readmissions within 30 days of operation decreased from 14.5% pre- to 6.5% postintervention (P = .046). Approximately 30% of outreach interactions required outpatient intervention. Factors associated with readmission on univariate analysis included increased operative time (P = .007), major hepatectomy (P = .012), hemi or extended hepatectomy (P = .032), second stage operation (P = .031), bile leak (P = 0.022), and any complication/modified Accordion complication ≥ 3 within 30 days (P <.0001). On multivariate analysis, lack of post-discharge intervention (P = .012) and bile leak (P = .031) were independently associated with readmission. These data demonstrate the efficacy of a proactive communication intervention after discharge to decrease readmissions after hepatectomy. The additional work created by the intervention is likely offset by decreased inpatient care needs and costs. Identification of high-risk populations and application of technology are likely to lead to further improvements. Copyright © 2017 Elsevier Inc. All rights reserved.

Consistency in performance evaluation reports and medical records.

PubMed

Lu, Mingshan; Ma, Ching-to Albert

2002-12-01

In the health care market managed care has become the latest innovation for the delivery of services. For efficient implementation, the managed care organization relies on accurate information. So clinicians are often asked to report on patients before referrals are approved, treatments authorized, or insurance claims processed. What are clinicians responses to solicitation for information by managed care organizations? The existing health literature has already pointed out the importance of provider gaming, sincere reporting, nudging, and dodging the rules. We assess the consistency of clinicians reports on clients across administrative data and clinical records. For about 1,000 alcohol abuse treatment episodes, we compare clinicians reports across two data sets. The first one, the Maine Addiction Treatment System (MATS), was an administrative data set; the state government used it for program performance monitoring and evaluation. The second was a set of medical record abstracts, taken directly from the clinical records of treatment episodes. A clinician s reporting practice exhibits an inconsistency if the information reported in MATS differs from the information reported in the medical record in a statistically significant way. We look for evidence of inconsistencies in five categories: admission alcohol use frequency, discharge alcohol use frequency, termination status, admission employment status, and discharge employment status. Chi-square tests, Kappa statistics, and sensitivity and specificity tests are used for hypothesis testing. Multiple imputation methods are employed to address the problem of missing values in the record abstract data set. For admission and discharge alcohol use frequency measures, we find, respectively, strong and supporting evidence for inconsistencies. We find equally strong evidence for consistency in reports of admission and discharge employment status, and mixed evidence on report consistency on termination status. Patterns of inconsistency may be due to both altruistic and self-interest motives. Payment contracts based on performance may be subject to provider mis-reporting, which could seriously undermine its purpose. However, further analysis is needed to determine how much of the inconsistencies observed are results of clinician gaming in reporting. Increasing system accountability is becoming more and more important for health care policy makers. Results of this study will lead to a better understanding of physician reporting behavior. Our work in this paper on the data sets confirms the statistical significance of strategic reporting in alcohol addiction treatment. It will be of interest to confirm our finding in other data sets. Our on-going research will model the motives behind strategic reporting. We will hypothesize that both altruistic and financial incentives are present. Our empirical identification strategy will use Maine s Performance-Based Contracting system and client insurance sources to test how these incentives affect the direction of clinician s strategic reporting.

HydroClimATe: hydrologic and climatic analysis toolkit

USGS Publications Warehouse

Dickinson, Jesse; Hanson, Randall T.; Predmore, Steven K.

2014-01-01

The potential consequences of climate variability and climate change have been identified as major issues for the sustainability and availability of the worldwide water resources. Unlike global climate change, climate variability represents deviations from the long-term state of the climate over periods of a few years to several decades. Currently, rich hydrologic time-series data are available, but the combination of data preparation and statistical methods developed by the U.S. Geological Survey as part of the Groundwater Resources Program is relatively unavailable to hydrologists and engineers who could benefit from estimates of climate variability and its effects on periodic recharge and water-resource availability. This report documents HydroClimATe, a computer program for assessing the relations between variable climatic and hydrologic time-series data. HydroClimATe was developed for a Windows operating system. The software includes statistical tools for (1) time-series preprocessing, (2) spectral analysis, (3) spatial and temporal analysis, (4) correlation analysis, and (5) projections. The time-series preprocessing tools include spline fitting, standardization using a normal or gamma distribution, and transformation by a cumulative departure. The spectral analysis tools include discrete Fourier transform, maximum entropy method, and singular spectrum analysis. The spatial and temporal analysis tool is empirical orthogonal function analysis. The correlation analysis tools are linear regression and lag correlation. The projection tools include autoregressive time-series modeling and generation of many realizations. These tools are demonstrated in four examples that use stream-flow discharge data, groundwater-level records, gridded time series of precipitation data, and the Multivariate ENSO Index.

Numerical and Qualitative Contrasts of Two Statistical Models ...

EPA Pesticide Factsheets

Two statistical approaches, weighted regression on time, discharge, and season and generalized additive models, have recently been used to evaluate water quality trends in estuaries. Both models have been used in similar contexts despite differences in statistical foundations and products. This study provided an empirical and qualitative comparison of both models using 29 years of data for two discrete time series of chlorophyll-a (chl-a) in the Patuxent River estuary. Empirical descriptions of each model were based on predictive performance against the observed data, ability to reproduce flow-normalized trends with simulated data, and comparisons of performance with validation datasets. Between-model differences were apparent but minor and both models had comparable abilities to remove flow effects from simulated time series. Both models similarly predicted observations for missing data with different characteristics. Trends from each model revealed distinct mainstem influences of the Chesapeake Bay with both models predicting a roughly 65% increase in chl-a over time in the lower estuary, whereas flow-normalized predictions for the upper estuary showed a more dynamic pattern, with a nearly 100% increase in chl-a in the last 10 years. Qualitative comparisons highlighted important differences in the statistical structure, available products, and characteristics of the data and desired analysis. This manuscript describes a quantitative comparison of two recently-

Derivation and validation of a novel risk score for safe discharge after acute lower gastrointestinal bleeding: a modelling study.

PubMed

Oakland, Kathryn; Jairath, Vipul; Uberoi, Raman; Guy, Richard; Ayaru, Lakshmana; Mortensen, Neil; Murphy, Mike F; Collins, Gary S

2017-09-01

Acute lower gastrointestinal bleeding is a common reason for emergency hospital admission, and identification of patients at low risk of harm, who are therefore suitable for outpatient investigation, is a clinical and research priority. We aimed to develop and externally validate a simple risk score to identify patients with lower gastrointestinal bleeding who could safely avoid hospital admission. We undertook model development with data from the National Comparative Audit of Lower Gastrointestinal Bleeding from 143 hospitals in the UK in 2015. Multivariable logistic regression modelling was used to identify predictors of safe discharge, defined as the absence of rebleeding, blood transfusion, therapeutic intervention, 28 day readmission, or death. The model was converted into a simplified risk scoring system and was externally validated in 288 patients admitted with lower gastrointestinal bleeding (184 safely discharged) from two UK hospitals (Charing Cross Hospital, London, and Hammersmith Hospital, London) that had not contributed data to the development cohort. We calculated C statistics for the new model and did a comparative assessment with six previously developed risk scores. Of 2336 prospectively identified admissions in the development cohort, 1599 (68%) were safely discharged. Age, sex, previous admission for lower gastrointestinal bleeding, rectal examination findings, heart rate, systolic blood pressure, and haemoglobin concentration strongly discriminated safe discharge in the development cohort (C statistic 0·84, 95% CI 0·82-0·86) and in the validation cohort (0·79, 0·73-0·84). Calibration plots showed the new risk score to have good calibration in the validation cohort. The score was better than the Rockall, Blatchford, Strate, BLEED, AIMS65, and NOBLADS scores in predicting safe discharge. A score of 8 or less predicts a 95% probability of safe discharge. We developed and validated a novel clinical prediction model with good discriminative performance to identify patients with lower gastrointestinal bleeding who are suitable for safe outpatient management, which has important economic and resource implications. Bowel Disease Research Foundation and National Health Service Blood and Transplant. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Efficacy of Telemedicine-Supported Discharge Within an In Home Model of Care.

PubMed

Greenup, Edwin P; McCusker, Melissa; Potts, Boyd A; Bryett, Andrew

2017-09-01

To determine if mobile videoconferencing technology can facilitate the discharge of low-acuity patients receiving in-home care without compromising short-term health outcomes. A 6-month trial commenced in July 2015 with 345 patients considered unsuited to Criteria Led Discharge (CLD) receiving in-home care included as participants. Nurses providing clinical support to patients in their homes were supplied with a tablet computer (Apple iPad) with Internet connectivity (Telstra 4G Network) and videoconferencing software (Cisco Jabber for Telepresence). Device usage data combined with hospital admission records were collected to determine (a) instances where a telemedicine-facilitated discharge occurred and (b) if the accepted measure of short-term health outcomes (readmission within 28 days) was adversely affected by this alternative method. Telemedicine technology facilitated the discharge of 10.1% (n = 35) of patients considered unsuitable for CLD from the Hospital in the Home model during the trial period. Statistically insignificant differences in rates of readmission between patients discharged in person versus those participating in the telemedicine-supported model suggest that the clinical standards of the service have been maintained. The results of evaluating telemedicine support for nurses providing low-acuity in-home care indicate that patients may be discharged remotely while maintaining the existing clinical standards of the service.

Clinical Parameters and Outcomes in Periorbital Necrotizing Fasciitis.

PubMed

Wladis, Edward J; Levin, Flora; Shinder, Roman

2015-01-01

To describe the clinical features associated with periorbital necrotizing fasciitis and to correlate these features with clinical outcomes. The case logs of 3 surgeons were used to identify cases of necrotizing fasciitis. Chart reviews were performed to characterize clinical metrics, and statistical analyses were performed. Seventeen patients (9 males, 8 females; mean age = 48.1 years, standard deviation = 22.6 years) were identified with periorbital necrotizing fasciitis. Of these patients, 52.9% did not have immunodeficiencies, and 52.9% did not have antecedent trauma or infected facial lesions. One patient died from necrotizing fasciitis. A history of immunosuppression correlated with the requirement for exenteration, but did not correlate visual acuity of worse than 20/40 upon discharge from the hospital. Most of the patients (68.75%) were discharged with visual acuity of better than 20/40 in the affected eye. This study represents the largest case series of patients with periorbital necrotizing fasciitis. Most of the patients in this series did not have immunodeficiencies, and the majority were discharged with favorable visual acuities. Nonetheless, a history of immunosuppression correlated with the need for exenteration, but was not statistically linked with worse visual outcomes.

Integrated Data Collection Analysis (IDCA) Program - Statistical Analysis of RDX Standard Data Sets

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sandstrom, Mary M.; Brown, Geoffrey W.; Preston, Daniel N.

2015-10-30

The Integrated Data Collection Analysis (IDCA) program is conducting a Proficiency Test for Small- Scale Safety and Thermal (SSST) testing of homemade explosives (HMEs). Described here are statistical analyses of the results for impact, friction, electrostatic discharge, and differential scanning calorimetry analysis of the RDX Type II Class 5 standard. The material was tested as a well-characterized standard several times during the proficiency study to assess differences among participants and the range of results that may arise for well-behaved explosive materials. The analyses show that there are detectable differences among the results from IDCA participants. While these differences are statisticallymore » significant, most of them can be disregarded for comparison purposes to assess potential variability when laboratories attempt to measure identical samples using methods assumed to be nominally the same. The results presented in this report include the average sensitivity results for the IDCA participants and the ranges of values obtained. The ranges represent variation about the mean values of the tests of between 26% and 42%. The magnitude of this variation is attributed to differences in operator, method, and environment as well as the use of different instruments that are also of varying age. The results appear to be a good representation of the broader safety testing community based on the range of methods, instruments, and environments included in the IDCA Proficiency Test.« less

Discharge Against Medical Advice in the Pediatric Wards in Boo-ali Sina Hospital, Sari, Iran 2010.

PubMed

Mohseni Saravi, Benyamin; Reza Zadeh, Esmaeil; Siamian, Hasan; Yahghoobian, Mahboobeh

2013-12-01

Since children neither comprehended nor contribute to the decision, discharge against medical advice is a challenge of health care systems in the world. Therefore, the current study was designed to determine the rate and causes of discharge against medical advice. This descriptive cross-sectional study was done by reviewing the medical records by census method. Data was analyzed using SPSS software and x(2) statistics was used to determine the relationship between variables. The value of P<0.05 was considered significant. Rate of discharged against medical advice was 108 (2.2%). Mean of age and length of stay were 2.8±4 (SD).3 years old and 3.7±5.4 (SD) days, respectively. Totally, 95 patients (88.7%) had health insurance and 65 (60.2%) patients lived in urban areas. History of psychiatric disease and addiction in 22 (20.6%) of the parents were negative. In addition, 100 (92.3%) patients admitted for medical treatment and the others for surgery. The relationship of the signatory with patients (72.3%) was father. Of 108 patients discharged against medical advice, 20 (12%) were readmitted. The relationship between the day of discharge and discharge against medical advice was significant (ρ =0/03). Rate of discharge against medical advice in Boo-ali hospital is the same as the other studies in the same range. The form which is used for this purpose did not have suitable data elements about description of consequence of such discharge, and it has not shown the real causes of discharge against medical advice.

Analysis of Risk Factors for Patient Readmission 30 Days Following Discharge From General Surgery.

PubMed

McIntyre, Lisa K; Arbabi, Saman; Robinson, Ellen F; Maier, Ronald V

2016-09-01

Previous studies investigating patients at risk for hospital readmissions focus on medical services and have found chronic conditions as contributors. Little is known, however, of the characteristics of patients readmitted from surgical services. Surgical patients readmitted within 30 days following discharge were analyzed to identify opportunities for intervention in a cohort that may differ from the medical population. Medical record review of patients readmitted to any service within 30 days of discharge from the general surgery service to characterize index and readmission data between July 1, 2014, and June 30, 2015, at a Level I trauma center and safety-net hospital. Reasons for readmission identified by manual medical record review and risk factors identified via statistical analysis of all discharges during this period. One hundred seventy-three patients were identified as being unplanned readmissions within 30 days among 2100 discharges (8.2%). Of these 173 patients, 91 were men. Common reasons for readmission included 29 patients with injection drug use who were readmitted with soft tissue infections at new sites (16.8% of readmissions), 25 with disposition support issues (14.5%), 23 with infections not detectable during index admission (13.3%), and 16 with sequelae of their injury or condition (9.2%). Sixteen patients were identified as having a likely preventable complication of care (9.2%), and 2 were readmitted owing to deterioration of medical conditions (1.2%). On univariate and multivariate analyses, female sex (men to women risk of readmission odds ratio [OR], 0.5; 95% CI, 0.37-0.71; P < .001), presence of diabetes (OR, 1.7; 95% CI, 1.1-2.6; P = .009), sepsis on admission (OR, 1.7; 95% CI, 1.05-2.6; P = .03), or intensive care unit stay during index admission (OR, 1.7; 95% CI, 1.2-2.4; P = .002), as well as discharge to respite care (OR, 2.3; 95% CI, 1.2-4.5; P = .01) and payer status (Medicaid/Medicare compared with commercial OR, 2.0; 95% CI, 1.3-3.0; P = .002) , were identified as risk factors for readmission. Many readmissions may be unavoidable in our current paradigms of care. While medical comorbidities are contributory, a large number of readmissions were not caused by suboptimal medical care or deterioration of medical conditions but by confounding issues of substance abuse or homelessness. Identification of the highest risk cohort for readmission can allow more targeted intervention for similar populations with socially challenged patients.

Catchment-scale hydrologic implications of parcel-level stormwater management (Ohio USA)

NASA Astrophysics Data System (ADS)

Shuster, William; Rhea, Lee

2013-04-01

SummaryThe effectiveness of stormwater management strategies is a key issue affecting decision making on urban water resources management, and so proper monitoring and analysis of pilot studies must be addressed before drawing conclusions. We performed a pilot study in the suburban Shepherd Creek watershed located in Cincinnati, Ohio to evaluate the practicality of voluntary incentives for stormwater quantity reduction on privately owned suburban properties. Stream discharge and precipitation were monitored 3 years before and after implementation of the stormwater management treatments. To implement stormwater control measures, we elicited the participation of citizen landowners with two successive reverse-auctions. Auctions were held in spring 2007, and 2008, resulting in the installation of 85 rain gardens and 174 rain barrels. We demonstrated an analytic process of increasing model flexibility to determine hydrologic effectiveness of stormwater management at the sub-catchment level. A significant albeit small proportion of total variance was explained by both the effects of study period (˜69%) and treatment-vs.-control (˜7%). Precipitation-discharge relationships were synthesized in estimated unit hydrographs, which were decomposed and components tested for influence of treatments. Analysis of unit hydrograph parameters showed a weakened correlation between precipitation and discharge, and support the output from the initial model that parcel-level green infrastructure added detention capacity to treatment basins. We conclude that retrofit management of stormwater runoff quantity with green infrastructure in a small suburban catchment can be successfully initiated with novel economic incentive programs, and that these measures can impart a small, but statistically significant decrease in otherwise uncontrolled runoff volume. Given consistent monitoring data and analysis, water resource managers can use our approach as a way to estimate actual effectiveness of stormwater runoff volume management, with potential benefits for management of both separated and combined sewer systems. We also discuss lessons-learned with regard to monitoring design for catchment-scale hydrologic studies.

Outcomes in Children Treated with Pentobarbital Infusion for Refractory and Super-Refractory Status Epilepticus.

PubMed

Erklauer, Jennifer; Graf, Jeanine; McPherson, Mona; Anderson, Anne; Wilfong, Angus; Minard, Charles G; Loftis, Laura

2018-03-26

Functional neurologic outcome for children with refractory and super-refractory status epilepticus has not been well defined. Retrospective chart review including children age 0-17 years who received pentobarbital infusion from 2003 to 2016 for status epilepticus. Outcomes were defined in terms of mortality, need for new medical technology assistance at hospital discharge and functional neurologic outcome determined by pediatric cerebral performance category score (PCPC). Potential patient characteristics associated with functional neurologic outcome including age, sex, ethnicity, etiology of the status epilepticus, and duration of pentobarbital infusion were evaluated. Forty children met inclusion criteria. In-hospital mortality was 30% (12/40). Of survivors, 21% (6/28) returned to baseline PCPC while half (14/28) declined in function ≥ 2 PCPC categories at hospital discharge. 25% (7/28) of survivors required tracheostomy and 27% (7/26) required new gastrostomy. Seizures persisted at discharge for most patients with new onset status epilepticus while the majority of patients with known epilepsy returned to baseline seizure frequency. Etiology (p = 0.015), PCPC at admission (p = 0.0006), new tracheostomy (p = 0.012), and new gastrostomy tube (p = 0.012) were associated with increase in PCPC score ≥ 2 categories in univariable analysis. Duration of pentobarbital infusion (p = 0.005) and length of hospital stay (p = 0.056) were longer in patients who demonstrated significant decline in neurologic function. None of these variables maintained statistical significance when multiple logistic regression model adjusting for PCPC score at admission was applied. At long-term follow-up, 36% (8/22) of children demonstrated improvement in PCPC compared to discharge and 23% (5/22) showed deterioration including three additional deaths. Mortality in this population was high. The majority of children experienced some degree of disability at discharge. Despite prolonged pentobarbital infusion, there were cases of survival with good neurologic outcome.

Modeling land use change impacts on water resources in a tropical West African catchment (Dano, Burkina Faso)

NASA Astrophysics Data System (ADS)

Yira, Y.; Diekkrüger, B.; Steup, G.; Bossa, A. Y.

2016-06-01

This study investigates the impacts of land use change on water resources in the Dano catchment, Burkina Faso, using a physically based hydrological simulation model and land use scenarios. Land use dynamic in the catchment was assessed through the analysis of four land use maps corresponding to the land use status in 1990, 2000, 2007, and 2013. A reclassification procedure levels out differences between the classification schemes of the four maps. The land use maps were used to build five land use scenarios corresponding to different levels of land use change in the catchment. Water balance was simulated by applying the Water flow and balance Simulation Model (WaSiM) using observed discharge, soil moisture, and groundwater level for model calibration and validation. Model statistical quality measures (R2, NSE and KGE) achieved during calibration and validation ranged between 0.6 and 0.9 for total discharge, soil moisture, and groundwater level, indicating a good agreement between observed and simulated variables. After a successful multivariate validation the model was applied to the land use scenarios. The land use assessment exhibited a decrease of savannah at an annual rate of 2% since 1990. Conversely, cropland and urban areas have increased. Since urban areas occupy only 3% of the catchment it can be assumed that savannah was mainly converted to cropland. The conversion rate of savannah was lower than the annual population growth of 3%. A clear increase in total discharge (+17%) and decrease in evapotranspiration (-5%) was observed following land use change in the catchment. A strong relationship was established between savannah degradation, cropland expansion, discharge increase and reduction of evapotranspiration. The increase in total discharge is related to high peak flow, suggesting (i) an increase in water resources that are not available for plant growth and human consumption and (ii) an alteration of flood risk for both the population within and downstream of the catchment.

Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs.

PubMed

Karapinar-Çarkit, Fatma; Borgsteede, Sander D; Zoer, Jan; Egberts, Toine C G; van den Bemt, Patricia M L A; van Tulder, Maurits

2012-03-01

Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs. To evaluate the effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs. A prospective observational study was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed medication errors prevented by medication reconciliation. Interventions were classified into 3 categories: correcting hospital formulary-induced medication changes (eg, reinstating less costly generic drugs used before admission), optimizing pharmacotherapy (eg, discontinuing unnecessary laxative), and eliminating discrepancies (eg, restarting omitted preadmission medication). Because eliminating discrepancies does not represent real costs to society (before hospitalization, the patient was also using the medication), these medication costs were not included in the cost calculation. Medication costs at 1 month and 6 months after hospital discharge and the associated labor costs were assessed using descriptive statistics and scenario analyses. For the 6-month extrapolation, only medication intended for chronic use was included. Two hundred sixty-two patients were included. Correcting hospital formulary changes saved €1.63/patient (exchange rate: EUR 1 = USD 1.3443) in medication costs at 1 month after discharge and €9.79 at 6 months. Optimizing pharmacotherapy saved €20.13/patient in medication costs at 1 month and €86.86 at 6 months. The associated labor costs for performing medication reconciliation were €41.04/patient. Medication cost savings from correcting hospital formulary-induced changes and optimizing of pharmacotherapy (€96.65/patient) outweighed the labor costs at 6 months extrapolation by €55.62/patient (sensitivity analysis €37.25-71.10). Preventing medication errors through medication reconciliation results in higher benefits than the costs related to the net time investment.

Spatial Scaling of Floods in Atlantic Coastal Watersheds

NASA Astrophysics Data System (ADS)

Plank, C.

2013-12-01

Climate and land use changes are altering global, regional and local hydrologic cycles. As a result, past events may not accurately represent the events that will occur in the future. Methods for hydrologic prediction, both statistical and deterministic, require adequate data for calibration. Streamflow gauges tend to be located on large rivers. As a result, statistical flood frequency analysis, which relies on gauge data, is biased towards large watersheds. Conversely, the complexity of parameterizing watershed processes in deterministic hydrological models limits these to small watersheds. Spatial scaling relationships between drainage basin area and discharge can be used to bridge these two methodologies and provide new approaches to hydrologic prediction. The relationship of discharge (Q) to drainage basin area (A) can be expressed as a power function: Q = αAθ. This study compares scaling exponents (θ) and coefficients (α) for floods of varying magnitude across a selection of major Atlantic Coast watersheds. Comparisons are made by normalizing flood discharges to a reference area bankfull discharge for each watershed. These watersheds capture the geologic and geomorphic transitions along the Atlantic Coast from narrow bedrock-dominated river valleys to wide coastal plain watersheds. Additionally, there is a range of hydrometeorological events that cause major floods in these basins including tropical storms, thunderstorm systems and winter-spring storms. The mix of flood-producing events changes along a gradient as well, with tropical storms and hurricanes increasing in dominance from north to south as a significant cause of major floods. Scaling exponents and coefficients were determined for both flood quantile estimates (e.g. 1.5-, 10-, 100-year floods) and selected hydrometeorological events (e.g. hurricanes, summer thunderstorms, winter-spring storms). Initial results indicate that southern coastal plain watersheds have lower scaling exponents (θ) than northern watersheds. However, the relative magnitudes of 100-year and other large floods are higher in the coastal plain rivers. In the transition zone between northern and southern watersheds, basins like the Potomac in the Mid-Atlantic region have similar scaling exponents as northern river basins, but relative flood magnitudes comparable to the southern coastal plain watersheds. These differences reflect variations in both geologic/geomorphic and climatic settings. Understanding these variations are important to appropriately using these relationships to improve flood risk models and analyses.

Investigation of priorities in water quality management based on correlations and variations.

PubMed

Boyacıoğlu, Hülya; Gündogdu, Vildan; Boyacıoğlu, Hayal

2013-04-15

The development of water quality assessment strategies investigating spatial and temporal changes caused by natural and anthropogenic phenomena is an important tool in management practices. This paper used cluster analysis, water quality index method, sensitivity analysis and canonical correlation analysis to investigate priorities in pollution control activities. Data sets representing 22 surface water quality parameters were subject to analysis. Results revealed that organic pollution was serious threat for overall water quality in the region. Besides, oil and grease, lead and mercury were the critical variables violating the standard. In contrast to inorganic variables, organic and physical-inorganic chemical parameters were influenced by variations in physical conditions (discharge, temperature). This study showed that information produced based on the variations and correlations in water quality data sets can be helpful to investigate priorities in water management activities. Moreover statistical techniques and index methods are useful tools in data - information transformation process. Copyright © 2013 Elsevier Ltd. All rights reserved.

Atypical antipsychotic usage among Asian Americans and Pacific Islanders.

PubMed

Takeshita, Junji; Goebert, Deborah; Else, Iwalani; Carlton, Barry; Matsu, Courtenay; Guerrero, Anthony

2014-09-01

Previous studies have shown significant ethnic differences in prescribing patterns of two or more antipsychotics. This study examined changes in atypical and typical antipsychotic prescriptions among Asian Americans and Pacific Islanders. Five hundred consecutive charts were reviewed for antipsychotics at the time of admission and discharge from each of two inpatient psychiatric facilities in Hawai'i. Multiple antipsychotic prescription rates were 9% at intake and 6% at discharge. For the ethnic groups studied, there were no statistically significant differences by patient ethnicity regarding antipsychotics at intake (χ(2) = 29.2, df = 21, P = .110) or discharge (χ(2) = 20.5, df = 24, P = .667). There were no significant differences in prescription and polypharmacy patterns among Asian Americans and Pacific Islanders ethnic groups in this study.

Comparison of bottom-track to global positioning system referenced discharges measured using an acoustic Doppler current profiler

USGS Publications Warehouse

Wagner, Chad R.; Mueller, David S.

2011-01-01

A negative bias in discharge measurements made with an acoustic Doppler current profiler (ADCP) can be caused by the movement of sediment on or near the streambed. The integration of a global positioning system (GPS) to track the movement of the ADCP can be used to avoid the systematic negative bias associated with a moving streambed. More than 500 discharge transects from 63 discharge measurements with GPS data were collected at sites throughout the US, Canada, and New Zealand with no moving bed to compare GPS and bottom-track-referenced discharges. Although the data indicated some statistical bias depending on site conditions and type of GPS data used, these biases were typically about 0.5% or less. An assessment of differential correction sources was limited by a lack of data collected in a range of different correction sources and different GPS receivers at the same sites. Despite this limitation, the data indicate that the use of Wide Area Augmentation System (WAAS) corrected positional data is acceptable for discharge measurements using GGA as the boat-velocity reference. The discharge data based on GPS-referenced boat velocities from the VTG data string, which does not require differential correction, were comparable to the discharges based on GPS-referenced boat velocities from the differentially-corrected GGA data string. Spatial variability of measure discharges referenced to GGA, VTG and bottom-tracking is higher near the channel banks. The spatial variability of VTG-referenced discharges is correlated with the spatial distribution of maximum Horizontal Dilution of Precision (HDOP) values and the spatial variability of GGA-referenced discharges is correlated with proximity to channel banks.

Improving hospital discharge time: a successful implementation of Six Sigma methodology.

PubMed

El-Eid, Ghada R; Kaddoum, Roland; Tamim, Hani; Hitti, Eveline A

2015-03-01

Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions. The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process. This is a quantitative pre and post-intervention study. Three hundred and eighty-six bed tertiary care hospital. A series of Six Sigma driven interventions over a 10-month period. The primary outcome was discharge time (time from discharge order to patient leaving the room). Secondary outcome measures included percent of patients whose discharge order was written before noon, percent of patients leaving the room by noon, hospital length of stay (LOS), and LOS of admitted ED patients. Discharge time decreased by 22.7% from 2.2 hours during the preintervention period to 1.7 hours post-intervention (P < 0.001). A greater proportion of patients left their room before noon in the postintervention period (P < 0.001), though there was no statistical difference in before noon discharge. Hospital LOS dropped from 3.4 to 3.1 days postintervention (P < 0.001). ED mean LOS of patients admitted to the hospital was significantly lower in the postintervention period (6.9 ± 7.8 vs 5.9 ± 7.7 hours; P < 0.001). Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific.

On the use of administrative databases to support planning activities: the case of the evaluation of neonatal case-mix in the Emilia-Romagna region using DRG and APR-DRG classification systems.

PubMed

Fantini, M P; Cisbani, L; Manzoli, L; Vertrees, J; Lorenzoni, L

2003-06-01

There are several versions of the Diagnosis Related Group (DRG) classification systems that are used for case-mix analysis, utilization review, prospective payment, and planning applications. The objective of this study was to assess the adequacy of two of these DRG systems--Medicare DRG and All Patient Refined DRG--to classify neonatal patients. The first part of the paper contains a descriptive analysis that outlines the major differences between the two systems in terms of classification logic and variables used in the assignment process. The second part examines the statistical performance of each system on the basis of the administrative data collected in all public hospitals of the Emilia-Romagna region relating to neonates discharged in 1997 and 1998. The Medicare DRG are less developed in terms of classification structure and yield a poorer statistical performance in terms of reduction in variance for length of stay. This is important because, for specific areas, a more refined system can prove useful at regional level to remove systematic biases in the measurement of case-mix due to the structural characteristics of the Medicare DRGs classification system.

Modeling Land Use Change Impacts on Water Resources in a Tropical West African Catchment (dano, Burkina Faso)

NASA Astrophysics Data System (ADS)

Yira, Y.; Diekkrüger, B.; Steup, G.; Bossa, A. Y.

2015-12-01

This study investigates the impacts of land use change on water resources in the Dano catchment, Burkina Faso, using a physically based hydrological simulation model and land use scenarios. Land use dynamic in the catchment was assessed through the analysis of four land use maps corresponding to the land use status in 1990, 2000, 2007 and 2013. A reclassification procedure of the maps permitted to assess the major land use changes in the catchment from 1990 to 2013. The land use maps were used to build five land use scenarios corresponding to different levels of land use change in the catchment. Water balance was simulated by applying the Water flow and balance Simulation Model (WaSiM) using observed discharge, soil moisture, and groundwater level for model calibration and validation. Model statistical quality measures (R2, NSE and KGE) achieved during the calibration and the validation ranged between 0.9 and 0.6 for total discharge, soil moisture, and groundwater level, indicating satisfying to good agreements between observed and simulated variables. After a successful multi-criteria validation the model was run with the land use scenarios. The land use assessment exhibited a decrease of savannah at an annual rate of 2% since 1990. Conversely, cropland and urban areas have increased. Since urban areas occupy only 3% of the catchment in 2013 it can be assumed that savannah was mainly converted to cropland. The increase in cropland area results from the population growth and the farming system in the catchment. A clear increase in total discharge (+17%) and decrease in evapotranspiration (-5%) was observed following land use change in the catchment. A strong relationship was established between savannah degradation, cropland expansion, discharge increase and reduction of evapotranspiration. The increase in total discharge is related to high discharge and peak flow, suggesting (i) an increase in water resources that is not available for plant growth and the population of the catchment and (ii) an alteration of flood risk for both the population within and downstream of the catchment.

Meta-analysis of outcomes of the 2005 and 2010 cardiopulmonary resuscitation guidelines for adults with in-hospital cardiac arrest.

PubMed

Zhu, Aiqun; Zhang, Jingping

2016-06-01

The post-cardiac arrest survival rate has remained low since the 2010 cardiopulmonary resuscitation (CPR) guidelines were published. The present study aimed to review the 2010 vs 2005 CPR guideline outcomes in adults with in-hospital cardiac arrest. The Pub Med, EMBASE, and Cochrane Library databases were searched for articles published between January 2006 and July 2015. We extracted the following from observational studies and intervention studies: first author's name, publication year, study duration, age of study population, and sample size. The primary outcome variables were return of spontaneous circulation (ROSC) and survival to discharge. The data were divided into 2005 (data collected before December 2010) and 2010 (data collected in December 2010 or later) CPR guidelines groups. Twenty-four original articles (77,605 patients) were included. Statistically significant heterogeneity (ROSC: P<.01, I(2)=97.9%; survival to discharge: P<.01, I(2)=98.3%) was seen, and a random-effects model was used to pool the outcomes. The pooled ROSC rate for the 2010 group (n=5; mean, 48%; 95% confidence interval [CI], 0.38-0.58) was only slightly higher than that of the 2005 group (n=19; mean, 47%; 95% CI, 0.38-0.57). The opposite result was noted in the pooled survival to discharge rates (2010: n=5, mean, 14%; 95% CI, 0.08-0.20 vs 2005: n=19; mean, 15%; 95% CI, 0.10-0.20). There was actually no significant difference in ROSC or survival to discharge outcomes between the 2 groups. The 2010 CPR guidelines emphasized that high-quality chest compressions can increase the ROSC rate but did not show to improve long-term results. Copyright © 2016 Elsevier Inc. All rights reserved.

Semantic Classification of Diseases in Discharge Summaries Using a Context-aware Rule-based Classifier

PubMed Central

Solt, Illés; Tikk, Domonkos; Gál, Viktor; Kardkovács, Zsolt T.

2009-01-01

Objective Automated and disease-specific classification of textual clinical discharge summaries is of great importance in human life science, as it helps physicians to make medical studies by providing statistically relevant data for analysis. This can be further facilitated if, at the labeling of discharge summaries, semantic labels are also extracted from text, such as whether a given disease is present, absent, questionable in a patient, or is unmentioned in the document. The authors present a classification technique that successfully solves the semantic classification task. Design The authors introduce a context-aware rule-based semantic classification technique for use on clinical discharge summaries. The classification is performed in subsequent steps. First, some misleading parts are removed from the text; then the text is partitioned into positive, negative, and uncertain context segments, then a sequence of binary classifiers is applied to assign the appropriate semantic labels. Measurement For evaluation the authors used the documents of the i2b2 Obesity Challenge and adopted its evaluation measures: F1-macro and F1-micro for measurements. Results On the two subtasks of the Obesity Challenge (textual and intuitive classification) the system performed very well, and achieved a F1-macro = 0.80 for the textual and F1-macro = 0.67 for the intuitive tasks, and obtained second place at the textual and first place at the intuitive subtasks of the challenge. Conclusions The authors show in the paper that a simple rule-based classifier can tackle the semantic classification task more successfully than machine learning techniques, if the training data are limited and some semantic labels are very sparse. PMID:19390101

Development of a Clinical Tool to Predict Home Death of a Discharged Cancer Patient in Japan: a Case-Control Study.

PubMed

Fukui, Sakiko; Morita, Tatsuya; Yoshiuchi, Kazuhiro

2017-08-01

The aim of this study was to investigate the predictive value of a clinical tool to predict whether discharged cancer patients die at home, comparing groups of case who died at home and control who died in hospitals or other facilities. We conducted a nationwide case-control study to identify the determinants of home death for a discharged cancer patient. We randomly selected nurses in charge of 2000 home-visit nursing agencies from all 5813 agencies in Japan by referring to the nationwide databases in January 2013. The nurses were asked to report variables of their patients' place of death, patients' and caregivers' clinical statuses, and their preferences for home death. We used logistic regression analysis and developed a clinical tool to accurately predict it and investigated their predictive values. We identified 466 case and 478 control patients. Five predictive variables of home death were obtained: patients' and caregivers' preferences for home death [OR (95% CI) 2.66 (1.99-3.55)], availability of visiting physicians [2.13 (1.67-2.70)], 24-h contact between physicians and nurses [1.68 (1.30-2.18)], caregivers' experiences of deathwatch at home [1.41 (1.13-1.75)], and patients' insights as to their own prognosis [1.23 (1.02-1.50)]. We calculated the scores predicting home death for each variable (range 6-28). When using a cutoff point of 16, home death was predicted with a sensitivity of 0.72 and a specificity of 0.81 with the Harrell's c-statistic of 0.84. This simple clinical tool for healthcare professionals can help predict whether a discharged patient is likely to die at home.

Hypnosis closed loop TCI systems in outpatient surgery.

PubMed

Ramos-Luengo, A; Asensio-Merino, F

Determine the influence of general anaesthesia with closed-loop systems in the results of outpatient varicose vein surgery. Retrospective observational study including data from 270 outpatients between 2014 and 2015. The patients were divided into 2 groups according to the type of general anaesthesia used. The CL Group included patients who received propofol in closed-loop guided by BIS and remifentanil using TCI, and the C Group received non-closed-loop anaesthesia. Age, sex, surgical time, discharge time and failure of outpatient surgery were recorded. Quantitative data were checked for normal distribution by the method of Kolmogorov-Smirnov-Lilliefors. Differences between groups were analysed by a Student-t-test or Mann-Whitney-Wilcoxon test, depending on their distribution. Categorical data were analysed by a Chi-squared test. We used Kaplan-Meier estimator and the effect size (calculated by Cohen's d) to study the discharge time. Statistical analysis was performed using R 3.2.3 binary for Mac OS X 10.9. There were no significant differences in age, sex and surgical time and failure of outpatient surgery. Discharge time was different in both groups: 200 (100) vs. 180 (82.5) minutes, C Group and CL Group, respectively (data are median and interquartile rank); P=.005. The use of closed-loop devices for the hypnotic component of anaesthesia hastens discharge time. However, for this effect to be clinically significant, some improvements still need to be made in our outpatient surgery units. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Importance of physical and hydraulic characteristics to unionid mussels: A retrospective analysis in a reach of large river

USGS Publications Warehouse

Zigler, S.J.; Newton, T.J.; Steuer, J.J.; Bartsch, M.R.; Sauer, J.S.

2008-01-01

Interest in understanding physical and hydraulic factors that might drive distribution and abundance of freshwater mussels has been increasing due to their decline throughout North America. We assessed whether the spatial distribution of unionid mussels could be predicted from physical and hydraulic variables in a reach of the Upper Mississippi River. Classification and regression tree (CART) models were constructed using mussel data compiled from various sources and explanatory variables derived from GIS coverages. Prediction success of CART models for presence-absence of mussels ranged from 71 to 76% across three gears (brail, sled-dredge, and dive-quadrat) and 51% of the deviance in abundance. Models were largely driven by shear stress and substrate stability variables, but interactions with simple physical variables, especially slope, were also important. Geospatial models, which were based on tree model results, predicted few mussels in poorly connected backwater areas (e.g., floodplain lakes) and the navigation channel, whereas main channel border areas with high geomorphic complexity (e.g., river bends, islands, side channel entrances) and small side channels were typically favorable to mussels. Moreover, bootstrap aggregation of discharge-specific regression tree models of dive-quadrat data indicated that variables measured at low discharge were about 25% more predictive (PMSE = 14.8) than variables measured at median discharge (PMSE = 20.4) with high discharge (PMSE = 17.1) variables intermediate. This result suggests that episodic events such as droughts and floods were important in structuring mussel distributions. Although the substantial mussel and ancillary data in our study reach is unusual, our approach to develop exploratory statistical and geospatial models should be useful even when data are more limited. ?? 2007 Springer Science+Business Media B.V.

Skilled Nursing Facility Partnerships May Decrease 90-Day Costs in a Total Joint Arthroplasty Episode Under the Bundled Payments for Care Improvement Initiative.

PubMed

Behery, Omar A; Kouk, Shalen; Chen, Kevin K; Mullaly, Kathleen A; Bosco, Joseph A; Slover, James D; Iorio, Richard; Schwarzkopf, Ran

2018-03-01

The Bundled Payments for Care Improvement initiative was developed to reduce costs associated with total joint arthroplasty through a single payment for all patient care from index admission through a 90-day post-discharge period, including care at skilled nursing facilities (SNFs). The aim of this study is to investigate whether forming partnerships between hospitals and SNFs could lower the post-discharge costs. We hypothesize that institutionally aligned SNFs have lower post-discharge costs than non-aligned SNFs. A cohort of 615 elective, primary total hip and knee arthroplasty subjects discharged to an SNF under the Bundled Payments for Care Improvement from 2014 to 2016 were included in our analysis. Patients were grouped into one of the 3 categories of SNF alignment: group 1: non-partners; group 2: agreement-based partners; group 3: institution-owned partners. Demographics, comorbidities, length of stay (LOS) at SNF, and associated costs during the 90-day post-operative period were compared between the 3 groups. Mean index hospital LOS was statistically shortest in group 3 (mean 2.7 days vs 3.5 for groups 1 and 2, P = .001). SNF LOS was also shortest in group 3 (mean 11 days vs 19 and 21 days in groups 2 and 1 respectively, P < .001). Total SNF costs and total 90-day costs were both significantly lower in group 3 compared with groups 1 and 2 (P < .001 for all), even after controlling for medical comorbidities. Institution-owned partner SNFs demonstrated the shortest patient LOS, and the lowest SNF and total 90-day costs, without increased risk of readmissions, compared with other SNFs. Copyright © 2017 Elsevier Inc. All rights reserved.

A population-based longitudinal study of suicide risk in male schizophrenia patients: Proximity to hospital discharge and the moderating effect of premorbid IQ.

PubMed

Weiser, Mark; Kapra, Ori; Werbeloff, Nomi; Goldberg, Shira; Fenchel, Daphna; Reichenberg, Abraham; Yoffe, Rinat; Ginat, Keren; Fruchter, Eyal; Davidson, Michael

2015-12-01

Suicide is a major cause of death in schizophrenia. Identifying factors which increase the risk of suicide among schizophrenia patients might help focus prevention efforts. This study examined risk of suicide in male schizophrenia patients using population-based data, examining the timing of suicide in relation to the last hospital discharge, and the effect of premorbid IQ on risk of suicide. Data on 930,000 male adolescents from the Israeli military draft board were linked with data from the Israeli Psychiatric Hospitalization Case Registry and vital statistics from the Israeli Ministry of Health. The relationship between premorbid IQ and risk for suicide was examined among 2881 males hospitalized with schizophrenia and compared to a control group of 566,726 males from the same cohort, who were not hospitalized for a psychiatric disorder, using survival analysis methods. Over a mean follow-up period of 9.9 years (SD=5.8, range: 0-22 years), 77/3806 males with schizophrenia died by suicide (a suicide rate of 204.4 per 100,000 person-years). Approximately 48% of the suicides occurred within a year of discharge from the last hospital admission for schizophrenia. Risk of suicide was higher in male schizophrenia patients with high premorbid IQ (HR=4.45, 95% CI=1.37-14.43) compared to those with normal premorbid IQ. These data indicate that male schizophrenia patients with high premorbid IQ are at particularly high risk of suicide, and the time of peak risk is during the first year after the last hospitalization discharge. Copyright © 2015 Elsevier B.V. All rights reserved.

The contribution of sea-level rise to flooding in large river catchments

NASA Astrophysics Data System (ADS)

Thiele-Eich, I.; Hopson, T. M.; Gilleland, E.; Lamarque, J.; Hu, A.; Simmer, C.

2012-12-01

Climate change is expected to both impact sea level rise as well as flooding. Our study focuses on the combined effect of climate change on upper catchment precipitation as well as on sea-level rise at the river mouths and the impact this will have on river flooding both at the coast and further upstream. We concentrate on the eight catchments of the Amazonas, Congo, Orinoco, Ganges/Brahmaputra/Meghna, Mississippi, St. Lawrence, Danube and Niger rivers. To assess the impact of climate change, upper catchment precipitation as well as monthly mean thermosteric sea-level rise at the river mouth outflow are taken from the four CCSM4 1° 20th Century ensemble members as well as from six CCSM4 1° ensemble members for the RCP scenarios RCP8.5, 6.0, 4.5 and 2.6. Continuous daily time series for average catchment precipitation and discharge are available for each of the catchments. To arrive at a future discharge time series, we used these observations to develop a simple statistical hydrological model which can be applied to the modelled future upper catchment precipitation values. The analysis of this surrogate discharge time series alone already yields significant changes in flood return levels as well as flood duration. Using the geometry of the river channel, the backwater effect of sea-level rise is incorporated in our analysis of both flood frequencies and magnitudes by calculating the effective additional discharge due to the increase in water level at the river mouth outflow, as well as its tapering impact upstream. By combining these effects, our results focus on the merged impact of changes in extreme precipitation with increases in river height due to sea-level rise at the river mouths. Judging from our preliminary results, the increase in effective discharge due to sea-level rise cannot be neglected when discussing late 21st century flooding in the respective river basins. In particular, we find that especially in countries with low elevation gradient, flood characteristics are impacted by changes in sea-level rise as far inland as 150 kilometers. Therefore, a larger population than the coastal inhabitants alone are exposed to risks of further projected increases of sea-level rise. A prime example for a megacity greatly put at risk by this is Dhaka City in Bangladesh, with a population of roughly 14 million people.

Assessing various approaches for flash flood forecasting in the Yzeron periurban catchment (150 km2) south-east Lyon, France

NASA Astrophysics Data System (ADS)

Braud, Isabelle; Breil, Pascal; Javelle, Pierre; Pejakovic, Nikola; Guérin, Stéphane

2017-04-01

The Yzeron periurban catchment (150 km2) is prone to flash floods leading to overflow in the downstream part of the catchment. A prevention and management plan has been approved and the set-up of a flood forecasting system is planned. The present study presents a comparison of several solutions for flood forecasting in the catchment. It is based on an extensive data collection (rain gauges, radar/rain gauge reanalyses, discharge and water level data) from this experimental catchment. A set of rainfall-runoff events leading to floods (problematic and non-problematic floods) was extracted and formed the basis for the definition of a first forecasting method. It is based on data analysis and the identification of explaining factors amongst the following: rainfall amount, intensity, antecedent rainfall, initial discharge. Several statistical methods including Factorial Analysis of Mixed Data and Classification and Regression Tree were used for this purpose. They showed that several classes of problematic floods can be identified. The first one is related to wet conditions characterized with high initial discharge and antecedent rainfall. The second class is driven by rainfall amount, initial discharge and rainfall intensity. Thresholds of these variables can be identified to provide a first warning. The second forecasting method assessed in the study is the system that will be operational in France in 2017, based on the AIGA method (Javelle et al., 2016). For this purpose, 18-year discharge simulation using the hydrological model of the AIGA method, forced using radar/rain gauges reanalysis were available at 44 locations within the catchment. The dates for which quantiles of a given return period were overtopped were identified and compared with the list of problematic events. The AIGA method was found relevant in identifying the most problematic events, but the lead time needs further investigation in order to assess the usefulness for population warning. References: Pierre Javelle, Didier Organde, Julie Demargne, Clotilde Saint-Martin, Céline de Saint-Aubin, Léa Garandeau and Bruno Janet (2016). Setting up a French national flash flood warning system for ungauged catchments based on the AIGA method. E3S Web of Conferences 7, 18010 (2016), 3rd European Conference on Flood Risk Management (FLOODrisk 2016), http://dx.doi.org/10.1051/e3sconf/20160718010

Development and validation of an ICD-10-based disability predictive index for patients admitted to hospitals with trauma.

PubMed

Wada, Tomoki; Yasunaga, Hideo; Yamana, Hayato; Matsui, Hiroki; Fushimi, Kiyohide; Morimura, Naoto

2018-03-01

There was no established disability predictive measurement for patients with trauma that could be used in administrative claims databases. The aim of the present study was to develop and validate a diagnosis-based disability predictive index for severe physical disability at discharge using the International Classification of Diseases, 10th revision (ICD-10) coding. This retrospective observational study used the Diagnosis Procedure Combination database in Japan. Patients who were admitted to hospitals with trauma and discharged alive from 01 April 2010 to 31 March 2015 were included. Pediatric patients under 15 years old were excluded. Data for patients admitted to hospitals from 01 April 2010 to 31 March 2013 was used for development of a disability predictive index (derivation cohort), while data for patients admitted to hospitals from 01 April 2013 to 31 March 2015 was used for the internal validation (validation cohort). The outcome of interest was severe physical disability defined as the Barthel Index score of <60 at discharge. Trauma-related ICD-10 codes were categorized into 36 injury groups with reference to the categorization used in the Global Burden of Diseases study 2013. A multivariable logistic regression analysis was performed for the outcome using the injury groups and patient baseline characteristics including patient age, sex, and Charlson Comorbidity Index (CCI) score in the derivation cohort. A score corresponding to a regression coefficient was assigned to each injury group. The disability predictive index for each patient was defined as the sum of the scores. The predictive performance of the index was validated using the receiver operating characteristic curve analysis in the validation cohort. The derivation cohort included 1,475,158 patients, while the validation cohort included 939,659 patients. Of the 939,659 patients, 235,382 (25.0%) were discharged with severe physical disability. The c-statistics of the disability predictive index was 0.795 (95% confidence interval [CI] 0.794-0.795), while that of a model using the disability predictive index and patient baseline characteristics was 0.856 (95% CI 0.855-0.857). Severe physical disability at discharge may be well predicted with patient age, sex, CCI score, and the diagnosis-based disability predictive index in patients admitted to hospitals with trauma. Copyright © 2018 Elsevier Ltd. All rights reserved.

A study to derive a clinical decision rule for triage of emergency department patients with chest pain: design and methodology

PubMed Central

Hess, Erik P; Wells, George A; Jaffe, Allan; Stiell, Ian G

2008-01-01

Background Chest pain is the second most common chief complaint in North American emergency departments. Data from the U.S. suggest that 2.1% of patients with acute myocardial infarction and 2.3% of patients with unstable angina are misdiagnosed, with slightly higher rates reported in a recent Canadian study (4.6% and 6.4%, respectively). Information obtained from the history, 12-lead ECG, and a single set of cardiac enzymes is unable to identify patients who are safe for early discharge with sufficient sensitivity. The 2007 ACC/AHA guidelines for UA/NSTEMI do not identify patients at low risk for adverse cardiac events who can be safely discharged without provocative testing. As a result large numbers of low risk patients are triaged to chest pain observation units and undergo provocative testing, at significant cost to the healthcare system. Clinical decision rules use clinical findings (history, physical exam, test results) to suggest a diagnostic or therapeutic course of action. Currently no methodologically robust clinical decision rule identifies patients safe for early discharge. Methods/design The goal of this study is to derive a clinical decision rule which will allow emergency physicians to accurately identify patients with chest pain who are safe for early discharge. The study will utilize a prospective cohort design. Standardized clinical variables will be collected on all patients at least 25 years of age complaining of chest pain prior to provocative testing. Variables strongly associated with the composite outcome acute myocardial infarction, revascularization, or death will be further analyzed with multivariable analysis to derive the clinical rule. Specific aims are to: i) apply standardized clinical assessments to patients with chest pain, incorporating results of early cardiac testing; ii) determine the inter-observer reliability of the clinical information; iii) determine the statistical association between the clinical findings and the composite outcome; and iv) use multivariable analysis to derive a highly sensitive clinical decision rule to guide triage decisions. Discussion The study will derive a highly sensitive clinical decision rule to identify low risk patients safe for early discharge. This will improve patient care, lower healthcare costs, and enhance flow in our busy and overcrowded emergency departments. PMID:18254973

Invasive Mechanical Ventilation in California Over 2000-2009: Implications for Emergency Medicine.

PubMed

Mudumbai, Seshadri C; Barr, Juli; Scott, Jennifer; Mariano, Edward R; Bertaccini, Edward; Nguyen, Hieu; Memtsoudis, Stavros G; Cason, Brian; Phibbs, Ciaran S; Wagner, Todd

2015-09-01

Patients who require invasive mechanical ventilation (IMV) often represent a sequence of care between the emergency department (ED) and intensive care unit (ICU). Despite being the most populous state, little information exists to define patterns of IMV use within the state of California. We examined data from the masked Patient Discharge Database of California's Office of Statewide Health Planning and Development from 2000-2009. Adult patients who received IMV during their stay were identified using the International Classification of Diseases 9th Revision and Clinical Modification procedure codes (96.70, 96.71, 96.72). Patients were divided into age strata (18-34 yr, 35-64 yr, and >65 yr). Using descriptive statistics and regression analyses, for IMV discharges during the study period, we quantified the number of ED vs. non-ED based admissions; changes in patient characteristics and clinical outcome; evaluated the marginal costs for IMV; determined predictors for prolonged acute mechanical ventilation (PAMV, i.e. IMV>96 hr); and projected the number of IMV discharges and ED-based admissions by year 2020. There were 696,634 IMV discharges available for analysis. From 2000-2009, IMV discharges increased by 2.8%/year: n=60,933 (293/100,000 persons) in 2000 to n=79,868 (328/100,000 persons) in 2009. While ED-based admissions grew by 3.8%/year, non-ED-based admissions remained stable (0%). During 2000-2009, fastest growth was noted for 1) the 35-64 year age strata; 2) Hispanics; 3) patients with non-Medicare public insurance; and 4) patients requiring PAMV. Average total patient cost-adjusted charges per hospital discharge increased by 29% from 2000 (from $42,528 to $60,215 in 2014 dollars) along with increases in the number of patients discharged to home and skilled nursing facilities. Higher marginal costs were noted for younger patients (ages 18-34 yr), non-whites, and publicly insured patients. Some of the strongest predictors for PAMV were age 35-64 years (OR=1.12; 95% CI [1.09-1.14], p<0.05); non-Whites; and non-Medicare public insurance. Our models suggest that by 2020, IMV discharges will grow to n=153,153 (377 IMV discharges/100,000 persons) with 99,095 admitted through the ED. Based on sustained growth over the past decade, by the year 2020, we project a further increase to 153,153 IMV discharges with 99,095 admitted through the ED. Given limited ICU bed capacities, ongoing increases in the number and type of IMV patients have the potential to adversely affect California EDs that often admit patients to ICUs.

RELATIONS BETWEEN LIGHTNING DISCHARGES AND DIFFERENT TYPES OF MUSICAL ATMOSPHERICS,

DTIC Science & Technology

Recording cathode-ray oscillographs were used for the analysis of the lightning discharges whose relations to musical atmospherics were investigated...of the lightning discharges investigated. Through comparative harmonic analyses it was shown that lightning discharges producing musical atmospherics...followed by multiple whistlers. An investigation was made of correlations between lightning discharges and musical atmospherics of unusual and irregular

Hyperpycnal sediment discharge from semiarid southern California rivers: Implications for coastal sediment budgets

USGS Publications Warehouse

Warrick, J.A.; Milliman, John D.

2003-01-01

Southern California rivers discharge hyperpycnal (river density greater than ocean density) concentrations of suspended sediment (>40 g/L, according to buoyancy theory) during flood events, mostly during El Nin??o-Southern Oscillation (ENSO) conditions. Because hyperpycnal river discharge commonly occurs during brief periods (hours to occasionally days), mean daily flow statistics often do not reveal the magnitude of these events. Hyperpycnal events are particularly important in rivers draining the Transverse Range and account for 75% of the cumulative sediment load discharged by the Santa Clara River over the past 50 yr. These events are highly pulsed, totaling only ??? 30 days (??? 0.15% of the total 50 yr period). Observations of the fate of sediment discharge, although rare, are consistent with hyperpycnal river dynamics and the high likelihood of turbidity currents during these events. We suggest that much of the sediment load initially bypasses the littoral circulation cells and is directly deposited on the adjacent continental shelf, thus potentially representing a loss of immediate beach sand supply. During particularly exceptional events (>100 yr recurrence intervals), flood underflows may extend past the shelf and escape to offshore basins.

Correlations of turbidity to suspended-sediment concentration in the Toutle River Basin, near Mount St. Helens, Washington, 2010-11

USGS Publications Warehouse

Uhrich, Mark A.; Kolasinac, Jasna; Booth, Pamela L.; Fountain, Robert L.; Spicer, Kurt R.; Mosbrucker, Adam R.

2014-01-01

Researchers at the U.S. Geological Survey, Cascades Volcano Observatory, investigated alternative methods for the traditional sample-based sediment record procedure in determining suspended-sediment concentration (SSC) and discharge. One such sediment-surrogate technique was developed using turbidity and discharge to estimate SSC for two gaging stations in the Toutle River Basin near Mount St. Helens, Washington. To provide context for the study, methods for collecting sediment data and monitoring turbidity are discussed. Statistical methods used include the development of ordinary least squares regression models for each gaging station. Issues of time-related autocorrelation also are evaluated. Addition of lagged explanatory variables was used to account for autocorrelation in the turbidity, discharge, and SSC data. Final regression model equations and plots are presented for the two gaging stations. The regression models support near-real-time estimates of SSC and improved suspended-sediment discharge records by incorporating continuous instream turbidity. Future use of such models may potentially lower the costs of sediment monitoring by reducing time it takes to collect and process samples and to derive a sediment-discharge record.

Application of dimensional analysis to ozone production by pulsed streamer discharge in oxygen

NASA Astrophysics Data System (ADS)

Buntat, Z.; Harry, J. E.; Smith, I. R.

2003-07-01

This paper describes the use of dimensional analysis in investigating the effects of the electrical and the discharge configuration parameters on ozone production in oxygen, by means of a pulsed streamer discharge. Ozone destruction factors are taken into account in the model, and predicted results are shown to be in good agreement with experimental findings.

Effect of lunar phase on frequency of psychogenic nonepileptic events in the EMU.

PubMed

Bolen, Robert D; Campbell, Zeke; Dennis, William A; Koontz, Elizabeth H; Pritchard, Paul B

2016-06-01

Studies of the effect of a full moon on seizures have yielded mixed results, despite a continuing prevailing belief regarding the association of lunar phase with human behavior. The potential effect of a full moon on psychogenic nonepileptic events has not been as well studied, despite what anecdotal accounts from most epilepsy monitoring unit (EMU) staff would suggest. We obtained the dates and times of all events from patients diagnosed with psychogenic nonepileptic events discharged from our EMU over a two-year period. The events were then plotted on a 29.5-day lunar calendar. Events were also broken down into lunar quarters for statistical analysis. We found a statistically significant increase in psychogenic nonepileptic events during the new moon quarter in our EMU during our studied timeframe. Our results are not concordant with the results of a similarly designed past study, raising the possibility that psychogenic nonepileptic events are not influenced by lunar phase. Copyright © 2016 Elsevier Inc. All rights reserved.

Exploring the link between meteorological drought and streamflow to inform water resource management

NASA Astrophysics Data System (ADS)

Lennard, Amy; Macdonald, Neil; Hooke, Janet

2015-04-01

Drought indicators are an under-used metric in UK drought management. Standardised drought indicators offer a potential monitoring and management tool for operational water resource management. However, the use of these metrics needs further investigation. This work uses statistical analysis of the climatological drought signal based on meteorological drought indicators and observed streamflow data to explore the link between meteorological drought and hydrological drought to inform water resource management for a single water resource region. The region, covering 21,000 km2 of the English Midlands and central Wales, includes a variety of landscapes and climatological conditions. Analysis of the links between meteorological drought and hydrological drought performed using streamflow data from 'natural' catchments indicates a close positive relationship between meteorological drought indicators and streamflow, enhancing confidence in the application of drought indicators for monitoring and management. However, many of the catchments in the region are subject to modification through impoundments, abstractions and discharge. Therefore, it is beneficial to explore how climatological drought signal propagates into managed hydrological systems. Using a longitudinal study of catchments and sub-catchments that include natural and modified river reaches the relationship between meteorological and hydrological drought is explored. Initial statistical analysis of meteorological drought indicators and streamflow data from modified catchments shows a significantly weakened statistical relationship and reveals how anthropogenic activities may alter hydrological drought characteristics in modified catchments. Exploring how meteorological drought indicators link to streamflow across the water supply region helps build an understanding of their utility for operational water resource management.

Discharge Characteristics of Series Surface/Packed-Bed Discharge Reactor Diven by Bipolar Pulsed Power

NASA Astrophysics Data System (ADS)

Hu, Jian; Jiang, Nan; Li, Jie; Shang, Kefeng; Lu, Na; Wu, Yan; Mizuno, Akira

2016-03-01

The discharge characteristics of the series surface/packed-bed discharge (SSPBD) reactor driven by bipolar pulse power were systemically investigated in this study. In order to evaluate the advantages of the SSPBD reactor, it was compared with traditional surface discharge (SD) reactor and packed-bed discharge (PBD) reactor in terms of the discharge voltage, discharge current, and ozone formation. The SSPBD reactor exhibited a faster rising time and lower tail voltage than the SD and PBD reactors. The distribution of the active species generated in different discharge regions of the SSPBD reactor was analyzed by optical emission spectra and ozone analysis. It was found that the packed-bed discharge region (3.5 mg/L), rather than the surface discharge region (1.3 mg/L) in the SSPBD reactor played a more important role in ozone generation. The optical emission spectroscopy analysis indicated that more intense peaks of the active species (e.g. N2 and OI) in the optical emission spectra were observed in the packed-bed region. supported by National Natural Science Foundation of China (No. 51177007), the Joint Funds of National Natural Science Foundation of China (No. U1462105), and Dalian University of Technology Fundamental Research Fund of China (No. DUT15RC(3)030)

Computer Programs for Obtaining and Analyzing Daily Mean Steamflow Data from the U.S. Geological Survey National Water Information System Web Site

USGS Publications Warehouse

Granato, Gregory E.

2009-01-01

Streamflow information is important for many planning and design activities including water-supply analysis, habitat protection, bridge and culvert design, calibration of surface and ground-water models, and water-quality assessments. Streamflow information is especially critical for water-quality assessments (Warn and Brew, 1980; Di Toro, 1984; Driscoll and others, 1989; Driscoll and others, 1990, a,b). Calculation of streamflow statistics for receiving waters is necessary to estimate the potential effects of point sources such as wastewater-treatment plants and nonpoint sources such as highway and urban-runoff discharges on receiving water. Streamflow statistics indicate the amount of flow that may be available for dilution and transport of contaminants (U.S. Environmental Protection Agency, 1986; Driscoll and others, 1990, a,b). Streamflow statistics also may be used to indicate receiving-water quality because concentrations of water-quality constituents commonly vary naturally with streamflow. For example, concentrations of suspended sediment and sediment-associated constituents (such as nutrients, trace elements, and many organic compounds) commonly increase with increasing flows, and concentrations of many dissolved constituents commonly decrease with increasing flows in streams and rivers (O'Connor, 1976; Glysson, 1987; Vogel and others, 2003, 2005). Reliable, efficient and repeatable methods are needed to access and process streamflow information and data. For example, the Nation's highway infrastructure includes an innumerable number of stream crossings and stormwater-outfall points for which estimates of stream-discharge statistics may be needed. The U.S. Geological Survey (USGS) streamflow data-collection program is designed to provide streamflow data at gaged sites and to provide information that can be used to estimate streamflows at almost any point along any stream in the United States (Benson and Carter, 1973; Wahl and others, 1995; National Research Council, 2004). The USGS maintains the National Water Information System (NWIS), a distributed network of computers and file servers used to store and retrieve hydrologic data (Mathey, 1998; U.S. Geological Survey, 2008). NWISWeb is an online version of this database that includes water data from more than 24,000 streamflow-gaging stations throughout the United States (U.S. Geological Survey, 2002, 2008). Information from NWISWeb is commonly used to characterize streamflows at gaged sites and to help predict streamflows at ungaged sites. Five computer programs were developed for obtaining and analyzing streamflow from the National Water Information System (NWISWeb). The programs were developed as part of a study by the U.S. Geological Survey, in cooperation with the Federal Highway Administration, to develop a stochastic empirical loading and dilution model. The programs were developed because reliable, efficient, and repeatable methods are needed to access and process streamflow information and data. The first program is designed to facilitate the downloading and reformatting of NWISWeb streamflow data. The second program is designed to facilitate graphical analysis of streamflow data. The third program is designed to facilitate streamflow-record extension and augmentation to help develop long-term statistical estimates for sites with limited data. The fourth program is designed to facilitate statistical analysis of streamflow data. The fifth program is a preprocessor to create batch input files for the U.S. Environmental Protection Agency DFLOW3 program for calculating low-flow statistics. These computer programs were developed to facilitate the analysis of daily mean streamflow data for planning-level water-quality analyses but also are useful for many other applications pertaining to streamflow data and statistics. These programs and the associated documentation are included on the CD-ROM accompanying this report. This report and the appendixes on the

Discovering disease associations by integrating electronic clinical data and medical literature.

PubMed

Holmes, Antony B; Hawson, Alexander; Liu, Feng; Friedman, Carol; Khiabanian, Hossein; Rabadan, Raul

2011-01-01

Electronic health record (EHR) systems offer an exceptional opportunity for studying many diseases and their associated medical conditions within a population. The increasing number of clinical record entries that have become available electronically provides access to rich, large sets of patients' longitudinal medical information. By integrating and comparing relations found in the EHRs with those already reported in the literature, we are able to verify existing and to identify rare or novel associations. Of particular interest is the identification of rare disease co-morbidities, where the small numbers of diagnosed patients make robust statistical analysis difficult. Here, we introduce ADAMS, an Application for Discovering Disease Associations using Multiple Sources, which contains various statistical and language processing operations. We apply ADAMS to the New York-Presbyterian Hospital's EHR to combine the information from the relational diagnosis tables and textual discharge summaries with those from PubMed and Wikipedia in order to investigate the co-morbidities of the rare diseases Kaposi sarcoma, toxoplasmosis, and Kawasaki disease. In addition to finding well-known characteristics of diseases, ADAMS can identify rare or previously unreported associations. In particular, we report a statistically significant association between Kawasaki disease and diagnosis of autistic disorder.

Discovering Disease Associations by Integrating Electronic Clinical Data and Medical Literature

PubMed Central

Holmes, Antony B.; Hawson, Alexander; Liu, Feng; Friedman, Carol; Khiabanian, Hossein; Rabadan, Raul

2011-01-01

Electronic health record (EHR) systems offer an exceptional opportunity for studying many diseases and their associated medical conditions within a population. The increasing number of clinical record entries that have become available electronically provides access to rich, large sets of patients' longitudinal medical information. By integrating and comparing relations found in the EHRs with those already reported in the literature, we are able to verify existing and to identify rare or novel associations. Of particular interest is the identification of rare disease co-morbidities, where the small numbers of diagnosed patients make robust statistical analysis difficult. Here, we introduce ADAMS, an Application for Discovering Disease Associations using Multiple Sources, which contains various statistical and language processing operations. We apply ADAMS to the New York-Presbyterian Hospital's EHR to combine the information from the relational diagnosis tables and textual discharge summaries with those from PubMed and Wikipedia in order to investigate the co-morbidities of the rare diseases Kaposi sarcoma, toxoplasmosis, and Kawasaki disease. In addition to finding well-known characteristics of diseases, ADAMS can identify rare or previously unreported associations. In particular, we report a statistically significant association between Kawasaki disease and diagnosis of autistic disorder. PMID:21731656

Comparative assessment of efficacy of two different pretreatment single oral doses of betamethasone on inter-appointment and postoperative discomfort: An in vivo clinical evaluation.

PubMed

Gyanani, Hitesh; Chhabra, Naveen; Parmar, Ghanshyam R

2016-01-01

Study aimed to evaluate the efficacy of two different pretreatment single oral doses of betamethasone on the incidence of inter-appointment flare up and postoperative discomfort. Fifty-four patients aged 18-59 years requiring endodontic treatment were selected and randomly assigned to three groups; single pretreatment oral dose of placebo or betamethasone in two different oral doses of 0.5 mg and 1 mg, respectively. Endodontic therapy was completed in two visits using triple antibiotic paste as intracanal medicament. Patients were given a questionnaire to record their pain at 1, 2, 3, and 7 days after treatment. In the second visit, obturation was done, and the patients were again instructed to record their pain scores after treatment and discharged. The verbal rating scale was used for recording the pain scores. Statistical analysis was done using ANOVA and the Friedman test. 0.5 mg betamethasone group showed least mean pain scores among all experimental groups; however, there was no statistically significant difference between any of the groups ( P > 0.05). Pretreatment single oral dose of betamethasone is an effective in managing endodontic flare-ups; however, the results were statistically insignificant.

Acute infective conjunctivitis in primary care: who needs antibiotics? An individual patient data meta-analysis

PubMed Central

Jefferis, Joanna; Perera, Rafael; Everitt, Hazel; van Weert, Henk; Rietveld, Remco; Glasziou, Paul; Rose, Peter

2011-01-01

Background Acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the benefit of topical antibiotics for patients with acute infective conjunctivitis Aim To determine the benefit of antibiotics for the treatment of acute infective conjunctivitis in primary care and which subgroups benefit most Design An individual patient data meta-analysis Method Relevant trials were identified and individual patient data gathered for meta-analysis and subgroup analysis Results Three eligible trials were identified. Individual patient data were available from all primary care trials and data were available for analysis in 622 patients. Eighty per cent (246/308) of patients who received antibiotics and 74% (233/314) of controls were cured at day 7. There was a significant benefit of antibiotics versus control for cure at seven days in all cases combined (risk difference 0.08, 95% confidence interval (CI) = 0.01 to 0.14). Subgroups that showed a significant benefit from antibiotics were patients with purulent discharge (risk difference 0.09, 95% CI = 0.01 to 0.17) and patients with mild severity of red eye (risk difference 0.10, 95% CI = 0.02 to 0.18), while the type of control used (placebo drops versus nothing) showed a statistically significant interaction (P=0.03) Conclusion Acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics. Prescribing practices need to be updated, taking into account these results PMID:22152728

Information technology improves Emergency Department patient discharge instructions completeness and performance on a national quality measure: a quasi-experimental study.

PubMed

Bell, E J; Takhar, S S; Beloff, J R; Schuur, J D; Landman, A B

2013-01-01

To compare the completeness of Emergency Department (ED) discharge instructions before and after introduction of an electronic discharge instructions module by scoring compliance with the Centers for Medicare and Medicaid Services (CMS) Outpatient Measure 19 (OP-19). We performed a quasi-experimental study examining the impact of an electronic discharge instructions module in an academic ED. Three hundred patients discharged home from the ED were randomly selected from two time intervals: 150 patients three months before and 150 patients three to five months after implementation of the new electronic module. The discharge instructions for each patient were reviewed, and compliance for each individual OP-19 element as well as overall OP-19 compliance was scored per CMS specifications. Compliance rates as well as risk ratios (RR) and risk differences (RD) with 95% confidence intervals (CI) comparing the overall OP-19 scores and individual OP-19 element scores of the electronic and paper-based discharge instructions were calculated. The electronic discharge instructions had 97.3% (146/150) overall OP-19 compliance, while the paper-based discharge instructions had overall compliance of 46.7% (70/150). Electronic discharge instructions were twice as likely to achieve overall OP-19 compliance compared to the paper-based format (RR: 2.09, 95% CI: 1.75 - 2.48). The largest improvement was in documentation of major procedures and tests performed: only 60% of the paper-based discharge instructions satisfied this criterion, compared to 100% of the electronic discharge instructions (RD: 40.0%, 95% CI: 32.2% - 47.8%). There was a modest difference in medication documentation with 92.7% for paper-based and 100% for electronic formats (RD: 7.3%, 95% CI: 3.2% - 11.5%). There were no statistically significant differences in documentation of patient care instructions and diagnosis between paper-based and electronic formats. With careful design, information technology can improve the completeness of ED patient discharge instructions and performance on the OP-19 quality measure.

Investigation of complexity dynamics in a DC glow discharge magnetized plasma using recurrence quantification analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mitra, Vramori; Sarma, Bornali; Sarma, Arun

Recurrence is an ubiquitous feature which provides deep insights into the dynamics of real dynamical systems. A suitable tool for investigating recurrences is recurrence quantification analysis (RQA). It allows, e.g., the detection of regime transitions with respect to varying control parameters. We investigate the complexity of different coexisting nonlinear dynamical regimes of the plasma floating potential fluctuations at different magnetic fields and discharge voltages by using recurrence quantification variables, in particular, DET, L{sub max}, and Entropy. The recurrence analysis reveals that the predictability of the system strongly depends on discharge voltage. Furthermore, the persistent behaviour of the plasma time seriesmore » is characterized by the Detrended fluctuation analysis technique to explore the complexity in terms of long range correlation. The enhancement of the discharge voltage at constant magnetic field increases the nonlinear correlations; hence, the complexity of the system decreases, which corroborates the RQA analysis.« less

Effect of Sampling Period on Flood Frequency Distributions in the Susquehanna Basin

NASA Astrophysics Data System (ADS)

Kargar, M.; Beighley, R. E.

2010-12-01

Flooding is a devastating natural hazard that claims many human lives and significantly impact regional economies each year. Given the magnitude of flooding impacts, significant resources are dedicated to the development of forecasting models for early warning and evacuation planning, construction of flood defenses (levees/dams) to limit flooding, and the design of civil infrastructure (bridges, culverts, storm sewers) to convey flood flows without failing. In all these cases, it is particularly important to understand the potential flooding risk in terms of both recurrence interval (i.e., return period) and magnitude. Flood frequency analysis (FFA) is a form of risk analysis used to extrapolate the return periods of floods beyond the gauged record. The technique involves using observed annual peak flow discharge data to calculate statistical information such as mean values, standard deviations, skewness, and recurrence intervals. Since discharge data for most catchments have been collected for periods of time less than 100 years, the estimation of the design discharge requires a degree of extrapolation. This study focuses on the assessment and modifications of flood frequency based discharges for sites with limited sampling periods. Here, limited sampling period is intended to capture two issues: (1) limited number of observations to adequately capture the flood frequency signal (i.e., minimum number of annual peaks needed) and (2) climate variability (i.e., sampling period contains primarily “wet” or “dry” periods only). Total of 34 gauges (more than 70 years of data) spread throughout the Susquehanna River basin (71,000 sq km) were used to investigate the impact of sampling period on flood frequency distributions. Data subsets ranging from 10 years to the total number of years available were created from the data for each gauging station. To estimate the flood frequency, the Log Pearson Type III distribution was fit to the logarithms of instantaneous annual peak flows following Bulletin 17B guidelines of the U.S. Interagency Advisory Committee on Water Data. The resulting flood frequencies from these subsets were compared to the results from the entire record at each gauge. Based on the analysis, the minimum number of years required to obtain a reasonable flood frequency distribution was determined for each gauge. In addition, a method to adjust flood frequency distribution at a given gauging station with limited data based on other locations with longer periods of records was developed.

Recall of discharge advice given to patients with minor head injury presenting to a Singapore emergency department.

PubMed

Heng, K W J; Tham, K Y; How, K Y; Foo, J S; Lau, Y H; Li, A Y K

2007-12-01

Most patients presenting to the emergency department (ED) with minor head injury (HI) can be discharged, provided a caregiver is present and careful discharge instructions are given. The study ED uses an advice leaflet with verbal reinforcement to patients and caregivers detailing post-discharge instructions and warning symptoms of worsening HI. We aim to evaluate local patients' and caregivers' compliance to discharge instructions and their ability to recall HI advice. A prospective study was conducted in an adult ED between April 10, 2006 and May 1, 2006. All patients with minor HI discharged from the ED or its 24-hour observation ward were included in the study. A telephone survey was conducted within 48 hours of discharge using a standardised questionnaire. During the study period, 292 patients had HI, of which 182 were eligible for the study. 71 were uncontactable and one refused to participate, leaving 110 patients in the study. Patients' age ranged between 7 and 109 years (median 41 years). 100 confirmed receiving HI advice (57 percent received by patients, 26 percent caregivers, 16 percent both patients and caregivers). 29 percent of respondents reported non-compliance to discharge advice. Mean HI-symptom recall score was 1.9 (SD 1.6) (total 9 symptoms). 30 percent cited other symptoms not part of the HI advice, which they believed necessitated a return to the ED. Recall scores were not statistically different, regardless of mode of instruction (verbal or printed) or the recipient (patient, caregiver or both). Our study raises concerns about the reliability of discharge advice for minor HI patients.

Feasibility of Acoustic Doppler Velocity Meters for the Production of Discharge Records from U.S. Geological Survey Streamflow-Gaging Stations

USGS Publications Warehouse

Morlock, Scott E.; Nguyen, Hieu T.; Ross, Jerry H.

2002-01-01

It is feasible to use acoustic Doppler velocity meters (ADVM's) installed at U.S. Geological Survey (USGS) streamflow-gaging stations to compute records of river discharge. ADVM's are small acoustic current meters that use the Doppler principle to measure water velocities in a two-dimensional plane. Records of river discharge can be computed from stage and ADVM velocity data using the 'index velocity' method. The ADVM-measured velocities are used as an estimator or 'index' of the mean velocity in the channel. In evaluations of ADVM's for the computation of records of river discharge, the USGS installed ADVM's at three streamflow-gaging stations in Indiana: Kankakee River at Davis, Fall Creek at Millersville, and Iroquois River near Foresman. The ADVM evaluation study period was from June 1999 to February 2001. Discharge records were computed, using ADVM data from each station. Discharge records also were computed using conventional stage-discharge methods of the USGS. The records produced from ADVM and conventional methods were compared with discharge record hydrographs and statistics. Overall, the records compared closely from the Kankakee River and Fall Creek stations. For the Iroquois River station, variable backwater was present and affected the comparison; because the ADVM record compensates for backwater, the ADVM record may be superior to the conventional record. For the three stations, the ADVM records were judged to be of a quality acceptable to USGS standards for publications and near realtime ADVM-computed discharges are served on USGS real-time data World Wide Web pages.

Predicting Readmission at Early Hospitalization Using Electronic Clinical Data: An Early Readmission Risk Score.

PubMed

Tabak, Ying P; Sun, Xiaowu; Nunez, Carlos M; Gupta, Vikas; Johannes, Richard S

2017-03-01

Identifying patients at high risk for readmission early during hospitalization may aid efforts in reducing readmissions. We sought to develop an early readmission risk predictive model using automated clinical data available at hospital admission. We developed an early readmission risk model using a derivation cohort and validated the model with a validation cohort. We used a published Acute Laboratory Risk of Mortality Score as an aggregated measure of clinical severity at admission and the number of hospital discharges in the previous 90 days as a measure of disease progression. We then evaluated the administrative data-enhanced model by adding principal and secondary diagnoses and other variables. We examined the c-statistic change when additional variables were added to the model. There were 1,195,640 adult discharges from 70 hospitals with 39.8% male and the median age of 63 years (first and third quartile: 43, 78). The 30-day readmission rate was 11.9% (n=142,211). The early readmission model yielded a graded relationship of readmission and the Acute Laboratory Risk of Mortality Score and the number of previous discharges within 90 days. The model c-statistic was 0.697 with good calibration. When administrative variables were added to the model, the c-statistic increased to 0.722. Automated clinical data can generate a readmission risk score early at hospitalization with fair discrimination. It may have applied value to aid early care transition. Adding administrative data increases predictive accuracy. The administrative data-enhanced model may be used for hospital comparison and outcome research.

The UK Functional Assessment Measure (UK FIM+FAM): Psychometric Evaluation in Patients Undergoing Specialist Rehabilitation following a Stroke from the National UK Clinical Dataset.

PubMed

Nayar, Meenakshi; Vanderstay, Roxana; Siegert, Richard J; Turner-Stokes, Lynne

2016-01-01

The UK Functional Assessment Measure (UKFIM+FAM) is the principal outcome measure for the UK Rehabilitation Outcomes Collaborative (UKROC) national database for specialist rehabilitation. Previously validated in a mixed neurorehabilitation cohort, this study is the first to explore its psychometric properties in a stroke population, and compare left and right hemispheric strokes (LHS vs RHS). We analysed in-patient episode data from 62 specialist rehabilitation units collated through the UKROC database 2010-2013. Complete data were analysed for 1,539 stroke patients (LHS: 588, RHS: 566 with clear localisation). For factor analysis, admission and discharge data were pooled and randomised into two equivalent samples; the first for exploratory factor analysis (EFA) using principal components analysis, and the second for confirmatory factor analysis (CFA). Responsiveness for each subject (change from admission to discharge) was examined using paired t-tests and differences between LHS and RHS for the entire group were examined using non-paired t-tests. EFA showed a strong general factor accounting for >48% of the total variance. A three-factor solution comprising motor, communication and psychosocial subscales, accounting for >69% total variance, provided acceptable fit statistics on CFA (Root Mean Square Error of Approximation was 0.08 and Comparative Fit Index/ Tucker Lewis Index 0.922/0.907). All three subscales showed significant improvement between admission and discharge (p<0.001) with moderate effect sizes (>0.5). Total scores between LHS and RHS were not significantly different. However, LHS showed significantly higher motor scores (Mean 5.7, 95%CI 2.7, 8.6 p<0.001), while LHS had significantly lower cognitive scores, primarily in the communication domain (-6.8 95%CI -7.7, -5.8 p<0.001). To conclude, the UK FIM+FAM has a three-factor structure in stroke, similar to the general neurorehabilitation population. It is responsive to change during in-patient rehabilitation, and distinguishes between LHS and RHS. This tool extends stroke outcome measurement beyond physical disability to include cognitive, communication and psychosocial function.

Experimental investigation on the effect of plasma jet in the triggered discharge process of a gas switch

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tie, W., E-mail: twh.110.666@163.com, E-mail: 84470220@qq.com; Xi'an Jiaotong University, Xi'an 710049; Liu, S.

The temporal and spatial evolution of a plasma jet generated by a spark discharge was observed. The electron temperature and density were obtained under different time and gas pressures by optical emission spectroscopy. Moreover, the discharge process of the plasma-jet triggered gas switch was recorded and analyzed at the lowest working coefficient. The results showed that the plasma jet moved forward in a bullet mode, and the advancing velocity increased with the decrease of pressure, and decreased with time growing. At initial time, the maximum velocity of a plasma jet could reach 3.68 × 10{sup 6 }cm/s. The electron temperature decreased from 2.0 eVmore » to 1.3 eV, and the electron density increased from 3.1 × 10{sup 15}/cm{sup 3} to 6.3 × 10{sup 15}/cm{sup 3} at the initial moment as the gas pressure increases from 0.1 MPa to 0.32 MPa. For a two-gap gas switch, the discharge performances were more depended on the second discharge spark gap (gap 2). Because plasma jet promoted the discharge in Gap 2, the gas switch operating in mode II had better triggered discharge characteristics. In the discharge process, the plasma-jet triggering had the effect of non-penetrating inducing, which not only provided initial electrons for reducing statistical lag but also enhanced the local electric field. The discharge was initiated and accelerated from electron avalanche to streamer. Therefore, a fast discharge was occurred in the gas switch.« less

Early discharge hospital at home.

PubMed

Shepperd, Sasha; Doll, Helen; Broad, Joanna; Gladman, John; Iliffe, Steve; Langhorne, Peter; Richards, Suzanne; Martin, Finbarr; Harris, Roger

2009-01-21

'Early discharge hospital at home' is a service that provides active treatment by health care professionals in the patient's home for a condition that otherwise would require acute hospital in-patient care. If hospital at home were not available then the patient would remain in an acute hospital ward. To determine, in the context of a systematic review and meta-analysis, the effectiveness and cost of managing patients with early discharge hospital at home compared with in-patient hospital care. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Register , MEDLINE (1950 to 2008), EMBASE (1980 to 2008), CINAHL (1982 to 2008) and EconLit through to January 2008. We checked the reference lists of articles identified for potentially relevant articles. Randomised controlled trials recruiting patients aged 18 years and over. Studies comparing early discharge hospital at home with acute hospital in-patient care. Evaluations of obstetric, paediatric and mental health hospital at home schemes are excluded from this review. Two authors independently extracted data and assessed study quality. Our statistical analyses were done on an intention-to-treat basis. We requested individual patient data (IPD) from trialists, and relied on published data when we did not receive trial data sets or the IPD did not include the relevant outcomes. For the IPD meta-analysis, where at least one event was reported in both study groups in a trial, Cox regression models were used to calculate the log hazard ratio and its standard error for mortality and readmission separately for each data set. The calculated log hazard ratios were combined using fixed-effect inverse variance meta-analysis. Twenty-six trials were included in this review [n = 3967]; 21 were eligible for the IPD meta-analysis and 13 of the 21 trials contributed data [1899/2872; 66%]. For patients recovering from a stroke and elderly patients with a mix of conditions there was insufficient evidence of a difference in mortality between groups (adjusted HR 0.79, 95% CI 0.32 to 1.91; N = 494; and adjusted HR 1.06, 95% CI 0.69 to 1.61; N = 978). Readmission rates were significantly increased for elderly patients with a mix of conditions allocated to hospital at home (adjusted HR 1.57; 95% CI 1.10 to 2.24; N = 705). For patients recovering from a stroke and elderly patients with a mix of conditions respectively, significantly fewer people allocated to hospital at home were in residential care at follow up (RR 0.63; 95% CI 0.40 to 0.98; N = 4 trials; RR 0.69, 95% CI 0.48 to 0.99; N =3 trials). Patients reported increased satisfaction with early discharge hospital at home. There was insufficient evidence of a difference for readmission between groups in trials recruiting patients recovering from surgery. Evidence on cost savings was mixed. Despite increasing interest in the potential of early discharge hospital at home services as a cheaper alternative to in-patient care, this review provides insufficient objective evidence of economic benefit or improved health outcomes.

Role of sugammadex in accelerating postoperative discharge: A meta-analysis.

PubMed

Carron, Michele; Zarantonello, Francesco; Lazzarotto, Nadia; Tellaroli, Paola; Ori, Carlo

2017-06-01

Sugammadex has been introduced for reversal of neuromuscular blockade (NMB) induced by rocuronium (or vecuronium). Although its efficacy and safety have been established, data are conflicting as to whether it accelerates discharge to the surgical ward compared with neostigmine, which is traditionally used for reversing NMB. The object of this systematic review and meta-analysis was to review the research comparing sugammadex and neostigmine in the context of patient discharge after general anesthesia. Systematic review and meta-analysis. University medical hospital. Five-hundred eighteen patients from six studies were included. A comprehensive search was conducted using PubMed, Web of Science, Google Scholar, and Cochrane Library electronic databases to identify randomized controlled trials written in English. Two reviewers independently selected the studies, extracted data regarding postoperative discharge, and assessed the trials' methodological quality and evidence level. Postoperative discharge time was determined from the operating room (OR) to the postanesthesia care unit (PACU) and from the PACU to the surgical ward. This study was conducted using PRISMA methodology. Time to discharge after NMB reversal with sugammadex or neostigmine. Compared with neostigmine, sugammadex was associated with a significantly faster discharge from the OR to the PACU (mean difference [MD]=22.14min, 95% CI (14.62, 29.67), P<0.0001, I 2 =0%) and from the PACU to the surgical ward (MD=16.95min, 95% CI (0.23, 33.67), P=0.0469, I 2 =98.4%). Similarly, discharge-readiness was shorter for sugammadex than for neostigmine from the OR to the PACU (MD=5.58min, 95% CI (3.03, 8.14), P≤0.0001, I 2 =0%). However, discharge-readiness was similar in both groups for patients moving from the PACU to the surgical ward (MD=-1.10min, 95% CI (-5.69, 3.50), P=0.6394, I 2 =25.3%). Results from this meta-analysis suggest that sugammadex accelerates postoperative discharge of patients after general anesthesia compared with neostigmine. Copyright © 2017 Elsevier Inc. All rights reserved.

Experimental study of the processes accompanying argon breakdown in a long discharge tube at a reduced pressure

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meshchanov, A. V.; Ionikh, Yu. Z., E-mail: y.ionikh@spbu.ru; Shishpanov, A. I.

Results are presented from experimental studies of the breakdown stage of a low-pressure discharge (1 and 5 Torr) in a glass tube the length of which (75 cm) is much larger than its diameter (2.8 cm). Breakdowns occurred under the action of positive voltage pulses with an amplitude of up to 9.4 kV and a characteristic rise time of 2–50 μs. The discharge current in the steady-state mode was 10–120 mA. The electrode voltage, discharge current, and radiation from the discharge gap were detected simultaneously. The dynamic breakdown voltage was measured, the prebreakdown ionization wave was recorded, and its velocitymore » was determined. The dependence of the discharge parameters on the time interval between voltage pulses (the socalled “memory effect”) was analyzed. The memory effect manifests itself in a decrease or an increase in the breakdown voltage and a substantial decrease in its statistical scatter. The time interval between pulses in this case can reach 0.5 s. The effect of illumination of the discharge tube with a light source on the breakdown was studied. It is found that the irradiation of the anode region of the tube by radiation with wavelengths of ≤500 nm substantially reduces the dynamic breakdown voltage. Qualitative explanations of the obtained results are offered.« less

Smolt Monitoring at the Head of Lower Granite Reservoir and Lower Granite Dam, 2002 Annual Report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Buettner, Edwin W.; Putnam, Scott A.

This project monitored the daily passage of Chinook salmon Oncorhynchus tshawytscha, steelhead trout O. mykiss, and sockeye salmon smolts O. nerka during the 2002 spring out-migration at migrant traps on the Snake River and Salmon River. In 2002 fish management agencies released significant numbers of hatchery Chinook salmon and steelhead trout above Lower Granite Dam that were not marked with a fin clip or coded-wire tag. Generally, these fish were distinguishable from wild fish by the occurrence of fin erosion. Total annual hatchery Chinook salmon catch at the Snake River trap was 11.4 times greater in 2002 than in 2001.more » The wild Chinook catch was 15.5 times greater than the previous year. Hatchery steelhead trout catch was 2.9 times greater than in 2001. Wild steelhead trout catch was 2.8 times greater than the previous year. The Snake River trap collected 3,996 age-0 Chinook salmon of unknown rearing. During 2002, the Snake River trap captured 69 hatchery and 235 wild/natural sockeye salmon and 114 hatchery coho salmon O. kisutch. Differences in trap catch between years are due to fluctuations not only in smolt production, but also differences in trap efficiency and duration of trap operation associated with flow. The significant increase in catch in 2002 was due to a 3.1 fold increase in hatchery Chinook production and a more normal spring runoff. Trap operations began on March 10 and were terminated on June 7. The trap was out of operation for a total of four days due to mechanical failure or debris. Hatchery Chinook salmon catch at the Salmon River trap was 4.2 times greater and wild Chinook salmon catch was 2.4 times greater than in 2001. The hatchery steelhead trout collection in 2002 was 81% of the 2001 numbers. Wild steelhead trout collection in 2002 was 81% of the previous year's catch. Trap operations began on March 10 and were terminated on May 29 due to high flows. The trap was out of operation for four days due to high flow or debris. The increase in hatchery Chinook catch in 2002 was due to a 3.1 fold increase in hatchery production and differences in flow between years. Changes in hatchery and wild steelhead catch are probably due to differences in flow between years. Travel time (d) and migration rate (km/d) through Lower Granite Reservoir for PIT-tagged Chinook salmon and steelhead trout marked at the Snake River trap were affected by discharge. Statistical analysis of 2002 data detected a relation between migration rate and discharge for hatchery and wild Chinook salmon. For hatchery and wild Chinook salmon there was a 4.7-fold and a 3.7-fold increase in migration rate, respectively, between 50 and 100 kcfs. For steelhead trout tagged at the Snake River trap, statistical analysis detected a significant relation between migration rate and Lower Granite Reservoir inflow discharge. For hatchery and wild steelhead trout, there was a 1.8-fold and a 1.7-fold increase in migration rate, respectively, between 50 and 100 kcfs. Travel time and migration rate to Lower Granite Dam for fish marked at the Salmon River trap were calculated. Statistical analysis of the 2002 data detected a significant relation between migration rate and Lower Granite Reservoir inflow discharge for wild Chinook salmon and hatchery steelhead trout. The analysis was unable to detect a relation between migration rate and discharge for hatchery Chinook salmon. The lack of a detectable relation was probably a result of the migration rate data being spread over a very narrow range of discharge. Not enough data were available to perform the analysis for wild steelhead trout. Migration rate increased 4.3-fold for wild Chinook salmon and 2.2-fold for hatchery steelhead between 50 kcfs and 100 kcfs. Fish tagged with passive integrated transponder (PIT) tags at the Snake River trap were interrogated at four dams with PIT tag detection systems (Lower Granite, Little Goose, Lower Monumental, and McNary dams). Because of the addition of the fourth interrogation site (Lower Monumental) in 1993 and the installation of the Removable Spillway Weir at Lower Granite Dam in 2000, caution must be used in comparing cumulative interrogation data. Cumulative interrogations at the four dams for fish marked at the Snake River trap were 61% for hatchery Chinook, 68% for wild Chinook, 58% for hatchery steelhead, and 62% for wild steelhead. Cumulative interrogations at the four dams for fish marked at the Salmon River trap were 51% for hatchery Chinook, 59% for wild Chinook salmon, 45% for hatchery steelhead trout, and 54% for wild steelhead trout. Cumulative interrogations were significantly lower in 2002 than in previous years with similar flow.« less

Data mining applications in the context of casemix.

PubMed

Koh, H C; Leong, S K

2001-07-01

In October 1999, the Singapore Government introduced casemix-based funding to public hospitals. The casemix approach to health care funding is expected to yield significant benefits, including equity and rationality in financing health care, the use of comparative casemix data for quality improvement activities, and the provision of information that enables hospitals to understand their cost behaviour and reinforces the drive for more cost-efficient services. However, there is some concern about the "quicker and sicker" syndrome (that is, the rapid discharge of patients with little regard for the quality of outcome). As it is likely that consequences of premature discharges will be reflected in the readmission data, an analysis of possible systematic patterns in readmission data can provide useful insight into the "quicker and sicker" syndrome. This paper explores potential data mining applications in the context of casemix by using readmission data as an illustration. In particular, it illustrates how data mining can be used to better understand readmission data and to detect systematic patterns, if any. From a technical perspective, data mining (which is capable of analysing complex non-linear and interaction relationships) supplements and complements traditional statistical methods in data analysis. From an applications perspective, data mining provides the technology and methodology to analyse mass volume of data to detect hidden patterns in data. Using readmission data as an illustrative data mining application, this paper explores potential data mining applications in the general casemix context.

Resuscitation Outcomes Consortium (ROC) PRIMED Cardiac Arrest Trial Methods Part 2: Rationale and Methodology for “Analyze Later” Protocol

PubMed Central

Stiell, Ian G.; Callaway, Clif; Davis, Dan; Terndrup, Tom; Powell, Judy; Cook, Andrea; Kudenchuk, Peter J.; Daya, Mohamud; Kerber, Richard; Idris, Ahamed; Morrison, Laurie J.; Aufderheide, Tom

2008-01-01

Objective The primary objective of the trial is to compare survival to hospital discharge with Modified Rankin Score (MRS) ≤3 between a strategy that prioritizes a specified period of CPR before rhythm analysis (Analyze Later) versus a strategy of minimal CPR followed by early rhythm analysis (Analyze Early) in patients with out-of-hospital cardiac arrest. Methods   Design Cluster randomized trial with cluster units defined by geographic region, or monitor/defibrillator machine. Population Adults treated by Emergency Medical Service (EMS) providers for non-traumatic out-of-hospital cardiac arrest not witnessed by EMS. Setting EMS systems participating in the Resuscitation Outcomes Consortium and agreeing to cluster randomization to the Analyze Later versus Analyze Early intervention in a crossover fashion. Sample Size Based on a two-sided significance level of 0.05, a maximum of 13,239 evaluable patients will allow statistical power of 0.996 to detect a hypothesized improvement in the probability of survival to discharge with MRS ≤ 3 rate from 5.41% after Analyze Early to 7.45% after Analyze Later (2.04% absolute increase in primary outcome). Conclusion If this trial demonstrates a significant improvement in survival with a strategy of Analyze Later, it is estimated that 4,000 premature deaths from cardiac arrest would be averted annually in North America alone. PMID:18487004

Resuscitation Outcomes Consortium (ROC) PRIMED cardiac arrest trial methods part 2: rationale and methodology for "Analyze Later vs. Analyze Early" protocol.

PubMed

Stiell, Ian G; Callaway, Clif; Davis, Dan; Terndrup, Tom; Powell, Judy; Cook, Andrea; Kudenchuk, Peter J; Daya, Mohamud; Kerber, Richard; Idris, Ahamed; Morrison, Laurie J; Aufderheide, Tom

2008-08-01

The primary objective of the trial is to compare survival to hospital discharge with modified Rankin score (MRS) < or =3 between a strategy that prioritizes a specified period of CPR before rhythm analysis (Analyze Later) versus a strategy of minimal CPR followed by early rhythm analysis (Analyze Early) in patients with out-of-hospital cardiac arrest. Design-Cluster randomized trial with cluster units defined by geographic region, or monitor/defibrillator machine. Population-Adults treated by emergency medical service (EMS) providers for non-traumatic out-of-hospital cardiac arrest not witnessed by EMS. Setting-EMS systems participating in the Resuscitation Outcomes Consortium and agreeing to cluster randomization to the Analyze Later versus Analyze Early intervention in a crossover fashion. Sample size-Based on a two-sided significance level of 0.05, a maximum of 13,239 evaluable patients will allow statistical power of 0.996 to detect a hypothesized improvement in the probability of survival to discharge with MRS < or =3 rate from 5.41% after Analyze Early to 7.45% after Analyze Later (2.04% absolute increase in primary outcome). If this trial demonstrates a significant improvement in survival with a strategy of Analyze Later, it is estimated that 4000 premature deaths from cardiac arrest would be averted annually in North America alone.

A Study on the Surface and Subsurface Water Interaction Based on the Groundwater Recession Curve

NASA Astrophysics Data System (ADS)

Wang, S. T.; Chen, Y. W.; Chang, L. C.; Chiang, C. J.; Wang, Y. S.

2017-12-01

The interaction of surface to subsurface water is an important issue for groundwater resources assessment and management. The influences of surface water to groundwater are mainly through the rainfall recharge, river recharge and discharge and other boundary sources. During a drought period, the interaction of river and groundwater may be one of the main sources of groundwater level recession. Therefore, this study explores the interaction of surface water to groundwater via the groundwater recession. During drought periods, the pumping and river interaction together are the main mechanisms causing the recession of groundwater level. In principle, larger gradient of the recession curve indicates more groundwater discharge and it is an important characteristic of the groundwater system. In this study, to avoid time-consuming manual analysis, the Python programming language is used to develop a statistical analysis model for exploring the groundwater recession information. First, the slopes of the groundwater level hydrograph at every time step were computed for each well. Then, for each well, the represented slope to each groundwater level was defined as the slope with 90% exceedance probability. The relationship between the recession slope and the groundwater level can then be obtained. The developed model is applied to Choushui River Alluvial Fan. In most wells, the results show strong positive correlations between the groundwater levels and the absolute values of the recession slopes.

Effects of corticosteroids on hyposmia in persistent allergic rhinitis

PubMed Central

CATANA, IULIU V.; CHIRILA, MAGDALENA; NEGOIAS, SIMONA; BOLOGA, RAMONA; COSGAREA, MARCEL

2013-01-01

Objective To asses the effects of two topical nasal corticosteroids sprays on hyposmia in patients with persistent allergic rhinitis. Material and Methods The study was a prospective clinical trial and it included twenty four patients with persistent allergic rhinitis (PER) and hyposmia (H). The patients were divided into two groups depending on the type of corticosteroid topical nasal spray treatment: group A, 200 micrograms dose of mometasone furoate (MF) and group B, 110 micrograms dose of fluticasone furoate (FF) both administered in the morning for 4 weeks. The olfactory function of the patients was evaluated with the extended Test battery „Sniffin’ Sticks”. The visual analogue scale (VAS) was used for the assessment of hyposmia, nasal discharge. The level of the nasal obstruction, before and after the treatment, was evaluated through the anterior rhinomanometry. Results The comparisons between the two types of topical corticosteroids showed a significant improvement separately between scores of the odor threshold (OT), odor discrimination (OD) and odor identification (OI) and also on the final olfactory score (SDI) before and after 4 weeks of the treatment. The comparisons of the VAS scores pre and post treatment showed a significant improvement in hyposmia and nasal obstruction. The nasal airflow and the nasal discharge scores were improved, but the differences were not statistically significant between the groups. The final statistical analysis found no significant differences between the two patients groups. Conclusion The study concludes that fluticasone furoate and mometasone furoate have quite the same effects on hyposmia and on the classical symptoms from PER. PMID:26527931

A Multi-center Study on Improvement in Life Quality of Pediatric Patients with Asthma via Continuous Care

PubMed Central

CAI, Ying; CAO, Junhua; KAN, Ruixue; LIU, Yuping; ZHAO, Li; HU, Ming; ZHANG, Xuemei

2017-01-01

Background: To analyze and summarize the effect of continuous care on the life quality and control of asthma of pediatric patients with asthma discharged from multiple hospitals. Methods: Retrospective analysis was carried out on 172 pediatric patients with asthma aged between 6 and 11 yr old randomly selected from those admitted to five hospitals between January 2014 and December 2015. Among these 172 patients, only 86 (intervention group) received the continuous care between January 2015 and December 2015, while the rest (control group) did not receive from January 2014 and December 2014. Results: After the patients in the intervention group were discharged from the hospital, the ratio of practical forced expiratory volume in one second (FEV1) to the expected FEV1 at the 12th month was (90.28±10.35)%, and the ratio of peak expiratory flow to the expected value was (84.24±3.43)%, respectively higher than those [(82.73±8.86)% and (75.80±4.67)%] in the control group. Regarding pediatric asthma quality of life questionnaire (PAQLQ) between the intervention group and the control group, the difference had statistical significance (Z=−7.254, P<0.05). Childhood asthma control test (C-ACT) comparison between the intervention group and the control group indicated that the difference had statistical significance (Z=−7.918, P<0.05). Conclusion: Continuous care can improve the pediatric patient’s pulmonary function and life quality, and effectively control the asthmatic symptoms. PMID:29167770

Climate change and dissolved organic carbon export to the Gulf of Maine

USGS Publications Warehouse

Huntington, Thomas G.; Balch, William M.; Aiken, George R.; Sheffield, Justin; Luo, Lifeng; Roesler, Collin S.; Camill, Philip

2016-01-01

Ongoing climate change is affecting the concentration, export (flux), and timing of dissolved organic carbon (DOC) exported to the Gulf of Maine (GoM) through changes in hydrologic regime. DOC export was calculated for water years 1950 through 2013 for 20 rivers and for water years 1930 through 2013 for 14 rivers draining to the GoM. DOC export was also estimated for the 21st century based on climate and hydrologic modeling in a previously published study. DOC export was calculated by using the regression model LOADEST to fit seasonally adjusted concentration discharge (C-Q) relations. Our results are an analysis of the sensitivity of DOC export to changes in hydrologic conditions over time since land cover and vegetation were held constant over time. Despite large interannual variability, all rivers had increasing DOC export during winter and these trends were significant (p < 0.05) in 10 out of 20 rivers for 1950 to 2013 and in 13 out of 14 rivers for 1930 to 2013. All rivers also had increasing annual export of DOC although fewer trends were statistically significant than for winter export. Projections for DOC export during the 21st century were variable depending on the climate model and greenhouse gas emission scenario that affected future river discharge through effects on precipitation and evapotranspiration. The most consistent result was a significant increase in DOC export in winter in all model-by-emission scenarios. DOC export was projected to decrease during the summer in all model-by-emission scenarios, with statistically significant decreases in half of the scenarios.

Experimental Analysis of Dampened Breathing Mode Oscillation on Hall Thruster Performance

DTIC Science & Technology

2013-03-01

38 4.5 Analysis of Discharge RMS Effect on Breathing Mode Amplitude...20 xii EXPERIMENTAL ANALYSIS OF DAMPENED BREATHING MODE OSCILLATION ON HALL EFFECT THRUSTER...the large error in the data presented above prevents many conclusions from being drawn. 4.5 Analysis of Discharge RMS Effect on Breathing Mode

Increased Mortality Rates During Resident Handoff Periods and the Effect of ACGME Duty Hour Regulations.

PubMed

Denson, Joshua L; McCarty, Matthew; Fang, Yixin; Uppal, Amit; Evans, Laura

2015-09-01

Medical errors occur following handoff-related miscommunication. Data regarding the effect on patient-centered outcomes, specifically mortality, are lacking. Our objective was to investigate handoff-related mortality and the effect of duty-hour regulations. Retrospective cohort study of adult medical patients at a public, university-affiliated hospital from 2010 to 2012. Patients were divided into 2 cohorts: handoff group (discharged within 7 days following a change in resident physician team) vs control group (discharged the 3 weeks of each 4-week rotation before resident service change). The primary outcome was unadjusted and adjusted hospital mortality rate. As a secondary prespecified analysis, we examined the effect of 2011 Accreditation Council for Graduate Medical Education (ACGME) duty-hour changes. Among 23,736 patients, unadjusted hospital mortality during the handoff group was higher than the control group (2.68% vs 2.08%, respectively; P = .007; odds ratio [OR] 1.30; 95% confidence interval [CI], 1.08-1.57). Following adjustment, this association remained statistically significant (adjusted OR 1.34; P = .003; 95% CI, 1.10-1.62). Similarly, pre-duty-hour unadjusted hospital mortality was higher in the handoff group vs control group (2.87% vs 2.01%, respectively; P = .006; OR 1.44; 95% CI, 1.11-1.86), which remained statistically significant following adjustment (adjusted OR 1.50; P = .002; 95% CI, 1.16-1.95). However, this association lost statistical significance following duty-hour revision with respect to both unadjusted (2.48% vs 2.15%, respectively; P = .30; OR 1.16; 95% CI, 0.88-1.53) and adjusted mortality (OR 1.18; P = .26; 95% CI, 0.89-1.56). Resident transition in care was significantly associated with an increase in unadjusted and adjusted hospital mortality. Although improved by 2011 ACGME duty-hour amendments, a trend toward higher mortality remained following resident handoff. Copyright © 2015 Elsevier Inc. All rights reserved.

Analysis of the Magnitude and Frequency of Peak Discharge and Maximum Observed Peak Discharge in New Mexico and Surrounding Areas

USGS Publications Warehouse

Waltemeyer, Scott D.

2008-01-01

Estimates of the magnitude and frequency of peak discharges are necessary for the reliable design of bridges, culverts, and open-channel hydraulic analysis, and for flood-hazard mapping in New Mexico and surrounding areas. The U.S. Geological Survey, in cooperation with the New Mexico Department of Transportation, updated estimates of peak-discharge magnitude for gaging stations in the region and updated regional equations for estimation of peak discharge and frequency at ungaged sites. Equations were developed for estimating the magnitude of peak discharges for recurrence intervals of 2, 5, 10, 25, 50, 100, and 500 years at ungaged sites by use of data collected through 2004 for 293 gaging stations on unregulated streams that have 10 or more years of record. Peak discharges for selected recurrence intervals were determined at gaging stations by fitting observed data to a log-Pearson Type III distribution with adjustments for a low-discharge threshold and a zero skew coefficient. A low-discharge threshold was applied to frequency analysis of 140 of the 293 gaging stations. This application provides an improved fit of the log-Pearson Type III frequency distribution. Use of the low-discharge threshold generally eliminated the peak discharge by having a recurrence interval of less than 1.4 years in the probability-density function. Within each of the nine regions, logarithms of the maximum peak discharges for selected recurrence intervals were related to logarithms of basin and climatic characteristics by using stepwise ordinary least-squares regression techniques for exploratory data analysis. Generalized least-squares regression techniques, an improved regression procedure that accounts for time and spatial sampling errors, then were applied to the same data used in the ordinary least-squares regression analyses. The average standard error of prediction, which includes average sampling error and average standard error of regression, ranged from 38 to 93 percent (mean value is 62, and median value is 59) for the 100-year flood. The 1996 investigation standard error of prediction for the flood regions ranged from 41 to 96 percent (mean value is 67, and median value is 68) for the 100-year flood that was analyzed by using generalized least-squares regression analysis. Overall, the equations based on generalized least-squares regression techniques are more reliable than those in the 1996 report because of the increased length of record and improved geographic information system (GIS) method to determine basin and climatic characteristics. Flood-frequency estimates can be made for ungaged sites upstream or downstream from gaging stations by using a method that transfers flood-frequency data at the gaging station to the ungaged site by using a drainage-area ratio adjustment equation. The peak discharge for a given recurrence interval at the gaging station, drainage-area ratio, and the drainage-area exponent from the regional regression equation of the respective region is used to transfer the peak discharge for the recurrence interval to the ungaged site. Maximum observed peak discharge as related to drainage area was determined for New Mexico. Extreme events are commonly used in the design and appraisal of bridge crossings and other structures. Bridge-scour evaluations are commonly made by using the 500-year peak discharge for these appraisals. Peak-discharge data collected at 293 gaging stations and 367 miscellaneous sites were used to develop a maximum peak-discharge relation as an alternative method of estimating peak discharge of an extreme event such as a maximum probable flood.

Statistical analysis and mathematical modeling of a tracer test on the Santa Clara River, Ventura County, California

USGS Publications Warehouse

Paybins, Katherine S.; Nishikawa, Tracy; Izbicki, John A.; Reichard, Eric G.

1998-01-01

To better understand flow processes, solute-transport processes, and ground-water/surface-water interactions on the Santa Clara River in Ventura County, California, a 24-hour fluorescent-dye tracer study was performed under steady-state flow conditions on a 28-mile reach of the river. The study reach includes perennial (uppermost and lowermost) subreaches and ephemeral subreaches of the lower Piru Creek and the middle Santa Clara River. Dye was injected at a site on Piru Creek, and fluorescence of river water was measured continuously at four sites and intermittently at two sites. Discharge measurements were also made at the six sites. The time of travel of the dye, peak dye concentration, and time-variance of time-concentration curves were obtained at each site. The long tails of the time-concentration curves are indicative of sources/sinks within the river, such as riffles and pools, or transient bank storage. A statistical analysis of the data indicates that, in general, the transport characteristics follow Fickian theory. These data and previously collected discharge data were used to calibrate a one-dimensional flow model (DAFLOW) and a solute-transport model (BLTM). DAFLOW solves a simplified form of the diffusion-wave equation and uses empirical relations between flow rate and cross-sectional area, and flow rate and channel width. BLTM uses the velocity data from DAFLOW and solves the advection-dispersion transport equation, including first-order decay. The simulations of dye transport indicated that (1) ground-water recharge explains the loss of dye mass in the middle, ephemeral, subreaches, and (2) ground-water recharge does not explain the loss of dye mass in the uppermost and lowermost, perennial, subreaches. This loss of mass was simulated using a linear decay term. The loss of mass in the perennial subreaches may be caused by a combination of photodecay or adsorption/desorption.

Characterising Record Flooding in the United Kingdom

NASA Astrophysics Data System (ADS)

Cox, A.; Bates, P. D.; Smith, J. A.

2017-12-01

Though the most notable floods in history have been carefully explained, there remains a lack of literature that explores the nature of record floods as a whole in the United Kingdom. We characterise the seasonality, statistical and spatial distribution, and meteorological causes of peak river flows for 521 gauging stations spread across the British Isles. We use annual maximum data from the National River Flow Archive, catchment descriptors from the Flood Estimation Handbook, and historical records of large floods. What we aim to find is in what ways, if any, the record flood for a station is different from more 'typical' floods. For each station, we calculate two indices: the seasonal anomaly and the flood index. Broadly, the seasonal anomaly is the degree to which a station's record flood happens at a different time of year compared to typical floods at that site, whilst the flood index is a station's record flood discharge divided by the discharge of the 1-in-10-year return period event. We find that while annual maximum peaks are dominated by winter frontal rainfall, record floods are disproportionately caused by summer convective rainfall. This analysis also shows that the larger the seasonal anomaly, the higher the flood index. Additionally, stations across the country have record floods that occur in the summer with no notable spatial pattern, yet the most seasonally anomalous record events are concentrated around the south and west of the British Isles. Catchment descriptors tell us little about the flood index at a particular station, but generally areas with lower mean annual precipitation have a higher flood index. The inclusion of case studies from recent and historical examples of notable floods across the UK supplements our analysis and gives insight into how typical these events are, both statistically and meteorologically. Ultimately, record floods in general happen at relatively unexpected times and with unpredictable magnitudes, which is a worrying reality for those who live in flood-prone areas, and to those who study the upper tail of flood events.

Predictors of thirty-day readmission among hospitalized family medicine patients.

PubMed

Garrison, Gregory M; Mansukhani, Meghna P; Bohn, Bradley

2013-01-01

Hospital readmissions within 30 days of initial discharge occur frequently. In studies of elderly patients receiving Medicare, readmissions have been associated with poor-quality inpatient care, ineffective hospital-to-home transitions, patient characteristics, disease burden, and socioeconomic status. Among adult family medicine patients spanning a wide age range, we hypothesize that previous hospitalizations, length of stay, number of discharge medications, medical comorbidities, and patient demographics are associated with a greater risk of hospital readmission within 30 days. A retrospective case-control study of 276 family medicine inpatients was conducted to determine the factors associated with 30-day readmission. Bivariate statistics were computed and a multivariate analysis using logistic regression was performed to determine the independent effects of each factor. Patients readmitted within 30 days had more hospitalizations, more emergency department visits, longer hospital stays, more comorbidities, and more discharge medications and were less likely to be married. Multivariate logistic regression found that hospitalization within the previous 12 months (odds ratio, 2.71) and long hospital stays (odds ratio, 2.16) were associated with 30-day readmission; being married (odds ratio, 0.54) had a protective effect. This study demonstrates that factors previously found to be associated with 30-day readmission among elderly patients receiving Medicare also apply to family medicine patients of all ages. It also demonstrates prior hospitalizations, length of stay, and marital status are useful proxies for many more complicated factors, such as disease burden, medical complexity, and social issues, that influence hospital readmission.

The use of standard operating procedures in day case anterior cruciate ligament reconstruction.

PubMed

Khan, T; Jackson, W F; Beard, D J; Marfin, A; Ahmad, M; Spacie, R; Jones, R; Howes, S; Barker, K; Price, A J

2012-08-01

The current rate of day-case anterior cruciate ligament reconstruction (ACLR) in the UK remains low. Although specialised care pathways with standard operating procedures (SOPs) have been effective in reducing length of stay following some surgical procedures, this has not been previously reported for ACLR. We evaluate the effectiveness of SOPs for establishing day-case ACLR in a specialist unit. Fifty patients undergoing ACLR between May and September 2010 were studied prospectively ("study group"). SOPs were designed for pre-operative assessment, anaesthesia, surgical procedure, mobilisation and discharge. We evaluated length of stay, readmission rates, patient satisfaction and compliance to SOPs. A retrospective analysis of 50 patients who underwent ACLR prior to implementation of the day-case pathway was performed ("standard practice group"). Eighty percent of patients in the study group were discharged on the day of surgery (mean length of stay=5.3h) compared to 16% in the standard practice group (mean length of stay=21.6h). This difference was statistically significant (p<0.05, Mann-Whitney U test). All patients were satisfied with the day case pathway. Ninety-two percent of the study group were discharged on the day of surgery when all SOPs were followed and 46% where they were not. High rates of day-case ACLR with excellent patient satisfaction can be achieved with the use of a specialised patient pathway with SOPs. Copyright © 2011 Elsevier B.V. All rights reserved.

Modelling river discharge and precipitation from estuarine salinity in the northern Chesapeake Bay: Application to Holocene palaeoclimate

USGS Publications Warehouse

Saenger, C.; Cronin, T.; Thunell, R.; Vann, C.

2006-01-01

Long-term chronologies of precipitation can provide a baseline against which twentieth-century trends in rainfall can be evaluated in terms of natural variability and anthropogenic influence. However, there are relatively few methods to quantitatively reconstruct palaeoprecipitation and river discharge compared with proxies of other climatic factors, such as temperature. We developed autoregressive and least squares statistical models relating Chesapeake Bay salinity to river discharge and regional precipitation records. Salinity in northern and central parts of the modern Chesapeake Bay is influenced largely by seasonal, interannual and decadal variations in Susquehanna River discharge, which in turn are controlled by regional precipitation patterns. A power regressive discharge model and linear precipitation model exhibit well-defined decadal variations in peak discharge and precipitation. The utility of the models was tested by estimating Holocene palaeoprecipitation and Susquehanna River palaeodischarge, as indicated by isotopically derived palaeosalinity reconstructions from Chesapeake Bay sediment cores. Model results indicate that the early-mid Holocene (7055-5900 yr BP) was drier than the late Holocene (1500 yr BP - present), the 'Mediaeval Warm Period' (MWP) (1200-600 yr BP) was drier than the 'Little Ice Age' (LIA) (500-100 yr BP), and the twentieth century experienced extremes in precipitation possibly associated with changes in ocean-atmosphere teleconnections. ?? 2006 Edward Arnold (Publishers) Ltd.

A Systematic Review of the Liaison Nurse Role on Patient's Outcomes after Intensive Care Unit Discharge.

PubMed

Tabanejad, Zeinab; Pazokian, Marzieh; Ebadi, Abbas

2014-10-01

This review focuses on the impact of liaison nurse in nursing care of patient after ICU discharge on patient's outcomes, compared with patients that are not taken care of by liaison nurses. The role of the ICU liaison nurse has transpired to solve the gap between intensive care unit and wards. Therefore, we aimed to review the outcomes of all studies in this field. A systematic review of intervention studies between 2004 and 2013 was undertaken using standard and sensitive keywords such as liaison nurse, intensive care unit, and patient outcomes in the following databases: Science direct, PubMed, Scopus, Ovid, Oxford, Wiley, Scholar, and Mosby. Then, the articles which had the inclusion criteria after quality control were selected for a systematic review. From 662 retrieved articles, six articles were analyzed in a case study and four articles showed a statistically significant effect of the liaison nurse on the patient's outcomes such as reducing delays in patient discharge, effective discharge planning, improvement in survival for patients at the risk for readmission. Liaison nurses have a positive role on the outcomes of patients who are discharged from the ICU and more research should be done to examine the exact function of liaison nurses and other factors that influence outcomes in patients discharged from ICU.

Coupling hydrologic and hydraulic models to take into consideration retention effects on extreme peak discharges in Switzerland

NASA Astrophysics Data System (ADS)

Felder, Guido; Zischg, Andreas; Weingartner, Rolf

2015-04-01

Estimating peak discharges with very low probabilities is still accompanied by large uncertainties. Common estimation methods are usually based on extreme value statistics applied to observed time series or to hydrological model outputs. However, such methods assume the system to be stationary and do not specifically consider non-stationary effects. Observed time series may exclude events where peak discharge is damped by retention effects, as this process does not occur until specific thresholds, possibly beyond those of the highest measured event, are exceeded. Hydrological models can be complemented and parameterized with non-linear functions. However, in such cases calibration depends on observed data and non-stationary behaviour is not deterministically calculated. Our study discusses the option of considering retention effects on extreme peak discharges by coupling hydrological and hydraulic models. This possibility is tested by forcing the semi-distributed deterministic hydrological model PREVAH with randomly generated, physically plausible extreme precipitation patterns. The resulting hydrographs are then used to force the hydraulic model BASEMENT-ETH (riverbed in 1D, potential inundation areas in 2D). The procedure ensures that the estimated extreme peak discharge does not exceed the physical limit given by the riverbed capacity and that the dampening effect of inundation processes on peak discharge is considered.

Statistical prediction of seasonal discharge in the Naryn basin for water resources planning in Central Asia

NASA Astrophysics Data System (ADS)

Apel, Heiko; Gafurov, Abror; Gerlitz, Lars; Unger-Shayesteh, Katy; Vorogushyn, Sergiy; Merkushkin, Aleksandr; Merz, Bruno

2016-04-01

The semi-arid regions of Central Asia crucially depend on the water resources supplied by the mountainous areas of the Tien-Shan and Pamirs. During the summer months the snow and glacier melt water of the rivers originating in the mountains provides the only water resource available for agricultural production but also for water collection in reservoirs for energy production in winter months. Thus a reliable seasonal forecast of the water resources is crucial for a sustainable management and planning of water resources.. In fact, seasonal forecasts are mandatory tasks of national hydro-meteorological services in the region. Thus this study aims at a statistical forecast of the seasonal water availability, whereas the focus is put on the usage of freely available data in order to facilitate an operational use without data access limitations. The study takes the Naryn basin as a test case, at which outlet the Toktogul reservoir stores the discharge of the Naryn River. As most of the water originates form snow and glacier melt, a statistical forecast model should use data sets that can serve as proxy data for the snow masses and snow water equivalent in late spring, which essentially determines the bulk of the seasonal discharge. CRU climate data describing the precipitation and temperature in the basin during winter and spring was used as base information, which was complemented by MODIS snow cover data processed through ModSnow tool, discharge during the spring and also GRACE gravimetry anomalies. For the construction of linear forecast models monthly as well as multi-monthly means over the period January to April were used to predict the seasonal mean discharge of May-September at the station Uchterek. An automatic model selection was performed in multiple steps, whereas the best models were selected according to several performance measures and their robustness in a leave-one-out cross validation. It could be shown that the seasonal discharge can be predicted with exceptionally high skill reaching explained variances of 86% in the cross validation using ModSnow processed snow cover data and CRU temperature and precipitation data, i.e. freely available data only. Using antecedent discharge information from the Uchterek station over the period January to April the skill can be improved even further. Also the addition of latest EGSIEM GRACE products can improve this skill to > 90% explained variance by replacing the CRU temperature data in the forecast model. From all variables the ModSnow processed MODIS snow cover data proved to be the most important predictor. However, although the prediction models proved to be robust in the cross validation, it has to be mentioned that the models are based on a limited time spanning the period 2000-2012 only. Nevertheless it is believed that the models are reliable, as this time period shows a high variability in seasonal water availability spanning from exceptionally dry to wet years. In summary, the developed forecast model may be a valuable complementary tool for the seasonal discharge prediction in Central Asia for water resources planning, that does not suffer from limited data access required for other forecast methods.

Meals Enhancing Nutrition after Discharge (MEND): Findings from a Pilot Randomized Controlled Trial

PubMed Central

Campbell, Anthony D.; Godfryd, Alice; Flood, Kellie; Kitchin, Elizabeth; Kilgore, Meredith L.; Allocca, Sally; Locher, Julie L.

2016-01-01

Background After older adults experience episodes of poor health or are hospitalized, they may not return to pre-morbid eating behaviors. Furthermore, poor nutrition increases hospital readmission risk, but evidence-based interventions addressing these risks are limited. Objective The pilot study’s objective was to evaluate the feasibility of conducting a randomized controlled trial assessing a post-discharge home-delivered meals program’s impact on older adults’ nutritional intake and hospital readmissions and to assess patient acceptability and satisfaction with the program. The aims of the study were to 1) to evaluate successful recruitment, randomization, and retention of at least 80% of the 24 participants sought; 2) to compare the outcomes of hospital readmission and total daily caloric intake between participants in the intervention and control groups; and 3) to assess patient acceptability and satisfaction with the program. Design This study used a two-arm randomized controlled trial design, and baseline data were collected at enrollment; three 24-hour food recalls were collected during the intervention period; and health services utilization and intervention satisfaction was evaluated 45 days post-discharge. Participants/setting Twenty-four patients from the University of Alabama at Birmingham (UAB) Hospital’s Acute Care for Elders Unit were enrolled from May 2014 to June 2015. They were 65 or older, at risk of malnutrition, cognitively intact, able to communicate, discharged to a place where the patient or family was responsible for preparing meals, and diagnosed with congestive heart failure, chronic obstructive pulmonary disease, acute myocardial infarction, or pneumonia. Final analysis included 21 participants. Intervention The intervention group received 10 days of home-delivered meals and nutrition education; the control group received usual care and nutrition education. Main outcome measures The main outcome was intervention feasibility, measured by recruitment and retention goals. Hospital readmissions, caloric intake, and satisfaction with the intervention were also evaluated. Statistical analyses performed Univariate and bivariate parametric statistics were used to evaluate differences between groups. Goals for success were identified to assess feasibility of conducting a full-scale study, and outcomes were measured against the goals. Results 87.5% of randomized participants were retained for final data collection, indicating that this intervention study is feasible. There were no significant differences between groups for hospital readmissions; however, caloric intake during the intervention period was greater for intervention vs. control participants (1595 vs. 1235, p=.03). Participants were overwhelmingly satisfied (82–100% satisfied or very satisfied) with staff performance, meal quality, and delivery processes. Conclusions Conducting a randomized controlled trial to assess outcomes of providing home-delivered meals to older adults after hospital discharge in partnership with a small nonprofit organization is feasible and warrants future research. PMID:28065635

Service innovation: a comparison of two approaches for physical screening of psychiatric inpatients.

PubMed

Harrison, Mark Richard; McMillan, Catherine Frances; Dickinson, Timothy

2012-06-01

Psychiatric medications have clear links to obesity, diabetes, dyslipidaemia, hypertension, hyperprolactinaemia and movement disorders. These disorders are a common cause of morbidity and mortality in psychiatric patients but physical screening by health services is often haphazard. We report the findings of an audit of physical screening across two hospital wards. Each ward undertook a process of service improvement. One ward modified the admissions proforma and the other developed a discharge screening clinic. The effectiveness of each of these interventions was then compared through a reaudit of practice across both wards. At baseline, screening was performed inconsistently and infrequently. On average, the modified admissions proforma increased screening rates by 4.7% compared to 30.7% for discharge screening clinics. The discharge screening clinic demonstrated statistically significant improvements in screening rates and effectively delivered health promotion advice. Discharge screening clinics are significantly more likely than improved admissions procedures to detect clinically significant abnormalities. If these abnormalities are detected and treated then the long-term physical health of psychiatric patients may be improved.

Purification of inkjet ink from water using liquid phase, electric discharge polymerization and cellulosic membrane filtration.

PubMed

Jordan, Alexander T; Hsieh, Jeffery S; Lee, Daniel T

2013-01-01

A method to separate inkjet ink from water was developed using a liquid phase, electric discharge process. The liquid phase, electric discharge process with filtration or sedimentation was shown to remove 97% of inkjet ink from solutions containing between 0.1-0.8 g/L and was consistent over a range of treatment conditions. Additionally, particle size analysis of treated allyl alcohol and treated propanol confirmed the electric discharge treatment has a polymerization mechanism, and small molecule analysis of treated methanol using gas chromatography and mass spectroscopy confirmed the mechanism was free radical initiated polymerization.

Trauma patient discharge and care transition experiences: Identifying opportunities for quality improvement in trauma centres.

PubMed

Gotlib Conn, Lesley; Zwaiman, Ashley; DasGupta, Tracey; Hales, Brigette; Watamaniuk, Aaron; Nathens, Avery B

2018-01-01

Challenges delivering quality care are especially salient during hospital discharge and care transitions. Severely injured patients discharged from a trauma centre will go either home, to rehabilitation or another acute care hospital with complex management needs. This purpose of this study was to explore the experiences of trauma patients and families treated in a regional academic trauma centre to better understand and improve their discharge and care transition experiences. A qualitative study using inductive thematic analysis was conducted between March and October 2016. Telephone interviews were conducted with trauma patients and/or a family member after discharge from the trauma centre. Data collection and analysis were completed inductively and iteratively consistent with a qualitative approach. Twenty-four interviews included 19 patients and 7 family members. Participants' experiences drew attention to discharge and transfer processes that either (1) Fostered quality discharge or (2) Impeded quality discharge. Fostering quality discharge was ward staff preparation efforts; establishing effective care continuity; and, adequate emotional support. Impeding discharge quality was perceived pressure to leave the hospital; imposed transfer decisions; and, sub-optimal communication and coordination around discharge. Patient-provider communication was viewed to be driven by system, rather than patient need. Inter-facility information gaps raised concern about receiving facilities' ability to care for injured patients. The quality of trauma patient discharge and transition experiences is undermined by system- and ward-level processes that compete, rather than align, in producing high quality patient-centred discharge. Local improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients encounter complex barriers to quality discharge that likely require a comprehensive, multimodal intervention. Copyright © 2017 Elsevier Ltd. All rights reserved.

Stochastic hydrological and degree-day model coupled for the Himalayan glacierized catchments: the case study of Dudh Koshi River, Nepal

NASA Astrophysics Data System (ADS)

Salerno, Franco; Guyennon, Nicolas; Sudeep, Thakuri; Romano, Emanuele; Tartari, Gianni

2015-04-01

This contribution aims at linking temperature and precipitation trends detected with ground stations at high elevations of south slopes of Mt. Everest in the last twenty years, extended back with gridded and reanalysis data, with changes observed for discharges of Dudh Koshi River (3715 km2), Nepal. The study is carried out though: a) the daily temperature and precipitation reconstruction of the last twenty years (1994-2013) at 5050 m a.s.l. and 25 AWSs located at lower elevation and on the Tibetan Plateau (Salerno et al., on TCD); d) all available gridded and reanalysis data set both for temperature and precipitation for extending our analysis back to '60s. b) glacier surfaces (about 400 km2) changes since 60s using all available satellite imagery and glacier mass losses since the beginning of 2000s (Thakuri et al., 2014); c) a stochastic hydrological model for detecting changes observed for discharges of Dudh Koshi river since 60s; c) a degree day model for simulating the glacier melt since 60s. In the last years physically-based hydrological models are started to be adopted for Himalayan glacierized catchments. However, such models present several limitations due to lack of data for the calibration/validation and to an over-parameterization. In this paper, a simple statistical method to simulate the river discharge of a glacierized (~14%) Himalayan basin, based on Standardized Precipitation Index (SPI), is proposed. The SPI approach is ground on these assumptions: a) as a first approximation discharges can be assessed at monthly time scale; b) in monsoon regimes the discharge is mainly dependent on precipitation taken into account at different time scales and with different "weights"; and c) the parameters linking the precipitation regime to discharge are considered constant over time. On the base of such assumptions, to seek for relationships between the precipitation regime and discharge (Q), a multi-linear regression model (called SPI-Q) is calibrated and validated at monthly scale using the least-square method. We observed an increasing temperature trend occurred mainly in winter months, but during the summer ones we noted a slight decreasing of maximum temperature. We confirm for these high elevations the generalized weakening of the monsoon, already observed in literature, accounting here over 50% of reduction in the last twenty years! In the previous period (70s to 90s) gridded and reanalysis data revealed for our reference site a slight increasing mean temperature and weak increasing precipitation. As a result, glaciers experienced an overall surface area loss of 13% and an upward shift of the snowline altitude (SLA) by 182 m.. Moreover, since early '90s, we found a significant upward shift of SLA which increased almost three times. The accelerated shrinkage in recent decades has only affected glaciers with the largest sizes (>10 km2), presenting accumulation zones at higher elevations and along the preferable south-north direction of the monsoons. This finding leads to the hypothesis that Mt. Everest glaciers are shrinking, not only due to warming temperatures, but also as a result of weakening Asian monsoons (Thakuri et al., 2014). Our hypothesis are corroborated by coupling of the stochastic hydrological and the degree-day model. The SPI-Q model implies that (i) the Dudh Koshi river discharge is mainly dependent on precipitation from 1960s to 2000s. In this period, the monsoon alone is able to describe over 90% of annual river discharge; (ii) however since the beginning of 2000s, we observed a non-stationarity in the river discharge and the model fails to predict correctly the increased summer discharge, not justified by the observed weakening monsoon; (iii) coupling SPI-Q with the degree-day model underline as in the last decades the summer discharges are affected by an accelerated glacier melting, even observed with the glaciological analysis.

Transformer partial discharge monitoring based on optical fiber sensing

NASA Astrophysics Data System (ADS)

Wang, Kun; Tong, Xinglin; Zhu, Xiaolong

2014-06-01

The power transformer is the most important equipment of the high voltage power grid, however, some traditional methods of online partial discharge monitoring have some limitations. Based on many advantages of the optical fiber sensing technology, we have done some research on fiber optics Fabry-Perot (FP) sensing which can be useful for the transformer on online partial discharge monitoring. This research aimed at improving the reliability of power system safety monitoring. We have done some work as follows: designing a set for fiber optics FP sensor preparation, according to the fabrication procedure strictly making out the sensors, building a reasonable signal demodulation system for fiber optics FP sensing, doing a preliminary analysis about online partial discharge signal monitoring, including the research on different discharge intensities with the same measuring distance and different measuring distances with the same discharge intensity, and then making a detailed analysis of the experimental results.

Pediatric primary care providers' perspectives regarding hospital discharge communication: a mixed methods analysis.

PubMed

Leyenaar, JoAnna K; Bergert, Lora; Mallory, Leah A; Engel, Richard; Rassbach, Caroline; Shen, Mark; Woehrlen, Tess; Cooperberg, David; Coghlin, Daniel

2015-01-01

Effective communication between inpatient and outpatient providers may mitigate risks of adverse events associated with hospital discharge. However, there is an absence of pediatric literature defining effective discharge communication strategies at both freestanding children's hospitals and general hospitals. The objectives of this study were to assess associations between pediatric primary care providers' (PCPs) reported receipt of discharge communication and referral hospital type, and to describe PCPs' perspectives regarding effective discharge communication and areas for improvement. We administered a questionnaire to PCPs referring to 16 pediatric hospital medicine programs nationally. Multivariable models were developed to assess associations between referral hospital type and receipt and completeness of discharge communication. Open-ended questions asked respondents to describe effective strategies and areas requiring improvement regarding discharge communication. Conventional qualitative content analysis was performed to identify emergent themes. Responses were received from 201 PCPs, for a response rate of 63%. Although there were no differences between referral hospital type and PCP-reported receipt of discharge communication (relative risk 1.61, 95% confidence interval 0.97-2.67), PCPs referring to general hospitals more frequently reported completeness of discharge communication relative to those referring to freestanding children's hospitals (relative risk 1.78, 95% confidence interval 1.26-2.51). Analysis of free text responses yielded 4 major themes: 1) structured discharge communication, 2) direct personal communication, 3) reliability and timeliness of communication, and 4) communication for effective postdischarge care. This study highlights potential differences in the experiences of PCPs referring to general hospitals and freestanding children's hospitals, and presents valuable contextual data for future quality improvement initiatives. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

ESTIMATING LOW-FLOW FREQUENCIES OF UNGAGED STREAMS IN NEW ENGLAND.

USGS Publications Warehouse

Wandle, S. William

1987-01-01

Equations to estimate low flows were developed using multiple-regression analysis with a sample of 48 river basins, which were selected from the U. S. Geological Survey's network of gaged river basins in Massachusetts, New Hampshire, Rhode Island, Vermont, and southwestern Maine. Low-flow characteristics are represented by the 7Q2 and 7Q10 (the annual minimum 7-day mean low flow at the 2- and 10-year recurrence intervals). These statistics for each of the 48 basins were determined from a low-flow frequency analysis of streamflow records for 1942-71, or from a graphical or mathematical relationship if the record did not cover this 30-year period. Estimators for the mean and variance of the 7-day low flows at the index and short-term sites were used for two stations where discharge measurements of base flow were available and for two sites where the graphical technique was unsatisfactory.

Hydrometry's classical and Innovative methods and tools comparison for Stara river flows at Agios Germanos monitoring station in north-west Greece.

NASA Astrophysics Data System (ADS)

Filintas, Agathos, , Dr; Hatzigiannakis, Evagellos, , Dr; Arampatzis, George, , Dr; Ilias, Andreas; Panagopoulos, Andreas, , Dr; Hatzispiroglou, Ioannis

2015-04-01

The aim of the present study is a thorough comparison of hydrometry's conventional and innovative methods-tools for river flow monitoring. A case study was conducted in Stara river at Agios Germanos monitoring station (northwest Greece), in order to investigate possible deviations between conventional and innovative methods-tools on river flow velocity and discharge. For this study, two flowmeters were used, which manufac-tured in 2013 (OTT Messtechnik Gmbh, 2013), as follows: a) A conventional propeller flow velocity meter (OTT-Model C2) which is a me-chanical current flow meter with a certification of calibration BARGO, operated with a rod and a relocating device, along with a digital measuring device including an elec-tronic flow calculator, data logger and real time control display unit. The flowmeter has a measurement velocity range 0.025-4.000 m/s. b) An innovative electromagnetic flowmeter (OTT-Model MF pro) which it is con-sisted of a compact and light-weight sensor and a robust handheld unit. Both system components are designed to be attached to conventional wading rods. The electromag-netic flowmeter uses Faraday's Law of electromagnetic induction to measure the process flow. When an electrically conductive fluid flows along the meter, an electrode voltage is induced between a pair of electrodes placed at right angles to the direction of mag-netic field. The electrode voltage is directly proportional to the average fluid velocity. The electromagnetic flowmeter was operated with a rod and relocating device, along with a digital measuring device with various logging and graphical capabilities and vari-ous methods of velocity measurement (ISO/USGS standards). The flowmeter has a measurement velocity range 0.000-6.000 m/s. The river flow data were averaged over a pair measurement of 60+60 seconds and the measured river water flow velocity, depths and widths of the segments were used for the estimation of cross-section's mean flow velocity in each measured segment. Then it was used the mid-section method for the overall discharge calculation of all segments flow area. The cross-section characteristics, the river flow velocity of segments and the mean water flow velocity and discharge total profile were measured, calculated and an-notated respectively. A series of concurrent conventional and innovative (electromag-netic) flow measurements were performed during 2014. The results and statistical analysis showed that Froude number during the measurement period in all cases was Fr<1 which means that the water flow of the Stara river is classified as subcritical flow. The 12 months' study showed various advantages for the elec-tromagnetic sensor that is virtually maintenance-free because there are no moving parts, no calibration was required in practice, and it can be used even in the lowest water ve-locities from 0.000 m/s. Moreover, based on the concurrent hydromeasurements of the Stara River, on the velocity and discharge modelling and the statistical analysis, it was found that there was not a significant statistical difference (α=0.05) between mean velocity measured with a) conventional and b) electromagnetic method which seems to be more accurate in low velocities where a significant statistical difference was found. Acknowledgments Data in this study are collected in the framework of the elaboration of the national water resources monitoring network, supervised by the Special Secretariat for Water-Hellenic Ministry for the Environment and Climate Change. This project is elaborated in the framework of the operational program "Environment and Sustainable Development" which is co-funded by the National Strategic Reference Framework (NSRF) and the Public Investment Program (PIP).

Statistical and simulation analysis of hydraulic-conductivity data for Bear Creek and Melton Valleys, Oak Ridge Reservation, Tennessee

USGS Publications Warehouse

Connell, J.F.; Bailey, Z.C.

1989-01-01

A total of 338 single-well aquifer tests from Bear Creek and Melton Valley, Tennessee were statistically grouped to estimate hydraulic conductivities for the geologic formations in the valleys. A cross-sectional simulation model linked to a regression model was used to further refine the statistical estimates for each of the formations and to improve understanding of ground-water flow in Bear Creek Valley. Median hydraulic-conductivity values were used as initial values in the model. Model-calculated estimates of hydraulic conductivity were generally lower than the statistical estimates. Simulations indicate that (1) the Pumpkin Valley Shale controls groundwater flow between Pine Ridge and Bear Creek; (2) all the recharge on Chestnut Ridge discharges to the Maynardville Limestone; (3) the formations having smaller hydraulic gradients may have a greater tendency for flow along strike; (4) local hydraulic conditions in the Maynardville Limestone cause inaccurate model-calculated estimates of hydraulic conductivity; and (5) the conductivity of deep bedrock neither affects the results of the model nor does it add information on the flow system. Improved model performance would require: (1) more water level data for the Copper Ridge Dolomite; (2) improved estimates of hydraulic conductivity in the Copper Ridge Dolomite and Maynardville Limestone; and (3) more water level data and aquifer tests in deep bedrock. (USGS)

Influence of the very polluted inputs of the Tinto-Odiel system on the adjacent littoral sediments of southwestern Spain: a statistical approach.

PubMed

Sainz, A; Ruiz, F

2006-03-01

A spatial and temporal analysis (period 1990-2003) of 15 sampling points distributed along the southwestern Spanish coast permits to delimitate the influence area of the extremely polluted discharges coming from the Tinto-Odiel system in the bottom sediments of the adjacent littoral area. As, Cu, Pb and Zn are the main heavy metals transported by the freshwater runoffs toward the shallow shelf and present very high negative (r < -0.7) and significant (p < 0.001) correlations with the distance to the estuarine mouth. The statistical analysis (index of geoaccumulation, Pearson correlation matrix, cluster analysis) of their concentrations in the littoral sediments located between the Guadiana and Guadalquivir mouths delimitates three zones: (a) Zone 1 (from the estuarine mouth to 6 km to the east), characterized by moderate to strongly polluted bottom sediments and main responsible of the mean annual variations of the former heavy metals in the area studied; (b) Zone 2 (from 21.2 km to the west to 29 km to the east), characterized by moderate pollution levels; and (c) Zone 3, located near the Guadiana and Guadalquivir mouths, with very low As-Cu-Pb contents and unpolluted to moderately levels of Zn due to urban sewages or the presence of local low mobility areas for this element.

Discharge estimation in arid areas with the help of optical satellite data

NASA Astrophysics Data System (ADS)

Mett, M.; Aufleger, M.

2009-04-01

The MENA region is facing severe water scarcity. Overexploitation of groundwater resources leads to an ongoing drawdown of the water tables, salinisation and desertification of vast areas. To make matters worse enormous birth-rates, economic growth and refugees from conflict areas let the need for water explode. In the context of climate change this situation will even worsen and armed conflicts are within the bounds of possibility. To ease water scarcity many innovative techniques like artificial groundwater recharge are being developed or already state of the art. But missing hydrological information (for instance discharge data) often prevents design and efficient operation of such measures. Especially in poor countries hydrological measuring devices like gage stations are often missing, in a bad status or professionals of the water sector are absent. This leads to the paradox situation that in many arid regions water resources are indeed available but they cannot be utilised because they are not known. Nowadays different approaches are being designed to obtain hydrological information from perennial river systems with the help of satellite techniques. Mostly they are based on hydraulic parameters like river dimensions, roughness and water levels which can be derived from satellite data. By using conventional flow formulas and additional field investigations the discharge can be estimated. Another methodology derived information about maximum flow depth and flow width from optical sensors of high resolution to calculate discharge of the rivers whilst the flood. Attempts to derive discharge information from structural components of the river and fluviomorphologic changes due to changing flow regimes are in the focus of recent research. One attempt used Synthetic Aperture Radar (SAR) data to estimate discharge in braided river systems. Other attempts used airborne SAR imagery to obtain information about sinuosity and total river width of perennial braided river systems which were related to specific discharges. Such approaches cannot be applied in arid areas with ephemeral discharges. In this groundbreaking proposal, discharge data for arid riverine landscapes (dry wadi systems) will be derived from remotely sensed structural patterns and fluvio-morphologic changes. The main idea of the research work is as follows: In arid areas seldom precipitation events lead to flash floods which may significantly alter the geomorphology of a wadi river system. This is due to the mainly sparse vegetation cover in arid areas which enables mobilization and transport of large amounts of bed material whilst flood events. For example maximum river width of single channels, total river width of braided river networks and sinuosity of river beds change during a floods. Also river branches can be dislocated. These morphologic changes can be observed and judged from space. There is a correlation between intensity and duration of a flood and the resulting changes in riverbed structure. The kind of changes gives evidence about stream power and flow behaviour of the observed river systems. Satellite images from date A are compared with data from date B regarding morphologic changes and specific river patterns. Satellite data of different spatial and spectral solutions will be used from environmental and commercial satellites such as Landsat, SPOT, ASTER, IKONOS and so on. If a change in river morphology can be observed it was due to a flood event. Multitemporal analysis (change detection) with the help of digital image processing now enables to observe the nature and intensity of morphological changes. Structural patterns are extracted from the images and compared to field observations from the two exemplarily test sites in Jordan and Oman. Comprehensive field work was already performed to summarise detailed fluvial structures and to gather hydrologic data for each test site. The whole river networks will be visualised and extracted from the images with the help of spectral classification for further investigation such as fractal analysis of the river patterns. The "Morphologic Activity Index (MAI)" combines the above acquired information to one specific parameter for the examined test site. MAI contains information about general river patterns, river energy and the behaviour of the river system. MAI will be necessary for calibrating the calculated river discharges with discharge measurements which were taken on ground whilst the flood. With the available satellite images it will be possible to perform discharge estimation for duration of at least two or three decades. Statistical approaches and time series analysis will allow deriving information about the general flow behaviour (e.g. repeat interval of discharge and probable maximum flood) which are essential for planning infrastructural measures. First results from the test sites in Jordan and Oman showed the applicability of satellite data analysis regarding morphologic changes. The goal of the presented research work is to develop a fast and economic methodology to derive spatial distributed discharge information for large and inaccessible arid areas.

Early coordinated rehabilitation in acute phase after hip fracture - a model for increased patient participation.

PubMed

Asplin, Gillian; Carlsson, Gunnel; Zidén, Lena; Kjellby-Wendt, Gunilla

2017-10-17

Studies have shown that patients with hip fracture treated in a Comprehensive Geriatric Care (CGC) unit report better results in comparison to orthopaedic care. Furthermore, involving patients in their healthcare by encouraging patient participation can result in better quality of care and improved outcomes. To our knowledge no study has been performed comparing rehabilitation programmes within a CGC unit during the acute phase after hip fracture with focus on improving patients' perceived participation and subsequent effect on patients' function. A prospective, controlled, intervention performed in a CGC unit and compared with standard care. A total of 126 patients with hip fracture were recruited who were prior to fracture; community dwelling, mobile indoors and independent in personal care. Intervention Group (IG): 63 patients, mean age 82.0 years and Control Group (CG): 63 patients mean age 80.5 years. coordinated rehabilitation programme with early onset of patient participation and intensified occupational therapy and physiotherapy after hip fracture surgery. The primary outcome measure was self-reported patient participation at discharge. Secondary outcome measures were: TLS-BasicADL; Bergs Balance Scale (BBS); Falls Efficacy Scale FES(S); Short Physical Performance Battery (SPPB) and Timed Up and Go (TUG) at discharge and 1 month and ADL staircase for instrumental ADL at 1 month. At discharge a statistically significant greater number of patients in the IG reported higher levels of participation (p < 0.05) and independence in lower body hygiene (p < 0.05) and dressing (p < 0.001). There were however no statistically significant differences at discharge and 1 month between groups in functional balance and confidence, performance measures or risk for falls. This model of OT and PT coordinated inpatient rehabilitation had a positive effect on patients' perceived participation in their rehabilitation and ADL at discharge but did not appear to affect level of recovery or risk for future falls at 1 month. A large proportion of patients remained at risk for future falls at 1 month in both groups highlighting the need for continued rehabilitation after discharge. ClinicalTrials.gov Identifier: NCT03301584 (Retrospectively registered: 4 th October 2017).

Statistical patterns in the location of natural lightning

NASA Astrophysics Data System (ADS)

Zoghzoghy, F. G.; Cohen, M. B.; Said, R. K.; Inan, U. S.

2013-01-01

Lightning discharges are nature's way of neutralizing the electrical buildup in thunderclouds. Thus, if an individual discharge destroys a substantial fraction of the cloud charge, the probability of a subsequent flash is reduced until the cloud charge separation rebuilds. The temporal pattern of lightning activity in a localized region may thus inherently be a proxy measure of the corresponding timescales for charge separation and electric field buildup processes. We present a statistical technique to bring out this effect (as well as the subsequent recovery) using lightning geo-location data, in this case with data from the National Lightning Detection Network (NLDN) and from the GLD360 Network. We use this statistical method to show that a lightning flash can remove an appreciable fraction of the built up charge, affecting the neighboring lightning activity for tens of seconds within a ˜ 10 km radius. We find that our results correlate with timescales of electric field buildup in storms and suggest that the proposed statistical tool could be used to study the electrification of storms on a global scale. We find that this flash suppression effect is a strong function of flash type, flash polarity, cloud-to-ground flash multiplicity, the geographic location of lightning, and is proportional to NLDN model-derived peak stroke current. We characterize the spatial and temporal extent of the suppression effect as a function of these parameters and discuss various applications of our findings.

Ballast Water Discharges into the Great Lakes from Overseas Vessels

EPA Pesticide Factsheets

Analysis of Ballast Water Discharges into the Great Lakes from Overseas Vessels from 2010 to 2013 - An assessment of the volume, location, and global port origins of ballast water discharges in the Great Lakes (May 2015).

Uses and misuses of compositional data in sedimentology

NASA Astrophysics Data System (ADS)

Tolosana-Delgado, Raimon

2012-12-01

This paper serves two goals. The first part shows how mass evolution processes of different nature become undistinguishable once we take a size-limited, noisy sample of its compositional fingerprint: processes of exponential decay, mass mixture and complementary accumulation are simulated, and then samples contaminated with noise are extracted. The aim of this exercise is to illustrate the limitations of typical graphical representations and statistical methods when dealing with compositional data, i.e. data in percentages, concentrations or proportions. The second part presents a series of concepts, tools and methods to represent and statistically treat a compositional data set attending to these limitations. The aim of this second part is to offer a state-of-the-art Compositional Data Analysis. This includes: descriptive statistics and graphics (the biplot); ternary diagrams with confidence regions for the mean; regression and ANalysis-Of-VAriance models to explain compositional variability; and the use of compositional information to predict environmental covariables or discriminate between groups. All these tools share a four-step algorithm: (1) transform compositions with an invertible log-ratio transformation; (2) apply a statistical method to the transformed scores; (3) back-transform the results to compositions; and (4) interpret results in relative terms. Using these techniques, a data set of sand petrographic composition has been analyzed, highlighting that: finer sands are richer in single-crystal grains in relation to polycrystalline grains, and that grain-size accounts for almost all compositional variability; a stronger water flow (river discharge) favors mica grains against quartz or rock fragment grains, possibly due to hydrodynamic sorting effects; a higher relief ratio implies shorter residence times, which may favor survival of micas and rock fragments, relatively more labile grains.

Stroke rehabilitation services to accelerate hospital discharge and provide home-based care: an overview and cost analysis.

PubMed

Anderson, Craig; Ni Mhurchu, Cliona; Brown, Paul M; Carter, Kristie

2002-01-01

Limited information exists on the best way to organise stroke rehabilitation after hospital discharge and the relative costs of such services. To review the evidence of the cost effectiveness of services that accelerate hospital discharge and provide home-based rehabilitation for patients with acute stroke. A systematic review with economic analysis of published randomised clinical trials (available to March 2001) comparing early hospital discharge and domiciliary rehabilitation with usual care in patients with stroke was conducted. From included studies, data were extracted on study quality; major clinical outcomes including hospital stay, death, institutionalisation, disability, and readmission rates; and resource use associated with hospital stay, rehabilitation, and community services. The resources were priced using Australian dollars ($A) healthcare costs. The outcomes and costs of the new intervention were compared with standard care. Seven published trials involving 1277 patients (54% men; mean age 73 years) were identified. The pooled data showed that overall, a policy of early hospital discharge and domiciliary rehabilitation reduced total length of stay by 13 days [95% confidence interval (CI): -19 to -7 days]. There was no significant effect on mortality (odds ratio = 0.95; 95% CI: 0.65 to 1.38) or other clinical outcomes making a cost minimisation analysis for the economic analysis appropriate. The overall mean costs were approximately 15% lower for the early discharge intervention [$A16 016 ($US9941) versus $A18 350] ($US11 390)] compared with standard care. A policy of early hospital discharge and home-based rehabilitation for patients with stroke may reduce the use of hospital beds without compromising clinical outcomes. Our analysis shows this service to be a cost saving alternative to conventional in-hospital stroke rehabilitation for an important subgroup of patients with stroke-related disability.

A comparison of performance of several artificial intelligence methods for forecasting monthly discharge time series

NASA Astrophysics Data System (ADS)

Wang, Wen-Chuan; Chau, Kwok-Wing; Cheng, Chun-Tian; Qiu, Lin

2009-08-01

SummaryDeveloping a hydrological forecasting model based on past records is crucial to effective hydropower reservoir management and scheduling. Traditionally, time series analysis and modeling is used for building mathematical models to generate hydrologic records in hydrology and water resources. Artificial intelligence (AI), as a branch of computer science, is capable of analyzing long-series and large-scale hydrological data. In recent years, it is one of front issues to apply AI technology to the hydrological forecasting modeling. In this paper, autoregressive moving-average (ARMA) models, artificial neural networks (ANNs) approaches, adaptive neural-based fuzzy inference system (ANFIS) techniques, genetic programming (GP) models and support vector machine (SVM) method are examined using the long-term observations of monthly river flow discharges. The four quantitative standard statistical performance evaluation measures, the coefficient of correlation ( R), Nash-Sutcliffe efficiency coefficient ( E), root mean squared error (RMSE), mean absolute percentage error (MAPE), are employed to evaluate the performances of various models developed. Two case study river sites are also provided to illustrate their respective performances. The results indicate that the best performance can be obtained by ANFIS, GP and SVM, in terms of different evaluation criteria during the training and validation phases.

Raman spectroscopic analysis of gunshot residue offering great potential for caliber differentiation.

PubMed

Bueno, Justin; Sikirzhytski, Vitali; Lednev, Igor K

2012-05-15

Near-infrared (NIR) Raman microspectroscopy combined with advanced statistics was used to differentiate gunshot residue (GSR) particles originating from different caliber ammunition. The firearm discharge process is analogous to a complex chemical reaction. The reagents of this process are represented by the chemical composition of the ammunition, firearm, and cartridge case. The specific firearm parameters determine the conditions of the reaction and thus the subsequent product, GSR. We found that Raman spectra collected from these products are characteristic for different caliber ammunition. GSR particles from 9 mm and 0.38 caliber ammunition, collected under identical discharge conditions, were used to demonstrate the capability of confocal Raman microspectroscopy for the discrimination and identification of GSR particles. The caliber differentiation algorithm is based on support vector machines (SVM) and partial least squares (PLS) discriminant analyses, validated by a leave-one-out cross-validation method. This study demonstrates for the first time that NIR Raman microspectroscopy has the potential for the reagentless differentiation of GSR based upon forensically relevant parameters, such as caliber size. When fully developed, this method should have a significant impact on the efficiency of crime scene investigations.

Smolt Monitoring at the Head of Lower Granite Reservoir and Lower Granite Dam, 2005 Annual Report.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Buettner, Edwin W.; Putnam, Scott A.

This project monitored the daily passage of Chinook salmon Oncorhynchus tshawytscha, steelhead trout O. mykiss, and sockeye salmon O. nerka smolts during the 2005 spring out-migration at migrant traps on the Snake River and Salmon River. In 2005 fish management agencies released significant numbers of hatchery Chinook salmon and steelhead trout above Lower Granite Dam that were not marked with a fin clip or coded-wire tag. Generally, the age-1 and older fish were distinguishable from wild fish by the occurrence of fin erosion. Age-0 Chinook salmon are more difficult to distinguish between wild and non-adclipped hatchery fish and therefore classifiedmore » as unknown rearing. The total annual hatchery spring/summer Chinook salmon catch at the Snake River trap was 0.34 times greater in 2005 than in 2004. The wild spring/summer Chinook catch was 0.34 times less than the previous year. Hatchery steelhead trout catch was 0.67 times less than in 2004. Wild steelhead trout catch was 0.72 times less than the previous year. The Snake River trap collected 1,152 age-0 Chinook salmon of unknown rearing. During 2005, the Snake River trap captured 219 hatchery and 44 wild/natural sockeye salmon and 110 coho salmon O. kisutch of unknown rearing. Differences in trap catch between years are due to fluctuations not only in smolt production, but also differences in trap efficiency and duration of trap operation associated with flow. Trap operations began on March 6 and were terminated on June 3. The trap was out of operation for a total of one day due to heavy debris. FPC requested that the trap be restarted on June 15 through June 22 to collect and PIT tag age-0 Chinook salmon. Hatchery Chinook salmon catch at the Salmon River trap was 1.06 times greater and wild Chinook salmon catch was 1.26 times greater than in 2004. The hatchery steelhead trout collection in 2005 was 1.41 times greater and wild steelhead trout collection was 1.27 times greater than the previous year. Trap operations began on March 6 and were terminated on May 17 due to high flows. There were two days when the trap was taken out of service because of mechanical failure. Travel time (d) and migration rate (km/d) through Lower Granite Reservoir for passive integrated transponder (PIT) tagged Chinook salmon and steelhead trout marked at the Snake River trap were affected by discharge. Statistical analysis of 2005 data detected a relation between migration rate and discharge for hatchery Chinook but was unable to detect a relation for wild Chinook. The inability to detect a migration rate discharge relation for wild Chinook salmon was caused by a lack of data. For hatchery Chinook salmon there was a 1.8-fold increase in migration rate between 50 and 100 kcfs. For steelhead trout tagged at the Snake River trap, statistical analysis detected a significant relation between migration rate and lower Granite Reservoir inflow discharge. For hatchery and wild steelhead trout, there was a 2.2-fold and a 2.2-fold increase in migration rate, respectively, between 50 and 100 kcfs. Travel time and migration rate to Lower Granite Dam for fish marked at the Salmon River trap were calculated. Statistical analysis of the 2005 data detected a significant relation between migration rate and Lower Granite Reservoir inflow discharge for hatchery Chinook salmon, wild Chinook salmon, hatchery steelhead trout, and wild steelhead trout. Migration rate increased 4.2-fold for hatchery Chinook salmon, 2.9-fold for wild Chinook salmon and 2.5-fold for hatchery steelhead, and 1.7-fold for wild steelhead as discharge increased between 50 kcfs and 100 kcfs. Fish tagged with PIT tags at the Snake River and Salmon River traps were interrogated at four dams with PIT tag detection systems (Lower Granite, Little Goose, Lower Monumental and McNary dams). Because of the addition of the fourth interrogation site (Lower Monumental) in 1993 and the installation of the Removable Spillway Weir at Lower Granite Dam in 2001, caution must be used in comparing cumulative interrogation data. Cumulative interrogations at the four dams for fish marked at the Snake River trap were 84% for hatchery Chinook, 89% for wild Chinook, 94% for hatchery steelhead, and 93% for wild steelhead. Cumulative interrogations at the four dams for fish marked at the Salmon River trap were 71% for hatchery Chinook, 78% for wild Chinook salmon, 80% for hatchery steelhead trout, and 81% for wild steelhead trout.« less

Seasonal to Decadal Discharge Predictions: Dream, Reality, or Somewhere in Between?

NASA Astrophysics Data System (ADS)

Villarini, G.

2016-12-01

Rivers have always played a central role in human activities including transportation and the provision of freshwater resources for agriculture, industry, and household use. However, too much or too little water in our rivers can have profound societal and economic repercussions, affecting the livelihood of millions of people and resulting in billions of dollars in economic damage. Despite these profound impacts and the critical role that rivers have played in our society, the development of systems enabling skillful predictions of discharge with lead times ranging from several months to several years is still in its infancy. The availability of discharge predictions could have major impacts on a number of sectors and industries, from water resources management to disaster prevention, policy-making and transportation. In this presentation, I will use recent developments from my research group to discuss some of the advances that we have made towards answering the question: Are skillful seasonal to decadal discharge predictions a dream, a reality, or somewhere in between? Results are based on a statistical-dynamical prediction system providing probabilistic seasonal discharge forecasts across the central United States with lead times ranging from a few months to several years.

Comparison of three artificial intelligence techniques for discharge routing

NASA Astrophysics Data System (ADS)

Khatibi, Rahman; Ghorbani, Mohammad Ali; Kashani, Mahsa Hasanpour; Kisi, Ozgur

2011-06-01

SummaryThe inter-comparison of three artificial intelligence (AI) techniques are presented using the results of river flow/stage timeseries, that are otherwise handled by traditional discharge routing techniques. These models comprise Artificial Neural Network (ANN), Adaptive Nero-Fuzzy Inference System (ANFIS) and Genetic Programming (GP), which are for discharge routing of Kizilirmak River, Turkey. The daily mean river discharge data with a period between 1999 and 2003 were used for training and testing the models. The comparison includes both visual and parametric approaches using such statistic as Coefficient of Correlation (CC), Mean Absolute Error (MAE) and Mean Square Relative Error (MSRE), as well as a basic scoring system. Overall, the results indicate that ANN and ANFIS have mixed fortunes in discharge routing, and both have different abilities in capturing and reproducing some of the observed information. However, the performance of GP displays a better edge over the other two modelling approaches in most of the respects. Attention is given to the information contents of recorded timeseries in terms of their peak values and timings, where one performance measure may capture some of the information contents but be ineffective in others. Thus, this makes a case for compiling knowledge base for various modelling techniques.

Analysis of patients ≥65 with predominant cervical spine fractures: Issues of disposition and dysphagia

PubMed Central

Poole, Lisa M.; Le, Phong; Drake, Rachel M.; Helmer, Stephen D.; Haan, James M.

2017-01-01

Background: Cervical spine fractures occur in 2.6% to 4.7% of trauma patients aged 65 years or older. Mortality rates in this population ranges from 19% to 24%. A few studies have specifically looked at dysphagia in elderly patients with cervical spine injury. Aims: The aim of this study is to evaluate dysphagia, disposition, and mortality in elderly patients with cervical spine injury. Settings and Design: Retrospective review at an the American College of Surgeons-verified level 1 trauma center. Methods: Patients 65 years or older with cervical spine fracture, either isolated or in association with other minor injuries were included in the study. Data included demographics, injury details, neurologic deficits, dysphagia evaluation and treatment, hospitalization details, and outcomes. Statistical Analysis: Categorical and continuous data were analyzed using Chi-square analysis and one-way analysis of variance, respectively. Results: Of 136 patients in this study, 2 (1.5%) had a sensory deficit alone, 4 (2.9%) had a motor deficit alone, and 4 (2.9%) had a combined sensory and motor deficit. Nearly one-third of patients (n = 43, 31.6%) underwent formal swallow evaluation, and 4 (2.9%) had a nasogastric tube or Dobhoff tube placed for enteral nutrition, whereas eight others (5.9%) had a gastrostomy tube or percutaneous endoscopic gastrostomy tube placed. Most patients were discharged to a skilled nursing unit (n = 50, 36.8%), or to home or home with home health (n = 48, 35.3%). Seven patients (5.1%) died in the hospital, and eight more (5.9%) were transferred to hospice. Conclusion: Cervical spine injury in the elderly patient can lead to significant consequences, including dysphagia and need for skilled nursing care at discharge. PMID:28243007

A quantitative analysis of municipal solid waste disposal charges in China.

PubMed

Wu, Jian; Zhang, Weiqian; Xu, Jiaxuan; Che, Yue

2015-03-01

Rapid industrialization and economic development have caused a tremendous increase in municipal solid waste (MSW) generation in China. China began implementing a policy of MSW disposal fees for household waste management at the end of last century. Three charging methods were implemented throughout the country: a fixed disposal fee, a potable water-based disposal fee, and a plastic bag-based disposal fee. To date, there has been little qualitative or quantitative analysis on the effectiveness of this relatively new policy. This paper provides a general overview of MSW fee policy in China, attempts to verify whether the policy is successful in reducing general waste collected, and proposes an improved charging system to address current problems. The paper presents an empirical statistical analysis of policy effectiveness derived from an environmental Kuznets curve (EKC) test on panel data of China. EKC tests on different kinds of MSW charge systems were then examined for individual provinces or cities. A comparison of existing charging systems was conducted using environmental and economic criteria. The results indicate the following: (1) the MSW policies implemented over the study period were effective in the reduction of waste generation, (2) the household waste discharge fee policy did not act as a strong driver in terms of waste prevention and reduction, and (3) the plastic bag-based disposal fee appeared to be performing well according to qualitative and quantitative analysis. Based on current situation of waste discharging management in China, a three-stage transitional charging scheme is proposed and both advantages and drawbacks discussed. Evidence suggests that a transition from a fixed disposal fee to a plastic bag-based disposal fee involving various stakeholders should be the next objective of waste reduction efforts.

Visual Analytics for Pattern Discovery in Home Care

PubMed Central

Monsen, Karen A.; Bae, Sung-Heui; Zhang, Wenhui

2016-01-01

Summary Background Visualization can reduce the cognitive load of information, allowing users to easily interpret and assess large amounts of data. The purpose of our study was to examine home health data using visual analysis techniques to discover clinically salient associations between patient characteristics with problem-oriented health outcomes of older adult home health patients during the home health service period. Methods Knowledge, Behavior and Status ratings at discharge as well as change from admission to discharge that was coded using the Omaha System was collected from a dataset on 988 de-identified patient data from 15 home health agencies. SPSS Visualization Designer v1.0 was used to visually analyze patterns between independent and outcome variables using heat maps and histograms. Visualizations suggesting clinical salience were tested for significance using correlation analysis. Results The mean age of the patients was 80 years, with the majority female (66%). Of the 150 visualizations, 69 potentially meaningful patterns were statistically evaluated through bivariate associations, revealing 21 significant associations. Further, 14 associations between episode length and Charlson co-morbidity index mainly with urinary related diagnoses and problems remained significant after adjustment analyses. Through visual analysis, the adverse association of the longer home health episode length and higher Charlson co-morbidity index with behavior or status outcomes for patients with impaired urinary function was revealed. Conclusions We have demonstrated the use of visual analysis to discover novel patterns that described high-needs subgroups among the older home health patient population. The effective presentation of these data patterns can allow clinicians to identify areas of patient improvement, and time periods that are most effective for implementing home health interventions to improve patient outcomes. PMID:27466053

Investigation of hydrophobic substrates for solution residue analysis utilizing an ambient desorption liquid sampling-atmospheric pressure glow discharge microplasma.

PubMed

Paing, Htoo W; Marcus, R Kenneth

2018-03-12

A practical method for preparation of solution residue samples for analysis utilizing the ambient desorption liquid sampling-atmospheric pressure glow discharge optical emission spectroscopy (AD-LS-APGD-OES) microplasma is described. Initial efforts involving placement of solution aliquots in wells drilled into copper substrates, proved unsuccessful. A design-of-experiment (DOE) approach was carried out to determine influential factors during sample deposition including solution volume, solute concentration, number of droplets deposited, and the solution matrix. These various aspects are manifested in the mass of analyte deposited as well as the size/shape of the product residue. Statistical analysis demonstrated that only those initial attributes were significant factors towards the emission response of the analyte. Various approaches were investigated to better control the location/uniformity of the deposited sample. Three alternative substrates, a glass slide, a poly(tetrafluoro)ethylene (PTFE) sheet, and a polydimethylsiloxane (PDMS)-coated glass slide, were evaluated towards the microplasma analytical performance. Co-deposition with simple organic dyes provided an accurate means of determining the location of the analyte with only minor influence on emission responses. The PDMS-coated glass provided the best performance by virtue of its providing a uniform spatial distribution of the residue material. This uniformity yielded an improved limits of detection by approximately 22× for 20 μL and 4 x for 2 μL over the other two substrates. While they operate by fundamentally different processes, this choice of substrate is not restricted to the LS-APGD, but may also be applicable to other AD methods such as DESI, DART, or LIBS. Further developments will be directed towards a field-deployable ambient desorption OES source for quantitative analysis of microvolume solution residues of nuclear forensics importance.

Recharge in semiarid mountain environments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gross, G.W.

A systematic investigation of tritium activity in precipitation, surface water, springs, and ground water of the Roswell artesian basin in New Mexico, has been supplemented by hydrogeologic reconnaissance of spring systems; by various statistical correlations and spectral analysis of stream flow and water level records of observation wells; by spring discharge measurements; by stable isotope determinations (oxygen 18 and deuterium); and by numerical modeling of part of the basin. Two recharge contributions to the Principal or Carbonate Aquifer have been distinguished principally on the basis of their tritium label and aquifer response characteristics. Almost all basin waters (including deep groundmore » water) fall close to the meteoric line of hydrogen/oxygen isotope composition, and this rules out a juvenile origin or appreciable bedrock interaction.« less

Prenatal irradiation, possible etiological factor in epilepsy (in French)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Geets, W.

1972-01-01

Twenty four cases of epilepsy in a group of 28 children aged 1 month to 16 yrs, in whom antecedents were negative except that - the mother had undergone an abdominal radiography during pregnancy were observed. In seven cases a mild mental retardation was noted. Generalized seizures were first observed between the age of 1 month and 4.5 yrs, focal attacks between the age of 7 and 12.5 yrs. EEG recordings at rest show discharges of generalized or focal slow waves in eight cases and a reduced acceleration of the cerebral rhythm between 3 and 7 yrs, in seven cases.more » These clinical observations confirm some experimental data but a statistical analysis on a larger scale is necessary. (auth)« less

Assessment of readability, understandability, and completeness of pediatric hospital medicine discharge instructions.

PubMed

Unaka, Ndidi I; Statile, Angela; Haney, Julianne; Beck, Andrew F; Brady, Patrick W; Jerardi, Karen E

2017-02-01

The average American adult reads at an 8th-grade level. Discharge instructions written above this level might increase the risk of adverse outcomes for children as they transition from hospital to home. We conducted a cross-sectional study at a large urban academic children's hospital to describe readability levels, understandability scores, and completeness of written instructions given to families at hospital discharge. Two hundred charts for patients discharged from the hospital medicine service were randomly selected for review. Written discharge instructions were extracted and scored for readability (Fry Readability Scale [FRS]), understandability (Patient Education Materials Assessment Tool [PEMAT]), and completeness (5 criteria determined by consensus). Descriptive statistics enumerated the distribution of readability, understandability, and completeness of written discharge instructions. Of the patients included in the study, 51% were publicly insured. Median age was 3.1 years, and median length of stay was 2.0 days. The median readability score corresponded to a 10th-grade reading level (interquartile range, 8-12; range, 1-13). Median PEMAT score was 73% (interquartile range, 64%-82%; range, 45%-100%); 36% of instructions scored below 70%, correlating with suboptimal understandability. The diagnosis was described in only 33% of the instructions. Although explicit warning signs were listed in most instructions, 38% of the instructions did not include information on the person to contact if warning signs developed. Overall, the readability, understandability, and completeness of discharge instructions were subpar. Efforts to improve the content of discharge instructions may promote safe and effective transitions home. Journal of Hospital Medicine 2017;12:98-101. © 2017 Society of Hospital Medicine.

Detection of coastal and submarine discharge on the Florida Gulf Coast with an airborne thermal-infrared mapping system

USGS Publications Warehouse

Raabe, Ellen; Stonehouse, David; Ebersol, Kristin; Holland, Kathryn; Robbins, Lisa

2011-01-01

Along the Gulf Coast of Florida north of Tampa Bay lies a region characterized by an open marsh coast, low topographic gradient, water-bearing limestone, and scattered springs. The Floridan aquifer system is at or near land surface in this region, discharging water at a consistent 70-72°F. The thermal contrast between ambient water and aquifer discharge during winter months can be distinguished using airborne thermal-infrared imagery. An airborne thermal-infrared mapping system was used to collect imagery along 126 miles of the Gulf Coast from Jefferson to Levy County, FL, in March 2009. The imagery depicts a large number of discharge locations and associated warm-water plumes in ponds, creeks, rivers, and nearshore waters. A thermal contrast of 6°F or more was set as a conservative threshold for identifying sites, statistically significant at the 99% confidence interval. Almost 900 such coastal and submarine-discharge locations were detected, averaging seven to nine per mile along this section of coast. This represents approximately one hundred times the number of previously known discharge sites in the same area. Several known coastal springs in Taylor and Levy Counties were positively identified with the imagery and were used to estimate regional discharge equivalent to one 1st-order spring, discharging 100 cubic feet per second or more, for every two miles of coastline. The number of identified discharge sites is a conservative estimate and may represent two-thirds of existing features due to low groundwater levels at time of overflight. The role of aquifer discharge in coastal and estuarine health is indisputable; however, mapping and quantifying discharge in a complex karst environment can be an elusive goal. The results of this effort illustrate the effectiveness of the instrument and underscore the influence of coastal springs along this stretch of the Florida coast.

Nutrition Care after Discharge from Hospital: An Exploratory Analysis from the More-2-Eat Study

PubMed Central

Curtis, Lori; Dubin, Joel; McNicholl, Tara; Valaitis, Renata; Douglas, Pauline; Bell, Jack; Bernier, Paule; Keller, Heather

2018-01-01

Many patients leave hospital in poor nutritional states, yet little is known about the post-discharge nutrition care in which patients are engaged. This study describes the nutrition-care activities 30-days post-discharge reported by patients and what covariates are associated with these activities. Quasi-randomly selected patients recruited from 5 medical units across Canada (n = 513) consented to 30-days post-discharge data collection with 48.5% (n = 249) completing the telephone interview. Use of nutrition care post-discharge was reported and bivariate analysis completed with relevant covariates for the two most frequently reported activities, following recommendations post-discharge or use of oral nutritional supplements (ONS). A total of 42% (n = 110) received nutrition recommendations at hospital discharge, with 65% (n = 71/110) of these participants following those recommendations; 26.5% (n = 66) were taking ONS after hospitalization. Participants who followed recommendations were more likely to report following a special diet (p = 0.002), different from before their hospitalization (p = 0.008), compared to those who received recommendations, but reported not following them. Patients taking ONS were more likely to be at nutrition risk (p < 0.0001), malnourished (p = 0.0006), taking ONS in hospital (p = 0.01), had a lower HGS (p = 0.0013; males only), and less likely to believe they were eating enough to meet their body’s needs (p = 0.005). This analysis provides new insights on nutrition-care post-discharge. PMID:29361696

Hydrogeochemistry and water quality of the Kordkandi-Duzduzan plain, NW Iran: application of multivariate statistical analysis and PoS index.

PubMed

Soltani, Shahla; Asghari Moghaddam, Asghar; Barzegar, Rahim; Kazemian, Naeimeh; Tziritis, Evangelos

2017-08-18

Kordkandi-Duzduzan plain is one of the fertile plains of East Azarbaijan Province, NW of Iran. Groundwater is an important resource for drinking and agricultural purposes due to the lack of surface water resources in the region. The main objectives of the present study are to identify the hydrogeochemical processes and the potential sources of major, minor, and trace metals and metalloids such as Cr, Mn, Cd, Fe, Al, and As by using joint hydrogeochemical techniques and multivariate statistical analysis and to evaluate groundwater quality deterioration with the use of PoS environmental index. To achieve these objectives, 23 groundwater samples were collected in September 2015. Piper diagram shows that the mixed Ca-Mg-Cl is the dominant groundwater type, and some of the samples have Ca-HCO 3 , Ca-Cl, and Na-Cl types. Multivariate statistical analyses indicate that weathering and dissolution of different rocks and minerals, e.g., silicates, gypsum, and halite, ion exchange, and agricultural activities influence the hydrogeochemistry of the study area. The cluster analysis divides the samples into two distinct clusters which are completely different in EC (and its dependent variables such as Na + , K + , Ca 2+ , Mg 2+ , SO 4 2- , and Cl - ), Cd, and Cr variables according to the ANOVA statistical test. Based on the median values, the concentrations of pH, NO 3 - , SiO 2 , and As in cluster 1 are elevated compared with those of cluster 2, while their maximum values occur in cluster 2. According to the PoS index, the dominant parameter that controls quality deterioration is As, with 60% of contribution. Samples of lowest PoS values are located in the southern and northern parts (recharge area) while samples of the highest values are located in the discharge area and the eastern part.

Seasonal assessment and apportionment of surface water pollution using multivariate statistical methods: Sinos River, southern Brazil.

PubMed

Alves, Darlan Daniel; Riegel, Roberta Plangg; de Quevedo, Daniela Müller; Osório, Daniela Montanari Migliavacca; da Costa, Gustavo Marques; do Nascimento, Carlos Augusto; Telöken, Franko

2018-06-08

Assessment of surface water quality is an issue of currently high importance, especially in polluted rivers which provide water for treatment and distribution as drinking water, as is the case of the Sinos River, southern Brazil. Multivariate statistical techniques allow a better understanding of the seasonal variations in water quality, as well as the source identification and source apportionment of water pollution. In this study, the multivariate statistical techniques of cluster analysis (CA), principal component analysis (PCA), and positive matrix factorization (PMF) were used, along with the Kruskal-Wallis test and Spearman's correlation analysis in order to interpret a water quality data set resulting from a monitoring program conducted over a period of almost two years (May 2013 to April 2015). The water samples were collected from the raw water inlet of the municipal water treatment plant (WTP) operated by the Water and Sewage Services of Novo Hamburgo (COMUSA). CA allowed the data to be grouped into three periods (autumn and summer (AUT-SUM); winter (WIN); spring (SPR)). Through the PCA, it was possible to identify that the most important parameters in contribution to water quality variations are total coliforms (TCOLI) in SUM-AUT, water level (WL), water temperature (WT), and electrical conductivity (EC) in WIN and color (COLOR) and turbidity (TURB) in SPR. PMF was applied to the complete data set and enabled the source apportionment water pollution through three factors, which are related to anthropogenic sources, such as the discharge of domestic sewage (mostly represented by Escherichia coli (ECOLI)), industrial wastewaters, and agriculture runoff. The results provided by this study demonstrate the contribution provided by the use of integrated statistical techniques in the interpretation and understanding of large data sets of water quality, showing also that this approach can be used as an efficient methodology to optimize indicators for water quality assessment.

Change of flood risk under climate change based on Discharge Probability Index in Japan

NASA Astrophysics Data System (ADS)

Nitta, T.; Yoshimura, K.; Kanae, S.; Oki, T.

2010-12-01

Water-related disasters under the climate change have recently gained considerable interest, and there have been many studies referring to flood risk at the global scale (e.g. Milly et al., 2002; Hirabayashi et al., 2008). In order to build adaptive capacity, however, regional impact evaluation is needed. We thus focus on the flood risk over Japan in the present study. The output from the Regional Climate Model 20 (RCM20), which was developed by the Meteorological Research Institute, was used. The data was first compared with observed data based on Automated Meteorological Data Acquisition System and ground weather observations, and the model biases were corrected using the ratio and difference of the 20-year mean values. The bias-corrected RCM20 atmospheric data were then forced to run a land surface model and a river routing model (Yoshimura et al., 2007; Ngo-Duc, T. et al. 2007) to simulate river discharge during 1981-2000, 2031-2050, and 2081-2100. Simulated river discharge was converted to Discharge Probability Index (DPI), which was proposed by Yoshimura et al based on a statistical approach. The bias and uncertainty of the models are already taken into account in the concept of DPI, so that DPI serves as a good indicator of flood risk. We estimated the statistical parameters for DPI using the river discharge for 1981-2000 with an assumption that the parameters stay the same in the different climate periods. We then evaluated the occurrence of flood events corresponding to DPI categories in each 20 years and averaged them in 9 regions. The results indicate that low DPI flood events (return period of 2 years) will become more frequent in 2031-2050 and high DPI flood events (return period of 200 years) will become more frequent in 2081-2100 compared with the period of 1981-2000, though average precipitation will become larger during 2031-2050 than during 2081-2100 in most regions. It reflects the increased extreme precipitation during 2081-2100.

Structural analysis of HyFlex EDM instruments.

PubMed

Iacono, F; Pirani, C; Generali, L; Bolelli, G; Sassatelli, P; Lusvarghi, L; Gandolfi, M G; Giorgini, L; Prati, C

2017-03-01

To compare the phase transformation behaviour, the microstructure, the nano-hardness and the surface chemistry of electro-discharge machined HyFlex EDM instruments with conventionally manufactured HyFlex CM. New and laboratory used HyFlex EDM were examined by X-ray diffraction (XRD) and differential scanning calorimetry (DSC). Nano-hardness and modulus of elasticity were also investigated using a maximum load of 20 mN with a minimum of 40 significant indentations for each sample. Raman spectroscopy and field emission-scanning electron microscope (FE-SEM) were used to assess the surface chemistry of HyFlex EDM. HyFlex CM were subjected to the same investigations and used as a comparison. Nano-indentation data were statistically analysed using the Student's t-test. XRD analysis on HyFlex EDM revealed the presence of martensite and rhombohedral R-phase, while a mixture of martensite and austenite structure was identified in HyFlex CM. DSC analysis also disclosed higher austenite finish (Af) temperatures for electro-discharge machining (EDM) instruments. Significant differences in nano-hardness and modulus of elasticity were found between EDM and CM files (P < 0.05). FE-SEM and EDS analyses confirmed that both new EDM and CM files were covered by an oxide layer. Micro-Raman spectroscopy assessed the presence of rutile-TiO 2 . HyFlex EDM revealed peculiar structural properties, such as increased phase transformation temperatures and hardness. Present results corroborated previous findings and shed light on the enhanced mechanical behaviour of these instruments. © 2016 International Endodontic Journal. Published by John Wiley & Sons Ltd.

Is prescribed lower extremity weight-bearing status after geriatric lower extremity trauma associated with increased mortality?

PubMed

Gitajn, Ida Leah; Connelly, Daniel; Mascarenhas, Daniel; Breazeale, Stephen; Berger, Peter; Schoonover, Carrie; Martin, Brook; O'Toole, Robert V; Pensy, Raymond; Sciadini, Marcus

2018-02-01

Evaluate whether mortality after discharge is elevated in geriatric fracture patients whose lower extremity weight-bearing is restricted. Retrospective cohort study SETTING: Urban Level 1 trauma center PATIENTS/PARTICIPANTS: 1746 patients >65 years of age INTERVENTION: Post-operative lower extremity weight-bearing status MAIN OUTCOME MEASURE: Mortality, as determined by the Social Security Death Index RESULTS: Univariate analysis demonstrated that patients who were weight-bearing as tolerated on bilateral lower extremities (BLE) had significantly higher 5-year mortality compared to patients with restricted weight-bearing on one lower extremity and restricted weight-bearing on BLE (30%, 21% and 22% respectively, p < 0.001). Cox regression analysis controlling for variables including age, Charlson Comorbidity Index, Injury Severity Scale, combined UE/LE injury, injury mechanism (high vs low), sex, BMI and GCS demonstrated that, in comparison to patients who were weight bearing as tolerated on BLE, restricted weight-bearing on one lower extremity had a hazard ratio (HR) of 0.97 (95% confidence interval 0.78 to 1.20, p = 0.76) and restricted weight-bearing in BLE had a HR of 0.91 (95% confidence interval 0.60 to 1.36, p = 0.73). In geriatric patients, prescribed weight-bearing status did not have a statistically significant association with mortality after discharge, when controlling for age, sex, body mass index, medical comorbidities, Injury Severity Scale (ISS), mechanism of injury, nonoperative treatment and admission GCS. This remained true in when the analysis was restricted to operative injuries only. Copyright © 2017 Elsevier Ltd. All rights reserved.

Base-flow characteristics of streams in the Valley and Ridge, Blue Ridge, and Piedmont physiographic provinces of Virginia

USGS Publications Warehouse

Nelms, D.L.; Harlow, G.E.; Hayes, Donald C.

1995-01-01

Growth within the Valley and Ridge, Blue Ridge, and Piedmont Physiographic Provinces of Virginia has focussed concern about allocation of surface-water flow and increased demands on the ground-water resources. The purpose of this report is to (1) describe the base-flow characteristics of streams, (2) identify regional differences in these flow characteristics, and (3) describe, if possible, the potential surface-water and ground-water yields of basins on the basis of the base-flow character- istics. Base-flow characteristics are presented for streams in the Valley and Ridge, Blue Ridge, and Piedmont Physiographic Provinces of Virginia. The provinces are separated into five regions: (1) Valley and Ridge, (2) Blue Ridge, (3) Piedmont/Blue Ridge transition, (4) Piedmont northern, and (5) Piedmont southern. Different flow statistics, which represent streamflows predominantly comprised of base flow, were determined for 217 continuous-record streamflow-gaging stations from historical mean daily discharge and for 192 partial-record streamflow-gaging stations by means of correlation of discharge measurements. Variability of base flow is represented by a duration ratio developed during this investigation. Effective recharge rates were also calculated. Median values for the different flow statistics range from 0.05 cubic foot per second per square mile for the 90-percent discharge on the streamflow-duration curve to 0.61 cubic foot per second per square mile for mean base flow. An excellent estimator of mean base flow for the Piedmont/Blue Ridge transition region and Piedmont southern region is the 50-percent discharge on the streamflow-duration curve, but tends to under- estimate mean base flow for the remaining regions. The base-flow variability index ranges from 0.07 to 2.27, with a median value of 0.55. Effective recharge rates range from 0.07 to 33.07 inches per year, with a median value of 8.32 inches per year. Differences in the base-flow characteristics exist between regions. The median discharges for the Valley and Ridge, Blue Ridge, and Piedmont/Blue Ridge transition regions are higher than those for the Piedmont regions. Results from statistical analysis indicate that the regions can be ranked in terms of base-flow characteristics from highest to lowest as follows: (1) Piedmont/Blue Ridge transition, (2) Valley and Ridge and Blue Ridge, (3) Piedmont southern, and (4) Piedmont northern. The flow statistics are consistently higher and the values for base-flow variability are lower for basins within the Piedmont/Blue Ridge transition region relative to those from the other regions, whereas the basins within the Piedmont northern region show the opposite pattern. The group rankings of the base-flow characteristics were used to designate the potential surface-water yield for the regions. In addition, an approach developed for this investigation assigns a rank for potential surface- water yield to a basin according to the quartiles in which the values for the base-flow character- istics are located. Both procedures indicate that the Valley and Ridge, Blue Ridge, and Piedmont/Blue Ridge transition regions have moderate-to-high potential surface-water yield and the Piedmont regions have low-to-moderate potential surface- water yield. In order to indicate potential ground-water yield from base-flow characteristics, aquifer properties for 51 streamflow-gaging stations with continuous record of streamflow data were determined by methods that use streamflow records and basin characteristics. Areal diffusivity ranges from 17,100 to 88,400 feet squared per day, with a median value of 38,400 feet squared per day. Areal transmissivity ranges from 63 to 830 feet squared per day, with a median value of 270 feet squared per day. Storage coefficients, which were estimated by dividing areal transmissivity by areal diffusivity, range from approximately 0.001 to 0.019 (dimensionless), with a median value of 0.007. The median value for areal diffus

40 CFR 434.71 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-07-01

... determines that it is not feasible for a remining operator to re-establish baseline pollutant levels in accordance with the statistical procedures contained in Appendix B of this part, pre-existing discharge limitations at existing remining operations shall remain subject to baseline pollutant levels established...

Risk Factors for Post-NICU Discharge Mortality Among Extremely Low Birth Weight Infants

PubMed Central

De Jesus, Lilia C.; Pappas, Athina; Shankaran, Seetha; Kendrick, Douglas; Das, Abhik; Higgins, Rosemary D.; Bell, Edward F.; Stoll, Barbara J.; Laptook, Abbot R.; Walsh, Michele C.

2012-01-01

Objective To evaluate maternal and neonatal risk factors associated with post-neonatal intensive care unit (NICU) discharge mortality among ELBW infants. Study design This is a retrospective analysis of extremely low birth weight (<1,000 g) and <27 weeks' gestational age infants born in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network sites from January 2000 to June 2007. Infants were tracked until death or 18–22 months corrected age. Infants who died between NICU discharge and the 18–22 month follow-up visit were classified as post-NICU discharge mortality. Association of maternal and infant risk factors with post-NICU discharge mortality was determined using logistic regression analysis. A prediction model with six significant predictors was developed and validated. Results 5,364 infants survived to NICU discharge. 557 (10%) infants were lost to follow-up, and 107 infants died following NICU discharge. Post-NICU discharge mortality rate was 22.3 per 1000 ELBW infants. In the prediction model, African-American race, unknown maternal health insurance, and hospital stay ≥120 days significantly increased risk, and maternal exposure to intra-partum antibiotics was associated with decreased risk of post-NICU discharge mortality. Conclusion We identified African-American race, unknown medical insurance and prolonged NICU stay as risk factors associated with post-NICU discharge mortality among ELBW infants. PMID:22325187

Impact of a Focused Approach for Discharge Teaching Regarding the Use of Aspirin as Anticoagulant After Joint Replacement Surgery.

PubMed

Wittig-Wells, Deborah; Higgins, Melinda; Davis, Erica; Johnson, Ifeya; Louis, Latalya; Mason, Olga; Samms-McPherson, Jacqueline; Sims, Sandra; Jacob, Ani

2015-01-01

Patient education for the use and administration of aspirin (ASA) as an anticoagulant may be deficient. To pilot a knowledge assessment tool regarding the use of aspirin (ASA) as an anticoagulant and to evaluate the impact of a focused approach for discharge teaching. One-group pretest-posttest pilot study. Convenience sample of patients hospitalized for total knee and total hip arthroplasty. Researcher developed ASA quiz. Focused education on aspirin as an anticoagulant. There was a statistically significant improvement in knowledge (Wilcoxon rank sum test Z = 3.880, p < .001).

The impact of early discharge laws on the health of newborns.

PubMed

Evans, William N; Garthwaite, Craig; Wei, Heng

2008-07-01

Using an interrupted time series design and a census of births in California over a 6-year period, we show that state and federal laws passed in the late 1990s designed to increase the length of postpartum hospital stays reduced considerably the fraction of newborns that were discharged early. The law had little impact on re-admission rates for privately insured, vaginally delivered newborns, but reduced re-admission rates for privately insured c-section-delivered and Medicaid-insured vaginally delivered newborns by statistically significant amounts. Our calculations suggest the program was not cost saving.

Comparison of Flow and Volume Incentive Spirometry on Pulmonary Function and Exercise Tolerance in Open Abdominal Surgery: A Randomized Clinical Trial.

PubMed

Kumar, Amaravadi Sampath; Alaparthi, Gopala Krishna; Augustine, Alfred Joseph; Pazhyaottayil, Zulfeequer Chundaanveetil; Ramakrishna, Anand; Krishnakumar, Shyam Krishnan

2016-01-01

Surgical procedures in abdominal area lead to changes in pulmonary function, respiratory mechanics and impaired physical capacity leading to postoperative pulmonary complications, which can affect up to 80% of upper abdominal surgery. To evaluate the effects of flow and volume incentive spirometry on pulmonary function and exercise tolerance in patients undergoing open abdominal surgery. A randomized clinical trial was conducted in a hospital of Mangalore city in Southern India. Thirty-seven males and thirteen females who were undergoing abdominal surgeries were included and allocated into flow and volume incentive spirometry groups by block randomization. All subjects underwent evaluations of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow (PEF). Preoperative and postoperative measurements were taken up to day 5 for both groups. Exercise tolerance measured by Six- Minute Walk Test during preoperative period and measured again at the time of discharge for both groups. Pulmonary function was analysed by post-hoc analysis and carried out using Bonferroni's 't'-test. Exercise tolerance was analysed by Paired 'T'-test. Pulmonary function (FVC, FEV1, and PEFR) was found to be significantly decreased in 1(st), 2(nd) and 3(rd) postoperative day when compared with preoperative day. On 4(th) and 5(th) postoperative day the pulmonary function (FVC, FEV1, and PEFR) was found to be better preserved in both flow and volume incentive spirometry groups. The Six-Minute Walk Test showed a statistically significant improvement in pulmonary function on the day of discharge than in the preoperative period. In terms of distance covered, the volume- incentive spirometry group showed a greater statistically significant improvement from the preoperative period to the time of discharge than was exhibited by the flow incentive spirometry group. Flow and volume incentive spirometry can be safely recommended to patients undergoing open abdominal surgery as there have been no adverse events recorded. Also, these led to a demonstrable improvement in pulmonary function and exercise tolerance.

Comparison of Flow and Volume Incentive Spirometry on Pulmonary Function and Exercise Tolerance in Open Abdominal Surgery: A Randomized Clinical Trial

PubMed Central

Kumar, Amaravadi Sampath; Augustine, Alfred Joseph; Pazhyaottayil, Zulfeequer Chundaanveetil; Ramakrishna, Anand; Krishnakumar, Shyam Krishnan

2016-01-01

Introduction Surgical procedures in abdominal area lead to changes in pulmonary function, respiratory mechanics and impaired physical capacity leading to postoperative pulmonary complications, which can affect up to 80% of upper abdominal surgery. Aim To evaluate the effects of flow and volume incentive spirometry on pulmonary function and exercise tolerance in patients undergoing open abdominal surgery. Materials and Methods A randomized clinical trial was conducted in a hospital of Mangalore city in Southern India. Thirty-seven males and thirteen females who were undergoing abdominal surgeries were included and allocated into flow and volume incentive spirometry groups by block randomization. All subjects underwent evaluations of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow (PEF). Preoperative and postoperative measurements were taken up to day 5 for both groups. Exercise tolerance measured by Six- Minute Walk Test during preoperative period and measured again at the time of discharge for both groups. Pulmonary function was analysed by post-hoc analysis and carried out using Bonferroni’s ‘t’-test. Exercise tolerance was analysed by Paired ‘T’-test. Results Pulmonary function (FVC, FEV1, and PEFR) was found to be significantly decreased in 1st, 2nd and 3rd postoperative day when compared with preoperative day. On 4th and 5th postoperative day the pulmonary function (FVC, FEV1, and PEFR) was found to be better preserved in both flow and volume incentive spirometry groups. The Six-Minute Walk Test showed a statistically significant improvement in pulmonary function on the day of discharge than in the preoperative period. In terms of distance covered, the volume- incentive spirometry group showed a greater statistically significant improvement from the preoperative period to the time of discharge than was exhibited by the flow incentive spirometry group. Conclusion Flow and volume incentive spirometry can be safely recommended to patients undergoing open abdominal surgery as there have been no adverse events recorded. Also, these led to a demonstrable improvement in pulmonary function and exercise tolerance. PMID:26894090

Development of a predictive model to identify inpatients at risk of re-admission within 30 days of discharge (PARR-30)

PubMed Central

Billings, John; Blunt, Ian; Steventon, Adam; Georghiou, Theo; Lewis, Geraint; Bardsley, Martin

2012-01-01

Objectives To develop an algorithm for identifying inpatients at high risk of re-admission to a National Health Service (NHS) hospital in England within 30 days of discharge using information that can either be obtained from hospital information systems or from the patient and their notes. Design Multivariate statistical analysis of routinely collected hospital episode statistics (HES) data using logistic regression to build the predictive model. The model's performance was calculated using bootstrapping. Setting HES data covering all NHS hospital admissions in England. Participants The NHS patients were admitted to hospital between April 2008 and March 2009 (10% sample of all admissions, n=576 868). Main outcome measures Area under the receiver operating characteristic curve for the algorithm, together with its positive predictive value and sensitivity for a range of risk score thresholds. Results The algorithm produces a ‘risk score’ ranging (0–1) for each admitted patient, and the percentage of patients with a re-admission within 30 days and the mean re-admission costs of all patients are provided for 20 risk bands. At a risk score threshold of 0.5, the positive predictive value (ie, percentage of inpatients identified as high risk who were subsequently re-admitted within 30 days) was 59.2% (95% CI 58.0% to 60.5%); representing 5.4% (95% CI 5.2% to 5.6%) of all inpatients who would be re-admitted within 30 days (sensitivity). The area under the receiver operating characteristic curve was 0.70 (95% CI 0.69 to 0.70). Conclusions We have developed a method of identifying inpatients at high risk of unplanned re-admission to NHS hospitals within 30 days of discharge. Though the models had a low sensitivity, we show how to identify subgroups of patients that contain a high proportion of patients who will be re-admitted within 30 days. Additional work is necessary to validate the model in practice. PMID:22885591

Wind Tunnel Analysis of the Airflow through Insect-Proof Screens and Comparison of Their Effect When Installed in a Mediterranean Greenhouse

PubMed Central

López, Alejandro; Molina-Aiz, Francisco D.; Valera, Diego L.; Peña, Araceli

2016-01-01

The present work studies the effect of three insect-proof screens with different geometrical and aerodynamic characteristics on the air velocity and temperature inside a Mediterranean multi-span greenhouse with three roof vents and without crops, divided into two independent sectors. First, the insect-proof screens were characterised geometrically by analysing digital images and testing in a low velocity wind tunnel. The wind tunnel tests gave screen discharge coefficient values of Cd,φ of 0.207 for screen 1 (10 × 20 threads·cm−2; porosity φ = 35.0%), 0.151 for screen 2 (13 × 30 threads·cm−2; φ = 26.3%) and 0.325 for screen 3 (10 × 20 threads·cm−2; porosity φ = 36.0%), at an air velocity of 0.25 m·s−1. Secondly, when screens were installed in the greenhouse, we observed a statistical proportionality between the discharge coefficient at the openings and the air velocity ui measured in the centre of the greenhouse, ui = 0.856 Cd + 0.062 (R2 = 0.68 and p-value = 0.012). The inside-outside temperature difference ΔTio diminishes when the inside velocity increases following the statistically significant relationship ΔTio = (−135.85 + 57.88/ui)0.5 (R2 = 0.85 and p-value = 0.0011). Different thread diameters and tension affects the screen thickness, and means that similar porosities may well be associated with very different aerodynamic characteristics. Screens must be characterised by a theoretical function Cd,φ = [(2eμ/Kpρ)·(1/us) + (2eY/Kp0.5)]−0.5 that relates the discharge coefficient of the screen Cd,φ with the air velocity us. This relationship depends on the three parameters that define the aerodynamic behaviour of porous medium: permeability Kp, inertial factor Y and screen thickness e (and on air temperature that determine its density ρ and viscosity μ). However, for a determined temperature of air, the pressure drop-velocity relationship can be characterised only with two parameters: ΔP = aus2 + bus. PMID:27187401

Wind Tunnel Analysis of the Airflow through Insect-Proof Screens and Comparison of Their Effect When Installed in a Mediterranean Greenhouse.

PubMed

López, Alejandro; Molina-Aiz, Francisco D; Valera, Diego L; Peña, Araceli

2016-05-12

The present work studies the effect of three insect-proof screens with different geometrical and aerodynamic characteristics on the air velocity and temperature inside a Mediterranean multi-span greenhouse with three roof vents and without crops, divided into two independent sectors. First, the insect-proof screens were characterised geometrically by analysing digital images and testing in a low velocity wind tunnel. The wind tunnel tests gave screen discharge coefficient values of Cd,φ of 0.207 for screen 1 (10 × 20 threads·cm(-2); porosity φ = 35.0%), 0.151 for screen 2 (13 × 30 threads·cm(-2); φ = 26.3%) and 0.325 for screen 3 (10 × 20 threads·cm(-2); porosity φ = 36.0%), at an air velocity of 0.25 m·s(-1). Secondly, when screens were installed in the greenhouse, we observed a statistical proportionality between the discharge coefficient at the openings and the air velocity ui measured in the centre of the greenhouse, ui = 0.856 Cd + 0.062 (R² = 0.68 and p-value = 0.012). The inside-outside temperature difference ΔTio diminishes when the inside velocity increases following the statistically significant relationship ΔTio = (-135.85 + 57.88/ui)(0.5) (R² = 0.85 and p-value = 0.0011). Different thread diameters and tension affects the screen thickness, and means that similar porosities may well be associated with very different aerodynamic characteristics. Screens must be characterised by a theoretical function Cd,φ = [(2eμ/Kpρ)·(1/us) + (2eY/Kp(0.5))](-0.5) that relates the discharge coefficient of the screen Cd,φ with the air velocity us. This relationship depends on the three parameters that define the aerodynamic behaviour of porous medium: permeability Kp, inertial factor Y and screen thickness e (and on air temperature that determine its density ρ and viscosity μ). However, for a determined temperature of air, the pressure drop-velocity relationship can be characterised only with two parameters: ΔP = aus² + bus.

Investigation of the SCS-CN initial abstraction ratio using a Monte Carlo simulation for the derived flood frequency curves

NASA Astrophysics Data System (ADS)

Caporali, E.; Chiarello, V.; Galeati, G.

2014-12-01

Peak discharges estimates for a given return period are of primary importance in engineering practice for risk assessment and hydraulic structure design. Different statistical methods are chosen here for the assessment of flood frequency curve: one indirect technique based on the extreme rainfall event analysis, the Peak Over Threshold (POT) model and the Annual Maxima approach as direct techniques using river discharge data. In the framework of the indirect method, a Monte Carlo simulation approach is adopted to determine a derived frequency distribution of peak runoff using a probabilistic formulation of the SCS-CN method as stochastic rainfall-runoff model. A Monte Carlo simulation is used to generate a sample of different runoff events from different stochastic combination of rainfall depth, storm duration, and initial loss inputs. The distribution of the rainfall storm events is assumed to follow the GP law whose parameters are estimated through GEV's parameters of annual maximum data. The evaluation of the initial abstraction ratio is investigated since it is one of the most questionable assumption in the SCS-CN model and plays a key role in river basin characterized by high-permeability soils, mainly governed by infiltration excess mechanism. In order to take into account the uncertainty of the model parameters, this modified approach, that is able to revise and re-evaluate the original value of the initial abstraction ratio, is implemented. In the POT model the choice of the threshold has been an essential issue, mainly based on a compromise between bias and variance. The Generalized Extreme Value (GEV) distribution fitted to the annual maxima discharges is therefore compared with the Pareto distributed peaks to check the suitability of the frequency of occurrence representation. The methodology is applied to a large dam in the Serchio river basin, located in the Tuscany Region. The application has shown as Monte Carlo simulation technique can be a useful tool to provide more robust estimation of the results obtained by direct statistical methods.

Analysis of the high water wave volume for the Sava River near Zagreb

NASA Astrophysics Data System (ADS)

Trninic, Dusan

2010-05-01

The paper analyses volumes of the Sava River high water waves near Zagreb during the period: 1926-2008 (N = 83 years), which is needed for more efficient control of high and flood waters. The primary Sava flood control structures in the City of Zagreb are dikes built on both riverbanks, and the Odra Relief Canal with lateral spillway upstream from the City of Zagreb. Intensive morphological changes in the greater Sava area near Zagreb, and anthropological and climate variations and changes at the Sava catchment up to the Zagreb area require detailed analysis of the water wave characteristics. In one analysis, maximum annual volumes are calculated for high water waves with constant duration of: 10, 20, 30, 40, 50 and 60 days. Such calculations encompass total quantity of water (basic and surface runoff). The log Pearson III distribution is adapted for this series of maximum annual volumes. Based on the results obtained, the interrelations are established between the wave volume as function of duration and occurrence probability. In addition to the analysis of maximum volumes of constant duration, it is interesting to carry out the analyses of maximum volume in excess of the reference discharge since it is very important for the flood control. To determine the reference discharges, a discharge of specific duration is used from an average discharge duration curve. The adopted reference discharges have durations of 50, 40, 30, 20 and 10%. Like in the previous case, log Pearson III distribution is adapted to the maximum wave data series. For reference discharge Q = 604 m3/s (duration 10%), a linear trend is calculated of maximum annual volumes exceeding the reference discharge for the Sava near Zagreb during the analyzed period. The analysis results show a significant decrease trend. A similar analysis is carried out for the following three reference discharges: regular flood control measures at the Sava near Zagreb, which are proclaimed when the water level is 350 cm (Q = 2114 m3/s), extraordinary flood control measures taken when the water level is 450 cm (Q = 2648 m3/s), and the discharge at the deterministic inlet into the Odra Canal of approximately Q = 2300 m3/s. The results of these analyses have shown that water wave volumes higher than the reference discharges occurred in a comparatively small number of years, and that their duration was one to two days.