Motor unit recruitment in human genioglossus muscle in response to hypercapnia.

PubMed

Nicholas, Christian L; Bei, Bei; Worsnop, Christopher; Malhotra, Atul; Jordan, Amy S; Saboisky, Julian P; Chan, Julia K M; Duckworth, Ella; White, David P; Trinder, John

2010-11-01

single motor unit recordings of the genioglossus (GG) muscle indicate that GG motor units have a variety of discharge patterns, including units that have higher discharge rates during inspiration (inspiratory phasic and inspiratory tonic), or expiration (expiratory phasic and expiratory tonic), or do not modify their rate with respiration (tonic). Previous studies have shown that an increase in GG muscle activity is a consequence of increased activity in inspiratory units. However, there are differences between studies as to whether this increase is primarily due to recruitment of new motor units (motor unit recruitment) or to increased discharge rate of already active units (rate coding). Sleep-wake state studies in humans have suggested the former, while hypercapnia experiments in rats have suggested the latter. In this study, we investigated the effect of hypercapnia on GG motor unit activity in humans during wakefulness. sleep research laboratory. sixteen healthy men. each participant was administered at least 6 trials with P(et)CO(2) being elevated 8.4 (SD = 1.96) mm Hg over 2 min following a 30-s baseline. Subjects were instrumented for GG EMG and respiratory measurements with 4 fine wire electrodes inserted subcutaneously into the muscle. One hundred forty-one motor units were identified during the baseline: 47% were inspiratory modulated, 29% expiratory modulated, and 24% showed no respiratory related modulation. Sixty-two new units were recruited during hypercapnia. The distribution of recruited units was significantly different from the baseline distribution, with 84% being inspiratory modulated (P < 0.001). Neither units active during baseline, nor new units recruited during hypercapnia, increased their discharge rate as P(et)CO(2) increased (P > 0.05 for all comparisons). increased GG muscle activity in humans occurs because of recruitment of previously inactive inspiratory modulated units.

[Analysis of hydrodynamics parameters of runoff erosion and sediment-yielding on unpaved road].

PubMed

Huang, Peng-Fei; Wang, Wen-Long; Luo, Ting; Wang, Zhen; Wang, Zheng-Li; Li, Ren

2013-02-01

By the method of field runoff washout experiment, a simulation study was conducted on the relationships between the soil detachment rate and the hydrodynamic parameters on unpaved road, and the related quantitative formulas were established. Under the conditions of different flow discharges and road gradients, the averaged soil detachment rate increased with increasing flow discharge and road gradient, and the relationships between them could be described by a power function. As compared with road gradient, flow discharge had greater effects on the soil detachment rate. The soil detachment rate had a power relation with water flow velocity and runoff kinetic energy, and the runoff kinetic energy was of importance to the soil detachment rate. The soil detachment rate was linearly correlated with the unit runoff kinetic energy. The averaged soil erodibility was 0.120 g m-1.J-F-1, and the averaged critical unit runoff kinetic energy was 2.875 g.m-1.J-1. Flow discharge, road gradient, and unit runoff kinetic energy could be used to accurately describe the soil erosion process and calculate the soil erosion rate on unpaved road.

Muscle vibration sustains motor unit firing rate during submaximal isometric fatigue in humans

PubMed Central

Griffin, L; Garland, S J; Ivanova, T; Gossen, E R

2001-01-01

In keeping with the ‘muscular wisdom hypothesis’, many studies have documented that the firing rate of the majority of motor units decreased during fatiguing isometric contractions. The present study investigated whether the application of periodic muscle vibration, which strongly activates muscle spindles, would alter the modulation of motor unit firing rate during submaximal fatiguing isometric contractions. Thirty-three motor units from the lateral head of the triceps brachii muscle were recorded from 10 subjects during a sustained isometric 20 % maximal voluntary contraction (MVC) of the elbow extensors. Vibration was interposed on the contraction for 2 s every 10 s. Twenty-two motor units were recorded from the beginning of the fatigue task. The discharge rate of the majority of motor units remained constant (12/22) or increased (4/22) with fatigue. Six motor units demonstrated a reduction in discharge rate that later returned toward initial values; these motor units had higher initial discharge rates than the other 16 motor units. In a second series of experiments, four subjects held a sustained isometric 20 % MVC for 2 min and then vibration was applied as above for the remainder of the contraction. In this case, motor units initially demonstrated a decrease in firing rate that increased after the vibration was applied. Thus muscle spindle disfacilitation of the motoneurone pool may be associated with the decline of motor unit discharge rate observed during the first 2 min of the contraction. In a third set of experiments, seven subjects performed the main experiment on one occasion and repeated the fatigue task without vibration on a second occasion. Neither the endurance time of the fatiguing contraction nor the MVC torque following fatigue was affected by the application of vibration. This finding calls into question the applicability of the muscular wisdom hypothesis to submaximal contractions. PMID:11559785

Muscle vibration sustains motor unit firing rate during submaximal isometric fatigue in humans.

PubMed

Griffin, L; Garland, S J; Ivanova, T; Gossen, E R

2001-09-15

1. In keeping with the 'muscular wisdom hypothesis', many studies have documented that the firing rate of the majority of motor units decreased during fatiguing isometric contractions. The present study investigated whether the application of periodic muscle vibration, which strongly activates muscle spindles, would alter the modulation of motor unit firing rate during submaximal fatiguing isometric contractions. 2. Thirty-three motor units from the lateral head of the triceps brachii muscle were recorded from 10 subjects during a sustained isometric 20 % maximal voluntary contraction (MVC) of the elbow extensors. Vibration was interposed on the contraction for 2 s every 10 s. Twenty-two motor units were recorded from the beginning of the fatigue task. The discharge rate of the majority of motor units remained constant (12/22) or increased (4/22) with fatigue. Six motor units demonstrated a reduction in discharge rate that later returned toward initial values; these motor units had higher initial discharge rates than the other 16 motor units. 3. In a second series of experiments, four subjects held a sustained isometric 20 % MVC for 2 min and then vibration was applied as above for the remainder of the contraction. In this case, motor units initially demonstrated a decrease in firing rate that increased after the vibration was applied. Thus muscle spindle disfacilitation of the motoneurone pool may be associated with the decline of motor unit discharge rate observed during the first 2 min of the contraction. 4. In a third set of experiments, seven subjects performed the main experiment on one occasion and repeated the fatigue task without vibration on a second occasion. Neither the endurance time of the fatiguing contraction nor the MVC torque following fatigue was affected by the application of vibration. This finding calls into question the applicability of the muscular wisdom hypothesis to submaximal contractions.

Asynchronous recruitment of low-threshold motor units during repetitive, low-current stimulation of the human tibial nerve

PubMed Central

Dean, Jesse C.; Clair-Auger, Joanna M.; Lagerquist, Olle; Collins, David F.

2014-01-01

Motoneurons receive a barrage of inputs from descending and reflex pathways. Much of our understanding about how these inputs are transformed into motor output in humans has come from recordings of single motor units during voluntary contractions. This approach, however, is limited because the input is ill-defined. Herein, we quantify the discharge of soleus motor units in response to well-defined trains of afferent input delivered at physiologically-relevant frequencies. Constant frequency stimulation of the tibial nerve (10–100 Hz for 30 s), below threshold for eliciting M-waves or H-reflexes with a single pulse, recruited motor units in 7/9 subjects. All 25 motor units recruited during stimulation were also recruited during weak (<10% MVC) voluntary contractions. Higher frequencies recruited more units (n = 3/25 at 10 Hz; n = 25/25 at 100 Hz) at shorter latencies (19.4 ± 9.4 s at 10 Hz; 4.1 ± 4.0 s at 100 Hz) than lower frequencies. When a second unit was recruited, the discharge of the already active unit did not change, suggesting that recruitment was not due to increased synaptic drive. After recruitment, mean discharge rate during stimulation at 20 Hz (7.8 Hz) was lower than during 30 Hz (8.6 Hz) and 40 Hz (8.4 Hz) stimulation. Discharge was largely asynchronous from the stimulus pulses with “time-locked” discharge occurring at an H-reflex latency with only a 24% probability. Motor units continued to discharge after cessation of the stimulation in 89% of trials, although at a lower rate (5.8 Hz) than during the stimulation (7.9 Hz). This work supports the idea that the afferent volley evoked by repetitive stimulation recruits motor units through the integration of synaptic drive and intrinsic properties of motoneurons, resulting in “physiological” recruitment which adheres to Henneman’s size principle and results in relatively low discharge rates and asynchronous firing. PMID:25566025

Asynchronous recruitment of low-threshold motor units during repetitive, low-current stimulation of the human tibial nerve.

PubMed

Dean, Jesse C; Clair-Auger, Joanna M; Lagerquist, Olle; Collins, David F

2014-01-01

Motoneurons receive a barrage of inputs from descending and reflex pathways. Much of our understanding about how these inputs are transformed into motor output in humans has come from recordings of single motor units during voluntary contractions. This approach, however, is limited because the input is ill-defined. Herein, we quantify the discharge of soleus motor units in response to well-defined trains of afferent input delivered at physiologically-relevant frequencies. Constant frequency stimulation of the tibial nerve (10-100 Hz for 30 s), below threshold for eliciting M-waves or H-reflexes with a single pulse, recruited motor units in 7/9 subjects. All 25 motor units recruited during stimulation were also recruited during weak (<10% MVC) voluntary contractions. Higher frequencies recruited more units (n = 3/25 at 10 Hz; n = 25/25 at 100 Hz) at shorter latencies (19.4 ± 9.4 s at 10 Hz; 4.1 ± 4.0 s at 100 Hz) than lower frequencies. When a second unit was recruited, the discharge of the already active unit did not change, suggesting that recruitment was not due to increased synaptic drive. After recruitment, mean discharge rate during stimulation at 20 Hz (7.8 Hz) was lower than during 30 Hz (8.6 Hz) and 40 Hz (8.4 Hz) stimulation. Discharge was largely asynchronous from the stimulus pulses with "time-locked" discharge occurring at an H-reflex latency with only a 24% probability. Motor units continued to discharge after cessation of the stimulation in 89% of trials, although at a lower rate (5.8 Hz) than during the stimulation (7.9 Hz). This work supports the idea that the afferent volley evoked by repetitive stimulation recruits motor units through the integration of synaptic drive and intrinsic properties of motoneurons, resulting in "physiological" recruitment which adheres to Henneman's size principle and results in relatively low discharge rates and asynchronous firing.

Neonatal Intensive Care Unit Census Influences Discharge of Moderately Preterm Infants

PubMed Central

Profit, Jochen; McCormick, Marie C.; Escobar, Gabriel J.; Richardson, Douglas K.; Zheng, Zheng; Coleman-Phox, Kim; Roberts, Rebecca; Zupancic, John A. F.

2011-01-01

Objective The timely discharge of moderately premature infants has important economic implications. The decision to discharge should occur independent of unit census. We evaluated the impact of unit census on the decision to discharge moderately preterm infants. Design/Methods In a prospective multicenter cohort study, we enrolled 850 infants born between 30 and 34 weeks' gestation at 10 NICUs in Massachusetts and California. We divided the daily census from each hospital into quintiles and tested whether discharges were evenly distributed among them. Using logistic regression, we analyzed predictors of discharge within census quintiles associated with a greater- or less-than-expected likelihood of discharge. We then explored parental satisfaction and postdischarge resource consumption in relation to discharge during census periods that were associated with high proportions of discharge. Results There was a significant correlation between unit census and likelihood of discharge. When unit census was in the lowest quintile, patients were 20% less likely to be discharged when compared with all of the other quintiles of unit census. In the lowest quintile of unit census, patient/nurse ratio was the only variable associated with discharge. When census was in the highest quintile, patients were 32% more likely to be discharged when compared with all of the other quintiles of unit census. For patients in this quintile, a higher patient/nurse ratio increased the likelihood of discharge. Conversely, infants with prolonged lengths of stay, an increasing Score for Neonatal Acute Physiology II, and minor congenital anomalies were less likely to be discharged. Infants discharged at high unit census did not differ from their peers in terms of parental satisfaction, emergency department visits, home nurse visits, or rehospitalization rates. Conclusions Discharges are closely correlated with unit census. Providers incorporate demand and case mix into their discharge decisions. PMID:17272621

Mortality in infants discharged from neonatal intensive care units in Georgia.

PubMed

Allen, D M; Buehler, J W; Samuels, B N; Brann, A W

Although neonatal intensive care units (NICUs) have contributed to advances in neonatal survival, little is known about the epidemiology of deaths that occur after NICU discharge. To determine mortality rates following NICU discharge, we used linked birth, death, and NICU records for infants born to Georgia residents from 1980 through 1982 and who were admitted to NICUs participating in the state's perinatal care network. Infants who died after discharge (n = 120) had a median duration of NICU hospitalization of 20 days (range, 1 to 148 days) and a median birth weight of 1983 g (range, 793 to 5159 g). The postdischarge mortality rate was 22.7 per 1000 NICU discharges. This rate is more than five times the overall postneonatal mortality rate for Georgia from 1980 to 1982. The most common causes of death were congenital heart disease (23%), sudden infant death syndrome (21%), and infection (13%). Demographic characteristics commonly associated with infant mortality were not strongly associated with the mortality following NICU discharge.

The n-by-T Target Discharge Strategy for Inpatient Units.

PubMed

Parikh, Pratik J; Ballester, Nicholas; Ramsey, Kylie; Kong, Nan; Pook, Nancy

2017-07-01

Ineffective inpatient discharge planning often causes discharge delays and upstream boarding. While an optimal discharge strategy that works across all units at a hospital is likely difficult to identify and implement, a strategy that provides a reasonable target to the discharge team appears feasible. We used observational and retrospective data from an inpatient trauma unit at a Level 2 trauma center in the Midwest US. Our proposed novel n-by-T strategy-discharge n patients by the Tth hour-was evaluated using a validated simulation model. Outcome measures included 2 measures: time-based (mean discharge completion and upstream boarding times) and capacity-based (increase in annual inpatient and upstream bed hours). Data from the pilot implementation of a 2-by-12 strategy at the unit was obtained and analyzed. The model suggested that the 1-by-T and 2-by-T strategies could advance the mean completion times by over 1.38 and 2.72 h, respectively (for 10 AM ≤ T ≤ noon, occupancy rate = 85%); the corresponding mean boarding time reductions were nearly 11% and 15%. These strategies could increase the availability of annual inpatient and upstream bed hours by at least 2,469 and 500, respectively. At 100% occupancy rate, the hospital-favored 2-by-12 strategy reduced the mean boarding time by 26.1%. A pilot implementation of the 2-by-12 strategy at the unit corroborated with the model findings: a 1.98-h advancement in completion times (P<0.0001) and a 14.5% reduction in boarding times (P = 0.027). Target discharge strategies, such as the n-by-T, can help substantially reduce discharge lateness and upstream boarding, especially during high unit occupancy. To sustain implementation, necessary commitment from the unit staff and physicians is vital, and may require some training.

Project RED Impacts Patient Experience.

PubMed

Cancino, Ramon S; Manasseh, Chris; Kwong, Lana; Mitchell, Suzanne E; Martin, Jessica; Jack, Brian W

2017-12-01

Hospitalized patients are frequently unprepared to care for themselves after discharge often leading to unplanned hospital readmission. One strategy to reduce readmission rates is improving the quality of patient education and preparation before hospital discharge. The ReEngineered Discharge (RED) is a standardized hospital-based program designed to provide patients and caregivers the information they need to continue care at home. We sought to study the impact of the RED intervention on posthospitalization adult patient experience scores in an urban academic safety-net hospital. We conducted a descriptive study of a pilot program that compared posthospitalization survey responses to the Press Ganey survey item "Instructions were given about how to care for yourself at home." We compared the survey results for 3 groups of adult patients: those receiving the RED program, those receiving a standard discharge on the same hospital unit, and those receiving a standard discharge on other hospital units. A greater percentage of adult patients who received the RED discharge program rated the quality of their discharge as "very good" as compared to those receiving a standard discharge on the same hospital unit and those receiving a standard discharge on other hospital units (61%, 35%, and 41%, respectively, P = .0001). Delivery of a standardized hospital discharge program resulted in a larger proportion of top-box "very good" responses on a Press Ganey posthospitalization survey. Future research should examine whether hospital-based transition programs can sustain improvement in patient experience measures and whether these improvements can be observed in other patient populations.

The Association of Unfavorable Outcomes with the Intensity of Neurosurgical Care in the United States

PubMed Central

2014-01-01

Object There is wide regional variability in the volume of procedures performed for similar surgical patients throughout the United States. We investigated the association of the intensity of neurosurgical care (defined as the average annual number of neurosurgical procedures per capita) with mortality, length of stay (LOS), and rate of unfavorable discharge for inpatients after neurosurgical procedures. Methods We performed a retrospective cohort study involving the 202,518 patients who underwent cranial neurosurgical procedures from 2005–2010 and were registered in the National Inpatient Sample (NIS) database. Regression techniques were used to investigate the association of the average intensity of neurosurgical care with the average mortality, LOS, and rate of unfavorable discharge. Results The inpatient neurosurgical mortality, rate of unfavorable discharge, and average LOS varied significantly among several states. In a multivariate analysis male gender, coverage by Medicaid, and minority racial status were associated with increased mortality, rate of unfavorable discharge, and LOS. The opposite was true for coverage by private insurance, higher income, fewer comorbidities and small hospital size. There was no correlation of the intensity of neurosurgical care with the mortality (Pearson's ρ = −0.18, P = 0.29), rate of unfavorable discharge (Pearson's ρ = 0.08, P = 0.62), and LOS of cranial neurosurgical procedures (Pearson's ρ = −0.21, P = 0.22). Conclusions We observed significant disparities in mortality, LOS, and rate of unfavorable discharge for cranial neurosurgical procedures in the United States. Increased intensity of neurosurgical care was not associated with improved outcomes. PMID:24647225

Changes in force, surface and motor unit EMG during post-exercise development of low frequency fatigue in vastus lateralis muscle.

PubMed

de Ruiter, C J; Elzinga, M J H; Verdijk, P W L; van Mechelen, W; de Haan, A

2005-08-01

We investigated the effects of low frequency fatigue (LFF) on post-exercise changes in rectified surface EMG (rsEMG) and single motor unit EMG (smuEMG) in vastus lateralis muscle (n = 9). On two experimental days the knee extensors were fatigued with a 60-s-isometric contraction (exercise) at 50% maximal force capacity (MFC). On the first day post-exercise (15 s, 3, 9, 15, 21 and 27 min) rsEMG and electrically-induced (surface stimulation) forces were investigated. SmuEMG was obtained on day two. During short ramp and hold (5 s) contractions at 50% MFC, motor unit discharges of the same units were followed over time. Post-exercise MFC and tetanic force (100 Hz stimulation) recovered to about 90% of the pre-exercise values, but recovery with 20 Hz stimulation was less complete: the 20-100 Hz force ratio (mean +/- SD) decreased from 0.65+/-0.06 (pre-exercise) to 0.56+/-0.04 at 27 min post-exercise (P<0.05), indicative of LFF. At 50% MFC, pre-exercise rsEMG (% pre-exercise maximum) and motor unit discharge rate were 51.1 +/- 12.7% and 14.1 +/- 3.7 (pulses per second; pps) respectively, 15 s post-exercise the respective values were 61.4 +/- 15.4% (P<0.05) and 13.2 +/- 5.6 pps (P>0.05). Thereafter, rsEMG (at 50% MFC) remained stable but motor unit discharge rate significantly increased to 17.7 +/- 3.9 pps 27 min post-exercise. The recruitment threshold decreased (P<0.05) from 27.7 +/- 6.6% MFC before exercise to 25.2 +/- 6.7% 27 min post-exercise. The increase in discharge rate was significantly greater than could be expected from the decrease in recruitment threshold. Thus, post-exercise LFF was compensated by increased motor unit discharge rates which could only partly be accounted for by the small decrease in motor unit recruitment threshold.

Contribution of intrinsic properties and synaptic inputs to motoneuron discharge patterns: a simulation study

PubMed Central

ElBasiouny, Sherif M.; Rymer, W. Zev; Heckman, C. J.

2012-01-01

Motoneuron discharge patterns reflect the interaction of synaptic inputs with intrinsic conductances. Recent work has focused on the contribution of conductances mediating persistent inward currents (PICs), which amplify and prolong the effects of synaptic inputs on motoneuron discharge. Certain features of human motor unit discharge are thought to reflect a relatively stereotyped activation of PICs by excitatory synaptic inputs; these features include rate saturation and de-recruitment at a lower level of net excitation than that required for recruitment. However, PIC activation is also influenced by the pattern and spatial distribution of inhibitory inputs that are activated concurrently with excitatory inputs. To estimate the potential contributions of PIC activation and synaptic input patterns to motor unit discharge patterns, we examined the responses of a set of cable motoneuron models to different patterns of excitatory and inhibitory inputs. The models were first tuned to approximate the current- and voltage-clamp responses of low- and medium-threshold spinal motoneurons studied in decerebrate cats and then driven with different patterns of excitatory and inhibitory inputs. The responses of the models to excitatory inputs reproduced a number of features of human motor unit discharge. However, the pattern of rate modulation was strongly influenced by the temporal and spatial pattern of concurrent inhibitory inputs. Thus, even though PIC activation is likely to exert a strong influence on firing rate modulation, PIC activation in combination with different patterns of excitatory and inhibitory synaptic inputs can produce a wide variety of motor unit discharge patterns. PMID:22031773

Physiological identification of morphologically distinct afferent classes innervating the cristae ampullares of the squirrel monkey

NASA Technical Reports Server (NTRS)

Lysakowski, A.; Minor, L. B.; Fernandez, C.; Goldberg, J. M.

1995-01-01

1. Semicircular-canal afferents in the squirrel monkey were characterized by their resting discharge, discharge regularity, sensitivity to galvanic currents delivered to the ear (beta *), the gain (g2Hz), and phase lead (phi 2Hz) of their response to 2-Hz sinusoidal head rotations, and their antidromic conduction velocity. Discharge regularity was measured by a normalized coefficient of variation (CV*); the higher the CV*, the more irregular the discharge. g2Hz and phi 2Hz were expressed relative to angular head velocity. 2. These physiological measures were used in an attempt to discern the discharge properties of the three morphological classes of afferents innervating the crista. Presumed bouton (B) fibers were identified as slowly conducting afferents. Presumed calyx (C) fibers were recognized by their irregular discharge and low rotational gains. The remaining fibers were considered to be dimorphic (D) units. Single letters (B, C, and D) are used to emphasize that the classification is based on circumstantial evidence and may be wrong for individual fibers. Of the 125 identified fibers, 13 (10%) were B units, 36 (29%) were C units, and 76 (61%) were D units. 3. B units were regularly discharging D units ranged from regularly to irregularly discharging. C units were the most irregularly discharging afferents encountered. The mean resting discharge for the entire sample was 74 spikes/s. Resting rates were similar for regularly discharging B and D units and higher than those for irregularly discharging C and D units. 4. Except for their lower conduction velocities, the discharge properties of B units are indistinguishable from those of regularly discharging D units. Many of the discharge properties of B and D units vary with discharge regularity. There is a strong, positive relation when beta *, g2Hz, or phi 2Hz is plotted against CV*. For beta * or phi 2Hz, C units conform to the relation for B and D units. In contrast, values of g2Hz for C units are three to four times lower than predicted from the relation for the other two classes. 5. Internal (axon) diameters (dp) of peripheral vestibular-nerve fibers were estimated from central antidromic conduction velocities. Thick fibers (dp > or = 49 microns) were irregularly discharging, mostly C units. Medium-sized fibers (dp = 1.5-4 microns) included regular, intermediate, and irregular D units, as well as C units. Thin fibers (dp < or = 1.5 microns) were defined as B units.(ABSTRACT TRUNCATED AT 400 WORDS).

Dependence of the paired motor unit analysis on motor unit discharge characteristics in the human tibialis anterior muscle

PubMed Central

Stephenson, Jennifer L.; Maluf, Katrina S.

2011-01-01

The paired motor unit analysis provides in vivo estimates of the magnitude of persistent inward currents (PIC) in human motoneurons by quantifying changes in the firing rate (ΔF) of an earlier recruited (reference) motor unit at the time of recruitment and derecruitment of a later recruited (test) motor unit. This study assessed the variability of ΔF estimates, and quantified the dependence of ΔF on the discharge characteristics of the motor units selected for analysis. ΔF was calculated for 158 pairs of motor units recorded from nine healthy individuals during repeated submaximal contractions of the tibialis anterior muscle. The mean (SD) ΔF was 3.7 (2.5) pps (range −4.2 to 8.9 pps). The median absolute difference in ΔF for the same motor unit pair across trials was 1.8 pps, and the minimal detectable change in ΔF required to exceed measurement error was 4.8 pps. ΔF was positively related to the amount of discharge rate modulation in the reference motor unit (r2=0.335; P<0.001), and inversely related to the rate of increase in discharge rate (r2=0.125; P<0.001). A quadratic function provided the best fit for relations between ΔF and the time between recruitment of the reference and test motor units (r2=0.229, P<0.001), the duration of test motor unit activity (r2=0.110, P<0.001), and the recruitment threshold of the test motor unit (r2=0.237, P<0.001). Physiological and methodological contributions to the variability in ΔF estimates of PIC magnitude are discussed, and selection criteria to reduce these sources of variability are suggested for the paired motor unit analysis. PMID:21459110

Mapping Evapotranspiration Units in the Basin and Range Carbonate-Rock Aquifer System, White Pine County, Nevada, and Adjacent Areas in Nevada and Utah

USGS Publications Warehouse

Smith, J. LaRue; Laczniak, Randell J.; Moreo, Michael T.; Welborn, Toby L.

2007-01-01

Accurate estimates of ground-water discharge are crucial in the development of a water budget for the Basin and Range carbonate-rock aquifer system study area. One common method used throughout the southwestern United States is to estimate ground-water discharge from evapotranspiration (ET). ET is a process by which water from the Earth's surface is transferred to the atmosphere. The volume of water lost to the atmosphere by ET can be computed as the product of the ET rate and the acreage of vegetation, open water, and moist soil through which ET occurs. The procedure used in the study groups areas of similar vegetation, water, and soil conditions into different ET units, assigns an average annual ET rate to each unit, and computes annual ET from each ET unit within the outer extent of potential areas of ground-water discharge. Data sets and the procedures used to delineate the ET-unit map used to estimate ground-water discharge from the study area and a qualitative assessment of the accuracy of the map are described in this report.

Oscillations in motor unit discharge are reflected in the low-frequency component of rectified surface EMG and the rate of change in force.

PubMed

Yoshitake, Yasuhide; Shinohara, Minoru

2013-11-01

Common drive to a motor unit (MU) pool manifests as low-frequency oscillations in MU discharge rate, producing fluctuations in muscle force. The aim of the study was to examine the temporal correlation between instantaneous MU discharge rate and rectified EMG in low frequencies. Additionally, we attempted to examine whether there is a temporal correlation between the low-frequency oscillations in MU discharge rate and the first derivative of force (dF/dt). Healthy young subjects produced steady submaximal force with their right finger as a single task or while maintaining a pinch-grip force with the left hand as a dual task. Surface EMG and fine-wire MU potentials were recorded from the first dorsal interosseous muscle in the right hand. Surface EMG was band-pass filtered (5-1,000 Hz) and full-wave rectified. Rectified surface EMG and the instantaneous discharge rate of MUs were smoothed by a Hann-window of 400 ms duration (equivalent to 2 Hz low-pass filtering). In each of the identified MUs, the smoothed MU discharge rate was positively correlated with the rectified-and-smoothed EMG as confirmed by the distinct peak in cross-correlation function with greater values in the dual task compared with the single task. Additionally, the smoothed MU discharge rate was temporally correlated with dF/dt more than with force and with rectified-and-smoothed EMG. The results indicated that the low-frequency component of rectified surface EMG and the first derivative of force provide temporal information on the low-frequency oscillations in the MU discharge rate.

Recovery and concordance in a secure forensic psychiatry hospital - the self rated DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales.

PubMed

Davoren, Mary; Hennessy, Sarah; Conway, Catherine; Marrinan, Seamus; Gill, Pauline; Kennedy, Harry G

2015-03-28

Detention in a secure forensic psychiatric hospital may inhibit engagement and recovery. Having validated the clinician rated DUNDRUM-3 (programme completion) and DUNDRUM-4 (recovery) in a forensic hospital, we set out to draft and validate scales measuring the same programme completion and recovery items that patients could use to self-rate. Based on previous work, we hypothesised that self-rating scores might be predictors of objective progress including conditional discharge. We hypothesised also that the difference between patients' and clinicians' ratings of progress in treatment and other factors relevant to readiness for discharge (concordance) would diminish as patients neared discharge. We hypothesised also that this difference in matched scores would predict objective progress including conditional discharge. In a prospective naturalistic observational cohort study in a forensic hospital, we examined whether scores on the self-rated DUNDRUM-3 programme completion and DUNDRUM-4 recovery scales or differences between clinician and patient ratings on the same scales (concordance) would predict moves between levels of therapeutic security and conditional discharge over the next twelve months. Both scales stratified along the recovery pathway of the hospital, but clinician ratings matched the level of therapeutic security more accurately than self ratings. The clinician rated scales predicted moves to less secure units and to more secure units and predicted conditional discharge but the self-rated scores did not. The difference between clinician and self-rated scores (concordance) predicted positive and negative moves and conditional discharge, but this was not always an independent predictor as shown by regression analysis. In regression analysis the DUNDRUM-3 predicted moves to less secure places though the HCR-20 C & R score dominated the model. Moves back to more secure places were predicted by lack of concordance on the DUNDRUM-4. Conditional discharge was predicted predominantly by the DUNDRUM-3. Patients accurately self-rate relative to other patients however their absolute ratings were consistently lower (better) than clinicians' ratings and were less accurate predictors of outcomes including conditional discharge. Quantifying concordance is a useful part of the recovery process and predicts outcomes but self-ratings are not accurate predictors.

Motor unit potential induced repetitive discharges (MIRDs): description of an unusual iterative discharge.

PubMed

So, Noel F; Rubin, Devon I; Jones, Lyell K; Litchy, William J; Sorenson, Eric J

2013-12-01

Repetitive discharges may be recorded during nerve conduction studies (NCS) or during needle electromyography in a muscle at rest. Repetitive discharges that occur during voluntary activation and are time-locked to voluntary motor unit potentials (MUP) have not been described. Retrospective review of motor unit potential induced repetitive discharges (MIRDs) identified in the EMG laboratory. Characteristics of each MIRD, patient demographics, other EMG findings in the same muscle, and electrophysiological diagnosis were analyzed. MIRDs were observed in 15 patients. The morphology and number of spikes and duration of MIRDs varied. The discharges fired at rates of 50-200 Hz. All but 2 patients had EMG findings of a chronic neurogenic disorder. MIRDs are rare iterative discharges time-locked to a voluntary MUP. The pathophysiology of MIRDs is unclear, but their presence may indicate a chronic neurogenic process. Copyright © 2013 Wiley Periodicals, Inc.

Annual ground-water discharge by evapotranspiration from areas of spring-fed riparian vegetation along the eastern margin of Death Valley, 2000-02

USGS Publications Warehouse

Laczniak, Randell J.; Smith, J. LaRue; DeMeo, Guy A.

2006-01-01

Flow from major springs and seeps along the eastern margin of Death Valley serves as the primary local water supply and sustains much of the unique habitat in Death Valley National Park. Together, these major spring complexes constitute the terminus of the Death Valley Regional Ground-Water Flow System--one of the larger flow systems in the Southwestern United States. The Grapevine Springs complex is the least exploited for water supply and consequently contains the largest area of undisturbed riparian habitat in the park. Because few estimates exist that quantify ground-water discharge from these spring complexes, a study was initiated to better estimate the amount of ground water being discharged annually from these sensitive, spring-fed riparian areas. Results of this study can be used to establish a basis for estimating water rights and as a baseline from which to assess any future changes in ground-water discharge in the park. Evapotranspiration (ET) is estimated volumetrically as the product of ET-unit (general vegetation type) acreage and a representative ET rate. ET-unit acreage is determined from high-resolution multi-spectral imagery; and a representative ET rate is computed from data collected in the Grapevine Springs area using the Bowen-ratio solution to the energy budget, or from rates given in other ET studies in the Death Valley area. The ground-water component of ET is computed by removing the local precipitation component from the ET rate. Two different procedures, a modified soil-adjusted vegetation index using the percent reflectance of the red and near-infrared wavelengths and land-cover classification using multi-spectral imagery were used to delineate the ET units within each major spring-discharge area. On the basis of the more accurate procedure that uses the vegetation index, ET-unit acreage for the Grapevine Springs discharge area totaled about 192 acres--of which 80 acres were moderate-density vegetation and 112 acres were high-density vegetation. ET-unit acreage for two other discharge areas delineated in the Grapevine Springs area (Surprise Springs and Staininger Spring) totaled about 6 and 43 acres, respectively; and for the discharge areas delineated in the Furnace Creek area (Nevares Springs, Cow Creek-Salt Springs, Texas Spring, and Travertine Springs) totaled about 29, 13, 11, and 21 acres, respectively. In discharge areas other than Grapevine Springs, watering and spring diversions have altered the natural distribution of the vegetation. More...

Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital.

PubMed

Pages, K P; Russo, J E; Wingerson, D K; Ries, R K; Roy-Byrne, P P; Cowley, D S

1998-09-01

The study examined predictors of discharge against medical advice (AMA) and outcomes of psychiatric patients with AMA discharges, as measured by poorer symptom ratings at discharge and higher rates of rehospitalization. A total of 195 patients discharged AMA from general hospital psychiatric units were compared retrospectively with 2,230 regularly discharged patients. AMA status was defined as signing out against medical advice, being absent without leave, or being administratively discharged. All patients received standardized assessments within 24 hours of admission and at discharge. Demographic characteristics, psychiatric history, DSA-IV psychiatric and substance use diagnoses, and scores on an expanded 32-item version of the Psychiatric Symptom Assessment Scale were compared. The groups did not differ in primary psychiatric diagnoses. Patients discharged AMA were significantly less likely to be Caucasian or to be functionally impaired due to physical illness. They were more likely to live alone, have a substance use diagnosis, use more psychoactive substances, and have more previous hospitalizations. Patients discharged AMA had significantly shorter lengths of stay, higher rehospitalization rates, and more severe symptoms at discharge, even when length of stay was taken into account. The differences between the groups in male gender and young age were better accounted for by a greater likelihood of substance abuse in these groups. The results suggest a profile of patients who may be discharged AMA. Such patients have worse outcomes and are more likely to be high utilizers of inpatient resources. Aggressive identification of patients likely to be discharged AMA and early discharge planning for appropriate outpatient treatment are recommended.

Motor unit activity when young and old adults perform steady contractions while supporting an inertial load

PubMed Central

Gould, Jeffrey R.; Enoka, Roger M.

2013-01-01

The purpose of the study was to compare the discharge characteristics of biceps brachii motor units of young and old adults when they performed steady, submaximal contractions while the arm supported different inertial loads. Young (28 ± 4 yr; n = 16) and old (75 ± 4 yr; n = 14) adults performed steady contractions with the elbow flexors at target forces set at either small (11.7 ± 4.4% maximum) or large (17.8 ± 6.5% maximum) differences below the recruitment threshold force of the motor unit (n = 40). The task was to maintain an elbow angle at 1.57 rad until the motor unit was recruited and discharged action potentials for ∼120 s. Time to recruitment was longer for the larger target force difference (187 ± 227 s vs. 23 ± 46 s, P < 0.001). Once recruited, motor units discharged action potentials either repetitively or intermittently, with a greater proportion of motor units exhibiting the repetitive pattern for old adults. Discharge rate at recruitment and during the steady contraction was similar for the two target force differences for old adults but was greater for the small target force difference for young adults. Discharge variability was similar at recruitment for the two age groups but less for the old adults during the steady contraction. The greatest difference between the present results and those reported previously when the arm pulled against a rigid restraint was that old adults modulated discharge rate less than young adults across the two contraction intensities for both load types. PMID:23221403

Changes in motor unit recruitment strategy during pain alters force direction.

PubMed

Tucker, Kylie J; Hodges, Paul W

2010-10-01

Motor unit (MU) recruitment is altered (decreased discharge rate and cessation of discharge in some units, and recruitment of new units) in force-matched contractions during pain compared to contractions performed before pain. As MU's within a motoneurone pool have different force direction properties we hypothesised that altered MU recruitment during experimental knee pain would change the force vector (total force (F(T)): amplitude and angle) generated by the quadriceps. Force was produced at two levels during 1 × 60-s and 3 × 10-s isometric contractions of knee extensors, and recorded by two force transducers at right angles. This enabled calculation of both F(E) (extension force) and F(T). MU recruitment was recorded from the medial and lateral vastii with four fine-wire electrodes. Pain was induced by hypertonic saline injection in the infra-patella fat pad. Nine subjects matched F(E) and six subjects also matched both medial and lateral forces (F(T)) before and during pain. Changes in MU discharge pattern (decreased discharge rate (P<0.001), complete cessation of firing, and recruitment of new units) during pain were associated with a ∼5° change in absolute force angle. As force angle changed in both directions (left/right) for individual subjects with pain there was no change in average F(T) amplitude between conditions. When both medial and lateral forces were matched MU discharge rate decreased (P<0.001) with pain, but, fewer units ceased firing or were newly recruited during pain. Change in motoneurone recruitment during pain alters direction of muscle force. This may be a strategy to avoid pain or protect the painful part. Copyright © 2010 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data.

PubMed

Hallowell, Sunny G; Rogowski, Jeannette A; Spatz, Diane L; Hanlon, Alexandra L; Kenny, Michael; Lake, Eileen T

2016-01-01

Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. Cross sectional analysis combining nurse survey data with infant discharge data. A national sample of neonatal intensive care units (N=97), nurses (N=5614) and very low birth weight infants (N=6997). Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on "any human milk") and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p<0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor's degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p<0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p=.056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p<0.001). Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge. Copyright © 2015 Elsevier Ltd. All rights reserved.

Factors associated with infant feeding of human milk at discharge from neonatal intensive care: Cross-sectional analysis of nurse survey and infant outcomes data

PubMed Central

Hallowell, Sunny G.; Rogowski, Jeannette A.; Spatz, Diane L.; Hanlon, Alexandra L.; Kenny, Michael; Lake, Eileen T.

2016-01-01

Context Nurses are principal caregivers in the neonatal intensive care unit and support mothers to establish and sustain a supply of human milk for their infants. Whether an infant receives essential nutrition and immunological protection provided in human milk at discharge is an issue of health care quality in this setting. Objectives To examine the association of the neonatal intensive care unit work environment, staffing levels, level of nurse education, lactation consultant availability, and nurse-reported breastfeeding support with very low birth weight infant receipt of human milk at discharge. Design and setting Cross sectional analysis combining nurse survey data with infant discharge data. Participants A national sample of neonatal intensive care units (N = 97), nurses (N = 5614) and very low birth weight infants (N = 6997). Methods Sequential multivariate linear regression models were estimated at the unit level between the dependent variable (rate of very low birth weight infants discharged on “any human milk”) and the independent variables (nurse work environment, nurse staffing, nursing staff education and experience, lactation consultant availability, and nurse-reported breastfeeding support). Results The majority of very low birth weight infants (52%) were discharged on formula only. Fewer infants (42%) received human milk mixed with fortifier or formula. Only 6% of infants were discharged on exclusive human milk. A 1 SD increase (0.25) in the Practice Environment Scale of the Nursing Work Index composite score was associated with a four percentage point increase in the fraction of infants discharged on human milk (p < 0.05). A 1 SD increase (0.15) in the fraction of nurses with a bachelor’s degree in nursing was associated with a three percentage point increase in the fraction infants discharged on human milk (p < 0.05). The acuity-adjusted staffing ratio was marginally associated with the rate of human milk at discharge (p = .056). A 1 SD increase (7%) in the fraction of infants who received breastfeeding support was associated with an eight percentage point increase in the fraction of infants discharged on human milk (p < 0.001). Conclusions Neonatal intensive care units with better work environments, better educated nurses, and more infants who receive breastfeeding support by nurses have higher rates of very low birth weight infants discharged home on human milk. Investments by nurse administrators to improve work environments and support educational preparation of nursing staff may ensure that the most vulnerable infants have the best nutrition at the point of discharge. PMID:26518107

A Multidisciplinary Initiative to Increase Inpatient Discharges Before Noon.

PubMed

Kane, Marlena; Weinacker, Ann; Arthofer, Rudolph; Seay-Morrison, Timothy; Elfman, Wesley; Ramirez, Mark; Ahuja, Neera; Pickham, David; Hereford, James; Welton, Mark

2016-12-01

The aim of this study is to evaluate the effect of 2 hospital-wide interventions on achieving a discharge-before-noon rate of 40%. A multidisciplinary team led by administrative and physician leadership developed a plan to diminish capacity constraints by minimizing late afternoon hospital discharges using 2 patient flow management techniques. The study was a preintervention/postintervention retrospective analysis observing all inpatients discharged across 19 inpatient units in a 484-bed, academic teaching hospital measuring calendar month discharge-before-noon percentage, patient satisfaction, and readmission rates. Patient satisfaction and readmission rates were used as baseline metrics. The discharge-before-noon percentage increased from 14% in the 11-month preintervention period to an average of 24% over the 11-month postintervention period, whereas patient satisfaction scores and readmission rates remained stable. Implementation of the 2 interventions successfully increased the percentage of discharges before noon yet did not achieve the goal of 40%. Patient satisfaction and readmission rates were not negatively impacted by the program.

Animated Simulation: Determining Cost Effective Nurse Staffing for an Acute Care Unit

DTIC Science & Technology

1997-06-19

Rate - Unscheduled Physician Visits Post- - Decubitus Ulcer Rate Discharge - Nosocomial Infection Rate (total) - Patient Knowledge of Disease...Condition - Nosocomial Urinary Tract Infection Rate and Care Requirements - Nosocomial Pneumonia Rate - Nosocomial Surgical Wound Infection Rate PROCESS...Nagaprasanna, 1988). A maternity unit at Bristol Hospital displayed dissatisfaction with their patient classification system. They found the patient

The short mean length of stay of post-emergency geriatric units is associated with the rate of early readmission in frail elderly.

PubMed

Traissac, Thalie; Videau, Marie-Neige; Bourdil, Marie-José; Bourdel-Marchasson, Isabelle; Salles, Nathalie

2011-06-01

Specific postemergency short-stay geriatric units may decrease length of hospital stay, functional decline, and early readmission rates. The aim of this study was to evaluate risk factors of early rehospitalization in a shortstay geriatric unit. This study was a prospective observational study comprising over one year patients aged over 75 years, admitted to the post-emergency short-stay geriatric unit (Hôpital Saint André, Bordeaux, France) and discharged home. Socio-demographic data, length of hospital stay, and a standardized geriatric assessment were collected for all patients. One month after home discharge, patients were followed-up by phone, and the hospital readmission rate was calculated. descriptive, unvaried and multivariate analyses were carried out. A total of 476 patients were included in this study (mean age 86.5±6 yrs; 154 men, 322 women). Mean length of stay in the post-emergency short-stay geriatric unit was 6.3±2.7 days, and a total of 68 (14.3%) patients were readmitted within one month after home discharge. The readmission rate was associated with a diagnosis of delirium (Odds Ratio (OR) 1.9; 95% CI 1.1-3.3; p=0.02), mean length of stay exceeding 6 days (OR 1.9, 95% CI 1.1-3.5; p=0.02), and decision of home discharge (OR 2.4; 95% CI 1.4-4.1; p=0.002). Short mean lengths of stay were not considered as a risk factor for readmissions within one month, even in frail, dependent, hospitalized elderly persons.

A four kHz repetition rate compact TEA CO2 laser

NASA Astrophysics Data System (ADS)

Zheng, Yijun; Tan, Rongqing

2013-09-01

A compact transversely excited atmospheric (TEA) CO2 laser with high repetition-rate was reported. The size of the laser is 380 mm×300 mm×200 mm, and the discharge volume is 12×103 mm3. The laser cavity has a length of 320mm and consists of a totally reflective concave mirror with a radius of curvature of 4 m (Cu metal substrate coated with Au) and a partially reflecting mirror. The ultraviolet preionization makes the discharge even and stable，the output energy can be as high as 28 mJ under the circumstance of free oscillation, and the width of the light pulse is 60ns．To acquire the high wind velocity, a turbocharger is used in the system of the fast-gas flow cycle. When the wind speed is 100m/s, the repetition rate of the transversely excited atmospheric CO2 laser is up to 2 kHz. On this basis, a dual modular structure with two sets of the gas discharge unit is adopted to obtain a higher pulse repetition frequency output. The dual discharge unit composed two sets of electrodes and two sets of turbo fan. Alternate trigger technology is used to make the two sets of discharge module work in turn with repetition frequency of 2 kHz, the discharge interval of two sets of the gas discharge unit can be adjusted continuously from 20 microseconds to 250 microseconds. Under the conditions of maintaining the other parameters constant, the repetition frequency of the laser pulse is up to 4 kHz. The total size of laser with dual modular structure is 380mm×520mm×200mm, and the discharge volume is 24×103 mm3 with the cavity length of 520mm.

Ground-water discharge determined from estimates of evapotranspiration, Death Valley regional flow system, Nevada and California

USGS Publications Warehouse

Laczniak, Randell J.; Smith, J. LaRue; Elliott, Peggy E.; DeMeo, Guy A.; Chatigny, Melissa A.; Roemer, Gaius J.

2001-01-01

The Death Valley regional flow system (DVRFS) is one of the larger ground-water flow systems in the southwestern United States and includes much of southern Nevada and the Death Valley region of eastern California. Centrally located within the ground-water flow system is the Nevada Test Site (NTS). The NTS, a large tract covering about 1,375 square miles, historically has been used for testing nuclear devices and currently is being studied as a potential repository for the long-term storage of high-level nuclear waste generated in the United States. The U.S. Department of Energy, as mandated by Federal and State regulators, is evaluating the risk associated with contaminants that have been or may be introduced into the subsurface as a consequence of any past or future activities at the NTS. Because subsurface contaminants can be transported away from the NTS by ground water, components of the ground-water budget are of great interest. One such component is regional ground-water discharge. Most of the ground water leaving the DVRFS is limited to local areas where geologic and hydrologic conditions force ground water upward toward the surface to discharge at springs and seeps. Available estimates of ground-water discharge are based primarily on early work done as part of regional reconnaissance studies. These early efforts covered large, geologically complex areas and often applied substantially different techniques to estimate ground-water discharge. This report describes the results of a study that provides more consistent, accurate, and scientifically defensible measures of regional ground-water losses from each of the major discharge areas of the DVRFS. Estimates of ground-water discharge presented in this report are based on a rigorous quantification of local evapotranspiration (ET). The study identifies areas of ongoing ground-water ET, delineates different ET areas based on similarities in vegetation and soil-moisture conditions, and determines an ET rate for each delineated area. Each area, referred to as an ET unit, generally consists of one or more assemblages of local phreatophytes or a unique moist soil environment. Ten ET units are identified throughout the DVRFS based on differences in spectral-reflectance characteristics. Spectral differences are determined from satellite imagery acquired June 21, 1989, and June 13, 1992. The units identified include areas of open playa, moist bare soils, sparse to dense vegetation, and open water. ET rates estimated for each ET unit range from a few tenths of a foot per year for open playa to nearly 9 feet per year for open water. Mean annual ET estimates are computed for each discharge area by summing estimates of annual ET from each ET unit within a discharge area. The estimate of annual ET from each ET unit is computed as the product of an ET unit's acreage and estimated ET rate. Estimates of mean annual ET range from 450 acre-feet in the Franklin Well area to 30,000 acre-feet in Sarcobatus Flat. Ground-water discharge is estimated as annual ET minus that part of ET attributed to local precipitation. Mean annual ground-water discharge estimates range from 350 acre-feet in the Franklin Well area to 18,000 acre-feet in Ash Meadows. Generally, these estimates are greater for the northern discharge areas (Sarcobatus Flat and Oasis Valley) and less for the southern discharge areas (Franklin Lake, Shoshone area, and Tecopa/ California Valley area) than those previously reported.

Influence of perched groundwater on base flow

USGS Publications Warehouse

Niswonger, Richard G.; Fogg, Graham E.

2008-01-01

Analysis with a three‐dimensional variably saturated groundwater flow model provides a basic understanding of the interplay between streams and perched groundwater. A simplified, layered model of heterogeneity was used to explore these relationships. Base flow contribution from perched groundwater was evaluated with regard to varying hydrogeologic conditions, including the size and location of the fine‐sediment unit and the hydraulic conductivity of the fine‐sediment unit and surrounding coarser sediment. Simulated base flow was sustained by perched groundwater with a maximum monthly discharge in excess of 15 L/s (0.6 feet3/s) over the length of the 2000‐m stream reach. Generally, the rate of perched‐groundwater discharge to the stream was proportional to the hydraulic conductivity of sediment surrounding the stream, whereas the duration of discharge was proportional to the hydraulic conductivity of the fine‐sediment unit. Other aspects of the perched aquifer affected base flow, such as the depth of stream penetration and the size of the fine‐sediment unit. Greater stream penetration decreased the maximum base flow contribution but increased the duration of contribution. Perched groundwater provided water for riparian vegetation at the demand rate but reduced the duration of perched‐groundwater discharge nearly 75%.

Motor control differs for increasing and releasing force

PubMed Central

Park, Seoung Hoon; Kwon, MinHyuk; Solis, Danielle; Lodha, Neha

2016-01-01

Control of the motor output depends on our ability to precisely increase and release force. However, the influence of aging on force increase and release remains unknown. The purpose of this study, therefore, was to determine whether force control differs while increasing and releasing force in young and older adults. Sixteen young adults (22.5 ± 4 yr, 8 females) and 16 older adults (75.7 ± 6.4 yr, 8 females) increased and released force at a constant rate (10% maximum voluntary contraction force/s) during an ankle dorsiflexion isometric task. We recorded the force output and multiple motor unit activity from the tibialis anterior (TA) muscle and quantified the following outcomes: 1) variability of force using the SD of force; 2) mean discharge rate and variability of discharge rate of multiple motor units; and 3) power spectrum of the multiple motor units from 0–4, 4–10, 10–35, and 35–60 Hz. Participants exhibited greater force variability while releasing force, independent of age (P < 0.001). Increased force variability during force release was associated with decreased modulation of multiple motor units from 35 to 60 Hz (R2 = 0.38). Modulation of multiple motor units from 35 to 60 Hz was further correlated to the change in mean discharge rate of multiple motor units (r = 0.66) and modulation from 0 to 4 Hz (r = −0.64). In conclusion, these findings suggest that force control is altered while releasing due to an altered modulation of the motor units. PMID:26961104

Motor unit behaviour and contractile changes during fatigue in the human first dorsal interosseus

PubMed Central

Carpentier, Alain; Duchateau, Jacques; Hainaut, Karl

2001-01-01

In 67 single motor units, the mechanical properties, the recruitment and derecruitment thresholds, and the discharge rates were recorded concurrently in the first dorsal interosseus (FDI) of human subjects during intermittent fatiguing contractions. The task consisted of isometric ramp-and-hold contractions performed at 50% of the maximal voluntary contraction (MVC). The purpose of this study was to examine the influence of fatigue on the behaviour of motor units with a wide range of activation thresholds. For low-threshold (< 25% MVC) motor units, the mean twitch force increased with fatigue and the recruitment threshold either did not change or increased. In contrast, the twitch force and the activation threshold decreased for the high-threshold (> 25% MVC) units. The observation that in low-threshold motor units a quick stretch of the muscle at the end of the test reset the unit force and recruitment threshold to the prefatigue value suggests a significant role for fatigue-related changes in muscle stiffness but not twitch potentiation or motor unit synchronization. Although the central drive intensified during the fatigue test, as indicated by an increase in surface electromyogram (EMG), the discharge rate of the motor units during the hold phase of each contraction decreased progressively over the course of the task for motor units that were recruited at the beginning of the test, especially the low-threshold units. In contrast, the discharge rates of newly activated units first increased and then decreased. Such divergent behaviour of low- and high-threshold motor units could not be individually controlled by the central drive to the motoneurone pool. Rather, the different behaviours must be the consequence of variable contributions from motoneurone adaptation and afferent feedback from the muscle during the fatiguing contraction. PMID:11483719

Spontaneous activity of single neurones in the hypothalamus of rabbits during sleep and waking

PubMed Central

Findlay, Alan L. R.; Hayward, James N.

1969-01-01

1. A method is described for recording from single cells in the hypothalamus of unanaesthetized freely moving rabbits. Behaviour, bodily movement, skin and brain temperatures and e.e.g. were monitored. 2. Patterns of unit firing during slow sleep, paradoxical sleep and waking were studied in several regions of the hypothalamus, thalamus and in the septum. 3. Of the 144 cells analysed from waking to slow sleep, fifty-six (39%) decreased mean firing rates, thirty (21%) increased spike discharges and fifty-eight (40%) showed no marked change. Dorsal hypothalamic and massa intermedia thalamic cells fired in brief high frequency clusters during slow sleep with a characteristic `bimodal' interspike interval histogram. Waking and paradoxical sleep abolished these cluster discharges with a concomitant change to an `asymmetric' histogram. 4. Of the thirty-two cells observed during the three states of waking, slow sleep and paradoxical sleep, a majority (twenty-five or 78%) showed their highest rates of spontaneous discharge during paradoxical sleep. Discharge rates of cells sometimes changed in the course of paradoxical sleep according to the presence or absence of phasic events such as myoclonic motor activity. Two hypothalmic cells were almost totally arrested during paradoxical sleep. 5. Analysis of unit firing rates during spontaneous rises in brain temperature during waking and paradoxical sleep revealed that a majority of the neurones (22/24) changed their discharge rates in relation to behaviour rather than to brain temperature. Two cells did appear to respond specifically to the central thermal stimulus. 6. Hypothalamic cells do not behave as a homogeneous population in relation to changes in the state of arousal of the rabbit. Spontaneous changes in cell discharge related to sleep-waking behaviour must be considered in any interpretation of hypothalamic unit activity as related to neuroendocrine or autonomic mechanisms. PMID:4304342

Suicide mortality among male veterans discharged from Veterans Health Administration acute psychiatric units from 2005 to 2010.

PubMed

Britton, Peter C; Bohnert, Kipling M; Ilgen, Mark A; Kane, Cathleen; Stephens, Brady; Pigeon, Wilfred R

2017-09-01

The purpose of this study was to calculate suicide rates and identify correlates of risk in the year following discharge from acute Veterans Health Administration psychiatric inpatient units among male veterans discharged from 2005 to 2010 (fiscal years). Suicide rates and standardized mortality ratios were calculated. Descriptive analyses were used to describe suicides and non-suicides and provide base rates for interpretation, and unadjusted and adjusted proportional hazard models were used to identify correlates of suicide. From 2005 to 2010, 929 male veterans died by suicide in the year after discharge and the suicide rate was 297/100,000 person-years (py). The suicide rate significantly increased from 234/100,000 py (95% CI = 193-282) in 2005 to 340/100,000 py (95% CI = 292-393) in 2008, after which it plateaued. Living in a rural setting, HR (95% CI) = 1.20 (1.05, 1.36), and being diagnosed with a mood disorder such as major depression, HR (95% CI) = 1.60 (1.36, 1.87), or other anxiety disorder, HR (95% CI) = 1.52 (1.24, 1.87), were associated with increased risk for suicide. Among male veterans, the suicide rate in the year after discharge from acute psychiatric hospitalization increased from 2005 to 2008, after which it plateaued. Prevention efforts should target psychiatrically hospitalized veterans who live in rural settings and/or are diagnosed with mood or other anxiety disorders.

Effect of ageing on the force development in tetanic contractions of motor units in rat medial gastrocnemius muscle.

PubMed

Łochyński, Dawid; Kaczmarek, Dominik; Krutki, Piotr; Celichowski, Jan

2010-09-01

The purpose of this study was to determine the effect of ageing on the rate of force generation of motor units, and the mechanical efficiency of contraction produced by a doublet discharge. The study was carried out on isolated motor units of rat medial gastrocnemius muscle of young (5-10 mo) and two groups of old (24-25 and 28-30 mo) Wistar rats. Motor units were classified into the fast fatigable (FF), fast resistant (FR) and slow (S) ones. The force output and rate of force development were determined for non-doublet unfused tetanic contractions evoked by a series of a constant-rate trains of pulses and corresponding doublet contractions starting with an initial brief interpulse interval of 5 ms, and for maximal tetanic contraction. In FF motor units the rate of force development and the force produced by the doublet discharge increased transiently at the age of 24-25 mo, while in S and FR motor units this increase was observed at the age of 28-30 mo. Age-related decrease in the rate of force development of skeletal muscle cannot be attributed to a decline in efficiency of force production by functioning motor units. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Human motor unit recordings: origins and insight into the integrated motor system.

PubMed

Duchateau, Jacques; Enoka, Roger M

2011-08-29

Soon after Edward Liddell [1895-1981] and Charles Sherrington [1857-1952] introduced the concept of a motor unit in 1925 and the necessary technology was developed, the recording of single motor unit activity became feasible in humans. It was quickly discovered by Edgar Adrian [1889-1977] and Detlev Bronk [1897-1975] that the force exerted by muscle during voluntary contractions was the result of the concurrent recruitment of motor units and modulation of the rate at which they discharged action potentials. Subsequent studies found that the relation between discharge frequency and motor unit force was characterized by a sigmoidal function. Based on observations on experimental animals, Elwood Henneman [1915-1996] proposed a "size principle" in 1957 and most studies in humans focussed on validating this concept during various types of muscle contractions. By the end of the 20th C, the experimental evidence indicated that the recruitment order of human motor units was determined primarily by motoneuron size and that the occasional changes in recruitment order were not an intended strategy of the central nervous system. Fundamental knowledge on the function of Sherrington's "common final pathway" was expanded with observations on motor unit rotation, minimal and maximal discharge rates, discharge variability, and self-sustained firing. Despite the great amount of work on characterizing motor unit activity during the first century of inquiry, however, many basic questions remain unanswered and these limit the extent to which findings on humans and experimental animals can be integrated and generalized to all movements. 2011 Elsevier B.V. All rights reserved.

Reducing length of stay in hospital for very low birthweight infants by involving mothers in a stepdown unit: an experience from Karachi (Pakistan).

PubMed

Bhutta, Zulfiqar A; Khan, Iqtidar; Salat, Suhail; Raza, Farukh; Ara, Husan

2004-11-13

Clinical care of infants with a very low birth weight (less than 1500 g) in developing countries can be labour intensive and is often associated with a prolonged stay in hospital. The Aga Khan University Medical Center in Karachi, Pakistan, established a neonatal intensive care unit in 1987. By 1993-4, very low birthweight infants remained in hospital for 18-21 days. A stepdown unit was established in September 1994, with mothers providing all basic nursing care for their infants before being discharged under supervision. We analysed neonatal outcomes for the time periods before and after the stepdown unit was created (1987-94 and 1995-2001). We compared these two time periods for survival after birth until discharge, morbidity patterns during hospitalisation, length of stay in hospital, and readmission rates to hospital in the four weeks after discharge. Of 509 consecutive, very low birthweight infants, 494 (97%) preterm and 140 (28%) weighing < 1000 g at birth), 391 (76%) survived to discharge from the hospital. The length of hospitalisation fell significantly from 1987-90, when it was 34 (SD 18) days, to 16 (SD 14) days in 1999-2001 (P < 0.001). Readmission rates to hospital did not rise, nor did adverse outcomes at 12 months of age. Our results indicate that it is possible to involve mothers in the active care of their very low birthweight infants before discharge. This may translate into earlier discharge from hospital to home settings without any increase in short term complications and readmissions.

Vastus Lateralis Motor Unit Firing Rate Is Higher in Women With Patellofemoral Pain.

PubMed

Gallina, Alessio; Hunt, Michael A; Hodges, Paul W; Garland, S Jayne

2018-05-01

To compare neural drive, determined from motor unit firing rate, in the vastus medialis and lateralis in women with and without patellofemoral pain. Cross-sectional study. University research laboratory. Women (N=56) 19 to 35 years of age, including 36 with patellofemoral pain and 20 controls. Not applicable. Participants sustained an isometric knee extension contraction at 10% of their maximal voluntary effort for 70 seconds. Motor units (N=414) were identified using high-density surface electromyography. Average firing rate was calculated between 5 and 35 seconds after recruitment for each motor unit. Initial firing rate was the inverse of the first 3 motor unit interspike intervals. In control participants, vastus medialis motor units discharged at higher rates than vastus lateralis motor units (P=.001). This was not observed in women with patellofemoral pain (P=.78) because of a higher discharge rate of vastus lateralis compared with control participants (P=.002). No between-group differences were observed for vastus medialis (P=.93). Similar results were obtained for the initial motor unit firing rate. These findings suggest that women with patellofemoral pain have a higher neural drive to vastus lateralis but not vastus medialis, which may be a contributor of the altered patellar kinematics observed in some studies. The different neural drive may be an adaptation to patellofemoral pain, possibly to compensate for decreased quadriceps force production, or a precursor of patellofemoral pain. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Vestibular afferent responses to linear accelerations in the alert squirrel monkey

NASA Technical Reports Server (NTRS)

Somps, Christopher J.; Schor, Robert H.; Tomko, David L.

1994-01-01

The spontaneous activity of 40 otolith afferents and 44 canal afferents was recorded in 4 alert, intact squirrel monkeys. Polarization vectors and response properties of otolith afferents were determined during static re-orientations relative to gravity and during Earth-horizontal, sinusoidal, linear oscillations. Canal afferents were tested for sensitivity to linear accelerations. For regular otolith afferents, a significant correlation between upright discharge rate and sensitivity to dynamic acceleration in the horizontal plane was observed. This correlation was not present in irregular units. The sensitivity of otolith afferents to both static tilts and dynamic linear acceleration was much greater in irregularly discharging units than in regularly discharging units. The spontaneous activity and static and dynamic response properties of regularly discharging otolith afferents were similar to those reported in barbiturate-anesthetized squirrel monkeys. Irregular afferents also had similar dynamic response properties when compared to anesthetized monkeys. However, this sample of irregular afferents in alert animals had higher resting discharge rates and greater sensitivity to static tilts. The majority of otolith polarization vectors were oriented near the horizontal in the plane of the utricular maculae; however, directions of maximum sensitivity were different during dynamic and static testing. Canal afferents were not sensitive to static tilts or linear oscillations of the head.

[Readmission to an Adolescent Psychiatry Inpatient Unit: Readmission Rates and Risk Factors].

PubMed

Mendes, Patricia; Fonseca, Maria; Aguiar, Inês; Pangaio, Nuno; Confraria, Luísa; Queirós, Otília; Saraiva, Joana; Monteiro, Pedro; Guerra, João

2017-11-29

Most mental disorders have a chronic evolution and therefore a certain amount of psychiatric readmissions are inevitable. Several studies indicate that over 25% of child and adolescent inpatients were readmitted within one year of discharge. Several risk factors for psychiatric readmissions have been reported in the literature, but the history of repeated readmissions is the most consistent risk factor. Our aim is to calculate the readmission rates at 30 days and 12 months after discharge and to identify associated risk factors. The authors consulted the clinical files of patients admitted to the Inpatient Unit between 2010 and 2013, in order to calculate the readmission rates at 30 days and at 12 months. The demographic and clinical characteristics of the readmitted patients were analyzed and compared with a second group of patients with no hospital readmissions, in order to investigate possible predictors of readmission. A total of 445 patients were admitted to our inpatient unit between 2010 and 2013. Six adolescents were readmitted in a 30 days period (1.3%) and 52 were readmitted in a 12 month period after discharge (11.5%). Duration of the hospitalization and the previous number of mental health admissions were significant predictors of future hospital readmissions (p = 0.04 and p = 0.014). The low readmission rates may reflect the positive clinical and sociofamilial support being provided after discharge. Rehospitalisation is considered a fundamental target for intervention concerning prevention and intervention in mental healthcare. Thus, knowledge regarding their minimisation is crucial.

An Evaluation of Selected Extraordinary Floods in the United States Reported by the U.S. Geological Survey and Implications for Future Advancement of Flood Science

USGS Publications Warehouse

Costa, John E.; Jarrett, Robert D.

2008-01-01

Thirty flood peak discharges determine the envelope curve of maximum floods documented in the United States by the U.S. Geological Survey. These floods occurred from 1927 to 1978 and are extraordinary not just in their magnitude, but in their hydraulic and geomorphic characteristics. The reliability of the computed discharge of these extraordinary floods was reviewed and evaluated using current (2007) best practices. Of the 30 flood peak discharges investigated, only 7 were measured at daily streamflow-gaging stations that existed when the flood occurred, and 23 were measured at miscellaneous (ungaged) sites. Methods used to measure these 30 extraordinary flood peak discharges consisted of 21 slope-area measurements, 2 direct current-meter measurements, 1 culvert measurement, 1 rating-curve extension, and 1 interpolation and rating-curve extension. The remaining four peak discharges were measured using combinations of culvert, slope-area, flow-over-road, and contracted-opening measurements. The method of peak discharge determination for one flood is unknown. Changes to peak discharge or rating are recommended for 20 of the 30 flood peak discharges that were evaluated. Nine floods retained published peak discharges, but their ratings were downgraded. For two floods, both peak discharge and rating were corrected and revised. Peak discharges for five floods that are subject to significant uncertainty due to complex field and hydraulic conditions, were re-rated as estimates. This study resulted in 5 of the 30 peak discharges having revised values greater than about 10 percent different from the original published values. Peak discharges were smaller for three floods (North Fork Hubbard Creek, Texas; El Rancho Arroyo, New Mexico; South Fork Wailua River, Hawaii), and two peak discharges were revised upward (Lahontan Reservoir tributary, Nevada; Bronco Creek, Arizona). Two peak discharges were indeterminate because they were concluded to have been debris flows with peak discharges that were estimated by an inappropriate method (slope-area) (Big Creek near Waynesville, North Carolina; Day Creek near Etiwanda, California). Original field notes and records could not be found for three of the floods, however, some data (copies of original materials, records of reviews) were available for two of these floods. A rating was assigned to each of seven peak discharges that had no rating. Errors identified in the reviews include misidentified flow processes, incorrect drainage areas for very small basins, incorrect latitude and longitude, improper field methods, arithmetic mistakes in hand calculations, omission of measured high flows when developing rating curves, and typographical errors. Common problems include use of two-section slope-area measurements, poor site selection, uncertainties in Manning's n-values, inadequate review, lost data files, and insufficient and inadequately described high-water marks. These floods also highlight the extreme difficulty in making indirect discharge measurements following extraordinary floods. Significantly, none of the indirect measurements are rated better than fair, which indicates the need to improve methodology to estimate peak discharge. Highly unsteady flow and resulting transient hydraulic phenomena, two-dimensional flow patterns, debris flows at streamflow-gaging stations, and the possibility of disconnected flow surfaces are examples of unresolved problems not well handled by current indirect discharge methodology. On the basis of a comprehensive review of 50,000 annual peak discharges and miscellaneous floods in California, problems with individual flood peak discharges would be expected to require a revision of discharge or rating curves at a rate no greater than about 0.10 percent of all floods. Many extraordinary floods create complex flow patterns and processes that cannot be adequately documented with quasi-steady, uniform one-dimensional analyses. These floods are most accura

Deciphering the contribution of intrinsic and synaptic currents to the effects of transient synaptic inputs on human motor unit discharge

PubMed Central

Powers, Randall K.; Türker, Kemal S.

2010-01-01

The amplitude and time course of synaptic potentials in human motoneurons can be estimated in tonically discharging motor units by measuring stimulus-evoked changes in the rate and probability of motor unit action potentials. However, in spite of the fact that some of these techniques have been used for over thirty years, there is still no consensus on the best way to estimate the characteristics of synaptic potentials or on the accuracy of these estimates. In this review, we compare different techniques for estimating synaptic potentials from human motor unit discharge and also discuss relevant animal models in which estimated synaptic potentials can be compared to those directly measured from intracellular recordings. We also review the experimental evidence on how synaptic noise and intrinsic motoneuron properties influence their responses to synaptic inputs. Finally, we consider to what extent recordings of single motor unit discharge in humans can be used to distinguish the contribution of changes in synaptic inputs versus changes in intrinsic motoneuron properties to altered motoneuron responses following CNS injury. PMID:20427230

Floods of August and September 1971 in Maryland and Delaware

USGS Publications Warehouse

Carpenter, D.H.

1974-01-01

Flood discharge data are presented for 75 gaging stations and for 6 miscellaneous sites. New peaks of record occurred at 32 of the gaging stations. The maximum unit peak discharge rate recorded was 2,400 cubic fee t per second per square mile.

Vastus lateralis single motor unit EMG at the same absolute torque production at different knee angles.

PubMed

Altenburg, T M; de Haan, A; Verdijk, P W L; van Mechelen, W; de Ruiter, C J

2009-07-01

Single motor unit electromyographic (EMG) activity of the knee extensors was investigated at different knee angles with subjects (n = 10) exerting the same absolute submaximal isometric torque at each angle. Measurements were made over a 20 degrees range around the optimum angle for torque production (AngleTmax) and, where feasible, over a wider range (50 degrees ). Forty-six vastus lateralis (VL) motor units were recorded at 20.7 +/- 17.9 %maximum voluntary contraction (%MVC) together with the rectified surface EMG (rsEMG) of the superficial VL muscle. Due to the lower maximal torque capacity at positions more flexed and extended than AngleTmax, single motor unit recruitment thresholds were expected to decrease and discharge rates were expected to increase at angles above and below AngleTmax. Unexpectedly, the recruitment threshold was higher (P < 0.05) at knee angles 10 degrees more extended (43.7 +/- 22.2 N.m) and not different (P > 0.05) at knee angles 10 degrees more flexed (35.2 +/- 17.9 N.m) compared with recruitment threshold at AngleTmax (41.8 +/- 21.4 N.m). Also, unexpectedly the discharge rates were similar (P > 0.05) at the three angles: 11.6 +/- 2.2, 11.6 +/- 2.1, and 12.3 +/- 2.1 Hz. Similar angle independent discharge rates were also found for 12 units (n = 5; 7.4 +/- 5.4 %MVC) studied over the wider (50 degrees ) range, while recruitment threshold only decreased at more flexed angles. In conclusion, the similar recruitment threshold and discharge behavior of VL motor units during submaximal isometric torque production suggests that net motor unit activation did not change very much along the ascending limb of the knee-angle torque relationship. Several factors such as length-dependent twitch potentiation, which may contribute to this unexpected aspect of motor control, are discussed.

Recruitment and derecruitment characteristics of motor units in a hand muscle of young and old adults.

PubMed

Jesunathadas, Mark; Marmon, Adam R; Gibb, James M; Enoka, Roger M

2010-06-01

The significant decline in motor neuron number after approximately 60 yr of age is accompanied by a remodeling of the neuromuscular system so that average motor unit force increases and the ability of old adults to produce an intended force declines. One possible explanation for the loss of movement precision is that the remodeling increases the difference in recruitment forces between successively recruited motor units in old adults and this augments force variability at motor unit recruitment. The purpose of the study was to compare the forces and discharge characteristics of motor units in a hand muscle of young and old adults at motor unit recruitment and derecruitment. The difference in recruitment force between pairs of motor units did not differ between young (n=54) and old adults (n=56; P=0.702). However, old adults had a greater proportion of contractions in which motor units discharged action potentials transiently before discharging continuously during the ramp increase in force (young: 0.32; old: 0.41; P=0.045). Force variability at motor unit recruitment was greater for old adults compared with young adults (Por=0.729). These results suggest that the difference in force between the recruitment of successive motor units does not differ between age groups, but that motor unit recruitment may be more transient and could contribute to the greater variability in force observed in old adults during graded ramp contractions.

FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture.

PubMed

Wang, Ching-Yi; Graham, James E; Karmarkar, Amol M; Reistetter, Timothy A; Protas, Elizabeth J; Ottenbacher, Kenneth J

2014-06-01

To assess the utility of functional status in classifying patients by discharge setting after inpatient rehabilitation for hip fracture. Retrospective cohort study. A total of 1257 inpatient rehabilitation facilities in the United States. Medicare beneficiaries (N = 117,168) receiving inpatient rehabilitation for hip fracture from 2007 to 2009. Receiver operating characteristic curve analyses to assess the overall discriminatory ability of functional status scores (Functional Independence Measure [FIM] total, FIM cognition, and FIM motor) and to identify the functioning threshold that best differentiates patients by discharge setting. Discharge setting (community versus institutional). Approximately 68% of patients were discharged to the community after inpatient rehabilitation for hip fracture. Receiver operating characteristic curve analyses indicate that discharge FIM motor ratings (area under the curve: 0.84) alone are as effective as a multivariable model (area under the curve: 0.85), including sociodemographic and clinical factors, in discriminating patients discharged to the community from those discharged to an institution. A discharge FIM motor rating of 58 yielded the best balance in sensitivity and specificity for classifying patients by discharge setting. Discharge FIM motor ratings demonstrated good discriminatory ability for classifying discharge setting. An FIM motor rating of 58 may serve as a clinical tool to guide treatment plans and/or as additional information in complex discharge planning decisions for patients with hip fracture. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Discharge regularity in the turtle posterior crista: comparisons between experiment and theory.

PubMed

Goldberg, Jay M; Holt, Joseph C

2013-12-01

Intra-axonal recordings were made from bouton fibers near their termination in the turtle posterior crista. Spike discharge, miniature excitatory postsynaptic potentials (mEPSPs), and afterhyperpolarizations (AHPs) were monitored during resting activity in both regularly and irregularly discharging units. Quantal size (qsize) and quantal rate (qrate) were estimated by shot-noise theory. Theoretically, the ratio, σV/(dμV/dt), between synaptic noise (σV) and the slope of the mean voltage trajectory (dμV/dt) near threshold crossing should determine discharge regularity. AHPs are deeper and more prolonged in regular units; as a result, dμV/dt is larger, the more regular the discharge. The qsize is larger and qrate smaller in irregular units; these oppositely directed trends lead to little variation in σV with discharge regularity. Of the two variables, dμV/dt is much more influential than the nearly constant σV in determining regularity. Sinusoidal canal-duct indentations at 0.3 Hz led to modulations in spike discharge and synaptic voltage. Gain, the ratio between the amplitudes of the two modulations, and phase leads re indentation of both modulations are larger in irregular units. Gain variations parallel the sensitivity of the postsynaptic spike encoder, the set of conductances that converts synaptic input into spike discharge. Phase variations reflect both synaptic inputs to the encoder and postsynaptic processes. Experimental data were interpreted using a stochastic integrate-and-fire model. Advantages of an irregular discharge include an enhanced encoder gain and the prevention of nonlinear phase locking. Regular and irregular units are more efficient, respectively, in the encoding of low- and high-frequency head rotations, respectively.

Discharge regularity in the turtle posterior crista: comparisons between experiment and theory

PubMed Central

Holt, Joseph C.

2013-01-01

Intra-axonal recordings were made from bouton fibers near their termination in the turtle posterior crista. Spike discharge, miniature excitatory postsynaptic potentials (mEPSPs), and afterhyperpolarizations (AHPs) were monitored during resting activity in both regularly and irregularly discharging units. Quantal size (qsize) and quantal rate (qrate) were estimated by shot-noise theory. Theoretically, the ratio, σV/(dμV/dt), between synaptic noise (σV) and the slope of the mean voltage trajectory (dμV/dt) near threshold crossing should determine discharge regularity. AHPs are deeper and more prolonged in regular units; as a result, dμV/dt is larger, the more regular the discharge. The qsize is larger and qrate smaller in irregular units; these oppositely directed trends lead to little variation in σV with discharge regularity. Of the two variables, dμV/dt is much more influential than the nearly constant σV in determining regularity. Sinusoidal canal-duct indentations at 0.3 Hz led to modulations in spike discharge and synaptic voltage. Gain, the ratio between the amplitudes of the two modulations, and phase leads re indentation of both modulations are larger in irregular units. Gain variations parallel the sensitivity of the postsynaptic spike encoder, the set of conductances that converts synaptic input into spike discharge. Phase variations reflect both synaptic inputs to the encoder and postsynaptic processes. Experimental data were interpreted using a stochastic integrate-and-fire model. Advantages of an irregular discharge include an enhanced encoder gain and the prevention of nonlinear phase locking. Regular and irregular units are more efficient, respectively, in the encoding of low- and high-frequency head rotations, respectively. PMID:24004525

Identifying patient-level health and social care costs for older adults discharged from acute medical units in England.

PubMed

Franklin, Matthew; Berdunov, Vladislav; Edmans, Judi; Conroy, Simon; Gladman, John; Tanajewski, Lukasz; Gkountouras, Georgios; Elliott, Rachel A

2014-09-01

acute medical units allow for those who need admission to be correctly identified, and for those who could be managed in ambulatory settings to be discharged. However, re-admission rates for older people following discharge from acute medical units are high and may be associated with substantial health and social care costs. identifying patient-level health and social care costs for older people discharged from acute medical units in England. a prospective cohort study of health and social care resource use. an acute medical unit in Nottingham, England. four hundred and fifty-six people aged over 70 who were discharged from an acute medical unit within 72 h of admission. hospitalisation and social care data were collected for 3 months post-recruitment. In Nottingham, further approvals were gained to obtain data from general practices, ambulance services, intermediate care and mental healthcare. Resource use was combined with national unit costs. costs from all sectors were available for 250 participants. The mean (95% CI, median, range) total cost was £1926 (1579-2383, 659, 0-23,612). Contribution was: secondary care (76.1%), primary care (10.9%), ambulance service (0.7%), intermediate care (0.2%), mental healthcare (2.1%) and social care (10.0%). The costliest 10% of participants accounted for 50% of the cost. this study highlights the costs accrued by older people discharged from acute medical units (AMUs): they are mainly (76%) in secondary care and half of all costs were incurred by a minority of participants (10%). © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

High Input Voltage Discharge Supply for High Power Hall Thrusters Using Silicon Carbide Devices

NASA Technical Reports Server (NTRS)

Pinero, Luis R.; Scheidegger, Robert J.; Aulsio, Michael V.; Birchenough, Arthur G.

2014-01-01

A power processing unit for a 15 kW Hall thruster is under development at NASA Glenn Research Center. The unit produces up to 400 VDC with two parallel 7.5 kW discharge modules that operate from a 300 VDC nominal input voltage. Silicon carbide MOSFETs and diodes were used in this design because they were the best choice to handle the high voltage stress while delivering high efficiency and low specific mass. Efficiencies in excess of 97 percent were demonstrated during integration testing with the NASA-300M 20 kW Hall thruster. Electromagnet, cathode keeper, and heater supplies were also developed and will be integrated with the discharge supply into a vacuum-rated brassboard power processing unit with full flight functionality. This design could be evolved into a flight unit for future missions that requires high power electric propulsion.

[Children's medically complex diseases unit. A model required in all our hospitals].

PubMed

Climent Alcalá, Francisco José; García Fernández de Villalta, Marta; Escosa García, Luis; Rodríguez Alonso, Aroa; Albajara Velasco, Luis Adolfo

2018-01-01

The increase in survival of children with severe diseases has led to the rise of children with chronic diseases, sometimes with lifelong disabilities. In 2008, a unit for the specific care of medically complex children (MCC) was created in Hospital La Paz. To describe the work and care activities of this Unit. Patients and methods An analysis was performed on all discharge reports of the Unit between January 2014 and July 2016. The MCC Unit has 6 beds and daily outpatient clinic. A total of 1,027 patients have been treated since the creation of the unit, with 243 from 2014. The median age was 24.2 months (IQ: 10.21-84.25). The large majority (92.59%) have multiple diseases, the most frequent chronic conditions observed were neurological (76.95%), gastrointestinal (63.78%), and respiratory diseases (61.72%). More than two-thirds (69.54%) of MCC are dependent on technology, 53.49% on respiratory support, and 35.80% on nutritional support. Hospital admission rates have increased annually. There have been 403 admissions since 2014, of which 8.93% were re-admissions within 30 days of hospital discharge. The median stay during 2014-2016 was 6 days (IQ: 3-14). The occupancy rate has been above 100% for this period. Currently, 210 patients remain on follow-up (86.42%), and 11 children (4.53%) were discharged to their referral hospitals. The mortality rate is 9.05% (22 deaths). The main condition of these 22 patients was neurological (9 patients). Infectious diseases were the leading cause of death. MCC should be treated in specialized units in tertiary or high-level hospitals. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Effect of pain on the modulation in discharge rate of sternocleidomastoid motor units with force direction.

PubMed

Falla, Deborah; Lindstrøm, Rene; Rechter, Lotte; Farina, Dario

2010-05-01

To compare the behavior of sternocleidomastoid motor units of patients with chronic neck pain and healthy controls. Nine women (age, 40.4+/-3.5 yr) with chronic neck pain and nine age- and gender-matched healthy controls participated. Surface and intramuscular EMG were recorded from the sternocleidomastoid muscle bilaterally as subjects performed isometric contractions of 10-s duration in the horizontal plane at a force of 15 N in eight directions (0-360 degrees ; 45 degrees intervals) and isometric contractions at 15 and 30 N force with continuous change in force direction in the range 0-360 degrees . Motor unit behavior was monitored during the 10-s contractions and the subsequent resting periods. The mean motor unit discharge rate depended on the direction of force in the control subjects (P<0.05) but not in the patients. Moreover, in three of the nine patients, but in none of the controls, single motor unit activity continued for 8.1+/-6.1s upon completion of the contraction. The surface EMG amplitude during the circular contraction at 15N was greater for the patients (43.5+/-54.2 microV) compared to controls (16.9+/-14.9 microV; P<0.05). The modulation in discharge rate of individual motor units with force direction is reduced in the sternocleidomastoid muscle in patients with neck pain, with some patients showing prolonged motor unit activity when they were instructed to rest. These observations suggest that chronic neck pain affects the change in neural drive to muscles with force direction. Copyright 2009 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Performance Charts for a Turbojet System

NASA Technical Reports Server (NTRS)

Karp, Irving M.

1947-01-01

Convenient charts are presented for computing the thrust, fuel consumption, and other performance values of a turbojet system. These charts take into account the effects of ram pressure, compressor pressure ratio, ratio of combustion-chamber-outlet temperature to atmospheric temperature, compressor efficiency, turbine efficiency, combustion efficiency, discharge-nozzle coefficient, losses in total pressure in the inlet to the jet-propulsion unit and in the combustion chamber, and variation in specific heats with temperature. The principal performance charts show clearly the effects of the primary variables and correction charts provide the effects of the secondary variables. The performance of illustrative cases of turbojet systems is given. It is shown that maximum thrust per unit mass rate of air flow occurs at a lower compressor pressure ratio than minimum specific fuel consumption. The thrust per unit mass rate of air flow increases as the combustion-chamber discharge temperature increases. For minimum specific fuel consumption, however, an optimum combustion-chamber discharge temperature exists, which in some cases may be less than the limiting temperature imposed by the strength temperature characteristics of present materials.

Quantifying Ground-Water and Surface-Water Discharge from Evapotranspiration Processes in 12 Hydrographic Areas of the Colorado Regional Ground-Water Flow System, Nevada, Utah, and Arizona

USGS Publications Warehouse

DeMeo, Guy A.; Smith, J. LaRue; Damar, Nancy A.; Darnell, Jon

2008-01-01

Rapid population growth in southern Nevada has increased the demand for additional water supplies from rural areas of northern Clark and southern Lincoln counties to meet projected water-supply needs. Springs and rivers in these undeveloped areas sustain fragile riparian habitat and may be susceptible to ground-water withdrawals. Most natural ground-water and surface-water discharge from these basins occurs by evapotranspiration (ET) along narrow riparian corridors that encompassed about 45,000 acres or about 1 percent of the study area. This report presents estimates of ground- and surface-water discharge from ET across 3.5 million acres in 12 hydrographic areas of the Colorado Regional Ground-Water Flow System. Ground-and surface-water discharge from ET were determined by identifying areas of ground- and surface-water ET, delineating areas of similar vegetation and soil conditions (ET units), and computing ET rates for each of these ET units. Eight ET units were identified using spectral-reflectance characteristics determined from 2003 satellite imagery, high-resolution aerial photography, and land classification cover. These ET units are dense meadowland vegetation (200 acres), dense woodland vegetation (7,200 acres), moderate woodland vegetation (6,100 acres), dense shrubland vegetation (5,800 acres), moderate shrubland vegetation (22,600 acres), agricultural fields (3,100 acres), non-phreatophytic areas (3,400,000 acres), and open water (300 acres). ET from diffuse ground-water and channelized surface-water is expressed as ETgs and is equal to the difference between total annual ET and precipitation. Total annual ET rates were calculated by the Bowen ratio and eddy covariance methods using micrometeorological data collected from four sites and estimated at 3.9 ft at a dense woodland site (February 2003 to March 2005), 3.6 ft at a moderate woodland site (July 2003 to October 2006), 2.8 ft at a dense shrubland site (June 2005 to October 2006), and 1.5 ft at a moderate shrubland site (April 2006 to October 2006). Annual ETgs rates were 3.4 ft for dense woodland vegetation, 3.2 ft for moderate woodland vegetation, 2.2 ft for dense shrubland vegetation, and 1.0 ft for moderate shrubland vegetation. Published annual rates of ETgs were used for the other ET units found in the study area. These rates were 3.4 ft for dense meadowland vegetation, 5.2 ft for agricultural fields, and 4.9 ft for open water. For the non-phreatophytic ET unit, ETgs was assumed to be zero. Estimated ground- and surface-water discharge from ET was calculated by multiplying the ETgs by the ET-unit acreage and equaled 24,480 acre-ft for dense woodland vegetation, 19,520 acre-ft for moderate woodland vegetation, 12,760 acre-ft for dense shrubland vegetation, 22,600 acre-ft for moderate shrubland vegetation, 680 acre-ft for dense meadowland vegetation, 16,120 acre-ft for agricultural fields, 1,440 acre-ft for open water, and 0 acre-ft for the non-phreatophytic ET unit. Estimated ground-water and surface-water discharge from ET from each hydrographic area was calculated by summing the total annual ETgs rate for ET units found within each hydrographic area and equaled 1,952 acre-ft for the Black Mountains Area, 6,080 acre-ft for California Wash, 4,090 acre-ft for the Muddy River Springs Area, 11,510 acre-ft for Lower Moapa Valley, 51,960 acre-ft for the Virgin River Valley, 16,168 acre-ft for Lower Meadow Valley Wash, 5,840 acre-ft for Clover Valley, and 0 acre-ft for Coyote Spring Valley, Kane Springs Valley, Tule Desert, Hidden Valley (North), and Garnet Valley. The annual discharge from ETgs for the study area totals about 98,000 acre-ft.

Neural coding of repetitive clicks in the medial geniculate body of cat.

PubMed

Rouiller, E; de Ribaupierre, Y; Toros-Morel, A; de Ribaupierre, F

1981-09-01

The activity of 418 medial geniculate body (MGB) units was studied in response to repetitive acoustic pulses in 35 nitrous oxide anaesthetized cats. The proportion of MGB neurons insensitive to repetitive clicks was close to 30%. On the basis of their pattern of discharge, the responsive units were divided into three categories. The majority of them (71%), classified as "lockers', showed discharges precisely time-locked to the individual clicks of the train. A few units (8%), called "groupers', had discharges loosely synchronized to low-rate repetitive clicks. When the spikes were not synchronized, the cell had transient or sustained responses for a limited frequency range and was classified as a "special responder' (21%). Responses of "lockers' were time-locked up to a limiting rate, which varied between 10 and 800 Hz; half of the "lockers' had a limiting rate of locking equal to or higher than 100 Hz. The degree of entrainment, defined as the probability that each click evokes at least one spike, regularly decreases for increasing rates; on the other hand, the precision of locking increasing increases with frequency. The time jitter observed at 100 Hz might be as small as 0.2 ms and was 1.2 ms on average. The population of "lockers' can mark with precision the transients of complex sounds and has response properties still compatible with a temporal coding of the fundamental frequency of most animal vocalizations.

Discharged Elderly Nursing Home Care Unit Patients: A Follow-Up Study.

ERIC Educational Resources Information Center

Barnes, Lori; And Others

The success of rehabilitative nursing homes has been measured by their ability to return patients to their homes. The rates of reinstitutionalization after discharge are less studied but are basic to the role of alternative levels of care. This research examines the relationship of predischarge factors with long term outcomes of patients…

Coupling fine particle and bedload transport in gravel-bedded streams

NASA Astrophysics Data System (ADS)

Park, Jungsu; Hunt, James R.

2017-09-01

Fine particles in the silt- and clay-size range are important determinants of surface water quality. Since fine particle loading rates are not unique functions of stream discharge this limits the utility of the available models for water quality assessment. Data from 38 minimally developed watersheds within the United States Geological Survey stream gauging network in California, USA reveal three lines of evidence that fine particle release is coupled with bedload transport. First, there is a transition in fine particle loading rate as a function of discharge for gravel-bedded sediments that does not appear when the sediment bed is composed of sand, cobbles, boulders, or bedrock. Second, the discharge at the transition in the loading rate is correlated with the initiation of gravel mobilization. Third, high frequency particle concentration and discharge data are dominated by clockwise hysteresis where rising limb discharges generally have higher concentrations than falling limb discharges. These three observations across multiple watersheds lead to a conceptual model that fine particles accumulate within the sediment bed at discharges less than the transition and then the gravel bed fluidizes with fine particle release at discharges above the transition discharge. While these observations were individually recognized in the literature, this analysis provides a consistent conceptual model based on the coupling of fine particle dynamics with filtration at low discharges and gravel bed fluidization at higher discharges.

Cost-effectiveness of 'Program We Care' for patients with chronic obstructive pulmonary disease: A case-control study.

PubMed

Wong, Eliza Mi Ling; Lo, Shuk Man; Ng, Ying Chu; Lee, Larry Lap Yip; Yuen, T M Y; Chan, Jimmy Tak Shing; Chair, Sek Ying

2016-07-01

To evaluate the effectiveness of a discharge program for patients with chronic obstructive pulmonary disease (COPD) patients on discharge from an emergency medical ward on discharge home rate, hospital length of stay (LOS), inpatient admission rate and cost. Frequent visits to the emergency department (ED) and subsequent hospital admission are common among patients with COPD, which adds a burden to ED and hospital care. A discharge program was implemented in an ED emergency medical ward. The program consisted of multidisciplinary care, discharge planning, discharge health education on disease management, and continued support from the community nursing services. A retrospective case-control study was used. Data were retrieved and compared between 478 COPD program cases and 478 COPD non-program cases. No significant difference was found in age, gender, and triage category, LOS in ED, and readmission rate between the program and non-program groups. The program group demonstrated a significantly higher discharge home rate from the ED (33.89% vs. 20.08%) and fewer medical admissions (40.59% vs. 55.02%) compared with the non-program group, resulting in lower total medical costs after the program was implemented. The program provides insight on the strategic planning for discharge care in a short stay unit of emergency department. Copyright © 2015 Elsevier Ltd. All rights reserved.

Adjustments in motor unit properties during fatiguing contractions after training.

PubMed

Vila-Chã, Carolina; Falla, Deborah; Correia, Miguel Velhote; Farina, Dario

2012-04-01

The objective of the study was to investigate the effect of strength and endurance training on muscle fiber membrane properties and discharge rates of low-threshold motor units of the vasti muscles during fatiguing contractions. Twenty-five sedentary healthy men (age (mean ± SD) = 26.3 ± 3.9 yr) were randomly assigned to one of three groups: strength training, endurance training, or a control group. Conventional endurance and strength training was performed 3 d·wk⁻¹, during a period of 6 wk. Motor unit conduction velocity and EMG amplitude of the vastus medialis obliquus and lateralis muscles and biceps femoris were measured during sustained isometric knee extensions at 10% and 30% of the maximum voluntary contraction before and immediately after training. After 6 wk of training, the reduction in motor unit conduction velocity during the sustained contractions at 30% of the maximum voluntary force occurred at slower rates compared with baseline (P < 0.05). However, the rate of decrease was lower after endurance training compared with strength training (P < 0.01). For all groups, motor unit discharge rates declined during the sustained contraction (P < 0.001), and their trend was not altered by training. In addition, the biceps femoris-vasti coactivation ratio declined after the endurance training. Short-term strength and endurance training induces alterations of the electrophysiological membrane properties of the muscle fiber. In particular, endurance training lowers the rate of decline of motor unit conduction velocity during sustained contractions more than strength training.

How the states stack up: disparities in substance abuse outpatient treatment completion rates for minorities.

PubMed

Arndt, Stephan; Acion, Laura; White, Kristin

2013-10-01

This study was an exploratory investigation of state-level minority disparities in successfully completing outpatient treatment, a major objective for attending substance abuse treatment and a known process outcome measure. This was a retrospective analysis of state discharge and admission data from the 2006 to 2008 Treatment Episode Datasets-Discharge (TEDS-D). Data were included representing all discharges from outpatient substance abuse treatment centers across the United States. All first treatment episode clients with admission/discharge records meeting inclusion criteria who could be classified as White, Latino, or Black/African American were used (n=940,058). States demonstrated racial and ethnic disparities in their crude and adjusted completion rates, which also varied considerably among the states. Minorities typically showed a disadvantage. A few states showed significantly higher completion rates for Blacks or Latinos. Realistically, a variety of factors likely cause the state race/ethnic differences in successful completion rates. States should investigate their delivery systems to reduce completion disparities. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

[Rehospitalization and early discharge in neonatology: retrospective evaluation].

PubMed

Giroux, J D; Finel, E; Sizun, J; Guillois, B; Alix, D; de Parscau, L

1993-03-01

This retrospective study compared discharge summary data in neonates discharged from the Brest Teaching Hospital Neonatology Unit between May 1, 1980 and April 30, 1981 (Period I) or between May 1, 1990 and April 30, 1991 (Period II). Birth weight, gestational age, duration of hospitalization, corrected age at discharge and rehospitalization rate were compared. Among infants with intrauterine growth retardation (IUGR) with or without prematurity, weight at discharge was 2,500 g or less in none of Period I patients (n = 144) versus 67.8% of Period II patients (n = 87). Four Period II infants weighted 2,000 g or less at discharge (1,850, 1,930, 1,960, and 2,000 g). Among premature infants without growth retardation, weight at discharge was 2,500 g or less in 2.2% of Period I infants versus 52.5% of Period II infants (p < 0.0001). Period II infants were not rehospitalized more often or earlier than Period I infants. Early discharge reduces the duration of separation of the child from his or her parents without increasing the rehospitalization rate.

Discharge rates in electromyography distinguish early between peripheral and central paresis.

PubMed

Jürgens, Tim P; Puchner, Christoph; Schulte-Mattler, Wilhelm J

2012-10-01

Abnormally increased discharge rates (DRs) of motor unit potentials on concentric needle electromyography (CNEMG) indicate a loss of motor units in peripheral neurogenic lesions. To determine when increased DRs occur during the course of a peripheral nerve lesion, we retrospectively analyzed CNEMG recordings of 19 patients with acute weakness of peripheral origin. The initial CNEMG studies took place from 3.7 hours to 10 days after the onset of the lesion. Abnormally increased DRs (≥20/s) were found in all but 1 of the muscles in which MRC grade was <4. Peripheral neurogenic damage was confirmed in all patients thereafter. The DRs depended on neither the kind of lesion nor the time between onset and CNEMG examination. The measurement of DRs of motor unit potentials is helpful immediately after a sudden paresis of MRC grade 3 or worse to differentiate between a central and a peripheral lesion. Copyright © 2012 Wiley Periodicals, Inc.

Change in muscle fascicle length influences the recruitment and discharge rate of motor units during isometric contractions.

PubMed

Pasquet, Benjamin; Carpentier, Alain; Duchateau, Jacques

2005-11-01

This study examines the effect of fascicle length change on motor-unit recruitment and discharge rate in the human tibialis anterior (TA) during isometric contractions of various intensities. The torque produced during dorsiflexion and the surface and intramuscular electromyograms (EMGs) from the TA were recorded in eight subjects. The behavior of the same motor unit (n = 59) was compared at two ankle joint angles (+10 and -10 degrees around the ankle neutral position). Muscle fascicle length of the TA was measured noninvasively using ultrasonography recordings. When the ankle angle was moved from 10 degrees plantarflexion to 10 degrees dorsiflexion, the torque produced during maximal voluntary contraction (MVC) was significantly reduced [35.2 +/- 3.3 vs. 44.3 +/- 4.2 (SD) Nm; P < 0.001] and the average surface EMG increased (0.47 +/- 0.08 vs. 0.43 +/- 0.06 mV; P < 0.05). At reduced ankle joint angle, muscle fascicle length declined by 12.7% (P < 0.01) at rest and by 18.9% (P < 0.001) during MVC. Motor units were activated at a lower recruitment threshold for short compared with long muscle fascicle length, either when expressed in absolute values (2.1 +/- 2.5 vs. 3.6 +/- 3.7 Nm; P < 0.001) or relative to their respective MVC (5.2 +/- 6.1 vs. 8.8 +/- 9.0%). Higher discharge rate and additional motor-unit recruitment were observed at a given absolute or relative torque when muscle fascicles were shortened. However, the data indicate that increased rate coding was mainly present at low torque level (<10% MVC), when the muscle-tendon complex was compliant, whereas recruitment of additional motor units played a dominant role at higher torque level and decreased compliance (10-35% MVC). Taken together, the results suggest that the central command is modulated by the afferent proprioceptive information during submaximal contractions performed at different muscle fascicle lengths.

Estimates of ground-water discharge as determined from measurements of evapotranspiration, Ash Meadows area, Nye County, Nevada

USGS Publications Warehouse

Laczniak, R.J.; DeMeo, G.A.; Reiner, S.R.; Smith, J. LaRue; Nylund, W.E.

1999-01-01

Ash Meadows is one of the major discharge areas within the regional Death Valley ground-water flow system of southern Nevada and adjacent California. Ground water discharging at Ash Meadows is replenished from inflow derived from an extensive recharge area that includes the eastern part of the Nevada Test Site (NTS). Currently, contaminants introduced into the subsurface by past nuclear testing at NTS are the subject of study by the U.S. Department of Energy's Environmental Restoration Program. The transport of any contaminant in contact with ground water is controlled in part by the rate and direction of ground-water flow, which itself depends on the location and quantity of ground water discharging from the flow system. To best evaluate any potential risk associated with these test-generated contaminants, studies were undertaken to accurately quantify discharge from areas downgradient from the NTS. This report presents results of a study to refine the estimate of ground-water discharge at Ash Meadows. The study estimates ground-water discharge from the Ash Meadows area through a rigorous quantification of evapotranspiration (ET). To accomplish this objective, the study identifies areas of ongoing ground-water ET, delineates unique areas of ET defined on the basis of similarities in vegetation and soil-moisture conditions, and computes ET rates for each of the delineated areas. A classification technique using spectral-reflectance characteristics determined from satellite images recorded in 1992 identified seven unique units representing areas of ground-water ET. The total area classified encompasses about 10,350 acres dominated primarily by lush desert vegetation. Each unique area, referred to as an ET unit, generally consists of one or more assemblages of local phreatophytes. The ET units identified range from sparse grasslands to open water. Annual ET rates are computed by energy-budget methods from micrometeorological measurements made at 10 sites within six of the seven identified ET units. Micrometeorological data were collected for a minimum of 1 year at each site during 1994 through 1997. Evapotranspiration ranged from 0.6 foot per year in a sparse, dry saltgrass environment to 8.6 feet per year over open water. Ancillary data, including water levels, were collected during this same period to gain additional insight into the evapotranspiration process. Water levels measured in shallow wells showed annual declines of more than 10 feet and daily declines as high as 0.3 foot attributed to water losses associated with evapotranspiration. Mean annual ET from the Ash Meadows area is estimated at 21,000 acre-feet. An estimate of ground-water discharge, based on this ET estimate, is presented as a range to account for uncertainties in the contribution of local precipitation. The estimates given for mean annual ground-water discharge range from 18,000 to 21,000 acre-feet. The low estimate assumes a large contribution from local precipitation in computed ET rates; whereas, the high estimate assumes no contribution from local precipitation. The range presented is only slightly higher than previous estimates of ground-water discharge from the Ash Meadows area based primarily on springflow measurements.

Single motor unit firing rate after stroke is higher on the less-affected side during stable low-level voluntary contractions

PubMed Central

McNulty, Penelope A.; Lin, Gaven; Doust, Catherine G.

2014-01-01

Muscle weakness is the most common outcome after stroke and a leading cause of adult-acquired motor disability. Single motor unit properties provide insight into the mechanisms of post-stroke motor impairment. Motor units on the more-affected side are reported to have lower peak firing rates, reduced discharge variability and a more compressed dynamic range than healthy subjects. The activity of 169 motor units was discriminated from surface electromyography in 28 stroke patients during sustained voluntary contractions 10% of maximal and compared to 110 units recorded in 16 healthy subjects. Motor units were recorded in three series: ankle dorsiflexion, wrist flexion and elbow flexion. Mean firing rates after stroke were significantly lower on the more-affected than the less-affected side (p < 0.001) with no differences between dominant and non-dominant sides for healthy subjects. When data were combined, firing rates on the less-affected side were significantly higher than those either on the more-affected side or healthy subjects (p < 0.001). Motor unit mean firing rate was higher in the upper-limb than the lower-limb (p < 0.05). The coefficient of variation of motor unit discharge rate was lower for motor units after stroke compared to controls for wrist flexion (p < 0.05) but not ankle dorsiflexion. However the dynamic range of motor units was compressed only for motor units on the more-affected side during wrist flexion. Our results show that the pathological change in motor unit firing rate occurs on the less-affected side after stroke and not the more-affected side as previously reported, and suggest that motor unit behavior recorded in a single muscle after stroke cannot be generalized to muscles acting on other joints even within the same limb. These data emphasize that the less-affected side does not provide a valid control for physiological studies on the more-affected side after stroke and that both sides should be compared to data from age- and sex-matched healthy subjects. PMID:25100969

Distinguishing intrinsic from extrinsic factors underlying firing rate saturation in human motor units

PubMed Central

Lester, Rosemary A.; Johns, Richard K.

2014-01-01

During voluntary contraction, firing rates of individual motor units (MUs) increase modestly over a narrow force range beyond which little additional increase in firing rate is seen. Such saturation of MU discharge may be a consequence of extrinsic factors that limit net synaptic excitation acting on motor neurons (MNs) or may be due to intrinsic properties of the MNs. Two sets of experiments involving recording of human biceps brachii MUs were carried out to evaluate saturation. In the first set, the extent of saturation was quantified for 136 low-threshold MUs during isometric ramp contractions. Firing rate-force data were best fit by a saturating function for 90% of MUs recorded with a maximum rate of 14.8 ± 2.0 impulses/s. In the second set of experiments, to distinguish extrinsic from intrinsic factors underlying saturation, we artificially augmented descending excitatory drive to biceps MNs by activation of muscle spindle afferents through tendon vibration. We examined the change in firing rate caused by tendon vibration in 96 MUs that were voluntarily activated at rates below and at saturation. Vibration had little effect on the discharge of MUs that were firing at saturation frequencies but strongly increased firing rates of the same units when active at lower frequencies. These results indicate that saturation is likely caused by intrinsic mechanisms that prevent further increases in firing rate in the presence of increasing synaptic excitation. Possible intrinsic cellular mechanisms that limit firing rates of motor units during voluntary effort are discussed. PMID:25475356

Effect of casemix funding on outcomes in patients admitted to hospital with suspected unstable angina.

PubMed

Kerr, G D; Dunt, D; Gordon, I R

1998-01-19

To determine the effect of the introduction of casemix funding on resource utilisation and clinical outcomes in patients admitted to hospital with suspected unstable angina. A prospective cohort study with a 6-month follow-up. A suburban community hospital in Melbourne, Victoria. 336 consecutive patients admitted to the coronary care unit with suspected unstable angina before (156) and after (180) the introduction of casemix funding. Introduction of casemix funding in July 1993. Indices of resource utilisation: length of stay in hospital, length of stay in the coronary care unit, and total cost of investigations (pathology and radiology). Rates of serious cardiac events during hospital stay and after discharge. Readmissions within 28 days and 6 months of discharge. After the introduction of casemix funding there was a 1% increase in duration of hospital stay and a 5% increase in time spent in the coronary care unit, but neither of these increases was statistically significant. However, there was a significant reduction in total cost of investigations (39% decrease; 95% confidence interval, 14%-70%; P < 0.001). The rate of serious cardiac events after discharge did not increase, and neither did readmission rates, either within 28 days or over the 6 months' follow-up. Casemix funding had no effect on short term clinical outcomes but resulted in significantly reduced investigation costs.

Respiration-related discharge of hyoglossus muscle motor units in the rat.

PubMed

Powell, Gregory L; Rice, Amber; Bennett-Cross, Seres J; Fregosi, Ralph F

2014-01-01

Although respiratory muscle motor units have been studied during natural breathing, simultaneous measures of muscle force have never been obtained. Tongue retractor muscles, such as the hyoglossus (HG), play an important role in swallowing, licking, chewing, breathing, and, in humans, speech. The HG is phasically recruited during the inspiratory phase of the respiratory cycle. Moreover, in urethane anesthetized rats the drive to the HG waxes and wanes spontaneously, providing a unique opportunity to study motor unit firing patterns as the muscle is driven naturally by the central pattern generator for breathing. We recorded tongue retraction force, the whole HG muscle EMG and the activity of 38 HG motor units in spontaneously breathing anesthetized rats under low-force and high-force conditions. Activity in all cases was confined to the inspiratory phase of the respiratory cycle. Changes in the EMG were correlated significantly with corresponding changes in force, with the change in EMG able to predict 53-68% of the force variation. Mean and peak motor unit firing rates were greater under high-force conditions, although the magnitude of discharge rate modulation varied widely across the population. Changes in mean and peak firing rates were significantly correlated with the corresponding changes in force, but the correlations were weak (r(2) = 0.27 and 0.25, respectively). These data indicate that, during spontaneous breathing, recruitment of HG motor units plays a critical role in the control of muscle force, with firing rate modulation playing an important but lesser role.

Information theoretic analysis of proprioceptive encoding during finger flexion in the monkey sensorimotor system.

PubMed

Witham, Claire L; Baker, Stuart N

2015-01-01

There is considerable debate over whether the brain codes information using neural firing rate or the fine-grained structure of spike timing. We investigated this issue in spike discharge recorded from single units in the sensorimotor cortex, deep cerebellar nuclei, and dorsal root ganglia in macaque monkeys trained to perform a finger flexion task. The task required flexion to four different displacements against two opposing torques; the eight possible conditions were randomly interleaved. We used information theory to assess coding of task condition in spike rate, discharge irregularity, and spectral power in the 15- to 25-Hz band during the period of steady holding. All three measures coded task information in all areas tested. Information coding was most often independent between irregularity and 15-25 Hz power (60% of units), moderately redundant between spike rate and irregularity (56% of units redundant), and highly redundant between spike rate and power (93%). Most simultaneously recorded unit pairs coded using the same measure independently (86%). Knowledge of two measures often provided extra information about task, compared with knowledge of only one alone. We conclude that sensorimotor systems use both rate and temporal codes to represent information about a finger movement task. As well as offering insights into neural coding, this work suggests that incorporating spike irregularity into algorithms used for brain-machine interfaces could improve decoding accuracy. Copyright © 2015 the American Physiological Society.

A study on the optimal hydraulic loading rate and plant ratios in recirculation aquaponic system.

PubMed

Endut, Azizah; Jusoh, A; Ali, N; Wan Nik, W B; Hassan, A

2010-03-01

The growths of the African catfish (Clarias gariepinus) and water spinach (Ipomoea aquatica) were evaluated in recirculation aquaponic system (RAS). Fish production performance, plant growth and nutrient removal were measured and their dependence on hydraulic loading rate (HLR) was assessed. Fish production did not differ significantly between hydraulic loading rates. In contrast to the fish production, the water spinach yield was significantly higher in the lower hydraulic loading rate. Fish production, plant growth and percentage nutrient removal were highest at hydraulic loading rate of 1.28 m/day. The ratio of fish to plant production has been calculated to balance nutrient generation from fish with nutrient removal by plants and the optimum ratio was 15-42 gram of fish feed/m(2) of plant growing area. Each unit in RAS was evaluated in terms of oxygen demand. Using specified feeding regime, mass balance equations were applied to quantify the waste discharges from rearing tanks and treatment units. The waste discharged was found to be strongly dependent on hydraulic loading rate. 2009 Elsevier Ltd. All rights reserved.

Measurement of submarine groundwater discharge using diverse methods in Coleroon Estuary, Tamil Nadu, India

NASA Astrophysics Data System (ADS)

Prakash, R.; Srinivasamoorthy, K.; Gopinath, S.; Saravanan, K.

2018-03-01

Submarine groundwater discharge (SGD) is described as submarine inflow of fresh and brackish groundwater from land into the sea. The release of sewages from point and non-point source pollutants from industries, agricultural and domestic activities gets discharged through groundwater to ocean creating natural disparity like decreasing flora fauna and phytoplankton blooms. Hence, to quantify fluxes of SGD in coastal regions is important. Quantification of SGD was attempted in Coleroon estuary, India, using three dissimilar methods like water budget, Darcy law and manual seepage meter. Three seepage meters were installed at two prominent litho units (alluvium and fluvio marine) at a distance of (0-14.7 km) away from Bay of Bengal. The water budget and Darcy law-quantified submarine seepage at a rate of 6.9 × 106 and 3.2 × 103 to 308.3 × 103 m3 year-1, respectively, and the seepage meter quantified seepage rate of 0.7024 m h-1 at an average. Larger seepage variations were isolated from three different techniques and the seepage rates were found to be influenced by hydrogeological characteristics of the litho units and distance from the coast.

Evaluating Micrometeorological Estimates of Groundwater Discharge from Great Basin Desert Playas

NASA Astrophysics Data System (ADS)

Jackson, T.; Halford, K. J.; Gardner, P.

2017-12-01

Groundwater availability studies in the arid southwestern United States traditionally have assumed that groundwater discharge by evapotranspiration (ETg) from desert playas is a significant component of the groundwater budget. This result occurs because desert playa ETg rates are poorly constrained by Bowen Ratio energy budget (BREB) and eddy-covariance (EC) micrometeorological measurement approaches. Best attempts by previous studies to constrain ETg from desert playas have resulted in ETg rates that are below the detection limit of micrometeorological approaches. This study uses numerical models to further constrain desert playa ETg rates that are below the detection limit of EC (0.1 mm/d) and BREB (0.3 mm/d) approaches, and to evaluate the effect of hydraulic properties and salinity-based groundwater-density contrasts on desert playa ETg rates. Numerical models simulated ETg rates from desert playas in Death Valley, California and Dixie Valley, Nevada. Results indicate that actual ETg rates from desert playas are significantly below the upper detection limits provided by the BREB- and EC-based micrometeorological measurements. Discharge from desert playas contribute less than 2 percent of total groundwater discharge from Dixie and Death Valleys, which suggests discharge from desert playas is negligible in other basins. Numerical simulation results also show that ETg from desert playas primarily is limited by differences in hydraulic properties between alluvial fan and playa sediments and, to a lesser extent, by salinity-based groundwater density contrasts.

A large format in operando wound cell for analysing the structural dynamics of lithium insertion materials

NASA Astrophysics Data System (ADS)

Brant, William R.; Roberts, Matthew; Gustafsson, Torbjörn; Biendicho, Jordi Jacas; Hull, Stephen; Ehrenberg, Helmut; Edström, Kristina; Schmid, Siegbert

2016-12-01

This paper presents a large wound cell for in operando neutron diffraction (ND) from which high quality diffraction patterns are collected every 15 min while maintaining conventional electrochemical performance. Under in operando data collection conditions the oxygen atomic displacement parameters (ADPs) and cell parameters were extracted for Li0.18Sr0.66Ti0.5Nb0.5O3. Analysis of diffraction data collected under in situ conditions revealed that the lithium is located on the (0.5 0.5 0) site, corresponding to the 3c Wyckoff position in the cubic perovskite unit cell, after the cell is discharged to 1 V. When the cell is discharged under potentiostatic conditions the quantity of lithium on this site increases, indicating a potential position where lithium becomes pinned in the thermodynamically stable phase. During this potentiostatic step the oxygen ADPs reduce significantly. On discharge, however, the oxygen ADPs were observed to increase gradually as more lithium is inserted into the structure. Finally, the rate of unit cell expansion changed by ∼44% once the lithium content approached ∼0.17 Li per formula unit. A link between lithium content and degree of mobility, disorder of the oxygen positions and changing rate of unit cell expansion at various stages during lithium insertion and extraction is thus presented.

Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000-2009.

PubMed

Kazaure, Hadiza S; Roman, Sanziana A; Sosa, Julie A

2013-09-01

To examine temporal trends in the epidemiology and outcomes of in-hospital cardiopulmonary resuscitation (CPR) recipients at a population level. Retrospective analysis of temporal trends in CPR incidence, survival to discharge, discharge disposition, hospital length of stay, and cost of hospitalization for CPR recipients (age ≥ 18 years) captured in the Nationwide Inpatient Sample (2000-2009) in the United States. Between years 2000 and 2009, CPR incidence increased by 33.7%, from 1 case per 453 to 1 case per 339 hospitalized patients (annual percentage increase: 4.3%, 95% CI: 3.4-5.2%, p<0.001). Compared to CPR recipients in years 2000-2001, those in 2008-2009 were more often younger (age<65 years: 33.4% vs. 40.0%), non-white (29.3% vs. 36.4%), and higher comorbidity scores (score ≥ 4: 22.2% vs. 27.1%) (all p<0.001). Rates of neurologic compromise, mechanical ventilator, and feeding tube use increased by 37.7, 28.2, and 58.5%, respectively (all p<0.001). Adjusted rate of survival to discharge increased by 41.3% (20.6-29.1%, p<0.001). Compared to survivors in 2000, those discharged in 2009 were more often discharged to hospice (0.4% vs. 7.1%, p<0.001); a 35% decrease in discharge to home was noted (36.4% vs. 23.8%, p<0.001). Mean cost of hospitalization per day increased for both survivors ($2742-$3462, p=0.006) and decedents ($3159-$4212, p<0.001). The rate of in-hospital CPR in the U.S. increased, and CPR recipients have become younger and sicker over time. Survival to discharge has improved by 41.3%. Functional outcomes after in-hospital CPR appear to have worsened, with considerable clinical and economic implications. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

False Labor at Term in Singleton Pregnancies: Discharge After a Standardized Assessment and Perinatal Outcomes.

PubMed

Nelson, David B; McIntire, Donald D; Leveno, Kenneth J

2017-07-01

To evaluate perinatal outcomes in women sent home with a diagnosis of false labor at term and assess the time interval to return for delivery. This was a prospective observational cohort study of women at 37 0/7 to 41 6/7 weeks of gestation without pre-existing medical complications who presented to our hospital-based triage unit with symptoms of labor and underwent a standardized evaluation. Women diagnosed as having false labor with a live singleton fetus in cephalic presentation without a prior cesarean delivery and sent home were compared with a group of similar women diagnosed to be in spontaneous labor. Women with hypertension, diabetes, and known fetal malformations were excluded. Using a perinatal composite outcome of respiratory insufficiency, intraventricular hemorrhage, culture-proven sepsis, Apgar score 3 or less at 5 minutes, phototherapy, and perinatal death, we tested the noninferiority of being sent home compared with being admitted for labor. The relationship of cervical dilatation to the time interval from discharge home to delivery was also analyzed. Between October 2012 and March 2016, a total of 3,949 women met inclusion criteria and were diagnosed with false labor, discharged, and returned to deliver, whereas 2,592 similar women were admitted in early labor. The mean interval from discharge to return was 4.9 days. Cesarean delivery rates were not different between the study groups-11% for both (P=.69), and the perinatal composite outcome rates were not significantly different between those sent home and those admitted-3.2% compared with 3.1% (P=.79). Women with more advanced cervical dilatation at discharge returned and delivered significantly earlier than those with less dilatation regardless of parity. Discharge with false labor at term after a standardized assessment in a triage unit was not associated with increased rates of adverse perinatal composite outcomes or cesarean delivery. The time interval to return for delivery was significantly associated with the cervical dilatation at discharge.

A Multidisciplinary Quality Improvement Approach Increases Breastmilk Availability at Discharge from the Neonatal Intensive Care Unit for the Very-Low-Birth-Weight Infant.

PubMed

Bixby, Christine; Baker-Fox, Cindy; Deming, Crystal; Dhar, Vijay; Steele, Caroline

2016-03-01

Mothers of very-low-birth-weight (VLBW) infants often struggle to establish and maintain a milk supply. Children's Hospital of Orange County (CHOC Children's) data from 2005 to 2011 showed that while the total percentage of all neonatal intensive care unit (NICU) babies being discharged on breastmilk had remained stable, the percentage of VLBW babies with breastmilk at discharge had declined. This information resulted in a quality improvement initiative to remove barriers and implement programs shown to have the greatest impact on initiating and sustaining lactation in this patient subset. The objective of this initiative was to increase breastmilk availability at discharge for the VLBW population. A multidisciplinary program was initiated, which included NICU parent and staff education, clarification of roles, and improved access to pumping supplies. Physicians and nurses completed online education. An algorithm defining roles in lactation support was developed, and a resource team of trained bedside nurses was formed. Lactation consultant time was then refocused on the VLBW population. In addition, "Lactation Support" was added to the physician daily documentation to bring the topic to daily bedside rounds. Twice weekly lactation rounds between the lactation consultant and neonatologist addressed lactation concerns for each dyad. To address pumping issues, the loaner pump program was enhanced. To assess the effectiveness of the initiative, breastmilk availability at discharge for the VLBW population at CHOC Children's was compared from baseline (2011) to the end of June 2015. VLBW breastmilk availability at discharge upon project initiation was 58.7% and increased by 36% to a final rate of 80% by 2013--a rate sustained through the first 6 months of 2015. The results of this initiative suggest that a multidisciplinary approach, including education, changes in workflow, and redefinition of roles, is effective in improving breastmilk rates at discharge in the VLBW patient population.

Variations in Static Force Control and Motor Unit Behavior with Error Amplification Feedback in the Elderly.

PubMed

Chen, Yi-Ching; Lin, Linda L; Lin, Yen-Ting; Hu, Chia-Ling; Hwang, Ing-Shiou

2017-01-01

Error amplification (EA) feedback is a promising approach to advance visuomotor skill. As error detection and visuomotor processing at short time scales decline with age, this study examined whether older adults could benefit from EA feedback that included higher-frequency information to guide a force-tracking task. Fourteen young and 14 older adults performed low-level static isometric force-tracking with visual guidance of typical visual feedback and EA feedback containing augmented high-frequency errors. Stabilogram diffusion analysis was used to characterize force fluctuation dynamics. Also, the discharge behaviors of motor units and pooled motor unit coherence were assessed following the decomposition of multi-channel surface electromyography (EMG). EA produced different behavioral and neurophysiological impacts on young and older adults. Older adults exhibited inferior task accuracy with EA feedback than with typical visual feedback, but not young adults. Although stabilogram diffusion analysis revealed that EA led to a significant decrease in critical time points for both groups, EA potentiated the critical point of force fluctuations [Formula: see text], short-term effective diffusion coefficients (Ds), and short-term exponent scaling only for the older adults. Moreover, in older adults, EA added to the size of discharge variability of motor units and discharge regularity of cumulative discharge rate, but suppressed the pooled motor unit coherence in the 13-35 Hz band. Virtual EA alters the strategic balance between open-loop and closed-loop controls for force-tracking. Contrary to expectations, the prevailing use of closed-loop control with EA that contained high-frequency error information enhanced the motor unit discharge variability and undermined the force steadiness in the older group, concerning declines in physiological complexity in the neurobehavioral system and the common drive to the motoneuronal pool against force destabilization.

Variations in Static Force Control and Motor Unit Behavior with Error Amplification Feedback in the Elderly

PubMed Central

Chen, Yi-Ching; Lin, Linda L.; Lin, Yen-Ting; Hu, Chia-Ling; Hwang, Ing-Shiou

2017-01-01

Error amplification (EA) feedback is a promising approach to advance visuomotor skill. As error detection and visuomotor processing at short time scales decline with age, this study examined whether older adults could benefit from EA feedback that included higher-frequency information to guide a force-tracking task. Fourteen young and 14 older adults performed low-level static isometric force-tracking with visual guidance of typical visual feedback and EA feedback containing augmented high-frequency errors. Stabilogram diffusion analysis was used to characterize force fluctuation dynamics. Also, the discharge behaviors of motor units and pooled motor unit coherence were assessed following the decomposition of multi-channel surface electromyography (EMG). EA produced different behavioral and neurophysiological impacts on young and older adults. Older adults exhibited inferior task accuracy with EA feedback than with typical visual feedback, but not young adults. Although stabilogram diffusion analysis revealed that EA led to a significant decrease in critical time points for both groups, EA potentiated the critical point of force fluctuations <ΔFc2>, short-term effective diffusion coefficients (Ds), and short-term exponent scaling only for the older adults. Moreover, in older adults, EA added to the size of discharge variability of motor units and discharge regularity of cumulative discharge rate, but suppressed the pooled motor unit coherence in the 13–35 Hz band. Virtual EA alters the strategic balance between open-loop and closed-loop controls for force-tracking. Contrary to expectations, the prevailing use of closed-loop control with EA that contained high-frequency error information enhanced the motor unit discharge variability and undermined the force steadiness in the older group, concerning declines in physiological complexity in the neurobehavioral system and the common drive to the motoneuronal pool against force destabilization. PMID:29167637

Basic statistical analyses of candidate nickel-hydrogen cells for the Space Station Freedom

NASA Technical Reports Server (NTRS)

Maloney, Thomas M.; Frate, David T.

1993-01-01

Nickel-Hydrogen (Ni/H2) secondary batteries will be implemented as a power source for the Space Station Freedom as well as for other NASA missions. Consequently, characterization tests of Ni/H2 cells from Eagle-Picher, Whittaker-Yardney, and Hughes were completed at the NASA Lewis Research Center. Watt-hour efficiencies of each Ni/H2 cell were measured for regulated charge and discharge cycles as a function of temperature, charge rate, discharge rate, and state of charge. Temperatures ranged from -5 C to 30 C, charge rates ranged from C/10 to 1C, discharge rates ranged from C/10 to 2C, and states of charge ranged from 20 percent to 100 percent. Results from regression analyses and analyses of mean watt-hour efficiencies demonstrated that overall performance was best at temperatures between 10 C and 20 C while the discharge rate correlated most strongly with watt-hour efficiency. In general, the cell with back-to-back electrode arrangement, single stack, 26 percent KOH, and serrated zircar separator and the cell with a recirculating electrode arrangement, unit stack, 31 percent KOH, zircar separators performed best.

Discharge properties of motor units during steady isometric contractions performed with the dorsiflexor muscles

PubMed Central

Klass, Malgorzata; Duchateau, Jacques; Enoka, Roger M.

2012-01-01

The purpose of this study was to record the discharge characteristics of tibialis anterior motor units over a range of target forces and to import these data, along with previously reported observations, into a computational model to compare experimental and simulated measures of torque variability during isometric contractions with the dorsiflexor muscles. The discharge characteristics of 44 motor units were quantified during brief isometric contractions at torques that ranged from recruitment threshold to an average of 22 ± 14.4% maximal voluntary contraction (MVC) torque above recruitment threshold. The minimal [range: 5.8–19.8 pulses per second (pps)] and peak (range: 8.6–37.5 pps) discharge rates of motor units were positively related to the recruitment threshold torque (R2 ≥ 0.266; P < 0.001). The coefficient of variation for interspike interval at recruitment was positively associated with recruitment threshold torque (R2 = 0.443; P < 0.001) and either decreased exponentially or remained constant as target torque increased above recruitment threshold torque. The variability in the simulated torque did not differ from the experimental values once the recruitment range was set to ∼85% MVC torque, and the association between motor twitch contraction times and peak twitch torque was defined as a weak linear association (R2 = 0.096; P < 0.001). These results indicate that the steadiness of isometric contractions performed with the dorsiflexor muscle depended more on the distributions of mechanical properties than discharge properties across the population of motor units in the tibialis anterior. PMID:22442023

Discharge properties of motor units during steady isometric contractions performed with the dorsiflexor muscles.

PubMed

Jesunathadas, Mark; Klass, Malgorzata; Duchateau, Jacques; Enoka, Roger M

2012-06-01

The purpose of this study was to record the discharge characteristics of tibialis anterior motor units over a range of target forces and to import these data, along with previously reported observations, into a computational model to compare experimental and simulated measures of torque variability during isometric contractions with the dorsiflexor muscles. The discharge characteristics of 44 motor units were quantified during brief isometric contractions at torques that ranged from recruitment threshold to an average of 22 ± 14.4% maximal voluntary contraction (MVC) torque above recruitment threshold. The minimal [range: 5.8-19.8 pulses per second (pps)] and peak (range: 8.6-37.5 pps) discharge rates of motor units were positively related to the recruitment threshold torque (R(2) ≥ 0.266; P < 0.001). The coefficient of variation for interspike interval at recruitment was positively associated with recruitment threshold torque (R(2) = 0.443; P < 0.001) and either decreased exponentially or remained constant as target torque increased above recruitment threshold torque. The variability in the simulated torque did not differ from the experimental values once the recruitment range was set to ∼85% MVC torque, and the association between motor twitch contraction times and peak twitch torque was defined as a weak linear association (R(2) = 0.096; P < 0.001). These results indicate that the steadiness of isometric contractions performed with the dorsiflexor muscle depended more on the distributions of mechanical properties than discharge properties across the population of motor units in the tibialis anterior.

Reduction in acute myocardial infarction mortality in the United States: risk-standardized mortality rates from 1995-2006.

PubMed

Krumholz, Harlan M; Wang, Yun; Chen, Jersey; Drye, Elizabeth E; Spertus, John A; Ross, Joseph S; Curtis, Jeptha P; Nallamothu, Brahmajee K; Lichtman, Judith H; Havranek, Edward P; Masoudi, Frederick A; Radford, Martha J; Han, Lein F; Rapp, Michael T; Straube, Barry M; Normand, Sharon-Lise T

2009-08-19

During the last 2 decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction (AMI). However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates. To estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with AMI. Observational study using administrative data and a validated risk model to evaluate 3,195,672 discharges in 2,755,370 patients discharged from nonfederal acute care hospitals in the United States between January 1, 1995, and December 31, 2006. Patients were 65 years or older (mean, 78 years) and had at least a 12-month history of fee-for-service enrollment prior to the index hospitalization. Patients discharged alive within 1 day of an admission not against medical advice were excluded, because it is unlikely that these patients had sustained an AMI. Hospital-specific 30-day all-cause RSMR. At the patient level, the odds of dying within 30 days of admission if treated at a hospital 1 SD above the national average relative to that if treated at a hospital 1 SD below the national average were 1.63 (95% CI, 1.60-1.65) in 1995 and 1.56 (95% CI, 1.53-1.60) in 2006. In terms of hospital-specific RSMRs, a decrease from 18.8% in 1995 to 15.8% in 2006 was observed (odds ratio, 0.76; 95% CI, 0.75-0.77). A reduction in between-hospital heterogeneity in the RSMRs was also observed: the coefficient of variation decreased from 11.2% in 1995 to 10.8%, the interquartile range from 2.8% to 2.1%, and the between-hospital variance from 4.4% to 2.9%. Between 1995 and 2006, the risk-standardized hospital mortality rate for Medicare patients discharged with AMI showed a significant decrease, as did between-hospital variation.

Spool-type control valve assembly with reduced spool stroke for hydraulic belt-and-pulley type continuously variable transmission

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

Itoh, H.; Akashi, T.; Takada, M.

1987-03-31

This patent describes a hydraulic control system for controlling a speed ratio of a hydraulically-operated continuously variable transmission of belt-and-pulley type having a variable-diameter pulley and a hydraulic cylinder for changing an effective diameter of the variable diameter-pulley of the transmission. The hydraulic control system includes a speed-ratio control valve assembly for controlling the supply and discharge of a pressurized fluid to and from the hydraulic cylinder to thereby change the speed ratio of the transmission. The speed-ratio control valve assembly comprises: a shift-direction switching valve unit disposed in fluid supply and discharge conduits communicating with the hydraulic cylinder, formore » controlling a direction in which the speed ratio of the transmission is varied; a shift-speed control valve unit of spool-valve type connected to the shift-direction switching valve unit. The shift-speed control valve unit is selectively placed in a first state in which the fluid supply and discharge flows to and from the hydraulic cylinder through the conduits are permitted, or in a second state in which the fluid supply flow is restricted while the fluid discharge flow is inhibited; an actuator means for placing the shift speed control valve unit alternately in the first and second states to control a rate of variation in the speed ratio of the transmission in the direction established by the shift-direction switching valve unit.« less

Discharge patterns of human genioglossus motor units during arousal from sleep.

PubMed

Wilkinson, Vanessa; Malhotra, Atul; Nicholas, Christian L; Worsnop, Christopher; Jordan, Amy S; Butler, Jane E; Saboisky, Julian P; Gandevia, Simon C; White, David P; Trinder, John

2010-03-01

Single motor unit recordings of the human genioglossus muscle reveal motor units with a variety of discharge patterns. Integrated multiunit electromyographic recordings of genioglossus have demonstrated an abrupt increase in the muscle's activity at arousal from sleep. The aim of the present study was to determine the effect of arousal from sleep on the activity of individual motor units as a function of their particular discharge pattern. Genioglossus activity was measured using intramuscular fine-wire electrodes inserted via a percutaneous approach. Arousals from sleep were identified using the ASDA criterion and the genioglossus electromyogram recordings analyzed for single motor unit activity. Sleep research laboratory. Sleep and respiratory data were collected in 8 healthy subjects (6 men). 138 motor units were identified during prearousalarousal sleep: 25% inspiratory phasic, 33% inspiratory tonic, 4% expiratory phasic, 3% expiratory tonic, and 35% tonic. At arousal from sleep inspiratory phasic units significantly increased the proportion of a breath over which they were active, but did not appreciably increase their rate of firing. 80 new units were identified at arousals, 75% were inspiratory, many of which were active for only 1 or 2 breaths. 22% of units active before arousal, particularly expiratory and tonic units, stopped at the arousal. Increased genioglossus muscle activity at arousal from sleep is primarily due to recruitment of inspiratory phasic motor units. Further, activity within the genioglossus motoneuron pool is reorganized at arousal as, in addition to recruitment, approximately 20% of units active before arousals stopped firing.

Changes in Nutritional and Functional Status in Longer Stay Patients Admitted to a Geriatric Evaluation and Management Unit.

PubMed

Whitley, A; Skliros, E; Graven, C; McIntosh, R; Lasry, C; Newsome, C; Bowie, A

2017-01-01

Malnutrition and functional decline are common in older inpatients admitted to subacute care settings. However the association between changes in nutritional status and relevant functional outcomes remains under-researched. This study examined changes in nutritional status, function and mobility in patients admitted to a Geriatric Evaluation and Management (GEM) unit who had a length of stay (LOS) longer than 21 days. A prospective, observational study. Two GEM units at St Vincent's Hospital Melbourne, Australia. Patients admitted to the GEM units who stayed longer than 21 days were included in the study. Patients were assessed on admission and prior to discharge using the Subjective Global Assessment (SGA), Functional Independence Measure (FIM) motor domain and the Modified Elderly Mobility Scale (MEMS). Fifty-nine patients (Mean age 84.0 ± 7 years) met the required length of stay and were included in the study. Fifty-four per cent (n=32) were malnourished on admission (SGA B/C) and 44% (n=26) were malnourished on discharge. Twenty-two per cent (n=13) improved SGA category, 75% remained stable (n=44) and 3% deteriorated (n=2) from admission to discharge. Total Motor FIM scores significantly increased from admission to discharge in both the improved (p<0.001) and stable or deteriorated (p<0.001) nutritional status groups. Subjects who improved in nutritional status had a significantly higher MEMS score at discharge (p<0.001). On admission to the GEM unit, just over half the included patients were rated as malnourished defined by SGA category. Nearly one quarter of the sample had improved their nutritional status at the time of discharge. Improvement in nutritional status was associated with greater improvement in mobility scores. Further studies are required to investigate the effectiveness of nutrition interventions, which will inform models of care aiming to optimise nutritional, functional, and associated clinical outcomes in patients admitted to GEM units.

Predictors for Perioperative Outcomes following Total Laryngectomy: A University HealthSystem Consortium Discharge Database Study.

PubMed

Rutledge, Jonathan W; Spencer, Horace; Moreno, Mauricio A

2014-07-01

The University HealthSystem Consortium (UHC) database collects discharge information on patients treated at academic health centers throughout the United States. We sought to use this database to identify outcome predictors for patients undergoing total laryngectomy. A secondary end point was to assess the validity of the UHC's predictive risk mortality model in this cohort of patients. Retrospective review. Academic medical centers (tertiary referral centers) and their affiliate hospitals in the United States. Using the UHC discharge database, we retrieved and analyzed data for 4648 patients undergoing total laryngectomy who were discharged between October 2007 and January 2011 from all of the member institutions. Demographics, comorbidities, institutional data, and outcomes were retrieved. The length of stay and overall costs were significantly higher among female patients (P < .0001), while age was a predictor of intensive care unit stay (P = .014). The overall complication rate was higher among Asians (P = .019) and in patients with anemia and diabetes compared with other comorbidities. The average institutional case load was 1.92 cases/mo; we found an inverse correlation (R = -0.47) between the institutional case load and length of stay (P < .0001). The UHC admit mortality risk estimator was found to be an accurate predictor not only of mortality (P < .0002) but also of intensive care unit admission and complication rate (P < .0001). This study provides an overview of laryngectomy outcomes in a contemporary cohort of patients treated at academic health centers. UHC admit mortality risk is an excellent outcome predictor and a valuable tool for risk stratification in these patients. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Northeastern Florida Bay estuarine creek data, water years 1996-2000

USGS Publications Warehouse

Hittle, Clinton D.; Zucker, Mark A.

2004-01-01

From October 1995 to September 2000 (water years 1996-2000), continuous 15-minute stage, water velocity, salinity, and water temperature data were collected at seven estuarine creeks that flow into northeastern Florida Bay. These creeks include West Highway Creek, Stillwater Creek, Trout Creek, Mud Creek, Taylor River, Upstream Taylor River, and McCormick Creek. Discharge was computed at 15-minute intervals using mean water velocity and the cross-sectional area of the channel. Fifteen-minute unit values are presented for comparison of the quantity, quality, timing, and distribution of flows through the creeks. Revised discharge estimation formulas are presented for three noninstrumented sites (East Highway Creek, Oregon Creek and Stillwater Creek) that utilize an improved West Highway discharge rating. Stillwater Creek and Upstream Taylor River were originally noninstrumented sites; both were fully instrumented in 1999. Discharge rating equations are presented for these sites and were developed using a simple linear regression.

Wear Trends of the HERMeS Thruster as a Function of Throttle Point

NASA Technical Reports Server (NTRS)

Williams, George J., Jr.; Kamhawi, Hani; Choi, Maria; Haag, Thomas; Huang, Wensheng; Herman, Daniel A.; Gilland, James H.; Peterson, Peter Y.

2017-01-01

A series of short-duration (200 hour) wear tests were conducted with two Hall Effect Rocket with Magnetic Shielding (HERMeS) technology demonstration units (TDU). Front pole covers, cathode keeper, and discharge channel wear were characterized as a function of discharge voltage, magnetic field strength, and chamber pressure. No discharge channel erosion was observed. Inner pole cover erosion was shown to be a weak function of discharge voltage with most erosion occurring at the lowest value, 300 volts. The TDU-3 keeper electrode eroded with each operating condition, with high magnetic field yielding the greatest erosion rate. The TDU-1 keeper electrode exhibited net deposition suggesting its configuration is more consistent with meeting overall HERMeS service life requirements. Ratios of molybdenum to graphite erosion rates suggests, with high uncertainty, that the sputtering ions are originating downstream of the thruster exit plane, striking the surface with small angles of incidence.

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children.

PubMed

Wu, Susan; Tyler, Amy; Logsdon, Tina; Holmes, Nicholas M; Balkian, Ara; Brittan, Mark; Hoover, LaVonda; Martin, Sara; Paradis, Melisa; Sparr-Perkins, Rhonda; Stanley, Teresa; Weber, Rachel; Saysana, Michele

2016-08-01

To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges. This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children's hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan-do-study-act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies. Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05). Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non-children's hospital settings. Copyright © 2016 by the American Academy of Pediatrics.

National Hospital Discharge Survey: 2001 annual summary with detailed diagnosis and procedure data.

PubMed

Kozak, Lola Jean; Owings, Maria F; Hall, Margaret J

2004-06-01

This report presents 2001 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Admission source and type, collected for the first time in the 2001 National Hospital Discharge Survey, are shown. The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2001, data were collected for approximately 330,000 discharges. Of the 477 eligible non-Federal short-stay hospitals in the sample, 448 (94 percent) responded to the survey. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code numbers. Rates are computed with 2001 population estimates based on the 2000 census. The appendix includes a comparison of rates computed with 1990 and 2000 census-based population estimates. An estimated 32.7 million inpatients were discharged from non-Federal short-stay hospitals in 2001. They used 159.4 million days of care and had an average length of stay of 4.9 days. Common first-listed discharge diagnoses included delivery, psychoses, pneumonia, malignant neoplasm, and coronary atherosclerosis. Males had higher rates for procedures such as cardiac catheterization and coronary artery bypass graft, and females had higher rates for procedures such as cholecystectomy and total knee replacement. The rates of all cesarean deliveries, primary and repeat, rose from 1995 to 2001; the rate of vaginal birth after cesarean delivery dropped 37 percent during this period.

Physical Tasks of Military Occupational Specialties as Risk Factors for Knee-Related Disability Discharge.

DTIC Science & Technology

2000-02-01

also associated with certain sports , such as professional or recreational volleyball, soccer, basketball, and rugby.58 One study showed injuries in...hyperextended.5 Another study showed sports with contact, such as rugby, to have higher levels of knee injuries than non-contact sports .8 Physical...housing, and amount of weekly exercise. Also, combat units had higher injury rates than non- combat units. Rates of injury also increased with the amount of

Discharge planning for heart failure patients in a tertiary hospital in Shanghai: a best practice implementation project.

PubMed

Chen, Yu; Zhu, Li; Xu, Fei; Chen, Jun

2016-02-01

Heart failure is a major public health concern which contributes significantly to rising healthcare costs. Comprehensive discharge planning can improve health outcomes and reduce readmission rates which, in turn, can lead to cost savings. The aim of this project was to promote best practice in the discharge planning of heart failure patients admitted in the coronary care unit of Zhongshan Hospital. A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Five audit criteria that represent best practice recommendations for heart failure discharge planning were used. A baseline audit was conducted followed by the implementation of multiple strategies, and the project was finalized with a follow-up audit to determine change in practice. Improvements in practice were observed for all five criteria. The most significant improvements were in the following: completion of a discharge checklist (from 0% to 100% compliance), comprehensive (i.e. inclusion of six topics for self-care) discharge education for patients (from 7% to 100% compliance), and conducting a telephone follow-up (from 0% to 76% compliance). The compliance rates for the two remaining criteria, completion of a structured education for patients and scheduling an outpatient clinic visit, both increased from 93% to 100%.Strategies that were implemented to achieve change in practice included development of a local discharge planning checklist, provision of training for nurses, and development of resources. The project demonstrated positive changes in the discharge planning practices of nurses in the coronary care unit of Zhongshan Hospital. A formalized discharge planning is currently in place and plans for sustaining practice change are underway. A continuous cycle of audit and re-audit will need to be carried out in the future to determine the impact of this evidence implementation activity on heart failure patient outcomes.

Hospital discharge rates for nontraumatic lower extremity amputation by diabetes status--United States, 1997.

PubMed

2001-11-02

Lower extremity amputation (LEA) is a costly and disabling procedure that disproportionately affects persons with diabetes. One of the national health objectives for 2000 was to reduce the LEA rate from a 1991 baseline of approximately eight per 1,000 persons with diabetes to a target of approximately five per 1,000 persons with diabetes. Review of 1996 data indicated an LEA rate of approximately 11. To estimate the national rates of hospital discharges for LEA among persons with and without diabetes and to assess the excess risk for LEA among persons with diabetes, CDC and the Agency for Healthcare Research and Quality (AHRQ) analyzed data from the 1997 Nationwide Inpatient Sample (NIS) and the 1997 National Health Interview Survey (NHIS). This report summarizes the findings of the analysis, which indicated that the age-adjusted rates of hospital discharges among persons with LEA who had diabetes were 28 times that of those without diabetes. This higher rate underscores the need to increase efforts to prevent risk factors (e.g., peripheral vascular disease, neuropathy, and infection) that result in LEA among persons with diabetes.

Trends and Burden of Bronchiectasis-Associated Hospitalizations in the United States, 1993-2006

PubMed Central

Seitz, Amy E.; Olivier, Kenneth N.; Steiner, Claudia A.; Montes de Oca, Ruben; Holland, Steven M.

2010-01-01

Background: Current data on bronchiectasis prevalence, trends, and risk factors are lacking; such data are needed to estimate the burden of disease and for improved medical care and public health resource allocation. The objective of the present study was to estimate the trends and burden of bronchiectasis-associated hospitalizations in the United States. Methods: We extracted hospital discharge records containing International Classification of Diseases, 9th Revision, Clinical Modification codes for bronchiectasis (494, 494.0, and 494.1) as any discharge diagnosis from the State Inpatient Databases from the Agency for Healthcare Research and Quality. Discharge records were extracted for 12 states with complete and continuous reporting from 1993 to 2006. Results: The average annual age-adjusted hospitalization rate from 1993 to 2006 was 16.5 hospitalizations per 100,000 population. From 1993 to 2006, the age-adjusted rate increased significantly, with an average annual percentage increase of 2.4% among men and 3.0% among women. Women and persons aged > 60 years had the highest rate of bronchiectasis-associated hospitalizations. The median cost for inpatient care was 7,827 US dollars (USD) (range, 13-543,914 USD). Conclusions: The average annual age-adjusted rate of bronchiectasis-associated hospitalizations increased from 1993 to 2006. This study furthers the understanding of the impact of bronchiectasis and demonstrates the need for further research to identify risk factors and reasons for the increasing burden. PMID:20435655

Evaluating Micrometeorological Estimates of Groundwater Discharge from Great Basin Desert Playas.

PubMed

Jackson, Tracie R; Halford, Keith J; Gardner, Philip M

2018-03-06

Groundwater availability studies in the arid southwestern United States traditionally have assumed that groundwater discharge by evapotranspiration (ET g ) from desert playas is a significant component of the groundwater budget. However, desert playa ET g rates are poorly constrained by Bowen ratio energy budget (BREB) and eddy-covariance (EC) micrometeorological measurement approaches. Best attempts by previous studies to constrain ET g from desert playas have resulted in ET g rates that are within the measurement error of micrometeorological approaches. This study uses numerical models to further constrain desert playa ET g rates that are within the measurement error of BREB and EC approaches, and to evaluate the effect of hydraulic properties and salinity-based groundwater density contrasts on desert playa ET g rates. Numerical models simulated ET g rates from desert playas in Death Valley, California and Dixie Valley, Nevada. Results indicate that actual ET g rates from desert playas are significantly below the uncertainty thresholds of BREB- and EC-based micrometeorological measurements. Discharge from desert playas likely contributes less than 2% of total groundwater discharge from Dixie and Death Valleys, which suggests discharge from desert playas also is negligible in other basins. Simulation results also show that ET g from desert playas primarily is limited by differences in hydraulic properties between alluvial fan and playa sediments and, to a lesser extent, by salinity-based groundwater density contrasts. Published 2018. This article is a U.S. Government work and is in the public domain in the USA.

Comparative Analgesic Efficacy of Oxycodone/Acetaminophen Versus Hydrocodone/Acetaminophen for Short-term Pain Management in Adults Following ED Discharge.

PubMed

Chang, Andrew K; Bijur, Polly E; Holden, Lynne; Gallagher, E John

2015-11-01

The objective was to test the hypothesis that oxycodone/acetaminophen provides superior analgesia to hydrocodone/acetaminophen for the treatment of acute extremity pain following emergency department (ED) discharge. This was a prospective, randomized, double-blind clinical trial of nonelderly adult ED patients with acute musculoskeletal extremity pain, randomly allocated at discharge to receive oxycodone/acetaminophen (5 mg/325 mg) or hydrocodone/acetaminophen (5 mg/325 mg). The primary outcome was the between-group difference in improvement in numerical rating scale (NRS) pain scores over a 2-hour period following the most recent ingestion of study drug, obtained during telephone contact 24 hours after ED discharge. Secondary outcomes included proportionate decrease in pain, comparative side-effect profiles, and patient satisfaction. A total of 240 patients were enrolled. The final sample consisted of 220 patients, 107 randomly allocated to oxycodone/acetaminophen and 113 to hydrocodone/acetaminophen. At 24 hours after ED discharge, the mean NRS pain scores prior to the most recent dose of outpatient pain medication were 7.8 and 7.9 in the oxycodone/acetaminophen and hydrocodone/acetaminophen groups, respectively. The mean decreases in pain scores over 2 hours were 4.4 NRS units in the oxycodone/acetaminophen group versus 4.0 NRS units in the hydrocodone/acetaminophen group, for a difference of 0.4 NRS units (95% confidence interval = -0.2 to 1.1 NRS units). Satisfaction with the analgesics was similar. This study design could not detect a clinically or statistically significant difference in analgesic efficacy between oxycodone/acetaminophen (5 mg/325 mg) and hydrocodone/acetaminophen (5 mg/325 mg) for treatment of acute musculoskeletal extremity pain in adults following ED discharge. Both opioids reduced pain scores by approximately 50%. © 2015 by the Society for Academic Emergency Medicine.

Gas and plasma dynamics of RF discharge jet of low pressure in a vacuum chamber with flat electrodes and inside tube, influence of RF discharge on the steel surface parameters

NASA Astrophysics Data System (ADS)

Khristoliubova, V. I.; Kashapov, N. F.; Shaekhov, M. F.

2016-06-01

Researches results of the characteristics of the RF discharge jet of low pressure and the discharge influence on the surface modification of high speed and structural steels are introduced in the article. Gas dynamics, power and energy parameters of the RF low pressure discharge flow in the discharge chamber and the electrode gap are studied in the presence of the materials. Plasma flow rate, discharge power, the concentration of electrons, the density of RF power, the ion current density, and the energy of the ions bombarding the surface materials are considered for the definition of basic properties crucial for the process of surface modification of materials as they were put in the plasma jet. The influence of the workpiece and effect of products complex configuration on the RF discharge jet of low pressure is defined. The correlation of the input parameters of the plasma unit on the characteristics of the discharge is established.

The RECALCAR Project. Healthcare in the Cardiology Units of the Spanish National Health System, 2011 to 2014.

PubMed

Íñiguez Romo, Andrés; Bertomeu Martínez, Vicente; Rodríguez Padial, Luis; Anguita Sánchez, Manuel; Ruiz Mateas, Francisco; Hidalgo Urbano, Rafael; Bernal Sobrino, José Luis; Fernández Pérez, Cristina; Macaya de Miguel, Carlos; Elola Somoza, Francisco Javier

2017-07-01

The RECALCAR project (Spanish acronym for Resources and Quality in Cardiology Units) uses 2 data sources: a survey of cardiology units and an analysis of the Minimum Basic Data set of all hospital discharges of the Spanish National Health System. From 2011 to 2014, there was marked stability in all indicators of the availability, utilization, and productivity of cardiology units. There was significant variability between units and between the health services of the autonomous communities. There was poor implementation of process management (only 14% of the units) and scarce development of health care networks (17%). Structured cardiology units tended to have better results, in terms of both quality and efficiency. No significant differences were found between the different types of unit in the mean length of stay (5.5±1.1 days) or the ratio between successive and first consultations (2:1). The mean discharge rate was 5/1000 inhabitants/y and the mean rate of initial consultations was 16±4/1000 inhabitants/y. No duty or on-call cardiologist was available in 30% of cardiology units with 24 or more beds; of these, no critical care beds were available in 45%. Our findings support the recommendation to regionalize cardiology care and to promote the development of cardiology unit networks. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Independence of motor unit recruitment and rate modulation during precision force control.

PubMed

Kamen, G; Du, D C

1999-01-01

The vertebrate motor system chiefly employs motor unit recruitment and rate coding to modulate muscle force output. In this paper, we studied how the recruitment of new motor units altered the firing rate of already-active motor units during precision force production in the first dorsal interosseous muscle. Six healthy adults performed linearly increasing isometric voluntary contractions while motor unit activity and force output were recorded. After motor unit discharges were identified, motor unit firing rates were calculated before and after the instances of new motor unit recruitment. Three procedures were applied to compute motor unit firing rate, including the mean of a fixed number of inter-spike intervals and the constant width weighted Hanning window filter method, as well as a modified boxcar technique. In contrast to previous reports, the analysis of the firing rates of over 200 motor units revealed that reduction of the active firing rates was not a common mechanism used to accommodate the twitch force produced by the recruitment of a new motor unit. Similarly, during de-recruitment there was no tendency for motor unit firing rates to increase immediately following the cessation of activity in other motor units. Considerable consistency in recruitment behavior was observed during repeated contractions. However, firing rates during repeated contractions demonstrated considerably more fluctuation. It is concluded that the neuromuscular system does not use short-term preferential motor unit disfacilitation to effect precise regulation of muscular force output.

Load type influences motor unit recruitment in biceps brachii during a sustained contraction.

PubMed

Baudry, Stéphane; Rudroff, Thorsten; Pierpoint, Lauren A; Enoka, Roger M

2009-09-01

Twenty subjects participated in four experiments designed to compare time to task failure and motor-unit recruitment threshold during contractions sustained at 15% of maximum as the elbow flexor muscles either supported an inertial load (position task) or exerted an equivalent constant torque against a rigid restraint (force task). Subcutaneous branched bipolar electrodes were used to record single motor unit activity from the biceps brachii muscle during ramp contractions performed before and at 50 and 90% of the time to failure for the position task during both fatiguing contractions. The time to task failure was briefer for the position task than for the force task (P=0.0002). Thirty and 29 motor units were isolated during the force and position tasks, respectively. The recruitment threshold declined by 48 and 30% (P=0.0001) during the position task for motor units with an initial recruitment threshold below and above the target force, respectively, whereas no significant change in recruitment threshold was observed during the force task. Changes in recruitment threshold were associated with a decrease in the mean discharge rate (-16%), an increase in discharge rate variability (+40%), and a prolongation of the first two interspike intervals (+29 and +13%). These data indicate that there were faster changes in motor unit recruitment and rate coding during the position task than the force task despite a similar net muscle torque during both tasks. Moreover, the results suggest that the differential synaptic input observed during the position task influences most of the motor unit pool.

The effect of NACHRI children's hospital designation on outcome in pediatric malignant brain tumors.

PubMed

Donoho, Daniel A; Wen, Timothy; Liu, Jonathan; Zarabi, Hosniya; Christian, Eisha; Cen, Steven; Zada, Gabriel; McComb, J Gordon; Krieger, Mark D; Mack, William J; Attenello, Frank J

2017-08-01

OBJECTIVE Although current pediatric neurosurgery guidelines encourage the treatment of pediatric malignant brain tumors at specialized centers such as pediatric hospitals, there are limited data in support of this recommendation. Previous studies suggest that children treated by higher-volume surgeons and higher-volume hospitals may have better outcomes, but the effect of treatment at dedicated children's hospitals has not been investigated. METHODS The authors analyzed the Healthcare Cost and Utilization Project Kids' Inpatient Database (KID) from 2000-2009 and included all patients undergoing a craniotomy for malignant pediatric brain tumors based on ICD-9-CM codes. They investigated the effects of patient demographics, tumor location, admission type, and hospital factors on rates of routine discharge and mortality. RESULTS From 2000 through 2009, 83.6% of patients had routine discharges, and the in-hospital mortality rate was 1.3%. In multivariate analysis, compared with children treated at an institution designated as a pediatric hospital by NACHRI (National Association of Children's Hospitals and Related Institutions), children receiving treatment at a pediatric unit within an adult hospital (OR 0.5, p < 0.01) or a general hospital without a designated pediatric unit (OR 0.4, p < 0.01) were less likely to have routine discharges. Treatment at a large hospital (> 400 beds; OR 1.8, p = 0.02) and treatment at a teaching hospital (OR 1.7, p = 0.02) were independently associated with greater likelihood of routine discharge. However, patients transferred between facilities had a significantly decreased likelihood of routine discharge (OR 0.5, p < 0.01) and an increased likelihood of mortality (OR 5.0, p < 0.01). Procedural volume was not associated with rate of routine discharge or mortality. CONCLUSIONS These findings may have implications for planning systems of care for pediatric patients with malignant brain tumors. The authors hope to motivate future research into the specific factors that may lead to improved outcomes at designated pediatric hospitals.

COPD Surveillance—United States, 1999-2011

PubMed Central

Croft, Janet B.; Mannino, David M.; Wheaton, Anne G.; Zhang, Xingyou; Giles, Wayne H.

2013-01-01

This report updates surveillance results for COPD in the United States. For 1999 to 2011, data from national data systems for adults aged ≥ 25 years were analyzed. In 2011, 6.5% of adults (approximately 13.7 million) reported having been diagnosed with COPD. From 1999 to 2011, the overall age-adjusted prevalence of having been diagnosed with COPD declined (P = .019). In 2010, there were 10.3 million (494.8 per 10,000) physician office visits, 1.5 million (72.0 per 10,000) ED visits, and 699,000 (32.2 per 10,000) hospital discharges for COPD. From 1999 to 2010, no significant overall trends were noted for physician office visits and ED visits; however, the age-adjusted hospital discharge rate for COPD declined significantly (P = .001). In 2010 there were 312,654 (11.2 per 1,000) Medicare hospital discharge claims submitted for COPD. Medicare claims (1999-2010) declined overall (P = .045), among men (P = .022) and among enrollees aged 65 to 74 years (P = .033). There were 133,575 deaths (63.1 per 100,000) from COPD in 2010. The overall age-adjusted death rate for COPD did not change during 1999 to 2010 (P = .163). Death rates (1999-2010) increased among adults aged 45 to 54 years (P < .001) and among American Indian/Alaska Natives (P = .008) but declined among those aged 55 to 64 years (P = .002) and 65 to 74 years (P < .001), Hispanics (P = .038), Asian/Pacific Islanders (P < .001), and men (P = .001). Geographic clustering of prevalence, Medicare hospitalizations, and deaths were observed. Declines in the age-adjusted prevalence, death rate in men, and hospitalizations for COPD since 1999 suggest progress in the prevention of COPD in the United States. PMID:23619732

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.

Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations

MedlinePlus

... the United States is becoming more common over time. In 2007, the reported food allergy rate among ... excluded. The NHDS uses a three-stage sampling design procedure to produce national estimates of hospital discharges. ...

Favorable bed utilization and readmission rates for emergency department observation unit heart failure patients.

PubMed

Schrager, Justin; Wheatley, Matthew; Georgiopoulou, Vasiliki; Osborne, Anwar; Kalogeropoulos, Andreas; Hung, Olivia; Butler, Javed; Ross, Michael

2013-06-01

The objective was to compare readmission rates and hospital bed-days between acute decompensated heart failure (AHF) patients admitted or discharged following accelerated treatment protocol (ATP)-driven care in an emergency department observation unit (OU). This was a retrospective cohort study conducted at two urban university-affiliated hospitals. A total of 358 selected AHF patients received treatment on an ATP in the OU between October 1, 2007, and June 30, 2011. The comparison of interest was admission or discharge following OU treatment. The outcome of interest was readmission within 30 and 90 days of hospital discharge following care in the OU. We also examined resource use (inpatient, inpatient plus outpatient-days) between the admitted and discharged groups. Time to readmission analysis was performed with Cox proportional hazards regression. Discharged and admitted patients were similar with respect to age, race, sex, ED length of stay (LOS), and OU LOS. Patients admitted from the OU had a higher median B-type natriuretic peptide (BNP; 1,063 pg/mL [interquartile range {IQR} = 552 to 2,067 pg/mL] vs. 708 pg/mL [IQR = 254 to 1,683 pg/mL]; p = 0.002) and blood urea nitrogen (BUN; 19 mg/dL [IQR = 14 to 26 mg/dL] vs. 17 mg/dL [IQR = 13 to 23 mg/dL]) than those discharged (p = 0.04) and a lower median ejection fraction (EF; 22.5% [15% to 43%] vs. 35% [IQR 20% to 55%]; p = 0.002). In models controlling for age, race, sex, clinical site, BNP, BUN, creatinine, and EF, the 30-day readmission rate (13.8% in the study population as a whole) was not significantly different between the patients discharged or admitted following OU care (hazard ratio [HR] = 0.99; 95% confidence interval [CI] = 0.47 to 2.10). The readmission rates were also not significantly different at 90 days (HR = 1.07; 95% CI = 0.65 to 1.77). Within 30 days of discharge from the OU, patients spent a median of 1.7 days (IQR = 0.0 to 5.1 days) as inpatients, compared to 3.5 days (IQR = 2.3 to 5.8 days) among patients admitted from the OU (p < 0.0001). Among readmitted patients, the total median inpatient time was not significantly different between the comparison groups at both 30 and 90 days of follow-up. Selected acute heart failure (HF) patients managed by a rapid treatment protocol in the OU demonstrated favorable hospital use, with discharged patients using fewer bed-days and demonstrating readmission rates that were not higher than admitted patients. © 2013 by the Society for Academic Emergency Medicine.

Factors Associated With the Increasing Rates of Discharges Directly Home From Intensive Care Units-A Direct From ICU Sent Home Study.

PubMed

Lau, Vincent I; Priestap, Fran A; Lam, Joyce N H; Ball, Ian M

2018-02-01

To evaluate the relationship between rates of discharge directly to home (DDH) from the intensive care unit (ICU) and bed availability (ward and ICU). Also to identify patient characteristics that make them candidates for safe DDH and describe transfer delay impact on length of stay (LOS). Retrospective cohort study of all adult patients who survived their stay in our medical-surgical-trauma ICU between April 2003 and March 2015. Median age was 49 years (interquartile range [IQR]: 33.5-60.4), and the majority of the patients were males (54.8%). Median number of preexisting comorbidities was 5 (IQR: 2-7) diagnoses. Discharge directly to home increased from 28 (3.1% of all survivors) patients in 2003 to 120 (12.5%) patients in 2014. The mean annual rate of DDH was between 11% and 12% over the last 6 years. Approximately 62% (n = 397) of patients waited longer than 4 hours for a ward bed, with a median delay of 2.0 days (IQR: 0.5-4.7) before being DDH. There was an inverse correlation between ICU occupancy and DDH rates ( r P = -.55, P < .0001, 95% confidence interval [CI] = -0.36 to -0.69, R 2 = .29). There was no correlation with ward occupancy and DDH rates ( r s = -.055, P = .64, 95% CI = -0.25 to 0.21). The DDH rates have been increasing over time at our institution and were inversely correlated with ICU bed occupancy but were not associated with ward occupancy. The DDH patients are young, have few comorbidities on admission, and few discharge diagnoses, which are usually reversible single system problems with low disease burden. Transfers to the ward are delayed in a majority of cases, leading to increased ICU LOS and likely increased overall hospital LOS as well.

Deinstitutionalization of American public hospitals for the mentally ill before and after the introduction of antipsychotic medications.

PubMed

Pow, Joni Lee; Baumeister, Alan A; Hawkins, Mike F; Cohen, Alex S; Garand, James C

2015-01-01

Deinstitutionalization following the introduction of antipsychotic medications in 1954 has received much attention as a major narrative in psychiatry. Little attention has been given, however, to deinstitutionalization before 1954. Using United States census data on discharge and readmission rates of US mental hospitals from 1935 to 1964, this article analyzes deinstitutionalization using an interrupted time-series model, with particular attention to the statistical significance of trends before and after the advent of antipsychotics. Discharge rates significantly increased in the period before antipsychotics, indicating that deinstitutionalization began before 1954, although readmissions during that same period increased at the same rate as discharges. A reasonable inference is that patients discharged in the pre-antipsychotic period were unable to live independently outside the hospital. After 1954, both discharges and readmissions increased significantly, but due to a continuing increase in admissions, no significant decrease in mental hospital populations occurred during the seven-year period after 1954. The decline began in 1961 and coincided with changes in federal policy. The fate of mental patients discharged from hospitals during this second period of deinstitutionalization is examined. The central conclusions are (1) the overall reduction in the population of mental hospitals did not coincide with the 1954 introduction of antipsychotic medications, and (2) deinstitutionalization before and after drugs has been met with inadequate community-based care.

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.

The Uniform Data System for Medical Rehabilitation

PubMed Central

Graham, James E.; Granger, Carl V.; Karmarkar, Amol M.; Deutsch, Anne; Niewczyk, Paulette; DiVita, Margaret A.; Ottenbacher, Kenneth J.

2013-01-01

Objective Present yearly aggregated summaries of rehabilitation outcomes at admission, discharge, and follow-up from a national sample of patients receiving inpatient medical rehabilitation for stroke, traumatic brain injury, lower extremity fracture, lower extremity joint replacement, traumatic spinal cord injury, or debility. Design Analysis of secondary data from more than 300 inpatient rehabilitation facilities in the United States that contributed inpatient and follow-up data to the Uniform Data System for Medical Rehabilitation during the period January 2002 through December 2010. Aggregate variables reported include demographic information, social situation, and functional status (FIM® instrument ratings at admission, discharge, and follow-up). Follow-up data were obtained 80–180 days post-discharge through telephone interviews by trained clinical staff. Results The final sample included 287,104 patients with follow-up information. Median time to follow-up was 95 days. Overall, more than 90% of patients within each impairment group were living in the community at follow-up. Follow-up FIM total ratings were stable to slightly increased over time. Change scores (discharge to follow-up) increased in all six groups. Mean FIM gains from discharge to follow-up, as a percentage of mean gains from admission to discharge, varied by impairment category: 46% for spinal cord injury to 71% for lower extremity fracture. Locomotion yielded the lowest ratings at all three assessments within each of the six impairment groups. Conclusions Follow-up data from a national sample of patients discharged from inpatient rehabilitation indicate that gains in mean functional independence scores from both admission to discharge and discharge to follow-up gradually increased from 2002 to 2010. At follow-up, more than 9 out of 10 patients in all 6 groups are living in the community. PMID:24088780

The Relationship between Toxics Release Inventory Discharges and Mortality Rates in Rural and Urban Areas of the United States

ERIC Educational Resources Information Center

Hendryx, Michael; Fedorko, Evan

2011-01-01

Background: Potential environmental exposures from chemical manufacturing or industrial sites have not been well studied for rural populations. The current study examines whether chemical releases from facilities monitored through the Toxics Release Inventory (TRI) program are associated with population mortality rates for both rural and urban…

Evidence of Temporal Postdischarge Decontamination of Bacteria by Gliding Electric Discharges: Application to Hafnia alvei▿

PubMed Central

Kamgang-Youbi, Georges; Herry, Jean-Marie; Bellon-Fontaine, Marie-Noëlle; Brisset, Jean-Louis; Doubla, Avaly; Naïtali, Murielle

2007-01-01

This study aimed to characterize the bacterium-destroying properties of a gliding arc plasma device during electric discharges and also under temporal postdischarge conditions (i.e., when the discharge was switched off). This phenomenon was reported for the first time in the literature in the case of the plasma destruction of microorganisms. When cells of a model bacterium, Hafnia alvei, were exposed to electric discharges, followed or not followed by temporal postdischarges, the survival curves exhibited a shoulder and then log-linear decay. These destruction kinetics were modeled using GinaFiT, a freeware tool to assess microbial survival curves, and adjustment parameters were determined. The efficiency of postdischarge treatments was clearly affected by the discharge time (t*); both the shoulder length and the inactivation rate kmax were linearly modified as a function of t*. Nevertheless, all conditions tested (t* ranging from 2 to 5 min) made it possible to achieve an abatement of at least 7 decimal logarithm units. Postdischarge treatment was also efficient against bacteria not subjected to direct discharge, and the disinfecting properties of “plasma-activated water” were dependent on the treatment time for the solution. Water treated with plasma for 2 min achieved a 3.7-decimal-logarithm-unit reduction in 20 min after application to cells, and abatement greater than 7 decimal logarithm units resulted from the same contact time with water activated with plasma for 10 min. These disinfecting properties were maintained during storage of activated water for 30 min. After that, they declined as the storage time increased. PMID:17557841

[Predictors of the therapeutic discharge in patients with dual pathology admitted to a therapeutic community with a psychiatric unit].

PubMed

Madoz-Gúrpide, Agustín; García Vicent, Vicente; Luque Fuentes, Encarnación; Ochoa Mangado, Enriqueta

2013-01-01

This study aims to analyze the variables on which depends therapeutic discharge, in patients with a severe dual diagnosis admitted to a professional therapeutic community where their pathology is treated. 325 patients admitted between June 2000 and June 2009 to the therapeutic community. This is a retrospective, cross-sectional study with no control group, based on the detailed analysis of the information collected in a model of semi-structured clinical interview designed in the therapeutic community. The 29.5% of the individuals included in the sample were therapeutically discharged. Of all the variables introduced in this analysis the most significant ones were gender, age at the beginning of treatment, education level, opiate dependence, polidrug abuse, and the presence of psychotic disorders and borderline personality disorder. In our study, gender determines the type of discharge, being therapeutic discharge more frequent among women. A higher educational also increases a better prognosis with a higher rate of therapeutic discharge among individuals with higher education level. A later age at the beginning of the treatment reduces the likelihood of therapeutic discharge. Likewise, polidrug abuse, diagnosis of psychotic disorders and borderline personality disorder are associated to a lower rate of therapeutic discharge. Recognizing these characteristics will allow the early identification of those patients more at risk of dropping treatment hastily, while trying to prevent it by increasing the therapeutic intensity.

Discharge properties of upper airway motor units during wakefulness and sleep.

PubMed

Trinder, John; Jordan, Amy S; Nicholas, Christian L

2014-01-01

Upper airway muscle motoneurons, as assessed at the level of the motor unit, have a range of different discharge patterns, varying as to whether their activity is modulated in phase with the respiratory cycle, are predominantly inspiratory or expiratory, or are phasic as opposed to tonic. Two fundamental questions raised by this observation are: how are synaptic inputs from premotor neurons distributed over motoneurons to achieve these different discharge patterns; and how do different discharge patterns contribute to muscle function? We and others have studied the behavior of genioglossus (GG) and tensor palatini (TP) single motor units at transitions from wakefulness to sleep (sleep onset), from sleep to wakefulness (arousal from sleep), and during hypercapnia. Results indicate that decreases or increases in GG and TP muscle activity occur as a consequence of derecruitment or recruitment, respectively, of phasic and tonic inspiratory-modulated motoneurons, with only minor changes in rate coding. Further, sleep-wake state and chemical inputs to this "inspiratory system" appear to be mediated through the respiratory pattern generator. In contrast, phasic and tonic expiratory units and units with a purely tonic pattern, the "tonic system," are largely unaffected by sleep-wake state, and are only weakly influenced by chemical stimuli and the respiratory cycle. We speculate that the "inspiratory system" produces gross changes in upper airway muscle activity in response to changes in respiratory drive, while the "tonic system" fine tunes airway configuration with activity in this system being determined by local mechanical conditions. © 2014 Elsevier B.V. All rights reserved.

Quantifying the risk of nosocomial infection within Ebola Holding Units: a retrospective cohort study of negative patients discharged from five Ebola Holding Units in Western Area, Sierra Leone.

PubMed

Arkell, Paul; Youkee, Daniel; Brown, Colin S; Kamara, Abdul; Kamara, Thaim B; Johnson, Oliver; Lado, Marta; George, Viginia; Koroma, Fatmata; King, Matilda B; Parker, Benson E; Baker, Peter

2017-01-01

A central pillar in the response to the 2014 Ebola virus disease (EVD) epidemic in Sierra Leone was the role of Ebola Holding Units (EHUs). These units isolated patients meeting a suspect case definition, tested them for EVD, initiated appropriate early treatment and discharged negative patients to onward inpatient care or home. Positive patients were referred to Ebola Treatment Centres. We aimed to estimate the risk of nosocomial transmission within these EHUs. We followed up a cohort of 543 patients discharged with a negative EVD test from five EHUs in the Western Area, Sierra Leone, and examined all line-listed subsequent EVD tests from any facility in the Western Area to see whether the patient was retested within 30 days, matching by name, age and address. We defined possible readmissions as having the same name and age but uncertain address, and confirmed readmissions where name, age and address matched. We found a positive readmission rate of 3.3% (18 cases), which included 1.5% confirmed readmissions (8 cases) and 1.8% possible readmissions (10 cases). This is lower than rates previously reported. We cannot ascertain whether EVD was acquired within the EHUs or from re-exposure in the community. No demographic or clinical variables were identified as risk factors for positive readmission, likely due to our small sample size. These findings support the EHU model as a safe method for isolation of suspect EVD patients and their role in limiting the spread of EVD. © 2016 John Wiley & Sons Ltd.

Discharge planning for acute coronary syndrome patients in a tertiary hospital: a best practice implementation project.

PubMed

Lu, Minmin; Tang, Jun; Wu, Jianjin; Yang, Jie; Yu, Jiangyue

2015-08-14

Acute coronary syndromes threaten the lives of patients, and pose a high risk for morbidity and mortality despite advances in treatment. Evidence highlights that effective discharge planning is associated with long-term prognosis of patients. The aim of this project was to improve local practice in discharge planning for acute coronary syndrome patients in Huadong Hospital, Shanghai. Five criteria identified by the Joanna Briggs Institute were used to conduct an audit in the Cardiovascular Ward and Coronary Care Unit of Huadong Hospital, Shanghai. Forty-two nurses and 65 patients were involved. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in health practice were used to ascertain compliance with the criteria before and after the implementation of best practice. The program included three phases and was conducted over five months. The project showed that the compliance rates of in-house education, advice on lifestyle changes, education on discharge medication and left ventricular assessment reached 100%. Psychological screening also attained 97% compliance. There were improvements in the compliance rates of four criteria from 38% to 100%, excluding in-house education which was already 100% compliant. The project achieved significant improvements in establishing evidence-based practice of discharge planning for acute coronary syndrome patients in the Cardiovascular Ward and Coronary Care Unit. Strategies for sustaining best practice will continue to be developed in the future. The Joanna Briggs Institute.

Hydrologic Predictions in the Anthropocene: Exploration with Co-evolutionary Socio-hydrologic Models

NASA Astrophysics Data System (ADS)

Sivapalan, Murugesu; Tian, Fuqiang; Liu, Dengfeng

2013-04-01

Socio-hydrology studies the co-evolution and self-organization of humans in the hydrologic landscape, which requires a thorough understanding of the complex interactions between humans and water. On the one hand, the nature of water availability greatly impacts the development of society. On the other hand, humans can significantly alter the spatio-temporal distribution of water and in this way provide feedback to the society itself. The human-water system functions underlying such complex human-water interactions are not well understood. Exploratory models with the appropriate level of simplification in any given area can be valuable to understand these functions and the self-organization associated with socio-hydrology. In this study, a simple coupled modeling framework for socio-hydrology co-evolution is developed, and is used to illustrate the explanatory power of such models. In the Tarim River, humans depend heavily on agricultural production (other industries can be ignored for a start), and the social processes can be described principally by two variables, i.e., irrigated-area and human population. The eco-hydrological processes are expressed in terms of area under natural vegetation and stream discharge. The study area is the middle and the lower reaches of the Tarim River, which is divided into two modeling units, i.e. middle reach and lower reach. In each modeling unit, four ordinary differential equations are used to simulate the dynamics of the hydrological system represented by stream discharge, ecological system represented by area under natural vegetation, the economic system represented by irrigated area under agriculture and social system represented by human population. The four dominant variables are coupled together by several internal variables. For example, the stream discharge is coupled to irrigated area by the colonization rate and mortality rate of the irrigated area in the middle reach and the irrigated area is coupled to stream discharge by water used for irrigation. In a similar way, the stream discharge and natural vegetation are coupled together. The irrigated area is coupled to population by the colonization rate and mortality rate of the population. The discharge of the lower reach is determined by the discharge from the middle reach. The natural vegetation area in the lower reach is coupled to the discharge in the middle reach by water resources management policy. The co-evolution of the Tarim socio-hydrological system is then analyzed within this modeling framework to gain insights into the overall system dynamics and sensitivity to the external drivers and internal system variables.

Impact of a transition-of-care pharmacist during hospital discharge.

PubMed

Balling, Lauren; Erstad, Brian L; Weibel, Kurt

2015-01-01

To assess the impact of a transition-of-care pharmacist during hospital discharge. An academic medical center in southern Arizona. One pharmacist coordinated patient discharges in two inpatient units from August 2012 through July 2013. The pharmacist attended interdisciplinary discharge coordination meetings, ensured appropriate discharge orders, facilitated the filling of medications, and educated patients on discharge medications. The implementation of a transition-of-care pharmacist to provide discharge medication reconciliation and education. Readmission rates and medication interventions made by the pharmacist at discharge. The pharmacist was involved in the education of 1,011 patients and performed 452 interventions. There were more readmissions per month in the control year versus the year of pharmacist involvement (median 27.5 vs. 25, P = 0.0369). Interventions made by the pharmacist to improve discharge management included starting an omitted medication (23.5%), preventing multiple discharge problems (16.4%), avoiding duplication of therapy (15.7%), correcting insurance issues related to medication coverage (12.2%), changing an improper medication dose or quantity (11.3%), changing an inappropriate prescription for a medication (5.1%), preventing a drug interaction (3.3%), and resolving other problems (12.6%). The most common medication classes involved were antimicrobial agents (9.1%), anticoagulants (8%), antihyperglycemic agents (3.8%), other drug classes (24%), and multiple drug classes (35%). A transition-of-care pharmacist is in a unique position to educate patients on hospital discharge, to intercept a substantial number of medication errors, and to resolve insurance issues that may lead to adherence problems. These improvements in care may result in reduced hospital readmission rates.

Smoking cessation following admission to a coronary care unit.

PubMed

Rigotti, N A; Singer, D E; Mulley, A G; Thibault, G E

1991-01-01

To determine the impact of an episode of serious cardiovascular disease on smoking behavior and to identify factors associated with smoking cessation in this setting. Prospective observational study in which smokers admitted to a coronary care unit (CCU) were followed for one year after hospital discharge to determine subsequent smoking behavior. Coronary care unit of a teaching hospital. Preadmission smoking status was assessed in all 828 patients admitted to the CCU during one year. The 310 smokers surviving to hospital discharge were followed and their smoking behaviors assessed by self-report at six and 12 months. None. Six months after discharge, 32% of survivors were not smoking; the rate of sustained cessation at one year was 25%. Smokers with a new diagnosis of coronary heart disease (CHD) made during hospitalization had the highest cessation rate (53% vs. 31%, p = 0.01). On multivariate analysis, smoking cessation was more likely if patients were discharged with a diagnosis of CHD, had no prior history of CHD, were lighter smokers (less than 1 pack/day), and had congestive heart failure during hospitalization. Among smokers admitted because of suspected myocardial infarction (MI), cessation was more likely if the diagnosis was CHD than if it was noncoronary (37% vs. 19%, p less than 0.05), but a diagnosis of MI led to no more smoking cessation than did coronary insufficiency. Hospitalization in a CCU is a stimulus to long-term smoking cessation, especially for lighter smokers and those with a new diagnosis of CHD. Admission to a CCU may represent a time when smoking habits are particularly susceptible to intervention. Smoking cessation in this setting should improve patient outcomes because cessation reduces cardiovascular mortality, even when quitting occurs after the onset of CHD.

Gender Role in Total Knee Arthroplasty: A Retrospective Analysis of Perioperative Outcomes in US Patients.

PubMed

Whitlock, Keith G; Piponov, Hristo I; Shah, Sapan H; Wang, Olivia J; Gonzalez, Mark H

2016-12-01

Women present later than men for total knee arthroplasty (TKA) with more severe osteoarthritic disease but achieve comparable functional improvement and implant survival and also lower rates of revision. Despite these findings, there is significant underutilization of the procedure for women compared to men. We conducted a retrospective study to address the lack of information in the literature concerning the immediate and short-term perioperative outcomes between genders. The National Hospital Discharge Survey was evaluated between 2001 and 2010 for men and women undergoing primary TKA in the United States. Differences in gender, patient demographics, comorbidities, complications, length of stay, and discharge disposition were analyzed and identified. The growth in TKA was 145% for men and 131% for women over the 10-year period. Women presented with significantly higher rates of obesity, morbid obesity, postoperative transfusion rate, and length of stay. In contrast, men showed a greater proportion of diabetes, postoperative wound infections, and increased mortality rates. Males were also more likely to be discharged to home, whereas females were more likely to be discharged to rehabilitation facilities. Our findings provide important insight into the perioperative outcomes that may be influencing gender disparity in TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

A comparison of resource utilization following chemotherapy for acute myeloid leukemia in children discharged versus children that remain hospitalized during neutropenia

PubMed Central

Getz, Kelly D; Miller, Tamara P; Seif, Alix E; Li, Yimei; Huang, Yuan-Shung; Bagatell, Rochelle; Fisher, Brian T; Aplenc, Richard

2015-01-01

Comparisons of early discharge and outpatient postchemotherapy supportive care in pediatric acute myeloid leukemia (AML) patients are limited. We used data from the Pediatric Health Information System on a cohort of children treated for newly diagnosed AML to compare course-specific mortality and resource utilization in patients who were discharged after chemotherapy to outpatient management during neutropenia relative to patients who remained hospitalized. Patients were categorized at each course as early or standard discharge. Discharges within 3 days after chemotherapy completion were considered “early”. Resource utilization was determined based on daily billing data and reported as days of use per 1000 hospital days. Inpatient mortality, occurrence of intensive care unit (ICU)-level care, and duration of hospitalization were compared using logistic, log-binomial and linear regression methods, respectively. Poisson regression with inpatient days as offset was used to compare resource use by discharge status. The study population included 996 patients contributing 2358 treatment courses. Fewer patients were discharged early following Induction I (7%) than subsequent courses (22–24%). Across courses, patients discharged early experienced high readmission rates (69–84%), yet 9–12 fewer inpatient days (all P < 0.001). Inpatient mortality was low across courses and did not differ significantly by discharge status. The overall risk for ICU-level care was 116% higher for early compared to standard discharge patients (adjusted risk ratio: 2.16, 95% confidence interval: 1.50, 3.11). Rates of antibiotic, vasopressor, and supplemental oxygen use were consistently elevated for early discharge patients. Despite similar inpatient mortality to standard discharge patients, early discharge patients may be at greater risk for life-threatening chemotherapy-related complications, including infections. PMID:26105201

Test stand for gas-discharge chamber of TEA CO2 lasers with pulse-periodical energy supply

NASA Astrophysics Data System (ADS)

Shorin, Vladimyr P.; Bystrov, N. D.; Zhuravlyov, O. A.; Nekrasov, V. V.

1997-05-01

Test stand for function optimization (incomposition of gas- dynamic circuit (GDC) of operating characteristics of full- size discharge chamber of flowing TEA carbon-dioxide lasers (power up to 100 kW) was created in Samara State Aerospace University (former Kuibyshev Aviation Institute). Test stand includes an inside-type GDC, low inductive generators of voltage pulses of preionization and main discharges, two-flow rate system of gas supply and noise immunity diagnostic system. Module construction of units of GDC, power supplies of preionization and main discharges allows to change configuration of stand's systems for providing given properties of gas flow and its energy supply. This test stand can also be used in servicing of laser system. The diagnostic system of this stand allows us to analyze energy properties of discharge by means of oscillographic measurements of voltage and current with following processing of discharges' volt- ampere characteristics by means of a computer; rate of non- stationary gas-dynamic disturbances in discharge gap of discharge chamber was measured by means of pulse holographic system (UlG-1M) with data processing of schliren- and interferogram (density fluctuation sensitivity approximately 10-2) and sensor measurement system of gas-dynamic shock and acoustics process with resonance frequency exceeding 100 kHz. Research results of process of plasma plate wave and channel structures interaction with mediums, including actuation non-stationary gas-dynamic flows, cavitation erosion of preionization electrodes' dielectric substructure, ancillary heating of channels by main volumetric discharge are presented as well.

Rates of strabismus surgery in the United States: implications for manpower needs in pediatric ophthalmology.

PubMed

Dombrow, Matthew; Engel, Harry M

2007-08-01

To investigate rates of strabismus surgery and population projections in the United States and to consider whether a sufficient number of pediatric ophthalmologists are being trained to meet future needs. Review of online data from Series 13 reports from the National Center for Health Statistics for the period 1965 to 1996, including reports from the National Hospital Discharge Survey and the National Survey of Ambulatory Surgery. Population data were obtained from the U.S. Census Bureau. The current rate of strabismus surgery for children under 15 years of age is 80 per 100,000 persons in the United States. This rate would generate an additional 389 strabismus cases annually, based on the predicted growth of the pediatric population. On average, today's pediatric ophthalmologist performs about 114 strabismus procedures annually. If the current rates and trends remain stable over the coming years, it is not likely that there will be a shortage of pediatric ophthalmologists in the United States.

User experience of a centralized hyperacute stroke service: a prospective evaluation.

PubMed

Moynihan, Barry; Paul, Selina; Markus, Hugh S

2013-10-01

Centralizing hyperacute stroke unit (HASU) care services allows improved access to thrombolysis but could be associated with worse patient experience, particularly when early repatriation to a local stroke recovery unit occurs as this may result in discontinuity of care. A centralized model of care was introduced in London, United Kingdom, with 8 HASUs providing acute care for the whole 8.3 million population, with repatriation on day 3 to a local stroke recovery unit. The patient and carer experience of this model of care has not been previously reported. We undertook a prospective observational study of the new model of care in the South West London sector. Patient and carer experiences were evaluated using a modified Picker Questionnaire. Separate questionnaires were used for patients discharged directly home from the HASU, those repatriated to local stroke recovery units, and for carers of patients admitted to the HASU. Despite moving from a selected to nonselected admission pattern, thrombolysis rates increased from 6% to 9%. High satisfaction rates were reported among both patients and carers. Patients discharged directly home had higher satisfaction levels than those requiring repatriation to their local stroke unit, who were older and had more severe stroke. A total of 47% of carers expressed anxiety over the repatriation from the HASU back to the local stroke recovery unit, but few patients and carers reported an impact of this move on patient recovery. Centralized HASU care is associated with good levels of patient and carer satisfaction.

Mortality of adult intensive care units in Turkey using the APACHE II and SOFA systems (outcome assessment in Turkish intensive care units).

PubMed

Kaymak, Cetin; Sencan, Irfan; Izdes, Seval; Sari, Aydin; Yagmurdur, Hatice; Karadas, Derya; Oztuna, Derya

2018-04-01

The aim of this study was to evaluate intensive care unit (ICU) performance using risk-adjusted ICU mortality rates nationally, assessing patients who died or had been discharged from the ICU. For this purpose, this study analyzed the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) databases, containing detailed clinical and physiological information and mortality of mixed critically ill patients in a medical ICU at secondary and tertiary referral ICUs in Turkey. A total of 690 adult intensive care units in Turkey were included in the study. Among 690 ICUs evaluated, 39.7% were secondary and 60.3% were tertiary ICUs. A total of 4188 patients were enrolled in this study. Intensive care units of ministry, university, and private hospitals were evaluated all over Turkey. During the study period, clinical data that were collected concurrently for each patient contained demographic details and the diagnostic category leading to ICU admission. APACHE II and SOFA scores following ICU admission were calculated and recorded. Patients were followed up for outcome data until death or ICU discharge. The mean age of patients was 68.8 ±19 and 54% of them were male. The mean APACHE II score was 20 ±8.7. The ICUs' mortality rate was 46.3%, and mean predicted mortality was 37.2% for APACHE II. The standardized mortality ratio was 1.28 (95% confidence interval: 1.21-1.31). There was a wide difference in outcome for patients admitted to different ICUs and severity of illness using risk adjustment methods. The high mortality rate in patients could be related to comorbid diseases, high mechanical ventilation rates and older ages.

Reflex control of discharge in motor fibres to the larynx

PubMed Central

Głogowska, Maria; Stransky, A.; Widdicombe, J. G.

1974-01-01

1. Action potentials have been recorded from single laryngeal motor fibres, with expiratory or inspiratory phases, in cats anaesthetized with pentobarbitone and breathing through a tracheal cannula. 2. Pneumothorax increased the discharge of both inspiratory and expiratory units, the inspiratory response being greatly reduced by bilateral vagotomy below the origin of the recurrent laryngeal nerves. 3. Addition of a `viscous' resistance to breathing, or asphyxial rebreathing through an added dead space, increased the activity of inspiratory units and decreased that of expiratory units. 4. Induction of pulmonary oedema decreased the discharge of inspiratory units and increased that of expiratory units. After vagotomy the response of inspiratory units was reversed. 5. Intravenous injections of potassium cyanide increased the activity of both types of unit. 6. Chemical irritation of the laryngeal mucosa decreased the discharge of inspiratory units and increased that of expiratory units, whether the vagi were intact or cut. 7. It is concluded that expiratory unit discharge can be correlated with expiratory laryngeal resistance, but that inspiratory unit discharge does not correlate so well with inspiratory laryngeal resistance. 8. The relationship between laryngeal motor-fibre activity and the contractions of the inspiratory and expiratory muscles of breathing is discussed. PMID:4415512

National Hospital Discharge Survey: 2002 annual summary with detailed diagnosis and procedure data.

PubMed

Kozak, Lola J; Owings, Maria F; Hall, Margaret J

2005-03-01

This report presents 2002 national estimates and selected trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2002, data were collected for approximately 327,000 discharges. Of the 474 eligible non-Federal short-stay hospitals in the sample, 445 (94 percent) responded to the survey. An estimated 33.7 million inpatients were discharged from non-Federal short-stay hospitals in 2002. They used 164.2 million days of care and had an average length of stay of 4.9 days. Common first-listed discharge diagnoses included delivery, ischemic heart disease, psychoses, pneumonia, and malignant neoplasms. Inpatients had 6.8 million cardiovascular procedures and 6.6 million obstetric procedures. Males had higher rates for cardiac procedures such as cardiac catheterization and coronary artery bypass graft, but males and females had similar rates of pacemaker procedures. The number and rate of all cesarean deliveries, primary and repeat, rose from 1995 to 2002; the rate of vaginal birth after cesarean delivery dropped from 35.5 in 1995 to 15.8 in 2002.

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.

Consumption of the electric power inside silent discharge reactors

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

Yehia, Ashraf, E-mail: yehia30161@yahoo.com

An experimental study was made in this paper to investigate the relation between the places of the dielectric barriers, which cover the surfaces of the electrodes in the coaxial cylindrical reactors, and the rate of change of the electric power that is consumed in forming silent discharges. Therefore, silent discharges have been formed inside three coaxial cylindrical reactors. The dielectric barriers in these reactors were pasted on both the internal surface of the outer electrode in the first reactor and the external surface of the inner electrode in the second reactor as well as the surfaces of the two electrodesmore » in the third reactor. The reactor under study has been fed by atmospheric air that flowed inside it with a constant rate at normal temperature and pressure, in parallel with the application of a sinusoidal ac voltage between the electrodes of the reactor. The electric power consumed in forming the silent discharges inside the three reactors was measured as a function of the ac peak voltage. The validity of the experimental results was investigated by applying Manley's equation on the same discharge conditions. The results have shown that the rate of consumption of the electric power relative to the ac peak voltage per unit width of the discharge gap improves by a ratio of either 26.8% or 80% or 128% depending on the places of the dielectric barriers that cover the surfaces of the electrodes inside the three reactors.« less

Hospital use by the elderly in Poland and the United States.

PubMed Central

Bacon, W E; Wotjyniak, B; Krzyzanowski, M

1984-01-01

Hospital use by elderly patients in Poland and the United States was compared using data from the 1980 General Hospital Morbidity Study (Poland) and the National Hospital Discharge Survey (US). Discharge and days-of-care rates were higher in the US but average lengths of stay were longer in Poland. All three measures increased with advancing age in the US but remained relatively constant or decreased with age in Poland. Although the most frequent causes of hospitalization were similar in the two countries, the characteristic use patterns across age were evident for most frequently occurring disease conditions. The greater use of hospitals in the US is not associated with marked differences between the two countries in health status of the elderly. PMID:6388364

[Intensive care medicine-survival and prospect of life].

PubMed

Valentin, A

2017-10-01

Intensive care medicine has achieved a significant increase in survival rates from critical illness. In addition to short-term outcomes like intensive care unit or hospital mortality, long-term prognosis and prospect of life of intensive care patients have recently become increasingly important. Pure survival is no longer a sole goal of intensive care medicine. The prediction of an intensive care patient's individual course should include the period after intensive care. A relevant proportion of all intensive care patients is affected by physical, psychological, cognitive, and social limitations after discharge from the intensive care unit. The prognosis of the status of the patient after discharge from the intensive care unit is an important part of the decision-making process with respect to the implementation or discontinuation of intensive care measures. The heavy burden of intensive care treatment should not solely be argued by pure survival but an anticipated sound prospect of life.

The Uniform Data System for Medical Rehabilitation: report of follow-up information on patients discharged from inpatient rehabilitation programs in 2002-2010.

PubMed

Graham, James E; Granger, Carl V; Karmarkar, Amol M; Deutsch, Anne; Niewczyk, Paulette; Divita, Margaret A; Ottenbacher, Kenneth J

2014-03-01

The aim of this study was to present yearly aggregated summaries of rehabilitation outcomes at admission, discharge, and follow-up from a national sample of patients receiving inpatient medical rehabilitation for stroke, traumatic brain injury, lower extremity fracture, lower extremity joint replacement, traumatic spinal cord injury, or debility. This is an analysis of secondary data from more than 300 inpatient rehabilitation facilities in the United States that contributed inpatient and follow-up data to the Uniform Data System for Medical Rehabilitation during the period January 2002 through December 2010. Aggregate variables reported include demographic information, social situation, and functional status (Functional Independence Measure instrument ratings at admission, discharge, and follow-up). Follow-up data were obtained 80-180 days after discharge through telephone interviews by trained clinical staff. The final sample included 287,104 patients with follow-up information. The median time to follow-up was 95 days. Overall, more than 90% of the patients within each impairment group were living in the community at follow-up. Follow-up Functional Independence Measure total ratings were stable to slightly increased over time. Change scores (discharge to follow-up) increased in all six groups. The mean Functional Independence Measure gains from discharge to follow-up, as a percentage of mean gains from admission to discharge, varied by impairment category: 46% for spinal cord injury to 71% for lower extremity fracture. Locomotion yielded the lowest ratings at all three assessments within each of the six impairment groups. The follow-up data from the national sample of patients discharged from inpatient rehabilitation indicate that gains in mean functional independence scores from both admission to discharge and discharge to follow-up gradually increased from 2002 to 2010. At follow-up, more than nine of ten patients in all six groups are living in the community.

Recruitment and Retention Challenges in a Technology-Based Study with Older Adults Discharged from a Geriatric Rehabilitation Unit.

PubMed

McCloskey, Rose; Jarrett, Pamela; Stewart, Connie; Keeping-Burke, Lisa

2015-01-01

Technology has the potential to offer support to older adults after being discharged from geriatric rehabilitation. This article highlights recruitment and retention challenges in a study examining an interactive voice response telephone system designed to monitor and support older adults and their informal caregivers following discharge from a geriatric rehabilitation unit. A prospective longitudinal study was planned to examine the feasibility of an interactive voice telephone system in facilitating the transition from rehabilitation to home for older adults and their family caregivers. Patient participants were required to make daily calls into the system. Using standardized instruments, data was to be collected at baseline and during home visits. Older adults and their caregivers may not be willing to learn how to use new technology at the time of hospital discharge. Poor recruitment and retention rates prevented analysis of findings. The importance of recruitment and retention in any study should never be underestimated. Target users of any intervention need to be included in both the design of the intervention and the study examining its benefit. Identifying the issues associated with introducing technology with a group of older rehabilitation patients should assist others who are interested in exploring the role of technology in facilitating hospital discharge. © 2014 Association of Rehabilitation Nurses.

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.

Prolonged mechanical ventilation in Canadian intensive care units: a national survey.

PubMed

Rose, Louise; Fowler, Robert A; Fan, Eddy; Fraser, Ian; Leasa, David; Mawdsley, Cathy; Pedersen, Cheryl; Rubenfeld, Gordon

2015-02-01

We sought to describe prevalence and care practices for patients experiencing prolonged mechanical ventilation (PMV), defined as ventilation for 21 or more consecutive days and medical stability. We provided the survey to eligible units via secure Web link to a nominated unit champion from April to November 2012. Weekly telephone and e-mail reminders were sent for 6 weeks. Response rate was 215 (90%) of 238 units identifying 308 patients requiring PMV on the survey day occupying 11% of all Canadian ventilator-capable beds. Most units (81%) used individualized plans for both weaning and mobilization. Weaning and mobilization protocols were available in 48% and 38% of units, respectively. Of those units with protocols, only 25% reported weaning guidance specific to PMV, and 11% reported mobilization content for PMV. Only 30% of units used specialized mobility equipment. Most units referred to speech language pathologists (88%); use of communication technology was infrequent (11%). Only 29% routinely referred to psychiatry/psychology, and 17% had formal discharge follow-up services. Prolonged mechanical ventilation patients occupied 11% of Canadian acute care ventilator bed capacity. Most units preferred an individualized approach to weaning and mobilization with considerable variation in weaning methods, protocol availability, access to specialized rehabilitation equipment, communication technology, psychiatry, and discharge follow-up. Copyright © 2014 Elsevier Inc. All rights reserved.

Reduction in Acute Myocardial Infarction Mortality in the United States

PubMed Central

Krumholz, Harlan M.; Wang, Yun; Chen, Jersey; Drye, Elizabeth E.; Spertus, John A.; Ross, Joseph S.; Curtis, Jeptha P.; Nallamothu, Brahmajee K.; Lichtman, Judith H.; Havranek, Edward P.; Masoudi, Frederick A.; Radford, Martha J.; Han, Lein F.; Rapp, Michael T.; Straube, Barry M.; Normand, Sharon-Lise T.

2012-01-01

Context During the last 2 decades, health care professional, consumer, and payer organizations have sought to improve outcomes for patients hospitalized with acute myocardial infarction (AMI). However, little has been reported about improvements in hospital short-term mortality rates or reductions in between-hospital variation in short-term mortality rates. Objective To estimate hospital-level 30-day risk-standardized mortality rates (RSMRs) for patients discharged with AMI. Design, Setting, and Patients Observational study using administrative data and a validated risk model to evaluate 3 195 672 discharges in 2 755 370 patients discharged from nonfederal acute care hospitals in the United States between January 1, 1995, and December 31, 2006. Patients were 65 years or older (mean, 78 years) and had at least a 12-month history of fee-for-service enrollment prior to the index hospitalization. Patients discharged alive within 1 day of an admission not against medical advice were excluded, because it is unlikely that these patients had sustained an AMI. Main Outcome Measure Hospital-specific 30-day all-cause RSMR. Results At the patient level, the odds of dying within 30 days of admission if treated at a hospital 1 SD above the national average relative to that if treated at a hospital 1 SD below the national average were 1.63 (95% CI, 1.60-1.65) in 1995 and 1.56 (95% CI, 1.53-1.60) in 2006. In terms of hospital-specific RSMRs, a decrease from 18.8% in 1995 to 15.8% in 2006 was observed (odds ratio, 0.76; 95% CI, 0.75-0.77). A reduction in between-hospital heterogeneity in the RSMRs was also observed: the coefficient of variation decreased from 11.2% in 1995 to 10.8%, the interquartile range from 2.8% to 2.1%, and the between-hospital variance from 4.4% to 2.9%. Conclusion Between 1995 and 2006, the risk-standardized hospital mortality rate for Medicare patients discharged with AMI showed a significant decrease, as did between-hospital variation. PMID:19690309

Comparative analysis of ex-situ and operando X-ray diffraction experiments for lithium insertion materials

NASA Astrophysics Data System (ADS)

Brant, William R.; Li, Dan; Gu, Qinfen; Schmid, Siegbert

2016-01-01

A comparative study of ex-situ and operando X-ray diffraction techniques using the fast lithium ion conductor Li0.18Sr0.66Ti0.5Nb0.5O3 is presented. Ex-situ analysis of synchrotron X-ray diffraction data suggests that a single phase material exists for all discharges to as low as 0.422 V. For samples discharged to 1 V or lower, i.e. with higher lithium content, it is possible to determine the lithium position from the X-ray data. However, operando X-ray diffraction from a coin cell reveals that a kinetically driven two phase region occurs during battery cycling below 1 V. Through monitoring the change in unit cell dimension during electrochemical cycling the dynamics of lithium insertion are explored. A reduction in the rate of unit cell expansion of 22(2)% part way through the first discharge and 13(1)% during the second discharge is observed. This reduction may be caused by a drop in lithium diffusion into the bulk material for higher lithium contents. A more significant change is a jump in the unit cell expansion by 60(2)% once the lithium content exceeds one lithium ion per vacant site. It is suggested that this jump is caused by damping of octahedral rotations, thus establishing a link between lithium content and octahedral rotations.

Spatial distribution of the largest rainfall-runoff floods from basins between 2.6 and 26,000 km2 in the United States and Puerto Rico

NASA Astrophysics Data System (ADS)

O'Connor, Jim E.; Costa, John E.

2004-01-01

We assess the spatial distribution of the largest rainfall-generated streamflows from a database of 35,663 flow records composed of the largest 10% of annual peak flows from each of 14,815 U.S. Geological Survey stream gaging stations in the United States and Puerto Rico. High unit discharges (peak discharge per unit contributing area) from basins with areas of 2.6 to 26,000 km2 (1-10,000 mi2) are widespread, but streams in Hawaii, Puerto Rico, and Texas together account for more than 50% of the highest unit discharges. The Appalachians and western flanks of Pacific coastal mountain systems are also regions of high unit discharges, as are several areas in the southern Midwest. By contrast, few exceptional discharges have been recorded in the interior West, northern Midwest, and Atlantic Coastal Plain. Most areas of high unit discharges result from the combination of (1) regional atmospheric conditions that produce large precipitation volumes and (2) steep topography, which enhances precipitation by convective and orographic processes and allows flow to be quickly concentrated into stream channels. Within the conterminous United States, the greatest concentration of exceptional unit discharges is at the Balcones Escarpment of central Texas, where maximum U.S. rainfall amounts apparently coincide with appropriate basin physiography to produce many of the largest measured U.S. floods. Flood-related fatalities broadly correspond to the spatial distribution of high unit discharges, with Texas having nearly twice the average annual flood-related fatalities of any other state.

Parasympathetic activation is involved in reducing epileptiform discharges when listening to Mozart music.

PubMed

Lin, Lung-Chang; Chiang, Ching-Tai; Lee, Mei-Wen; Mok, Hin-Kiu; Yang, Yi-Hsin; Wu, Hui-Chuan; Tsai, Chin-Lin; Yang, Rei-Cheng

2013-08-01

Listening to Mozart K.448 has been demonstrated to improve spatial task scores, leading to what is known as the Mozart effect. Our previous work revealed the positive effects of Mozart K.448 in reducing epileptiform discharges in children with epilepsy. However, the mechanism remains unclear. parasympathetic activation has been shown to help seizure control in many studies. In this study, we investigated the effect of Mozart music on epileptiform discharges and autonomic activity. Sixty-four epileptic children with epileptiform discharges were included. They all received electroencephalogram and electrocardiogram examinations simultaneously before, during, and after listening to Mozart K.448 or K.545. The total number of epileptiform discharges during each session (before, during, and after music) were divided by the duration (in minutes) of the session and then compared. Heart rate variability including time and frequency domain analysis was used to represent the autonomic function. The results showed that epileptiform discharges were significantly reduced during and right after listening to Mozart music (33.3 ± 31.1% reduction, p<0.001, during Mozart K.448 and 38.6 ± 43.3% reduction, p<0.001, during Mozart K.545) (28.1 ± 43.2% reduction, p<0.001, after Mozart K.448 and 46.0 ± 40.5% reduction, p<0.001, after Mozart K.545). No significant difference was noticed between the two pieces of music. The reduction was greatest in patients with generalized seizures and discharges. Significant increases in high-frequency (HF), the square root of the mean squared differences of successive RR intervals (RMSSD), the standard deviation of differences between adjacent RR intervals (SDSD), and a decrease in mean beats per minute (bpm) were found during listening to Mozart music. Most of the patients with reduced epileptiform discharges also showed a decreased LF/HF ratio, low-frequency normalized units (LF nu), mean bpm, and an increased high-frequency normalized units (HF nu). Listening to Mozart music decreased epileptiform discharges in children with epilepsy. The majority of these patients showed an increase in parasympathetic tone during music exposure. Our results suggested that Mozart music stimuli induced parasympathetic activation which may be involved in the effect of music in reducing epileptiform discharges and the recurrence rate of seizures. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Bedload transport rates in a step-pool channel at near-bankfull flows

Treesearch

Daniel A. Marion

2001-01-01

This paper examines unit bedload transport rates (BTRs) at near-bankfull flows within a small step-pool channel in the Ouachita Mountains of central Arkansas. For this study, five runoff events with peak discharges between 0.25 and 1.34 cms (1.0- to 1.6-yr recurrence intervals) were produced in a natural channel using a streamflow simulation system. BTRs range from...

Predictive validity of disability rating scale in determining functional outcome in patients with severe traumatic brain injury.

PubMed

Deepika, Akhil; Devi, B Indira; Shukla, Dhaval

2017-01-01

Most patients with severe traumatic brain injury (TBI) are discharged when they have still not recovered completely. Many such patients are not available for follow up. We conducted this study to determine whether the condition at discharge from acute care setting, as assessed with disability rating scale (DRS), correlates with functional outcome at follow up. This study was conducted at a Neurosurgical intensive care unit (ICU) of a tertiary care referral center. This was a prospective observational study. Patients admitted to ICU with a diagnosis of severe TBI were enrolled for the study. On the day of discharge, all patients underwent DRS assessment. A final assessment was performed using Glasgow outcome scale extended (GOSE) at 6 months after discharge from the hospital. The correlation between the DRS scores at the time of discharge with DRS scores and GOSE categories at 6 months after discharge was determined using Spearman's rho correlation coefficient. A total of 88 patients were recruited for the study. The correlation coefficient of DRS at discharge for DRS at 6 months was 0.536 and for GOSE was -0.553. The area under the curve of DRS score at discharge for predicting unfavorable outcome and mortality at 6 months was 0.770 and 0.820, respectively. The predictive validity of DRS is fair to good in determining GOSE at follow-up. Pending availability of a more accurate outcome assessment tool, DRS at discharge can be used as a surrogate outcome for GOSE at follow up.

Patient safety in the era of the 80-hour workweek.

PubMed

Shelton, Julia; Kummerow, Kristy; Phillips, Sharon; Arbogast, Patrick G; Griffin, Marie; Holzman, Michael D; Nealon, William; Poulose, Benjamin K

2014-01-01

In 2003, duty-hour regulations (DHR) were initially implemented for residents in the United States to improve patient safety and protect resident's well-being. The effect of DHR on patient safety remains unclear. The study objective was to evaluate the effect of DHR on patient safety. Using an interrupted time series analysis, we analyzed selected patient safety indicators (PSIs) for 376 million discharges in teaching (T) vs nonteaching (NT) hospitals before and after implementation of DHR in 2003 that restricted resident work hours to 80 hours per week. The PSIs evaluated were postoperative pulmonary embolus or deep venous thrombosis (PEDVT), iatrogenic pneumothorax (PTx), accidental puncture or laceration, postoperative wound dehiscence (WD), postoperative hemorrhage or hematoma, and postoperative physiologic or metabolic derangement. Propensity scores were used to adjust for differences in patient comorbidities between T and NT hospitals and between discharge quarters. The primary outcomes were differences in the PSI rates before and after DHR implementation. The PSI differences between T and NT institutions were the secondary outcome. T and NT hospitals in the United States. Participants were 376 million patient discharges from 1998 to 2007 in the Nationwide Inpatient Sample. Declining rates of PTx in both T and NT hospitals preintervention slowed only in T hospitals postintervention (p = 0.04). Increasing PEDVT rates in both T and NT hospitals increased further only in NT hospitals (p = 0.01). There were no differences in the PSI rates over time for hemorrhage or hematoma, physiologic or metabolic derangement, accidental puncture or laceration, or WD. T hospitals had higher rates than NT hospitals both preintervention and postintervention for all the PSIs except WD. Trends in rates for 2 of the 6 PSIs changed significantly after DHR implementation, with PTx rates worsening in T hospitals and PEDVT rates worsening in NT hospitals. Lack of consistent patterns of change suggests no measurable effect of the policy change on these PSIs. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Patient Safety in the Era of the 80-Hour Workweek

PubMed Central

Shelton, Julia; Kummerow, Kristy; Phillips, Sharon; Arbogast, Patrick G.; Griffin, Marie; Holzman, Michael D.; Nealon, William; Poulose, Benjamin K.

2016-01-01

OBJECTIVE In 2003, duty-hour regulations (DHR) were initially implemented for residents in the United States to improve patient safety and protect resident’s well-being. The effect of DHR on patient safety remains unclear. The study objective was to evaluate the effect of DHR on patient safety. DESIGN Using an interrupted time series analysis, we analyzed selected patient safety indicators (PSIs) for 376 million discharges in teaching (T) vs nonteaching (NT) hospitals before and after implementation of DHR in 2003 that restricted resident work hours to 80 hours per week. The PSIs evaluated were postoperative pulmonary embolus or deep venous thrombosis (PEDVT), iatrogenic pneumothorax (PTx), accidental puncture or laceration, postoperative wound dehiscence (WD), postoperative hemorrhage or hematoma, and postoperative physiologic or metabolic derangement. Propensity scores were used to adjust for differences in patient comorbidities between T and NT hospitals and between discharge quarters. The primary outcomes were differences in the PSI rates before and after DHR implementation. The PSI differences between T and NT institutions were the secondary outcome. SETTING T and NT hospitals in the United States. PARTICIPANTS Participants were 376 million patient discharges from 1998 to 2007 in the Nationwide Inpatient Sample. RESULTS Declining rates of PTx in both T and NT hospitals preintervention slowed only in T hospitals postintervention (p = 0.04). Increasing PEDVT rates in both T and NT hospitals increased further only in NT hospitals (p = 0.01). There were no differences in the PSI rates over time for hemorrhage or hematoma, physiologic or metabolic derangement, accidental puncture or laceration, or WD. T hospitals had higher rates than NT hospitals both preintervention and postintervention for all the PSIs except WD. CONCLUSIONS Trends in rates for 2 of the 6 PSIs changed significantly after DHR implementation, with PTx rates worsening in T hospitals and PEDVT rates worsening in NT hospitals. Lack of consistent patterns of change suggests no measurable effect of the policy change on these PSIs. PMID:24776874

Impact of double counting and transfer bias on estimated rates and outcomes of acute myocardial infarction.

PubMed

Westfall, J M; McGloin, J

2001-05-01

Ischemic heart disease is the leading cause of death in the United States. Recent studies report inconsistent findings on the changes in the incidence of hospitalizations for ischemic heart disease. These reports have relied primarily on hospital discharge data. Preliminary data suggest that a significant percentage of patients suffering acute myocardial infarction (MI) in rural communities are transferred to urban centers for care. Patients transferred to a second hospital may be counted twice for one episode of ischemic heart disease. To describe the impact of double counting and transfer bias on the estimation of incidence rates and outcomes of ischemic heart disease, specifically acute MI, in the United States. Analysis of state hospital discharge data from Kansas, Colorado (State Inpatient Database [SID]), Nebraska, Arizona, New Jersey, Michigan, Pennsylvania, and Illinois (SID) for the years 1995 to 1997. A matching algorithm was developed for hospital discharges to determine patients counted twice for one episode of ischemic heart disease. Validation of our matching algorithm. Patients reported to have suffered ischemic heart disease (ICD9 codes 410-414, 786.5). Number of patients counted twice for one episode of acute MI. It is estimated that double count rates range from 10% to 15% for all states and increased over the 3 years. Moderate sized rural counties had the highest estimated double count rates at 15% to 20% with a few counties having estimated double count rates a high as 35% to 50%. Older patients and females were less likely to be double counted (P <0.05). Double counting patients has resulted in a significant overestimation in the incidence rate for hospitalization for acute MI. Correction of this double counting reveals a significantly lower incidence rate and a higher in-hospital mortality rate for acute MI. Transferred patients differ significantly from nontransferred patients, introducing significant bias into MI outcome studies. Double counting and transfer bias should be considered when conducting and interpreting research on ischemic heart disease, particularly in rural regions.

Hydrogeology and predevelopment flow in the Texas Gulf Coast aquifer systems

USGS Publications Warehouse

Ryder, Paul D.

1988-01-01

Total simulated recharge in the outcrop areas is 269 million cubic feet per day, which is offset by an equal amount of discharge in the outcrop areas. The smallest rates of leakage are across the Vicksburg-Jackson confining unit, with downward and upward rates of less than one million cubic feet per day. The greatest rate of leakage is 47 million cubic feet per day upward into the Holocene-upper Pleistocene permeable zone.

Hypothermia and rapid rewarming is associated with worse outcome following traumatic brain injury.

PubMed

Thompson, Hilaire J; Kirkness, Catherine J; Mitchell, Pamela H

2010-01-01

The purpose of the present study was to determine (1) the prevalence and degree of hypothermia in patients on emergency department admission and (2) the effect of hypothermia and rate of rewarming on patient outcomes. Secondary data analysis was conducted on patients admitted to a level I trauma center following severe traumatic brain injury (n = 147). Patients were grouped according to temperature on admission according to hypothermia status and rate of rewarming (rapid or slow). Regression analyses were performed. Hypothermic patients were more likely to have lower postresuscitation Glasgow Coma Scale scores and a higher initial injury severity score. Hypothermia on admission was correlated with longer intensive care unit stays, a lower Glasgow Coma Scale score at discharge, higher mortality rate, and lower Glasgow outcome score-extended scores up to 6 months postinjury (P < .05). When controlling for other factors, rewarming rates more than 0.25°C/h were associated with lower Glasgow Coma Scale scores at discharge, longer intensive care unit length of stay, and higher mortality rate than patients rewarmed more slowly although these did not reach statistical significance. Hypothermia on admission is correlated with worse outcomes in brain-injured patients. Patients with traumatic brain injury who are rapidly rewarmed may be more likely to have worse outcomes. Trauma protocols may need to be reexamined to include controlled rewarming at rates 0.25°C/h or less.

Temporal trends in early clinical outcomes and health care resource utilization for liver transplantation in the United States.

PubMed

Scarborough, John E; Pietrobon, Ricardo; Marroquin, Carlos E; Tuttle-Newhall, Janet E; Kuo, Paul C; Collins, Bradley H; Desai, Dev M; Pappas, Theodore N

2007-01-01

Procedures such as liver transplantation, which entail large costs while benefiting only a small percentage of the population, are being increasingly scrutinized by third-party payors. The purpose of our study was to conduct a longitudinal analysis of the early clinical outcomes and health care resource utilization for liver transplantation in the United States. The Nationwide Inpatient Sample database was used to conduct a longitudinal analysis of the clinical outcome and resource utilization data for liver transplantation procedures in adult recipients performed in the United States over three time periods (Period I: 1988-1993; Period II: 1994-1998: Period III: 1999-2003). Compared to Period I, adult liver transplant recipients were more likely to be male, older, and non-White in Period III. Recipients were more likely to have at least one major comorbidity preoperatively than in Period I. The in-hospital mortality rate after liver transplantation decreased significantly from Period I to Period III, but the major intraoperative and postoperative complication rates increased over the same time period. Mean length of hospital stay decreased over the 15-year period, but the percentage of patients with a non-routine discharge status increased. Our findings indicate that the rate of postoperative complications and non-routine discharges after liver transplantation is increasing. However, these negative changes in the cost-outcomes relationship for liver transplantation are balanced by improving postoperative survival rates and reductions in the length of hospital stay.

Motor unit recruitment strategies and muscle properties determine the influence of synaptic noise on force steadiness

PubMed Central

Dideriksen, Jakob L.; Negro, Francesco; Enoka, Roger M.

2012-01-01

Motoneurons receive synaptic inputs from tens of thousands of connections that cause membrane potential to fluctuate continuously (synaptic noise), which introduces variability in discharge times of action potentials. We hypothesized that the influence of synaptic noise on force steadiness during voluntary contractions is limited to low muscle forces. The hypothesis was examined with an analytical description of transduction of motor unit spike trains into muscle force, a computational model of motor unit recruitment and rate coding, and experimental analysis of interspike interval variability during steady contractions with the abductor digiti minimi muscle. Simulations varied contraction force, level of synaptic noise, size of motor unit population, recruitment range, twitch contraction times, and level of motor unit short-term synchronization. Consistent with the analytical derivations, simulations and experimental data showed that force variability at target forces above a threshold was primarily due to low-frequency oscillations in neural drive, whereas the influence of synaptic noise was almost completely attenuated by two low-pass filters, one related to convolution of motoneuron spike trains with motor unit twitches (temporal summation) and the other attributable to summation of single motor unit forces (spatial summation). The threshold force above which synaptic noise ceased to influence force steadiness depended on recruitment range, size of motor unit population, and muscle contractile properties. This threshold was low (<10% of maximal force) for typical values of these parameters. Results indicate that motor unit recruitment and muscle properties of a typical muscle are tuned to limit the influence of synaptic noise on force steadiness to low forces and that the inability to produce a constant force during stronger contractions is mainly attributable to the common low-frequency oscillations in motoneuron discharge rates. PMID:22423000

National Hospital Discharge Survey: 2005 annual summary with detailed diagnosis and procedure data.

PubMed

DeFrances, Carol J; Cullen, Karen A; Kozak, Lola Jean

2007-12-01

This report presents 2005 national estimates and selected trend data on the use of nonfederal short-stay hospitals in the United States. Estimates are provided by selected patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to International Classification of Diseases, Ninth Revision, Clinical Modification codes. The estimates are based on data collected through the National Hospital Discharge Survey. The survey has been conducted annually since 1965. In 2005, data were collected for approximately 375,000 discharges. Of the 473 eligible nonfederal short-stay hospitals in the sample, 444 (94 percent) responded to the survey. An estimated 34.7 million discharges from nonfederal short-stay hospitals occurred in 2005. Discharges used 165.9 million days of care and had an average length of stay of 4.8 days. Persons 65 years and over accounted for 38 percent of the hospital discharges and 44 percent of the days of care. The proportion of discharges whose status was described as routine discharge or discharged to the patient's home declined with age, from 91 percent for inpatients under 45 years of age to 41 percent for those 85 years and over. Hospitalization for malignant neoplasms decreased from 1990-2005. The hospitalization rate for asthma was the highest for children under 15 years of age and those 65 years of age and over. The rate was lowest for those 15-44 years of age. Thirty-eight percent of hospital discharges had no procedures performed, whereas 12 percent had four or more procedures performed. An episiotomy was performed during a majority of vaginal deliveries in 1980 (64 percent), but by 2005, it was performed during less than one of every five vaginal deliveries (19 percent).

Formula Milk Supplementation on the Postnatal Ward: A Cross-Sectional Analytical Study

PubMed Central

Biggs, Kirsty V.; Hurrell, Katherine; Matthews, Eleanor

2018-01-01

Breastfeeding rates are low in the UK, where approximately one quarter of infants receive a breastmilk substitute (BMS) in the first week of life. We investigated the reasons for early BMS use in two large maternity units in the UK, in order to understand the reasons for the high rate of early BMS use in this setting. Data were collected through infant feeding records, as well as maternal and midwife surveys in 2016. During 2016, 28% of infants received a BMS supplement prior to discharge from the hospital maternity units with only 10% supplementation being clinically indicated. There was wide variation in BMS initiation rates between different midwives, which was associated with ward environment and midwife educational level. Specific management factors associated with non-clinically indicated initiation of BMS were the absence of skin-to-skin contact within an hour of delivery (p = 0.01), and no attendance at an antenatal breastfeeding discussion (p = 0.01). These findings suggest that risk of initiating a BMS during postnatal hospital stay is largely modifiable. Concordance with UNICEF Baby Friendly 10 steps, attention to specific features of the postnatal ward working environment, and the targeting of midwives and mothers with poor educational status may all lead to improved exclusive breastfeeding rates at hospital discharge. PMID:29757936

Formula Milk Supplementation on the Postnatal Ward: A Cross-Sectional Analytical Study.

PubMed

Biggs, Kirsty V; Hurrell, Katherine; Matthews, Eleanor; Khaleva, Ekaterina; Munblit, Daniel; Boyle, Robert J

2018-05-14

Breastfeeding rates are low in the UK, where approximately one quarter of infants receive a breastmilk substitute (BMS) in the first week of life. We investigated the reasons for early BMS use in two large maternity units in the UK, in order to understand the reasons for the high rate of early BMS use in this setting. Data were collected through infant feeding records, as well as maternal and midwife surveys in 2016. During 2016, 28% of infants received a BMS supplement prior to discharge from the hospital maternity units with only 10% supplementation being clinically indicated. There was wide variation in BMS initiation rates between different midwives, which was associated with ward environment and midwife educational level. Specific management factors associated with non-clinically indicated initiation of BMS were the absence of skin-to-skin contact within an hour of delivery ( p = 0.01), and no attendance at an antenatal breastfeeding discussion ( p = 0.01). These findings suggest that risk of initiating a BMS during postnatal hospital stay is largely modifiable. Concordance with UNICEF Baby Friendly 10 steps, attention to specific features of the postnatal ward working environment, and the targeting of midwives and mothers with poor educational status may all lead to improved exclusive breastfeeding rates at hospital discharge.

An electrophysiological investigation of the receptor apparatus of the duck's bill

PubMed Central

Gregory, J. E.

1973-01-01

1. The properties of receptors in the duck's bill have been studied by recording from units isolated by dissecting fine filaments from the maxillary and ophthalmic nerves. 2. The units studied were divisible into three groups, phasic mechanoreceptors responsive to vibration, thermoreceptive units, and high threshold mechanoreceptors. 3. Vibration-sensitive mechanoreceptors (113 units) had small receptive fields, showed a rapidly adapting discharge to mechanical stimulation of the bill, were sensitive to vibratory but not to thermal stimuli and showed no background discharge. 4. Temperature receptors (twenty-one units) were insensitive to mechanical stimulation and showed a temperature-dependent background discharge. Sudden cooling produced a transient increase in discharge frequency. 5. High threshold mechanosensitive units (eight units) gave a slowly adapting discharge to strong mechanical stimulation and were insensitive to vibratory and thermal stimulation. 6. It is concluded that the low-threshold, vibration-sensitive responses come from Herbst corpuscles. No specific function can yet be assigned to the Grandry corpuscles. PMID:4689962

A heart failure initiative to reduce the length of stay and readmission rates.

PubMed

White, Sabrina Marie; Hill, Alethea

2014-01-01

The purpose of this pilot was to improve multidisciplinary coordination of care and patient education and foster self-management behaviors. The primary and secondary outcomes achieved from this pilot were to decrease the 30-day readmission rate and heart failure length of stay. The primary practice site was an inpatient medical-surgical nursing unit. The length of stay decreased from 6.05% to 4.42% for heart failure diagnostic-related group 291 as a result of utilizing the model. The length of stay decreased from 3.9% to 3.09%, which was also less than the national rate of 3.8036% for diagnostic-related group 292. In addition, the readmission rate decreased from 23.1% prior to January 2013 to 12.9%. Implementation of standards of care coordination can decrease length of stay, readmission rate, and improve self-management. Implementation of evidence-based heart failure guidelines, improved interdisciplinary coordination of care, patient education, self-management skills, and transitional care at the time of discharge improved overall heart failure outcome measures. Utilizing the longitudinal model of care to transition patients to home aided in evaluating social support, resource allocation and utilization, access to care postdischarge, and interdisciplinary coordination of care. The collaboration between disciplines improved continuity of care, patient compliance to their discharge regimen, and adequate discharge follow-up.

The Epidemiology of Emergency Department Trauma Discharges in the United States.

PubMed

DiMaggio, Charles J; Avraham, Jacob B; Lee, David C; Frangos, Spiros G; Wall, Stephen P

2017-10-01

Injury-related morbidity and mortality is an important emergency medicine and public health challenge in the United States. Here we describe the epidemiology of traumatic injury presenting to U.S. emergency departments (EDs), define changes in types and causes of injury among the elderly and the young, characterize the role of trauma centers and teaching hospitals in providing emergency trauma care, and estimate the overall economic burden of treating such injuries. We conducted a secondary retrospective, repeated cross-sectional study of the Nationwide Emergency Department Data Sample (NEDS), the largest all-payer ED survey database in the United States. Main outcomes and measures were survey-adjusted counts, proportions, means, and rates with associated standard errors (SEs) and 95% confidence intervals. We plotted annual age-stratified ED discharge rates for traumatic injury and present tables of proportions of common injuries and external causes. We modeled the association of Level I or II trauma center care with injury fatality using a multivariable survey-adjusted logistic regression analysis that controlled for age, sex, injury severity, comorbid diagnoses, and teaching hospital status. There were 181,194,431 (SE = 4,234) traumatic injury discharges from U.S. EDs between 2006 and 2012. There was a mean year-to-year decrease of 143 (95% CI = -184.3 to -68.5) visits per 100,000 U.S. population during the study period. The all-age, all-cause case-fatality rate for traumatic injuries across U.S. EDs during the study period was 0.17% (SE = 0.001%). The case-fatality rate for the most severely injured averaged 4.8% (SE = 0.001%), and severely injured patients were nearly four times as likely to be seen in Level I or II trauma centers (relative risk = 3.9 [95% CI = 3.7 to 4.1]). The unadjusted risk ratio, based on group counts, for the association of Level I or II trauma centers with mortality was risk ratio = 4.9 (95% CI = 4.5 to 5.3); however, after sex, age, injury severity, and comorbidities were accounted for, Level I or II trauma centers were not associated with an increased risk of fatality (odds ratio = 0.96 [95% CI = 0.79 to 1.18]). There were notable changes at the extremes of age in types and causes of ED discharges for traumatic injury between 2009 and 2012. Age-stratified rates of diagnoses of traumatic brain injury increased 29.5% (SE = 2.6%) for adults older than 85 and increased 44.9% (SE = 1.3%) for children younger than 18. Firearm-related injuries increased 31.7% (SE = 0.2%) in children 5 years and younger. The total inflation-adjusted cost of ED injury care in the United States between 2006 and 2012 was $99.75 billion (SE = $0.03 billion). Emergency departments are a sensitive barometer of the continuing impact of traumatic injury as an important cause of morbidity and mortality in the United States. Level I or II trauma centers remain a bulwark against the tide of severe trauma in the United States, but the types and causes of traumatic injury in the United States are changing in consequential ways, particularly at the extremes of age, with traumatic brain injuries and firearm-related trauma presenting increased challenges. © 2017 by the Society for Academic Emergency Medicine.

The Role of Inhibition in a Computational Model of an Auditory Cortical Neuron during the Encoding of Temporal Information

PubMed Central

Bendor, Daniel

2015-01-01

In auditory cortex, temporal information within a sound is represented by two complementary neural codes: a temporal representation based on stimulus-locked firing and a rate representation, where discharge rate co-varies with the timing between acoustic events but lacks a stimulus-synchronized response. Using a computational neuronal model, we find that stimulus-locked responses are generated when sound-evoked excitation is combined with strong, delayed inhibition. In contrast to this, a non-synchronized rate representation is generated when the net excitation evoked by the sound is weak, which occurs when excitation is coincident and balanced with inhibition. Using single-unit recordings from awake marmosets (Callithrix jacchus), we validate several model predictions, including differences in the temporal fidelity, discharge rates and temporal dynamics of stimulus-evoked responses between neurons with rate and temporal representations. Together these data suggest that feedforward inhibition provides a parsimonious explanation of the neural coding dichotomy observed in auditory cortex. PMID:25879843

Neonatal family care for 24 hours per day: effects on maternal confidence and breast-feeding.

PubMed

Wataker, Heidi; Meberg, Alf; Nestaas, Eirik

2012-01-01

In family care (FC) program for neonatal intensive care units (NICUs), parents are encouraged to reside together with their infant for 24 hours a day to actively be involved in the care. The aim of this study was to assess the impact of FC on maternal confidence and breast-feeding. Maternal confidence and rate of breast-feeding were assessed in 31 mothers offered FC that included special family rooms in the NICU, and in 30 mothers from a comparable NICU providing traditional care without such facilities. One week prior to hospital discharge, mothers in the FC group felt better informed regarding nursing issues and had more confidence in interpretation of the infants regarding feeding issues and in caregiving without staff attendance (P < .05). They also reported a higher level of empowerment (P < .05). Three months after discharge, the mothers in the FC group had a higher self-reported skill level for interpretation of the infant's signals and knowledge about breast-feeding (P < .05). Despite similar rate of breast-feeding at discharge, more infants in the FC group were breastfed 3 months after discharge (P < .05). An FC program in the NICU promoted better maternal confidence during the hospital stay and 3 months after discharge compared with traditional care.

Improving Outcomes After Hospitalization: A Prospective Observational Multicenter Evaluation of Care Coordination Strategies for Reducing 30-Day Readmissions to Maryland Hospitals.

PubMed

Hoyer, Erik H; Brotman, Daniel J; Apfel, Ariella; Leung, Curtis; Boonyasai, Romsai T; Richardson, Melissa; Lepley, Diane; Deutschendorf, Amy

2018-05-01

Patients frequently experience suboptimal transitions from the hospital to the community, which can increase the likelihood of readmission. It is not known which care coordination services can lead to improvements in readmission rates. To evaluate the effects of two care coordination interventions on 30-day readmission rates. Prospective multicenter observational study of hospitalized patients eligible for two care coordination services between January 1, 2013, and October 31, 2015. Readmission rates were compared for patients who received each care coordination intervention versus those who did not using multivariable generalized estimating equation logistic regression models. A total of 25,628 patients hospitalized in medicine, neurosciences, or surgical sciences units. Patients discharged home and deemed to be at high risk for readmission were assigned a nurse Transition Guide (TG) for 30 days post-discharge. All other patients were assigned the Patient Access Line (PAL) intervention, which provided a post-discharge phone call from a registered nurse. Two large academic hospitals in Baltimore, MD. Thirty-day all-cause readmission to any Maryland hospital. Among all patients, 14.2% (2409/16,993) of those referred for the PAL intervention and 22.8% (1973/8635) of those referred for the TG intervention were readmitted. PAL-referred patients who did not receive the intervention had an adjusted odds ratio (aOR) for readmission of 1.27 (95% confidence interval [95% CI] 1.12-1.44, p < 0.001) compared with patients who did. TG-referred patients who did not receive the TG intervention had an aOR of 1.83 (95% CI 1.60-2.10, p < 0.001) compared with patients who received the intervention. Younger age, male sex, having more comorbidities, and being discharged from a medicine unit were associated with not receiving an assigned intervention. These characteristics were also associated with higher readmission rates. PAL and TG care coordination interventions were associated with lower rates of 30-day readmission. Our findings underscore the importance of determining the appropriate intervention for the hardest-to-reach patients, who are also at the highest risk of being readmitted.

Discharges to prison from medium secure psychiatric units in England and Wales.

PubMed

Doyle, Michael; Coid, Jeremy; Archer-Power, Laura; Dewa, Lindsay; Hunter-Didrichsen, Alice; Stevenson, Rachel; Wainwright, Verity; Kallis, Costas; Ullrich, Simone; Shaw, Jenny

2014-09-01

Early findings from a national study of discharges from 32 National Health Service medium secure units revealed that nearly twice as many patients than expected were discharged back to prison. To compare the characteristics of those discharged back to prison with those discharged to the community, and consider the implications for ongoing care and risk. Prospective cohort follow-up design. All forensic patients discharged from 32 medium secure units across England and Wales over a 12-month period were identified. Those discharged to prison were compared with those who were discharged to the community. Nearly half of the individuals discharged to prison were diagnosed with a serious mental illness and over a third with schizophrenia. They were a higher risk, more likely to have a personality disorder, more symptomatic and less motivated than those discharged to the community. Findings suggest that alternative models of prison mental healthcare should be considered to reduce risks to the patient and the public. Royal College of Psychiatrists.

Adult mouse motor units develop almost all of their force in the subprimary range: a new all-or-none strategy for force recruitment?

PubMed

Manuel, Marin; Heckman, C J

2011-10-19

Classical studies of the mammalian neuromuscular system have shown an impressive adaptation match between the intrinsic properties of motoneurons and the contractile properties of their motor units. In these studies, the rate at which motoneurons start to fire repetitively corresponds to the rate at which individual twitches start to sum, and the firing rate increases linearly with the amount of excitation ("primary range") up to the point where the motor unit develops its maximal force. This allows for the gradation of the force produced by a motor unit by rate modulation. In adult mouse motoneurons, however, we recently described a regime of firing ("subprimary range") that appears at lower excitation than what is required for the primary range, a finding that might challenge the classical conception. To investigate the force production of mouse motor units, we simultaneously recorded, for the first time, the motoneuron discharge elicited by intracellular ramps of current and the force developed by its motor unit. We showed that the motor unit developed nearly its maximal force during the subprimary range. This was found to be the case regardless of the input resistance of the motoneuron, the contraction speed, or the tetanic force of the motor unit. Our work suggests that force modulation in small mammals mainly relies on the number of motor units that are recruited rather than on rate modulation of individual motor units.

Groundwater discharge by evapotranspiration, Dixie Valley, west-central Nevada, March 2009-September 2011

USGS Publications Warehouse

Garcia, C. Amanda; Huntington, Jena M; Buto, Susan G.; Moreo, Michael T.; Smith, J. LaRue; Andraski, Brian J.

2014-01-01

Mean annual basin-scale ETg totaled about 28 million cubic meters (Mm3) (23,000 acre-feet [acre-ft]), and represents the sum of ETg from all ET units. Annual groundwater ET from vegetated areas totaled about 26 Mm3 (21,000 acre-ft), and was dominated by the moderate-to-dense shrubland ET unit (54 percent), followed by sparse shrubland (37 percent) and grassland (9 percent) ET units. Senesced grasses observed in the northern most areas of the moderate-to-dense ET unit likely confounded the vegetation index and led to an overestimate of ETg for this ET unit. Therefore, mean annual ETg for moderate-to-dense shrubland presented here is likely an upper bound. Annual groundwater ET from the playa ET unit was 2.2 Mm3 (1,800 acre-ft), whereas groundwater ET from the playa lake ET unit was 0–0.1 Mm3 (0–100 acre-ft). Oxygen-18 and deuterium data indicate discharge from the playa center predominantly represents removal of local precipitation-derived recharge. The playa lake estimate, therefore, is considered an upper bound. Mean annual ETg estimates for Dixie Valley are assumed to represent the pre‑development, long-term ETg rates within the study area.

Fall in readmission rate for heart failure after implementation of B-type natriuretic peptide testing for discharge decision: a retrospective study.

PubMed

Valle, Roberto; Aspromonte, Nadia; Carbonieri, Emanuele; D'Eri, Alessandra; Feola, Mauro; Giovinazzo, Prospero; Noventa, Federica; Prevaldi, Carolina; Barro, Sabrina; Milani, Loredano

2008-06-06

B-type natriuretic peptide is the most powerful predictor of long term prognosis in patients hospitalised with heart failure. On an outsetting basis, a decrease in B-type natriuretic peptide levels is associated to a decrease in event rate for outpatients managed using the neuro-hormone levels as the target in heart failure therapy. We have retrospectively checked whether the addition of pre-discharge B-type natriuretic peptide levels to a clinical-instrumental decisional score for discharge decision in patients admitted for heart failure reduced readmission rate for heart failure and related cost. We studied two series of consecutive patients admitted to the Heart Failure Unit due to acute heart failure as a main diagnosis. One-hundred and forty-nine patients discharged on the basis of the sole clinical acumen were compared to one hundred and sixty-six subjects discharged adding B-type natriuretic peptide levels to the decisional score. During a six-month follow-up period, there were 52 readmissions (35%) among the clinical group (n=149) compared with 38 (23%) readmissions in the B-type natriuretic peptide group (n=166) (chi(2)=5.5; P=0.02). Survival did not differ between groups (87%). Changes in B-type natriuretic peptide values were correlated to clinical events: a B-type natriuretic peptide value on discharge of < or =250 pg/ml or a reduction of > or =30% in B-type natriuretic peptide values predicted a 23% event rate (death, plus readmission for heart failure), whereas a far higher percentage (71%) were observed in the remaining patients (chi(2)=32.7; P=0.001). Likewise, the overall costs of care were lower (-7%) in the B-type natriuretic peptide group: 2.781+/-923 vs 2.978+/-1.057 euros per patient respectively. our study suggest that the addition of pre-discharge B-type natriuretic peptide levels to a clinical-instrumental decisional score for discharge decision in patients admitted for heart failure may contribute to reduce the number of readmissions and related cost.

Prospective observational study of delirium recovery trajectories and associated short-term outcomes in older adults admitted to a specialized delirium unit.

PubMed

Lam, Ching-yu; Tay, Laura; Chan, Mark; Ding, Yew Yoong; Chong, Mei Sian

2014-09-01

To describe the recovery trajectories of delirium and to determine factors predicting the course of recovery and adverse outcome. A prospective observational study. Geriatric monitoring unit (GMU), a five-bed unit specializing in managing older adults with delirium. Individuals admitted to the GMU between December 2010 and August 2012 (N = 234; mean age 84.1 ± 7.4). Information was collected on demographic characteristics; comorbidities; severity of illness; functional status; and daily cognitive, Delirium Rating Scale, Revised-98 (DRS-R98) severity, and functional scoring. Resolution of delirium, and thus GMU discharge, was determined according to clinical assessment. The primary outcome was residual subsyndromal delirium (SSD) (DRS-R98 severity ≥13) upon GMU discharge. Univariate and multivariate methods were used to determine the predictors of residual SSD and adverse outcomes (inpatient mortality and incident nursing home admission upon discharge). Participants with residual SSD had a slower recovery in terms of delirium severity, cognition, and functional status than those with no residual SSD. Residual SSD predictors included underlying dementia, admission DRS-R98 severity, DRS-R98 severity on Day 1 minus Day 3 of GMU stay, and admission modified Barthel Index. Only presence of residual SSD at discharge predicted adverse outcomes (odds ratio = 5.27, 95% confidence interval = 1.43-19.47). Individuals with residual SSD had prolonged recovery trajectory of delirium. These new insights into the recovery trajectories of delirium may help formulate early discharge planning and provide the basis for future research on delirium treatment. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

Incidence and Outcomes of Cardiopulmonary Resuscitation in Pediatric Intensive Care Units

PubMed Central

Berg, Robert A.; Nadkarni, Vinay M.; Clark, Amy E.; Moler, Frank; Meert, Kathleen; Harrison, Rick E.; Newth, Christopher J. L.; Sutton, Robert M.; Wessel, David L.; Berger, John T.; Carcillo, Joseph; Dalton, Heidi; Heidemann, Sabrina; Shanley, Thomas P.; Zuppa, Athena F.; Doctor, Allan; Tamburro, Robert F.; Jenkins, Tammara L.; Dean, J. Michael; Holubkov, Richard; Pollack, Murray M.

2015-01-01

Objective To determine the incidence of cardiopulmonary resuscitation (CPR) in pediatric intensive care units (PICU) and subsequent outcomes. Design, Setting, and Patients Multi-center prospective observational study of children 30 minutes, p30 minutes of CPR. Conclusions These data establish that contemporary PICU CPR, including long durations of CPR, results in high rates of survival to hospital discharge (45%) and favorable neurologic outcomes among survivors (89%). Rates of survival with favorable neurologic outcomes were similar among cardiac and non-cardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data. PMID:26646466

Intensive Care Unit Admission and Death Rates of Infants Admitted With Respiratory Syncytial Virus Lower Respiratory Tract Infection in Mexico.

PubMed

Vizcarra-Ugalde, Sergio; Rico-Hernández, Montserrat; Monjarás-Ávila, César; Bernal-Silva, Sofía; Garrocho-Rangel, Maria E; Ochoa-Pérez, Uciel R; Noyola, Daniel E

2016-11-01

Respiratory syncytial virus (RSV) is the most common etiology for acute respiratory infection hospital admissions in young children. Case fatality rates for hospitalized patients range between 0% and 3.4%. Recent reports indicate that deaths associated with RSV are uncommon in developed countries. However, the role of this virus as a current cause of mortality in other countries requires further examination. Children with RSV infection admitted between May 2003 and December 2014 to a level 2 specialty hospital in Mexico were included in this analysis. Underlying risk factors, admission to the intensive care unit (ICU) and condition on discharge were assessed to determine the ICU admission and death rates associated to RSV infection. We analyzed data of 1153 patients with RSV infection in whom information regarding underlying illnesses and discharge status was available. Sixty patients (5.2 %) were admitted to the ICU and 12 (1.04 %) died. Relevant underlying conditions were present in 320 (27.7%) patients. Infants with underlying respiratory disorders (excluding asthma) and a history of prematurity had high ICU admission rates (17.1% and 13.8%, respectively). Mortality rates were highest for infants with respiratory disease (excluding asthma) (7.3%), cardiovascular diseases (5.9%) and neurologic disorders (5.3%). The ICU admission and death rates were higher in infants <6 months of age than in other age groups. The ICU admission rate and mortality rate in Mexican infants hospitalized with RSV infection were 5.2% and 1%, respectively. Mortality rates were high in infants with respiratory, cardiovascular and neurologic disorders.

Performance, Facility Pressure Effects, and Stability Characterization Tests of NASA's Hall Effect Rocket with Magnetic Shielding Thruster

NASA Technical Reports Server (NTRS)

Kamhawi, Hani; Huang, Wensheng; Haag, Thomas; Yim, John; Herman, Daniel; Peterson, Peter Y.; Williams, George J.; Gilland, James; Hofer, Richard; Mikellides, Ioannis

2016-01-01

NASA's Hall Effect Rocket with Magnetic Shielding (HERMeS) 12.5 kW Technology Demonstration Unit-1 (TDU-1) has been the subject of extensive technology maturation in preparation for flight system development. Part of the technology maturation effort included experimental evaluation of the TDU-1 thruster with conducting and dielectric front pole cover materials in two different electrical configurations. A graphite front magnetic pole cover thruster configuration with the thruster body electrically tied to cathode, and an alumina front pole cover thruster configuration with the thruster body floating were evaluated. Both configurations were also evaluated at different facility background pressure conditions to evaluate background pressure effects on thruster operation. Performance characterization tests found that higher thruster performance was attained with the graphite front pole cover configuration with the thruster electrically tied to cathode. A total thrust efficiency of 68% and a total specific impulse of 2,820 s was demonstrated at a discharge voltage of 600 V and a discharge power of 12.5 kW. Thruster stability regimes were characterized with respect to the thruster discharge current oscillations and with maps of the discharge current-voltage-magnetic field (IVB). Analysis of TDU-1 discharge current waveforms found that lower normalized discharge current peak-to-peak and root mean square magnitudes were attained when the thruster was electrically floated with alumina front pole covers. Background pressure effects characterization tests indicated that the thruster performance and stability were mostly invariant to changes in the facility background pressure for vacuum chamber pressure below 1×10-5 Torr-Xe (for thruster flow rates of 20.5 mg/s). Power spectral density analysis of the discharge current waveforms showed that increasing the vacuum chamber background pressure resulted in a higher discharge current dominant breathing mode frequency. Finally, IVB maps of the TDU-1 thruster indicated that the discharge current became more oscillatory with higher discharge current peak-to-peak and RMS values with increased facility background pressure at lower thruster mass flow rates; thruster operation at higher flow rates resulted in less change to the thruster's IVB characteristics with elevated background pressure.

Analyzing discharge strategies during acute care: a discrete-event simulation study.

PubMed

Crawford, Elizabeth A; Parikh, Pratik J; Kong, Nan; Thakar, Charuhas V

2014-02-01

We developed a discrete-event simulation model of patient pathway through an acute care hospital that comprises an ED and several inpatient units. The effects of discharge timing on ED waiting and boarding times, ambulance diversions, leave without treatment, and readmissions were explicitly modeled. We then analyzed the impact of 1 static and 2 proactive discharge strategies on these system outcomes. Our analysis indicated that although the 2 proactive discharge strategies significantly reduced ED waiting and boarding times, and several other measures, compared with the static strategy (P < 0.01), the number of readmissions increased substantially. Further analysis indicated that these findings are sensitive to changes in patient arrival rate and conditions for ambulance diversion. Determining the appropriate time to discharge patients not only can affect individual patients' health outcomes, but also can affect various aspects of the hospital. The study improves our understanding of how individual inpatient discharge decisions can be objectively viewed in terms of their impact on other operations, such as ED crowding and readmission, in an acute care hospital.

Comparative Analgesic Efficacy of Oxycodone/Acetaminophen vs Codeine/Acetaminophen for Short-Term Pain Management Following ED Discharge.

PubMed

Chang, Andrew K; Bijur, Polly E; Lupow, Jason B; Gallagher, E John

2015-12-01

To test the hypothesis that oxycodone/acetaminophen provides analgesia superior to codeine/acetaminophen following emergency department (ED) discharge. Prospective, randomized, double-blind, trial. Adult inner city ED. ED patients with acute extremity pain who were discharged home. Patients randomized to oxycodone/acetaminophen (5 mg/325 mg) or codeine/acetaminophen (30 mg/300 mg). The primary outcome, obtained via telephone one day after ED discharge, was the between-group difference in improvement in numerical rating scale (NRS) pain scores over a 2-hour period following the most recent ingestion of study drug. Secondary outcomes included proportion of patients with >50% pain reduction, side-effect profile, and patient satisfaction. Two hundred and forty patients were enrolled. Mean baseline NRS scores were 7.9 in both groups. Mean decrease over 2 hours was 4.5 NRS units in the oxycodone/acetaminophen group vs 4.2 NRS units in the codeine/acetaminophen group, for a clinically and statistically nonsignificant difference of 0.2 NRS units (95% CI -0.4-0.9 NRS units). Similarly, 66% vs 61% achieved >50% pain relief for a nonsignificant difference of 5% (95% CI -8% to 17%). Side-effect profile and patient satisfaction were similar. Our hypothesis that oxycodone/acetaminophen provides analgesia superior to codeine/acetaminophen was rejected. Although pain within each group was reduced by more than half, the between-group difference was not significant. Pending independent validation, these unexpected findings suggest that codeine/acetaminophen, a Schedule III agent, may be a clinically reasonable outpatient opioid alternative to oxycodone/acetaminophen, a more tightly restricted Schedule II agent thought to be more prone to misuse. Wiley Periodicals, Inc.

Multisite evaluation of environmental cleanliness of high-touch surfaces in intensive care unit patient rooms.

PubMed

Hopman, Joost; Donskey, Curtis J; Boszczowski, Icaro; Alfa, Michelle J

2018-05-23

The efficacy of discharge cleaning and disinfection of high-touch surfaces of intensive care unit patient rooms in Brazil, Canada, the Netherlands, and the United States was evaluated and the effect of an educational intervention was determined. Significant site-to-site differences in cleaning regimens and baseline cleanliness levels were observed using ATP levels, colony-forming units, and reflective surface marker removal percent pass rates. An educational intervention that includes rapid feedback of the ATP measurements could significantly improve the quality of the cleaning and disinfection regimens. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.

A population-based study of severity in patients with acute on chronic pancreatitis.

PubMed

Akshintala, Venkata S; Hutfless, Susan M; Yadav, Dhiraj; Khashab, Mouen A; Lennon, Anne Marie; Makary, Martin A; Hirose, Kenzo; Andersen, Dana K; Kalloo, Anthony N; Singh, Vikesh K

2013-11-01

The objectives of this study were to evaluate the severity of patients with acute pancreatitis (AP) on chronic pancreatitis (CP) and compare this to patients with AP without CP. The Maryland Health Services database was queried for all adult inpatient discharges with a primary diagnosis of AP from 1994 to 2010. Acute pancreatitis on CP and AP without CP were defined by the presence of the associated diagnosis code for CP. Severity was defined as organ failure, intensive care unit stay, or mortality. Acute pancreatitis on CP accounted for 13.7% of all AP discharges (9747/70,944). The proportion of AP-on-CP discharges doubled during the study period (8.8% to 17.6%; P < 0.0001). When compared with patients with AP without CP, AP-on-CP patients were younger, were more likely to be male and black, had higher rates of alcohol and drug abuse, and had less severe disease with lower rates of mortality, organ failure, need for mechanical ventilation, and intensive care unit stay. Among AP-on-CP patients, significant predictors of severity included advanced age, weight loss, and 2 or more comorbidities. Patients with AP on CP have less severe disease than do those with AP without CP. Weight loss, advanced age, and comorbidity increase the risk of severity in patients with AP on CP.

Neural Issues in the Control of Muscular Strength

ERIC Educational Resources Information Center

Kamen, Gary

2004-01-01

During the earliest stages of resistance exercise training, initial muscular strength gains occur too rapidly to be explained solely by muscle-based mechanisms. However, increases in surface-based EMG amplitude as well as motor unit discharge rate provide some insight to the existence of neural mechanisms in the earliest phases of resistance…

42 CFR 412.624 - Methodology for calculating the Federal prospective payment rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... defined in § 412.602. (4) Adjustments for teaching hospitals. For discharges on or after October 1, 2005... facilities that are teaching institutions or units of teaching institutions. This adjustment is made on a... location, and for teaching programs) as specified by CMS. The additional payment equals 80 percent of the...

Pahoehoe and aa in Hawaii: volumetric flow rate controls the lava structure

NASA Astrophysics Data System (ADS)

Rowland, Scott K.; Walker, George Pl

1990-11-01

The historical records of Kilauea and Mauna Loa volcanoes reveal that the rough-surfaced variety of basalt lava called aa forms when lava flows at a high volumetric rate (>5 10 m3/s), and the smooth-surfaced variety called pahoehoe forms at a low volumetric rate (<5 10 m3/s). This relationship is well illustrated by the 1983 1990 and 1969 1974 eruptions of Kilauea and the recent eruptions of Mauna Loa. It is also illustrated by the eruptions that produced the remarkable paired flows of Mauna Loa, in which aa formed during an initial short period of high discharge rate (associated with high fountaining) and was followed by the eruption of pahoehoe over a sustained period at a low discharge rate (with little or no fountaining). The finest examples of paired lava flows are those of 1859 and 1880 1881. We attribute aa formation to rapid and concentrated flow in open channels. There, rapid heat loss causes an increase in viscosity to a threshold value (that varies depending on the actual flow velocity) at which, when surface crust is torn by differential flow, the underlying lava is unable to move sufficiently fast to heal the tear. We attribute pahoehoe formation to the flowage of lava at a low volumetric rate, commonly in tubes that minimize heat loss. Flow units of pahoehoe are small (usually <1 m thick), move slowly, develop a chilled skin, and become virtually static before the viscosity has risen, to the threshold value. We infer that the high-discharge-rate eruptions that generate aa flows result from the rapid emptying of major or subsidiary magma chambers. Rapid near-surface vesiculation of gas-rich magma leads to eruptions with high discharge rates, high lava fountains, and fast-moving channelized flows. We also infer that long periods of sustained flow at a low discharge rate, which favor pahoehoe, result from the development of a free and unimpeded pathway from the deep plumbing system of the volcano and the separation of gases from the magma before eruption. Achievement of this condition requires one or more episodes of rapid magma excursion through the rift zone to establish a stable magma pathway.

Targeting treatment technologies to address specific stormwater pollutants and numeric discharge limits.

PubMed

Clark, Shirley E; Pitt, Robert

2012-12-15

Stormwater treatment is entering a new phase with stormwater management systems being required to meet specific numeric objectives, as opposed to the historic approach of meeting guidance-document-provided percent removal rates. Meeting numeric discharge requirements will require designers to better understand and apply the physical, chemical, and biological processes underpinning these treatment technologies. This critical review paper focuses on the potential unit treatment operations available for stormwater treatment and outlines how to identify the most applicable treatment options based on the needed pollutant removal goals. Copyright © 2012 Elsevier Ltd. All rights reserved.

Ethnic disparities in traumatic brain injury care referral in a Hispanic-majority population.

PubMed

Budnick, Hailey C; Tyroch, Alan H; Milan, Stacey A

2017-07-01

Functional outcomes after traumatic brain injury (TBI) can be significantly improved by discharge to posthospitalization care facilities. Many variables influence the discharge disposition of the TBI patient, including insurance status, patient condition, and patient prognosis. The literature has demonstrated an ethnic disparity in posthospitalization care referral, with Hispanics being discharged to rehabilitation and nursing facilities less often than non-Hispanics. However, this relationship has not been studied in a Hispanic-majority population, and thus, this study seeks to determine if differences in neurorehabilitation referrals exist among ethnic groups in a predominately Hispanic region. This study is a retrospective cohort that includes 1128 TBI patients who presented to University Medical Center El Paso, Texas, between the years 2005 and 2015. The patients' age, sex, race, residence, admission Glasgow Coma Scale (GCS), GCS motor, Injury Severity Score (ISS), hospital and intensive care unit length of stay (LOS), mechanism of injury, and discharge disposition were analyzed in univariate and multivariate models. Our study population had an insurance rate of 55.5%. Insurance status and markers of injury severity (hospital LOS, intensive care unit LOS, ISS, GCS, and GCS motor) were predictive of discharge disposition to rehabilitation facilities. The study population was 70% Hispanic, yet Hispanics were discharged to rehabilitation facilities (relative risk: 0.56, P: 0.001) and to long-term acute care/nursing facilities (relative risk: 0.35, P < 0.0001) less than non-Hispanics even after LOS, ISS, ethnicity, insurance status, and residence were adjusted for in multivariate analysis. This study suggests that patients of different ethnicities but comparable traumatic severity and insurance status receive different discharge dispositions post-TBI even in regions in which Hispanics are the demographic majority. Copyright © 2017 Elsevier Inc. All rights reserved.

Nationwide trends of hospitalizations for cystic fibrosis in the United States from 2003 to 2013

PubMed Central

Agrawal, Abhinav; Agarwal, Abhishek; Mehta, Dhruv; Sikachi, Rutuja R; Du, Doantrang; Wang, Janice

2017-01-01

Summary Cystic fibrosis (CF) is a multisystem autosomal recessive genetic disorder with significant advances in early diagnosis and treatment in the last decade. It is important to provide updated information regarding these changing demographics as they also reflect a considerable improvement in survival. We analyzed the National Inpatient Sample Database (NIS) in the United States for all patients in which CF was the primary discharge diagnosis (ICD-9: 277.0–277.09) from 2003 to 2013 to evaluate the rate of hospitalizations and determine the cost and mortality associated with CF along with other epidemiological findings. The statistical significance of the difference in the number of hospital discharges, lengths of stays and associated hospital costs over the study period was calculated. In 2003, there were 8,328 hospital discharges with the principal discharge diagnosis of CF in the United States, which increased to 12,590 discharges in 2013 (p < 0.001). The mean hospital charges increased by 57.64% from US$ 60,051 in 2003 to US$ 94,664 in 2013. The aggregate cost of hospital visits increased by 138.31% from US$ 500,105,727 to US$ 1,191,819,760. In the same time, the mortality decreased by 49.3 %. The number of inpatient discharges related to CF has increased from 2003 to 2013. This is due to increased life expectancy of CF patients, resulting in increased disease prevalence. There has been a significant increase in the mean and aggregate cost associated with CF admissions. Over the last decade, many advances have been made in the diagnosis and treatment of CF, consequentially leading to a significant transformation in the epidemiology and demographics of this chronic disease. Rising hospital costs associated with the care of CF patients necessitates future studies analyzing the diagnostic modalities, algorithms and treatment practices of physician's treating CF patients. PMID:28944141

Triplet firing origin in human motor units: emerging hypotheses.

PubMed

Kudina, Lydia P; Andreeva, Regina E

2016-03-01

A specific feature of motor unit (MU) firing behaviour is rhythmic trains of single discharges at low rate resulting from the prolonged motoneuronal afterhyperpolarization. However, some MUs exhibit occasional doublets with uniquely short interspike intervals (2.5-20.0 ms). Motoneuronal delayed depolarization is commonly accepted to be doublet underlying mechanism. Apart from doublets, much scarcer MU triple discharges were described, but their mechanisms are disputable. The aim of the present study was to analyse MU triplet firing origin in healthy humans. MU triple discharges occasionally arising during gentle voluntary muscle contractions were compared with those arising in axons during motor nerve stimulation. Firing pattern was analysed in 109 MUs of four muscles: the tibialis anterior, the flexor carpi ulnaris, the abductor pollicis brevis, and the abductor digiti minimi. Our findings present evidence that during voluntary contractions two kinds of MU triplet firing can be occasionally observed: "true" motoneuronal triplets (interspike intervals of 3.6-17.3 ms) with the delayed depolarization as the possible underlying mechanism and axonal triple discharges including the M-response and F-wave. The findings can be useful not only for understanding mechanisms of the very rare motoneuronal firing in healthy humans but also for estimation of pathological triplet firing origin.

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

PubMed

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

2016-04-01

OBJECTIVE Traumatic brain injury (TBI) in children is a significant public health concern estimated to result in over 500,000 emergency department (ED) visits and more than 60,000 hospitalizations in the United States annually. Sports activities are one important mechanism leading to pediatric TBI. In this study, the authors characterize the demographics of sports-related TBI in the pediatric population and identify predictors of prolonged hospitalization and of 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 children (age 0-17 years) across 5 sports 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 length of stay (LOS) in the hospital or intensive care unit (ICU), medical complications, inpatient mortality rates, and hospital discharge disposition. Statistical significance was assessed at α < 0.05, and the Bonferroni correction (set at significance threshold p = 0.01) for multiple comparisons was applied in each outcome analysis. RESULTS From 2003 to 2012, in total 3046 pediatric sports-related TBIs were recorded in the NTDB, and these injuries represented 11,614 incidents nationally after sample weighting. Fall or interpersonal contact events were the greatest contributors to sports-related TBI (47.4%). Mild TBI represented 87.1% of the injuries overall. Mean (± SEM) LOSs in the hospital and ICU were 2.68 ± 0.07 days and 2.73 ± 0.12 days, respectively. The overall mortality rate was 0.8%, and the prevalence of medical complications was 2.1% across all patients. Severities of head and extracranial injuries were significant predictors of prolonged hospital and ICU LOSs, medical complications, failure to discharge to home, and death. Hypotension on admission to the ED was a significant predictor of failure to discharge to home (OR 0.05, 95% CI 0.03-0.07, p < 0.001). Traumatic brain injury incurred during roller sports was independently associated with prolonged hospital LOS compared with FIC events (mean increase 0.54 ± 0.15 days, p < 0.001). CONCLUSIONS In pediatric sports-related TBI, the severities of head and extracranial traumas are important predictors of patients developing acute medical complications, prolonged hospital and ICU LOSs, in-hospital mortality rates, and failure to discharge to home. Acute hypotension after a TBI event decreases the probability of successful discharge to home. Increasing TBI awareness and use of head-protective gear, particularly in high-velocity sports in older age groups, is necessary to prevent pediatric sports-related TBI or to improve outcomes after a TBI.

Does appropriate empiric antibiotic therapy modify intensive care unit-acquired Enterobacteriaceae bacteraemia mortality and discharge?

PubMed

Pouwels, K B; Van Kleef, E; Vansteelandt, S; Batra, R; Edgeworth, J D; Smieszek, T; Robotham, J V

2017-05-01

Conflicting results have been found regarding outcomes of intensive care unit (ICU)-acquired Enterobacteriaceae bacteraemia and the potentially modifying effect of appropriate empiric antibiotic therapy. To evaluate these associations while adjusting for potential time-varying confounding using methods from the causal inference literature. Patients who stayed more than two days in two general ICUs in England between 2002 and 2006 were included in this cohort study. Marginal structural models with inverse probability weighting were used to estimate the mortality and discharge associated with Enterobacteriaceae bacteraemia and the impact of appropriate empiric antibiotic therapy on these outcomes. Among 3411 ICU admissions, 195 (5.7%) ICU-acquired Enterobacteriaceae bacteraemia cases occurred. Enterobacteriaceae bacteraemia was associated with an increased daily risk of ICU death [cause-specific hazard ratio (HR): 1.48; 95% confidence interval (CI): 1.10-1.99] and a reduced daily risk of ICU discharge (HR: 0.66; 95% CI: 0.54-0.80). Appropriate empiric antibiotic therapy did not significantly modify ICU mortality (HR: 1.08; 95% CI: 0.59-1.97) or discharge (HR: 0.91; 95% CI: 0.63-1.32). ICU-acquired Enterobacteriaceae bacteraemia was associated with an increased daily risk of ICU mortality. Furthermore, the daily discharge rate was also lower after acquiring infection, even when adjusting for time-varying confounding using appropriate methodology. No evidence was found for a beneficial modifying effect of appropriate empiric antibiotic therapy on ICU mortality and discharge. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Moderately premature infants at Kaiser Permanente Medical Care Program in California are discharged home earlier than their peers in Massachusetts and the United Kingdom

PubMed Central

Profit, J; Zupancic, J A F; McCormick, M C; Richardson, D K; Escobar, G J; Tucker, J; Tarnow‐Mordi, W; Parry, G

2006-01-01

Objective To compare gestational age at discharge between infants born at 30–34+6 weeks gestational age who were admitted to neonatal intensive care units (NICUs) in California, Massachusetts, and the United Kingdom. Design Prospective observational cohort study. Setting Fifty four United Kingdom, five California, and five Massachusetts NICUs. Subjects A total of 4359 infants who survived to discharge home after admission to an NICU. Main outcome measures Gestational age at discharge home. Results The mean (SD) postmenstrual age at discharge of the infants in California, Massachusetts, and the United Kingdom were 35.9 (1.3), 36.3 (1.3), and 36.3 (1.9) weeks respectively (p  =  0.001). Compared with the United Kingdom, adjusted discharge of infants occurred 3.9 (95% confidence interval (CI) 1.4 to 6.5) days earlier in California, and 0.9 (95% CI −1.2 to 3.0) days earlier in Massachusetts. Conclusions Infants of 30–34+6 weeks gestation at birth admitted and cared for in hospitals in California have a shorter length of stay than those in the United Kingdom. Certain characteristics of the integrated healthcare approach pursued by the health maintenance organisation of the NICUs in California may foster earlier discharge. The California system may provide opportunities for identifying practices for reducing the length of stay of moderately premature infants. PMID:16449257

Lung function, functional capacity, and respiratory symptoms at discharge from hospital in patients with acute pulmonary embolism: A cross-sectional study.

PubMed

Danielsbacka, Jenny S; Olsén, Monika Fagevik; Hansson, Per-Olof; Mannerkorpi, Kaisa

2018-03-01

Acute pulmonary embolism (PE) is a cardiovascular disease with symptoms including respiratory associated chest pain (RACP) and dyspnea. No previous studies exist focusing on lung function, functional capacity, and respiratory symptoms at discharge after PE. The aim was to examine and describe lung function, functional capacity, and respiratory symptoms at discharge in patients with PE and compare to reference values. Fifty consecutive patients with PE admitted to the Acute Medical Unit, Sahlgrenska University Hospital, were included. Size of PE was calculated by Qanadli score (QS) percentage (mean QS 33.4% (17.6)). FVC and FEV 1 were registered and 6-minute walk test (6MWT) performed at the day of discharge. RACP was rated before and after spirometry/6MWT with the Visual Analogue Scale. Perceived exertion was rated with Borg CR-10 scale. Spirometry and 6MWT results were compared with reference values. This study shows that patients with PE have significantly reduced lung function (p < 0.05) and functional capacity (p < 0.001) at discharge compared with reference values. Patients with higher QS percentage were more dyspneic after 6MWT, no other significant differences in lung function or functional capacity were found between the groups. The patients still suffer from RACP (30%) and dyspnea (60%) at discharge. This study indicates that patients with PE have a reduced lung function, reduced functional capacity, and experience respiratory symptoms as pain and dyspnea at discharge. Further studies are needed concerning long-term follow-up of lung function, functional capacity, and symptoms after PE.

Estimating discharge of shallow groundwater by transpiration from greasewood in the Northern Great Basin

USGS Publications Warehouse

Nichols, William D.

1993-01-01

Evapotranspiration from bare soil and phreatophytes is a principal mechanism of groundwater discharge in arid and semiarid regions of the midwestern and western United States including the Great Basin. The imbalance between independent estimates of groundwater recharge from precipitation and of groundwater discharge based on estimates of groundwater evapotranspiration leads to large uncertainties in groundwater budgets. Few studies have addressed this problem. Energy budget micrometeorological field studies were conducted in a stand of sparse-canopy greasewood growing in an area of shallow groundwater in the western Great Basin during the summer of 1989. The data were used to calculate above-canopy fluxes of sensible and latent heat using the energy budget-Bowen ratio method. The calculated energy budget fluxes were used, with soil surface and plant canopy temperature measurements, to calibrate and apply a two-component, energy-combination model that partitions the energy and heat fluxes between bare soil and the canopy. This permitted the separation of evaporation from the soil and transpiration from greasewood. The calibrated model was used to estimate daily transpiration of groundwater by greasewood growing in an area with a depth to water of about 2 m. The daily rate of groundwater discharge by transpiration during July and August was estimated to be 2.4 mm. A period of 100 days for groundwater discharge at this rate was assumed to estimate an annual discharge of groundwater of 24 cm at the study site.

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

Ground-Water Flow Model of the Sierra Vista Subwatershed and Sonoran Portions of the Upper San Pedro Basin, Southeastern Arizona, United States, and Northern Sonora, Mexico

USGS Publications Warehouse

Pool, D.R.; Dickinson, Jesse

2007-01-01

A numerical ground-water model was developed to simulate seasonal and long-term variations in ground-water flow in the Sierra Vista subwatershed, Arizona, United States, and Sonora, Mexico, portions of the Upper San Pedro Basin. This model includes the simulation of details of the groundwater flow system that were not simulated by previous models, such as ground-water flow in the sedimentary rocks that surround and underlie the alluvial basin deposits, withdrawals for dewatering purposes at the Tombstone mine, discharge to springs in the Huachuca Mountains, thick low-permeability intervals of silt and clay that separate the ground-water flow system into deep-confined and shallow-unconfined systems, ephemeral-channel recharge, and seasonal variations in ground-water discharge by wells and evapotranspiration. Steady-state and transient conditions during 1902-2003 were simulated by using a five-layer numerical ground- water flow model representing multiple hydrogeologic units. Hydraulic properties of model layers, streamflow, and evapotranspiration rates were estimated as part of the calibration process by using observed water levels, vertical hydraulic gradients, streamflow, and estimated evapotranspiration rates as constraints. Simulations approximate observed water-level trends throughout most of the model area and streamflow trends at the Charleston streamflow-gaging station on the San Pedro River. Differences in observed and simulated water levels, streamflow, and evapotranspiration could be reduced through simulation of climate-related variations in recharge rates and recharge from flood-flow infiltration.

Firing patterns of spontaneously active motor units in spinal cord-injured subjects.

PubMed

Zijdewind, Inge; Thomas, Christine K

2012-04-01

Involuntary motor unit activity at low rates is common in hand muscles paralysed by spinal cord injury. Our aim was to describe these patterns of motor unit behaviour in relation to motoneurone and motor unit properties. Intramuscular electromyographic activity (EMG), surface EMG and force were recorded for 30 min from thenar muscles of nine men with chronic cervical SCI. Motor units fired for sustained periods (>10 min) at regular (coefficient of variation ≤ 0.15, CV, n =19 units) or irregular intervals (CV>0.15, n =14). Regularly firing units started and stopped firing independently suggesting that intrinsic motoneurone properties were important for recruitment and derecruitment. Recruitment (3.6 Hz, SD 1.2), maximal (10.2 Hz, SD 2.3, range: 7.5-15.4 Hz) and derecruitment frequencies were low (3.3 Hz, SD 1.6), as were firing rate increases after recruitment (~20 intervals in 3 s). Once active, firing often covaried, promoting the idea that units received common inputs.Half of the regularly firing units showed a very slow decline (>40 s) in discharge before derecruitment and had interspike intervals longer than their estimated after hyperpolarisation potential (AHP) duration (estimated by death rate and breakpoint analyses). The other units were derecruited more abruptly and had shorter estimated AHP durations. Overall, regularly firing units had longer estimated AHP durations and were weaker than irregularly firing units, suggesting they were lower threshold units. Sustained firing of units at regular rates may reflect activation of persistent inward currents, visible here in the absence of voluntary drive, whereas irregularly firing units may only respond to synaptic noise.

Estimated discharge and chemical-constituent loading from the upper Floridan aquifer to the lower St John's River, northeastern Florida, 1990-91

USGS Publications Warehouse

Spechler, R.M.

1995-01-01

The lower St. Johns River, a 101-mile long segment of the St. Johns River, begins at the confluence of the Ocklawaha River and ends where the river discharges into the Atlantic Ocean at Mayport. The St. Johns River is affected by tides as far upstream as Lake George, 106 miles from the mouth. Saltwater from the ocean advances inland during each incoming tide and recedes during each outgoing tide. The chemical quality of the lower St. Johns River is highly variable primarily because of the inflow of saltwater from the ocean, and in some areas, from the discharge of mineralized ground water. Three hydrogeologic units are present in the study area: the surficial aquifer system, the intermediate confining unit, and the Floridan aquifer system. The surficial aquifer system overlies the intermediate confining unit and consists of deposits containing sand, clay, shell, and some limestone and dolomite. The intermediate confining unit underlies all of the study area and retards the vertical movement of water between the surficial aquifer system and the Floridan aquifer system. The intermediate confining unit consists of beds of relatively low permeability sediments that vary in thickness and areal extent and can be breached by sinkholes, fractures, and other openings. The Floridan aquifer system primarily consists of limestone and dolomite. The quality of water in the Upper Floridan aquifer varies throughout the study area. Dissolved solids in water range from about 100 to more than 5,000 milligrams per liter. Chloride and sulfate concentrations in water from the Upper Floridan aquifer range from about 4 to 3,700 milligrams per liter and from 1 to 1,300 milligrams per liter, respectively. The rate of leakage through the intermediate confining unit is controlled by the leakance coefficient of the intermediate confining unit and by the head difference between the Upper Floridan aquifer and the surficial aquifer system. The total ground-water discharge from the Upper Floridan aquifer to the St. Johns River within the lower St. Johns River drainage basin, based on the potentiometric surface of the Upper Floridan aquifer in September 1990, was estimated to be 86 cubic feet per second. Total estimated ground-water discharge to the lower St. Johns River in September 1991, when heads in the Upper Floridan aquifer averaged about 4 feet higher than in 1990, was 133 cubic feet per second. The load of dissolved-solids that discharged from the Upper Floridan aquifer into the lower St. Johns River on the basis of September 1990 heads is estimated to be 47,000 tons per year. Estimated chloride and sulfate loads are 18,000 and 9,500 tons per year, respectively. Dissolved-solids, chloride, and sulfate loads discharging into the lower St. Johns River are estimated to be 81,000, 39,000, and 15,000 tons per year, respectively, on the basis of September 1991 heads.

Factors contributing to the process of intensive care patient discharge: an ethnographic study informed by activity theory.

PubMed

Lin, Frances; Chaboyer, Wendy; Wallis, Marianne; Miller, Anne

2013-08-01

Patient flow from intensive care to acute care units is often problematic and many discharges from intensive care to acute care are unsuccessful on the first attempt. The aim of this study was to explore the factors that influence intensive care patient discharge. This ethnographic study was undertaken in an Australian metropolitan tertiary hospital that had a 14-bed level 3 intensive care unit. Intensive care and acute care unit medical and nursing staff, and other hospital staff who were involved in the intensive care patient discharge process participated in this study. A total of 28 discharges were observed, and 56 one on one interviews were conducted. Data collection techniques including direct observations, semi-structured interviews, and collection of existing documents were used. Activity theory was the theoretical framework that underpinned this study. Three patient activity systems were identified: intensive care patient discharge activity, acute care unit accepting patient activity, and hospital bed management activity. Analysis of the interactions among these activity systems revealed conflicting objects (goals), communication breakdowns, and teamwork issues. Discharge delay was found to be a significant problem, which was associated with limited acute care unit bed availability. Strategies to improve acute care unit bed availability are needed. Routine after-hours ICU discharge could raise patient safety concerns which need to be considered. All team members' input in discharge decision making should be encouraged. Problems identified in clinical handover call for actions to change the handover practice. Activity theory successfully guided the study by providing a practical and descriptive framework for the study, facilitating the understanding of the interrelationships among the activity systems. Copyright © 2012 Elsevier Ltd. All rights reserved.

Trends in US Hospital Stays for Listeriosis in Infants.

PubMed

Veesenmeyer, Angela F; Edmonson, M Bruce

2016-04-01

Although listeriosis is rare in infants, it is common for young infants with suspected serious bacterial infection to be treated empirically with agents selected, in part, for their activity against Listeria monocytogenes. Our objectives were to describe the recent epidemiology of hospital discharges for listeriosis among infants in the United States and to precisely estimate the incidence of listeriosis according to infant age and meningitis status. We generated national estimates for listeriosis discharges in each of the 6 years for which samples were available in the Kids' Inpatient Database during the period 1997-2012. We used random-effects models to pool descriptive information and population rates across study years. The cumulative number of US hospital discharges for listeriosis in infants was 344 (95% confidence interval [CI]: 290-397) over the 6 study years. The pooled annual incidence rate in infants (per 100,000 births) was 1.41 (95% CI: 1.01-1.80) after accounting for marked fluctuation in annual rates (range: 0.66-1.86; I2=79.3%). Discharges for listeriosis without meningitis were particularly rare after the first week of life. Our models predicted only 2.7 (95% CI: 1.1-4.2) and 1.8 (95% CI: 0.0-3.6) such discharges per year in infants admitted at ages 7 to 28 days and 29 to 364 days, respectively. From the perspective of providing coverage against listeriosis, the routine practice of including ampicillin in the empirical treatment of febrile infants should be reevaluated for those older than 1 week without clinical evidence of meningitis. Copyright © 2016 by the American Academy of Pediatrics.

The application of a non-thermal plasma generated by gas-liquid gliding arc discharge in sterilization

NASA Astrophysics Data System (ADS)

Du, Chang Ming; Wang, Jing; Zhang, Lu; Xia Li, Hong; Liu, Hui; Xiong, Ya

2012-01-01

Gliding arc discharge has been investigated in recent years as an innovative physicochemical technique for contaminated water treatment at atmospheric pressure and ambient temperature. In this study we tested a gas-liquid gliding arc discharge reactor, the bacterial suspension of which was treated circularly. When the bacterial suspension was passed through the electrodes and circulated at defined flow rates, almost 100% of the bacteria were killed in less than 3.0 min. Experimental results showed that it is possible to achieve an abatement of 7.0 decimal logarithm units within only 30 s. Circulation flow rates and types of feeding gas caused a certain impact on bacteria inactivation, but the influences are not obvious. So, under the promise of sterilization effect, industrial applications can select their appropriate operating conditions. All inactivation curves presented the same three-phase profile showing an apparent sterilization effect. Analysis of the scanning electron microscope images of bacterial cells supports the speculation that the gas-liquid gliding arc discharge plasma is acting under various mechanisms driven essentially by oxidation and the effect of electric field. These results enhance the possibility of applying gas-liquid gliding arc discharge decontamination systems to disinfect bacterial-contaminated water. Furthermore, correlational research indicates the potential applications of this technology in rapid sterilization of medical devices, spacecraft and food.

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…

42 CFR 412.624 - Methodology for calculating the Federal prospective payment rates.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) Adjustments for teaching hospitals. For discharges on or after October 1, 2005, CMS adjusts the Federal prospective payment on a facility basis by a factor as specified by CMS for facilities that are teaching institutions or units of teaching institutions. This adjustment is made on a claim basis as an interim payment...

Projected increase in lightning strikes in the United States due to global warming

NASA Astrophysics Data System (ADS)

Romps, David M.; Seeley, Jacob T.; Vollaro, David; Molinari, John

2014-11-01

Lightning plays an important role in atmospheric chemistry and in the initiation of wildfires, but the impact of global warming on lightning rates is poorly constrained. Here we propose that the lightning flash rate is proportional to the convective available potential energy (CAPE) times the precipitation rate. Using observations, the product of CAPE and precipitation explains 77% of the variance in the time series of total cloud-to-ground lightning flashes over the contiguous United States (CONUS). Storms convert CAPE times precipitated water mass to discharged lightning energy with an efficiency of 1%. When this proxy is applied to 11 climate models, CONUS lightning strikes are predicted to increase 12 ± 5% per degree Celsius of global warming and about 50% over this century.

Association between pediatric home management plan of care compliance and asthma readmission.

PubMed

Zipkin, Ronen; Schrager, Sheree M; Nguyen, Eugene; Mamey, Mary Rose; Banuelos, Ingrid; Wu, Susan

2017-09-01

In 2007, The Joint Commission implemented three children's asthma care (CAC) measures to help improve the quality of care for patients admitted with asthma. Due to lack of consistent evidence showing a relationship between home management plan of care (HMPC) compliance and readmission rates, CAC-3 was retired in 2016. We aimed to understand the relationship between HMPC compliance and revisits to the hospital, and investigate which components of the HMPC, if any, were driving the effect. This was a retrospective cohort study at a quaternary care freestanding children's hospital, including patients between 2 and 17 years of age admitted with a primary diagnosis of asthma between January 1, 2006, and July 1, 2013. Bivariate and multiple logistic regression analyses examined effects of HMPC provider compliance on hospital readmission and emergency department utilization for asthma within 180 days of initial discharge, controlling for admission to the intensive care unit, age, gender, ethnicity, insurance type, and whether inhaled corticosteroids were prescribed. A total of 1,176 patients were included. Those discharged with an HMPC (n = 756, of which 84% were fully compliant) were found to have significantly lower readmission rates (7 vs. 11.9%; aOR = 0.63; 95% CI, 0.41-0.95) and ED revisit rates (aOR = 0.73; 95% CI, 0.56-0.96) within 180 days of discharge. Providing an HMPC upon discharge was found to be associated with decreased asthma readmission and ED utilization rates. This suggests that although HMPC is no longer a required measure, there may still be utility in continuing this practice.

Variation in day-case nasal surgery - why cannot we improve our day-case rates?

PubMed

Hopkins, C; Browne, J; Slack, R; Brown, P

2007-02-01

The NHS plan states that 75% of all elective operations should be performed as day-cases. We set out to evaluate day surgery rates in sinonasal surgery and to identify factors limiting current practice. Prospective multicentre cohort study. 3128 patients undergoing sinonasal surgery during 2000 and 2001. Same day discharge, complication and readmission rates. There is potential selection bias due to the non-random selection of NHS Trusts and patients in this study. However, as results are similar to Hospital Episode Statistics data such bias is probably small. Only 15.5% of all procedures are performed as day surgery. We are achieving day-case rates of 18, 20 and 6% for nasal polypectomy, intranasal antrostomy and extensive FESS respectively, compared with recently published targets of 90%, 80% and 50%. Factors significantly associated with overnight admission were use of packs, extensive surgery, excess post-operative bleeding and high ASA grade. There was considerable unexplained variation in day-case rates and the use of packs between different surgeons. A third of consultants pack all patients post-operatively. More than 51% of consultants admit all patients, while 5% discharge all patients on the day of surgery. There were no excess adverse events or readmissions amongst the day surgery patients. However, only 17% of in-patients would have liked to be discharged on the day of surgery. Both patient and surgeon must overcome resistance to day case surgery before targets can be reached. Strategies for improving day-case rates in sinonasal surgery. All ASA grade 1 and 2 patients could be considered for day-case surgery, but particularly those with less extensive disease on radiography, and those planned to undergo less extensive procedures. Excess peri-operative bleeding was reported in 6% of patients. There must therefore be provision for overnight admission if required. Greater utilisation of day-case units, selective use of packs, and earlier removal may increase the proportion of patients managed as day-cases. There remains considerable variation in practice at both consultant and trust levels. Units should continue to audit their own figures and compare them against national rates in order to reduce nationwide variation in practice.

Adjustments differ among low-threshold motor units during intermittent, isometric contractions.

PubMed

Farina, Dario; Holobar, Ales; Gazzoni, Marco; Zazula, Damjan; Merletti, Roberto; Enoka, Roger M

2009-01-01

We investigated the changes in muscle fiber conduction velocity, recruitment and derecruitment thresholds, and discharge rate of low-threshold motor units during a series of ramp contractions. The aim was to compare the adjustments in motor unit activity relative to the duration that each motor unit was active during the task. Multichannel surface electromyographic (EMG) signals were recorded from the abductor pollicis brevis muscle of eight healthy men during 12-s contractions (n = 25) in which the force increased and decreased linearly from 0 to 10% of the maximum. The maximal force exhibited a modest decline (8.5 +/- 9.3%; P < 0.05) at the end of the task. The discharge times of 73 motor units that were active for 16-98% of the time during the first five contractions were identified throughout the task by decomposition of the EMG signals. Action potential conduction velocity decreased during the task by a greater amount for motor units that were initially active for >70% of the time compared with that of less active motor units. Moreover, recruitment and derecruitment thresholds increased for these most active motor units, whereas the thresholds decreased for the less active motor units. Another 18 motor units were recruited at an average of 171 +/- 32 s after the beginning of the task. The recruitment and derecruitment thresholds of these units decreased during the task, but muscle fiber conduction velocity did not change. These results indicate that low-threshold motor units exhibit individual adjustments in muscle fiber conduction velocity and motor neuron activation that depended on the relative duration of activity during intermittent contractions.

Quantification of tidally-influenced seasonal groundwater discharge to the Bay of Bengal by seepage meter study

NASA Astrophysics Data System (ADS)

Debnath, Palash; Mukherjee, Abhijit

2016-06-01

Submarine groundwater discharges (SGD) play a major role in solute transport and nutrient flux to the ocean. We have conducted a spatio-temporal high-resolution lunar-tidal cycle-scale seepage meter experiment during pre-monsoon and post-monsoon seasons, to quantify the spatio-temporal patterns and variability of SGD, its terrestrial (T-SGD) and marine components (M-SGD). The measured daily average SGD rates range from no discharge to 3.6 m3 m-2 d-1 during pre-monsoon season and 0.08-5.9 m3 m-2 d-1 during post-monsoon seasons, depending on the tidal pattern. The uncertainty for SGD measurement is calculated as ±0.8% to ±11% for pre-monsoon and ±1.8% to ±17% for post-monsoon respectively. A linear, inverse relationship was observed between the calculated T-SGD and M-SGD components, which varied along the distance from the coast and position in the tidal-cycle, spatial and temporal (daily) variations of seepage rates within the lunar tidal cycle period distinctly demonstrate the influence of tides on groundwater seepage rate. As an instance, for the identification of the bulk discharge location, the centroid of the integrated SGD rate has been calculated and found to be near 20 m offshore area. The average discharge rate per unit area further extrapolated to total SGD fluxes to the Bay of Bengal from eastern Indian coast by extrapolation of the annual and seasonal fluxes observed in the study area, which are first direct/experimental estimate of SGD to the Bay of Bengal. Approximations suggest that in present-day condition, total average annual SGD to the Bay of Bengal is about 8.98 ± 0.6 × 108 m3/y. This is suggested that the SGD input to the ocean through the Bay of Bengal is approximately 0.9% of the global input from the inter-tidal zone and that has an implication on the mass balance of discharging solutes/nutrients to the global oceans. High T-SGD input is observed for all season, which is largest toward landward direction from the delineated saltwater-freshwater interface. The high magnitude of T-SGD could play an important role in mass balance of fresh water discharge and solute transport to the global ocean, thereby influence coastal ecohydrological systems.

Critical Congenital Heart Disease Screening by Pulse Oximetry in a Neonatal Intensive Care Unit

PubMed Central

Manja, Veena; Mathew, Bobby; Carrion, Vivien; Lakshminrusimha, Satyan

2014-01-01

Critical congenital heart disease (CCHD) screening is effective in asymptomatic late preterm and term newborn infants with a low false positive rate (0.035%). Objective (1) To compare 2817 NICU discharges before and after implementation of CCHD screening; and (2) to evaluate CCHD screening at < 35 weeks gestation. Methods collection of results of CCHD screening including preductal and postductal SpO2 values. Results During the pre-CCHD screen period, 1247 infants were discharged from the NICU and one case of CCHD was missed. After 3/1/12, 1508 CCHD screens were performed among 1570 discharges and no CCHDs were missed. The preductal and postductal SpO2 values were 98.8±1.4% and 99±1.3% respectively in preterm and 98.9±1.3% and 98.9±1.4% in term infants. Ten infants had false positive screens (10/1508=0.66%). Conclusions Performing universal screening in the NICU is feasible but is associated with a higher false positive rate compared to asymptomatic newborn infants. PMID:25058746

Early life factors associated with the exclusivity and duration of breast feeding in an Irish birth cohort study.

PubMed

Smith, Hazel Ann; O'B Hourihane, Jonathan; Kenny, Louise C; Kiely, Mairead; Murray, Deirdre M; Leahy-Warren, Patricia

2015-09-01

to investigate the influence of parental and infant characteristics on exclusive breast feeding from birth to six months of age and breast feeding rates at two, six and 12 months of age in Ireland. secondary data analysis from the Cork BASELINE Birth Cohort Study (http://www.baselinestudy.net/). Infants were seen at birth and two, six, and 12 months of age. Maternal and paternal history, neonatal course and feeding data were collected at birth and using parental questionnaires at each time point. 1094 singleton infants of primiparous women recruited at 20 weeks' gestation who were breastfeeding on discharge from the maternity hospital. at discharge from the maternity hospital and at two months, neonatal intensive-care unit admission had the strongest influence on exclusive breast feeding status (adjusted OR 0.17, 95% CI 0.07-0.41 at discharge) and at two months (adjusted OR=0.20, 95% CI 0.05-0.83). A shorter duration of breast feeding was significantly associated with younger maternal age, non-tertiary education, Irish nationality and neonatal intensive-care unit admission. There was a significant difference in the duration of any breast feeding between infants who were and were not admitted to the neonatal intensive-care unit, 28(10.50, 32) weeks versus 32(27, 40) weeks. Mothers whose maternity leave was between seven and 12 months (adjusted OR=2.76, 95% CI 1.51-5.05) breast fed for a longer duration compared to mothers who had less than six months of maternity leave. admission to the neonatal intensive care unit negatively influenced both exclusivity and duration of breast feeding. Length of maternity leave, and not employment status, was significantly associated with duration of breast feeding. additional support may be required to ensure continued breast feeding in infants admitted to the neonatal intensive-care unit. Length of maternity leave is a modifiable influence on breast feeding and offers the opportunity for intervention to improve our rates of breast feeding. Copyright © 2015 Elsevier Ltd. All rights reserved.

The impact of DRGs on the cost and quality of health care in the United States.

PubMed

Davis, C; Rhodes, D J

1988-01-01

The prospective Payment System (PPS) represents a fundamental change in the way the United States government reimburses hospitals for medical services covered under Medicare, a federal health care insurance program for the elderly and disabled. PPS replaced the retrospective cost-based system of payment for Medicare services with a prospective payment system. Under PPS, a predetermined specific rate for each discharge dictates payment according to the diagnosis related group (DRG) in which the discharge is classified. The PPS was intended to create financial incentives that encourage hospitals to restrain the use of resources while providing high-quality inpatient care. Both objectives appear to have been met under PPS. Hospital utilization has declined, average length of stay has fallen, and the locus of care has shifted from the inpatient setting to less costly outpatient settings. The growth in inpatient hospital benefits has slowed and the impending insolvency of the Medicare trust fund has been forestalled. Studies have found no deterioration in the quality of care rendered to Medicare beneficiaries. Neither the mortality rate nor the rate of re-admission (presumably related to premature discharge) increased under PPS. Indeed, PPS appears to have enhanced the quality of inpatient care by discouraging unnecessary and potentially harmful procedures, and by encouraging the concentration of complex procedures in facilities in which the high frequency of these procedures promotes efficiency. Incentive-based reimbursement also appears to have contributed to the growth in alternative delivery systems, such as HMOs and PPOs, which contain costs by maintaining a high volume of a limited range of services. The success of the PPS/DRG system in controlling costs and promoting quality in this country suggests its application in other countries, either as a method of reimbursement or as a product line management tool.

Dolomite dissolution rates and possible Holocene dedolomitization of water-bearing units in the Edwards aquifer, south-central Texas

USGS Publications Warehouse

Deike, R.G.

1990-01-01

Rates of dolomite dissolution can be used to test the concept, based on geomorphologic evidence, that a major part of the Edwards aquifer could have formed within the Holocene, a timeframe of approximately 10,000 years. During formation of the aquifer in the Edwards limestone (Cretaceous, Albian) of the Balcones fault zone, dolomite dissolution and porosity development were synchronous and the result of mixing-zone dedolomitization. Initiation of the mixing zone in the early Holocene (???11,000 years before present) is suggested by the maximum age of formation of major discharge sites that allowed the influx of meteoric water into brine-filled, dolomitic preaquifer units. Dedolomitization, the dissolution of dolomite and net precipitation of calcite, has left aquifer units that are calcitic, and 40 vol.% interconnected pore space. The mass of dolomite missing is obtained by comparison of stratigraphically equivalent altered and unaltered units. One dissolution rate (1.76 ?? 10-4 mmol dolomite kgH2O-1yr-1) is determined from this mass, 104yr reaction time, and a log-linear function describing the increase in mass discharge (three orders of magnitude) during aquifer formation. The second estimated dissolution rate is obtained from the mass transfer of dolomite to solution calculated from the increase in magnesium in pore fluids selected from the modern aquifer to represent a typical flowpath during aquifer formation. A reaction time of 104yr for this mass transfer yields a rate of 0.56 ?? 10-4 mmol dolomite kgH2O-1yr-1. Both of these rates are comparable to modern rates of dolomite dissolution (0.3 to 4.5 ?? 10-4 mmol dolomite kgH2O-1yr-1) calculated from measured reaction times in the Tertiary Floridan aquifer system in Florida and the Madison aquifer in the Mississippian Madison Limestone of the Northern Great Plains. Similarity of these rates to the estimated paleo-rates of dolomite dissolution supports a 104 yr reaction timeframe. The Holocene reaction time also can be compared to a series of reaction times calculated by assuming that the mass of dolomite missing from the Edwards was removed at rates observed in the Floridan and Madison aquifers. These reaction times (for complete removal of dolomite) range from 2700 to 58,500 yr and span the Pleistocene-Holocene boundary. Finally, an estimated dolomite reaction rate during dedolomitization of the Edwards aquifer based on surface area of exposed dolomite [mmol cm-2s-1 (millimoles per square centimeter per second)] may be approximated from reaction times. This rate is directly a function of the mass of dolomite removed and the surface area exposed per pore volume passing through the rock. The surface area is available from the observed dolomite rhomb size in unaltered rock. The rate of pore fluid movement is obtained from the averaged annual discharge. Rates during formation of the Edwards aquifer calculated from all reaction times range from 10-13 to 10-14 mmol dolomite cm-2s-1. These rates are faster than rates (10-18 mmol cm-2s-1), measured in the pure laboratory system, CaMg(CO3)2CO2H2O, but slower than rates determined in an alpine stream study (10-10 to 10-11 mmol cm-2s-1) where cold glacial melt water flows over dolostone. Dolomite dissolution rates from both the Edwards and other aquifers support the concept that a major part of the Edwards aquifer could have formed within the Holocene. ?? 1990.

A longitudinal ecological study of household firearm ownership and firearm-related deaths in the United States from 1999 through 2014: A specific focus on gender, race, and geographic variables.

PubMed

Geier, David A; Kern, Janet K; Geier, Mark R

2017-06-01

Firearms have a longstanding tradition in the United States (US) and are viewed by many with iconic stature with regards to safety and personal freedom. Unfortunately, from a public health point of view, firearm-related deaths (FRDs) in the US have reached a crisis point with an estimated > 31,000 deaths and 74,000 nonfatal injuries resulting from firearms each year. This longitudinal ecological study analyzed variations in FRDs following firearm assaults (FAs) and law enforcement incidents involving a firearm (LEIF) in comparison to variations in household firearm ownership (HFO) among different geographic and demographic groups in the US from 1999 to 2014. The Underlying Cause of Death database was examined on the CDC Wonder online interface. Records coded with ICD-10 codes: FA (X93 - assault by handgun discharge, X94 - assault by rifle, shotgun, and larger firearm discharge, or X95 - assault by other and unspecified firearm discharge) and LEIF (Y35.0) were examined, and the prevalence of HFO was determined using the well-established proxy of the percentage of suicides committed with a firearm. Gender, ethnicity, Census Division, and urbanization significantly impacted the death rates from FA and LEIF. Significant direct correlations between variations in HFO and death rates from FAs and LEIF were observed. Understanding the significant impacts of gender, race, Census Division, and urbanization status may help shape future public health policy to promote increased firearm safety.

Geriatric Hip Fracture Care: Fixing a Fragmented System.

PubMed

Anderson, Mary E; Mcdevitt, Kelly; Cumbler, Ethan; Bennett, Heather; Robison, Zachary; Gomez, Bryan; Stoneback, Jason W

2017-01-01

Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners. To describe a stepwise approach to systems redesign for this patient population. We designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning. Hospital length of stay. We identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved. Our comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system.

Prevalence of and outcomes from Staphylococcus aureus pneumonia among hospitalized patients in the United States, 2009-2012.

PubMed

Jacobs, David M; Shaver, Amy

2017-04-01

The burden of Staphylococcus aureus pneumonia is unknown despite being a major cause of mortality. We investigated national estimates of methicillin-resistant S aureus (MRSA) and methicillin-susceptible S aureus (MSSA) pneumonias and predictors of in-hospital mortality and hospital length of stay (LOS). This was a retrospective analysis of the National Inpatient Sample from 2009-2012. Adult patients with an ICD-9-CM primary diagnosis code for MRSA or MSSA pneumonia were included. Data weights were used to derive national estimates. Prevalence rates were reported per 100,000 hospital discharges, with trends presented descriptively. There were 104,562 patients who had a primary diagnosis of S aureus pneumonia, with 81,275 from MRSA. MRSA pneumonia prevalence decreased steadily from 2009 (75.6 cases per 100,000 discharges) to 2012 (56.6 cases per 100,000 discharges), with MSSA pneumonia experiencing a slight decrease. Mortality rates decreased between 2009 and 2012 for MRSA pneumonia (7.9% to 6.4%) and MSSA pneumonia (6.9% to 4.7%; P = .008). LOS was higher for MRSA (6.9-7.8 days) compared with MSSA (6.1-6.4 days). The prevalence of MRSA pneumonia has decreased among hospitalized adults in the United States in recent years accompanied by improvements in mortality and LOS. Although the prevalence of MRSA pneumonia is declining, national vigilance is still warranted. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Bedload transport associated with high stream power, Jordan River, Israel

PubMed Central

Inbar, Moshe; Schick, Asher P.

1979-01-01

During a flood of a magnitude that recurs once in 100 years, boulders up to 1700 mm in size were transported in the Jordan and Meshushim Rivers, northern Israel. Bedload discharge rates were estimated for periods of 3-72 hr of peak flow by a combination of hydrologic and geomorphic methods. Bedload transport rate is proportional to unit stream power in excess of that necessary for initial motion, raised to the power 3/2, as has been shown for data on other rivers. PMID:16592661

Stress in caregivers of elderly patients: the effect of an admission to a rehabilitation unit.

PubMed

Caradoc-Davies, T H; Dixon, G S

1991-06-12

to study stress in caregivers of elderly dependent persons after admission to a geriatric assessment and rehabilitation unit. in 1986-7 we studied patients admitted to a geriatric assessment and rehabilitation unit in Dunedin to establish the relationship between caregiver stress, their psychological health and social functioning, and patient variables such as physical dependency. of the 64 patients who were admitted from the community and who had a caregiver, 42 were discharged back to the community, and 30 remained there until six weeks. On admission caregiver stress was increased by problems perceived in social function (lack of companionship, excessive responsibilities and financial problems) and decreased when the caregiver had a high sense of psychological wellbeing. It was not associated with high patient dependency or the level of social support. Caregiver stress one week after discharge was lower among those with high emotional support and those with an internal locus of control. If caregiver stress one week after discharge was high there was an increased rate of readmission. rehabilitation should include interventions directed towards the psychological health and social function of the caregiver as well as the physical independence of the patient. Improved financial support and the provision of companionship through community support groups may result in reduced caregiver stress, which should help dependent elderly people to continue to live in the community.

Water balance in irrigation districts. Uncertainty in on-demand pressurized networks

NASA Astrophysics Data System (ADS)

Sánchez-Calvo, Raúl; Rodríguez-Sinobas, Leonor; Juana, Luis; Laguna, Francisco Vicente

2015-04-01

In on-demand pressurized irrigation distribution networks, applied water volume is usually controlled opening a valve during a calculated time interval, and assuming constant flow rate. In general, pressure regulating devices for controlling the discharged flow rate by irrigation units are needed due to the variability of pressure conditions. A pressure regulating valve PRV is the commonly used pressure regulating device in a hydrant, which, also, executes the open and close function. A hydrant feeds several irrigation units, requiring a wide range in flow rate. In addition, some flow meters are also available, one as a component of the hydrant and the rest are placed downstream. Every land owner has one flow meter for each group of field plots downstream the hydrant. Ideal PRV performance would maintain a constant downstream pressure. However, the true performance depends on both upstream pressure and the discharged flow rate. Theoretical flow rates values have been introduced into a PRV behavioral model, validated in laboratory, coupled with an on-demand irrigation district waterworks, composed by a distribution network and a multi-pump station. Variations on flow rate are simulated by taking into account the consequences of variations on climate conditions and also decisions in irrigation operation, such us duration and frequency application. The model comprises continuity, dynamic and energy equations of the components of both the PRV and the water distribution network. In this work the estimation of water balance terms during the irrigation events in an irrigation campaign has been simulated. The effect of demand concentration peaks has been estimated.

Role of aquifer heterogeneity in fresh groundwater discharge and seawater recycling: An example from the Carmel coast, Israel

USGS Publications Warehouse

Weinstein, Y.; Burnett, W.C.; Swarzenski, P.W.; Shalem, Y.; Yechieli, Y.; Herut, B.

2007-01-01

A case study is shown in which the pattern of submarine groundwater discharge and of seawater recycling is controlled by local hydrogeological variability. The coastal aquifer in Dor Bay is composed of two units: a partly confined calcaranitic sandstone (Kurkar) and an overlying loose sand. Groundwater in the Kurkar has elevated activities of 222Rn (∼390 dpm/L) and relatively low 224Ra/223Ra activity ratios (3–4), while the sand groundwater is significantly less radiogenic (6–90 dpm/L) and shows higher 224Ra/223Ra ratios. Groundwater discharging from sand-covered areas of the bay has salinities of 16–31 and an average 222Rn activity of 168 dpm/L, which lies on a mixing line between Rn-rich Kurkar fresh water and Rn-poor seawater. Another key observation is that seawater infiltrates to some extent into onshore sand groundwater, while the fresh water within the submarine Kurkar can be traced up to 40 m offshore. This implies that while fresh water mainly discharges from the Kurkar unit, seawater recycling is limited to the loose sand, and that the discharge from sand-covered areas is a mixture of Kurkar water with recycled seawater. Advection rates from the bay floor were calculated from Rn time series and found to vary between 0 and 36 cm/d, correlating negatively with bay water depth. The average flux was 8.1 cm/d, and it did not seem to change much during March, May, and July 2006. The average amount of fresh water discharging to the bay was 5.0 m3/d per meter of shoreline. Radon activity in the sand groundwater also fluctuates due to influx of Kurkar-type groundwater.

Accelerated life test of sputtering and anode deposit spalling in a small mercury ion thruster

NASA Technical Reports Server (NTRS)

Power, J. L.

1975-01-01

Tantalum and molybdenum sputtered from discharge chamber components during operation of a 5 centimeter diameter mercury ion thruster adhered much more strongly to coarsely grit blasted anode surfaces than to standard surfaces. Spalling of the sputtered coating did occur from a coarse screen anode surface but only in flakes less than a mesh unit long. The results were obtained in a 200 hour accelerated life test conducted at an elevated discharge potential of 64.6 volts. The test approximately reproduced the major sputter erosion and deposition effects that occur under normal operation but at approximately 75 times the normal rate. No discharge chamber component suffered sufficient erosion in the test to threaten its structural integrity or further serviceability. The test indicated that the use of tantalum-surfaced discharge chamber components in conjunction with a fine wire screen anode surface should cure the problems of sputter erosion and sputtered deposits spalling in long term operation of small mercury ion thrusters.

Firing patterns of spontaneously active motor units in spinal cord-injured subjects

PubMed Central

Zijdewind, Inge; Thomas, Christine K

2012-01-01

Involuntary motor unit activity at low rates is common in hand muscles paralysed by spinal cord injury. Our aim was to describe these patterns of motor unit behaviour in relation to motoneurone and motor unit properties. Intramuscular electromyographic activity (EMG), surface EMG and force were recorded for 30 min from thenar muscles of nine men with chronic cervical SCI. Motor units fired for sustained periods (>10 min) at regular (coefficient of variation ≤ 0.15, CV, n = 19 units) or irregular intervals (CV > 0.15, n = 14). Regularly firing units started and stopped firing independently suggesting that intrinsic motoneurone properties were important for recruitment and derecruitment. Recruitment (3.6 Hz, SD 1.2), maximal (10.2 Hz, SD 2.3, range: 7.5–15.4 Hz) and derecruitment frequencies were low (3.3 Hz, SD 1.6), as were firing rate increases after recruitment (∼20 intervals in 3 s). Once active, firing often covaried, promoting the idea that units received common inputs. Half of the regularly firing units showed a very slow decline (>40 s) in discharge before derecruitment and had interspike intervals longer than their estimated afterhyperpolarisation potential (AHP) duration (estimated by death rate and breakpoint analyses). The other units were derecruited more abruptly and had shorter estimated AHP durations. Overall, regularly firing units had longer estimated AHP durations and were weaker than irregularly firing units, suggesting they were lower threshold units. Sustained firing of units at regular rates may reflect activation of persistent inward currents, visible here in the absence of voluntary drive, whereas irregularly firing units may only respond to synaptic noise. PMID:22310313

Performance, Facility Pressure Effects, and Stability Characterization Tests of NASA's Hall Effect Rocket with Magnetic Shielding Thruster

NASA Technical Reports Server (NTRS)

Kamhawi, Hani; Huang, Wensheng; Haag, Thomas; Yim, John; Herman, Daniel; Williams, George; Gilland, James; Peterson, Peter; Hofer, Richard; Mikellides, Ioannis

2016-01-01

NASAs Hall Effect Rocket with Magnetic Shielding (HERMeS) 12.5 kW Technology Demonstration Unit-1 (TDU-1) Hall thruster has been the subject of extensive technology maturation in preparation for flight system development. Part of the technology maturation effort included experimental evaluation of the TDU-1 thruster with conducting and dielectric front pole cover materials in two different electrical configurations. A graphite front pole cover thruster configuration with the thruster body electrically tied to cathode and an alumina front pole cover thruster configuration with the thruster body floating were evaluated. Both configurations were also evaluated at different facility background pressure conditions to evaluate background pressure effects on thruster operation. Performance characterization tests found that higher thruster performance was attained with the graphite front pole cover configuration with the thruster electrically tied to cathode. A total thrust efficiency of 68 and a total specific impulse of 2,820 s was demonstrated at a discharge voltage of 600 V and a discharge power of 12.5 kW. Thruster stability regimes were characterized with respect to the thruster discharge current oscillations and with maps of the current-voltage-magnetic field (IVB). Analysis of TDU-1 discharge current waveforms found that lower normalized discharge current peak-to-peak and root mean square magnitudes were attained when the thruster was electrically floated with alumina front pole covers. Background pressure effects characterization tests indicated that the thruster performance and stability was mostly invariant to changes in the facility background pressure for vacuum chamber pressure below 110-5 Torr-Xe (for thruster flow rate above 8 mgs). Power spectral density analysis of the discharge current waveform showed that increasing the vacuum chamber background pressure resulted in a higher discharge current dominant frequency. Finally the IVB maps of the TDU-1 thruster taken at elevated magnetic fields indicated that the discharge current became more oscillatory with increased facility background pressure at lower thruster mass flow rates, where thruster operation at higher flow rates resulted in less change to the thrusters IVB characteristics.

Evaluation of functional independence after discharge from the intensive care unit

PubMed Central

Curzel, Juliane; Forgiarini Junior, Luiz Alberto; Rieder, Marcelo de Mello

2013-01-01

Objective 1) To evaluate the functional independence measures immediately after discharge from an intensive care unit and to compare these values with the FIMs 30 days after that period. 2) To evaluate the possible associated risk factors. Methods The present investigation was a prospective cohort study that included individuals who were discharged from the intensive care unit and underwent physiotherapy in the unit. Functional independence was evaluated using the functional independence measure immediately upon discharge from the intensive care unit and 30 days thereafter via a phone call. The patients were admitted to the Hospital Santa Clara intensive care unit during the period from May 2011 to August 2011. Results During the predetermined period of data collection, 44 patients met the criteria for inclusion in the study. The mean age of the patients was 55.4±10.5 years. Twenty-seven of the subjects were female, and 15 patients were admitted due to pulmonary disease. The patients exhibited an functional independence measure of 84.1±24.2. When this measure was compared to the measure at 30 days after discharge, there was improvement across the functional independence variables except for that concerned with sphincter control. There were no significant differences when comparing the gender, age, clinical diagnosis, length of stay in the intensive care unit, duration of mechanical ventilation, and the presence of sepsis during this period. Conclusion Functional independence, as evaluated by the functional independence measure scale, was improved at 30 days after discharge from the intensive care unit, but it was not possible to define the potentially related factors. PMID:23917973

Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit

PubMed Central

Escobar, G J; McCormick, M C; Zupancic, J A F; Coleman‐Phox, K; Armstrong, M A; Greene, J D; Eichenwald, E C; Richardson, D K

2006-01-01

Background Newborns of 30–34 weeks gestation comprise 3.9% of all live births in the United States and 32% of all premature infants. They have been studied much less than very low birthweight infants. Objective To measure in‐hospital outcomes and readmission within three months of discharge of moderately premature infants. Design Prospective cohort study including retrospective chart review and telephone interviews after discharge. Setting Ten birth hospitals in California and Massachusetts. Patients Surviving moderately premature infants born between October 2001 and February 2003. Main outcome measures (a) Occurrence of assisted ventilation during the hospital stay after birth; (b) adverse in‐hospital outcomes—for example, necrotising enterocolitis; (c) readmission within three months of discharge. Results With the use of prospective cluster sampling, 850 eligible infants and their families were identified, randomly selected, and enrolled. A total of 677 families completed a telephone interview three months after hospital discharge. During the birth stay, these babies experienced substantial morbidity: 45.7% experienced assisted ventilation, and 3.2% still required supplemental oxygen at 36 weeks. Readmission within three months occurred in 11.2% of the cohort and was higher among male infants and those with chronic lung disease. Conclusions Moderately premature infants experience significant morbidity, as evidenced by high rates of assisted ventilation, use of oxygen at 36 weeks, and readmission. Such morbidity deserves more research. PMID:16611647

Discharge characteristics of biceps brachii motor units at recruitment when older adults sustained an isometric contraction.

PubMed

Pascoe, Michael A; Holmes, Matthew R; Enoka, Roger M

2011-02-01

The purpose of this study was to compare the discharge characteristics of motor units recruited during an isometric contraction that was sustained with the elbow flexor muscles by older adults at target forces that were less than the recruitment threshold force of each isolated motor unit. The discharge times of 27 single motor units were recorded from the biceps brachii in 11 old adults (78.8 ± 5.9 yr). The target force was set at either a relatively small (6.6 ± 3.7% maximum) or large (11.4 ± 4.5% maximum) difference below the recruitment threshold force and the contraction was sustained until the motor unit was recruited and discharged action potentials for about 60 s. The time to recruitment was longer for the large target-force difference (P = 0.001). At recruitment, the motor units discharged repetitively for both target-force differences, which contrasts with data from young adults when motor units discharged intermittently at recruitment for the large difference between recruitment threshold force and target force. The coefficient of variation (CV) for the first five interspike intervals (ISIs) increased from the small (18.7 ± 7.9) to large difference (35.0 ± 10.2%, P = 0.008) for the young adults, but did not differ for the two target force differences for the old adults (26.3 ± 14.7 to 24.0 ± 13.1%, P = 0.610). When analyzed across the discharge duration, the average CV for the ISI decreased similarly for the two target-force differences (P = 0.618) in old adults. These findings contrast with those of young adults and indicate that the integration of synaptic input during sustained contractions differs between young and old adults.

Accurate identification of motor unit discharge patterns from high-density surface EMG and validation with a novel signal-based performance metric

NASA Astrophysics Data System (ADS)

Holobar, A.; Minetto, M. A.; Farina, D.

2014-02-01

Objective. A signal-based metric for assessment of accuracy of motor unit (MU) identification from high-density surface electromyograms (EMG) is introduced. This metric, so-called pulse-to-noise-ratio (PNR), is computationally efficient, does not require any additional experimental costs and can be applied to every MU that is identified by the previously developed convolution kernel compensation technique. Approach. The analytical derivation of the newly introduced metric is provided, along with its extensive experimental validation on both synthetic and experimental surface EMG signals with signal-to-noise ratios ranging from 0 to 20 dB and muscle contraction forces from 5% to 70% of the maximum voluntary contraction. Main results. In all the experimental and simulated signals, the newly introduced metric correlated significantly with both sensitivity and false alarm rate in identification of MU discharges. Practically all the MUs with PNR > 30 dB exhibited sensitivity >90% and false alarm rates <2%. Therefore, a threshold of 30 dB in PNR can be used as a simple method for selecting only reliably decomposed units. Significance. The newly introduced metric is considered a robust and reliable indicator of accuracy of MU identification. The study also shows that high-density surface EMG can be reliably decomposed at contraction forces as high as 70% of the maximum.

Immunization Status of NICU Graduates at a Tertiary Care Children's Hospital.

PubMed

Macintosh, Janelle L B; Huggins, Leslie J; Eden, Lacey M; Merrill, Katreena Collette; Luthy, Karlen E Beth

2017-04-01

Approximately 500,000 infants are born prematurely each year in the United States. Immunization of infants in a neonatal intensive care unit (NICU) set a precedence for future immunizations. The objectives of this study were to determine the current rates of immunization and identify variables associated with immunizations of NICU graduates who were aged 60 days or older at time of discharge. This descriptive pilot study utilized retrospective paper medical record review in one tertiary children's hospital. The relationships between immunization status and study variables were examined using t tests and logistic regression. Of 43 infants discharged at least 60 days of age or older from the NICU, 74.4% were fully immunized in accordance with American Academy of Pediatrics (AAP) recommendations. Significant predictors were age at discharge for immunization and steroid use for nonimmunization. Immunization needs to be a priority in order to give NICU infants every advantage regarding their future health status. Nurses need to implement hospital policies ensuring immunizations of NICU graduates. Future studies should focus on samples from diverse hospitals and levels of NICUs. Qualitative studies exploring and describing parent and provider knowledge of current AAP guidelines will strengthen our understanding of potential barriers to immunization.

77 FR 27769 - Greybull Valley Irrigation District; Notice of Preliminary Permit Application Accepted for Filing...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-11

... unit rated at 5 megawatts or less at 150 feet of net head; (3) a tailrace channel discharging from the... instructions on the Commission's Web site http://www.ferc.gov/docs-filing/efiling.asp . Commenters can submit...://www.ferc.gov/docs-filing/ecomment.asp . You must include your name and contact information at the end...

Innovative Remote Sensors for Streamflow Measurement

NASA Astrophysics Data System (ADS)

Gourley, J. J.; Fulton, J. W.; Daniel, W.

2016-12-01

The United States Geological Survey operates and maintains over 7000 streamgages across the United States., Conventional streamgages have several important limitations: annual maintenance cost of approximately $15k makes gaging smaller basins uneconomical, manual updating of stage-discharge rating curves is inefficient and can be hazardous to operators, and instruments in contact with the water are sometimes damaged or lost during flood events. A suite of new, non-contact sensors is proposed to address these limitations and add new, previously unmeasured variables. First, a commercially available radar system has been fielded in a very dynamic stream environment and successfully used to measure stage height and stream velocity at high temporal resolution, on the order of a few minutes. Second, a custom water-penetrating lidar has been developed and demonstrated to map 1-D bathymetry (cross-section) in clear streams. Combined with stage and velocity measurements from the radar, this will allow for computation of discharge using non-contact methods without the need to update and maintain an empirical rating curve. Once mature, these technologies promise to reduce cost and manual intervention, allow proliferation of measurements to smaller streams, and introduce previously unmeasured variables to the hydrological scientist's toolbox.

Hospitalization Drug Regimen Changes in Geriatric Patients and Adherence to Modifications by General Practitioners in Primary Care.

PubMed

Rouch, L; Farbos, F; Cool, C; McCambridge, C; Hein, C; Elmalem, S; Rolland, Y; Vellas, B; Cestac, P

2018-01-01

To evaluate the overall rate of adherence by general practitioners (GPs) to treatment modifications suggested at discharge from hospital and to assess the way communication between secondary and primary care could be improved. Observational prospective cohort study. Patients hospitalized from the emergency department to the acute geriatric care unit of a university hospital. 206 subjects with a mean age of 85 years. Changes in drug regimen undertaken during hospitalization were collected with the associated justifications. Adherence at one month by GPs to treatment modifications was assessed as well as modifications implemented in primary care with their rationale in case of non-adherence. Community pharmacists' and GPs' opinions about quality of communication and information transfer at hospital-general practice interface were investigated. 5.5 ± 2.8 drug regimen changes were done per patient during hospitalization. The rate of adherence by GPs to treatment modifications suggested at discharge from hospital was 83%. In most cases, non-adherence by GPs to treatment modifications done during hospitalization was due to dosage adjustments, symptoms resolution but also worsening of symptoms. The last of which was particularly true for psychotropic drugs. All GPs received their patients' discharge letters but the timely dissemination still needs to be improved. Only 6.6% of community pharmacists were informed of treatment modifications done during their patients' hospitalization. Our findings showed a successful rate of adherence by GPs to treatment modifications suggested at discharge from hospital, due to the fact that optimization was done in a collaborative way between geriatricians and hospital pharmacists and that justifications for drug regimen changes were systematically provided in discharge letters. Communication processes at the interface between secondary and primary care, particularly with community pharmacists, must be strengthened to improve seamless care.

Outcome following inhalation anesthesia in birds at a veterinary referral hospital: 352 cases (2004-2014).

PubMed

Seamon, Amanda B; Hofmeister, Erik H; Divers, Stephen J

2017-10-01

OBJECTIVE To determine the outcome in birds undergoing inhalation anesthesia and identify patient or procedure variables associated with an increased likelihood of anesthesia-related death. DESIGN Retrospective case series. ANIMALS 352 birds that underwent inhalation anesthesia. PROCEDURES Medical records of birds that underwent inhalation anesthesia from January 1, 2004, through December 31, 2014, at a single veterinary referral hospital were reviewed. Data collected included date of visit, age, species, sex, type (pet, free ranging, or wild kept in captivity), body weight, body condition score, diagnosis, procedure, American Society of Anesthesiologists status, premedication used for anesthesia, drug for anesthetic induction, type of maintenance anesthesia, route and type of fluid administration, volumes of crystalloid and colloid fluids administered, intraoperative events, estimated blood loss, duration of anesthesia, surgery duration, recovery time, recovery notes, whether birds survived to hospital discharge, time of death, total cost of hospitalization, cost of anesthesia, and nadir and peak values for heart rate, end-tidal partial pressure of carbon dioxide, concentration of inhaled anesthetic, and body temperature. Comparisons were made between birds that did and did not survive to hospital discharge. RESULTS Of 352 birds, 303 (86%) were alive at hospital discharge, 12 (3.4%) died during anesthesia, 15 (4.3%) died in the intensive care unit after anesthesia, and 22 (6.3%) were euthanatized after anesthesia. Overall, none of the variables studied were associated with survival to hospital discharge versus not surviving to hospital discharge. CONCLUSIONS AND CLINICAL RELEVANCE Results confirmed previous findings that indicated birds have a high mortality rate during and after anesthesia, compared with mortality rates published for dogs and cats.

In operando neutron diffraction study of LaNdMgNi9H13 as a metal hydride battery anode

NASA Astrophysics Data System (ADS)

Nazer, N. S.; Denys, R. V.; Yartys, V. A.; Hu, Wei-Kang; Latroche, M.; Cuevas, F.; Hauback, B. C.; Henry, P. F.; Arnberg, L.

2017-03-01

La2MgNi9-related alloys are superior metal hydride battery anodes as compared to the commercial AB5 alloys. Nd-substituted La2-yNdyMgNi9 intermetallics are of particular interest because of increased diffusion rate of hydrogen and thus improved performance at high discharge currents. The present work presents in operando characterization of the LaNdMgNi9 intermetallic as anode for the nickel metal hydride (Ni-MH) battery. We have studied the structural evolution of LaNdMgNi9 during its charge and discharge using in situ neutron powder diffraction. The work included experiments using deuterium gas and electrochemical charge-discharge measurements. The alloy exhibited a high electrochemical discharge capacity (373 mAh/g) which is 20% higher than the AB5 type alloys. A saturated β-deuteride synthesized by solid-gas reaction at PD2 = 1.6 MPa contained 12.9 deuterium atoms per formula unit (D/f.u.) which resulted in a volume expansion of 26.1%. During the electrochemical charging, the volume expansion (23.4%) and D-contents were found to be slightly reduced. The reversible electrochemical cycling is performed through the formation of a two-phase mixture of the α-solid solution and β-hydride phases. Nd substitution contributes to the high-rate dischargeability, while maintaining a good cyclic stability. Electrochemical Impedance Spectroscopy (EIS) was used to characterize the anode electrode on cycling. A mathematical model for the impedance response of a porous electrode was utilized. The EIS showed a decreased hydrogen transport rate during the long-term cycling, which indicated a corresponding slowing down of the electrochemical processes at the surface of the metal hydride anode.

Accuracy and Coverage of Diagnosis and Procedural Coding of Severely Injured Patients in the Finnish Hospital Discharge Register: Comparison to Patient Files and the Helsinki Trauma Registry.

PubMed

Heinänen, M; Brinck, T; Handolin, L; Mattila, V M; Söderlund, T

2017-09-01

The Finnish Hospital Discharge Register data are frequently used for research purposes. The Finnish Hospital Discharge Register has shown excellent validity in single injuries or disease groups, but no studies have assessed patients with multiple trauma diagnoses. We aimed to evaluate the accuracy and coverage of the Finnish Hospital Discharge Register but at the same time validate the data of the trauma registry of the Helsinki University Hospital's Trauma Unit. We assessed the accuracy and coverage of the Finnish Hospital Discharge Register data by comparing them to the original patient files and trauma registry files from the trauma registry of the Helsinki University Hospital's Trauma Unit. We identified a baseline cohort of patients with severe thorax injury from the trauma registry of the Helsinki University Hospital's Trauma Unit of 2013 (sample of 107 patients). We hypothesized that the Finnish Hospital Discharge Register would lack valuable information about these patients. Using patient files, we identified 965 trauma diagnoses in these 107 patients. From the Finnish Hospital Discharge Register, we identified 632 (65.5%) diagnoses and from the trauma registry of the Helsinki University Hospital's Trauma Unit, 924 (95.8%) diagnoses. A total of 170 (17.6%) trauma diagnoses were missing from the Finnish Hospital Discharge Register data and 41 (4.2%) from the trauma registry of the Helsinki University Hospital's Trauma Unit data. The coverage and accuracy of diagnoses in the Finnish Hospital Discharge Register were 65.5% (95% confidence interval: 62.5%-68.5%) and 73.8% (95% confidence interval: 70.4%-77.2%), respectively, and for the trauma registry of the Helsinki University Hospital's Trauma Unit, 95.8% (95% confidence interval: 94.5%-97.0%) and 97.6% (95% confidence interval: 96.7%-98.6%), respectively. According to patient records, these patients were subjects in 249 operations. We identified 40 (16.1%) missing operation codes from the Finnish Hospital Discharge Register and 19 (7.6%) from the trauma registry of the Helsinki University Hospital's Trauma Unit. The validity of the Finnish Hospital Discharge Register data is unsatisfactory in terms of the accuracy and coverage of diagnoses in patients with multiple trauma diagnoses. Procedural codes provide greater accuracy. We found the coverage and accuracy of the trauma registry of the Helsinki University Hospital's Trauma Unit to be excellent. Therefore, a special trauma registry, such as the trauma registry of the Helsinki University Hospital's Trauma Unit, provides much more accurate data and should be the preferred registry when extracting data for research or for administrative use, such as resource prioritizing.

The economic costs of intrapartum care in Tower Hamlets: A comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications.

PubMed

Schroeder, Liz; Patel, Nishma; Keeler, Michelle; Rocca-Ihenacho, Lucia; Macfarlane, Alison J

2017-02-01

to compare the economic costs of intrapartum maternity care in an inner city area for 'low risk' women opting to give birth in a freestanding midwifery unit compared with those who chose birth in hospital. micro-costing of health service resources used in the intrapartum care of mothers and their babies during the period between admission and discharge, data extracted from clinical notes. the Barkantine Birth Centre, a freestanding midwifery unit and the Royal London Hospital's consultant-led obstetric unit, both run by the former Barts and the London NHS Trust in Tower Hamlets, a deprived inner city borough in east London, England, 2007-2010. maternity records of 333 women who were resident in Tower Hamlets and who satisfied the Trust's eligibility criteria for using the Birth Centre. Of these, 167 women started their intrapartum care at the Birth Centre and 166 started care at the Royal London Hospital. women who planned their birth at the Birth Centre experienced continuous intrapartum midwifery care, higher rates of spontaneous vaginal delivery, greater use of a birth pool, lower rates of epidural use, higher rates of established breastfeeding and a longer post-natal stay, compared with those who planned for care in the hospital. The total average cost per mother-baby dyad for care where mothers started their intrapartum care at the Birth Centre was £1296.23, approximately £850 per patient less than the average cost per mother and baby who received all their care at the Royal London Hospital. These costs reflect intrapartum throughput using bottom up costing per patient, from admission to discharge, including transfer, but excluding occupancy rates and the related running costs of the units. the study showed that intrapartum throughput in the Birth Centre could be considered cost-minimising when compared to hospital. Modelling the financial viability of midwifery units at a local level is important because it can inform the appropriate provision of these services. This finding from this study contribute a local perspective and thus further weight to the evidence from the Birthplace Programme in support of freestanding midwifery unit care for women without obstetric complications. Copyright © 2016. Published by Elsevier Ltd.

Investigation of a Mercury-Argon Hot Cathode Discharge

NASA Astrophysics Data System (ADS)

Wamsley, Robert Charles

Classical absorption and laser induced fluorescence (LIF) experiments are used to investigate processes in the cathode region of a Hg-Ar hot cathode discharge. The absorption and LIF measurements are used to test the qualitative understanding and develop a quantitative model of a hot cathode discharge. The main contribution of this thesis is a model of the negative glow region that demonstrates the importance of Penning ionization to the ionization balance in the negative glow. We modeled the excited argon balance equation using a Monte Carlo simulation. In this simulation we used the trapped radiative decay rate of the resonance levels and the Penning ionization rate as the dominant loss terms in the balance equation. The simulated data is compared to and found to agree with absolute excited argon densities measured in a classical absorption experiment. We found the primary production rate per unit volume of excited Ar atoms in the simulation is sharply peaked near the cathode hot spot. We used the ion production rate from this simulation and a Green's function solution to the ambipolar diffusion equation to calculate the contribution of Penning ionization to the total ion density. We compared the results of this calculation to our experimental values of the Hg ^+ densities in the negative glow. We found that Penning ionization is an important and possibly the dominant ionization process in the negative glow.

A short-stay unit for thyroidectomy patients increases discharge efficiency.

PubMed

Vrabec, Sara; Oltmann, Sarah C; Clark, Nicholas; Chen, Herbert; Sippel, Rebecca S

2013-09-01

Patients traditionally recover overnight on a general surgery ward after a thyroidectomy; however, these units often lack the efficiency and focus for rapid discharge, which is the goal of a short-stay (SS) unit. Using an SS unit for thyroidectomy patients, who are often discharged in <24 h, may reduce the duration of hospital stay and subsequently decrease associated costs and increase hospital bed and resource availability. A retrospective review of 400 patients undergoing thyroidectomy at a single academic hospital. We analyzed postoperative discharge information and hospital cost data. Adult patients who stayed a single night in the hospital were included. We compared patients staying on a designated SS unit versus a general surgery (GS) ward. A total of 223 patients were admitted to SS, and 177 to GS. Trends of admission location were blocked based on time period, with most patients per time period going to the same location. Discharge times were significantly quicker for patients admitted to SS (P < 0.001). A total of 70% of SS patients were discharged before noon, versus 40% of GS patients (P < 0.001). Many variances were identified to account for these differences. Direct costs were significantly lower with SS, owing to savings in pharmacy, recovery room, and nursing expenses (all P < 0.01). A designated short-stay hospital unit is an effective model for increasing the efficiency of discharge for thyroidectomy patients compared with those admitted to a general surgery ward. It also serves to increase bed availability, which decreases hospital cost and may improve patient flow. Copyright © 2013 Elsevier Inc. All rights reserved.

Increasing hip fracture rates among older adults in Ecuador: analysis of the National Hospital Discharge System, 1999-2016.

PubMed

Orces, Carlos H; Gavilanez, Enrique Lopez

2017-12-07

The Ecuadorian hospital discharge system examined trends in hip fracture hospitalization rates among older adults. A significant upward trend in hip fracture rates occurred in both genders over the study period. Previous research has reported increasing hip fracture rates in Ecuador. Thus, this study aimed to extend previous findings by examining the nationwide incidence of hip fractures among adults aged 65 years and older between 1999 and 2016. A secondary objective was to compare hip fracture trends among older Ecuadorians with their counterparts in the United States (U.S.). The National Hospital Discharge System and the Healthcare Cost and Utilization Project net were assessed to identify older adults hospitalized with a principal diagnosis of hip fractures in Ecuador and the U.S., respectively. The Joinpoint regression analysis software was used to examine the average annual percent change in hip fracture rates. A total of 20,091 adults with a mean age of 82.3 (SD 8.1) years were hospitalized with a principal diagnosis of hip fractures during the study period. After an adjustment for age, hip fracture rates increased annually on average by 4.6% (95% CI 3.8%, 5.4%) from 96.4/100,000 in 1999 to 173.1/100,000 persons in 2016. Between 1999 and 2014, hip fracture age-adjusted rates decreased on average by - 2.5% (95% CI - 2.7%, - 2.3%) among older adults in the U.S. while hip fracture rates steadily increased by 4.6% (95% CI, 3.6%, 5.7%) per year in their Ecuadorian counterparts. Hip fracture rates markedly increased among older adults in Ecuador. The present findings should alert public health authorities to implement policies of osteoporosis awareness and prevention in Ecuador.

Projected Increase in Lightning Strikes in the United States Due to Global Warming

NASA Astrophysics Data System (ADS)

Romps, D. M.; Seeley, J.; Vollaro, D.; Molinari, J.

2014-12-01

Lightning plays an important role in atmospheric chemistry and in the initiation of wildfires, but the impact of global warming on lightning rates is poorly constrained. The lightning flash rate is proposed here to be proportional to the convective available potential energy (CAPE) times the precipitation rate. Using observations, the product of CAPE and precipitation is found to explain the majority of variance in the time series of total cloud-to-ground lightning flashes over the contiguous United States (CONUS) on timescales ranging from diurnal to seasonal. The observations reveal that storms convert the CAPE of water mass to discharged lightning energy with an efficiency of about 1%. This proxy can be applied to global climate models, which provide predictions for the increase in lightning due to global warming. Results from 11 GCMs will be shown.

Climate change. Projected increase in lightning strikes in the United States due to global warming.

PubMed

Romps, David M; Seeley, Jacob T; Vollaro, David; Molinari, John

2014-11-14

Lightning plays an important role in atmospheric chemistry and in the initiation of wildfires, but the impact of global warming on lightning rates is poorly constrained. Here we propose that the lightning flash rate is proportional to the convective available potential energy (CAPE) times the precipitation rate. Using observations, the product of CAPE and precipitation explains 77% of the variance in the time series of total cloud-to-ground lightning flashes over the contiguous United States (CONUS). Storms convert CAPE times precipitated water mass to discharged lightning energy with an efficiency of 1%. When this proxy is applied to 11 climate models, CONUS lightning strikes are predicted to increase 12 ± 5% per degree Celsius of global warming and about 50% over this century. Copyright © 2014, American Association for the Advancement of Science.

Prevalence and Trends in Donor Milk Use in the Well-Baby Nursery: A Survey of Northeast United States Birth Hospitals.

PubMed

Belfort, Mandy Brown; Drouin, Kaitlin; Riley, Jennifer F; Gregory, Katherine E; Philipp, Barbara L; Parker, Margaret G; Sen, Sarbattama

Pasteurized donor human milk ("donor milk") is an alternative to formula for supplementation of breastfed infants. We conducted a survey to determine (1) prevalence, trends, and hospital-level correlates of donor milk use for healthy newborns in the northeast United States and (2) clinician knowledge and opinions regarding this practice. We conducted parallel surveys of clinicians (88% nurse and/or lactation consultant) at (1) all birth hospitals in Massachusetts (MA) and (2) all birth hospitals served by a northeast United States milk bank. We asked about hospital use of donor milk for newborns ≥35 weeks' gestation and receiving Level I care in well nursery, hospital-related factors we hypothesized would be associated with this practice, and clinician knowledge and opinions about donor milk use. 35/46 (76%) of MA birth hospitals and 51/69 (74%) of hospitals served by the milk bank responded; 71 unique hospitals were included. Twenty-nine percent of MA birth hospitals and 43% of hospitals served by the milk bank reported using donor milk for healthy newborns. Hospitals that used donor milk for healthy newborns had higher exclusive breastfeeding at hospital discharge than hospitals that did not (77% versus 56%, p = 0.02). Eighty-three percent of respondents agreed or strongly agreed that using donor milk is an effective way to increase the hospital's exclusive breastfeeding rate. Many northeast United States birth hospitals currently use donor milk for healthy newborns. This practice is associated with higher exclusive breastfeeding at hospital discharge. Relationships with breastfeeding after discharge and related outcomes are unknown.

Fast repetition rate (FRR) flasher

DOEpatents

Kolber, Zbigniew; Falkowski, Paul

1997-02-11

A fast repetition rate (FRR) flasher suitable for high flash photolysis including kinetic chemical and biological analysis. The flasher includes a power supply, a discharge capacitor operably connected to be charged by the power supply, and a flash lamp for producing a series of flashes in response to discharge of the discharge capacitor. A triggering circuit operably connected to the flash lamp initially ionizes the flash lamp. A current switch is operably connected between the flash lamp and the discharge capacitor. The current switch has at least one insulated gate bipolar transistor for switching current that is operable to initiate a controllable discharge of the discharge capacitor through the flash lamp. Control means connected to the current switch for controlling the rate of discharge of the discharge capacitor thereby to effectively keep the flash lamp in an ionized state between Successive discharges of the discharge capacitor. Advantageously, the control means is operable to discharge the discharge capacitor at a rate greater than 10,000 Hz and even up to a rate greater than about 250,000 Hz.

Patient Safety Incidents and Nursing Workload 1

PubMed Central

Carlesi, Katya Cuadros; Padilha, Kátia Grillo; Toffoletto, Maria Cecília; Henriquez-Roldán, Carlos; Juan, Monica Andrea Canales

2017-01-01

ABSTRACT Objective: to identify the relationship between the workload of the nursing team and the occurrence of patient safety incidents linked to nursing care in a public hospital in Chile. Method: quantitative, analytical, cross-sectional research through review of medical records. The estimation of workload in Intensive Care Units (ICUs) was performed using the Therapeutic Interventions Scoring System (TISS-28) and for the other services, we used the nurse/patient and nursing assistant/patient ratios. Descriptive univariate and multivariate analysis were performed. For the multivariate analysis we used principal component analysis and Pearson correlation. Results: 879 post-discharge clinical records and the workload of 85 nurses and 157 nursing assistants were analyzed. The overall incident rate was 71.1%. It was found a high positive correlation between variables workload (r = 0.9611 to r = 0.9919) and rate of falls (r = 0.8770). The medication error rates, mechanical containment incidents and self-removal of invasive devices were not correlated with the workload. Conclusions: the workload was high in all units except the intermediate care unit. Only the rate of falls was associated with the workload. PMID:28403334

Comparative epidemiology of Clostridium difficile infection: England and the USA.

PubMed

King, Alice; Mullish, Benjamin H; Williams, Horace R T; Aylin, Paul

2017-10-01

To examine whether there is an epidemiological difference between Clostridium difficile infection (CDI) inpatient populations in England and the United States. A cross-sectional study. National administrative inpatient discharge data from England (Hospital Episode Statistics) and the USA (National Inpatient Sample) in 2012. De-identifiable non-obstetric inpatient discharges from the national datasets were used to estimate national CDI incidence in the United States and England using ICD9-CM(008.45) and ICD10(A04.7) respectively. The rate of CDI was calculated per 100 000 population using national population estimates. Rate per 100 000 inpatient discharges was also calculated separated by primary and secondary diagnosis of CDI. Age, sex and Elixhauser comorbidities profiles were examined. The USA had a higher rate of CDI compared to England: 115.1/100 000 vs. 19.3/100 000 population (P < 0.001). CDI age profiles differed between the countries (P < 0.001): in England, patients ≥75 years constitute a larger proportion of CDI cases, whilst those aged 25-70 constitute more cases in the US (P < 0.001). Overall adjusted odds of CDI in females compared to males was elevated in both England (odds ratios (OR) 1.26 95% CI [1.21,1.31] P < 0.001) and the USA (OR 1.20 95% CI [1.18,1.22] P < 0.001). The proportion of CDI patients with comorbidities was greater in the USA compared to England apart from dementia, which was greater in England (9.63% vs. 1.25%, P < 0.0001). The 2012 inpatient CDI rate within the USA was much higher than in England. Age and comorbidity profiles also differed between CDI patients in both countries. The reasons for this are likely multi-factorial but may reflect national infection control policy. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

[Survival of out-hospital cardiac arrests attended by a mobile intensive care unit in Asturias (Spain) in 2010].

PubMed

Iglesias-Llaca, F; Suárez-Gil, P; Viña-Soria, L; García-Castro, A; Castro-Delgado, R; Fente Álvarez, A I; Álvarez-Ramos, M B

2013-12-01

To evaluate attendance timings, out- and in-hospital characteristics, and survival of cardiac arrests attended by an advanced life support unit in Asturias (Spain) in 2010. Factors related to survival upon admission and at discharge were also analyzed. A retrospective, observational trial was carried out involving a cohort of out-hospital cardiac arrests (OHCA) occurring between 1 January 2010 and 31 December 2010, with one year of follow-up from OHCA. Health Care Area IV of the Principality of Asturias, with a population of 342,020 in 2010. All patients with OHCA and attended by an advanced life support unit were considered. Demographic data, the etiology of cardiac arrest, bystander cardiopulmonary resuscitation (CPR), attendance timings and survival upon admission, at discharge and after one year. A total of 177 OHCA were included. Of these, 120 underwent CPR by the advanced life support team. Sixty-six of these cases (55%) were caused by presumed heart disease. A total of 63 patients (52.5%) recovered spontaneous circulation, and 51 (42.5%) maintained circulation upon admission to hospital. Thirteen patients (10.8%) were discharged alive. After one year, 11 patients were still alive (9.2%) - 9 of them (7.5%) with a Cerebral Performance Category (CPC) score of 1. Ventricular fibrillation and short attendance timings were related to increased survival. The survival rate upon admission was better than in other series and similar at discharge. Initial rhythm and attendance timings were related. Public automated external defibrillators (AED) were not used, and bystander CPR was infrequent. Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.

Comparison of Canadian versus American emergency department visits for acute asthma

PubMed Central

Rowe, Brian H; Bota, Gary W; Clark, Sunday; Camargo, Carlos A

2007-01-01

BACKGROUND: Acute asthma is a common emergency department (ED) presentation in both Canada and the United States. OBJECTIVE: To compare ED asthma management and outcomes between Canada and the United States. MEHODS: A prospective cohort study of 69 American and eight Canadian EDs was conducted. Patients aged two to 54 years who presented with acute asthma underwent a structured ED interview and telephone follow-up two weeks later. RESULTS: A total of 3031 patients were enrolled. Canadian patients were more likely to be white (89% versus 22%; P<0.001), have health insurance (100% versus 69%; P<0.001) and identify a primary care provider (89% versus 64%; P<0.001) than American patients. In addition, Canadian patients were more likely to be using inhaled corticosteroids (63% versus 44%; P<0.001) and had higher initial peak expiratory flow (61% versus 48%; P<0.001). In the ED, Canadians received fewer beta-agonist (one versus two; P<0.001) and more anticholinergic (two versus one; P<0.001) treatments in the first hour; use of systemic corticosteroids was similar (60% versus 68%; P=0.13). Canadians were less likely to be hospitalized (11% versus 21%; P=0.02). Corticosteroids were prescribed similarly at discharge (60% versus 69%; P=0.13); however, Canadians were discharged more commonly on inhaled corticosteroids (63% versus 11%; P<0.001) and relapses were similar. CONCLUSIONS: Canadian patients with acute asthma have fewer barriers to primary care and are more likely to be on preventive medications, both before the ED visit and following discharge. Admissions rates are higher in the United States; however, relapse after discharge is similar between countries. These findings highlight the influences of preventive practices and heath care systems on ED visits for asthma. PMID:17885692

Peach Bottom Atomic Power Station recirc pipe dose rates with zinc injection and condenser replacement

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

DiCello, D.C.; Odell, A.D.; Jackson, T.J.

1995-03-01

Peach Bottom Atomic Power Station (PBAPS) is located near the town of Delta, Pennsylvania, on the west bank of the Susquehanna River. It is situated approximately 20 miles south of Lancaster, Pennsylvania. The site contains two boiling water reactors of General Electric design and each rated at 3,293 megawatts thermal. The units are BWR 4s and went commercial in 1977. There is also a decommissioned high temperature gas-cooled reactor on site, Unit 1. PBAPS Unit 2 recirc pipe was replaced in 1985 and Unit 3 recirc pipes replaced in 1988 with 326 NGSS. The Unit 2 replacement pipe was electropolished,more » and the Unit 3 pipe was electropolished and passivated. The Unit 2 brass condenser was replaced with a Titanium condenser in the first quarter of 1991, and the Unit 3 condenser was replaced in the fourth quarter of 1991. The admiralty brass condensers were the source of natural zinc in both units. Zinc injection was initiated in Unit 2 in May 1991, and in Unit 3 in May 1992. Contact dose rate measurements were made in standard locations on the 28-inch recirc suction and discharge lines to determine the effectiveness of zinc injection and to monitor radiation build-up in the pipe. Additionally, HPGe gamma scans were performed to determine the isotopic composition of the oxide layer inside the pipe. In particular, the specific ({mu}Ci/cm{sup 2}) of Co-60 and Zn-65 were analyzed.« less

Length of stay for childbirth in Trentino (North-East of Italy): the impact of maternal characteristics and organizational features of the maternity unit on the probability of early discharge of healthy, term infants.

PubMed

Pertile, Riccardo; Pavanello, Lucia; Soffiati, Massimo; Manica, Laura; Piffer, Silvano

2018-01-01

Early discharge (ED) of healthy term infants has become a common practice due to current social and economic needs. The primary objective of the present study was to evaluate trends in early discharge of healthy term neonates (≥ 37 gestational weeks) by delivery method (cesarean and vaginal) in maternity units in the Province of Trento. The secondary objective was to identify the socio-demographic characteristics (including the area of residence and distance from the designated hospital) and clinical characteristics of mothers whose infants were discharged early. This retrospective study reviewed records of live births from 2006 to 2016, for a total of 45, 314 healthy term infants. The trend for ED grew significantly during the period 2006-2016, for both cesarean and vaginal deliveries. The multiple logistic regression analysis shows how the determinants of ED are maternal age, birth order, citizenship of mother, maternal smoking, maternal employment status, and the number of births at the hospital on the day of birth. The post-partum length of stay should be adjusted based on the characteristics and needs of the mother-infant dyad, identifying the criteria for safe discharge. In Trento, various procedures and programs are becoming more uniform today with the intention to provide family assistance service. What is Known: • Admission for childbirth is one of the primary causes of hospitalization in industrialized countries. • The length of stay for childbirth has been steadily declining in recent decades, with the aim of reducing costs while also demedicalizing pregnancy. What is New: • A higher rate of early discharge (ED) was recorded for neonates of women having foreign citizenship, < 30 years, pluriparous, smoked during pregnancy, housewife, and, if emplyed, entrepreneurs, self-employed professionals or managers. • ED was more common when the new mother gave birth on a day in which there was a higher number of births at the hospital, indicating overcrowding in the maternity unit.

Postintensive care unit psychological burden in patients with chronic obstructive pulmonary disease and informal caregivers: A multicenter study.

PubMed

de Miranda, Sandra; Pochard, Frédéric; Chaize, Marine; Megarbane, Bruno; Cuvelier, Antoine; Bele, Nicolas; Gonzalez-Bermejo, Jesus; Aboab, Jérome; Lautrette, Alexandre; Lemiale, Virginie; Roche, Nicolas; Thirion, Marina; Chevret, Sylvie; Schlemmer, Benoit; Similowski, Thomas; Azoulay, Elie

2011-01-01

To determine the prevalence and risk factors of symptoms of anxiety, depression, and posttraumatic stress disorder-related symptoms in patients with chronic obstructive pulmonary disease and their relatives after an intensive care unit stay. Prospective multicenter study. Nineteen French intensive care units. One hundred twenty-six patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and 102 relatives. None. Patients and relatives were interviewed at intensive care unit discharge and 90 days later to assess symptoms of anxiety and depression using Hospital Anxiety and Depression Scale (HADS) and posttraumatic stress disorder-related symptoms using the Impact of Event Scale (IES). At intensive care unit discharge, 90% of patients recollected traumatic psychological events in the intensive care unit. At day 90, we were able to conduct telephone interviews with 53 patients and 47 relatives. Hospital Anxiety and Depression Scale scores indicated symptoms of anxiety and depression in 52% and 45.5% of patients at intensive care unit discharge and in 28.3% and 18.9% on day 90, respectively. Corresponding prevalence in relatives were 72.2% and 25.7% at intensive care unit discharge and 40.4% and 14.9% on day 90, respectively. The Impact of Event Scale indicated posttraumatic stress disorder-related symptoms in 20.7% of patients and 29.8% of relatives on day 90. Peritraumatic dissociation assessed using the Peritraumatic Dissociative Experiences Questionnaire was independently associated with posttraumatic stress disorder-related symptoms in the patients and relatives. Previous intensive care unit experience and recollection of bothersome noise in the intensive care unit predicted posttraumatic stress disorder-related symptoms in the patients. Psychiatric symptoms were found to be common in a group of 126 patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and their relatives at intensive care unit discharge and 90 days later. Peritraumatic dissociation at intensive care unit discharge was found to independently predict posttraumatic stress disorder-related symptoms in this sample of patients and relatives.

Prevalence, clinical and economic burden of mucormycosis-related hospitalizations in the United States: a retrospective study.

PubMed

Kontoyiannis, Dimitrios P; Yang, Hongbo; Song, Jinlin; Kelkar, Sneha S; Yang, Xi; Azie, Nkechi; Harrington, Rachel; Fan, Alan; Lee, Edward; Spalding, James R

2016-12-01

Mucormycosis is a rare but devastating fungal infection primarily affecting immunocompromised patients such as those with hematological malignancy, bone marrow and solid organ transplantation, and patients with diabetes, and, even more rarely, immunocompetent patients. The objective of this study was to assess the prevalence and burden, both clinical and economic, of mucormycosis among hospitalized patients in the U.S. This is a retrospective study using the Premier Perspective TM Comparative Database, with more than 560 participating hospitals covering 104 million patients (January 2005-June 2014). All hospitalizations in the database were evaluated for the presence of mucormycosis using either an ICD-9 code of 117.7 or a positive laboratory result for Mucorales. Hospitalizations were further required to have prescriptions of amphotericin B or posaconazole to be considered as mucormycosis-related hospitalizations. The prevalence of mucormycosis-related hospitalizations among all hospital discharges was estimated. Mortality rate at discharge, length of hospital stay, and readmission rates at 1 and 3 months were evaluated among mucormycosis-related hospitalizations. Cost per hospital stay and average per diem cost (inflated to 2014 USD) were reported. The prevalence of mucormycosis-related hospitalizations was estimated as 0.12 per 10,000 discharges during January 2005-June 2014. It increased to 0.16 per 10,000 discharges if the definition of mucormycosis was relaxed to not require the use of amphotericin B or posaconazole. The median length of stay was 17 days, with 23% dead at discharge; readmission rates were high, with 30 and 37% of patients readmitted within one and three months of discharge, respectively. The average cost per hospital stay was $112,419, and the average per diem cost was $4,096. The study provides a recent estimate of the prevalence and burden of mucormycosis among hospitalized patients. The high clinical and economic burden associated with mucormycosis highlights the importance of establishing active surveillance and optimizing prophylactic and active treatment in susceptible patients.

Dual Coding of Frequency Modulation in the Ventral Cochlear Nucleus.

PubMed

Paraouty, Nihaad; Stasiak, Arkadiusz; Lorenzi, Christian; Varnet, Léo; Winter, Ian M

2018-04-25

Frequency modulation (FM) is a common acoustic feature of natural sounds and is known to play a role in robust sound source recognition. Auditory neurons show precise stimulus-synchronized discharge patterns that may be used for the representation of low-rate FM. However, it remains unclear whether this representation is based on synchronization to slow temporal envelope (ENV) cues resulting from cochlear filtering or phase locking to faster temporal fine structure (TFS) cues. To investigate the plausibility of those encoding schemes, single units of the ventral cochlear nucleus of guinea pigs of either sex were recorded in response to sine FM tones centered at the unit's best frequency (BF). The results show that, in contrast to high-BF units, for modulation depths within the receptive field, low-BF units (<4 kHz) demonstrate good phase locking to TFS. For modulation depths extending beyond the receptive field, the discharge patterns follow the ENV and fluctuate at the modulation rate. The receptive field proved to be a good predictor of the ENV responses for most primary-like and chopper units. The current in vivo data also reveal a high level of diversity in responses across unit types. TFS cues are mainly conveyed by low-frequency and primary-like units and ENV cues by chopper and onset units. The diversity of responses exhibited by cochlear nucleus neurons provides a neural basis for a dual-coding scheme of FM in the brainstem based on both ENV and TFS cues. SIGNIFICANCE STATEMENT Natural sounds, including speech, convey informative temporal modulations in frequency. Understanding how the auditory system represents those frequency modulations (FM) has important implications as robust sound source recognition depends crucially on the reception of low-rate FM cues. Here, we recorded 115 single-unit responses from the ventral cochlear nucleus in response to FM and provide the first physiological evidence of a dual-coding mechanism of FM via synchronization to temporal envelope cues and phase locking to temporal fine structure cues. We also demonstrate a diversity of neural responses with different coding specializations. These results support the dual-coding scheme proposed by psychophysicists to account for FM sensitivity in humans and provide new insights on how this might be implemented in the early stages of the auditory pathway. Copyright © 2018 the authors 0270-6474/18/384123-15$15.00/0.

Discharge rate measurements in a canal using radiotracer methods.

PubMed

Pant, H J; Goswami, Sunil; Biswal, Jayashree; Samantray, J S; Sharma, V K

2016-06-01

Discharge rates of water were measured in a canal using radiotracer methods with an objective to validate the efficacy of Concrete Volute Pumps (CVPs) installed at various pumping stations along the canal. Pulse velocity and dilution methods were applied to measure the discharge rates using Iodine-131 as a radiotracer. The discharge rate measured in one of the sections of the canal using the pulse velocity method was found to be 22.5m(3)/s, whereas the discharge rates measured using the dilution method in four different sections of the canal varied from 20.27 to 20.62m(3)/s with single CVP in operation. The standard error in discharge rate measurements using dilution method ranged from ±1.1 to ±1.8%. The experimentally measured values of the discharge rate were in good agreement with the design value of the discharge rate (20m(3)/s) thus validating the performance of the CVPs used in the canal. Copyright © 2016 Elsevier Ltd. All rights reserved.

40 CFR 60.103 - Standard for carbon monoxide.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Refineries § 60.103 Standard for carbon monoxide. Each owner or operator of any fluid catalytic cracking unit... the fluid catalytic cracking unit catalyst regenerator will be operated, or 180 days after initial... discharge or cause the discharge into the atmosphere from any fluid catalytic cracking unit catalyst...

40 CFR 60.103 - Standard for carbon monoxide.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Refineries § 60.103 Standard for carbon monoxide. Each owner or operator of any fluid catalytic cracking unit... the fluid catalytic cracking unit catalyst regenerator will be operated, or 180 days after initial... discharge or cause the discharge into the atmosphere from any fluid catalytic cracking unit catalyst...

Prediction of traveltime and longitudinal dispersion in rivers and streams

USGS Publications Warehouse

Jobson, Harvey E.

1996-01-01

The possibility of a contaminant being accidentally or intentionally spilled upstream from a water supply is a constant concern to those diverting and using water from streams and rivers. Although many excellent models are available to estimate traveltime and dispersion, none can be used with confidence before calibration and verification to the particular river reach in question. Therefore, the availability of reliable input information is usually the weakest link in the chain of events needed to predict the rate of movement, dilution, and mixing of contaminants in rivers and streams. Measured tracer-response curves produced from the injection of a known quantity of soluble tracer provide an efficient method of obtaining the necessary data. The purpose of this report is to use previously presented concepts along with extensive data collected on time of travel and dispersion to provide guidance to water-resources managers and planners in responding to spills. This is done by providing methods to estimate (1) the rate of movement of a contaminant through a river reach, (2) the rate of attenuation of the peak concentration of a conservative contaminant with time, and (3) the length of time required for the contaminant plume to pass a point in the river. Although the accuracy of the predictions can be greatly increased by performing time-oftravel studies on the river reach in question, the emphasis of this report is on providing methods for making estimates where few data are available. Results from rivers of all sizes can be combined by defining the unit concentration as that concentration of a conservative pollutant that would result from injecting a unit of mass into a unit of flow. Unit-peak concentrations are compiled for more than 60 different rivers representing a wide range of sizes, slopes, and geomorphic types. Analyses of these data indicate that the unitpeak concentration is well correlated with the time required for a pollutant cloud to reach a specific point in the river. The variance among different rivers is, of course, larger than for a specific river reach. Other river characteristics that were compiled and included in the correlation included the drainage area, the reach slope, the mean annual discharge, and the discharge at the time of the measurement. The most significant other variable in the correlation was the ratio of the river discharge to mean annual discharge. The prediction of the traveltime is more difficult than the prediction of unit-peak concentration; but the logarithm of stream velocity can be assumed to be linearly correlated with the logarithm of discharge. More than 980 subreaches for about 90 different rivers were analyzed and prediction equations were developed based on the drainage area, the reach slope, the mean annual discharge, and the discharge at the time of the measurement. The highest probable velocity, which will result in the highest concentration, is usually of concern after an accidental spill. Therefore, an envelope curve for which more than 99 percent of the velocities were smaller was developed to address this concern. The time of arrival of the leading edge of the pollutant indicates when a problem will first exist and defines the overall shape of the tracer-response function. The traveltime of the leading edge is generally about 89 percent of the traveltime to the peak concentration. The area under a tracer-response function (a known value when unit concentrations are used) can be closely approximated as the area under a triangle with a height of the peak concentration and a base extending from the leading edge to a point where the concentration has reduced to 1C percent of the peak. Knowing the time of the leading edge and the peak, the peak concentration, and the time when the response function has reduced to 10 percent of its peak value allows the complete response function to be sketched with fair accuracy. Four example applications are included to illustrate how the prediction equations developed in this report can be used either to calibrate a mathematical model or to make predictions directly.

Hydrological modelling of the Mara River Basin, Kenya: Dealing with uncertain data quality and calibrating using river stage

NASA Astrophysics Data System (ADS)

Hulsman, P.; Bogaard, T.; Savenije, H. H. G.

2016-12-01

In hydrology and water resources management, discharge is the main time series for model calibration. Rating curves are needed to derive discharge from continuously measured water levels. However, assuring their quality is demanding due to dynamic changes and problems in accurately deriving discharge at high flows. This is valid everywhere, but even more in African socio-economic context. To cope with these uncertainties, this study proposes to use water levels instead of discharge data for calibration. Also uncertainties in rainfall measurements, especially the spatial heterogeneity needs to be considered. In this study, the semi-distributed rainfall runoff model FLEX-Topo was applied to the Mara River Basin. In this model seven sub-basins were distinguished and four hydrological response units with each a unique model structure based on the expected dominant flow processes. Parameter and process constrains were applied to exclude unrealistic results. To calibrate the model, the water levels were back-calculated from modelled discharges, using cross-section data and the Strickler formula calibrating parameter `k•s1/2', and compared to measured water levels. The model simulated the water depths well for the entire basin and the Nyangores sub-basin in the north. However, the calibrated and observed rating curves differed significantly at the basin outlet, probably due to uncertainties in the measured discharge, but at Nyangores they were almost identical. To assess the effect of rainfall uncertainties on the hydrological model, the representative rainfall in each sub-basin was estimated with three different methods: 1) single station, 2) average precipitation, 3) areal sub-division using Thiessen polygons. All three methods gave on average similar results, but method 1 resulted in more flashy responses, method 2 dampened the water levels due to averaging the rainfall and method 3 was a combination of both. In conclusion, in the case of unreliable rating curves, water level data can be used instead and a new rating curve can be calibrated. The effect of rainfall uncertainties on the hydrological model was insignificant.

Patient outcomes with endovascular embolectomy therapy for acute ischemic stroke: a study of the national inpatient sample: 2006 to 2008.

PubMed

Brinjikji, Waleed; Rabinstein, Alejandro A; Kallmes, David F; Cloft, Harry J

2011-06-01

Maturing techniques have spurred widespread implementation of endovascular embolectomy therapy for ischemic stroke. We evaluated a large administrative database to determine outcomes in patients treated with endovascular embolectomy in the general population. Using the National Inpatient Sample, we evaluated outcomes of patients treated for acute ischemic stroke in the United States from 2006 to 2008. Patients who had an ischemic stroke and underwent endovascular clot retrieval were identified. Morbidity, defined as "discharge to long-term facility," and mortality were evaluated as a function of patient age and of concomitant thrombolytic agent administration. For 2006 to 2008, a total of 3864 patients received endovascular clot retrieval with 266 (6.9%) patients in 2006, 800 (20.7) patients in 2007, and 2798 (72.4%) patients in 2008. The discharge to a long-term facility rate was 51.3% (1983 of 3864). The in-hospital mortality rate was 24.3% (940 of 3864). For patients <65 years old, the rate of in-hospital death was 17.1% (283 of 1658) as compared with a rate of 29.7% (656 of 2206) for patients ≥65 years old (P<0.0001). The rate of discharge to a long-term facility was 47.6% (789 of 1658) for patients <65 years old and 54.1% (1193 of 2206) for patients ≥65 years old (P<0.0001). The rate of intracranial hemorrhage was 15.5% without concomitant thrombolysis and 20.0% with concomitant thrombolysis (P=0.0009). Rates of morbidity and mortality remain high for patients with acute stroke, even in the setting of endovascular embolectomy. Advanced age portends a worse outcome and patients treated with concomitant use of thrombolytic agent had higher rates of intracranial hemorrhage than those without such therapy.

Numerical groundwater-flow model of the Minnelusa and Madison hydrogeologic units in the Rapid City area, South Dakota

USGS Publications Warehouse

Putnam, Larry D.; Long, Andrew J.

2009-01-01

The city of Rapid City and other water users in the Rapid City area obtain water supplies from the Minnelusa and Madison aquifers, which are contained in the Minnelusa and Madison hydrogeologic units. A numerical groundwater-flow model of the Minnelusa and Madison hydrogeologic units in the Rapid City area was developed to synthesize estimates of water-budget components and hydraulic properties, and to provide a tool to analyze the effect of additional stress on water-level altitudes within the aquifers and on discharge to springs. This report, prepared in cooperation with the city of Rapid City, documents a numerical groundwater-flow model of the Minnelusa and Madison hydrogeologic units for the 1,000-square-mile study area that includes Rapid City and the surrounding area. Water-table conditions generally exist in outcrop areas of the Minnelusa and Madison hydrogeologic units, which form generally concentric rings that surround the Precambrian core of the uplifted Black Hills. Confined conditions exist east of the water-table areas in the study area. The Minnelusa hydrogeologic unit is 375 to 800 feet (ft) thick in the study area with the more permeable upper part containing predominantly sandstone and the less permeable lower part containing more shale and limestone than the upper part. Shale units in the lower part generally impede flow between the Minnelusa hydrogeologic unit and the underlying Madison hydrogeologic unit; however, fracturing and weathering may result in hydraulic connections in some areas. The Madison hydrogeologic unit is composed of limestone and dolomite that is about 250 to 610 ft thick in the study area, and the upper part contains substantial secondary permeability from solution openings and fractures. Recharge to the Minnelusa and Madison hydrogeologic units is from streamflow loss where streams cross the outcrop and from infiltration of precipitation on the outcrops (areal recharge). MODFLOW-2000, a finite-difference groundwater-flow model, was used to simulate flow in the Minnelusa and Madison hydrogeologic units with five layers. Layer 1 represented the fractured sandstone layers in the upper 250 ft of the Minnelusa hydrogeologic unit, and layer 2 represented the lower part of the Minnelusa hydrogeologic unit. Layer 3 represented the upper 150 ft of the Madison hydrogeologic unit, and layer 4 represented the less permeable lower part. Layer 5 represented an approximation of the underlying Deadwood aquifer to simulate upward flow to the Madison hydrogeologic unit. The finite-difference grid, oriented 23 degrees counterclockwise, included 221 rows and 169 columns with a square cell size of 492.1 ft in the detailed study area that surrounded Rapid City. The northern and southern boundaries for layers 1-4 were represented as no-flow boundaries, and the boundary on the east was represented with head-dependent flow cells. Streamflow recharge was represented with specified-flow cells, and areal recharge to layers 1-4 was represented with a specified-flux boundary. Calibration of the model was accomplished by two simulations: (1) steady-state simulation of average conditions for water years 1988-97 and (2) transient simulations of water years 1988-97 divided into twenty 6-month stress periods. Flow-system components represented in the model include recharge, discharge, and hydraulic properties. The steady-state streamflow recharge rate was 42.2 cubic feet per second (ft3/s), and transient streamflow recharge rates ranged from 14.1 to 102.2 ft3/s. The steady-state areal recharge rate was 20.9 ft3/s, and transient areal recharge rates ranged from 1.1 to 98.4 ft3/s. The upward flow rate from the Deadwood aquifer to the Madison hydrogeologic unit was 6.3 ft3/s. Discharge included springflow, water use, flow to overlying units, and regional outflow. The estimated steady-state springflow of 32.8 ft3/s from seven springs was similar to the simulated springflow of 31.6 ft3/s, which included 20.5 ft3

Fast repetition rate (FRR) flasher

DOEpatents

Kolber, Z.; Falkowski, P.

1997-02-11

A fast repetition rate (FRR) flasher is described suitable for high flash photolysis including kinetic chemical and biological analysis. The flasher includes a power supply, a discharge capacitor operably connected to be charged by the power supply, and a flash lamp for producing a series of flashes in response to discharge of the discharge capacitor. A triggering circuit operably connected to the flash lamp initially ionizes the flash lamp. A current switch is operably connected between the flash lamp and the discharge capacitor. The current switch has at least one insulated gate bipolar transistor for switching current that is operable to initiate a controllable discharge of the discharge capacitor through the flash lamp. Control means connected to the current switch for controlling the rate of discharge of the discharge capacitor thereby to effectively keep the flash lamp in an ionized state between successive discharges of the discharge capacitor. Advantageously, the control means is operable to discharge the discharge capacitor at a rate greater than 10,000 Hz and even up to a rate greater than about 250,000 Hz. 14 figs.

Hydrothermal heat discharge in the Cascade Range, northwestern United States

USGS Publications Warehouse

Ingebritsen, S.E.; Mariner, R.H.

2010-01-01

Hydrothermal heat discharge in the Cascade Range includes the heat discharged by thermal springs, by "slightly thermal" springs that are only a few degrees warmer than ambient temperature, and by fumaroles. Thermal-spring heat discharge is calculated on the basis of chloride-flux measurements and geothermometer temperatures and totals ~ 240 MW in the U.S. part of the Cascade Range, excluding the transient post-1980 discharge at Mount St. Helens (~80 MW as of 2004-5). Heat discharge from "slightly thermal" springs is based on the degree of geothermal warming (after correction for gravitational potential energy effects) and totals ~. 660. MW. Fumarolic heat discharge is calculated by a variety of indirect and direct methods and totals ~160 MW, excluding the transient mid-1970s discharge at Mount Baker (~80 MW) and transient post-1980 discharge at Mount St. Helens (>. 230. MW as of 2005). Other than the pronounced transients at Mount St. Helens and Mount Baker, hydrothermal heat discharge in the Cascade Range appears to be fairly steady over a ~25-year period of measurement. Of the total of ~. 1050. MW of "steady" hydrothermal heat discharge identified in the U.S. part of the Cascade Range, less than 50. MW occurs north of latitude 45??15' N (~0.1 MW per km arc length from 45??15' to 49??N). Much greater rates of hydrothermal heat discharge south of 45??15'N (~1.7 MW per km arc length from 40?? to 45??15'N) may reflect the influence of Basin and Range-style extensional tectonics (faulting) that impinges on the Cascades as far north as Mount Jefferson but is not evident farther north. ?? 2010.

Influence of an optical pulsed discharge on the structure of a supersonic air flow

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

Malov, A N; Orishich, A M

We present the results of investigation of the parameters of an optical pulsed discharge (OPD) and their relation with gasdynamic parameters of a supersonic flow and with characteristics of laser radiation. For the first time the discrete objects are detected in the OPD by an optical method, namely, low-density caverns moving along with the flow. The propagation velocity of the thermal track arising in a supersonic flow under the action of the OPD is measured. It is found that at a pulse repetition rate of 90 – 120 kHz the caverns unite into a single plasma jet. (laser applications andmore » other topics in quantum electronics)« less

A stage-normalized function for the synthesis of stage-discharge relations for the Colorado River in Grand Canyon, Arizona

USGS Publications Warehouse

Wiele, Stephen M.; Torizzo, Margaret

2003-01-01

A method was developed to construct stage-discharge rating curves for the Colorado River in Grand Canyon, Arizona, using two stage-discharge pairs and a stage-normalized rating curve. Stage-discharge rating curves formulated with the stage-normalized curve method are compared to (1) stage-discharge rating curves for six temporary stage gages and two streamflow-gaging stations developed by combining stage records with modeled unsteady flow; (2) stage-discharge rating curves developed from stage records and discharge measurements at three streamflow-gaging stations; and (3) stages surveyed at known discharges at the Northern Arizona Sand Bar Studies sites. The stage-normalized curve method shows good agreement with field data when the discharges used in the construction of the rating curves are at least 200 cubic meters per second apart. Predictions of stage using the stage-normalized curve method are also compared to predictions of stage from a steady-flow model.

Quantifying peak discharges for historical floods

USGS Publications Warehouse

Cook, J.L.

1987-01-01

It is usually advantageous to use information regarding historical floods, if available, to define the flood-frequency relation for a stream. Peak stages can sometimes be determined for outstanding floods that occurred many years ago before systematic gaging of streams began. In the United States, this information is usually not available for more than 100-200 years, but in countries with long cultural histories, such as China, historical flood data are available at some sites as far back as 2,000 years or more. It is important in flood studies to be able to assign a maximum discharge rate and an associated error range to the historical flood. This paper describes the significant characteristics and uncertainties of four commonly used methods for estimating the peak discharge of a flood. These methods are: (1) rating curve (stage-discharge relation) extension; (2) slope conveyance; (3) slope area; and (4) step backwater. Logarithmic extensions of rating curves are based on theoretical plotting techniques that results in straight line extensions provided that channel shape and roughness do not change significantly. The slope-conveyance and slope-area methods are based on the Manning equation, which requires specific data on channel size, shape and roughness, as well as the water-surface slope for one or more cross-sections in a relatively straight reach of channel. The slope-conveyance method is used primarily for shaping and extending rating curves, whereas the slope-area method is used for specific floods. The step-backwater method, also based on the Manning equation, requires more cross-section data than the slope-area ethod, but has a water-surface profile convergence characteristic that negates the need for known or estimated water-surface slope. Uncertainties in calculating peak discharge for historical floods may be quite large. Various investigations have shown that errors in calculating peak discharges by the slope-area method under ideal conditions for recent floods (i.e., when flood elevations, slope and channel characteristics are reasonably certain), may be on the order of 10-25%. Under less than ideal conditions, where streams are hydraulically steep and rough, errors may be much larger. The additional uncertainties for historical floods created by the passage of time may result in even larger errors of peak discharge. ?? 1987.

Theoretical and experimental investigation into high current hollow cathode arc attachment

NASA Astrophysics Data System (ADS)

Downey, Ryan T.

This research addresses several concerns of the mechanisms controlling performance and lifetime of high-current single-channel-hollow-cathodes, the central electrode and primary life-limiting component in Magnetoplasmadynamic thrusters. Specifically covered are the trends, and the theorized governing mechanisms, seen in the discharge efficiency and power, the size of the plasma attachment to the cathode (the active zone), cathode exit plume plasma density and energy, along with plasma property distributions of the internal plasma column (the IPC) of a single-channel-hollow-cathode. Both experiment and computational modeling were employed in the analysis of the cathodes. Employing Tantalum and Tungsten cathodes (of 2, 6 and 10 mm inner diameter), experiments were conducted to measure the temperature profile of operating cathodes, the width of the active zone, the discharge voltage, power, plasma arc resistance and efficiency, with mass flow rates of 50 to 300 sccm of Argon, and discharge currents of 15 to 50 Amps. Langmuir probing was used to obtain measurements for the electron temperature, plasma density and plasma potential at the cathode exit plane (down stream tip). A computational model was developed to predict the distribution of plasma inside the cathode, based upon experimentally determined boundary conditions. It was determined that the peak cathode temperature is a function of both interior cathode density and discharge current, though the location of the peak temperature is controlled gas density but not discharge current. The active zone width was found to be an increasing function of the discharge current, but a decreasing function of the mass flow rate. The width of the active zone was found to not be controlled by the magnitude of the peak cathode wall temperature. The discharge power consumed per unit of mass throughput is seen as a decreasing function of the mass flow rate, showing the increasing efficiency of the cathode. Finally, this new understanding of the mechanisms of the plasma attachment phenomena of a single-channel-hollow-cathode were extrapolated to the multi-channel-hollow-cathode environment, to explain performance characteristics of these devices seen in previous research.

The impact of social isolation on delayed hospital discharges of older hip fracture patients and associated costs.

PubMed

Landeiro, F; Leal, J; Gray, A M

2016-02-01

Delayed discharges represent an inefficient use of acute hospital beds. Social isolation and referral to a public-funded rehabilitation unit were significant predictors of delayed discharges while admission from an institution was a protective factor for older hip fracture patients. Preventing delays could save between 11.2 and 30.7 % of total hospital costs for this patient group. Delayed discharges of older patients from acute care hospitals are a major challenge for administrative, humanitarian, and economic reasons. At the same time, older people are particularly vulnerable to social isolation which has a detrimental effect on their health and well-being with cost implications for health and social care services. The purpose of the present study was to determine the impact and costs of social isolation on delayed hospital discharge. A prospective study of 278 consecutive patients aged 75 or older with hip fracture admitted, as an emergency, to the Orthopaedics Department of Hospital Universitário de Santa Maria, Portugal, was conducted. A logistic regression model was used to examine the impact of relevant covariates on delayed discharges, and a negative binomial regression model was used to examine the main drivers of days of delayed discharges. Costs of delayed discharges were estimated using unit costs from national databases. Mean age at admission was 85.5 years and mean length of stay was 13.1 days per patient. Sixty-two (22.3 %) patients had delayed discharges, resulting in 419 bed days lost (11.5 % of the total length of stay). Being isolated or at a high risk of social isolation, measured with the Lubben social network scale, was significantly associated with delayed discharges (odds ratio (OR) 3.5) as was being referred to a public-funded rehabilitation unit (OR 7.6). These two variables also increased the number of days of delayed discharges (2.6 and 4.9 extra days, respectively, holding all else constant). Patients who were admitted from an institution were less likely to have delayed discharges (OR 0.2) with 5.5 fewer days of delay. Total costs of delayed discharges were between 11.2 and 30.7 % of total costs (€2352 and €9317 per patient with delayed discharge) conditional on whether waiting costs for placement in public-funded rehabilitation unit were included. High risk of social isolation, social isolation and referral to public-funded rehabilitation units increase delays in patients' discharges from acute care hospitals.

The Impact of Harness Impedance on Hall Thruster Discharge Oscillations

NASA Technical Reports Server (NTRS)

Pinero, Luis R.

2017-01-01

Hall thrusters exhibit characteristic discharge voltage and current oscillations during steady-state operation. The lower frequency breathing-mode current oscillations are inherent to each thruster and could impact thruster operation and power processing unit (PPU) design. The design of the discharge output filter, in particular, the output capacitor is important because it supplies the high peak current oscillations that the thruster demands. However, space-rated, high-voltage capacitors are not readily available and can have significant mass and volume. So, it is important for a PPU designer to know what is the minimum amount of capacitance required to operate a thruster. Through Simulation Program with Integrated Circuit Emphasis modeling and electrical measurements on the Hall Effect Rocket with Magnetic Shielding thruster, it was shown that the harness impedance between the power supply and the thruster is the main contributor towards generating voltage ripple at the thruster. Also, increasing the size of the discharge filter capacitor, as previously implemented during thruster tests, does not reduce the voltage oscillations. The electrical characteristics of the electrical harness between the discharge supply and the thruster is crucial to system performance and could have a negative impact on performance, life and operation.

Geriatric Hip Fracture Care: Fixing a Fragmented System

PubMed Central

Anderson, Mary E; McDevitt, Kelly; Cumbler, Ethan; Bennett, Heather; Robison, Zachary; Gomez, Bryan; Stoneback, Jason W

2017-01-01

Context Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners. Objective To describe a stepwise approach to systems redesign for this patient population. Design We designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning. Main Outcome Measures Hospital length of stay. Results We identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved. Conclusion Our comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system. PMID:28488991

Utilizing Physiological Principles of Motor Unit Recruitment to Reduce Fatigability of Electrically-Evoked Contractions: A Narrative Review.

PubMed

Barss, Trevor S; Ainsley, Emily N; Claveria-Gonzalez, Francisca C; Luu, M John; Miller, Dylan J; Wiest, Matheus J; Collins, David F

2018-04-01

Neuromuscular electrical stimulation (NMES) is used to produce contractions to restore movement and reduce secondary complications for individuals experiencing motor impairment. NMES is conventionally delivered through a single pair of electrodes over a muscle belly or nerve trunk using short pulse durations and frequencies between 20 and 40Hz (conventional NMES). Unfortunately, the benefits and widespread use of conventional NMES are limited by contraction fatigability, which is in large part because of the nonphysiological way that contractions are generated. This review provides a summary of approaches designed to reduce fatigability during NMES, by using physiological principles that help minimize fatigability of voluntary contractions. First, relevant principles of the recruitment and discharge of motor units (MUs) inherent to voluntary contractions and conventional NMES are introduced, and the main mechanisms of fatigability for each contraction type are briefly discussed. A variety of NMES approaches are then described that were designed to reduce fatigability by generating contractions that more closely mimic voluntary contractions. These approaches include altering stimulation parameters, to recruit MUs in their physiological order, and stimulating through multiple electrodes, to reduce MU discharge rates. Although each approach has unique advantages and disadvantages, approaches that minimize MU discharge rates hold the most promise for imminent translation into rehabilitation practice. The way that NMES is currently delivered limits its utility as a rehabilitative tool. Reducing fatigability by delivering NMES in ways that better mimic voluntary contractions holds promise for optimizing the benefits and widespread use of NMES-based programs. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Post-Discharge Survival Outcomes of Patients with Advanced Cancer from the University of Texas MD Anderson Cancer Center Investigational Cancer Therapeutics (Phase I Trials) Inpatient Unit.

PubMed

Kinahan, Holly; Maiti, Abhishek; Hess, Kenneth; Dempsey, Jennifer; Beatty, Laura; Baldwin, Sarah; Hong, David S; Naing, Aung; Fu, Siqing; Tsimberidou, Apostolia M; Piha-Paul, Sarina; Janku, Filip; Karp, Daniel; Reddy, Suresh; Yennu, Sriram; Epner, Daniel; Bruera, Eduardo; Meric-Bernstam, Funda; Falchook, Gerald; Subbiah, Vivek

2017-01-01

Patients with advanced cancer who progress on standard therapy are potential candidates for phase I clinical trials. Due to their aggressive disease and complex comorbid conditions, these patients often need inpatient admission. This study assessed the outcomes of such patients after they were discharged to hospice care. We performed a retrospective analysis of patients with solid tumor malignancies who were discharged to hospice care from the inpatient service. One hundred thirty-three patients were included in the study cohort. All patients had metastatic disease and an Eastern Cooperative Oncology Group performance status ≥3. The median survival after discharge to hospice from an inpatient setting was 16 days, with a survival rate of 5% at 3 months after discharge. The median survival after the last cancer treatment was 46 days, with survival of 17% at 3 months, and 5% at 6 months. Patients with lactate dehydrogenase (LDH) >618 IU/L had a median post-discharge survival of 11 days versus 20 days for patients with LDH ≤618 IU/L. Patients with metastatic cancer participating in phase I trials who have poor performance status and require inpatient admission have a very short survival after discharge to hospice. A high LDH level predicts an even shorter survival. © 2016 S. Karger AG, Basel.

National Hospital Discharge Survey: 2003 annual summary with detailed diagnosis and procedure data.

PubMed

Kozak, Lola Jean; Lees, Karen A; DeFrances, Carol J

2006-05-01

This report presents 2003 national estimates and trend data on the use of non-Federal short-stay hospitals in the United States. Estimates are provided by patient and hospital characteristics, diagnoses, and surgical and nonsurgical procedures performed. Estimates of diagnoses and procedures are presented according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The estimates are based on data collected through the National Hospital Discharge Survey (NHDS). The survey has been conducted annually since 1965. In 2003, data were collected for approximately 320,000 discharges. Of the 479 eligible non-Federal short-stay hospitals in the sample, 426 (89 percent) responded to the survey. An estimated 34.7 million inpatients were discharged from non-Federal short-stay hospitals in 2003. They used 167.3 million days of care and had an average length of stay of 4.8 days. Females used almost one-third more days of hospital care than males. Patients with five or more diagnoses rose from 29 percent of discharges in 1990 to 57 percent in 2003. The leading diagnostic category was respiratory diseases for children under 15 years, childbirth for 15-44 year olds, and circulatory diseases for patients 45 years of age and over. Only surgical procedures were performed for 27 percent of discharges, 18 percent had surgical and nonsurgical procedures, and 16 percent had only nonsurgical procedures. A total of 664,000 coronary angioplasties were performed, and stents were inserted during 86 percent of these procedures with drug-eluting stents used in 28 percent. The number and rate of total and primary cesarean deliveries rose from 1995 to 2003. The rate of vaginal birth after cesarean delivery dropped 58 percent, from 35.5 in 1995 to 14.8 in 2003.

Effect of a Pediatric Early Warning System on All-Cause Mortality in Hospitalized Pediatric Patients: The EPOCH Randomized Clinical Trial.

PubMed

Parshuram, Christopher S; Dryden-Palmer, Karen; Farrell, Catherine; Gottesman, Ronald; Gray, Martin; Hutchison, James S; Helfaer, Mark; Hunt, Elizabeth A; Joffe, Ari R; Lacroix, Jacques; Moga, Michael Alice; Nadkarni, Vinay; Ninis, Nelly; Parkin, Patricia C; Wensley, David; Willan, Andrew R; Tomlinson, George A

2018-03-13

There is limited evidence that the use of severity of illness scores in pediatric patients can facilitate timely admission to the intensive care unit or improve patient outcomes. To determine the effect of the Bedside Paediatric Early Warning System (BedsidePEWS) on all-cause hospital mortality and late admission to the intensive care unit (ICU), cardiac arrest, and ICU resource use. A multicenter cluster randomized trial of 21 hospitals located in 7 countries (Belgium, Canada, England, Ireland, Italy, New Zealand, and the Netherlands) that provided inpatient pediatric care for infants (gestational age ≥37 weeks) to teenagers (aged ≤18 years). Participating hospitals had continuous physician staffing and subspecialized pediatric services. Patient enrollment began on February 28, 2011, and ended on June 21, 2015. Follow-up ended on July 19, 2015. The BedsidePEWS intervention (10 hospitals) was compared with usual care (no severity of illness score; 11 hospitals). The primary outcome was all-cause hospital mortality. The secondary outcome was a significant clinical deterioration event, which was defined as a composite outcome reflecting late ICU admission. Regression analyses accounted for hospital-level clustering and baseline rates. Among 144 539 patient discharges at 21 randomized hospitals, there were 559 443 patient-days and 144 539 patients (100%) completed the trial. All-cause hospital mortality was 1.93 per 1000 patient discharges at hospitals with BedsidePEWS and 1.56 per 1000 patient discharges at hospitals with usual care (adjusted between-group rate difference, 0.01 [95% CI, -0.80 to 0.81 per 1000 patient discharges]; adjusted odds ratio, 1.01 [95% CI, 0.61 to 1.69]; P = .96). Significant clinical deterioration events occurred during 0.50 per 1000 patient-days at hospitals with BedsidePEWS vs 0.84 per 1000 patient-days at hospitals with usual care (adjusted between-group rate difference, -0.34 [95% CI, -0.73 to 0.05 per 1000 patient-days]; adjusted rate ratio, 0.77 [95% CI, 0.61 to 0.97]; P = .03). Implementation of the Bedside Paediatric Early Warning System compared with usual care did not significantly decrease all-cause mortality among hospitalized pediatric patients. These findings do not support the use of this system to reduce mortality. clinicaltrials.gov Identifier: NCT01260831.

Introduction of enhanced recovery for elective caesarean section enabling next day discharge: a tertiary centre experience.

PubMed

Wrench, I J; Allison, A; Galimberti, A; Radley, S; Wilson, M J

2015-05-01

The widespread adoption of enhanced recovery programmes in various surgical specialties has resulted in patient benefits including reduced morbidity, reduced length of stay and an earlier return to normal activities. This evidence, along with the increased financial pressures in the UK National Health Service, has led many units to consider introducing such a programme for obstetric surgery. We report our experience in setting up an enhanced recovery programme for women undergoing elective caesarean section and a prospective analysis of factors that influence length of stay. An enhanced recovery pathway was designed by a multidisciplinary team and introduced in March 2012. Factors influencing length of stay were determined using a log normal model. The proportion of women discharged on Day 1 increased from 1.6% in the first quarter of 2012 to 25.2% in the first quarter of 2014. The 30-day readmission rate was 4.4% for those discharged on Day 1 and 5.6% for Day 2. Earlier gestation, multiple birth, intention to breast feed, longer surgery and more time in the post-anaesthesia recovery unit were all independently associated with a longer postoperative stay. Women presenting for obstetric surgery with the indication "one previous caesarean section" were more likely to leave hospital earlier compared to most other indications. An enhanced recovery programme was successfully introduced into our unit. Many of the interventions were straightforward and could be adopted easily elsewhere. Copyright © 2015 Elsevier Ltd. All rights reserved.

Early exercise in critically ill patients enhances short-term functional recovery.

PubMed

Burtin, Chris; Clerckx, Beatrix; Robbeets, Christophe; Ferdinande, Patrick; Langer, Daniel; Troosters, Thierry; Hermans, Greet; Decramer, Marc; Gosselink, Rik

2009-09-01

: To investigate whether a daily exercise session, using a bedside cycle ergometer, is a safe and effective intervention in preventing or attenuating the decrease in functional exercise capacity, functional status, and quadriceps force that is associated with prolonged intensive care unit stay. A prolonged stay in the intensive care unit is associated with muscle dysfunction, which may contribute to an impaired functional status up to 1 yr after hospital discharge. No evidence is available concerning the effectiveness of an early exercise training intervention to prevent these detrimental complications. : Randomized controlled trial. : Medical and surgical intensive care unit at University Hospital Gasthuisberg. : Ninety critically ill patients were included as soon as their cardiorespiratory condition allowed bedside cycling exercise (starting from day 5), given they still had an expected prolonged intensive care unit stay of at least 7 more days. : Both groups received respiratory physiotherapy and a daily standardized passive or active motion session of upper and lower limbs. In addition, the treatment group performed a passive or active exercise training session for 20 mins/day, using a bedside ergometer. : All outcome data are reflective for survivors. Quadriceps force and functional status were assessed at intensive care unit discharge and hospital discharge. Six-minute walking distance was measured at hospital discharge. No adverse events were identified during and immediately after the exercise training. At intensive care unit discharge, quadriceps force and functional status were not different between groups. At hospital discharge, 6-min walking distance, isometric quadriceps force, and the subjective feeling of functional well-being (as measured with "Physical Functioning" item of the Short Form 36 Health Survey questionnaire) were significantly higher in the treatment group (p < .05). : Early exercise training in critically ill intensive care unit survivors enhanced recovery of functional exercise capacity, self-perceived functional status, and muscle force at hospital discharge.

Decontamination of the digestive tract and oropharynx: hospital acquired infections after discharge from the intensive care unit.

PubMed

de Smet, Anne Marie G A; Hopmans, Titia E M; Minderhoud, Albertus L C; Blok, Hetty E M; Gossink-Franssen, Annelies; Bernards, Alexandra T; Bonten, Marc J M

2009-09-01

To determine the incidence rates of hospital acquired infections (HAI) during the first 14 days after ICU discharge after treatment during ICU-stay with Selective Decontamination of the Digestive tract (SDD), Selective Oropharyngeal Decontamination (SOD) or Standard Care (SC). Prospective observational study. ICUs in two tertiary care hospitals. Patients discharged from the ICU to the ward. None. Post-ICU incidences of HAI per 1,000 days at risk were 11.2, 12.9 and 8.3 for patients that had received SDD (n = 296), SOD (n = 286) or SC (n = 289) respectively in ICU, yielding relative risks, as compared to SC, of 1.49 (CI(95) 0.9-2.47) for SOD and 1.44 (CI(95) 0.87-2.39) for SDD. Incidences of surgical site infections (per 100 surgical procedures) were 4 after SC and 11.8 and 8 after SOD and SDD (p = 0.04). Among patients that succumbed in the hospital after ICU-stay (n = 58) eight (14%) had developed HAI after ICU discharge; 3 of 21 after SDD, 3 of 15 after SOD and 2 of 22 after SC. Incidences of HAI in general wards tended to be higher in patients that had received either SDD or SOD during ICU-stay, but it seems unlikely that these infections have an effect on hospital mortality rates.

Duct attachment and extension for an air conditioning unit

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

Lang, R.D.; Frenia, F.J.

1986-12-16

An apparatus is described for attaching a fixed duct extension to the discharge opening of an air conditioning unit, the unit slidably inserted in and removed from a fixed through-the-wall sleeve, for supplying conditioned air to the space containing the unit and an adjacent space comprising: a discharge plenum assembly adapted to be connected to the unit encase the discharge opening. The discharge plenum assembly defines an air flow path for the conditioned air discharged from the unit and includes a first housing member having a forward wall, a rear wall, and a pair of opposed side walls joining themore » front wall to the rear wall, and a second housing member having a top wall connected to a front wall. The top wall and the front wall are fixedly attached to the rear wall and the forward wall respectively of the first housing member and forming a duct outlet in one of the side walls. The top wall and the front wall of the second housing member and one of the pair of opposed side walls of the lower housing member having longitudinal flanges extending therefrom forming a C-like flange; a bracket removably secured to the through the wall sleeve having an outwardly extending flange member at the top of the bracket; and a duct extension means secured to the outwardly extending flange of the bracket near one end and to the wall of the adjacent space at the opposite end. The duct extension means has a collar at one end configured to engage with the C-like flange whereby the unit with the discharge plenum assembly attached thereto slidably engages with and disengages from the through-the-wall sleeve while the duct extension is secured to the bracket.« less

Ground-water flow paths and traveltime to three small embayments within the Peconic Estuary, eastern Suffolk County, New York

USGS Publications Warehouse

Schubert, Christopher E.

1999-01-01

The Peconic Estuary, at the eastern end of Long Island, has been plagued by a recurrent algal bloom that has caused the severe decline of local marine resources. Although the onset, duration, and cessation of the bloom remain unpredictable, ground-water discharge has been shown to affect surface-water quality in the western part of the estuary. Results from a study on the North Fork of Long Island indicate that local hydrogeologic factors cause differences in ground-water age and characteristics of discharge to the estuary. The need for information on the local patterns and rates of ground-water discharge to the Peconic Estuary prompted analysis of ground-water flow paths and traveltime to three small embayments within the estuary.Meetinghouse Creek, near the west end of the North Fork; Sag Harbor Cove, in the central part of the South Fork; and West Neck Bay, on Shelter Island.Ground-water-flow models were developed, and particle-tracking procedures were applied to the results of each model, to define the flow paths and traveltime of ground water to the three embayments. The steady-state flow models represent the two-dimensional ground-water-flow system along a vertical section through the uplands of each embayment and simulate long-term hydrologic conditions. The particle-tracking procedure used model-generated ground-water levels and flow rates to calculate the water-particle pathlines and times-of-travel through each flow system from the point of entry (recharge) to the point of exit at streams, the shore, or subsea-discharge areas.Results for the Meetinghouse Creek study area indicate that about 50 percent of the total recharge that enters the system flows southward to Meetinghouse Creek; half of this amount discharges as base flow to the fresh-water reach of the creek, and half as shoreline underflow to the estuarine reach. About 85 percent of the total discharge to Meetinghouse Creek has flowed entirely within the upper glacial aquifer, and about 15 percent has flowed through the Magothy aquifer. The average age of all ground water discharged to Meetinghouse Creek is about 60 years; the average age of base flow to the freshwater reach of the creek is about 7 years, and the average age of shoreline underflow to the estuarine reach is about 120 years. The results for the Sag Harbor Cove study area indicate that about 30 percent of the total recharge that enters the system flows northward to Sag Harbor Cove; about half of this amount discharges as shoreline underflow, and half as subsea underflow. About 40 percent of the total discharge to Sag Harbor Cove has flowed entirely within the upper glacial aquifer, and about 60 percent has flowed through the Pleistocene marine clay unit, Pleistocene(?) sand unit, or Magothy aquifer. The average age of all ground water discharged to Sag Harbor Cove is about 110 years; the average age of shoreline underflow is about 25 years, and the average age of subsea underflow is about 190 years.Results for the West Neck Bay study area indicate that about 65 percent of the total recharge that enters the system flows westward to West Neck Bay; virtually all of this amount discharges as shoreline underflow, but a negligible percentage discharges as subsea underflow. Virtually all discharge to West Neck Bay has flowed entirely within the upper glacial aquifer, although a minor amount has flowed through the Pleistocene marine clay unit. The average age of shoreline underflow to West Neck Bay is about 15 years, and the average age of subsea underflow is about 1,800 years.Ground water that discharges to streams and the shores represented in the models is mostly relatively young water that has flowed entirely within the shallow zones of the flow systems, whereas ground water that discharges to the subsea-discharge areas is mostly old water that has flowed through the deep zones. Data obtained from these models allows evaluation of each embayment.s vulnerability to contaminants introduced at the water table and can guide the development of source-area-protection strategies for the corresponding watersheds.

Turning Over Patient Turnover: An Ethnographic Study of Admissions, Discharges, and Transfers

PubMed Central

Mowinski Jennings, Bonnie; Sandelowski, Margarete; Boshamer, Cary C.; Higgins, Melinda K.

2014-01-01

The impact on nursing work of patient turnover (admissions, discharges, and transfers) became evident in an ethnographic study of turbulence. The patient turnover data were generated from extensive observations, 21 formal interviews, and a year of admission and discharge records on one medical and one surgical unit. Timing of turnover events on the two units differed, but on both units admissions typically interrupted workflow more than did discharges, clustered admissions were more disruptive than staggered admissions, and patient turnover during change of shift was more disruptive than during medication administration. Understanding the complexity of patient turnover will elucidate the work involved and improve the evidence base for nurse staffing, a key determinant of quality and safety of care. PMID:24242196

Correlation between discharge timings of pairs of motor units reveals the presence but not the proportion of common synaptic input to motor neurons

PubMed Central

Negro, Francesco; Farina, Dario

2017-01-01

We investigated whether correlation measures derived from pairs of motor unit (MU) spike trains are reliable indicators of the degree of common synaptic input to motor neurons. Several 50-s isometric contractions of the biceps brachii muscle were performed at different target forces ranging from 10 to 30% of the maximal voluntary contraction relying on force feedback. Forty-eight pairs of MUs were examined at various force levels. Motor unit synchrony was assessed by cross-correlation analysis using three indexes: the output correlation as the peak of the cross-histogram (ρ) and the number of synchronous spikes per second (CIS) and per trigger (E). Individual analysis of MU pairs revealed that ρ, CIS, and E were most often positively associated with discharge rate (87, 85, and 76% of the MU pairs, respectively) and negatively with interspike interval variability (69, 65, and 62% of the MU pairs, respectively). Moreover, the behavior of synchronization indexes with discharge rate (and interspike interval variability) varied greatly among the MU pairs. These results were consistent with theoretical predictions, which showed that the output correlation between pairs of spike trains depends on the statistics of the input current and motor neuron intrinsic properties that differ for different motor neuron pairs. In conclusion, the synchronization between MU firing trains is necessarily caused by the (functional) common input to motor neurons, but it is not possible to infer the degree of shared common input to a pair of motor neurons on the basis of correlation measures of their output spike trains. NEW & NOTEWORTHY The strength of correlation between output spike trains is only poorly associated with the degree of common input to the population of motor neurons. The synchronization between motor unit firing trains is necessarily caused by the (functional) common input to motor neurons, but it is not possible to infer the degree of shared common input to a pair of motor neurons on the basis of correlation measures of their output spike trains. PMID:28100652

The Effect of Utilization Review on Emergency Department Operations.

PubMed

Desai, Shoma; Gruber, Phillip F; Eiting, Erick; Seabury, Seth A; Mack, Wendy J; Voyageur, Christian; Vasquez, Veronica; Kim, Hyung T; Terp, Sophie

2017-11-01

Increasingly, hospitals are using utilization review software to reduce hospital admissions in an effort to contain costs. Such practices have the potential to increase the number of unsafe discharges, particularly in public safety-net hospitals. Utilization review software tools are not well studied with regard to their effect on emergency department (ED) operations. We study the effect of prospectively used admission decision support on ED operations. In 2012, Los Angeles County + University of Southern California Medical Center implemented prospective use of computerized admission criteria. After implementation, only ED patients meeting primary review (diagnosis-based criteria) or secondary review (medical necessity as determined by an on-site emergency physician) were assigned inpatient beds. Data were extracted from electronic medical records from September 2011 through December 2013. Outcomes included operational metrics, 30-day ED revisits, and 30-day admission rates. Excluding a 6-month implementation period, monthly summary metrics were compared pre- and postimplementation with nonparametric and negative binomial regression methods. All adult ED visits, excluding incarcerated and purely behavioral health visits, were analyzed. The primary outcomes were disposition rates. Secondary outcomes were 30-day ED revisits, 30-day admission rate among return visitors to the ED, and estimated cost. Analysis of 245,662 ED encounters was performed. The inpatient admission rate decreased from 14.2% to 12.8%. Increases in discharge rate (82.4% to 83.4%) and ED observation unit utilization (2.5% to 3.4%) were found. Thirty-day revisits increased (20.4% to 24.4%), although the 30-day admission rate decreased (3.2% to 2.8%). Estimated cost savings totaled $193.17 per ED visit. The prospective application of utilization review software in the ED led to a decrease in the admission rate. This was tempered by a concomitant increase in ED observation unit utilization and 30-day ED revisits. Cost savings suggest that resources should be redirected to the more highly affected ED and ED observation unit, although more work is needed to confirm the generalizability of these findings. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Quantifying the Uncertainty in Discharge Data Using Hydraulic Knowledge and Uncertain Gaugings

NASA Astrophysics Data System (ADS)

Renard, B.; Le Coz, J.; Bonnifait, L.; Branger, F.; Le Boursicaud, R.; Horner, I.; Mansanarez, V.; Lang, M.

2014-12-01

River discharge is a crucial variable for Hydrology: as the output variable of most hydrologic models, it is used for sensitivity analyses, model structure identification, parameter estimation, data assimilation, prediction, etc. A major difficulty stems from the fact that river discharge is not measured continuously. Instead, discharge time series used by hydrologists are usually based on simple stage-discharge relations (rating curves) calibrated using a set of direct stage-discharge measurements (gaugings). In this presentation, we present a Bayesian approach to build such hydrometric rating curves, to estimate the associated uncertainty and to propagate this uncertainty to discharge time series. The three main steps of this approach are described: (1) Hydraulic analysis: identification of the hydraulic controls that govern the stage-discharge relation, identification of the rating curve equation and specification of prior distributions for the rating curve parameters; (2) Rating curve estimation: Bayesian inference of the rating curve parameters, accounting for the individual uncertainties of available gaugings, which often differ according to the discharge measurement procedure and the flow conditions; (3) Uncertainty propagation: quantification of the uncertainty in discharge time series, accounting for both the rating curve uncertainties and the uncertainty of recorded stage values. In addition, we also discuss current research activities, including the treatment of non-univocal stage-discharge relationships (e.g. due to hydraulic hysteresis, vegetation growth, sudden change of the geometry of the section, etc.).

The region makes the difference: disparities in management of acute myocardial infarction within Switzerland.

PubMed

Insam, Charlène; Paccaud, Fred; Marques-Vidal, Pedro

2014-05-01

In Switzerland, health policies are decided at the local level, but little is known regarding their impact on the management of acute myocardial infarction (AMI). In this study, we assessed geographical differences within Switzerland regarding management of AMI. Cross-sectional study. Swiss hospital discharge database for period 2007-2008 (26,204 discharges from AMI). Seven Swiss regions (Leman, Mittelland, Northwest, Zurich, Central, Eastern, and Ticino) were analysed. Almost 53.7% of discharges from AMI were managed in a single hospital, ranging from 62.1% (Leman) to 31.6% (Ticino). The highest intensive care unit admission rate was in Leman (69.4%), the lowest (16.9%) in Ticino (Swiss average: 36.0%). Intracoronary revascularization rates were highest in Leman (51.1%) and lowest (30.9%) in Central Switzerland (average: 41.0%). Bare (non-drug-eluting) stent use was highest in Leman (61.4%) and lowest (16.9%) in Ticino (average: 42.1%), while drug-eluting stent use was highest (83.2%) in Ticino and lowest (38.6%) in Leman (average: 57.9%). Coronary artery bypass graft rates were highest (4.8%) in Ticino and lowest (0.5%) in Eastern Switzerland (average: 2.8%). Mechanical circulatory assistance rates were highest (4.2%) in Zurich and lowest (0.5%) in Ticino (average: 1.8%). The differences remained after adjusting for age, single or multiple hospital management, and gender. In Switzerland, significant geographical differences in management and revascularization procedures for AMI were found.

Impact of nursing overtime on nurse-sensitive patient outcomes in New York hospitals, 1995-2000.

PubMed

Berney, Barbara; Needleman, Jack

2006-05-01

During the past several years, nurses and their advocates have expressed concern about heavy use of overtime in hospitals and claimed that it undermines the quality of nursing care. Using staffing and discharge data covering 1995 to 2000 from 161 acute general hospitals in New York State, this study uses multi variate regression to analyze the relationship between overtime and the rates of six nurse-sensitive patient outcomes and mortality. We find an association of overtime with lower rates of mortality in medical and surgical patients but do not consider these findings definitive. Because overtime use is episodic and unit specific, further study of these issues using data that examines the occurrence of adverse events by unit during periods of heavy nurse overtime is recommended.

Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years

PubMed Central

Flacking, Renée; Hellström-Westas, Lena

2016-01-01

Objective There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants. Design, setting and participants This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004–2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups. Results From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22–27 weeks) from 55% to 16%, in very preterm (GA 28–31 weeks) from 41% to 34% and in moderately preterm infants (GA 32–36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants). Conclusions In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding. PMID:27965252

Activity of lingual, laryngeal and oesophageal receptors in conscious sheep.

PubMed Central

Falempin, M; Rousseau, J P

1984-01-01

Vagal afferent impulse traffic has been studied in conscious sheep by electromyographic recording from the motor units of the sterno-cleido-mastoid (s.c.m.) muscle reinnervated by sensory vagal axons. Units which responded during movements of the tongue and during the pharyngolaryngeal and oesophageal stages of swallowing were chosen for this study. Lingual units showed a phasic discharge bearing a temporal relation to movements of the tongue during licking of the lips or chewing of a bolus before swallowing. Laryngeal units had no spontaneous activity. A discharge occurred with the ascending movement of the larynx during swallowing. Oesophageal units did not exhibit any tonic activity. They fired only at the time of primary or secondary oesophageal peristalsis. The oesophageal units showed a bimodal distribution. The oesophageal receptors are more concentrated at the beginning and the end of the thoracic oesophagus. During primary peristalsis, the afferent discharge was reinforced in only 57% of the cases when sheep swallowed a bolus (pellets or inflated balloons). When the discharge was reinforced, its increase ceased as volumes of the bolus were increased from 20 to 40 ml. During local oesophageal contractions, the afferent discharge was only present when the inflated balloon was located at the site of the receptor. It was enhanced at the time the primary peristaltic wave passed over the balloon. Inflation of a second balloon cranially in the oesophagus led to abolition of the activity of the unit at the caudal site though the distension there was maintained. PMID:6707965

Fate and transport modeling of selected chlorinated organic compounds at Operable Unit 3, U.S. Naval Air Station, Jacksonville, Florida

USGS Publications Warehouse

Davis, J. Hal

2000-01-01

Ground water contaminated by the chlorinated organic compounds trichloroethene (TCE), cis-dichloroethene (DCE), and vinyl chloride (VC) has been found in the surficial aquifer beneath the Naval Aviation Depot at the U.S. Naval Air Station, Jacksonville, Florida. The affected area is designated Operable Unit 3 (OU3) and covers 134 acres adjacent to the St. Johns River. Site-specific ground-water flow modeling was conducted at OU3 using MODFLOW, and solute-transport modeling was conducted using MT3DMS. Simulations using a low dispersivity value, which resulted in the highest concentration discharging to the St. Johns River, gave the following results. At 60 years traveltime, the highest concentration of TCE associated with the Area C plume had discharged to St. Johns River at a level that exceeded 1x103 micrograms per liter (ug/L). At 100 years traveltime, the highest concentration of TCE associated with the Area D plume had discharged to the river at a level exceeding 3x103 ug/L. At 200 years traveltime, the Area B plume had not begun discharging to the river. Simulations using a first-order decay rate half-life of 13.5 years (the slowest documented) at Area G caused the TCE to degrade before reaching the St. Johns River. If the ratio of the concentrations of TCE to cis-DCE and VC remained relatively constant, these breakdown products would not reach the river. However, the actual breakdown rates of cis-DCE and VC are unknown. Simulations were repeated using average dispersivity values with the following results. At 60 years traveltime, the highest concentration of TCE associated with the Area C plume had discharged to St. Johns River at a level exceeding 4x102 ug/L. At 100 years traveltime, the highest concentration of TCE associated with the Area D plume had discharged to the river at a level exceeding 1x103 ug/L. At 200 years traveltime, the Area B plume had not begun discharging to the river. 'Pump and treat' was simulated as a remedial alternative. The concentration of TCE at Area B trended rapidly downward; however, one isolated pocket of TCE remained because of the low-permeability sediments present at this area. The concentration of TCE at Area C trended rapidly downward and was below 1 ug/L in about 16 years. The concentration of TCE at Area D also trended rapidly downward and was below 1 mg/L in about 18 years.

Preoperative oral Passiflora incarnata reduces anxiety in ambulatory surgery patients: a double-blind, placebo-controlled study.

PubMed

Movafegh, Ali; Alizadeh, Reza; Hajimohamadi, Fatimah; Esfehani, Fatimah; Nejatfar, Mohmad

2008-06-01

Many patients have preoperative anxiety; therefore, the development of a strong anxiolytic with minimal psychomotor impairment for premedication may be desirable. In this study, 60 patients were randomized into two groups to receive either oral Passiflora incarnata (500 mg, Passipy IranDarouk) (n = 30) or placebo (n = 30) as premedication, 90 min before surgery. A numerical rating scale (NRS) was used for each patient to assess anxiety and sedation before, and 10, 30, 60, and 90 min after premedication. Psychomotor function was assessed with the Trieger Dot Test and the Digit-Symbol Substitution Test at arrival in the operating room, 30 and 90 min after tracheal extubation. The time interval between arrival in the postanesthesia care unit and discharge to home (discharge time) was recorded for each patient. The demographic characteristics of patients, ASA physical status, duration of surgery, basal NRS score, sedation at the preset time intervals, and discharge time were similar in the two groups. The NRS anxiety scores were significantly lower in the passiflora group than in the control group (P < 0.001). There were no significant differences in psychological variables in the postanesthesia care unit and recovery of psychomotor function was comparable in both groups. In outpatient surgery, administration of oral Passiflora incarnata as a premedication reduces anxiety without inducing sedation.

Predictors of acceptance of a postpartum public health nurse home visit: findings from an Ontario survey.

PubMed

Sword, Wendy A; Krueger, Paul D; Watt, M Susan

2006-01-01

To determine 1) rates of offer and uptake of a home visit provided through Ontario's universal Hospital Stay and Postpartum Home Visiting Program, and 2) predictors of acceptance of a home visit. Women were eligible to participate if they had given birth vaginally to a live singleton infant, were being discharged with the infant to their care, were competent to give consent, and could communicate in one of the four study languages. A self-report questionnaire was used to collect data from 1,250 women recruited from five hospitals across the province; 890 (71.2%) women completed a structured telephone interview 4 weeks following discharge. Most women (81.4% to 97.8%) reported having received a telephone call from a public health nurse, although not necessarily within 48 hours of discharge. While the offer of a home visit reportedly was high across sites, there were statistically significant differences in rates of acceptance (40.8% to 76.2%). Important predictors of acceptance were first live birth, lower social support, lower maternal rating of services in labour and delivery, poorer maternal self-reported health, probable postpartum depression, lower maternal rating of services on the postpartum unit, and breastfeeding initiation. The home visiting component of the universal program is reaching most women through telephone follow-up. However, rates of acceptance of a home visit differed greatly across study sites. The findings suggest that it is women with specific problems or needs who are accepting a visit. Further research is necessary to guide the development of evidence-based programs and policies regarding postpartum nurse home visits.

Risk factors for discharge to an acute care hospital from inpatient rehabilitation among stroke patients.

PubMed

Roberts, Pamela S; DiVita, Margaret A; Riggs, Richard V; Niewczyk, Paulette; Bergquist, Brittany; Granger, Carl V

2014-01-01

To identify medical and functional health risk factors for being discharged directly to an acute-care hospital from an inpatient rehabilitation facility among patients who have had a stroke. Retrospective cohort study. Academic medical center. A total of 783 patients with a primary diagnosis of stroke seen from 2008 to 2012; 60 were discharged directly to an acute-care hospital and 723 were discharged to other settings, including community and other institutional settings. Logistic regression analysis. Direct discharge to an acute care hospital compared with other discharge settings from the inpatient rehabilitation unit. No significant differences in demographic characteristics were found between the 2 groups. The adjusted logistic regression model revealed 2 significant risk factors for being discharged to an acute care hospital: admission motor Functional Independence Measure total score (odds ratio 0.97, 95% confidence interval 0.95-0.99) and enteral feeding at admission (odds ratio 2.87, 95% confidence interval 1.34-6.13). The presence of a Centers for Medicare and Medicaid-tiered comorbidity trended toward significance. Based on this research, we identified specific medical and functional health risk factors in the stroke population that affect the rate of discharge to an acute-care hospital. With active medical and functional management, early identification of these critical components may lead to the prevention of stroke patients from being discharged to an acute-care hospital from the inpatient rehabilitation setting. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

COPD is independently associated with 6-month survival in patients who have life support withheld in intensive care.

PubMed

Maamar, Adel; Chevalier, Stéphanie; Fillâtre, Pierre; Botoc, Vlad; Le Tulzo, Yves; Gacouin, Arnaud; Tadié, Jean-Marc

2018-04-16

In-hospital outcomes following decisions of withholding or withdrawing in Intensive Care Unit (ICU) patients have been previously assessed, little is known about outcomes after ICU and hospital discharge. Our objective was to report the 6-month outcomes of discharged patients who had treatment limitations in a general ICU and to identify prognostic factors of survival. We retrospectively collected the data of patients discharged from the ICU for whom life support was withheld from 2009 to 2011. We assessed the survival status of all patients at 6 months post-discharge and their duration of survival. Survivors and non-survivors were compared using univariate and multivariate analyses by Cox's proportional hazard model. One hundred fourteen patients were included. The survival rate at 6 months was 58.8%. Survival was associated with acute respiratory failure (48% vs 19%, P = .006), a history of COPD (40% vs 21%, P = .03) and a lower SAPS II score (44 vs 49, P = .006). We identified a history of COPD as a prognostic factor for survival in the multivariate analysis (HR = 2.1; IC 95% 1.02-4.36, P = .04). A total of 58.8% of patients for whom life-sustaining therapies were withheld in the ICU survived for at least 6 months after discharge. Patients with COPD appeared to have a significantly higher survival rate. The decision to withhold life support in patients should not lead to a cessation of post-ICU care and to non-readmission of COPD patients. © 2018 John Wiley & Sons Ltd.

Timeliness in discharge summary dissemination is associated with patients' clinical outcomes.

PubMed

Li, Jordan Y Z; Yong, Tuck Y; Hakendorf, Paul; Ben-Tovim, David; Thompson, Campbell H

2013-02-01

To determine the relation of the readmission rate of general medical patients to either the existence of a discharge summary or the timeliness of its dispatch. This was a retrospective study on discharge summaries of all discharges from the general medical service at a tertiary referral teaching hospital from January 2005 to December 2009. The main outcome measures were readmission rate to hospital within 7 or 28 days of discharge A total of 16 496 patient admissions were included in the analysis. Of these discharges, 3397 (20.6%) patients did not have a summary completed within a week of discharge. There were significant linear trends between patients' readmission rates within 7 (P < 0.001) or 28 days (P < 0.001) and categories reflecting the delay in dispatch of their discharge summaries. The absence of a discharge summary was associated with a 79% increase in the rate of readmission within 7 days [95% confidence interval (CI) 42 to 124% increase; P < 0.001] and a 37% increased rate of readmission within 28 days (95% CI 17 to 61% increase; P < 0.001). If aged less than 80 years, the absence of a discharge summary was associated with a 127% increase in readmission rate within 7 days (95% CI 72 to 202% increase; P < 0.001) and a 55% increase within 28 days (95% CI 25 to 91% increase; P < 0.001) after discharge. Delayed transmission or absence of a discharge summary is associated with readmission of the patient; more so in patients less than 80 years old. If no summary is generated by 7 days after discharge, the rate of readmission within 7 or 28 days after discharge is indistinguishable from no summary being written at all. © 2011 Blackwell Publishing Ltd.

Physical characteristics and chemical quality of selected springs in parts of Juab, Millard, Tooele, and Utah counties, Utah

USGS Publications Warehouse

Wilberg, D.E.; Stolp, B.J.

1985-01-01

Hydrologic, geologic, and partial water quality data were collected at 90 selected springs in west-central Utah, and chemical analyses performed on water samples from 62 of the springs. Descriptions of the physiographic and geologic conditions, climate, and vegetation patterns for the study area are included. Allowable limits of certain chemical constituents in water for human and livestock consumption are included with the water quality data. Three classifications of springs were established based on physical characteristics of the springs, and chemical composition of the springflow: (1) mountain springs; (2) non-thermal valley springs, and (3) thermal valley springs. Mountain springs are in and near recharge areas, have seasonal variations of discharge and temperature, typically discharge from extrusive and metamorphic geohydrologic units, and generally discharge freshwater. Non-thermal valley springs are peripheral to recharge areas, have seasonal variations of discharge and temperature, typically discharge from a variety of geohydrologic units, and have variable water composition. Thermal valley springs are near topographic low areas of valleys , and have little seasonal variation of discharge or temperature. They typically discharge from unconsolidated deposits (but the discharge probably has flowed through buried carbonate geohydrologic units). They also have a considerable range of water composition that reflects the relative complexity of the groundwater system. (Author 's abstract)

Symptom changes in five dimensions of the Positive and Negative Syndrome Scale in refractory psychosis.

PubMed

Woodward, Todd S; Jung, Kwanghee; Smith, Geoffrey N; Hwang, Heungsun; Barr, Alasdair M; Procyshyn, Ric M; Flynn, Sean W; van der Gaag, Mark; Honer, William G

2014-12-01

Refractory psychosis units currently have little information regarding which symptoms profiles should be expected to respond to treatment. In the current study, we provide this information using structural equation modeling of Positive and Negative Syndrome Scale (PANSS) ratings at admission and discharge on a sample of 610 patients admitted to a treatment refractory psychosis program at a Canadian tertiary care unit between 1990 and 2011. The hypothesized five-dimensional structure of the PANSS fit the data well at both admission and discharge, and the latent variable scores are reported as a function of symptom dimension and diagnostic category. The results suggest that, overall, positive symptoms (POS) responded to treatment better than all other symptoms dimensions, but for the schizoaffective and bipolar groups, greater response on POS was observed relative to the schizophrenia and major depression groups. The major depression group showed the most improvement on negative symptoms and emotional distress, and the bipolar group showed the most improvement on disorganization. Schizophrenia was distinct from schizoaffective disorder in showing reduced treatment response on all symptom dimensions. These results can assist refractory psychosis units by providing information on how PANSS symptom dimensions respond to treatment and how this depends on diagnostic category.

A Sleep Education and Hypnotics Reduction Program for Hospitalized Patients at a General Hospital

PubMed Central

Youn, Soyoung; Park, Boram; Lee, Suyeon; Kim, Changnam

2018-01-01

Objective We applied a program of sleep education and hypnotics reduction for inpatients (the i-sleep program). This study explored whether the i-sleep program is effective for reducing the prescription rate of sleeping pills to inpatients in a general hospital. Methods We estimated the proportion of inpatients prescribed hypnotics at admission to and discharge from the hospital, excluding pediatric care units, before (2014) and after (2015) the program. In addition, we estimated the proportion of inpatients prescribed sleeping pills among all inpatients on the first day of each month of 2014 and 2015. Results The proportion of inpatients prescribed hypnotics as discharge medication among inpatients who had been prescribed them at the time of admission decreased significantly, from 57.0% to 46.8%, after the i-sleep program (RR=0.82, 95% CI: 0.79–0.86). The proportion of inpatients newly prescribed sleeping pills after admission to the hospital did not significantly decrease (1.97% to 2.00%; RR=1.01, 95% CI: 0.96–1.07). The mean prescription rate of sleeping pills per day was 8.18% in 2014 and 7.78% in 2015. Conclusion The i-sleep program reduced the proportion of inpatients who continued to take sleeping pills from admission until discharge, although it did't reduce the prescription rate per day. PMID:29422929

Effect of corona discharge plasma jet on surface-borne microorganisms and sprouting of broccoli seeds.

PubMed

Kim, Je-Wook; Puligundla, Pradeep; Mok, Chulkyoon

2017-01-01

Different pathogenic microorganisms have been reported to cause sprouts-associated outbreaks. In order to sterilise and enhance the germination of seeds, non-thermal plasma has been increasingly investigated in the field of agricultural science as an alternative to the traditional pre-sowing seed treatments. This work aimed to evaluate the effect of corona discharge plasma jet (CDPJ) on disinfection of the natural bio-contaminants of broccoli seed and also studied the plasma effect on sprout seed germination rate and physico-chemical properties of sprouts. Aerobic bacteria, moulds and yeasts, B. cereus, E. coli, Salmonella spp. were detected on the broccoli seed surface. After 0-3 min treatment using CDPJ, the detected microorganisms were reduced in the range of 1.2-2.3 log units. Inactivation patterns were better explained using pseudo-first-order kinetics. The plasma treatment of seeds up to 2 min exhibited a positive effect on germination rate, seedling growth. The physico-chemical and sensory characteristics of sprouts were unaffected due to the CDPJ treatment of their respective seeds. Corona discharge plasma jet can potentially be used for microbial decontamination of broccoli seeds. In addition, the plasma treatment of broccoli sprout seeds has enabled a significant enhancement in their germination rate and seedling growth without compromising physico-chemical and sensory characteristics of their corresponding sprouts. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

The effect of microstructure on the performance of Li-ion porous electrodes

NASA Astrophysics Data System (ADS)

Chung, Ding-Wen

By combining X-ray tomography data and computer-generated porous elec- trodes, the impact of microstructure on the energy and power density of lithium-ion batteries is analyzed. Specifically, for commercial LiMn2O4 electrodes, results indi- cate that a broad particle size distribution of active material delivers up to two times higher energy density than monodisperse-sized particles for low discharge rates, and a monodisperse particle size distribution delivers the highest energy and power density for high discharge rates. The limits of traditionally used microstructural properties such as tortuosity, reactive area density, particle surface roughness, morphological anisotropy were tested against degree of particle size polydispersity, thus enabling the identification of improved porous architectures. The effects of critical battery processing parameters, such as layer compaction and carbon black, were also rationalized in the context of electrode performance. While a monodisperse particle size distribution exhibits the lowest possible tortuosity and three times higher surface area per unit volume with respect to an electrode conformed of a polydisperse particle size distribution, a comparable performance can be achieved by polydisperse particle size distributions with degrees of polydispersity less than 0.2 of particle size standard deviation. The use of non-spherical particles raises the tortuosity by as much as three hundred percent, which considerably lowers the power performance. However, favorably aligned particles can maximize power performance, particularly for high discharge rate applications.

Motor units in vastus lateralis and in different vastus medialis regions show different firing properties during low-level, isometric knee extension contraction.

PubMed

de Souza, Leonardo Mendes Leal; Cabral, Hélio Veiga; de Oliveira, Liliam Fernandes; Vieira, Taian Martins

2018-04-01

Architectural differences along vastus medialis (VM) and between VM and vastus lateralis (VL) are considered functionally important for the patellar tracking, knee joint stability and knee joint extension. Whether these functional differences are associated with a differential activity of motor units between VM and VL is however unknown. In the present study, we, therefore, investigate neuroanatomical differences in the activity of motor units detected proximo-distally from VM and from the VL muscle. Nine healthy volunteers performed low-level isometric knee extension contractions (20% of their maximum voluntary contraction) following a trapezoidal trajectory. Surface electromyograms (EMGs) were recorded from VM proximal and distal regions and from VL using three linear adhesive arrays of eight electrodes. The firing rate and recruitment threshold of motor units decomposed from EMGs were then compared among muscle regions. Results show that VL motor units reached lower mean firing rates in comparison with VM motor units, regardless of their position within VM (P < .040). No significant differences in firing rate were found between proximal and distal, VM motor units (P = .997). Furthermore, no significant differences in the recruitment threshold were observed for all motor units analysed (P = .108). Our findings possibly suggest the greater potential of VL to generate force, due to its fibres arrangement, may account for the lower discharge rate observed for VL then either proximally or distally detected motor units in VM. Additionally, the present study opens new perspectives on the importance of considering muscle architecture in investigations of the neural aspects of motor behaviour. Copyright © 2017 Elsevier B.V. All rights reserved.

Impacts of effluent from Carlsbad Desalination Plant on the coastal biology and chemistry in a in-situ study of pre- and post-discharge

NASA Astrophysics Data System (ADS)

Petersen, K. L.; Heck, N.; Paytan, A.; Potts, D. C.

2016-12-01

Ongoing droughts throughout the world and increasing water demand are creating critical water shortage in arid and semi-arid regions. Desalination of seawater is a powerful source of potable water, however the effects of the brine discharge on coastal areas are insufficiently studied. Here we report results from in-situ measurements of the effects of brine discharge from a desalination plant in Carlsbad, in Southern California before and after operation began. Operation as of December 2015. Pre-discharge samples were collected in December 2014 and September 2015. Post-discharge samples were collected in May 2016 and November 2016. Water samples are collected at the mount of the discharge channel and out to 1000 m offshore. Both surface and bottom water samples were collected and analyzed for salinity, temperature, Chl a concentration, nutrients (NO3, PO4 and silica), δ13C and δ15N of suspended matter, DOC and organic contaminants. Samples are also collected for phytoplankton cell count and sediment grain size. A biological swath was done by SCUBA divers to verify abundance and diversity of benthic organisms. The pre-discharge measurements show a homogenous water column for salinity, Chl a and nutrients. There is a slight temperature difference between the discharge channel and the intake channel due to activities of a power plant around the discharge channel. There are significantly fewer species and a lower abundance of benthic organism by the discharge channel than by the intake. This is possibly due to a higher flow rate at the discharge channel. The preliminary post-discharge analyses show a stratified water column at the discharge area. The salinity was higher by 2 to 3 salinity units at the discharge site. This trend is evident to 600 m offshore. How this affects the benthic organisms and the phytoplankton will be reported.

Altered motor unit discharge patterns in paretic muscles of stroke survivors assessed using surface electromyography.

PubMed

Hu, Xiaogang; Suresh, Aneesha K; Rymer, William Z; Suresh, Nina L

2016-08-01

Hemispheric stroke survivors often show impairments in voluntary muscle activation. One potential source of these impairments could come from altered control of muscle, via disrupted motor unit (MU) firing patterns. In this study, we sought to determine whether MU firing patterns are modified on the affected side of stroke survivors, as compared with the analogous contralateral muscle. Using a novel surface electromyogram (EMG) sensor array, coupled with advanced template recognition software (dEMG) we recorded surface EMG signals over the first dorsal interosseous (FDI) muscle on both paretic and contralateral sides. Recordings were made as stroke survivors produced isometric index finger abductions over a large force range (20%-60% of maximum). Utilizing the dEMG algorithm, MU firing rates, recruitment thresholds, and action potential amplitudes were estimated for concurrently active MUs in each trial. Our results reveal significant changes in the firing rate patterns in paretic FDI muscle, in that the discharge rates, characterized in relation to recruitment force threshold and to MU size, were less clearly correlated with recruitment force than in contralateral FDI muscles. Firing rates in the affected muscle also did not modulate systematically with the level of voluntary muscle contraction, as would be expected in intact muscles. These disturbances in firing properties also correlated closely with the impairment of muscle force generation. Our results provide strong evidence of disruptions in MU firing behavior in paretic muscles after a hemispheric stroke, suggesting that modified control of the spinal motoneuron pool could be a contributing factor to muscular weakness in stroke survivors.

Altered motor unit discharge patterns in paretic muscles of stroke survivors assessed using surface electromyography

NASA Astrophysics Data System (ADS)

Hu, Xiaogang; Suresh, Aneesha K.; Rymer, William Z.; Suresh, Nina L.

2016-08-01

Objective. Hemispheric stroke survivors often show impairments in voluntary muscle activation. One potential source of these impairments could come from altered control of muscle, via disrupted motor unit (MU) firing patterns. In this study, we sought to determine whether MU firing patterns are modified on the affected side of stroke survivors, as compared with the analogous contralateral muscle. Approach. Using a novel surface electromyogram (EMG) sensor array, coupled with advanced template recognition software (dEMG) we recorded surface EMG signals over the first dorsal interosseous (FDI) muscle on both paretic and contralateral sides. Recordings were made as stroke survivors produced isometric index finger abductions over a large force range (20%-60% of maximum). Utilizing the dEMG algorithm, MU firing rates, recruitment thresholds, and action potential amplitudes were estimated for concurrently active MUs in each trial. Main results. Our results reveal significant changes in the firing rate patterns in paretic FDI muscle, in that the discharge rates, characterized in relation to recruitment force threshold and to MU size, were less clearly correlated with recruitment force than in contralateral FDI muscles. Firing rates in the affected muscle also did not modulate systematically with the level of voluntary muscle contraction, as would be expected in intact muscles. These disturbances in firing properties also correlated closely with the impairment of muscle force generation. Significance. Our results provide strong evidence of disruptions in MU firing behavior in paretic muscles after a hemispheric stroke, suggesting that modified control of the spinal motoneuron pool could be a contributing factor to muscular weakness in stroke survivors.

Metadata - National Hospital Discharge Survey (NHDS)

EPA Pesticide Factsheets

The National Hospital Discharge Survey (NHDS) is an annual probability survey that collects information on the characteristics of inpatients discharged from non-federal short-stay hospitals in the United States.

Computing discharge using the index velocity method

USGS Publications Warehouse

Levesque, Victor A.; Oberg, Kevin A.

2012-01-01

Application of the index velocity method for computing continuous records of discharge has become increasingly common, especially since the introduction of low-cost acoustic Doppler velocity meters (ADVMs) in 1997. Presently (2011), the index velocity method is being used to compute discharge records for approximately 470 gaging stations operated and maintained by the U.S. Geological Survey. The purpose of this report is to document and describe techniques for computing discharge records using the index velocity method. Computing discharge using the index velocity method differs from the traditional stage-discharge method by separating velocity and area into two ratings—the index velocity rating and the stage-area rating. The outputs from each of these ratings, mean channel velocity (V) and cross-sectional area (A), are then multiplied together to compute a discharge. For the index velocity method, V is a function of such parameters as streamwise velocity, stage, cross-stream velocity, and velocity head, and A is a function of stage and cross-section shape. The index velocity method can be used at locations where stage-discharge methods are used, but it is especially appropriate when more than one specific discharge can be measured for a specific stage. After the ADVM is selected, installed, and configured, the stage-area rating and the index velocity rating must be developed. A standard cross section is identified and surveyed in order to develop the stage-area rating. The standard cross section should be surveyed every year for the first 3 years of operation and thereafter at a lesser frequency, depending on the susceptibility of the cross section to change. Periodic measurements of discharge are used to calibrate and validate the index rating for the range of conditions experienced at the gaging station. Data from discharge measurements, ADVMs, and stage sensors are compiled for index-rating analysis. Index ratings are developed by means of regression techniques in which the mean cross-sectional velocity for the standard section is related to the measured index velocity. Most ratings are simple-linear regressions, but more complex ratings may be necessary in some cases. Once the rating is established, validation measurements should be made periodically. Over time, validation measurements may provide additional definition to the rating or result in the creation of a new rating. The computation of discharge is the last step in the index velocity method, and in some ways it is the most straight-forward step. This step differs little from the steps used to compute discharge records for stage-discharge gaging stations. The ratings are entered into database software used for records computation, and continuous records of discharge are computed.

26 CFR 301.6325-1 - Release of lien or discharge of property.

Code of Federal Regulations, 2010 CFR

2010-04-01

... property be worth not less than $12,200. (2) Part payment; interest of United States valueless—(i) Part... amount determined by him to be not less than the value of the interest of the United States in the... of the United States in the property with respect to which the certificate of discharge is to be...

Accuracy of patient's turnover time prediction using RFID technology in an academic ambulatory surgery center.

PubMed

Marchand-Maillet, Florence; Debes, Claire; Garnier, Fanny; Dufeu, Nicolas; Sciard, Didier; Beaussier, Marc

2015-02-01

Patients flow in outpatient surgical unit is a major issue with regards to resource utilization, overall case load and patient satisfaction. An electronic Radio Frequency Identification Device (RFID) was used to document the overall time spent by the patients between their admission and discharge from the unit. The objective of this study was to evaluate how a RFID-based data collection system could provide an accurate prediction of the actual time for the patient to be discharged from the ambulatory surgical unit after surgery. This is an observational prospective evaluation carried out in an academic ambulatory surgery center (ASC). Data on length of stay at each step of the patient care, from admission to discharge, were recorded by a RFID device and analyzed according to the type of surgical procedure, the surgeon and the anesthetic technique. Based on these initial data (n = 1520), patients were scheduled in a sequential manner according to the expected duration of the previous case. The primary endpoint was the difference between actual and predicted time of discharge from the unit. A total of 414 consecutive patients were prospectively evaluated. One hundred seventy four patients (42%) were discharged at the predicted time ± 30 min. Only 24% were discharged behind predicted schedule. Using an automatic record of patient's length of stay would allow an accurate prediction of the discharge time according to the type of surgery, the surgeon and the anesthetic procedure.

Study on quality of effluent discharge by the Tiruppur textile dyeing units and its impact on river Noyyal, Tamil Nadu (India).

PubMed

Rajkumar, A Samuel; Nagan, S

2010-10-01

In Tiruppur, 729 textile dyeing units are under operation and these units generate 96.1 MLD of wastewater. The untreated effluent was discharged into the Noyyal River till 1997. After the issuance of directions by Tamil Nadu Pollution Control Board (TNPCB) in 1997, these units have installed 8 common effluent treatment plants (CETP) consisting of physical, chemical and biological treatment units. Some of the units have installed individual ETP (IETP). The treated effluent was finally discharged into the river. The dyeing units use sodium chloride in the dyeing process for efficient fixing of dye in the fabric efficiently. This contributes high total dissolved solids (TDS) and chlorides in the effluent. CETPs and IETPs failed to meet discharge standards of TDS and chlorides and thereby significantly affected the river water quality. TDS level in the river water was in the range of 900 - 6600 mg/L, and chloride was in the range of 230 - 2700 mg/L. Orathupalayam dam is located across Noyyal river at 32 km down stream of Tiruppur. The pollutants carried by the river were accumulated in the dam. TDS in the dam water was in the range of 4250 - 7900 mg/L and chloride was in the range of 1600 - 2700 mg/L. The dam sediments contain heavy metals of chromium, copper, zinc and lead. In 2006, the High Court has directed the dyeing units to install zero liquid discharge (ZLD) plant and to stop discharging of effluent into the river. Accordingly, the industries have installed and commissioned the ZLD plant consisting of RO plant and reject management system in 2010. The effluent after secondary treatment from the CETP is further treated in RO plant. The RO permeate is reused by the member units. The RO reject is concentrated in multiple effect evaporator (MEE)/ mechanical vacuum re-compressor (MVR). The concentrate is crystallized and centrifuged to recover salt. The salt recovered is reused. The liquid separated from the centrifuge is sent to solar evaporation pan. The salt collected in the solar pan is bagged and stored in secure land fill facility. Thus, the discharge into the river is now stopped. However, the damage caused to the groundwater and soil contamination in the river basin is yet to be restored.

PRN 93-10: Effluent Discharge Labeling Statements

EPA Pesticide Factsheets

This notice describes revised effluent discharge labeling statements required on all manufacturing use products and end use products that may be discharged to waters of the United States ormunicipal sewer systems.

Effect of Discharge Rate on Positive Active Material of Lead Carbon Battery for Energy Storage

NASA Astrophysics Data System (ADS)

Chen, Kailun; Liu, Hao; Hu, Chen; Gao, Fei; Yang, Kai; Wang, Hao

2017-10-01

Lead carbon battery has been widespread concern with its excellent performance of charge and discharge under High Rate Part State of Charge (HRPSoC) as well as its cycle performance. In this paper, the cycling performance of lead carbon battery for energy storage was tested by different discharge rate. The effects of different discharge rate on the composition and morphology of positive active materials in the cycle was studied by XRD and SEM. The effect of different discharge rate on the ohmic impedance of lead carbon battery was studied by testing Electrochemical Impedance Spectroscopy with different capacity retention rates. The results show that with the increase of the discharge rate, the content of PbO2 in the positive active material increases, the active substance utilization and the particle size of PbO2 crystal declines, and the ohmic impedance of the battery decreases.

Physician Variability in Management of Emergency Department Patients with Chest Pain.

PubMed

Smulowitz, Peter B; Barrett, Orit; Hall, Matthew M; Grossman, Shamai A; Ullman, Edward A; Novack, Victor

2017-06-01

Chest pain is a common emergency department (ED) presentation accounting for 8-10 million visits per year in the United States. Physician-level factors such as risk tolerance are predictive of admission rates. The recent advent of accelerated diagnostic pathways and ED observation units may have an impact in reducing variation in admission rates on the individual physician level. We conducted a single-institution retrospective observational study of ED patients with a diagnosis of chest pain as determined by diagnostic code from our hospital administrative database. We included ED visits from 2012 and 2013. Patients with an elevated troponin or an electrocardiogram (ECG) demonstrating an ST elevation myocardial infarction were excluded. Patients were divided into two groups: "admission" (this included observation and inpatients) and "discharged." We stratified physicians by age, gender, residency location, and years since medical school. We controlled for patient- and hospital-related factors including age, gender, race, insurance status, daily ED volume, and lab values. Of 4,577 patients with documented dispositions, 3,252 (70.9%) were either admitted to the hospital or into observation (in an ED observation unit or in the hospital), while 1,333 (29.1%) were discharged. Median number of patients per physician was 132 (interquartile range 89-172). Average admission rate was 73.7±9.5% ranging from 54% to 96%. Of the 3,252 admissions, 2,638 (81.1%) were to observation. There was significant variation in the admission rate at the individual physician level with adjusted odds ratio ranging from 0.42 to 5.8 as compared to the average admission. Among physicians' characteristics, years elapsed since finishing medical school demonstrated a trend towards association with a higher admission probability. There is substantial variation among physicians in the management of patients presenting with chest pain, with physician experience playing a role.

State Firearm Legislation and Nonfatal Firearm Injuries.

PubMed

Simonetti, Joseph A; Rowhani-Rahbar, Ali; Mills, Brianna; Young, Bessie; Rivara, Frederick P

2015-08-01

We investigated whether stricter state-level firearm legislation was associated with lower hospital discharge rates for nonfatal firearm injuries. We estimated discharge rates for hospitalized and emergency department-treated nonfatal firearm injuries in 18 states in 2010 and used negative binomial regression to determine whether strength of state firearm legislation was independently associated with total nonfatal firearm injury discharge rates. We identified 26 744 discharges for nonfatal firearm injuries. The overall age-adjusted discharge rate was 19.0 per 100 000 person-years (state range = 3.3-36.6), including 7.9 and 11.1 discharges per 100 000 for hospitalized and emergency department-treated injuries, respectively. In models adjusting for differences in state sociodemographic characteristics and economic conditions, states in the strictest tertile of legislative strength had lower discharge rates for total (incidence rate ratio [IRR] = 0.60; 95% confidence interval [CI] = 0.44, 0.82), assault-related (IRR = 0.58; 95% CI = 0.34, 0.99), self-inflicted (IRR = 0.18; 95% CI = 0.14, 0.24), and unintentional (IRR = 0.53; 95% CI = 0.34, 0.84) nonfatal firearm injuries. There is significant variation in state-level hospital discharge rates for nonfatal firearm injuries, and stricter state firearm legislation is associated with lower discharge rates for such injuries.

State Firearm Legislation and Nonfatal Firearm Injuries

PubMed Central

Rowhani-Rahbar, Ali; Mills, Brianna; Young, Bessie; Rivara, Frederick P.

2015-01-01

Objectives. We investigated whether stricter state-level firearm legislation was associated with lower hospital discharge rates for nonfatal firearm injuries. Methods. We estimated discharge rates for hospitalized and emergency department–treated nonfatal firearm injuries in 18 states in 2010 and used negative binomial regression to determine whether strength of state firearm legislation was independently associated with total nonfatal firearm injury discharge rates. Results. We identified 26 744 discharges for nonfatal firearm injuries. The overall age-adjusted discharge rate was 19.0 per 100 000 person-years (state range = 3.3–36.6), including 7.9 and 11.1 discharges per 100 000 for hospitalized and emergency department–treated injuries, respectively. In models adjusting for differences in state sociodemographic characteristics and economic conditions, states in the strictest tertile of legislative strength had lower discharge rates for total (incidence rate ratio [IRR] = 0.60; 95% confidence interval [CI] = 0.44, 0.82), assault-related (IRR = 0.58; 95% CI = 0.34, 0.99), self-inflicted (IRR = 0.18; 95% CI = 0.14, 0.24), and unintentional (IRR = 0.53; 95% CI = 0.34, 0.84) nonfatal firearm injuries. Conclusions. There is significant variation in state-level hospital discharge rates for nonfatal firearm injuries, and stricter state firearm legislation is associated with lower discharge rates for such injuries. PMID:26066935

Differential Motor Unit Changes after Endurance or High-Intensity Interval Training.

PubMed

Martinez-Valdes, Eduardo; Falla, Deborah; Negro, Francesco; Mayer, Frank; Farina, Dario

2017-06-01

Using a novel technique of high-density surface EMG decomposition and motor unit (MU) tracking, we compared changes in the properties of vastus medialis and vastus lateralis MU after endurance (END) and high-intensity interval training (HIIT). Sixteen men were assigned to the END or the HIIT group (n = 8 each) and performed six training sessions for 14 d. Each session consisted of 8-12 × 60-s intervals at 100% peak power output separated by 75 s of recovery (HIIT) or 90-120 min continuous cycling at ~65% V˙O2peak (END). Pre- and postintervention, participants performed 1) incremental cycling to determine V˙O2peak and peak power output and 2) maximal, submaximal (10%, 30%, 50%, and 70% maximum voluntary contraction [MVC]), and sustained (until task failure at 30% MVC) isometric knee extensions while high-density surface EMG signals were recorded from the vastus medialis and vastus lateralis. EMG signals were decomposed (submaximal contractions) into individual MU by convolutive blind source separation. Finally, MU were tracked across sessions by semiblind source separation. After training, END and HIIT improved V˙O2peak similarly (by 5.0% and 6.7%, respectively). The HIIT group showed enhanced maximal knee extension torque by ~7% (P = 0.02) and was accompanied by an increase in discharge rate for high-threshold MU (≥50% knee extension MVC) (P < 0.05). By contrast, the END group increased their time to task failure by ~17% but showed no change in MU discharge rates (P > 0.05). HIIT and END induce different adjustments in MU discharge rate despite similar improvements in cardiopulmonary fitness. Moreover, the changes induced by HIIT are specific for high-threshold MU. For the first time, we show that HIIT and END induce specific neuromuscular adaptations, possibly related to differences in exercise load intensity and training volume.

Children and youth with non-traumatic brain injury: a population based perspective.

PubMed

Chan, Vincy; Pole, Jason D; Keightley, Michelle; Mann, Robert E; Colantonio, Angela

2016-07-20

Children and youth with non-traumatic brain injury (nTBI) are often overlooked in regard to the need for post-injury health services. This study provided population-based data on their burden on healthcare services, including data by subtypes of nTBI, to provide the foundation for future research to inform resource allocation and healthcare planning for this population. A retrospective cohort study design was used. Children and youth with nTBI in population-based healthcare data were identified using International Classification of Diseases Version 10 codes. The rate of nTBI episodes of care, demographic and clinical characteristics, and discharge destinations from acute care and by type of nTBI were identified. The rate of pediatric nTBI episodes of care was 82.3 per 100,000 (N = 17,977); the average stay in acute care was 13.4 days (SD = 25.6 days) and 35% were in intensive care units. Approximately 15% were transferred to another inpatient setting and 6% died in acute care. By subtypes of nTBI, the highest rates were among those with a diagnosis of toxic effect of substances (22.7 per 100,000), brain tumours (18.4 per 100,000), and meningitis (15.4 per 100,000). Clinical characteristics and discharge destinations from the acute care setting varied by subtype of nTBI; the proportion of patients that spent at least one day in intensive care units and the proportion discharged home ranged from 25.9% to 58.2% and from 50.6% to 76.4%, respectively. Children and youth with nTBI currently put an increased demand on the healthcare system. Active surveillance of and in-depth research on nTBI, including subtypes of nTBI, is needed to ensure that timely, appropriate, and targeted care is available for this pediatric population.

Robust and accurate decoding of motoneuron behavior and prediction of the resulting force output.

PubMed

Thompson, Christopher K; Negro, Francesco; Johnson, Michael D; Holmes, Matthew R; McPherson, Laura Miller; Powers, Randall K; Farina, Dario; Heckman, Charles J

2018-05-03

The spinal alpha motoneuron is the only cell in the human CNS whose discharge can be routinely recorded in humans. We have reengineered motor unit collection and decomposition approaches, originally developed in humans, to measure the neural drive to muscle and estimate muscle force generation in the decerebrate cat model. Experimental, computational, and predictive approaches are used to demonstrate the validity of this approach across a wide range of modes to activate the motor pool. The utility of this approach is shown through the ability to track individual motor units across trials, allowing for better predictions of muscle force than the electromyography signal, and providing insights in to the stereotypical discharge characteristics in response to synaptic activation of the motor pool. This approach now allows for a direct link between the intracellular data of single motoneurons, the discharge properties of motoneuron populations, and muscle force generation in the same preparation. The discharge of a spinal alpha motoneuron and the resulting contraction of its muscle fibers represents the functional quantum of the motor system. Recent advances in the recording and decomposition of the electromyographic signal allows for the identification of several tens of concurrently active motor units. These detailed population data provide the potential to achieve deep insights into the synaptic organization of motor commands. Yet most of our understanding of the synaptic input to motoneurons is derived from intracellular recordings in animal preparations. Thus, it is necessary to extend the new electrode and decomposition methods to recording of motor unit populations in these same preparations. To achieve this goal, we use high-density electrode arrays and decomposition techniques, analogous to those developed for humans, to record and decompose the activity of tens of concurrently active motor units in a hindlimb muscle in the decerebrate cat. Our results showed that the decomposition method in this animal preparation was highly accurate, with conventional two-source validation providing rates of agreement equal to or superior to those found in humans. Multidimensional reconstruction of the motor unit action potential provides the ability to accurately track the same motor unit across multiple contractions. Additionally, correlational analyses demonstrate that the composite spike train provides better estimates of whole muscle force than conventional estimates obtained from the electromyographic signal. Lastly, stark differences are observed between the modes of activation, in particular tendon vibration produced quantal interspike intervals at integer multiples of the vibration period. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Trends in hospitalized discharge rates for head injury in Maryland, 1979-86.

PubMed Central

MacKenzie, E J; Edelstein, S L; Flynn, J P

1990-01-01

Hospital discharge data from all acute care hospitals in Maryland were used to examine trends in hospitalized head injury incidence and outcome by severity. From 1979 to 1986, discharge rates increased by 3.4/100,000 per year; the largest percent increase was for more severe injuries. Discharge rates increased the most for adults ages 15-24 and ages 75+ but declined for children ages 0-4. Coinciding with the increase in head injury discharges was a decrease in the hospital case-fatality rate across all severity groups. PMID:2297074

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.

Factors associated with thromboembolic events following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

PubMed

Rottenstreich, Amihai; Kalish, Yosef; Kleinstern, Geffen; Yaacov, Almog Ben; Dux, Joseph; Nissan, Aviram

2017-12-01

We investigated the risk factors, incidence, and role of thromboprophylaxis in the development of thrombosis following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). We reviewed data of patients with CRS/HIPEC in three hospitals. Overall, 192 patients underwent CRS/HIPEC during 2007-2016. Mechanical (thigh-length pneumatic compression stockings) and pharmacologic thromboprophylaxis (40 mg enoxaparin daily, starting 12 h before surgery until discharge) was provided for all patients; and 116 (60.4%) also received an extended course of enoxaparin for 2-4 weeks after discharge. Twenty-six patients experienced thrombotic complications (13.5%) including portal-splenic-mesenteric venous thrombosis (n = 11, 5.7%), pulmonary embolism (n = 10, 5.2%), and deep vein thrombosis (n = 5, 2.6%); most (n = 21, 80.8%) occurred after hospital discharge. Univariate analysis identified Peritoneal Cancer Index, intraoperative transfusion requirement, operative blood loss, operative time, lengths of hospital, and intensive care unit stay, and lack of administration of anticoagulation at discharge as significantly associated with thrombosis. With multivariate analysis, only the lack of anticoagulation therapy at discharge remained significantly associated with thrombosis (P = 0.0001). Thromboembolic complications are common following CRS/HIPEC. As significantly lower rates of thrombosis were found in patients who received an extended course of anticoagulation, we support its use for at least 2 weeks after discharge. © 2017 Wiley Periodicals, Inc.

Quantifying the uncertainty in discharge data using hydraulic knowledge and uncertain gaugings: a Bayesian method named BaRatin

NASA Astrophysics Data System (ADS)

Le Coz, Jérôme; Renard, Benjamin; Bonnifait, Laurent; Branger, Flora; Le Boursicaud, Raphaël; Horner, Ivan; Mansanarez, Valentin; Lang, Michel; Vigneau, Sylvain

2015-04-01

River discharge is a crucial variable for Hydrology: as the output variable of most hydrologic models, it is used for sensitivity analyses, model structure identification, parameter estimation, data assimilation, prediction, etc. A major difficulty stems from the fact that river discharge is not measured continuously. Instead, discharge time series used by hydrologists are usually based on simple stage-discharge relations (rating curves) calibrated using a set of direct stage-discharge measurements (gaugings). In this presentation, we present a Bayesian approach (cf. Le Coz et al., 2014) to build such hydrometric rating curves, to estimate the associated uncertainty and to propagate this uncertainty to discharge time series. The three main steps of this approach are described: (1) Hydraulic analysis: identification of the hydraulic controls that govern the stage-discharge relation, identification of the rating curve equation and specification of prior distributions for the rating curve parameters; (2) Rating curve estimation: Bayesian inference of the rating curve parameters, accounting for the individual uncertainties of available gaugings, which often differ according to the discharge measurement procedure and the flow conditions; (3) Uncertainty propagation: quantification of the uncertainty in discharge time series, accounting for both the rating curve uncertainties and the uncertainty of recorded stage values. The rating curve uncertainties combine the parametric uncertainties and the remnant uncertainties that reflect the limited accuracy of the mathematical model used to simulate the physical stage-discharge relation. In addition, we also discuss current research activities, including the treatment of non-univocal stage-discharge relationships (e.g. due to hydraulic hysteresis, vegetation growth, sudden change of the geometry of the section, etc.). An operational version of the BaRatin software and its graphical interface are made available free of charge on request to the authors. J. Le Coz, B. Renard, L. Bonnifait, F. Branger, R. Le Boursicaud (2014). Combining hydraulic knowledge and uncertain gaugings in the estimation of hydrometric rating curves: a Bayesian approach, Journal of Hydrology, 509, 573-587.

Health problems related to early discharge of Turkish women.

PubMed

Gözüm, Sebahat; Kiliç, Dilek

2005-12-01

to determine women's problems when discharged early from hospital after normal vaginal birth among a simple convenience sample of mothers in one part of Turkey. a descriptive interview study. primary health-care unit in Erzurum, Turkey. 112 mothers who came to the primary health-care unit for vaccination of their 2-month old babies between May and June 2000. Data were collected by structured face-to-face interviews. A symptom checklist was used to determine health problems. length of hospital stay after delivery was a mean of 7.1+/-7.0 hrs, and 66.1% (n=74) of mothers did not receive appropriate education about potential postpartum health problems. The findings indicated that the morbidity rate of mothers in the postpartum period was high. Among the most prevalent problems experienced by mothers were fatigue (86.6%; n=97), insomnia (80.4%; n=90), breast problems [engorged breast, tenderness and pain] 71.4%; n=80) and constipation 61.7%; n=69). Vaginal infection was reported by 16 mothers (14.3%; n=16). The prevalence of the use of medical services resulting from postnatal health problems in the postpartum period was 42.0% (n=47). About half of the mothers (51.8%; n=58) were not visited by midwives during the first postpartum week after discharge from hospital because both the maternity hospital and mother had not reported any health problems to the midwife. RECOMMENDATIONS FOR PRACTICE: mothers can experience many problems in the postpartum period. It is not possible to predict which mother will experience risks, such as an infection or mastitis. Therefore, women discharged from hospital in the first 24 hrs after birth should be educated about the problems that may arise during the postpartum period. They should also be given professional care and help in their own home by midwives working in the primary-care unit. Mothers should be told to notify their midwives about delivery and discharge in order to receive early follow-up in their homes. We suggest promoting maternal health education that encourages women to seek appropriate and timely care.

Clinical outcomes and costs for people with complex psychosis; a naturalistic prospective cohort study of mental health rehabilitation service users in England.

PubMed

Killaspy, Helen; Marston, Louise; Green, Nicholas; Harrison, Isobel; Lean, Melanie; Holloway, Frank; Craig, Tom; Leavey, Gerard; Arbuthnott, Maurice; Koeser, Leonardo; McCrone, Paul; Omar, Rumana Z; King, Michael

2016-04-07

Mental health rehabilitation services in England focus on people with complex psychosis. This group tend to have lengthy hospital admissions due to the severity of their problems and, despite representing only 10-20 % of all those with psychosis, they absorb 25-50 % of the total mental health budget. Few studies have investigated the effectiveness of these services and there is little evidence available to guide clinicians working in this area. As part of a programme of research into inpatient mental health rehabilitation services, we carried out a prospective study to investigate longitudinal outcomes and costs for patients of these services and the predictors of better outcome. Inpatient mental health rehabilitation services across England that scored above average (median) on a standardised quality assessment tool used in a previous national survey were eligible for the study. Unit quality was reassessed and costs of care and patient characteristics rated using standardised tools at recruitment. Multivariable regression modelling was used to investigate the relationship between service quality, patient characteristics and the following clinical outcomes at 12 month follow-up: social function; length of admission in the rehabiliation unit; successful community discharge (without readmission or community placement breakdown) and costs of care. Across England, 50 units participated and 329 patients were followed over 12 months (94 % of those recruited). Service quality was not associated with patients' social function or length of admission (median 16 months) at 12 months but most patients were successfully discharged (56 %) or ready for discharge (14 %), with associated reductions in the costs of care. Factors associated with successful discharge were the recovery orientation of the service (OR 1.04, 95 % CI 1.00-1.08), and patients' activity (OR 1.03, 95 % CI 1.01-1.05) and social skills (OR 1.13, 95 % CI 1.04-1.24) at recruitment. Inpatient mental health rehabilitation services in England are able to successfully discharge over half their patients within 18 months, reducing the costs of care for this complex group. Provision of recovery orientated practice that promotes patients' social skills and activities may further enhance the effectiveness of these services.

Cost-Effectiveness of a Specialist Geriatric Medical Intervention for Frail Older People Discharged from Acute Medical Units: Economic Evaluation in a Two-Centre Randomised Controlled Trial (AMIGOS).

PubMed

Tanajewski, Lukasz; Franklin, Matthew; Gkountouras, Georgios; Berdunov, Vladislav; Edmans, Judi; Conroy, Simon; Bradshaw, Lucy E; Gladman, John R F; Elliott, Rachel A

2015-01-01

Poor outcomes and high resource-use are observed for frail older people discharged from acute medical units. A specialist geriatric medical intervention, to facilitate Comprehensive Geriatric Assessment, was developed to reduce the incidence of adverse outcomes and associated high resource-use in this group in the post-discharge period. To examine the costs and cost-effectiveness of a specialist geriatric medical intervention for frail older people in the 90 days following discharge from an acute medical unit, compared with standard care. Economic evaluation was conducted alongside a two-centre randomised controlled trial (AMIGOS). 433 patients (aged 70 or over) at risk of future health problems, discharged from acute medical units within 72 hours of attending hospital, were recruited in two general hospitals in Nottingham and Leicester, UK. Participants were randomised to the intervention, comprising geriatrician assessment in acute units and further specialist management, or to control where patients received no additional intervention over and above standard care. Primary outcome was incremental cost per quality adjusted life year (QALY) gained. We undertook cost-effectiveness analysis for 417 patients (intervention: 205). The difference in mean adjusted QALYs gained between groups at 3 months was -0.001 (95% confidence interval [CI]: -0.009, 0.007). Total adjusted secondary and social care costs, including direct costs of the intervention, at 3 months were £4412 (€5624, $6878) and £4110 (€5239, $6408) for the intervention and standard care groups, the incremental cost was £302 (95% CI: 193, 410) [€385, $471]. The intervention was dominated by standard care with probability of 62%, and with 0% probability of cost-effectiveness (at £20,000/QALY threshold). The specialist geriatric medical intervention for frail older people discharged from acute medical unit was not cost-effective. Further research on designing effective and cost-effective specialist service for frail older people discharged from acute medical units is needed. ISRCTN registry ISRCTN21800480 http://www.isrctn.com/ISRCTN21800480.

Cardiac acute care nurse practitioner and 30-day readmission.

PubMed

David, Daniel; Britting, Lorraine; Dalton, Joanne

2015-01-01

The utilization outcomes of nurse practitioners (NPs) in the acute care setting have not been widely studied. The purpose of this study was to determine the impact on utilization outcomes of NPs on medical teams who take care of patients admitted to a cardiovascular intensive care unit. A retrospective 2-group comparative design was used to evaluate the outcomes of 185 patients with ST- or non ST-segment elevation myocardial infarction or heart failure who were admitted to a cardiovascular intensive care unit in an urban medical center. Patients received care from a medical team that included a cardiac acute care NP (n = 109) or medical team alone (n = 76). Patient history, cardiac assessment, medical interventions, discharge disposition, discharge time, and 3 utilization outcomes (ie, length of stay, 30-day readmission, and time of discharge) were compared between the 2 treatment groups. Logistic regression was used to identify predictors of 30-day readmission. Patients receiving care from a medical team that included an NP were rehospitalized approximately 50% less often compared with those receiving care from a medical team without an NP. Thirty-day hospital readmission (P = .011) and 30-day return rates to the emergency department (P = .021) were significantly lower in the intervention group. Significant predictors for rehospitalization included diagnosis of heart failure versus myocardial infarction (odds ratio [OR], 3.153, P = 0.005), treatment by a medical team without NP involvement (OR, 2.905, P = 0.008), and history of diabetes (OR, 2.310, P = 0.032). The addition of a cardiac acute care NP to medical teams caring for myocardial infarction and heart failure patients had a positive impact on 30-day emergency department return and hospital readmission rates.

A randomized trial testing the superiority of a post-discharge care management model for stroke survivors

PubMed Central

Allen, Kyle; Hazelett, Susan; Jarjoura, David; Hua, Keding; Wright, Kathy; Weinhardt, Janice; Kropp, Denise

2009-01-01

Objective To evaluate whether comprehensive post-discharge care management for stroke survivors is superior to organized acute stroke unit care with enhanced discharge planning in improving a profile of health and well-being. Methods This was a randomized trial of a comprehensive post-discharge care management intervention for ischemic stroke patients with NIH Stroke Scale scores ≥1 discharged from an acute stroke unit. An Advanced Practice Nurse (APN) performed an in-home assessment for the intervention group from which an Interdisciplinary Team developed patient-specific care plans. The APN worked with the primary care physician (PCP) and patient to implement the plan over the next 6 months. Main outcome measures The intervention and usual care groups were compared using a global and closed hypothesis testing strategy. Outcomes fell into 5 domains: 1) Neuromotor Function, 2) Institution Time or Death, 3) Quality of Life, 4) Management of Risk, and 5) Stroke Knowledge and Lifestyle. Results Treatment effect was near zero standard deviations for all but the stroke knowledge and lifestyle domain which showed a significant effect of the intervention (p=0.0003). Conclusions Post discharge care management was not more effective than organized stroke unit care with enhanced discharge planning in most domains in this population. The intervention did, however, fill a post-discharge knowledge gap. PMID:19900646

Fibromyalgia: prevalence, course, and co-morbidities in hospitalized patients in the United States, 1999-2007.

PubMed

Haviland, M G; Banta, J E; Przekop, P

2011-01-01

To evaluate hospitalisation data for patients with a primary or secondary fibromyalgia (FM) diagnosis. We estimated the number of men and women with an FM diagnostic code and compared them across a number of demographic and hospitalisation characteristics; examined age-specific, population-based FM hospitalisation rates; and determined the most common co-morbid diagnoses when FM was either the primary or secondary diagnostic code. Hospital discharge data from the Nationwide Inpatient Sample (NIS) were used. Records were evaluated between 1999 and 2007 that contained the International Classification of Diseases, 9th Revision, Clinical Modification FM diagnostic code (729.1, Myositis and Myalgia, unspecified), the FM criterion used in large-scale health services studies. There were 1,727,765 discharges with a 729.1 diagnostic code (FM) during this nine-year span, 213,034 men (12.3%) and 1,513,995 women (87.6%). Discharges coded for FM increased steadily each year. The population-based rate of male FM discharges rose gradually across the lifespan; the rate for women rose sharply but then declined after age 64. Few differences between men and women across demographic and hospitalisation characteristics were evident. The most common co-morbidities with FM as the primary diagnosis were non-specific chest pain, mood disorders, and Spondylosis/intervertebral disc disorders/other back problems. Most common primary diagnoses, with FM as a secondary diagnosis, were essential hypertension, disorders of lipid metabolism, coronary atherosclerosis/other heart disease, and mental disorders. A substantial number of U.S. residents with FM were hospitalised over the study period. Further analysis of hospitalisation data from patients with FM may provide guidance for both research and treatment, with the goal of improved care for FM patients.

Effect of discharge instructions on readmission of hospitalised patients with heart failure: do all of the Joint Commission on Accreditation of Healthcare Organizations heart failure core measures reflect better care?

PubMed Central

VanSuch, Monica; Naessens, James M; Stroebel, Robert J; Huddleston, Jeanne M; Williams, Arthur R

2006-01-01

Background Most nationally standardised quality measures use widely accepted evidence‐based processes as their foundation, but the discharge instruction component of the United States standards of Joint Commission on Accreditation of Healthcare Organizations heart failure core measure appears to be based on expert opinion alone. Objective To determine whether documentation of compliance with any or all of the six required discharge instructions is correlated with readmissions to hospital or mortality. Research design A retrospective study at a single tertiary care hospital was conducted on randomly sampled patients hospitalised for heart failure from July 2002 to September 2003. Participants Applying the Joint Commission on Accreditation of Healthcare Organizations criteria, 782 of 1121 patients were found eligible to receive discharge instructions. Eligibility was determined by age, principal diagnosis codes and discharge status codes. Measures The primary outcome measures are time to death and time to readmission for heart failure or readmission for any cause and time to death. Results In all, 68% of patients received all instructions, whereas 6% received no instructions. Patients who received all instructions were significantly less likely to be readmitted for any cause (p = 0.003) and for heart failure (p = 0.035) than those who missed at least one type of instruction. Documentation of discharge instructions is correlated with reduced readmission rates. However, there was no association between documentation of discharge instructions and mortality (p = 0.521). Conclusions Including discharge instructions among other evidence‐based heart failure core measures appears justified. PMID:17142589

Increasing access to specialty care: patient discharges from a gastroenterology clinic.

PubMed

Tuot, Delphine S; Sewell, Justin L; Day, Lukejohn; Leeds, Kiren; Chen, Alice Hm

2014-10-01

Access to specialty care among safety net patients in the United States is inadequate. Discharging appropriate patients to routine primary care follow-up may improve specialty care access. We sought to identify, by consensus, patients who could safely be discharged from a gastroenterology (GI) clinic, and to evaluate the impact of the discharges on GI clinic work flow. Pre- and post intervention. We developed and implemented a modified Delphi process. Gastroenterologists and primary care providers (PCPs) rated their comfort (using 5-point Likert scales) with discharging patients immediately post endoscopy for 24 clinical scenarios, assuming formal recommendations were communicated to the PCP. We examined the impact of implementing these criteria on clinic wait times and on the ratio of new to follow-up visits. All gastroenterologists (100%; 7 of 7) and 71.0% of PCPs (130 of 183) participated. Consensus was achieved for 13 of the 24 clinical scenarios for which discharge criteria were developed. Post intervention, 403 patients were discharged from the GI clinic, compared with 0 patients in the same 4 calendar months pre-intervention. The ratio of new to follow-up appointments increased from 0.9:1 to 1:1 (P = .05). Median wait time for the third next available appointment at GI clinics decreased from 158 days to 74 days (P = .0001). Discharging patients from specialty care back to primary care with consensus standards is one method to improve access to specialty care. Understanding the concerns of all stakeholders is necessary to refine and disseminate this process to other specialties and healthcare systems to ensure timely access to specialty services for all patients.

Variable partitioning of flow and sediment transfer through a large river diffluence-confluence unit across a monsoonal flood pulse

NASA Astrophysics Data System (ADS)

Hackney, C. R.; Aalto, R. E.; Darby, S. E.; Parsons, D. R.; Leyland, J.; Nicholas, A. P.; Best, J.

2016-12-01

Bifurcations represent key morphological nodes within the channel networks of anabranching and braided fluvial channels, playing an important role in controlling local bed morphology, the routing of sediment and water, and defining the stability of the downstream reaches. Herein, we detail field observations of the three-dimensional flow structure, bed morphological changes and partitioning of both flow discharge and suspended sediment through a large diffluence-confluence unit on the Mekong River, Cambodia, across a range of flow stages (from 13,500 m3 s-1 to 27,000 m3 s-1) over the monsoonal flood-pulse cycle. We show that the discharge asymmetry (a measure of the disparity between discharges distributed down the left and right branches of the bifurcation) varies with flow discharge and that the influence of upstream curvature-induced cross-stream water surface slope and bed morphological changes are first-order controls in modulating the asymmetry in bifurcation discharge. Flow discharge is shown to play a key role in defining the morphodynamics of the diffluence-confluence unit downstream of the bifurcation. Our data show that during peak flows (Q 27,000 m3 s-1), the downstream island complex acts as a net sink of suspended sediment (with 2600 kg s-1 being deposited between the diffluence and confluence), whereas during lower flows, on both the rising and falling limbs of the flood wave, the sediment balance is in quasi-equilibrium. We propose a new conceptual model of bifurcation stability that incorporates varying flood discharge and in which the long term stability of the bifurcation, as well as the larger channel planform and morphology of the diffluence-confluence unit, are controlled by the variations in flood discharge.

The influence of flow discharge variations on the morphodynamics of a diffluence-confluence unit on the Mekong River

NASA Astrophysics Data System (ADS)

Hackney, Christopher; Darby, Stephen; Parsons, Daniel; Leyland, Julian; Aalto, Rolf; Nicholas, Andrew; Best, Jim

2017-04-01

Bifurcations represent key morphological nodes within the channel networks of anabranching and braided fluvial channels, playing an important role in controlling local bed morphology, the routing of sediment and water, and defining the stability of the downstream reaches. Herein, we detail field observations of the three-dimensional flow structure, bed morphological changes and partitioning of both flow discharge and suspended sediment through a large diffluence-confluence unit on the Mekong River, Cambodia, across a range of flow stages (from 13,500 m3 s-1 to 27,000 m3 s-1) over the monsoonal flood-pulse cycle. We show that the discharge asymmetry (a measure of the disparity between discharges distributed down the left and right branches of the bifurcation) varies with flow discharge and that the influence of upstream curvature-induced cross-stream water surface slope and bed morphological changes are first-order controls in modulating the asymmetry in bifurcation discharge. Flow discharge is shown to play a key role in defining the morphodynamics of the diffluence-confluence unit downstream of the bifurcation. Our data show that during high flows (Q 27,000 m3 s-1), the downstream island complex acts as a net sink of suspended sediment (with 2600 kg s-1 being deposited between the diffluence and confluence), whereas during lower flows, on both the rising and falling limbs of the flood wave, the sediment balance is in quasi-equilibrium. We propose, therefore, that the long term stability of the bifurcation, as well as the larger channel planform and morphology of the diffluence-confluence unit, is therefore controlled by annual monsoonal flood pulses and the associated variations in discharge.

Do New Mothers Understand the Risk Factors for Maternal Mortality?

PubMed

Logsdon, M Cynthia; Davis, Deborah Winders; Myers, John A; Masterson, Katlin M; Rushton, Jeffrey A; Lauf, Adrian P

2018-03-16

The purpose of this study was to describe new mothers' knowledge related to maternal mortality. Using a cross-sectional design, new mothers were recruited from a postpartum unit of an academic health sciences center where the population was predominately low-income women. Before hospital discharge, they answered questions on their knowledge of potential postpartum complications that could lead to maternal mortality. Questions were based on recommendations from an expert nursing panel. Descriptive statistics were used for data analysis. One hundred twenty new mothers participated. Results indicated that most new mothers knew that they should watch for heavy bleeding, a severe headache, and swelling after hospital discharge. However, fewer participants knew that a new mother could experience feelings that she could harm herself or her baby, have blood clots larger than a baby's hand, a temperature of 100.4 °F or more, and odor with vaginal discharge. Courses of action new mothers would take if experiencing any of the warning signs included 18% of mothers would take no action, 76.7% would tell their boyfriend/husband/partner, 72.5% would inform their mother. Only 60% who would call the labor and delivery unit. Only 38% of the sample knew that pregnancy-related complications can occur for up to 1 year after birth, and 13% of mothers reported not knowing that complications can occur for up to 6 weeks postpartum. Our findings provide a foundation to enhance postpartum education for new mothers and their families and to potentially decrease rates of maternal mortality in the United States.

Kagomé lattices as cathode: Effect of particle size and fluoride substitution on electrochemical lithium insertion in sodium- and ammonium Jarosites

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

Sandineni, Prashanth; Yaghoobnejad Asl, Hooman; Choudhury, Amitava, E-mail: choudhurya@mst.edu

Highly crystalline sodium and ammonium Jarosites, NaFe{sub 3}(SO{sub 4}){sub 2}(OH){sub 6} and NH{sub 4}Fe{sub 3}(SO{sub 4}){sub 2}(OH){sub 6}, have been synthesized employing hydrothermal synthesis routes. The structures consist of anionic layers of vertex-sharing FeO{sub 6} octahedra and SO{sub 4} tetrahedral units with interlayer space occupied by Na and ammonium ions, respectively. The corner-sharing FeO{sub 6} octahedral units form six and three rings similar to hexagonal tungsten bronze sheets also known as kagomé lattice. These sodium and ammonium Jarosites are thermally stable up to 400 °C and undergo facile electrochemical lithium insertion through the reduction of Fe{sup 3+} to Fe{sup 2+}.more » Galvanostatic charge–discharge indicates that up to 2.25 and 2 lithium ions per formula unit can be inserted at an average voltage of 2.49 and 2.26 V to the sodium and the ammonium Jarosites, respectively, under slow discharge rate of C/50. The cycle-life and experimental achievable capacity show strong dependence on particle sizes and synthesis conditions. A small amount of fluoride substitution improves both achievable capacity and average voltage. - Graphical abstract: Discharge capacity of jarosite phases as a function of particle size and fluoride substitution. - Highlights: • Synthesis of natro- and ammonium Jarosites. • Jarosites as cathodes for lithium ion batteries. • Li-ion electrochemistry of Jarosites. • Mössbauer spectroscopy of Jarosites.« less

Occupational therapy for delirium management in elderly patients without mechanical ventilation in an intensive care unit: A pilot randomized clinical trial.

PubMed

Álvarez, Evelyn A; Garrido, Maricel A; Tobar, Eduardo A; Prieto, Stephanie A; Vergara, Sebastian O; Briceño, Constanza D; González, Francisco J

2017-02-01

Delirium has negative consequences such as increased mortality, hospital expenses and decreased cognitive and functional status. This research aims to determine the impact of occupational therapy intervention in duration, incidence and severity of delirium in elderly patients in the intensive care unit; secondary outcome was to assess functionality at hospital discharge. This is a pilot randomized clinical trial of patients without mechanical ventilation for 60 years. Patients were assigned to a control group that received standard strategies of prevention (n=70) or to an experimental group that received standard strategies plus occupational therapy twice a day for 5 days (n=70). Delirium was valued with Confusion Assessment Method and Delirium Rating Scale, and functional outcomes at discharge with Functional Independence Measure, Hand Dynamometer, and Mini-Mental State Examination. A total of 140 participants were recruited. The experimental group had lower duration (risk incidence ratios, 0.15 [P=.000; 95% confidence interval, 0.12-0.19] vs 6.6 [P=.000, 95% confidence interval, 5.23-8.3]) and incidence of delirium (3% vs 20%, P=.001), and had higher scores in Motor Functional Independence Measure (59 vs 40 points, P<.0001), cognitive state (MMSE: 28 vs 26 points, P<.05), and grip strength in the dominant hand (26 vs 18 kg, P<.05), compared with the control group. Occupational therapy is effective in decreasing duration and incidence of delirium in nonventilated elderly patients in the intensive care unit and improved functionality at discharge. Copyright © 2016 Elsevier Inc. All rights reserved.

Discharge ratings for control gates at Mississippi River lock and dam 12, Bellevue, Iowa

USGS Publications Warehouse

Heinitz, Albert J.

1986-01-01

The water level of the navigation pools on the Mississippi River are maintained by the operation of tainter and roller gates at the locks and dams. Discharge ratings for the gates on Lock and Dam 12, at Bellevue, Iowa, were developed from current-meter discharge measurements made in the forebays of the gate structures. Methodology is given to accurately compute the gate openings of the tainter gates. Discharge coefficients, in equations that express discharge as a function of tailwater head , forebay head, and height of gate opening, were determined for conditions of submerged-orifice and fee-weir flow. A comparison of the rating discharges to the hydraulic-model rating discharges is given for submerged orifice flow for the tainter and roller gates.

Variations in costs for the care of low-birth-weight infants among academic hospitals.

PubMed

Herrod, Henry G; Chang, Cyril F; Steinberg, Stephanie S

2010-05-01

To determine the relative role that academic hospitals (AHs) play in providing neonatal care for low-birth-weight infants within a single state and to determine if there are variations in inpatient costs for neonatal services among AHs. Retrospective analysis of hospital costs for low-birth-weight infants. Cases were identified using 2003-2005 data from the Tennessee Hospital Discharge Data System. A specific focus was discharge data from the 5 AHs that support obstetrical residencies and have a neonatal intensive care unit. Cases included all discharged infants with a birth weight of <2500 grams. The 5 AHs discharged 18% of the total normal-birth-weight infants and 30% of the low-birth-weight infants for the entire state. AHs had higher costs associated with these infants than did other hospitals, with a single exception The difference in costs at this hospital was consistent with the finding of lower utilization rates of hospital services, a shorter average length of stay, and lower costs for infants insured by the state Medicaid program. Academic obstetrical hospitals discharged a disproportionately high percentage of low-birth-weight infants compared with other Tennessee hospitals. The lower costs observed in the Shelby County hospital indicates that other hospitals could potentially lower their costs for the care of low-birth-weight infants.

Crystal structure and electrochemical characteristics of non-AB 5 type La-Ni system alloys

NASA Astrophysics Data System (ADS)

Shi, Siqi; Ouyang, Chuying; Lei, Minsheng

The La-Ni system compounds have been prepared by arc-melting method under Ar atmosphere. X-ray diffraction analysis reveals that the as-prepared alloys consist of different phases. The electrochemical properties, including activation, maximum discharge capacity, high rate chargeability (HRC), and high rate dischargeability (HRD) of these alloy electrodes have been studied through the charge-discharge recycle testing at different temperatures and charge (or discharge) currents. Among the La-Ni alloy electrodes studied, LaNi 2.28 alloy has the most excellent high rate charging performance, and La 2Ni 7 alloy exhibit the highest high rate dischargeability, while La 7Ni 3 alloy is capable of discharging at low temperature.

30 CFR 7.64 - Technical requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... voltage that can be applied across an electric contact that discharges a capacitor shall not be greater...) Capacitor discharge. The blasting unit shall include an automatic means to dissipate any electric charge remaining in any capacitor after the blasting unit is deenergized and not in use. (j) Construction. Blasting...

30 CFR 7.64 - Technical requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... voltage that can be applied across an electric contact that discharges a capacitor shall not be greater...) Capacitor discharge. The blasting unit shall include an automatic means to dissipate any electric charge remaining in any capacitor after the blasting unit is deenergized and not in use. (j) Construction. Blasting...

30 CFR 7.64 - Technical requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... voltage that can be applied across an electric contact that discharges a capacitor shall not be greater...) Capacitor discharge. The blasting unit shall include an automatic means to dissipate any electric charge remaining in any capacitor after the blasting unit is deenergized and not in use. (j) Construction. Blasting...

Modification, validation and implementation of a protocol for post-thyroidectomy hypocalcaemia.

PubMed

Stedman, T; Chew, P; Truran, P; Lim, C B; Balasubramanian, S P

2018-02-01

Introduction The management of post-thyroidectomy hypocalcaemia should facilitate early discharge, and reduce risks of hypocalcaemia, readmission and treatment related hypercalcaemia. This paper describes the implementation, evaluation and revision a protocol for the optimal management of this condition. Methods Day 1 parathyroid hormone (PTH) measurements in addition to calcium measurements were commenced following review of the unit's outcomes and literature on post-thyroidectomy hypocalcaemia. Outcomes from a three-year cohort of patients undergoing thyroid surgery helped amend this protocol (revision 1) to reduce biochemical tests, stipulate the need, nature and dose of vitamin D/calcium supplements, and encourage early discharge. This was further validated over seven months to assess compliance, episodes of hyper and/or hypocalcaemia after discharge, readmissions and need for treatment changes. Further revisions were made (revision 2) and implemented. Results The temporary and long-term postoperative hypocalcaemia rates were 29.1% and 3.2% respectively. Repeat calcium measurements on the first day altered management in only 1.4% of cases. The revised protocol was adhered to in 90% of cases. One patient had hypocalcaemia (due to non-compliance) and one had hypercalcaemia. Revision 2 involved reducing the dose of calcium. Conclusions This is a good example of a unit protocol for post-thyroidectomy hypocalcaemia being developed and modified on the basis of the literature and local experience. Day 1 PTH and calcium levels determine the need for treatment and frequency of follow-up visits, facilitate early discharge, reduce risk of over and/or undertreatment, and are good indicators of permanent hypocalcaemia.

History dependence of human muscle-fiber conduction velocity during voluntary isometric contractions.

PubMed

McGill, Kevin C; Lateva, Zoia C

2011-09-01

The conduction velocity (CV) of a muscle fiber is affected by the fiber's discharge history going back ∼1 s. We investigated this dependence by measuring CV fluctuations during voluntary isometric contractions of the human brachioradialis muscle. We recorded electromyogram (EMG) signals simultaneously from multiple intramuscular electrodes, identified potentials belonging to the same motor unit using EMG decomposition, and estimated the CV of each discharge from the interpotential interval. In 12 of 14 subjects, CV increased by ∼10% during the first second after recruitment and then fluctuated by about ±2% in a way that mirrored the fluctuations in the instantaneous firing rate. The CV profile could be precisely described in terms of the discharge history by a simple mathematical model. In the other two subjects, and one subject retested after cooling the arm, the CV fluctuations were inversely correlated with instantaneous firing rate. In all subjects, CV was additionally affected by very short interdischarge intervals (<25 ms): it was increased in doublets at recruitment, but decreased in doublets during continuous firing and after short interdischarge intervals in doubly innervated fibers. CV also exhibited a slow trend of about -0.05%/s that did not depend on the immediate discharge history. We suggest that measurements of CV fluctuations during voluntary contractions, or during stimulation protocols that involve longer and more complex stimulation patterns than are currently being used, may provide a sensitive approach for estimating the dynamic characteristics of ion channels in the human muscle-fiber membrane.

Subtidal circulation patterns in a shallow, highly stratified estuary: Mobile Bay, Alabama

USGS Publications Warehouse

Noble, M.A.; Schroeder, W.W.; Wiseman, W.J.; Ryan, H.F.; Gelfenbaum, G.

1996-01-01

Mobile Bay is a wide (25-50 km), shallow (3 m), highly stratified estuary on the Gulf coast of the United States. In May 1991 a series of instruments that measure near-surface and near-bed current, temperature, salinity, and middepth pressure were deployed for a year-long study of the bay. A full set of measurements were obtained at one site in the lower bay; all but current measurements were obtained at a midbay site. These observations show that the subtidal currents in the lower bay are highly sheared, despite the shallow depth of the estuary. The sheared flow patterns are partly caused by differential forcing from wind stress and river discharge. Two wind-driven flow patterns actually exist in lower Mobile Bay. A barotropic response develops when the difference between near-surface and near-bottom salinity is less than 5 parts per thousand. For stronger salinity gradients the wind-driven currents are larger and the response resembles a baroclinic flow pattern. Currents driven by river flows are sheared and also have a nonlinear response pattern. Only near-surface currents are driven seaward by discharges below 3000 m3/s. At higher discharge rates, surface current variability uncouples from the river flow and the increased discharge rates drive near-bed current seaward. This change in the river-forced flow pattern may be associated with a hydraulic jump in the mouth of the estuary. Copyright 1996 by the American Geophysical Union.

History dependence of human muscle-fiber conduction velocity during voluntary isometric contractions

PubMed Central

Lateva, Zoia C.

2011-01-01

The conduction velocity (CV) of a muscle fiber is affected by the fiber's discharge history going back ∼1 s. We investigated this dependence by measuring CV fluctuations during voluntary isometric contractions of the human brachioradialis muscle. We recorded electromyogram (EMG) signals simultaneously from multiple intramuscular electrodes, identified potentials belonging to the same motor unit using EMG decomposition, and estimated the CV of each discharge from the interpotential interval. In 12 of 14 subjects, CV increased by ∼10% during the first second after recruitment and then fluctuated by about ±2% in a way that mirrored the fluctuations in the instantaneous firing rate. The CV profile could be precisely described in terms of the discharge history by a simple mathematical model. In the other two subjects, and one subject retested after cooling the arm, the CV fluctuations were inversely correlated with instantaneous firing rate. In all subjects, CV was additionally affected by very short interdischarge intervals (<25 ms): it was increased in doublets at recruitment, but decreased in doublets during continuous firing and after short interdischarge intervals in doubly innervated fibers. CV also exhibited a slow trend of about −0.05%/s that did not depend on the immediate discharge history. We suggest that measurements of CV fluctuations during voluntary contractions, or during stimulation protocols that involve longer and more complex stimulation patterns than are currently being used, may provide a sensitive approach for estimating the dynamic characteristics of ion channels in the human muscle-fiber membrane. PMID:21565985

The first seventy admissions to an adolescent unit in Edinburgh: general characteristics and treatment outcome.

PubMed

Framrose, R

1975-04-01

1. The clinical functioning of the Young People's Unit, Edinburgh is described. This involves a relatively permissive, democratic "milieu". Psychotherapeutic efforts are devoted to the resolution of family psychopathology and the achievement of maturational progress for the adolescent. 2. Data on the first seventy admittions to the Unit were examined. Two-thirds of the patients were diagnosed "developmental crisis"; the majority of these also had a personality disorder. 3. Assessments of family functioning showed high levels of disturbance and psychiatric morbidity among the parents. The adolescents had mutually good, positive relationships with their opposite-sexed parents, but markedly negative ones with the same-sexed parents. This was not in accordance with the usual findings in "normal" families. Delinquent and impulsive patients showed uniformly negative family attitudes. 4. A simple estimation of treatment outcome at discharge gave results comparable to those of other units, with 70 per cent of patients rated as improved. Neurotic and psychotic patients had a relatively better outcome. Tension-discharge personality disorder and a history of very disruptive or antisocial behaviour were associated with poor outcome. 5. The poor response of very disturbed, impulsive adolescents to this type of therapeutic regime is discussed. These individuals do not appear to have sufficient personality resources and organization to benefit from this type of treatment. Emerging from this is a suggestion for an increased provision of specialized units offering containment and intensive care to the very disturbed adolescent.

Association of heart rate at hospital discharge with mortality and hospitalizations in patients with heart failure.

PubMed

Habal, Marlena V; Liu, Peter P; Austin, Peter C; Ross, Heather J; Newton, Gary E; Wang, Xuesong; Tu, Jack V; Lee, Douglas S

2014-01-01

Heart failure (HF) is associated with a high burden of morbidity and mortality. Hospital discharge is an opportunity for identification of modifiable prognostic factors in the transition to chronic HF. We examined the association of discharge heart rate with 30-day and 1-year mortality and hospitalization outcomes in a cohort of 9097 patients with HF discharged from hospital. Discharge heart rate was categorized into predefined groups: 40 to 60 (n=1333), 61 to 70 (n=2170), 71 to 80 (n=2631), 81 to 90 (n=1700), and >90 bpm (n=1263). There was a significant increase in all-cause 30-day mortality with adjusted odds ratios of 1.59 (95% confidence interval [CI], 1.18-2.14; P=0.003) for discharge heart rates 81 to 90 bpm and 1.56 (95% CI, 1.13-2.16; P=0.007) for heart rates>90 bpm when compared with the reference group (heart rates, 61-70 bpm). Cardiovascular death risk at 30 days was also higher with adjusted odds ratio 1.59 (discharge heart rates, 81-90 bpm; 95% CI, 1.09-2.33; P=0.017) and 1.65 (discharge heart rates, >90 bpm; 95% CI, 1.09-2.48; P=0.017). One-year all-cause mortality (adjusted odds ratio, 1.41; 95% CI, 1.16-1.72; P<0.001) and cardiovascular death (adjusted odds ratio, 1.47; 95% CI, 1.12-1.92; P=0.005) were higher with discharge heart rates>90 bpm when compared with the reference group (heart rates, 40-60 bpm). Readmissions for HF (adjusted hazard ratio, 1.26; 95% CI, 1.04-1.54; P=0.021) and cardiovascular disease (adjusted hazard ratio, 1.29; 95% CI, 1.08-1.54; P=0.004) within 30 days were also higher with discharge heart rates>90 bpm. Higher discharge heart rates were associated with greater risk of all-cause and cardiovascular mortality≤1-year follow-up and an elevated risk of 30-day readmission for HF and cardiovascular disease.

Toward global mapping of river discharge using satellite images and at-many-stations hydraulic geometry

PubMed Central

Gleason, Colin J.; Smith, Laurence C.

2014-01-01

Rivers provide critical water supply for many human societies and ecosystems, yet global knowledge of their flow rates is poor. We show that useful estimates of absolute river discharge (in cubic meters per second) may be derived solely from satellite images, with no ground-based or a priori information whatsoever. The approach works owing to discovery of a characteristic scaling law uniquely fundamental to natural rivers, here termed a river’s at-many-stations hydraulic geometry. A first demonstration using Landsat Thematic Mapper images over three rivers in the United States, Canada, and China yields absolute discharges agreeing to within 20–30% of traditional in situ gauging station measurements and good tracking of flow changes over time. Within such accuracies, the door appears open for quantifying river resources globally with repeat imaging, both retroactively and henceforth into the future, with strong implications for water resource management, food security, ecosystem studies, flood forecasting, and geopolitics. PMID:24639551

Toward global mapping of river discharge using satellite images and at-many-stations hydraulic geometry.

PubMed

Gleason, Colin J; Smith, Laurence C

2014-04-01

Rivers provide critical water supply for many human societies and ecosystems, yet global knowledge of their flow rates is poor. We show that useful estimates of absolute river discharge (in cubic meters per second) may be derived solely from satellite images, with no ground-based or a priori information whatsoever. The approach works owing to discovery of a characteristic scaling law uniquely fundamental to natural rivers, here termed a river's at-many-stations hydraulic geometry. A first demonstration using Landsat Thematic Mapper images over three rivers in the United States, Canada, and China yields absolute discharges agreeing to within 20-30% of traditional in situ gauging station measurements and good tracking of flow changes over time. Within such accuracies, the door appears open for quantifying river resources globally with repeat imaging, both retroactively and henceforth into the future, with strong implications for water resource management, food security, ecosystem studies, flood forecasting, and geopolitics.

The usage of waste heat recovery units with improved heat engineering rates: theory and experimental research

NASA Astrophysics Data System (ADS)

Chebotarev, Victor; Koroleva, Alla; Pirozhnikova, Anastasia

2017-10-01

Use of recuperator in heat producing plants for utilization of natural gas combustion products allows to achieve the saving of gas fuel and also provides for environmental sanitation. Decrease of the volumes of natural gas combustion due to utilization of heat provides not only for reduction of harmful agents in the combustion products discharged into the atmosphere, but also creates conditions for increase of energy saving in heating processes of heat producing plants due to air overheating in the recuperator. Grapho-analytical method of determination of energy saving and reduction of discharges of combustion products into the atmosphere is represented in the article. Multifunctional diagram is developed, allowing to determine simultaneously savings from reduction of volumes of natural gas combusted and from reduction of amounts of harmful agents in the combustion products discharged into the atmosphere. Calculation of natural gas economy for heat producing plant taking into consideration certain capacity is carried out.

Clinical characteristics and outcomes of obstetric patients admitted to the Intensive Care Unit: a 10-year retrospective review.

PubMed

Leung, N Y W; Lau, A C W; Chan, K K C; Yan, W W

2010-02-01

To review the characteristics and health-related quality-of-life outcomes of obstetric patients admitted to the Intensive Care Unit. Retrospective cohort study. A regional hospital in Hong Kong. Consecutive obstetric patients admitted to the Intensive Care Unit of Pamela Youde Nethersole Eastern Hospital from January 1998 to December 2007. Fifty obstetric patients (mean [standard deviation] age, 31 [6] years; mean gestational age, 34 [9] weeks) were analysed. The most common obstetric cause of admission was postpartum haemorrhage (n=19, 38%), followed by pregnancy-associated hypertension (n=7, 14%). The commonest non-obstetric cause of admission was sepsis (n=7, 14%). The commonest intervention was arterial line insertion (n=33, 66%) and mechanical ventilation (n=29, 58%). Maternal mortality was 6% (n=3), while the perinatal mortality rate was 8% (n=4). The average Short Form-36 Health Survey scores of our patients were lower than the norm for the Hong Kong population of the same age and gender. Postpartum haemorrhage and pregnancy-associated hypertension were the most common causes of admission to our Intensive Care Unit. Overall mortality was low. Long-term health-related quality of life in discharged patients was lower than the norm of the Hong Kong population. Appropriate antenatal care is important in preventing obstetric complications. Continued psychosocial follow-up of discharged patients has to be implemented.

Management of patients with nonvariceal upper gastrointestinal hemorrhage before and after the adoption of the Rockall score, in the Italian Gastroenterology Units.

PubMed

Soncini, Marco; Triossi, Omero; Leo, Pietro; Magni, Giovanna; Bertelè, Anna Maria; Grasso, Tiziana; Ferraris, Luca; Caruso, Stefano; Spadaccini, Antonio; Brambilla, Gianfranco; Verta, Mario; Muratori, Rosangela; Attinà, Antonio; Grasso, Gianalberto

2007-07-01

Nonvariceal upper gastrointestinal hemorrhage is a frequent reason for ordinary hospital admission. In Italy the use of prognostic scores to stratify the risk has not been adequately validated: the impact on clinical management of a rating system like the Rockall score remains to be established. RING is a 'register' that has been collecting hospital discharge files from hospital gastroenterology units, giving a broad picture of the patients admitted for this pathology. We analyzed the hospital discharge files collected between 2001 and 2005 from 12 gastroenterology units, which issued more than 26,000 hospital discharge files for ordinary hospital admission and have been using the Rockall score for defining nonvariceal upper gastrointestinal hemorrhage since 2003. There were 2832 hospital discharge files with a main diagnosis of nonvariceal upper gastrointestinal hemorrhage: 1335 'before' the Rockall score was introduced, 1497 'after' the introduction. Patients' mean age was 67.7+/-16.7 years, with a male/female ratio of 1.7 and no significant changes over the years. There were no differences in the distribution of diagnoses in nonvariceal upper gastrointestinal hemorrhage patients before/after the introduction of the Rockall score, though the mean hospital stay became shorter (7.1+/-5.0 vs. 6.3+/-4.5 days), and mortality declined (2.8 vs. 2.3%), in parallel with the caselist as a whole. For 1102 ordinary hospital admission Rockall score was calculated. Diagnoses were more accurate: significantly fewer undefined causes and an increase in peptic ulcer. The mean Rockall score was 4.6+/-2.2: 17.8% low (0-2), 48.7% intermediate (3-5), and 33.5% high (>or=6). Mean hospital stay, rebleeding, and mortality were correlated with the severity of the score. The Rockall score enables the clinician to formulate a more precise diagnosis and substantially shortens the time in hospital, especially for patients at low-risk of rebleeding and death, so more resources can be dedicated to critically ill patients.

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

Probability-based classifications for spatially characterizing the water temperatures and discharge rates of hot springs in the Tatun Volcanic Region, Taiwan.

PubMed

Jang, Cheng-Shin

2015-05-01

Accurately classifying the spatial features of the water temperatures and discharge rates of hot springs is crucial for environmental resources use and management. This study spatially characterized classifications of the water temperatures and discharge rates of hot springs in the Tatun Volcanic Region of Northern Taiwan by using indicator kriging (IK). The water temperatures and discharge rates of the springs were first assigned to high, moderate, and low categories according to the two thresholds of the proposed spring classification criteria. IK was then used to model the occurrence probabilities of the water temperatures and discharge rates of the springs and probabilistically determine their categories. Finally, nine combinations were acquired from the probability-based classifications for the spatial features of the water temperatures and discharge rates of the springs. Moreover, various combinations of spring water features were examined according to seven subzones of spring use in the study region. The research results reveal that probability-based classifications using IK provide practicable insights related to propagating the uncertainty of classifications according to the spatial features of the water temperatures and discharge rates of the springs. The springs in the Beitou (BT), Xingyi Road (XYR), Zhongshanlou (ZSL), and Lengshuikeng (LSK) subzones are suitable for supplying tourism hotels with a sufficient quantity of spring water because they have high or moderate discharge rates. Furthermore, natural hot springs in riverbeds and valleys should be developed in the Dingbeitou (DBT), ZSL, Xiayoukeng (XYK), and Macao (MC) subzones because of low discharge rates and low or moderate water temperatures.

Urolithiasis, Urinary Cancer, and Home Drinking Water Source in the United States Territory of Guam, 2006-2010.

PubMed

Haddock, Robert L; Olson, David R; Backer, Lorraine; Malilay, Josephine

2016-05-24

We reviewed patient records with a first-listed diagnosis of urolithiasis-also known as urinary tract or kidney stone disease, nephrolithiasis-upon discharge from Guam's sole civilian hospital during 2006 to 2010 and urinary cancer mortality records from the Guam Cancer Registry for 1970 to 2009 to determine the source of municipal water supplied to the patients' residence. The objective was to investigate a possible relationship between the sources of municipal water supplied to Guam villages and the incidence of urolithiasis and urinary cancer. We analyzed hospital discharge diagnoses of urolithiasis or renal calculi by calculating the incidence of first-mentioned discharge for urolithiasis or renal calculi and comparing rates across demographic or geographic categories while adjusting by age, sex, and ethnicity/race. We reviewed cancer registry records of urinary cancer deaths by patient residence. The annual incidence of hospitalization for urolithiasis was 5.22 per 10,000. Rates adjusted for sex or age exhibited almost no change. The rate of 9.83 per 10,000 among Chamorros was significantly higher (p < 0.05) than the rates among any other ethnic group or race. When villages were grouped by water source, rates of patients discharged with a first-listed diagnosis of urolithiasis, adjusted for ethnicity/race, were similar for villages using either well water (5.44 per 10,000) or mixed source water (5.39 per 10,000), and significantly greater than the rate for villages using exclusively reservoir water (1.35 per 10,000). No statistically significant differences were found between the water source or village of residence and urinary cancer mortality. Some Guam residents living in villages served completely or partly by deep well water high in calcium carbonate may be at increased risk for urolithiasis compared with residents living in villages served by surface waters. Although the risk appears to be highest in villagers of Chamorro ethnicity, residents should be aware of other contributing risk factors and steps to take to avoid developing this health problem.

Urolithiasis, Urinary Cancer, and Home Drinking Water Source in the United States Territory of Guam, 2006–2010

PubMed Central

Haddock, Robert L.; Olson, David R.; Backer, Lorraine; Malilay, Josephine

2016-01-01

We reviewed patient records with a first-listed diagnosis of urolithiasis—also known as urinary tract or kidney stone disease, nephrolithiasis—upon discharge from Guam’s sole civilian hospital during 2006 to 2010 and urinary cancer mortality records from the Guam Cancer Registry for 1970 to 2009 to determine the source of municipal water supplied to the patients’ residence. The objective was to investigate a possible relationship between the sources of municipal water supplied to Guam villages and the incidence of urolithiasis and urinary cancer. We analyzed hospital discharge diagnoses of urolithiasis or renal calculi by calculating the incidence of first-mentioned discharge for urolithiasis or renal calculi and comparing rates across demographic or geographic categories while adjusting by age, sex, and ethnicity/race. We reviewed cancer registry records of urinary cancer deaths by patient residence. The annual incidence of hospitalization for urolithiasis was 5.22 per 10,000. Rates adjusted for sex or age exhibited almost no change. The rate of 9.83 per 10,000 among Chamorros was significantly higher (p < 0.05) than the rates among any other ethnic group or race. When villages were grouped by water source, rates of patients discharged with a first-listed diagnosis of urolithiasis, adjusted for ethnicity/race, were similar for villages using either well water (5.44 per 10,000) or mixed source water (5.39 per 10,000), and significantly greater than the rate for villages using exclusively reservoir water (1.35 per 10,000). No statistically significant differences were found between the water source or village of residence and urinary cancer mortality. Some Guam residents living in villages served completely or partly by deep well water high in calcium carbonate may be at increased risk for urolithiasis compared with residents living in villages served by surface waters. Although the risk appears to be highest in villagers of Chamorro ethnicity, residents should be aware of other contributing risk factors and steps to take to avoid developing this health problem. PMID:27231922

Human Immunodeficiency Viral Infection and Status Epilepticus in United States (2002-2009).

PubMed

Chaudhry, Saqib A; Afzal, Mohammad Rauf; Rodriguez, Gustavo J; Majidi, Shahram; Bundlie, Scott; Hassan, Ameer E; Suri, M Fareed K; Qureshi, Adnan I

2015-07-01

To determine the association between human immunodeficiency virus (HIV) infection and status epilepticus and compare the outcomes of patients with status epilepticus with or without underlying HIV infection. Patients with primary diagnosis of status epilepticus (cases) and status asthmaticus (controls) were identified from the 2002-2009 Nationwide Inpatient Sample (NIS) which is representative of all admissions in the United States. We performed logistic regression analysis adjusting for age, gender, co-morbid conditions, including hypertension, diabetes mellitus (DM), renal failure, alcohol use, and opportunistic infections. We compared the in hospital outcomes among patients admitted with status epilepticus in strata defined by underlying HIV infection. The rate of concurrent status epilepticus and HIV has increased over the last 7 years in hospitalized patients with status epilepticus in United States (0.14%-0.27% p<0.0001). The HIV infection was significantly associated with status epilepticus (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.8-2.6; p<0.0001)) after adjusting for age, gender, opportunistic infections, and cardiovascular risk factors. The in-hospital mortality was significantly higher while discharge with none or minimal disability was significantly lower in status epilepticus patients with underlying HIV infection (17.5% vs. 9.9%, p<0.0001) and (50.4% vs. 63.3%, p<0.0001), respectively. Our study suggests that there is a direct association between HIV infection and status epilepticus. The proportion of patients admitted with concurrent status epilepticus and HIV infections is increasing and such patients have higher rates of poor discharge outcomes.

Neonatal bacterial meningitis: Results from a cross-sectional hospital based study.

PubMed

Softić, Izeta; Tahirović, Husref; Hasanhodžić, Mensuda

2015-01-01

The aim of the study was to determine the epidemiological characteristics of bacterial meningitis observed in neonates born in the Department of Gynaecology and Obstetrics, University Clinical Centre Tuzla, Bosnia and Herzegovina, admitted to Intensive care unit (NICU) or readmitted, because of suspected infection, after discharge from the nursery. This study was carried out from July 1, 2012 to June 30, 2013. During this period 4136 neonates were born. All neonates admitted to the Intensive care unit with signs and symptoms of systemic infections, and neonates readmitted to the Intensive care unit, after discharge from the nursery for sepsis work up were included in the study. Eighteen of 200 neonates (9%) admitted or readmitted to the NICU developed meningitis. 61% cases were late onset meningitis. The overall incidence was 4.4/1000 live births. The mortality rate was 11.1%. The mean age of symptom presentation was 8.7 days. The most common clinical features were: fever, respiratory distress and jaundice. Significant risk factors for acquiring meningitis were: male gender, Caesarean delivery, stained amniotic fluid. Positive CSF finding were detected in 6/18 (33.3%) of cases. Gram-positive bacteria were more frequently responsible for confirmed meningitis. In all neonates with meningitis blood culture was examined and 5 (50%) yielded Gram-negative bacteria. The high rates of neonatal meningitis with predominant late onset may suggest nosocomial origin. Measures to improve antenatal, intrapartum and delivery care and measures during NICU hospitalisation are necessary to lower the risk of nosocomial infections. Copyright © 2015 by Academy of Sciences and Arts of Bosnia and Herzegovina.

Human Immunodeficiency Viral Infection and Status Epilepticus in United States (2002–2009)

PubMed Central

Chaudhry, Saqib A.; Afzal, Mohammad Rauf; Rodriguez, Gustavo J.; Majidi, Shahram; Bundlie, Scott; Hassan, Ameer E.; Suri, M. Fareed K.; Qureshi, Adnan I.

2015-01-01

Objective To determine the association between human immunodeficiency virus (HIV) infection and status epilepticus and compare the outcomes of patients with status epilepticus with or without underlying HIV infection. Methods Patients with primary diagnosis of status epilepticus (cases) and status asthmaticus (controls) were identified from the 2002–2009 Nationwide Inpatient Sample (NIS) which is representative of all admissions in the United States. We performed logistic regression analysis adjusting for age, gender, co-morbid conditions, including hypertension, diabetes mellitus (DM), renal failure, alcohol use, and opportunistic infections. We compared the in hospital outcomes among patients admitted with status epilepticus in strata defined by underlying HIV infection. Results The rate of concurrent status epilepticus and HIV has increased over the last 7 years in hospitalized patients with status epilepticus in United States (0.14%–0.27% p<0.0001). The HIV infection was significantly associated with status epilepticus (odds ratio [OR]: 2.2; 95% confidence interval [CI]: 1.8–2.6; p<0.0001)) after adjusting for age, gender, opportunistic infections, and cardiovascular risk factors. The in-hospital mortality was significantly higher while discharge with none or minimal disability was significantly lower in status epilepticus patients with underlying HIV infection (17.5% vs. 9.9%, p<0.0001) and (50.4% vs. 63.3%, p<0.0001), respectively. Conclusions Our study suggests that there is a direct association between HIV infection and status epilepticus. The proportion of patients admitted with concurrent status epilepticus and HIV infections is increasing and such patients have higher rates of poor discharge outcomes. PMID:26301033

Nurses' knowledge of inhaler technique in the inpatient hospital setting.

PubMed

De Tratto, Katie; Gomez, Christy; Ryan, Catherine J; Bracken, Nina; Steffen, Alana; Corbridge, Susan J

2014-01-01

High rates of inhaler misuse in patients with chronic obstructive pulmonary disease and asthma contribute to hospital readmissions and increased healthcare cost. The purpose of this study was to examine inpatient staff nurses' self-perception of their knowledge of proper inhaler technique compared with demonstrated technique and frequency of providing patients with inhaler technique teaching during hospitalization and at discharge. A prospective, descriptive study. A 495-bed urban academic medical center in the Midwest United States. A convenience sample of 100 nurses working on inpatient medical units. Participants completed a 5-item, 4-point Likert-scale survey evaluating self-perception of inhaler technique knowledge, frequency of providing patient education, and responsibility for providing education. Participants demonstrated inhaler technique to the investigators using both a metered dose inhaler (MDI) and Diskus device inhaler, and performance was measured via a validated checklist. Overall misuse rates were high for both MDI and Diskus devices. There was poor correlation between perceived ability and investigator-measured performance of inhaler technique. Frequency of education during hospitalization and at discharge was related to measured level of performance for the Diskus device but not for the MDI. Nurses are a key component of patient education in the hospital; however, nursing staff lack adequate knowledge of inhaler technique. Identifying gaps in nursing knowledge regarding proper inhaler technique and patient education about proper inhaler technique is important to design interventions that may positively impact patient outcomes. Interventions could include one-on-one education, Web-based education, unit-based education, or hospital-wide competency-based education. All should include return demonstration of appropriate technique.

Hospital-based, acute care after ambulatory surgery center discharge.

PubMed

Fox, Justin P; Vashi, Anita A; Ross, Joseph S; Gross, Cary P

2014-05-01

As a measure of quality, ambulatory surgery centers have begun reporting rates of hospital transfer at discharge. This process, however, may underestimate the acute care needs of patients after care. We conducted this study to determine rates and evaluate variation in hospital transfer and hospital-based, acute care within 7 days among patients discharged from ambulatory surgery centers. Using data from the Healthcare Cost and Utilization Project, we identified adult patients who underwent a medical or operative procedure between July 2008 and September 2009 at ambulatory surgery centers in California, Florida, and Nebraska. The primary outcomes were hospital transfer at the time of discharge and hospital-based, acute care (emergency department visits or hospital admissions) within 7-days expressed as the rate per 1,000 discharges. At the ambulatory surgery center level, rates were adjusted for age, sex, and procedure-mix. We studied 3,821,670 patients treated at 1,295 ambulatory surgery centers. At discharge, the hospital transfer rate was 1.1 per 1,000 discharges (95% confidence interval 1.1-1.1). Among patients discharged home, the hospital-based, acute care rate was 31.8 per 1,000 discharges (95% confidence interval 31.6-32.0). Across ambulatory surgery centers, there was little variation in adjusted hospital transfer rates (median = 1.0/1,000 discharges [25th-75th percentile = 1.0-2.0]), whereas substantial variation existed in adjusted, hospital-based, acute care rates (28.0/1,000 [21.0-39.0]). Among adult patients undergoing ambulatory care at surgery centers, hospital transfer at time of discharge from the ambulatory care center is a rare event. In contrast, the rate of need for hospital-based, acute care in the first week afterwards is nearly 30-fold greater, varies across centers, and may be a more meaningful measure for discriminating quality. Published by Mosby, Inc.

Drainage morphometric analysis for assessing form and processes of the watersheds of Pachamalai hills and its adjoinings, Central Tamil Nadu, India

NASA Astrophysics Data System (ADS)

Prabhakaran, A.; Jawahar Raj, N.

2018-03-01

The present study attempts to understand the form and geomorphic/hydrologic processes of the 20 watersheds of the Pachamalai hills and its adjoinings located in Tamil Nadu State of southern India from the analysis of its drainage morphometric characteristics. Survey of India's topographic sheets of 1:50,000 is the data source from which stream networks and watersheds of the study area were demarcated followed by the analysis of their morphometric characteristics using ArcGIS software. The results of the analysis formed the basis for deducing the form and processes of the watersheds of the study area. The form of the watersheds inferred from the analysis includes shape, length, slope steepness and length, degree of branching of streams, dissection and elongation of watersheds. The geomorphic/hydrologic processes inferred include denudation rate, potential energy, intensity of erosion, mean annual run off, mean discharge, discharge rate, rock resistivity and infiltration potential, amount of sediment transported, mean annual rainfall, rainfall intensity, lagtime, flash flood potential, flood discharge per unit area, sediment yield and speed of the water flow in the streams. The understanding of variations of form and processes mentioned can be used towards prioritizing the watersheds for development, management and conservation planning.

Novel Behavioral and Neural Evidences for Age-Related changes in Force complexity.

PubMed

Chen, Yi-Ching; Lin, Linda L; Hwang, Ing-Shiou

2018-02-17

This study investigated age-related changes in behavioral and neural complexity for a polyrhythmic movement, which appeared to be an exception to the loss of complexity hypothesis. Young (n = 15; age = 24.2 years) and older (15; 68.1 years) adults performed low-level force-tracking with isometric index abduction to couple a compound sinusoidal target. Multi-scale entropy (MSE) of tracking force and inter-spike interval (ISI) of motor unit (MU) in the first dorsal interosseus muscle were assessed. The MSE area of tracking force at shorter time scales of older adults was greater (more complex) than that of young adults, whereas an opposite trend (less complex for the elders) was noted at longer time scales. The MSE area of force fluctuations (the stochastic component of the tracking force) were generally smaller (less complex) for older adults. Along with greater mean and coefficient of ISI, the MSE area of the cumulative discharge rate of elders tended to be lower (less complex) than that of young adults. In conclusion, age-related complexity changes in polyrhythmic force-tracking depended on the time scale. The adaptive behavioral consequences could be multi-factorial origins of the age-related impairment in rate coding, increased discharge noises, and lower discharge complexity of pooled MUs.

An Apparatus for Measuring Rates of Discharge of a Fuel-Injection System

NASA Technical Reports Server (NTRS)

Dutee, Francis J

1941-01-01

A portable apparatus for rapidly determining rates of discharge of a fuel-injection system is described. Satisfactory operation of this apparatus with injection-pump speeds up to 2400 r.p.m was obtained. Rate-of-discharge tests were made with several cam-plunger-valve injection systems with long injection tubes. A check valve designed to reduce secondary discharges was tested. This check valve was operated with injection-pump speeds up to 2400 r.p.m without the occurrence of large secondary discharges.

Test methods and results of the 10-cell bipolar Ni-H2 battery

NASA Technical Reports Server (NTRS)

Cataldo, R.

1983-01-01

Characterization tests were carried out at three charge levels and four discharge levels. The "c' or capacity of the battery is designated at 6.5 ampere-hours. The recharge ampere-hours was the same for all test conditions, 6.5 A-H, regardless of the discharge capacity removed for any particular discharge rate. Less capacity can be removed at higher discharge rates to the same termination voltage, which was 0.50 volts for the weakest (lowest voltage) cell. The general trend of efficiencies increases as the charge rate increases as noted in results of the table included in the handout package. The data also indicate the efficiency increases as the discharge rate decreases. This is true; however, efficiencies at the discharge rates of c and 2c are penalized because these cycles received more overcharge than necessary.

Discharge ratings at gaging stations

USGS Publications Warehouse

Kennedy, E.J.

1984-01-01

A discharge rating is the relation of the discharge at a gaging station to stage and sometimes also to other variables. This chapter of 'Techniques of Water-Resources Investigations' describes the procedures commonly used to develop simple ratings where discharge is related only to stage and the most frequently encountered types of complex ratings where additional factors such as rate of change in stage, water-surface slope, or index velocity are used. Fundamental techniques of logarithmic plotting and the applications of simple storage routing to rating development are demonstrated. Computer applications, especially for handheld programmable calculators, and data handling are stressed.

Midodrine as adjunctive support for treatment of refractory hypotension in the intensive care unit: a multicenter, randomized, placebo controlled trial (the MIDAS trial).

PubMed

Anstey, Matthew H; Wibrow, Bradley; Thevathasan, Tharusan; Roberts, Brigit; Chhangani, Khushi; Ng, Pauline Yeung; Levine, Alexander; DiBiasio, Alan; Sarge, Todd; Eikermann, Matthias

2017-03-21

Patients admitted to intensive care units (ICU) are often treated with intravenous (IV) vasopressors. Persistent hypotension and dependence on IV vasopressors in otherwise resuscitated patients lead to delay in discharge from ICU. Midodrine is an oral alpha-1 adrenergic agonist approved for treatment of symptomatic orthostatic hypotension. This trial aims to evaluate whether oral administration of midodrine is an effective adjunct to standard therapy to reduce the duration of IV vasopressor treatment, and allow earlier discharge from ICU and hospital. The MIDAS trial is an international, multicenter, randomized, double-blind, placebo-controlled clinical trial being conducted in the USA and Australia. We are targeting 120 patients. Adult patients admitted to the ICU who are resuscitated and otherwise stable on low dose IV vasopressors for at least 24 h will be considered for recruitment. Participants will be randomized to receive midodrine (20 mg) or placebo three times a day, in addition to standard care. The primary outcome is time (hours) from initiation of midodrine or placebo to discontinuation of IV vasopressors. Secondary outcomes include time (hours) from ICU admission to discharge readiness, ICU length of stay (LOS) (days), hospital LOS (days), rates of ICU readmission, and rates of adverse events related to midodrine administration. Midodrine is approved by the Food and Drug Administration (FDA) for the treatment of symptomatic orthostatic hypotension. In August 2010, FDA proposed to withdraw approval of midodrine because of lack of studies that verify the clinical benefit of the drug. We obtained Investigational New Drug (IND 113,330) approval to study its effects in critically ill patients who require IV vasopressors but are otherwise ready for discharge from the ICU. A pilot observational study in a cohort of surgical ICU patients showed that the rate of decline in vasopressor requirements increased after initiation of midodrine treatment. We hypothesize that midodrine administration is effective to wean IV vasopressors and shorten ICU and hospital LOS. This trial may have significant implications on lowering costs of hospital care and obtaining FDA approval for new indications for midodrine. This study has been registered at clinicaltrials.gov on 02/09/2012 (NCT01531959).

Comparing ε-Aminocaproic Acid and Tranexamic Acid in Reducing Postoperative Transfusions in Total Knee Arthroplasty.

PubMed

Churchill, Jessica L; Puca, Kathleen E; Meyer, Elizabeth; Carleton, Matthew; Anderson, Michael J

2017-06-01

Multiple studies have shown tranexamic acid (TXA) to reduce blood loss and transfusion rates in patients undergoing total knee arthroplasty (TKA). Accordingly, TXA has become a routine blood conservation agent for TKA. In contrast, ε-aminocaproic acid (EACA), a similar acting antifibrinolytic to TXA, has been less frequently used. This study evaluated whether EACA is as efficacious as TXA in reducing postoperative blood transfusion rates and compared the cost per surgery between agents. A multicenter retrospective chart review of elective unilateral TKA from April 2012 through December 2014 was performed. Five hospitals within a health care system participated. Data collected included age, gender, severity of illness score, use of antifibrinolytic and dose, red blood cell (RBC) transfusions and the number of units, and preadmission and discharge hemoglobin (Hb). Dosing of the antifibrinolytic differed based on the agent used, 5 or 10 g (based on weight) for EACA versus 1 g for TXA. The institutional acquisition cost of each antifibrinolytic was obtained and averaged over the study period. Of 2,922 primary unilateral TKA cases, 820 patients received EACA, 610 patients received TXA, and 1,492 patients received no antifibrinolytic (control group). Compared with the control group both EACA and TXA groups had significantly fewer patients transfused (EACA 2.8% [ p  < 0.0001], TXA 3.2% [ p  < 0.0001] vs. control 10.8%) and lower mean RBC units transfused per patient (EACA 0.05 units/patient [pt] [ p  < 0.0001], TXA 0.05 units/pt [ p  < 0.0001] vs. control 0.19 units/pt]. There was no difference in mean RBC units transfused per patient, percentage of patients transfused, and discharge Hb levels between the EACA and TXA groups ( p  = 0.822, 0.236, and 0.322, respectively). Medication acquisition cost for EACA averaged $2.23 per surgery compared with TXA at $39.58 per surgery. Administration of EACA or TXA significantly decreased postoperative transfusion rates compared with no antifibrinolytic therapy. Utilization of EACA for unilateral TKA proved to be comparable to TXA in all studied aspects at a lower cost. The level of evidence for the study is Level 3. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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.

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.

Relationship of sediment discharge to streamflow

USGS Publications Warehouse

Colby, B.R.

1956-01-01

The relationship between rate of sediment discharge and rate of water discharge at a cross section of a stream is frequently expressed by an average curve. This curve is the sediment rating curve. It has been widely used in the computation of average sediment discharge from water discharge for periods when sediment samples were not collected. This report discusses primarily the applications of sediment rating curves for periods during which at least occasional sediment samples were collected. Because sediment rating curves are of many kinds, the selection of the correct kind for each use is important. Each curve should be carefully prepared. In particular, the correct dependent variable must be used or the slope of the sediment rating curve may be incorrect for computing sediment discharges. Sediment rating curves and their applications were studied for the following gaging stations: 1. Niobrara River near Cody, Nebr. 2. Colorado River near Grand Canyon, Ariz. 3. Rio Grande at San Martial, N. Mex. 4. Rio Puerto near Bernardo, N. Mex. 5. White River near Kadoka, S. Dak. 6. Sandusky River near Fremont, Ohio Except for the Sandusky River and the Rio Puerco, which transport mostly fine sediment, one instantaneous sediment rating curve was prepared for the discharge of suspended sands, at each station, and another for the discharge of sediment finer than 0.082 millimeter. Each curve was studied separately, and by trial-end-error multiple correlation some of the factors that cause scatter from the sediment rating curves were determined. Average velocity at the cross section, Water temperature, and erratic fluctuations in concentration seemed to be the three major factors that caused departures from the sediment rating curves for suspended sands. The concentration of suspended sands varied with about the 2.8 power of the mean velocity for the four sediment, rating curves for suspended sands. The effect of water temperature was not so consistent as that of velocity and theoretically should vary considerably with differences in the size composition of the suspended sands. Scatter from the sediment rating curves for sediments finer than 0.082 millimeter seemed to be caused by changes in supply of these sediments. Some of the scatter could be explained by seasonal variations, by a pattern of change in concentration of fine sediment following a rise, or by source of the runoff as indicated by the measured relative flows of certain tributaries. Daily or instantaneous sediment rating curves adjusted for factors that account for some of the scatter from an average curve often can be used to compute approximate daily, monthly, and annual sediment discharges. Accuracy of the computed sediment discharges should be better than average for streams that transport mostly sands rather than fine sediments and for some ephemeral or intermittent streams, such as Rio Puerco, in semiarid regions. Accuracy of computed sediment discharges can be much improved for many streams by shifting the sediment rating curve on the basis of 2 or 4 measurements of sediment discharge per month. Of 26 annual sediment discharges that were computed by shifting sediment rating curves to either 2 or 4 measured sediment discharges per month, 18 were within I0 percent of the annual-sediment discharges that were computed on the basis of a daily sampling program. Monthly and daily sediment discharges computed from daily or instantaneous sediment rating curves, either shifted or unshifted, were less accurate than similarly computed annual sediment discharges. Even so, the difference in cost between occasional sediment samples and daily samples is so great that the added accuracy from daily sampling may not Justify the added cost. Monthly and annual sediment-rating curves can be applied simply, with adjustments if required, to compute monthly and annual sediment discharges with reasonably good accuracy for gaging stations like the Rio Puerco near Bernardo,

The Identification of Seniors at Risk (ISAR) score to predict clinical outcomes and health service costs in older people discharged from UK acute medical units.

PubMed

Edmans, Judi; Bradshaw, Lucy; Gladman, John R F; Franklin, Matthew; Berdunov, Vladislav; Elliott, Rachel; Conroy, Simon P

2013-11-01

tools are required to identify high-risk older people in acute emergency settings so that appropriate services can be directed towards them. to evaluate whether the Identification of Seniors At Risk (ISAR) predicts the clinical outcomes and health and social services costs of older people discharged from acute medical units. an observational cohort study using receiver-operator curve analysis to compare baseline ISAR to an adverse clinical outcome at 90 days (where an adverse outcome was any of death, institutionalisation, hospital readmission, increased dependency in activities of daily living (decrease of 2 or more points on the Barthel ADL Index), reduced mental well-being (increase of 2 or more points on the 12-point General Health Questionnaire) or reduced quality of life (reduction in the EuroQol-5D) and high health and social services costs over 90 days estimated from routine electronic service records. two acute medical units in the East Midlands, UK. a total of 667 patients aged ≥70 discharged from acute medical units. an adverse outcome at 90 days was observed in 76% of participants. The ISAR was poor at predicting adverse outcomes (AUC: 0.60, 95% CI: 0.54-0.65) and fair for health and social care costs (AUC: 0.70, 95% CI: 0.59-0.81). adverse outcomes are common in older people discharged from acute medical units in the UK; the poor predictive ability of the ISAR in older people discharged from acute medical units makes it unsuitable as a sole tool in clinical decision-making.

The epidemiology and outcomes of pediatric in-hospital cardiopulmonary arrest in the United States during 1997 to 2012.

PubMed

Martinez, Paul A; Totapally, Balagangadhar R

2016-08-01

Evaluate the trends in the incidence of in-hospital cardiopulmonary arrest (IHCA) and the associated mortality rate in children during 1997 to 2012. Retrospective cohort study using the Kids' Inpatient Database (KID). Demographic and outcome data on children under 18 years of age with and without IHCA were extracted from the KID 1997 through 2012. ICD-9 procedure codes 99.60 or 99.63 were used to define IHCA. Chi-square, Chi-square for trend, and independent Student's t-test were used to analyze the data. A total of 29,577 discharges with IHCA were identified. The overall incidence of pediatric IHCA was 0.78/1000 discharges with a mortality rate of 46%. The incidence of pediatric IHCA increased significantly from 0.57 in 1997 to 1.01 in 2012 (p<0.05). The mortality rate after IHCA decreased significantly from 51% in 1997 to 40% in 2012 (p<0.05). The incidence of IHCA was significantly higher for males, infants, black children, children from metropolitan regions and children from lower median household income regions (p<0.05). The mortality rate was significantly higher for teenagers, black children, Hispanic children and children from metropolitan regions (p<0.05). The incidence of pediatric IHCA in the United States has increased from 1997 to 2012 while the mortality has decreased. The incidence of IHCA is higher among males, infants, black children, children from metropolitan regions and children from lower household income regions. The mortality after IHCA is higher among teenagers, black children, Hispanic children and children from metropolitan regions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

RECALMIN: The association between management of Spanish National Health Service Internal Medical Units and health outcomes.

PubMed

Zapatero-Gaviria, Antonio; Javier Elola-Somoza, Francisco; Casariego-Vales, Emilio; Fernandez-Perez, Cristina; Gomez-Huelgas, Ricardo; Bernal, José Luis; Barba-Martín, Raquel

2017-08-01

To investigate the association between management of Internal Medical Units (IMUs) with outcomes (mortality and length of stay) within the Spanish National Health Service. Data on management were obtained from a descriptive transversal study performed among IMUs of the acute hospitals. Outcome indicators were taken from an administrative database of all hospital discharges from the IMUs. Spanish National Health Service. One hundred and twenty-four acute general hospitals with available data of management and outcomes (401 424 discharges). IMU risk standardized mortality rates were calculated using a multilevel model adjusted by Charlson Index. Risk standardized myocardial infarction and heart failure mortality rates were calculated using specific multilevel models. Length of stay was adjusted by complexity. Greater hospital complexity was associated with longer average length of stays (r: 0.42; P < 0.001). Crude in-hospital mortality rates were higher at larger hospitals, but no significant differences were found when mortality was risk adjusted. There was an association between nurse workload with mortality rate for selected conditions (r: 0.25; P = 0.009). Safety committee and multidisciplinary ward rounds were also associated with outcomes. We have not found any association between complexity and intra-hospital mortality. There is an association between some management indicators with intra-hospital mortality and the length of stay. Better disease-specific outcomes adjustments and a larger number of IMUs in the sample may provide more insights about the association between management of IMUs with healthcare outcomes. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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.

A Novel Uncertainty Framework for Improving Discharge Data Quality Using Hydraulic Modelling.

NASA Astrophysics Data System (ADS)

Mansanarez, V.; Westerberg, I.; Lyon, S. W.; Lam, N.

2017-12-01

Flood risk assessments rely on accurate discharge data records. Establishing a reliable stage-discharge (SD) rating curve for calculating discharge from stage at a gauging station normally takes years of data collection efforts. Estimation of high flows is particularly difficult as high flows occur rarely and are often practically difficult to gauge. Hydraulically-modelled rating curves can be derived based on as few as two concurrent stage-discharge and water-surface slope measurements at different flow conditions. This means that a reliable rating curve can, potentially, be derived much faster than a traditional rating curve based on numerous stage-discharge gaugings. We introduce an uncertainty framework using hydraulic modelling for developing SD rating curves and estimating their uncertainties. The proposed framework incorporates information from both the hydraulic configuration (bed slope, roughness, vegetation) and the information available in the stage-discharge observation data (gaugings). This method provides a direct estimation of the hydraulic configuration (slope, bed roughness and vegetation roughness). Discharge time series are estimated propagating stage records through posterior rating curve results.We applied this novel method to two Swedish hydrometric stations, accounting for uncertainties in the gaugings for the hydraulic model. Results from these applications were compared to discharge measurements and official discharge estimations.Sensitivity analysis was performed. We focused analyses on high-flow uncertainty and the factors that could reduce this uncertainty. In particular, we investigated which data uncertainties were most important, and at what flow conditions the gaugings should preferably be taken.

Effective Discharge and Annual Sediment Yield on Brazos River

NASA Astrophysics Data System (ADS)

Rouhnia, M.; Salehi, M.; Keyvani, A.; Ma, F.; Strom, K. B.; Raphelt, N.

2012-12-01

Geometry of an alluvial river alters dynamically over the time due to the sediment mobilization on the banks and bottom of the river channel in various flow rates. Many researchers tried to define a single representative discharge for these morphological processes such as "bank-full discharge", "effective discharge" and "channel forming discharge". Effective discharge is the flow rate in which, the most sediment load is being carried by water, in a long term period. This project is aimed to develop effective discharge estimates for six gaging stations along the Brazos River from Waco, TX to Rosharon, TX. The project was performed with cooperation of the In-stream Flow Team of the Texas Water Development Board (TWDB). Project objectives are listed as: 1) developing "Flow Duration Curves" for six stations based on mean-daily discharge by downloading the required, additional data from U.S Geological Survey website, 2) developing "Rating Curves" for six gaging stations after sampling and field measurements in three different flow conditions, 3) developing a smooth shaped "Sediment Yield Histogram" with a well distinguished peak as effective discharge. The effective discharge was calculated using two methods of manually and automatic bin selection. The automatic method is based on kernel density approximation. Cross-sectional geometry measurements, particle size distributions and water field samples were processed in the laboratory to obtain the suspended sediment concentration associated with flow rate. Rating curves showed acceptable trends, as the greater flow rate we experienced, the more sediment were carried by water.

Rate Dependent Multi-Mechanism Discharge of Ag 0.50VOP 4·1.8H 2O: Insights from In Situ Energy Dispersive X-ray Diffraction

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

Huie, Matthew M.; Bock, David C.; Zhong, Zhong

Ag 0.50VOPO 4·1.8H 2O (silver vanadium phosphate, SVOP) demonstrates a counterintuitive higher initial loaded voltage under higher discharge current. Energy dispersive X-ray diffraction (EDXRD) from synchrotron radiation was used to create tomographic profiles of cathodes at various depths of discharge for two discharge rates. SVOP displays two reduction mechanisms, reduction of a vanadium center accompanied by lithiation of the structure, or reduction-displacement of a silver cation to form silver metal. In-situ EDXRD provides the opportunity to observe spatially resolved changes to the parent SVOP crystal and formation of Ag 0 during reduction. At a C/170 discharge rate V 5+ reductionmore » is the preferred initial reaction resulting in higher initial loaded voltage. At a discharge rate of C/400 reduction of Ag + with formation of conductive Ag 0 occurs earlier during discharge. Discharge rate also affects the spatial location of reduction products. The faster discharge rate initiates reduction close to the current collector with non-uniform distribution of silver metal resulting in isolated cathode areas. The slower rate develops a more homogenous distribution of reduced SVOP and silver metal. This study illuminates the roles of electronic and ionic conductivity limitations within a cathode at the mesoscale and how they impact the course of reduction processes and loaded voltage.« less

Rate Dependent Multi-Mechanism Discharge of Ag 0.50VOP 4·1.8H 2O: Insights from In Situ Energy Dispersive X-ray Diffraction

DOE PAGES

Huie, Matthew M.; Bock, David C.; Zhong, Zhong; ...

2016-09-01

Ag 0.50VOPO 4·1.8H 2O (silver vanadium phosphate, SVOP) demonstrates a counterintuitive higher initial loaded voltage under higher discharge current. Energy dispersive X-ray diffraction (EDXRD) from synchrotron radiation was used to create tomographic profiles of cathodes at various depths of discharge for two discharge rates. SVOP displays two reduction mechanisms, reduction of a vanadium center accompanied by lithiation of the structure, or reduction-displacement of a silver cation to form silver metal. In-situ EDXRD provides the opportunity to observe spatially resolved changes to the parent SVOP crystal and formation of Ag 0 during reduction. At a C/170 discharge rate V 5+ reductionmore » is the preferred initial reaction resulting in higher initial loaded voltage. At a discharge rate of C/400 reduction of Ag + with formation of conductive Ag 0 occurs earlier during discharge. Discharge rate also affects the spatial location of reduction products. The faster discharge rate initiates reduction close to the current collector with non-uniform distribution of silver metal resulting in isolated cathode areas. The slower rate develops a more homogenous distribution of reduced SVOP and silver metal. This study illuminates the roles of electronic and ionic conductivity limitations within a cathode at the mesoscale and how they impact the course of reduction processes and loaded voltage.« less

Integrating Smartphone Technology at the Time of Discharge from a Child and Adolescent Inpatient Psychiatry Unit

PubMed Central

Gregory, Jonathan M.; Sukhera, Javeed; Taylor-Gates, Melissa

2017-01-01

Objective As smartphone technology becomes an increasingly important part of youth mental health, there has been little to no examination of how to effectively integrate smartphone-based safety planning with inpatient care. Our study sought to examine whether or not we could effectively integrate smartphone-based safety planning into the discharge process on a child and adolescent inpatient psychiatry unit. Method Staff members completed a survey to determine the extent of smartphone ownership in a population of admitted child and adolescent inpatients. In addition to quantifying smartphone ownership, the survey also tracked whether youth would integrate their previously-established safety plan with a specific safety planning application on their smartphone (Be Safe) at the time of discharge. Results Sixty-six percent (50/76) of discharged youth owned a smartphone, which is consistent with prior reports of high smartphone ownership in adult psychiatric populations. A minority of youth (18%) downloaded the Be Safe app prior to discharge, with most (68%) suggesting they would download the app after discharge. Notably, all patients who downloaded the app prior to discharge were on their first admission to a psychiatric inpatient unit. Conclusion Child and adolescent psychiatric inpatients have a clear interest in smartphone-based safety planning. Our results suggest that integrating smartphone-related interventions earlier in an admission might improve access before discharge. This highlights the tension between restricting and incorporating smartphone access for child and adolescent inpatients and may inform future study in this area. PMID:28331503

Investigation of nanosecond pulsed dielectric barrier discharge using plate-to-plate electrode with asymmetric dielectric arrangement in airflow

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

Qi, Haicheng; School of Physics Science and Technology, Anshan Normal University, Anshan 114005; Fan, Zhihui

Atmospheric pressure dielectric barrier discharge plasma is produced in airflow by applying nanosecond high voltage pulses with peak voltage about 35 kV and rising time about 40 ns on a plate-to-plate electrode arrangement. The effects of airflow rate (0–50 m/s) on the discharge characteristics are investigated under different barrier conditions (the bare anode case and the bare cathode case). For both cases, the breakdown voltage and the time lag increase distinctly and the discharge intensity decreases sharply when the airflow rate increases from 0 to 30 m/s, and then keep almost constant until the airflow rate is further increased to 50 m/s. For the baremore » anode case (the cathode is covered by dielectric plate), the discharge mode transforms gradually from filamentary to diffuse discharge with the increasing airflow rate. While for the bare cathode case, some micro-discharge channels are still excited, though the discharge becomes more diffuse when the airflow rate is higher than 30 m/s. By acquiring the time-resolved images of the discharge, it is proved that it is the primary discharge which becomes diffuse when airflow is introduced and the following two discharges of the same voltage pulse occur principally at the positions where the primary discharge is more intense. And in both cases, the plasma temperatures are reduced, but the degree is different. All the phenomena can be explained mainly by the variation of the space charge distribution when the airflow is introduced into the discharge gap. And it is indicated that the bare anode case has an advantage in obtaining diffuse discharge.« less

Measuring Outcomes of an Intensive Care Unit Family Diary Program.

PubMed

Huynh, Truong-Giang; Covalesky, Miranda; Sinclair, Samantha; Gunter, Heather; Norton, Tamara; Chen, Alice; Yi, Cassia

2017-01-01

Patients discharged from intensive care units are at risk of short- and long-term physical, cognitive, and emotional symptoms known as post-intensive care syndrome. Family members of intensive care unit patients are at risk of similar symptoms known as post-intensive care syndrome-family. Both syndromes are common, and strategies to reduce risk factors should be employed. An intensive care unit diary project to help reduce these syndromes was implemented in 2 intensive care units using an evidence-based framework. The effects of these diaries were studied using the Family Satisfaction with Care in the Intensive Care Unit survey. Rates of referrals to a postintensive care unit recovery clinic were also observed in relation to the diaries. Although preliminary data did not reveal a significant increase in family satisfaction, the surveys provided important staff feedback. The diaries fostered feelings of compassion and caring as well as built trust between staff and family members of intensive care unit patients. The diaries increased referrals to the postintensive care unit recovery clinic. ©2017 American Association of Critical-Care Nurses.

Clinical characteristics and mental health outcomes for women admitted to an Australian Mother-Baby Unit: a focus on borderline personality disorder and emotional dysregulation?

PubMed

Yelland, Chris; Girke, Teresa; Tottman, Charlotte; Williams, Anne Sved

2015-12-01

To describe the clinical population of women admitted to a Mother-Baby Unit in Adelaide, South Australia and to evaluate changes during admission in both Axes I and II diagnoses of maternal mental health, and in mother-infant relationships. Both clinical and self-report assessments of maternal mental health were made at admission and discharge, and self-report comparisons of the mother-infant relationship. Depressive illnesses (46.2%) were found to be the most prevalent conditions leading to admission, with rates of psychosis (10.3%) and bipolar disorder (3.4%) being lower. A high incidence of borderline personality disorder (23.1%) was found clinically, with almost half the admitted women showing features of borderline personality disorder on a self-report measure at admission. Significant improvements in maternal mental health and the mother-infant relationship were found at the time of discharge. Admission to this Mother-Baby Unit on mothers' self-report scales showed improvement in mothers' mental health and the relationship that they have with their infant. Given the high prevalence of borderline personality disorder and emotional dysregulation identified within the population, treatment implications and possible consequences for the infant are discussed for this client group. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Comparison of Evapotranspiration and Forest Cover Type in the Southeast United States: A Long-term Water Budget Approach

NASA Astrophysics Data System (ADS)

Younger, S. E.

2015-12-01

This study assessed the relationship between evapotranspiration (ET) and different types of forest for 74 gaged drainage basins in the Southeast United States with at least 29 years of data and greater than 40% forest cover. The objective was to determine if a difference in tree water use was detectible at the USGS gaged basin scale. It was hypothesized that ET rates are higher in Evergreen dominated watershed due to greater annual productivity. Discharge from United States Geological Survey (USGS) gages (D), landcover from the National Landcover Dataset (NLCD), and precipitation (P) from Daymet, Mauer, Observed Gridded, and PRISM. Annual ET was estimated using ET = P - D. To reduce geological influences the study basins were selected from an area of crystalline bedrock within the Piedmont and Southern Blue Ridge physiographic provinces. Correlations between ET and forest type show a significant difference between evergreen and deciduous forest cover. Evergreen forest dominated watersheds had a positive relationship with ET. Deciduous and Mixed forest dominated watersheds had a negative relationship with ET. These findings are similar to other studies looking at the effect of forest type on ET although other land uses in the basins have potentially indiscernible influences on discharge.

Investigation of operating parameters on CO2 splitting by dielectric barrier discharge plasma

NASA Astrophysics Data System (ADS)

Pan, CHEN; Jun, SHEN; Tangchun, RAN; Tao, YANG; Yongxiang, YIN

2017-12-01

Experiments of CO2 splitting by dielectric barrier discharge (DBD) plasma were carried out, and the influence of CO2 flow rate, plasma power, discharge voltage, discharge frequency on CO2 conversion and process energy efficiency were investigated. It was shown that the absolute quantity of CO2 decomposed was only proportional to the amount of conductive electrons across the discharge gap, and the electron amount was proportional to the discharge power; the energy efficiency of CO2 conversion was almost a constant at a lower level, which was limited by CO2 inherent discharge character that determined a constant gap electric field strength. This was the main reason why CO2 conversion rate decreased as the CO2 flow rate increase and process energy efficiency was decreased a little as applied frequency increased. Therefore, one can improve the CO2 conversion by less feed flow rate or larger discharge power in DBD plasma, but the energy efficiency is difficult to improve.

Modeling sediment concentration of rill flow

NASA Astrophysics Data System (ADS)

Yang, Daming; Gao, Peiling; Zhao, Yadong; Zhang, Yuhang; Liu, Xiaoyuan; Zhang, Qingwen

2018-06-01

Accurate estimation of sediment concentration is essential to establish physically-based erosion models. The objectives of this study were to evaluate the effects of flow discharge (Q), slope gradient (S), flow velocity (V), shear stress (τ), stream power (ω) and unit stream power (U) on sediment concentration. Laboratory experiments were conducted using a 10 × 0.1 m rill flume under four flow discharges (2, 4, 8 and 16 L min-1), and five slope gradients (5°, 10°, 15°, 20° and 25°). The results showed that the measured sediment concentration varied from 87.08 to 620.80 kg m-3 with a mean value of 343.13 kg m-3. Sediment concentration increased as a power function with flow discharge and slope gradient, with R2 = 0.975 and NSE = 0.945. The sediment concentration was more sensitive to slope gradient than to flow discharge. The sediment concentration was well predicted by unit stream power (R2 = 0.937, NSE = 0.865), whereas less satisfactorily by flow velocity (R2 = 0.470, NSE = 0.539) and stream power (R2 = 0.773, NSE = 0.732). In addition, using the equations to simulate the measured sediment concentration of other studies, the result further indicated that slope gradient, flow discharge and unit stream power were good predictors of sediment concentration. In general, slope gradient, flow discharge and unit stream power seem to be the preferred predictors for estimating sediment concentration.

A Pilot Study of Heart Rate Variability Biofeedback Therapy in the Treatment of Perinatal Depression on a Specialized Perinatal Psychiatry Inpatient Unit

PubMed Central

Beckham, Jenna; Greene, Tammy B.; Meltzer-Brody, Samantha

2012-01-01

Purpose Heart rate variability biofeedback (HRVB) therapy may be useful in treating the prominent anxiety features of perinatal depression. We investigated the use of this non-pharmacologic therapy among women hospitalized with severe perinatal depression. Methods Three questionnaires, the State Trait Anxiety Inventory (STAI), Warwick Edinburgh Mental Well-Being Scale (WEMWBS), and Linear Analog Self Assessment (LASA), were administered to fifteen women in a specialized inpatient perinatal psychiatry unit. Participants were also contacted by telephone after discharge to assess continued use of HRVB techniques. Results The use of HRVB was associated with an improvement in all three scales. The greatest improvement (−13.867, p<0.001 and −11.533, p<0.001) was among STAI scores. A majority (81.9%, n=9) of women surveyed by telephone also reported continued frequent use at least once per week, and over half (54.6%, n=6) described the use of HRVB techniques as very or extremely beneficial. Conclusions The use of HRVB was associated with statistically significant improvement on all instrument scores, the greatest of which was STAI scores, and most women reported frequent continued use of HRVB techniques after discharge. These results suggest that HRVB may be particularly beneficial in the treatment of the prominent anxiety features of perinatal depression, both in inpatient and outpatient settings. PMID:23179141

40 CFR 52.145 - Visibility protection.

Code of Federal Regulations, 2012 CFR

2012-07-01

... paragraph is applicable to the fossil fuel-fired, steam-generating equipment designated as Units 1, 2, and 3... applicable. Unit-Week of Maintenance means a period of 7 days during which a fossil fuel-fired steam... operator shall discharge or cause the discharge of sulfur oxides into the atmosphere in excess of 42 ng/J...

40 CFR 52.145 - Visibility protection.

Code of Federal Regulations, 2011 CFR

2011-07-01

... paragraph is applicable to the fossil fuel-fired, steam-generating equipment designated as Units 1, 2, and 3... applicable. Unit-Week of Maintenance means a period of 7 days during which a fossil fuel-fired steam... operator shall discharge or cause the discharge of sulfur oxides into the atmosphere in excess of 42 ng/J...

Readmissions, Observation, and the Hospital Readmissions Reduction Program.

PubMed

Zuckerman, Rachael B; Sheingold, Steven H; Orav, E John; Ruhter, Joel; Epstein, Arnold M

2016-04-21

The Hospital Readmissions Reduction Program, which is included in the Affordable Care Act (ACA), applies financial penalties to hospitals that have higher-than-expected readmission rates for targeted conditions. Some policy analysts worry that reductions in readmissions are being achieved by keeping returning patients in observation units instead of formally readmitting them to the hospital. We examined the changes in readmission rates and stays in observation units over time for targeted and nontargeted conditions and assessed whether hospitals that had greater increases in observation-service use had greater reductions in readmissions. We compared monthly, hospital-level rates of readmission and observation-service use within 30 days after hospital discharge among Medicare elderly beneficiaries from October 2007 through May 2015. We used an interrupted time-series model to determine when trends changed and whether changes differed between targeted and nontargeted conditions. We assessed the correlation between changes in readmission rates and use of observation services after adoption of the ACA in March 2010. We analyzed data from 3387 hospitals. From 2007 to 2015, readmission rates for targeted conditions declined from 21.5% to 17.8%, and rates for nontargeted conditions declined from 15.3% to 13.1%. Shortly after passage of the ACA, the readmission rate declined quickly, especially for targeted conditions, and then continued to fall at a slower rate after October 2012 for both targeted and nontargeted conditions. Stays in observation units for targeted conditions increased from 2.6% in 2007 to 4.7% in 2015, and rates for nontargeted conditions increased from 2.5% to 4.2%. Within hospitals, there was no significant association between changes in observation-unit stays and readmissions after implementation of the ACA. Readmission trends are consistent with hospitals' responding to incentives to reduce readmissions, including the financial penalties for readmissions under the ACA. We did not find evidence that changes in observation-unit stays accounted for the decrease in readmissions.

Effectiveness of Acute Geriatric Unit Care Using Acute Care for Elders Components: A Systematic Review and Meta-Analysis

PubMed Central

Fox, Mary T; Persaud, Malini; Maimets, Ilo; O'Brien, Kelly; Brooks, Dina; Tregunno, Deborah; Schraa, Ellen

2012-01-01

Objectives To compare the effectiveness of acute geriatric unit care, based on all or part of the Acute Care for Elders (ACE) model and introduced in the acute phase of illness or injury, with that of usual care. Design Systematic review and meta-analysis of 13 randomized controlled and quasi-experimental trials with parallel comparison groups retrieved from multiple sources. Setting Acute care geriatric and nongeriatric hospital units. Participants Acutely ill or injured adults (N = 6,839) with an average age of 81. Interventions Acute geriatric unit care characterized by one or more ACE components: patient-centered care, frequent medical review, early rehabilitation, early discharge planning, prepared environment. Measurements Falls, pressure ulcers, delirium, functional decline at discharge from baseline 2-week prehospital and hospital admission statuses, length of hospital stay, discharge destination (home or nursing home), mortality, costs, and hospital readmissions. Results Acute geriatric unit care was associated with fewer falls (risk ratio (RR) = 0.51, 95% confidence interval (CI) = 0.29–0.88), less delirium (RR = 0.73, 95% CI = 0.61–0.88), less functional decline at discharge from baseline 2-week prehospital admission status (RR = 0.87, 95% CI = 0.78–0.97), shorter length of hospital stay (weighted mean difference (WMD) = −0.61, 95% CI = −1.16 to −0.05), fewer discharges to a nursing home (RR = 0.82, 95% CI = 0.68–0.99), lower costs (WMD = −$245.80, 95% CI = −$446.23 to −$45.38), and more discharges to home (RR = 1.05, 95% CI = 1.01–1.10). A nonsignificant trend toward fewer pressure ulcers was observed. No differences were found in functional decline between baseline hospital admission status and discharge, mortality, or hospital readmissions. Conclusion Acute geriatric unit care, based on all or part of the ACE model and introduced during the acute phase of older adults' illness or injury, improves patient- and system-level outcomes. PMID:23176020

Utilization and Short-Term Outcomes of Primary Total Hip and Knee Arthroplasty in the United States and Canada: An Analysis of New York and Ontario Administrative Data.

PubMed

Cram, Peter; Landon, Bruce E; Matelski, John; Ling, Vicki; Stukel, Therese A; Paterson, J Michael; Gandhi, Rajiv; Hawker, Gillian A; Ravi, Bheeshma

2018-04-01

Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are common and effective surgical procedures. This study sought to compare utilization and short-term outcomes of primary TKA and THA in adjacent regions of Canada and the United States. The study was designed as a retrospective cohort study of patients who underwent primary TKA or THA, comparing administrative data from New York and Ontario in 2012-2013. Demographic features of the TKA and THA patients, per capita utilization rates, and short-term outcomes were compared between the jurisdictions. A higher percentage of New York hospitals performed TKA compared to Ontario hospitals (75.7% versus 42.1%; P < 0.001), and the mean annual procedural volume for TKAs was lower in New York hospitals (mean 179 versus 327 in Ontario hospitals; P < 0.001). After direct standardization, utilization was significantly lower in New York compared to Ontario, both for TKA (16.1 TKAs versus 21.4 TKAs per 10,000 population per year; P < 0.001) and for THA (10.5 THAs versus 11.5 THAs per 10,000 population per year; P < 0.001). For those who underwent TKA, the length of stay in Ontario hospitals was significantly longer (mean 3.7 days versus 3.4 days in New York hospitals; P < 0.001). A smaller percentage of New York patients were discharged directly home (46.2% versus 90.9% of Ontario patients; P < 0.001), but 30-day and 90-day readmission rates were higher in New York compared to Ontario (30-day rates, 4.6% versus 3.9% [P < 0.001]; 90-day rates, 8.4% versus 6.7% [P < 0.001]). For the THA cohorts, the results with regard to length of stay, discharge disposition, and readmission rates were similar to those for TKA. Ontario has higher utilization of total joint arthroplasty than New York but has a smaller percentage of hospitals performing these procedures. Patients are more likely to be discharged home and less likely to be readmitted in Ontario. Our results suggest areas where each jurisdiction could improve. © 2017, American College of Rheumatology.

Temporal variability in stage-discharge relationships

NASA Astrophysics Data System (ADS)

Guerrero, José-Luis; Westerberg, Ida K.; Halldin, Sven; Xu, Chong-Yu; Lundin, Lars-Christer

2012-06-01

SummaryAlthough discharge estimations are central for water management and hydropower, there are few studies on the variability and uncertainty of their basis; deriving discharge from stage heights through the use of a rating curve that depends on riverbed geometry. A large fraction of the world's river-discharge stations are presumably located in alluvial channels where riverbed characteristics may change over time because of erosion and sedimentation. This study was conducted to analyse and quantify the dynamic relationship between stage and discharge and to determine to what degree currently used methods are able to account for such variability. The study was carried out for six hydrometric stations in the upper Choluteca River basin, Honduras, where a set of unusually frequent stage-discharge data are available. The temporal variability and the uncertainty of the rating curve and its parameters were analysed through a Monte Carlo (MC) analysis on a moving window of data using the Generalised Likelihood Uncertainty Estimation (GLUE) methodology. Acceptable ranges for the values of the rating-curve parameters were determined from riverbed surveys at the six stations, and the sampling space was constrained according to those ranges, using three-dimensional alpha shapes. Temporal variability was analysed in three ways: (i) with annually updated rating curves (simulating Honduran practices), (ii) a rating curve for each time window, and (iii) a smoothed, continuous dynamic rating curve derived from the MC analysis. The temporal variability of the rating parameters translated into a high rating-curve variability. The variability could turn out as increasing or decreasing trends and/or cyclic behaviour. There was a tendency at all stations to a seasonal variability. The discharge at a given stage could vary by a factor of two or more. The quotient in discharge volumes estimated from dynamic and static rating curves varied between 0.5 and 1.5. The difference between discharge volumes derived from static and dynamic curves was largest for sub-daily ratings but stayed large also for monthly and yearly totals. The relative uncertainty was largest for low flows but it was considerable also for intermediate and large flows. The standard procedure of adjusting rating curves when calculated and observed discharge differ by more than 5% would have required continuously updated rating curves at the studied locations. We believe that these findings can be applicable to many other discharge stations around the globe.

Development of a Power Electronics Unit for the Space Station Plasma Contactor

NASA Technical Reports Server (NTRS)

Hamley, John A.; Hill, Gerald M.; Patterson, Michael J.; Saggio, Joseph, Jr.; Terdan, Fred; Mansell, Justin D.

1994-01-01

A hollow cathode plasma contactor has been baselined as a charge control device for the Space Station (SS) to prevent deleterious interactions of coated structural components with the ambient plasma. NASA LeRC Work Package 4 initiated the development of a plasma contactor system comprised of a Power Electronics Unit (PEU), an Expellant Management Unit (EMU), a command and data interface, and a Plasma Contactor Unit (PCU). A breadboard PEU was designed and fabricated. The breadboard PEU contains a cathode heater and discharge power supply, which were required to operate the PCU, a control and auxiliary power converter, an EMU interface, a command and telemetry interface, and a controller. The cathode heater and discharge supplies utilized a push-pull topology with a switching frequency of 20 kHz and pulse-width-modulated (PWM) control. A pulse ignition circuit derived from that used in arcjet power processors was incorporated in the discharge supply for discharge ignition. An 8088 based microcontroller was utilized in the breadboard model to provide a flexible platform for controller development with a simple command/data interface incorporating a direct connection to SS Mulitplexer/Demultiplexer (MDM) analog and digital I/O cards. Incorporating this in the flight model would eliminate the hardware and software overhead associated with a 1553 serial interface. The PEU autonomously operated the plasma contactor based on command inputs and was successfully integrated with a prototype plasma contactor unit demonstrating reliable ignition of the discharge and steady-state operation.

High-repetition-rate short-pulse gas discharge.

PubMed

Tulip, J; Seguin, H; Mace, P N

1979-09-01

A high-average-power short-pulse gas discharge is described. This consists of a volume-preionized transverse discharge of the type used in gas lasers driven by a Blumlein energy storage circuit. The Blumlein circuit is fabricated from coaxial cable, is pulse-charged from a high-repetition-rate Marx-bank generator, and is switched by a high-repetition-rate segmented rail gap. The operation of this discharge under conditions typical of rare-gas halide lasers is described. A maximum of 900 pps was obtained, giving a power flow into the discharge of 30 kW.

Effectiveness of a financial incentive to physicians for timely follow-up after hospital discharge: a population-based time series analysis.

PubMed

Lapointe-Shaw, Lauren; Mamdani, Muhammad; Luo, Jin; Austin, Peter C; Ivers, Noah M; Redelmeier, Donald A; Bell, Chaim M

2017-10-02

Timely follow-up after hospital discharge may decrease readmission to hospital. Financial incentives to improve follow-up have been introduced in the United States and Canada, but it is unknown whether they are effective. Our objective was to evaluate the impact of an incentive program on timely physician follow-up after hospital discharge. We conducted an interventional time series analysis of all medical and surgical patients who were discharged home from hospital between Apr. 1, 2002, and Jan. 30, 2015, in Ontario, Canada. The intervention was a supplemental billing code for physician follow-up within 14 days of discharge from hospital, introduced in 2006. The primary outcome was an outpatient visit within 14 days of discharge. Secondary outcomes were 7-day follow-up and a composite of emergency department visits, nonelective hospital readmission and death within 14 days. We included 8 008 934 patient discharge records. The incentive code was claimed in 31% of eligible visits by 51% of eligible physicians, and cost $17.5 million over the study period. There was no change in the average monthly rate of outcomes in the year before the incentive was introduced compared with the year following introduction: 14-day follow-up (66.5% v. 67.0%, overall p = 0.5), 7-day follow-up (44.9% v. 44.9%, overall p = 0.5) and composite outcome (16.7% v. 16.9%, overall p = 0.2). Despite uptake by physicians, a financial incentive did not alter follow-up after hospital discharge. This lack of effect may be explained by features of the incentive or by extra-physician barriers to follow-up. These barriers should be considered by policymakers before introducing similar initiatives. © 2017 Canadian Medical Association or its licensors.

Use of Donor Human Milk and Maternal Breastfeeding Rates: A Systematic Review.

PubMed

Williams, Thomas; Nair, Harish; Simpson, Judith; Embleton, Nicholas

2016-05-01

The number of human milk banks is growing worldwide. The introduction of donor human milk (DHM) to neonatal units has been advocated as a strategy to promote maternal breastfeeding. However, concern has been raised that the introduction of DHM may actually lead to a decrease in maternal breastfeeding. To address this question, we conducted a systematic literature review of studies that assessed maternal breastfeeding rates before and after the introduction of DHM. We searched 7 electronic databases, carried out citation tracking, and contacted experts in the field. Where data for breastfeeding rates before and after the introduction of DHM were directly comparable, a relative risk was calculated. Our search identified 286 studies, of which 10 met the inclusion criteria. Definitions of patient populations and study outcomes varied, limiting meaningful comparison. Where possible, relative risks (RR) were calculated on aggregated data. The introduction of DHM had a significant positive impact on any breastfeeding on discharge (RR, 1.19; 95% confidence interval [CI], 1.06-1.35;P= .005) but none on exclusive maternal breastfeeding on discharge (RR, 1.12; 95% CI, 0.91-1.40;P= .27) or on exclusive administration of own mother's milk (OMM) days 1 to 28 of life (RR, 1.08; 95% CI, 0.78-1.49; P= .65). A single-center study demonstrated a significant decrease in the percentage of feeds that were OMM after the introduction of DHM. In conclusion, the available data demonstrate some evidence of positive and negative effects on measures of maternal breastfeeding when DHM is introduced to a neonatal unit. © The Author(s) 2016.

Noise over-exposure alters long-term somatosensory-auditory processing in the dorsal cochlear nucleus – possible basis for tinnitus-related hyperactivity?

PubMed Central

Dehmel, Susanne; Pradhan, Shashwati; Koehler, Seth; Bledsoe, Sanford; Shore, Susan

2012-01-01

The dorsal cochlear nucleus (DCN) is the first neural site of bimodal auditory-somatosensory integration. Previous studies have shown that stimulation of somatosensory pathways results in immediate suppression or enhancement of subsequent acoustically-evoked discharges. In the unimpaired auditory system suppression predominates. However, damage to the auditory input pathway leads to enhancement of excitatory somatosensory inputs to the cochlear nucleus, changing their effects on DCN neurons (Zeng et al., 2009; Shore et al., 2008). Given the well described connection between the somatosensory system and tinnitus in patients we sought to determine if plastic changes in long lasting bimodal somatosensory-auditory processing accompany tinnitus. Here we demonstrate for the first time in vivo long-term effects of somatosensory inputs on acoustically-evoked discharges of DCN neurons in guinea pigs. The effects of trigeminal nucleus stimulation are compared between normal-hearing animals and animals overexposed with narrow band noise and behaviorally tested for tinnitus. The noise exposure resulted in a temporary threshold shift (TTS) in auditory brainstem responses but a persistent increase in spontaneous and sound-evoked DCN unit firing rates and increased steepness of rate-level functions (RLFs). Rate increases were especially prominent in buildup units. The long-term somatosensory enhancement of sound-evoked responses was strengthened while suppressive effects diminished in noise-exposed animals, especially those that developed tinnitus. Damage to the auditory nerve (ANF) is postulated to trigger compensatory long-term synaptic plasticity of somatosensory inputs that might be an important underlying mechanism for tinnitus generation. PMID:22302808

Asthma hospitalization trends in Charleston, South Carolina, 1956 to 1997: twenty-fold increase among black children during a 30-year period.

PubMed

Crater, D D; Heise, S; Perzanowski, M; Herbert, R; Morse, C G; Hulsey, T C; Platts-Mills, T

2001-12-01

The increase in asthma prevalence has been documented worldwide, affecting many races living in many different climates. Multiple studies have demonstrated that the most striking prevalence and morbidity of asthma in the United States has been in black children, but little research has determined the scale of the increase, or specifically when the disease became severe in this group. This study sought to determine exactly when the rise in asthma hospitalizations among black patients began and what the pattern of asthma hospitalizations has been in different races and age groups over a 40-year period in 1 urban area. A retrospective chart review of discharges from the Medical University of South Carolina was conducted from 1956 to 1997. Charts with the primary discharge diagnosis of asthma were examined for discharge date, race, and age group (0- to 4-year-olds, 5- to 18-year-olds, 19- to 50-year-olds, > or =51-year-olds). The diagnostic codes used were based on the International Classification of Diseases (ICD)-6, 1956-1957; ICD-7, 1958-1967; ICD-8, 1968-1978; and ICD-9, 1979-1997. Over the period studied, this hospital was the primary inpatient provider for children in this area, and the only provider for uninsured children. Between 1960 and 1990, the racial makeup of the area remained stable, as did the percentage of blacks living at the poverty level. The raw number of asthma discharges, rate per 10 000 discharges of the same race, and rate per 100 000 population in Charleston County were tabulated for each age group and racial category. Over the time period examined, there has been a progressive increase in asthma hospitalizations in black individuals of all age groups and in whites under 18 years. The most striking increase has been in black children 0 to 18 years old (figure). The increase either as raw values or as a rate per 100 000 began around 1970, and was linear. This increase in black children discharged with asthma as a rate per 100 000 population was 20-fold: the rate increased from 18 in 1970 to 370 in 1997. Asthma discharges as a rate per 10 000 black children discharged increased by 24-fold from 1960 to 1997. Total discharges from the hospital increased from 49 000 to 128 000 per year over this period. Blacks made up only 28% of discharges in 1957, but that proportion increased to 56% in 1960 and remained relatively stable over the following 35 years. The increase seen in white children 0 to 18 years of age as a rate per 100 000 population was 5-fold and began around 1980. Both increases seem to be consistent over the time period studied, and continued to 1997. [figure: see text]. Among a predominantly poor black population living in a southern US city, there has been a steady increase in childhood asthma hospitalizations over the past 30 years. A significant although less dramatic rise has occurred in white children. Over this time period, although there have been many changes in lifestyle that could have contributed to this rise, there have been no major changes in housing conditions for poor patients. In addition, Medicaid coverage for children in South Carolina did not change significantly until 1999. The time course of these increases parallels increases reported in other Western populations, suggesting that there must be 1 or more common factors contributing to the rise. Many explanations have been offered for the changes in incidence and severity of asthma. The scale of the change, time course, and linearity of the increase in this study represent a challenge to many of the hypotheses proposed to explain this epidemic.

Diversity of coding profiles of mechanoreceptors in glabrous skin of kittens.

PubMed

Gibson, J M; Beitel, R E; Welker, W

1975-03-21

We examined stimulul-response (S-R) profiles of 35 single mechanoreceptive afferent units having small receptive fields in glabrous forepaw skin of 24 anesthetized domestic kittens. Single unit activity was recorded with tungsten microelectrodes from cervical dorsal root ganglia. The study was designed to be as quantitatively descriptive as possible. We indented each unit's receptive field with a broad battery of simple, carefully controlled stimuli whose major parameters, including amplitude, velocity, acceleration, duration, and interstimulus interval were systematically varied. Stimuli were delivered by a small probe driven by a feedback-controlled axial displacement generator. Single unit discharge data were analyzed by a variety of direct and derived measures including dot patterns, peristimulus histograms, instantaneous and mean instantaneous firing rates, tuning curves, thresholds for amplitude and velocity, adaptation rates, dynamic and static sensitivities, and others. We found that with respect to any of the S-R transactions examined, the properties of our sample of units were continuously and broadly distributed. Any one unit might exhibit either a slow or rapid rate of adaptation, or might superficially appear to preferentially code a single stimulus parameter such as amplitude or velocity. But when the entire range of responsiveness of units to the entire stimulus battery was surveyed by a variety of analytic techniques, we were unable to find any justifiable basis for designation of discrete categories of S-R profiles. Intermediate response types were always found, and in general, all units were both broadly tuned and capable of responding to integrals of several stimulus parameters, our data argue against the usefulness of evaluating a unit's S-R coding capabilities by means of a limited ste of stimulation of response analysis procedures.

Postglacial eruptive history of the Askja region, North Iceland

NASA Astrophysics Data System (ADS)

Hartley, Margaret E.; Thordarson, Thorvaldur; de Joux, Alexandra

2016-04-01

Temporal variations in magma discharge rates on Iceland's neovolcanic rift zones have been associated with deglaciation. We have used tephrochronological and stratigraphic dating of 175 separate eruptive units to estimate volumetric output and reconstruct eruption rates in the Askja region over the postglacial period. We have identified 14 tephra layers that can be used as time marker horizons in the near vicinity of Askja, including the Vatnaöldur (871 ± 2 AD) tephra which has not previously been reported in surface cover profiles in this region. Our improved tephrochronological resolution indicates that, over the past c. 1,500 years, Askja has been significantly more active than has previously been recognised. A minimum of 39 km3 of basaltic magma has been erupted at Askja since the area became ice-free at around 10.3 ka. The absence of the 7.2 ka Hekla 5 tephra from the Askja region suggests that all postglacial lavas now exposed at the surface are younger than 7.2 ka. Time-averaged magma discharge rates at Askja were highest between 7.2 and 4.3 ka. However, the available tephrochronological resolution is not sufficient to resolve any peak in volcanic activity following deglaciation.

Single unit activity in the medial prefrontal cortex during Pavlovian heart rate conditioning: Effects of peripheral autonomic blockade.

PubMed

Powell, D A; Ginsberg, Jay P

2005-11-01

Electrical activity was recorded from single neurons in the medial prefrontal cortex of rabbits during differential Pavlovian heart rate (HR) conditioning. A heterogeneous population of cells were found, some of which showed CS-evoked increases and others CS-evoked decreases in discharge, while some cells were biphasic. A subset of cells also showed trial-related changes in discharge that were related to acquisition of the HR discrimination between the reinforced CS+ and non-reinforced CS-. Administration of the peripheral cholinergic antagonist, methylscopolamine, and the andrenergic antagonist, atenolol, either increased or decreased maintained baseline activity of many cells, but had little or no effect on the CS-evoked activity of these cells. Waveform changes also did not result from administration of these drugs. This finding suggests that CS-evoked mPFC activity is not being driven by cardiac afferent input to CNS cardiac control centers. Previous studies have shown that ibotenic acid lesions of this area greatly decreases the magnitude of decelerative heart rate conditioned responses; the latter finding, plus the results of the present study, suggest that processing of CS/US contingencies by the prefrontal cortex contributes to the acquisition of autonomic changes during Pavlovian conditioning.

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.

40 CFR Appendix E to Part 300 - Oil Spill Response

Code of Federal Regulations, 2013 CFR

2013-07-01

... and Health Administration RSPA—Research and Special Programs Administration USCG—United States Coast... major discharge regardless of the following quantitative measures: (a) Minor discharge means a discharge... protection of response teams and necessary research, development, demonstration, and evaluation to improve...

40 CFR Appendix E to Part 300 - Oil Spill Response

Code of Federal Regulations, 2011 CFR

2011-07-01

... and Health Administration RSPA—Research and Special Programs Administration USCG—United States Coast... major discharge regardless of the following quantitative measures: (a) Minor discharge means a discharge... protection of response teams and necessary research, development, demonstration, and evaluation to improve...

40 CFR Appendix E to Part 300 - Oil Spill Response

Code of Federal Regulations, 2012 CFR

2012-07-01

... and Health Administration RSPA—Research and Special Programs Administration USCG—United States Coast... major discharge regardless of the following quantitative measures: (a) Minor discharge means a discharge... protection of response teams and necessary research, development, demonstration, and evaluation to improve...

Hospital discharge rates before and after implementation of a city-wide smoking ban in a Texas city, 2004-2008.

PubMed

Head, Phil; Jackson, Bradford E; Bae, Sejong; Cherry, Debra

2012-01-01

The objective of this study was to examine hospital discharge data on 5 tobacco-related diagnoses before and after implementation of a smoking ban in a small Texas city. We compared hospital discharge rates for 2 years before and 2 years after implementation of the ban in the intervention city with discharge rates during the same time in a similar city with no ban. The discharge rates for blacks and whites combined declined significantly after the ban in the intervention city for acute myocardial infarction (MI) (rate ratio [RR], 0.74; 95% confidence interval [CI], 0.65-0.85) and for stroke or cerebrovascular accident (RR, 0.71; 95% CI, 0.62-0.82); discharge rates in the intervention city also declined significantly for chronic obstructive pulmonary disease (RR, 0.64; 95% CI, 0.54-0.75) and asthma (RR, 0.69; 95% CI, 0.52-0.91) for whites only. Discharge rates for 4 of 5 diagnoses in the control city did not change. Although postban reduction in acute MI is well documented, this is one of the first studies to show a racial disparity in health benefits and a decline in tobacco-related diagnoses other than acute MI after implementation of a city-wide smoking ban.

The relationship between nurse staffing and failure to rescue: where does it matter most?

PubMed

Talsma, AkkeNeel; Jones, Katherine; Guo, Ying; Wilson, Deleise; Campbell, Darrell A

2014-09-01

This study further expands on the relationship between nurse staffing levels and patient outcomes, in particular, failure to rescue. Many studies are based on single-site hospitals or single-year data, thus limiting the generalizations of the findings. The purpose was to evaluate in a multisite multiyear study the relationship between unit-level nurse staffing and FTR mortality, for ICU and non-ICU patients. Using administrative and actual unit level nurse staffing data, we used AHRQ 2003 Patient Safety Indicator (2003) software and matched those with the patient's discharge month. Fixed effects multilevel logistic analyses were used to take into account the hierarchical structure of the database and patient clustering within units. We controlled for patient demographics, clinical conditions, and CCS categories. The majority (94%) of cases were discharged from general care units, ICUs reported higher nurse staffing levels based on patient complexity. Expired cases were 3 years older, male, and nonwhite. For general care discharges, the relationship between RN level HPPD approached significance (P = 0.07), suggesting increased odds of higher FTR mortality with higher staffing levels. We did not observe any of the expected associations between the nurse staffing variables and FTR for either general care unit or ICU discharges. The comprehensive risk adjustments provided adequate "leveling of the playing field" to evaluate the impact of unit-based nurse staffing levels on FTR mortality. Future studies should evaluate the influence of unit environment and patient risk.

Motor unit firing rate patterns during voluntary muscle force generation: a simulation study

NASA Astrophysics Data System (ADS)

Hu, Xiaogang; Rymer, William Z.; Suresh, Nina L.

2014-04-01

Objective. Muscle force is generated by a combination of motor unit (MU) recruitment and changes in the discharge rate of active MUs. There have been two basic MU recruitment and firing rate paradigms reported in the literature, which describe the control of the MUs during force generation. The first (termed the reverse ‘onion skin’ profile), exhibits lower firing rates for lower threshold units, with higher firing rates occurring in higher threshold units. The second (termed the ‘onion skin’ profile), exhibits an inverse arrangement, with lower threshold units reaching higher firing rates. Approach. Using a simulation of the MU activity in a hand muscle, this study examined the force generation capacity and the variability of the muscle force magnitude at different excitation levels of the MU pool under these two different MU control paradigms. We sought to determine which rate/recruitment scheme was more efficient for force generation, and which scheme gave rise to the lowest force variability. Main results. We found that the force output of both firing patterns leads to graded force output at low excitation levels, and that the force generation capacity of the two different paradigms diverged around 50% excitation. In the reverse ‘onion skin’ pattern, at 100% excitation, the force output reached up to 88% of maximum force, whereas for the ‘onion skin’ pattern, the force output only reached up to 54% of maximum force at 100% excitation. The force variability was lower at the low to moderate force levels under the ‘onion skin’ paradigm than with the reverse ‘onion skin’ firing patterns, but this effect was reversed at high force levels. Significance. This study captures the influence of MU recruitment and firing rate organization on muscle force properties, and our results suggest that the different firing organizations can be beneficial at different levels of voluntary muscle force generation and perhaps for different tasks.

Patient blood transfusion management: discharge hemoglobin level as a surrogate marker for red blood cell utilization appropriateness.

PubMed

Edwards, Jason; Morrison, Chris; Mohiuddin, Maleeha; Tchatalbachev, Vladislav; Patel, Charmi; Schwickerath, Vicki L; Menitove, Jay E; Singh, Gurmukh

2012-11-01

Blood transfusion management strategies minimize transfusion-associated risks, enhance outcomes, and reduce costs. We explored an association of discharge hemoglobin (Hb) with pretransfusion Hb, transfusion indications, and red blood cell (RBC) transfusions. We stipulate that patients with discharge Hb concentrations greater than 10.0 g/dL, or even 9.0 g/dL, received excessive RBC transfusions. We examined aggregate data from five hospitals and for one of the hospitals, the focus hospital, we reviewed patient records for a period of 6 months. Data analyses included number of RBC units transfused and Hb values before transfusion, after transfusion, and at discharge. In aggregate, 27% to 47% patients had discharge Hb levels greater than 10.0 g/dL. At the focus hospital, 27% had a discharge Hb level greater than 10 g/dL and 50.3% had a discharge Hb level greater than 9.0 g/dL. At the focus hospital, the mean Hb trigger for transfusion was a Hb level of 7.3 g/dL; the mean posttransfusion Hb level was 9.3 g/dL and mean discharge Hb level was 9.2 g/dL. Overall, 76% of the transfusions were of an even number of RBC units. In aggregate, overutilization exceeded 20%. At the focus hospital, approximately one-quarter of patients receiving transfusions had a Hb concentration greater than 10.0 g/dL at discharge. Transfused patients' discharge Hb concentration represents an effective indicator for retrospective monitoring of transfusion appropriateness. In light of the large number of patients receiving even number transfusions, reviewing Hb levels after transfusion of each RBC unit could reduce unnecessary transfusions. Retrospective review of discharge Hb data focuses providers on transfusion outcomes and affords an educational opportunity for blood utilization management. © 2012 American Association of Blood Banks.

77 FR 64033 - Discharge of Liens; Redemption by United States

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-18

... DEPARTMENT OF THE TREASURY Internal Revenue Service 26 CFR Part 301 Discharge of Liens; Redemption by United States CFR Correction In Title 26 of the Code of Federal Regulations, Parts 300 to 499, revised as of April 1, 2012, on page 563, in Sec. 301.7425-4, in paragraph (b)(5) Example 1, at the end of...

Estimates of peak flood discharge for 21 sites in the Front Range in Colorado in response to extreme rainfall in September 2013

USGS Publications Warehouse

Moody, John A.

2016-03-21

Extreme rainfall in September 2013 caused destructive floods in part of the Front Range in Boulder County, Colorado. Erosion from these floods cut roads and isolated mountain communities for several weeks, and large volumes of eroded sediment were deposited downstream, which caused further damage of property and infrastructures. Estimates of peak discharge for these floods and the associated rainfall characteristics will aid land and emergency managers in the future. Several methods (an ensemble) were used to estimate peak discharge at 21 measurement sites, and the ensemble average and standard deviation provided a final estimate of peak discharge and its uncertainty. Because of the substantial erosion and deposition of sediment, an additional estimate of peak discharge was made based on the flow resistance caused by sediment transport effects.Although the synoptic-scale rainfall was extreme (annual exceedance probability greater than 1,000 years, about 450 millimeters in 7 days) for these mountains, the resulting peak discharges were not. Ensemble average peak discharges per unit drainage area (unit peak discharge, [Qu]) for the floods were 1–2 orders of magnitude less than those for the maximum worldwide floods with similar drainage areas and had a wide range of values (0.21–16.2 cubic meters per second per square kilometer [m3 s-1 km-2]). One possible explanation for these differences was that the band of high-accumulation, high-intensity rainfall was narrow (about 50 kilometers wide), oriented nearly perpendicular to the predominant drainage pattern of the mountains, and therefore entire drainage areas were not subjected to the same range of extreme rainfall. A linear relation (coefficient of determination [R2]=0.69) between Qu and the rainfall intensity (ITc, computed for a time interval equal to the time-of-concentration for the drainage area upstream from each site), had the form: Qu=0.26(ITc-8.6), where the coefficient 0.26 can be considered to be an area-averaged peak runoff coefficient for the September 2013 rain storms in Boulder County, and the 8.6 millimeters per hour to be the rainfall intensity corresponding to a soil moisture threshold that controls the soil infiltration rate. Peak discharge estimates based on the sediment transport effects were generally less than the ensemble average and indicated that sediment transport may be a mechanism that limits velocities in these types of mountain streams such that the Froude number fluctuates about 1 suggesting that this type of floodflow can be approximated as critical flow.

Can hydraulic-modelled rating curves reduce uncertainty in high flow data?

NASA Astrophysics Data System (ADS)

Westerberg, Ida; Lam, Norris; Lyon, Steve W.

2017-04-01

Flood risk assessments rely on accurate discharge data records. Establishing a reliable rating curve for calculating discharge from stage at a gauging station normally takes years of data collection efforts. Estimation of high flows is particularly difficult as high flows occur rarely and are often practically difficult to gauge. Hydraulically-modelled rating curves can be derived based on as few as two concurrent stage-discharge and water-surface slope measurements at different flow conditions. This means that a reliable rating curve can, potentially, be derived much faster than a traditional rating curve based on numerous stage-discharge gaugings. In this study we compared the uncertainty in discharge data that resulted from these two rating curve modelling approaches. We applied both methods to a Swedish catchment, accounting for uncertainties in the stage-discharge gauging and water-surface slope data for the hydraulic model and in the stage-discharge gauging data and rating-curve parameters for the traditional method. We focused our analyses on high-flow uncertainty and the factors that could reduce this uncertainty. In particular, we investigated which data uncertainties were most important, and at what flow conditions the gaugings should preferably be taken. First results show that the hydraulically-modelled rating curves were more sensitive to uncertainties in the calibration measurements of discharge than water surface slope. The uncertainty of the hydraulically-modelled rating curves were lowest within the range of the three calibration stage-discharge gaugings (i.e. between median and two-times median flow) whereas uncertainties were higher outside of this range. For instance, at the highest observed stage of the 24-year stage record, the 90% uncertainty band was -15% to +40% of the official rating curve. Additional gaugings at high flows (i.e. four to five times median flow) would likely substantially reduce those uncertainties. These first results show the potential of the hydraulically-modelled curves, particularly where the calibration gaugings are of high quality and cover a wide range of flow conditions.

Discharge Outcomes and Survival of Patients with Advanced Cancer Admitted to an Acute Palliative Care Unit at a Comprehensive Cancer Center

PubMed Central

Hui, David; Elsayem, Ahmed; Palla, Shana; De La Cruz, Maxine; Li, Zhijun; Yennurajalingam, Sriram

2010-01-01

Abstract Background Acute palliative care units (APCUs) are new programs aimed at integrating palliative and oncology care. Few outcome studies from APCUs are available. Objectives We examined the frequency, survival, and predictors associated with home discharge and death in our APCU. Methods All patients discharged from the APCU between September 1, 2003 and August 31, 2008 were included. Demographics, cancer diagnosis, discharge outcomes, and overall survival from discharge were retrieved retrospectively. Results The 2568 patients admitted to APCU had the following characteristics: median age, 59 years (range, 18–101); male, 51%; median hospital stay, 11 days; median APCU stay, 7 days; and median survival 21 days (95% confidence interval [CI] 19–23 days). Five hundred ninety-two (20%), 89 (3%), and 1259 (43%) patients were discharged to home, health care facilities, and hospice, respectively, with a median survival of 60, 29, and 14 days, respectively (p < 0.001). Nine hundred fifty-eight (33%) patients died during admission (median stay, 11 days). Compared to hospice transfers, home discharge (hazard ratio = 0.35, 95% CI 0.30–0.41, p < 0.001) was associated with longer survival in multivariate analysis, with a 6-month survival of 22%. Multivariate logistic regression revealed that male gender, specific cancer primaries, and admissions from oncology units were associated with death in the APCU, while younger age and direct admissions to the APCU were associated with home discharge. Conclusions Our APCU serves patients with advanced cancer with diverse clinical characteristics and survival, and discharged home a significant proportion with survival greater than 6 months. Results from this simultaneous care program suggest a pattern of care different from that of traditional hospice and palliative care services. PMID:19824813

Paradigm Shifts in Voluntary Force Control and Motor Unit Behaviors with the Manipulated Size of Visual Error Perception

PubMed Central

Chen, Yi-Ching; Lin, Yen-Ting; Chang, Gwo-Ching; Hwang, Ing-Shiou

2017-01-01

The detection of error information is an essential prerequisite of a feedback-based movement. This study investigated the differential behavior and neurophysiological mechanisms of a cyclic force-tracking task using error-reducing and error-enhancing feedback. The discharge patterns of a relatively large number of motor units (MUs) were assessed with custom-designed multi-channel surface electromyography following mathematical decomposition of the experimentally-measured signals. Force characteristics, force-discharge relation, and phase-locking cortical activities in the contralateral motor cortex to individual MUs were contrasted among the low (LSF), normal (NSF), and high scaling factor (HSF) conditions, in which the sizes of online execution errors were displayed with various amplification ratios. Along with a spectral shift of the force output toward a lower band, force output with a more phase-lead became less irregular, and tracking accuracy was worse in the LSF condition than in the HSF condition. The coherent discharge of high phasic (HP) MUs with the target signal was greater, and inter-spike intervals were larger, in the LSF condition than in the HSF condition. Force-tracking in the LSF condition manifested with stronger phase-locked EEG activity in the contralateral motor cortex to discharge of the (HP) MUs (LSF > NSF, HSF). The coherent discharge of the (HP) MUs during the cyclic force-tracking predominated the force-discharge relation, which increased inversely to the error scaling factor. In conclusion, the size of visualized error gates motor unit discharge, force-discharge relation, and the relative influences of the feedback and feedforward processes on force control. A smaller visualized error size favors voluntary force control using a feedforward process, in relation to a selective central modulation that enhance the coherent discharge of (HP) MUs. PMID:28348530

Paradigm Shifts in Voluntary Force Control and Motor Unit Behaviors with the Manipulated Size of Visual Error Perception.

PubMed

Chen, Yi-Ching; Lin, Yen-Ting; Chang, Gwo-Ching; Hwang, Ing-Shiou

2017-01-01

The detection of error information is an essential prerequisite of a feedback-based movement. This study investigated the differential behavior and neurophysiological mechanisms of a cyclic force-tracking task using error-reducing and error-enhancing feedback. The discharge patterns of a relatively large number of motor units (MUs) were assessed with custom-designed multi-channel surface electromyography following mathematical decomposition of the experimentally-measured signals. Force characteristics, force-discharge relation, and phase-locking cortical activities in the contralateral motor cortex to individual MUs were contrasted among the low (LSF), normal (NSF), and high scaling factor (HSF) conditions, in which the sizes of online execution errors were displayed with various amplification ratios. Along with a spectral shift of the force output toward a lower band, force output with a more phase-lead became less irregular, and tracking accuracy was worse in the LSF condition than in the HSF condition. The coherent discharge of high phasic (HP) MUs with the target signal was greater, and inter-spike intervals were larger, in the LSF condition than in the HSF condition. Force-tracking in the LSF condition manifested with stronger phase-locked EEG activity in the contralateral motor cortex to discharge of the (HP) MUs (LSF > NSF, HSF). The coherent discharge of the (HP) MUs during the cyclic force-tracking predominated the force-discharge relation, which increased inversely to the error scaling factor. In conclusion, the size of visualized error gates motor unit discharge, force-discharge relation, and the relative influences of the feedback and feedforward processes on force control. A smaller visualized error size favors voluntary force control using a feedforward process, in relation to a selective central modulation that enhance the coherent discharge of (HP) MUs.

The Uniform Data System for Medical Rehabilitation Report of Patients with Traumatic Spinal Cord Injury Discharged from Rehabilitation Programs in 2002 – 2010

PubMed Central

Granger, Carl V.; Karmarkar, Amol M.; Graham, James E.; Deutsch, Anne; Niewczyk, Paulette; DiVita, Margaret A.; Ottenbacher, Kenneth J.

2012-01-01

Objective Provide benchmarking information from a large national sample of patients receiving inpatient rehabilitation following a traumatic spinal cord injury. Design Analysis of secondary data from 891 inpatient medical rehabilitation facilities in the United States that contributed traumatic spinal cord injury data to the Uniform Data System for Medical Rehabilitation (UDSmr) during the period January 2002 through December 2010. Variables analyzed included demographic information (age, sex, marital status, race/ethnicity, pre-hospital living setting, discharge setting), hospitalization information (length of stay, program interruptions, payer, onset date, rehabilitation impairment group, ICD-9 codes for admitting diagnosis, comorbidities), and functional status (FIM® instrument [“FIM”] ratings at admission and discharge, FIM efficiency, FIM gain). Results The final sample included 47,153 patients with traumatic spinal cord injury. Overall mean length of stay = 26.2 (±23.2) days: yearly means ranged from 29.7 (±25.4) in 2002 to 22.9 (±18.9) in 2009. FIM total admission and discharge ratings also declined over the 8-year study period: admission decreased from 60.5 (± 17.4) to 55.9 (±16.3); discharge decreased from 86.1 (±23.8) to 82.4 (±23.4). Rehabilitation efficiency (FIM gain per day) remained relatively stable over time (1.6 ±1.7 points per day). The percentage of all patients discharged to the community ranged from 75.8% to 71.5% per year. Wheelchair users stayed in rehabilitation longer than persons who could walk (34.6 ±217.4 vs. 17.4 ±14.1 days) and also experienced less functional improvement (21.6 ±15.8 vs. 29.6 ±16.3 FIM points). Conclusions National data from persons with traumatic spinal cord injury in 2002-2010 indicate that lengths of stay declined, but efficiency in functional independence was stable to slightly increased. Over seventy percent of patients were consistently discharged to community settings following inpatient rehabilitation. PMID:22407160

The uniform data system for medical rehabilitation: report of patients with traumatic spinal cord injury discharged from rehabilitation programs in 2002-2010.

PubMed

Granger, Carl V; Karmarkar, Amol M; Graham, James E; Deutsch, Anne; Niewczyk, Paulette; Divita, Margaret A; Ottenbacher, Kenneth J

2012-04-01

This study aimed to provide benchmarking information from a large national sample of patients receiving inpatient rehabilitation after a traumatic spinal cord injury. This was an analysis of secondary data from 891 inpatient medical rehabilitation facilities in the United States that contributed traumatic spinal cord injury data to the Uniform Data System for Medical Rehabilitation from January 2002 to December 2010. Variables analyzed included demographic information (age, sex, marital status, race/ethnicity, prehospital living setting, discharge setting), hospitalization information (length of stay, program interruptions, payer, onset date, rehabilitation impairment group, International Classification of Diseases 9 codes for admitting diagnosis, co-morbidities), and functional status (Functional Independence Measure [FIM] instrument ratings at admission and discharge, FIM efficiency, FIM gain). The final sample included 47,153 patients with traumatic spinal cord injury. Overall, the mean length of stay was 26.2 ± 23.2 days: yearly means ranged from 29.7 ± 25.4 in 2002 to 22.9 ± 18.9 in 2009. FIM total admission and discharge ratings also declined during the 8-yr study period; admission decreased from 60.5 ± 17.4 to 55.9 ± 16.3; discharge decreased from 86.1 ± 23.8 to 82.4 ± 23.4. Rehabilitation efficiency (FIM gain per day) remained relatively stable over time (1.6 ± 1.7 points per day). The percentage of all patients discharged to the community ranged from 75.8% to 71.5% per year. Wheelchair users stayed in rehabilitation longer than did persons who could walk (34.6 ± 217.4 vs. 17.4 ± 14.1 days) and also experienced less functional improvement (21.6 ± 15.8 vs. 29.6 ± 16.3 FIM points). National data from persons with traumatic spinal cord injury in 2002-2010 indicate that lengths of stay declined, but efficiency in functional independence was stable to slightly increased. More than 70% of patients were consistently discharged to community settings after inpatient rehabilitation.

Changes in the prevalence of breast feeding in preterm infants discharged from neonatal units: a register study over 10 years.

PubMed

Ericson, Jenny; Flacking, Renée; Hellström-Westas, Lena; Eriksson, Mats

2016-12-13

There are indications that the prevalence of exclusively breastfed preterm infants is decreasing in Sweden. The objective was to investigate trends in exclusive breast feeding at discharge from Swedish neonatal units and associated factors in preterm infants. This is a register study with data from the Swedish Neonatal Quality Register. Data from 29 445 preterm infants (gestational age (GA) <37 weeks) who were born during the period 2004-2013 were retrieved. Data included maternal, perinatal and neonatal characteristics. Data were analysed for the whole population as well as for 3 GA groups. From 2004 to 2013, the prevalence of exclusive breast feeding decreased, in extremely preterm (GA 22-27 weeks) from 55% to 16%, in very preterm (GA 28-31 weeks) from 41% to 34% and in moderately preterm infants (GA 32-36 weeks) from 64% to 49%. The decline was statistically significant (p<0.001) in all 3 GA groups. This decline remained significant when adjustments were made for factors negatively associated with exclusive breast feeding and which became more prevalent during the study period, that is, small for GA (all groups) and maternal mental illness (very preterm and moderately preterm infants). In the past 10 years, Sweden has experienced a lower rate of exclusive breast feeding in preterm infants, especially in extremely preterm infants. The factors analysed in this study explain only a small proportion of this decline. The decline in exclusive breast feeding at discharge from neonatal units raises concern and present challenges to the units to support and promote breast feeding. 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/.

The effect of flow data resolution on sediment yield estimation and channel design

NASA Astrophysics Data System (ADS)

Rosburg, Tyler T.; Nelson, Peter A.; Sholtes, Joel S.; Bledsoe, Brian P.

2016-07-01

The decision to use either daily-averaged or sub-daily streamflow records has the potential to impact the calculation of sediment transport metrics and stream channel design. Using bedload and suspended load sediment transport measurements collected at 138 sites across the United States, we calculated the effective discharge, sediment yield, and half-load discharge using sediment rating curves over long time periods (median record length = 24 years) with both daily-averaged and sub-daily streamflow records. A comparison of sediment transport metrics calculated with both daily-average and sub-daily stream flow data at each site showed that daily-averaged flow data do not adequately represent the magnitude of high stream flows at hydrologically flashy sites. Daily-average stream flow data cause an underestimation of sediment transport and sediment yield (including the half-load discharge) at flashy sites. The degree of underestimation was correlated with the level of flashiness and the exponent of the sediment rating curve. No consistent relationship between the use of either daily-average or sub-daily streamflow data and the resultant effective discharge was found. When used in channel design, computed sediment transport metrics may have errors due to flow data resolution, which can propagate into design slope calculations which, if implemented, could lead to unwanted aggradation or degradation in the design channel. This analysis illustrates the importance of using sub-daily flow data in the calculation of sediment yield in urbanizing or otherwise flashy watersheds. Furthermore, this analysis provides practical charts for estimating and correcting these types of underestimation errors commonly incurred in sediment yield calculations.

Yield of ultra-rapid carotid ultrasound and stroke specialist assessment in patients with TIA and minor stroke: an Italian TIA service audit.

PubMed

Gulli, Giosuè; Peron, Elisa; Ricci, Giorgio; Formaglio, Eva; Micheletti, Nicola; Tomelleri, Giampaolo; Moretto, Giuseppe

2014-12-01

In Italy the vast majority of TIA and minor strokes are seen in the A&E. Early diagnosis and management of TIA and minor stroke in this setting is habitually difficult and often lead to cost-ineffective hospital admissions. We set up an ultra-rapid TIA service run by neurovascular physicians based on early specialist assessment and ultrasound vascular imaging. We audit the clinical effectiveness and feasibility of the service and the impact of this service on TIA and minor strokes hospital admissions. We compared the rate of TIA and minor stroke admissions/discharges in the year before (T0) and in the year during which the TIA service was operating (T1). At T1 57 patients had specialist evaluation and 51 (89.5 %) of them were discharged home. Two (3.5 %) patients had recurrent symptoms after discharge. Seven had a pathological carotid Doppler ultrasound. Four of them had hospital admission and subsequent carotid endoarterectomy within a week. Taking the whole neurology department into consideration at T1 there was a 30-41 % reduction in discharges of patients with TIA or minor stroke. Taking the stroke unit section into consideration at T1 there was a 25 % reduction in admissions of patients with NIHSS score <4 and 40 % reduction in admissions of patients with Barthel Index above 80. The model of TIA service we implemented based on ultra-rapid stroke physician assessment and carotid ultrasound investigation is feasible and clinically valid. Indirect evidence suggests that it reduced the rate of expensive TIA/minor stroke hospital admissions.

Hysteresis, regime shifts, and non-stationarity in aquifer recharge-storage-discharge systems

NASA Astrophysics Data System (ADS)

Klammler, Harald; Jawitz, James; Annable, Michael; Hatfield, Kirk; Rao, Suresh

2016-04-01

Based on physical principles and geological information we develop a parsimonious aquifer model for Silver Springs, one of the largest karst springs in Florida. The model structure is linear and time-invariant with recharge, aquifer head (storage) and spring discharge as dynamic variables at the springshed (landscape) scale. Aquifer recharge is the hydrological driver with trends over a range of time scales from seasonal to multi-decadal. The freshwater-saltwater interaction is considered as a dynamic storage mechanism. Model results and observed time series show that aquifer storage causes significant rate-dependent hysteretic behavior between aquifer recharge and discharge. This leads to variable discharge per unit recharge over time scales up to decades, which may be interpreted as a gradual and cyclic regime shift in the aquifer drainage behavior. Based on field observations, we further amend the aquifer model by assuming vegetation growth in the spring run to be inversely proportional to stream velocity and to hinder stream flow. This simple modification introduces non-linearity into the dynamic system, for which we investigate the occurrence of rate-independent hysteresis and of different possible steady states with respective regime shifts between them. Results may contribute towards explaining observed non-stationary behavior potentially due to hydrological regime shifts (e.g., triggered by gradual, long-term changes in recharge or single extreme events) or long-term hysteresis (e.g., caused by aquifer storage). This improved understanding of the springshed hydrologic response dynamics is fundamental for managing the ecological, economic and social aspects at the landscape scale.

National water quality assessment of the Georgia-Florida Coastal Plain study unit; water withdrawals and treated wastewater discharges, 1990

USGS Publications Warehouse

Marella, R.L.; Fanning, J.L.

1996-01-01

The Georgia-Florida Coastal Plain study unit covers nearly 62,600 square miles along the southeastern United States coast in Georgia and Florida. In 1990, the estimated population of the study unit was 9.3 million, and included all or part of the cities of Atlanta, Jacksonville, Orlando, Tampa, and St. Petersburg. Estimated freshwater withdrawn in the study unit in 1990 was nearly 5,075 million gallons per day. Ground-water accounted for more than 57 percent of the water withdrawn during 1990 and the Floridan aquifer system provided nearly 91 percent of the total ground-water withdrawn. Surface-water accounted for nearly 43 percent of the water withdrawn in the study unit in 1990 with large amounts of withdrawals from the Altamaha River, Hillsborough River, the Ocmulgee River, the Oconee River, the St. Johns River, and the Suwannee River. Water withdrawn for public supply in the Georgia-Florida Coastal Plain study unit in 1990 totaled 1,139 million gallons per day, of which 83 percent was ground water and 17 percent was surface water. Self-supplied domestic withdrawals in the Georgia-Florida Coastal Plain study unit in 1990 totaled nearly 230 million gallons per day. Ground water supplied over 80 percent of the study units population for drining water purposes; nearly 5.8 million people were served by public supply and 1.8 million people were served by self-supplied systems. Water withdrawn for self-supplied domestic use in Georgia and Florida is derived almost exclusively from ground water, primarily because this source can provide the quantity and quality of water needed for drinking purposes. Nearly 1.7 million people served by public supply utilized surface water for their drinking water needs. Water withdrawn for self-supplied commercial-industrial uses in the study unit in 1990 totaled 862 million gallons per day, of which 93 percent was ground water and 7 percent was surface water. Water withdrawn for agriculture purposes in the study unit in 1990 totaled 1,293 million gallons per day, of which 69 percent was ground water and 31 percent was surface water. An estimated 1.254 millon acres were irrigated within the study unit during 1990. Water withdrawn for thermoelectric power generation in the study unit in 1990 totaled 1,552 million gallons per day, of which 99 percent was surface water and 1 percent was ground water. An additional 6,919 million gallons per day of saline surface water were withdrawn for thermoelectric power generation in 1990, solely for cooling purposes. Treated wastewater discharged within the Georgia-Florida Coastal Plain study unit totaled nearly 1,187 million gallons per day in 1990. Of the total water discharged, 58 percent was discharged directly into surface water and the remaining 42 percent was discharged to ground water (through drain fields, injection wells, percolation ponds or spray fields). Domestic wastewater facilities discharged in the study unit totaled nearly 789 million gallons per day, industrial wastewater facilities discharged 213 million gallons per day, and releases from septic tanks was estimated at 185 million gallons per day. More than 1.3 million septic tanks were estimated in use within the study unit in 1990.

46 CFR 108.453 - Discharge outlets.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Discharge outlets. 108.453 Section 108.453 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT Fire Extinguishing Systems Fixed Carbon Dioxide Fire Extinguishing Systems § 108.453 Discharge...

46 CFR 108.453 - Discharge outlets.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Discharge outlets. 108.453 Section 108.453 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) A-MOBILE OFFSHORE DRILLING UNITS DESIGN AND EQUIPMENT Fire Extinguishing Systems Fixed Carbon Dioxide Fire Extinguishing Systems § 108.453 Discharge...

6. CLOSEUP VIEW OF THE PUMP DISCHARGE CHANNEL, THE FLAP ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

6. CLOSEUP VIEW OF THE PUMP DISCHARGE CHANNEL, THE FLAP VALVES OF THE PUMPING UNITS 8, 6, AND 7 (L TO R) AND PART OF THE DISCHARGE WEIR OF THE INDIVIDUAL DISCHARGE CHAMBER OF PUMP NO. 5, LOOKING NORTHEAST. - Wyoming Valley Flood Control System, Woodward Pumping Station, East of Toby Creek crossing by Erie-Lackawanna Railroad, Edwardsville, Luzerne County, PA

Over atmospheric pressure flowing afterglow

NASA Astrophysics Data System (ADS)

Ganciu, Mihai; Orphal, Johannes; Vervloet, Michel; Pointu, Anne-Marie; Touzeau, Michel

2002-10-01

A Tabletop discharge * created above atmospheric pressure in a N2 gas flow, uses some 10 kV very fast high voltage pulses applied between needle electrodes with some 10 kHz repetition rate. It is followed by a post-discharge, in a plastic tube with 6-mm internal diameter. Adjusting the flow and the repetition rate, the post-discharge exhibits a surprisingly long size, 9-10 m, as shown by the tube fluorescence. Preliminary spectroscopic measurements demonstrate that fluorescence is due to internal gas excited molecules (CN and NH) that are locally created by active species interaction with organic impurities. The discharge emission spectrum evidences a high nitrogen atom production rate, much higher than attainable rate with a Dielectric Barrier Discharge with same applied voltage pulses. For small air quantities added in the post-discharge, spectrum exhibits rich UV range corresponding to NO excited states. Further studies will be devoted to the post-discharge kinetics and to possible applications to medical sterilization. *M. Ganciu, private communication

Automated pictographic illustration of discharge instructions with Glyph: impact on patient recall and satisfaction.

PubMed

Hill, Brent; Perri-Moore, Seneca; Kuang, Jinqiu; Bray, Bruce E; Ngo, Long; Doig, Alexa; Zeng-Treitler, Qing

2016-11-01

First, to evaluate the effect of standard vs pictograph-enhanced discharge instructions on patients' immediate and delayed recall of and satisfaction with their discharge instructions. Second, to evaluate the effect of automated pictograph enhancement on patient satisfaction with their discharge instructions. Glyph, an automated healthcare informatics system, was used to automatically enhance patient discharge instructions with pictographs. Glyph was developed at the University of Utah by our research team. Patients in a cardiovascular medical unit were randomized to receive pictograph-enhanced or standard discharge instructions. Measures of immediate and delayed recall and satisfaction with discharge instructions were compared between two randomized groups: pictograph (n = 71) and standard (n = 73). Study participants who received pictograph-enhanced discharge instructions recalled 35% more of their instructions at discharge than those who received standard discharge instructions. The ratio of instructions at discharge was: standard = 0.04 ± 0.03 and pictograph-enhanced = 0.06 ± 0.03. The ratio of instructions at 1 week post discharge was: standard = 0.04 ± 0.02 and pictograph-enhanced 0.04 ± 0.02. Additionally, study participants who received pictograph-enhanced discharge instructions were more satisfied with the understandability of their instructions at 1 week post-discharge than those who received standard discharge instructions. Pictograph-enhanced discharge instructions have the potential to increase patient understanding of and satisfaction with discharge instructions. It is feasible to automatically illustrate discharge instructions and provide them to patients in a timely manner without interfering with clinical work. Illustrations in discharge instructions were found to improve patients' short-term recall of discharge instructions and delayed satisfaction (1-week post hospitalization) with the instructions. Therefore, it is likely that patients' understanding of and interaction with their discharge instructions is improved by the addition of illustrations. Published by Oxford University Press on behalf of the American Medical Informatics Association 2015. This work is written by US Government employees and is in the public domain in the United States.

Communication at the interface between hospitals and primary care - a general practice audit of hospital discharge summaries.

PubMed

Belleli, Esther; Naccarella, Lucio; Pirotta, Marie

2013-12-01

Timeliness and quality of hospital discharge summaries are crucial for patient safety and efficient health service provision after discharge. We audited receipt rates, timeliness and the quality of discharge summaries for 49 admissions among 38 patients in an urban general practice. For missing discharge summaries, a hospital medical record search was performed. Discharge summaries were received for 92% of identified admissions; 73% were received within three days and 55% before the first post-discharge visit to the general practitioner (GP). Administrative information and clinical content, including diagnosis, treatment and follow-up plans, were well reported. However, information regarding tests, referrals and discharge medication was often missing; 57% of summaries were entirely typed and 13% had legibility issues. Completion rates were good but utility was compromised by delays, content omissions and formatting. Digital searching enables extraction of information from rich existing datasets contained in GP records for accurate measurement of discharge summary receipt rate and timing.

[Removal of SO2 from flue gas by water vapor DC corona discharge].

PubMed

Sun, Ming; Wu, Yan

2006-07-01

The influence of several factors on removal rate of SO2 from flue gas in unsaturated water vapor DC corona discharge was researched. Furthermore, the experiments of the removal rate of SO2 in pulsed discharge increased by water vapor DC corona discharge plasma were conducted. The experiment system is supplied with multi-nozzle-plate electrodes and the flow of simulated flue gas is under 70 m3/h. The results show that removal rate of SO2 can be improved by increasing the concentration of water vapor, intensity of electric field or decreasing flow of simulated flue gas. In unsaturated water vapor DC corona discharge, removal rate of SO2 can be improved by 10%, when NH3 is added as NH3 and SO2 is in a mole ratio of two to one, it can reach 60%. The removal rate of SO2 can be increased by 5% in pulsed corona discharge and reach above 90%.

[Low-dose hypobaric spinal anesthesia for anorectal surgery in jackknife position: levobupivacaine-fentanyl compared to lidocaine-fentanyl].

PubMed

de Santiago, J; Santos-Yglesias, J; Girón, J; Jiménez, A; Errando, C L

2010-11-01

To compare the percentage of patients who were able to bypass the postoperative intensive care recovery unit after selective spinal anesthesia with lidocaine-fentanyl versus levobupivacaine-fentanyl for anorectal surgery in jackknife position. Randomized double-blind clinical trial comparing 2 groups of 30 patients classified ASA 1-2. One group received 18 mg of 0.6% lidocaine plus 10 microg of fentanyl while the other group received 3 mg of 0.1% levobupivacaine plus 10 microg of fentanyl. Intraoperative variables were time of start of surgery, maximum extension of sensory blockade, requirement for rescue analgesics, and hemodynamic events. The level of sensory blockade was recorded at 5, 10, and 15 minutes after the start of surgery and at the end of the procedure. The degrees of postoperative motor blockade and proprioception were recorded, as were the results of the Romberg test and whether or not the patient was able to bypass the postoperative recovery unit. Also noted were times of start of ambulation and discharge, complications, and postoperative satisfaction. Intraoperative variables did not differ significantly between groups, and all patients in both groups bypassed the postoperative recovery unit. Times until walking and discharge home, complications, and overall satisfaction after surgery were similar in the 2 groups. Both spinal anesthetic solutions provide effective, selective anesthesia and are associated with similar rates of recovery care unit bypass after anorectal surgery in jackknife position.

Cost-effectiveness of a new short-stay unit to "rule out" acute myocardial infarction in low risk patients.

PubMed

Gaspoz, J M; Lee, T H; Weinstein, M C; Cook, E F; Goldman, P; Komaroff, A L; Goldman, L

1994-11-01

This study attempted to determine the safety and costs of a new short-stay unit for low risk patients who may be admitted to a hospital to rule out myocardial infarction or ischemia. One strategy to reduce the costs of ruling out acute myocardial infarction in low risk patients is to develop alternatives to coronary care units. The short-term and 6-month clinical outcomes and costs for 592 patients admitted to a short-stay coronary observation unit at Brigham and Women's Hospital with a low (< or = 10%) probability of acute myocardial infarction were compared with those for 924 consecutive comparison patients who were eligible for the same unit but were admitted to other hospital settings or discharged home. Actual costs were calculated using detailed cost-accounting methods that incorporated nursing intensity weights. The rate of major complications, recurrent myocardial infarction or cardiac death during 6 months after the initial presentation of the 592 patients admitted to the coronary observation unit was similar to that of the 924 comparison patients before and after adjustment for clinical factors influencing triage and initial diagnoses (adjusted relative risk 0.86, 95% confidence interval 0.49 to 1.53). Their median total costs (25th, 75th percentile) at 6 months ($1,927; 1,455, 3,650) were significantly lower than for comparison patients admitted to the wards $4,712; 1,868, 11,187), to stepdown or intermediate care units ($4,031; 2,069, 9,169) or to the coronary care unit ($9,201; 3,171, 20,011) but were higher than for comparison patients discharged home from the emergency department ($403; 403,927) before and after the same adjustments (all adjusted p < 0.0001). These data suggest that the coronary observation unit may be a safe and cost-saving alternative to current triage strategies for patients with a low risk of acute myocardial infarction admitted from the emergency department. Its replication in other hospitals should be tested.

Hydrogeologic Framework, Groundwater Movement, and Water Budget in the Chambers-Clover Creek Watershed and Vicinity, Pierce County, Washington

USGS Publications Warehouse

Savoca, Mark E.; Welch, Wendy B.; Johnson, Kenneth H.; Lane, R.C.; Fasser, Elisabeth T.

2010-01-01

This report presents information used to characterize the groundwater-flow system in the Chambers-Clover Creek Watershed and vicinity, and includes descriptions of the geology and hydrogeologic framework; groundwater recharge and discharge; groundwater levels and flow directions; seasonal groundwater level fluctuations; interactions between aquifers and the surface-water system; and a water budget. The study area covers about 706 square miles in western Pierce County, Washington, and extends north to the Puyallup River, southwest to the Nisqually River, and is bounded on the south and east by foothills of the Cascade Range and on the west by Puget Sound. The area is underlain by a northwest-thickening sequence of unconsolidated glacial and interglacial deposits which overlie sedimentary and volcanic bedrock units that crop out in the foothills along the southern and southeastern margin of the study area. Geologic units were grouped into 11 hydrogeologic units consisting of aquifers, confining units, and an underlying bedrock unit. A surficial hydrogeologic unit map was developed and used with well information from 450 drillers' logs to construct 6 hydrogeologic sections, and unit extent and thickness maps. Groundwater in unconsolidated glacial and interglacial aquifers generally flows to the northwest towards Puget Sound, and to the north and northeast towards the Puyallup River. These generalized flow patterns likely are complicated by the presence of low permeability confining units that separate discontinuous bodies of aquifer material and act as local groundwater-flow barriers. Water levels in wells completed in the unconsolidated hydrogeologic units show seasonal variations ranging from less than 1 to about 50 feet. The largest groundwater-level fluctuation (78 feet) observed during the monitoring period (March 2007-September 2008) was in a well completed in the bedrock unit. Synoptic streamflow measurements made in September 2007 and July 2008 indicated a total groundwater discharge to streams in the study area of 87,310 and 92,160 acre-feet per year, respectively. The synoptic streamflow measurements show a complex pattern of gains and losses to streamflows that varies throughout the study area, and appears to be influenced in places by local topography. Groundwater discharge occurs at numerous springs in the area and the total previously reported discharge of springs in the area is approximately 80,000 acre-feet per year. There are, in addition, many unmeasured springs and the total spring discharge in the area is unknown. The water-budget area (432 mi2 located within the larger study area) received an annual average (September1, 2006, to August 31, 2008) of about 1,025,000 acre-ft or about 45 inches of precipitation a year. About 44 percent of precipitation enters the groundwater system as recharge. Almost one-half of this recharge (49 percent) discharges to the Puyallup and Nisqually Rivers and leaves the groundwater system as submarine groundwater discharge to Puget Sound. The remaining groundwater recharge discharges to streams (20 percent) and springs (18 percent) or is withdrawn from wells (13 percent)

LAV@HAZARD: a Web-GIS Framework for Real-Time Forecasting of Lava Flow Hazards

NASA Astrophysics Data System (ADS)

Del Negro, C.; Bilotta, G.; Cappello, A.; Ganci, G.; Herault, A.

2014-12-01

Crucial to lava flow hazard assessment is the development of tools for real-time prediction of flow paths, flow advance rates, and final flow lengths. Accurate prediction of flow paths and advance rates requires not only rapid assessment of eruption conditions (especially effusion rate) but also improved models of lava flow emplacement. Here we present the LAV@HAZARD web-GIS framework, which combines spaceborne remote sensing techniques and numerical simulations for real-time forecasting of lava flow hazards. By using satellite-derived discharge rates to drive a lava flow emplacement model, LAV@HAZARD allows timely definition of parameters and maps essential for hazard assessment, including the propagation time of lava flows and the maximum run-out distance. We take advantage of the flexibility of the HOTSAT thermal monitoring system to process satellite images coming from sensors with different spatial, temporal and spectral resolutions. HOTSAT was designed to ingest infrared satellite data acquired by the MODIS and SEVIRI sensors to output hot spot location, lava thermal flux and discharge rate. We use LAV@HAZARD to merge this output with the MAGFLOW physics-based model to simulate lava flow paths and to update, in a timely manner, flow simulations. Thus, any significant changes in lava discharge rate are included in the predictions. A significant benefit in terms of computational speed was obtained thanks to the parallel implementation of MAGFLOW on graphic processing units (GPUs). All this useful information has been gathered into the LAV@HAZARD platform which, due to the high degree of interactivity, allows generation of easily readable maps and a fast way to explore alternative scenarios. We will describe and demonstrate the operation of this framework using a variety of case studies pertaining to Mt Etna, Sicily. Although this study was conducted on Mt Etna, the approach used is designed to be applicable to other volcanic areas around the world.

Restrictive transfusion threshold is safe in high-risk patients undergoing brain tumor surgery.

PubMed

Alkhalid, Yasmine; Lagman, Carlito; Sheppard, John P; Nguyen, Thien; Prashant, Giyarpuram N; Ziman, Alyssa F; Yang, Isaac

2017-12-01

To assess the safety of a restrictive threshold for the transfusion of red blood cells (RBCs) compared to a liberal threshold in high-risk patients undergoing brain tumor surgery. We reviewed patients who were 50 years of age or older with a preoperative American Society of Anesthesiologists physical status class II to V who underwent open craniotomy for tumor resection and were transfused packed RBCs during or after surgery. We retrospectively assigned patients to a restrictive-threshold (a pretransfusion hemoglobin level <8g/dL) or a liberal-threshold group (a pretransfusion hemoglobin level of 8-10/dL). The primary outcome was in-hospital mortality rate. Secondary outcomes were in-hospital complication rates, length of stay, and discharge disposition. Twenty-five patients were included in the study, of which 17 were assigned to a restrictive-threshold group and 8 patients to a liberal-threshold group. The in-hospital mortality rates were 12% for the restrictive-threshold group (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.07-12.11) and 13% for the liberal-threshold group. The in-hospital complication rates were 52.9% for the restrictive-threshold group (OR 1.13, 95% CI 0.21-6.05) and 50% for the liberal-threshold group. The average number of days in the intensive care unit and hospital were 8.6 and 22.4 days in the restrictive-threshold group and 6 and 15 days in the liberal-threshold group, respectively (P=0.69 and P=0.20). The rates of non-routine discharge were 71% in the restrictive-threshold group (OR 2.40, 95% CI 0.42-13.60) and 50% in the liberal-threshold group. A restrictive transfusion threshold did not significantly influence in-hospital mortality or complication rates, length of stay, or discharge disposition in patients at high operative risk. Copyright © 2017. Published by Elsevier B.V.

The natural channel of Brandywine Creek, Pennsylvania

USGS Publications Warehouse

Wolman, M.G.

1955-01-01

This study of the channel of Brandy wine Creek, Pennsylvania, consists of three parts. The first is an analysis of the changes which take place in the width, depth, velocity, slope of the water surface, suspended load, and roughness factor with changing discharge below the bankfull stage at each of several widely separated cross sections of the channel. Expressed as functions of the discharge, it is found that the variables behave systematically. In every section studied, as the discharge increases, the velocity increases to about the 0.6 power, depth to the 0.4, and load to the 2.0 power of the discharge. The roughness decreases to the 0.2 power of the discharge. The relative magnitudes and the direction of these variations are similar to those which have been observed in other rivers in the United States, primarily in the West. Some modifications of the hypotheses applicable to the western rivers are probably required because on Brandywine Creek the difference between the materials on the bed and in the banks is considerably greater than it is on most of the western rivers studied. In the second part of the paper the progressive changes of the same variables in the downstream direction with increasing discharge at a given frequency are described. Despite the disorderly appearance of the stream, it is found that the variables display a progressive, orderly change in the downstream direction when traced from the headwater tributaries through the trunk stream of Brandywine Creek. At a given frequency of flow, width increases with discharge to about the 0.5 power. Depth increases downstream somewhat less rapidly, while the slope and roughness both decrease in the downstream direction. Despite a decrease in the size of the material on the bed, both the mean velocity and the mean bed velocity increase downstream. The rates of change of these variables are in close accord with the changes observed on rivers flowing in alluvium and in stable irrigation canals. These relationships hold for all flows up to the bankfull stage. Analysis of the streamflow records indicates that the annual maximum discharge equals or exceeds the bankfull stage roughly once every 2 years. The regularity in the behavior of the variables with changing discharges both at-a-station and in the downstream direction and the similar rates of change of the variables on Brandywine Creek and in stable irrigation canals suggest the existence of a quasi-equilibrium in the channel of the creek. Part three of this study is concerned with this concept of equilibrium in streams. By analogy with canals and with several rivers in diverse regions of the United States it may be concluded that this quasi-equilibrium is closely related to the discharge, and to the concentration of the suspended load. The shape and longitudinal profile of the channel are determined by these two independent factors which operate within the limits set by the local geology. The latter determines the initial size, shape, and resistance of the material provided to the channel. The existence of a quasi-equilibrium among the variables studied suggests that most reaches on Brandywine Creek are at grade. This is true if the term "grade," when applied to natural rivers, is synonymous with quasi-equilibrium. The adjustability of the variables in the channel rather than the stability of any particular shape or longitudinal profile of the channel is emphasized when t

Spatial Characteristics of Geothermal Spring Temperatures and Discharge Rates in the Tatun Volcanic Area, Taiwan

NASA Astrophysics Data System (ADS)

Jang, C. S.; Liu, C. W.

2014-12-01

The Tatun volcanic area is the only potential volcanic geothermal region in the Taiwan island, and abundant in hot spring resources owing to stream water mixing with fumarolic gases. According to the Meinzer's classification, spring temperatures and discharge rates are the most important properties for characterizing spring classifications. This study attempted to spatially characterize spring temperatures and discharge rates in the Tatun volcanic area, Taiwanusing indicator kriging (IK). First, data on spring temperatures and discharge rates, which were collected from surveyed data of the Taipei City Government, were divided into high, moderate and low categories according to spring classification criteria, and the various categories were regarded as estimation thresholds. Then, IK was adopted to model occurrence probabilities of specified temperatures and discharge rates in springs, and to determine their classifications based on estimated probabilities. Finally, nine combinations were obtained from the classifications of temperatures and discharge rates in springs. Moreover, the combinations and features of spring water were spatially quantified according to seven sub-zones of spring utilization. A suitable and sustainable development strategy of the spring area was proposed in each sub-zone based on probability-based combinations and features of spring water.The research results reveal that the probability-based classifications using IK provide an excellent insight in exploring the uncertainty of spatial features in springs, and can provide Taiwanese government administrators with detailed information on sustainable spring utilization and conservation in the overexploited spring tourism areas. The sub-zones BT (Beitou), RXY (Rd. Xingyi), ZSL (Zhongshanlou) and LSK (Lengshuikeng) with high or moderate discharge rates are suitable to supply spring water for tourism hotels.Local natural hot springs should be planned in the sub-zones DBT (Dingbeitou), ZSL, XYK (Xiayoukeng), and MC (Macao) with low discharge rates, and low or moderate temperatures, particularly in riverbeds or valleys.Keywords: Spring; Temperature; Discharge rate; Indicator kriging; Uncertainty

Lead-acid batteries in micro-hybrid applications. Part II. Test proposal

NASA Astrophysics Data System (ADS)

Schaeck, S.; Stoermer, A. O.; Albers, J.; Weirather-Koestner, D.; Kabza, H.

In the first part of this work [1] selected key parameters for applying lead-acid (LA) batteries in micro-hybrid power systems (MHPS) were investigated. Main results are integrated in an accelerated, comprehensive test proposal presented here. The test proposal aims at a realistic representation of the pSoC operation regime, which is described in Refs. [1,6]. The test is designed to be sensitive with respect to dynamic charge acceptance (DCA) at partially discharged state (critical for regenerative braking) and the internal resistance at high-rate discharge (critical for idling stop applications). First results are presented for up-to-date valve-regulated LA batteries with absorbent glass mat (AGM) separators. The batteries are close to the limits of the first proposal of pass/fail-criteria. Also flooded batteries were tested; the first out of ten units failed already.

The suitability of using dissolved gases to determine groundwater discharge to high gradient streams

USGS Publications Warehouse

Gleeson, Tom; Manning, Andrew H.; Popp, Andrea; Zane, Mathew; Clark, Jordan F.

2018-01-01

Determining groundwater discharge to streams using dissolved gases is known to be useful over a wide range of streamflow rates but the suitability of dissolved gas methods to determine discharge rates in high gradient mountain streams has not been sufficiently tested, even though headwater streams are critical as ecological habitats and water resources. The aim of this study is to test the suitability of using dissolved gases to determine groundwater discharge rates to high gradient streams by field experiments in a well-characterized, high gradient mountain stream and a literature review. At a reach scale (550 m) we combined stream and groundwater radon activity measurements with an in-stream SF6 tracer test. By means of numerical modeling we determined gas exchange velocities and derived very low groundwater discharge rates (∼15% of streamflow). These groundwater discharge rates are below the uncertainty range of physical streamflow measurements and consistent with temperature, specific conductance and streamflow measured at multiple locations along the reach. At a watershed-scale (4 km), we measured CFC-12 and δ18O concentrations and determined gas exchange velocities and groundwater discharge rates with the same numerical model. The groundwater discharge rates along the 4 km stream reach were highly variable, but were consistent with the values derived in the detailed study reach. Additionally, we synthesized literature values of gas exchange velocities for different stream gradients which show an empirical relationship that will be valuable in planning future dissolved gas studies on streams with various gradients. In sum, we show that multiple dissolved gas tracers can be used to determine groundwater discharge to high gradient mountain streams from reach to watershed scales.

The suitability of using dissolved gases to determine groundwater discharge to high gradient streams

NASA Astrophysics Data System (ADS)

Gleeson, Tom; Manning, Andrew H.; Popp, Andrea; Zane, Matthew; Clark, Jordan F.

2018-02-01

Determining groundwater discharge to streams using dissolved gases is known to be useful over a wide range of streamflow rates but the suitability of dissolved gas methods to determine discharge rates in high gradient mountain streams has not been sufficiently tested, even though headwater streams are critical as ecological habitats and water resources. The aim of this study is to test the suitability of using dissolved gases to determine groundwater discharge rates to high gradient streams by field experiments in a well-characterized, high gradient mountain stream and a literature review. At a reach scale (550 m) we combined stream and groundwater radon activity measurements with an in-stream SF6 tracer test. By means of numerical modeling we determined gas exchange velocities and derived very low groundwater discharge rates (∼15% of streamflow). These groundwater discharge rates are below the uncertainty range of physical streamflow measurements and consistent with temperature, specific conductance and streamflow measured at multiple locations along the reach. At a watershed-scale (4 km), we measured CFC-12 and δ18O concentrations and determined gas exchange velocities and groundwater discharge rates with the same numerical model. The groundwater discharge rates along the 4 km stream reach were highly variable, but were consistent with the values derived in the detailed study reach. Additionally, we synthesized literature values of gas exchange velocities for different stream gradients which show an empirical relationship that will be valuable in planning future dissolved gas studies on streams with various gradients. In sum, we show that multiple dissolved gas tracers can be used to determine groundwater discharge to high gradient mountain streams from reach to watershed scales.

41 CFR 105-55.030 - Discharge of indebtedness; reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... offset, tax refund offset, Federal salary offset, referral to Treasury, Treasury-designated debt... action. (b) Section 3711(i), Title 31, United States Code, requires GSA to sell a delinquent non-tax debt... Discharge of indebtedness; reporting requirements. (a) Before discharging a delinquent debt (also referred...

38 CFR 52.80 - Enrollment, transfer and discharge rights.

Code of Federal Regulations, 2013 CFR

2013-07-01

... hospitalizations, outpatient clinic visits; or emergency evaluation unit visits, in the past 12 months. (v) Diagnosis of clinical depression. (vi) Recent discharge from nursing home or hospital. (vii) Significant... management must permit each participant to remain in the program, and not transfer or discharge the...

EXPERT SYSTEMS FOR MIXING-ZONE ANALYSIS AND DESIGN OF POLLUTANT DISCHARGES

EPA Science Inventory

Water-quality policy in the United States includes the concept of a mixing zone, a limited area or volume of water where initial dilution of an aqueous pollutant discharge occurs. iven a myriad of possible discharge configurations, ambient environments, and mixing zone definition...

Auditory thresholds in the American cockroach (Orthoptera: Blattidae): estimates using single-unit and compound-action potential recordings.

PubMed

Decker, T N; Jones, T A; Gold, R E

1989-06-01

Recent commercial suggestions that insect populations can be controlled through the use of ultrasound raises the question of whether or not certain insects have receptors that are sensitive to high-frequency sound. Single neural unit discharges and compound-action potentials were recorded from the ventral nerve cord in the American cockroach, Periplaneta americana L., to constant rise time tone pulses from 100 to 40,000 hertz (Hz). Unit responses and compound-action potentials show that the cockroach is insensitive to sound above approximately 3,000 Hz. Data relating latency of the response to intensity of the stimulus suggest that the cockroach cercal system operates on the principle of energy envelope detection. Decreases in latency likely occur primarily as a result of increases in the rate of membrane depolarization in cercal dendrites.

Method and means for measuring acoustic emissions

DOEpatents

Renken, Jr., Claus J.

1976-01-06

The detection of acoustic emissions emanating from an object is achieved with a capacitive transducer coupled to the object. The capacitive transducer is charged and then allowed to discharge with the rate of discharge being monitored. Oscillations in the rate of discharge about the normally exponential discharge curve for the capacitive transducer indicate the presence of acoustic emissions.

Large rivers of the United States

USGS Publications Warehouse

Iseri, Kathleen T.; Langbein, Walter Basil

1974-01-01

Information on the flow of the 28 largest rivers in the United States is presented for the base periods 1931-60 and 1941-70. Drainage area, stream length, source, and mouth are included. Table 1 shows the average discharge at downstream gaging stations. Table 2 lists large rivers in order of average discharge at the mouth, based on the period 1941-70.

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities

PubMed Central

Karb, Rebecca A.; Subramanian, S. V.; Fleegler, Eric W.

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999–2012. Complete annual compressed mortality and population data for 1999–2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty. PMID:27144919

County Poverty Concentration and Disparities in Unintentional Injury Deaths: A Fourteen-Year Analysis of 1.6 Million U.S. Fatalities.

PubMed

Karb, Rebecca A; Subramanian, S V; Fleegler, Eric W

2016-01-01

Unintentional injury is the fourth leading cause of death in the United States, and mortality due to injury has risen over the past decade. The social determinants behind these rising trends have not been well documented. This study examines the relationship between county-level poverty and unintentional injury mortality in the United States from 1999-2012. Complete annual compressed mortality and population data for 1999-2012 were obtained from the National Center for Health Statistics and linked with census yearly county poverty measures. The outcomes examined were unintentional injury fatalities, overall and by six specific mechanisms: motor vehicle collisions, falls, accidental discharge of firearms, drowning, exposure to smoke or fire, and unintentional poisoning. Age-adjusted mortality rates and time trends for county poverty categories were calculated, and multivariate negative binomial regression was used to determine changes over time in both the relative risk of living in high poverty concentration areas and the population attributable fraction. Age-adjusted mortality rates for counties with > 20% poverty were 66% higher mortality in 1999 compared with counties with < 5% poverty (45.25 vs. 27.24 per 100,000; 95% CI for rate difference 15.57,20.46), and that gap widened in 2012 to 79% (44.54 vs. 24.93; 95% CI for rate difference 17.13,22.09). The relative risk of living in the highest poverty counties has increased for all injury mechanisms with the exception of accidental discharge of firearms. The population attributable fraction for all unintentional injuries rose from 0.22 (95% CI 0.13,0.30) in 1999 to 0.35 (95% CI 0.22,0.45) in 2012. This is the first study that uses comprehensive mortality data to document the associations between county poverty and injury mortality rates for the entire US population over a 14 year period. This study suggests that injury reduction interventions should focus on areas of high or increasing poverty.

Sobriety as an admission criterion for transitional housing: a multi-site comparison of programs with a sobriety requirement to programs with no sobriety requirement.

PubMed

Tsai, Jack; Rosenheck, Robert A; Kasprow, Wesley J; McGuire, James F

2012-10-01

This study examined whether homeless clients enrolled in transitional housing programs that required sobriety (SR) as an admission criterion have outcomes comparable to clients enrolled in programs that did not require sobriety (NSR) as an admission criterion. A total of 1062 military veterans in 40 transitional housing programs funded by the United States Department of Veterans Affairs were grouped based on whether they were in SR or NSR programs and followed over a one-year period after program discharge. Participants in SR and NSR programs were compared on their ratings of the social climate of the program, and housing and psychosocial outcomes. Participants in SR programs reported more days housed and better psychosocial outcomes than participants in NSR programs, although the differences were small and there were no differences in ratings of their social climate. Both participants in SR and NSR programs showed improvements on most outcomes after discharge from transitional housing. There were no significant differences in outcomes between participants actively abusing substances at program entry compared to those who were not. Requiring sobriety as an admission criterion in transitional housing made only a small difference in housing outcomes post-discharge. Further study is needed to determine whether requiring sobriety at admission in transitional housing is necessary for successful client outcomes. Published by Elsevier Ireland Ltd.

Trends in rates of acetaminophen-related adverse events in the United States

PubMed Central

Major, Jacqueline M.; Zhou, Esther H.; Wong, Hui-Lee; Trinidad, James P.; Pham, Tracy M.; Mehta, Hina; Ding, Yulan; Staffa, Judy A.; Iyasu, Solomon; Wang, Cunlin; Willy, Mary E.

2017-01-01

Purpose The goal of this study is to summarize trends in rates of adverse events attributable to acetaminophen use, including hepatotoxicity and mortality. Methods A comprehensive analysis of data from three national surveillance systems estimated rates of acetaminophen-related events identified in different settings, including calls to poison centers (2008–2012), emergency department visits (2004–2012), and inpatient hospitalizations (1998–2011). Rates of acetaminophen-related events were calculated per setting, census population, and distributed drug units. Results Rates of poison center calls with acetaminophen-related exposures decreased from 49.5/1000 calls in 2009 to 43.5/1000 calls in 2012. Rates of emergency department visits for unintentional acetaminophen-related adverse events decreased from 58.0/1000 emergency department visits for adverse drug events in 2009 to 50.2/1000 emergency department visits in 2012. Rates of hospital inpatient discharges with acetaminophen-related poisoning decreased from 119.8/100 000 hospitalizations in 2009 to 108.6/100 000 hospitalizations in 2011. After 2009, population rates of acetaminophen-related events per 1million census population decreased for poison center calls and hospitalizations, while emergency department visit rates remained stable. However, when accounting for drug sales, the rate of acetaminophen-related events (per 1 million distributed drug units) increased after 2009. Prior to 2009, the rates of acetaminophen-related hospitalizations had been slowly increasing (p-trend = 0.001). Conclusions Acetaminophen-related adverse events continue to be a public health burden. Future studies with additional time points are necessary to confirm trends and determine whether recent risk mitigation efforts had a beneficial impact on acetaminophen-related adverse events. PMID:26530380

Everyone deserves a second chance: a decade of supports for teenage mothers.

PubMed

Hudgins, Rebekah; Erickson, Steve; Walker, Dion

2014-05-01

Georgia had the third highest 2010 repeat teenage birth rate in the United States and has had one of the worst rates for years. Since 2001, Georgia's Second Chance Home Network, administered by the Georgia Campaign for Adolescent Power and Potential, has provided housing and support to parenting teenagers--almost two-thirds of whom were in custody of and referred by Georgia's Department of Children and Family Services--to help them become nurturing and self-sufficient parents, to avoid repeat teenage pregnancies, and to promote healthy development of their children. Data were collected from each resident at intake, discharge, and three follow-up points at three, 12, and 24 months after discharge. Evaluation has consistently revealed improvements in several key outcomes, including education, housing, income, self-sufficiency, parenting, repeat pregnancy, and child outcomes. The 2012 evaluation revealed benefits in all these areas and found that those who stayed longer demonstrated better outcomes, especially related to the core outcomes of educational status, employment, and stable residence. Methods and findings about these outcomes are featured in this article.

Air and water cooled modulator

DOEpatents

Birx, Daniel L.; Arnold, Phillip A.; Ball, Don G.; Cook, Edward G.

1995-01-01

A compact high power magnetic compression apparatus and method for delivering high voltage pulses of short duration at a high repetition rate and high peak power output which does not require the use of environmentally unacceptable fluids such as chlorofluorocarbons either as a dielectric or as a coolant, and which discharges very little waste heat into the surrounding air. A first magnetic switch has cooling channels formed therethrough to facilitate the removal of excess heat. The first magnetic switch is mounted on a printed circuit board. A pulse transformer comprised of a plurality of discrete electrically insulated and magnetically coupled units is also mounted on said printed board and is electrically coupled to the first magnetic switch. The pulse transformer also has cooling means attached thereto for removing heat from the pulse transformer. A second magnetic switch also having cooling means for removing excess heat is electrically coupled to the pulse transformer. Thus, the present invention is able to provide high voltage pulses of short duration at a high repetition rate and high peak power output without the use of environmentally unacceptable fluids and without discharging significant waste heat into the surrounding air.

Effect of the Sm content on the structure and electrochemical properties of La 1.3 - xSm xCaMg 0.7Ni 9 ( x = 0-0.3) hydrogen storage alloys

NASA Astrophysics Data System (ADS)

Tang, Rui; Wei, Xuedong; Liu, Yongning; Zhu, Changchun; Zhu, Jiewu; Yu, Guang

La 1.3 - xSm xCaMg 0.7Ni 9 (x = 0-0.3) hydrogen storage alloys were prepared by inductive melting and the effect of the Sm content on the structure and electrochemical properties was investigated in the paper. The Sm substitution for La in La 1.3 - xSm xCaMg 0.7Ni 9 (x = 0-0.3) alloys does not change the main phase structure (the rhombohedral PuNi 3-type structure), but leads to a shrinkage of unit cell and a decrease of hydrogen storage capacity. With the increase of the Sm content in the alloys, the maximum discharge capacity of electrode decreases from 400.2 (x = 0) to 346.6 mAh g -1 (x = 0.3), but the high-rate dischargeability and cycling stability is improved. After 100 cycles, the capacity retention rate increases from 75 (x = 0) to 85% (x = 0.3).

Relationships between ecosystem metabolism, benthic macroinvertebrate densities, and environmental variables in a sub-arctic Alaskan river

USGS Publications Warehouse

Benson, Emily R.; Wipfli, Mark S.; Clapcott, Joanne E.; Hughes, Nicholas F.

2013-01-01

Relationships between environmental variables, ecosystem metabolism, and benthos are not well understood in sub-arctic ecosystems. The goal of this study was to investigate environmental drivers of river ecosystem metabolism and macroinvertebrate density in a sub-arctic river. We estimated primary production and respiration rates, sampled benthic macroinvertebrates, and monitored light intensity, discharge rate, and nutrient concentrations in the Chena River, interior Alaska, over two summers. We employed Random Forests models to identify predictor variables for metabolism rates and benthic macroinvertebrate density and biomass, and calculated Spearman correlations between in-stream nutrient levels and metabolism rates. Models indicated that discharge and length of time between high water events were the most important factors measured for predicting metabolism rates. Discharge was the most important variable for predicting benthic macroinvertebrate density and biomass. Primary production rate peaked at intermediate discharge, respiration rate was lowest at the greatest time since last high water event, and benthic macroinvertebrate density was lowest at high discharge rates. The ratio of dissolved inorganic nitrogen to soluble reactive phosphorus ranged from 27:1 to 172:1. We found that discharge plays a key role in regulating stream ecosystem metabolism, but that low phosphorous levels also likely limit primary production in this sub-arctic stream.

Staff perception of patient discharge from ICU to ward-based care.

PubMed

James, Stephen; Quirke, Sara; McBride-Henry, Karen

2013-11-01

The quality of information exchange between intensive care unit (ICU) and ward nurses, when patients are transferred out of intensive care, is important to the continuity of safe care. This research aimed to explore nurses' experiences of the discharge process from ICU to the ward environment. The study was conducted in a New Zealand Metropolitan hospital, using an exploratory descriptive design we adapted a questionnaire based on Whittaker and Ball's research on ICU patient handover. The questionnaires were then analysed using a descriptive thematic approach. The response rate of 48% included 45 ICU and 47 ward nurses. Key findings were that the written and verbal communication needs differ dependent upon setting and the timing of a discharge. Timing of handover also requires negotiation. Being able to negotiate the timing and nature of handover is important for nurses. In addition, standardized approaches to communication are believed to enhance patient safety. Standardized handover, with content and processes that are mutually negotiated, is crucial to providing the safest environment for patients. © 2013 The Authors. Nursing in Critical Care © 2013 British Association of Critical Care Nurses.

Method of inducing differential etch rates in glow discharge produced amorphous silicon

DOEpatents

Staebler, David L.; Zanzucchi, Peter J.

1980-01-01

A method of inducing differential etch rates in glow discharge produced amorphous silicon by heating a portion of the glow discharge produced amorphous silicon to a temperature of about 365.degree. C. higher than the deposition temperature prior to etching. The etch rate of the exposed amorphous silicon is less than the unheated amorphous silicon.

46 CFR 108.437 - Pipe sizes and discharge rates for enclosed ventilation systems for rotating electrical equipment.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 4 2011-10-01 2011-10-01 false Pipe sizes and discharge rates for enclosed ventilation... Systems Fixed Carbon Dioxide Fire Extinguishing Systems § 108.437 Pipe sizes and discharge rates for enclosed ventilation systems for rotating electrical equipment. (a) The minimum pipe size for the initial...

46 CFR 108.437 - Pipe sizes and discharge rates for enclosed ventilation systems for rotating electrical equipment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Pipe sizes and discharge rates for enclosed ventilation systems for rotating electrical equipment. 108.437 Section 108.437 Shipping COAST GUARD, DEPARTMENT OF... Systems Fixed Carbon Dioxide Fire Extinguishing Systems § 108.437 Pipe sizes and discharge rates for...

40 CFR 110.3 - Discharge of oil in such quantities as “may be harmful” pursuant to section 311(b)(4) of the Act.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Discharge of oil in such quantities as... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DISCHARGE OF OIL § 110.3 Discharge of... may be harmful to the public health or welfare or the environment of the United States include...

40 CFR 110.3 - Discharge of oil in such quantities as “may be harmful” pursuant to section 311(b)(4) of the Act.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Discharge of oil in such quantities as... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DISCHARGE OF OIL § 110.3 Discharge of... may be harmful to the public health or welfare or the environment of the United States include...

40 CFR 110.3 - Discharge of oil in such quantities as “may be harmful” pursuant to section 311(b)(4) of the Act.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Discharge of oil in such quantities as... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DISCHARGE OF OIL § 110.3 Discharge of... may be harmful to the public health or welfare or the environment of the United States include...

Current surgical practices in cleft care: cleft palate repair techniques and postoperative care.

PubMed

Katzel, Evan B; Basile, Patrick; Koltz, Peter F; Marcus, Jeffrey R; Girotto, John A

2009-09-01

The purpose of this study was to objectively report practices commonly used in cleft palate repair in the United States. This study investigates current surgical techniques, postoperative care, and complication rates for cleft palate repair surgery. All 803 surgeon members of the American Cleft Palate-Craniofacial Association were sent online and/or paper surveys inquiring about their management of cleft palate patients. Three-hundred six surveys were received, a 38 percent response rate. This represented responses of surgeons from 100 percent of American Cleft Palate-Craniofacial Association registered cleft teams. Ninety-six percent of respondents perform a one-stage repair. Eighty-five percent of surgeons perform palate surgery when the patient is between 6 and 12 months of age. The most common one-stage repair techniques are the Bardach style (two flaps) with intravelar veloplasty and the Furlow palatoplasty. After surgery, 39 percent of surgeons discharge patients within 24 hours. Another 43 percent discharge patients within 48 hours. During postoperative management, 92 percent of respondents implement feeding restrictions. Eighty-five percent of physicians use arm restraints. Surgeons' self-reported complications rates are minimal: 54 percent report a fistula in less than 5 percent of cases. The reported need for secondary speech surgery varies widely. The majority of respondents repair clefts in one stage. The most frequently used repair techniques are the Furlow palatoplasty and the Bardach style with intravelar veloplasty. After surgery, the majority of surgeons discharge patients in 1 or 2 days, and nearly all surgeons implement feeding restrictions and the use of arm restraints. The varying feeding protocols are reviewed in this article.

Incidence and outcome of in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit.

PubMed

Nolan, Jerry P; Soar, Jasmeet; Smith, Gary B; Gwinnutt, Carl; Parrott, Francesca; Power, Sarah; Harrison, David A; Nixon, Edel; Rowan, Kathryn

2014-08-01

To report the incidence, characteristics and outcome of adult in-hospital cardiac arrest in the United Kingdom (UK) National Cardiac Arrest Audit database. A prospectively defined analysis of the UK National Cardiac Arrest Audit (NCAA) database. 144 acute hospitals contributed data relating to 22,628 patients aged 16 years or over receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a 2222 call. The main outcome measures were incidence of adult in-hospital cardiac arrest and survival to hospital discharge. The overall incidence of adult in-hospital cardiac arrest was 1.6 per 1000 hospital admissions with a median across hospitals of 1.5 (interquartile range 1.2-2.2). Incidence varied seasonally, peaking in winter. Overall unadjusted survival to hospital discharge was 18.4%. The presenting rhythm was shockable (ventricular fibrillation or pulseless ventricular tachycardia) in 16.9% and non-shockable (asystole or pulseless electrical activity) in 72.3%; rates of survival to hospital discharge associated with these rhythms were 49.0% and 10.5%, respectively, but varied substantially across hospitals. These first results from the NCAA database describing the current incidence and outcome of adult in-hospital cardiac arrest in UK hospitals will serve as a benchmark from which to assess the future impact of changes in service delivery, organisation and treatment for in-hospital cardiac arrest. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Estimation of Uncertainties in Stage-Discharge Curve for an Experimental Himalayan Watershed

NASA Astrophysics Data System (ADS)

Kumar, V.; Sen, S.

2016-12-01

Various water resource projects developed on rivers originating from the Himalayan region, the "Water Tower of Asia", plays an important role on downstream development. Flow measurements at the desired river site are very critical for river engineers and hydrologists for water resources planning and management, flood forecasting, reservoir operation and flood inundation studies. However, an accurate discharge assessment of these mountainous rivers is costly, tedious and frequently dangerous to operators during flood events. Currently, in India, discharge estimation is linked to stage-discharge relationship known as rating curve. This relationship would be affected by a high degree of uncertainty. Estimating the uncertainty of rating curve remains a relevant challenge because it is not easy to parameterize. Main source of rating curve uncertainty are errors because of incorrect discharge measurement, variation in hydraulic conditions and depth measurement. In this study our objective is to obtain best parameters of rating curve that fit the limited record of observations and to estimate uncertainties at different depth obtained from rating curve. The rating curve parameters of standard power law are estimated for three different streams of Aglar watershed located in lesser Himalayas by maximum-likelihood estimator. Quantification of uncertainties in the developed rating curves is obtained from the estimate of variances and covariances of the rating curve parameters. Results showed that the uncertainties varied with catchment behavior with error varies between 0.006-1.831 m3/s. Discharge uncertainty in the Aglar watershed streams significantly depend on the extent of extrapolation outside the range of observed water levels. Extrapolation analysis confirmed that more than 15% for maximum discharges and 5% for minimum discharges are not strongly recommended for these mountainous gauging sites.

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.

Post-fire, rainfall intensity-peak discharge relations for three mountainous watersheds in the Western USA

USGS Publications Warehouse

Moody, J.A.; Martin, D.A.

2001-01-01

Wildfire alters the hydrologic response of watersheds, including the peak discharges resulting from subsequent rainfall. Improving predictions of the magnitude of flooding that follows wildfire is needed because of the increase in human population at risk in the wildland-urban interface. Because this wildland-urban interface is typically in mountainous terrain, we investigated rainfall-runoff relations by measuring the maximum 30 min rainfall intensity and the unit-area peak discharge (peak discharge divided by the area burned) in three mountainous watersheds (17-26.8 km2) after a wildfire. We found rainfall-runoff relations that relate the unit-area peak discharges to the maximum 30 min rainfall intensities by a power law. These rainfall-runoff relations appear to have a threshold value for the maximum 30 min rainfall intensity (around 10 mm h-1) such that, above this threshold, the magnitude of the flood peaks increases more rapidly with increases in intensity. This rainfall intensity could be used to set threshold limits in rain gauges that are part of an early-warning flood system after wildfire. The maximum unit-area peak discharges from these three burned watersheds ranged from 3.2 to 50 m3 s-1 km-2. These values could provide initial estimates of the upper limits of runoff that can be used to predict floods after wildfires in mountainous terrain. Published in 2001 by John Wiley and Sons, Ltd.

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.

Factors associated with variations in hospital expenditures for acute heart failure in the United States.

PubMed

Ziaeian, Boback; Sharma, Puza P; Yu, Tzy-Chyi; Johnson, Katherine Waltman; Fonarow, Gregg C

2015-02-01

Relatively little contemporary data are available that describe differences in acute heart failure (AHF) hospitalization expenditures as a function of patient and hospital characteristics, especially from a population-based investigation. This study aimed to evaluate factors associated with variations in hospital expenditures for AHF in the United States. A cross-sectional analysis using discharge data from the 2011 Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, was conducted. Discharges with primary International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis codes for AHF in adults were included. Costs were estimated by converting Nationwide Inpatient Sample charge data using the Healthcare Cost and Utilization Project Cost-to-Charge Ratio File. Discharges with highest (≥80th percentile) versus lowest (≤20th percentile) costs were compared for patient characteristics, hospital characteristics, utilization of procedures, and outcomes. Of the estimated 1 million AHF hospital discharges, the mean cost estimates were $10,775 per episode. Younger age, higher percentage of obesity, atrial fibrillation, pulmonary disease, fluid/electrolyte disturbances, renal insufficiency, and greater number of cardiac/noncardiac procedures were observed in stays with highest versus lowest costs. Highest-cost discharges were more likely to be observed in urban and teaching hospitals. Highest-cost AHF discharges also had 5 times longer length of stay, were 9 times more costly, and had higher in-hospital mortality (5.6% vs 3.5%) compared with discharges with lowest costs (all P < .001). Acute heart failure hospitalizations are costly. Expenditures vary markedly among AHF hospitalizations in the United States, with substantial differences in patient and hospital characteristics, procedures, and in-hospital outcomes among discharges with highest compared with lowest costs. Copyright © 2014 Elsevier Inc. All rights reserved.

Assssment and Mapping of the Riverine Hydrokinetic Resource in the Continental United States

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

Jacobson, Paul T.; Ravens, Thomas M.; Cunningham, Keith W.

2012-12-14

The U.S. Department of Energy (DOE) funded the Electric Power Research Institute and its collaborative partners, University of Alaska ? Anchorage, University of Alaska ? Fairbanks, and the National Renewable Energy Laboratory, to provide an assessment of the riverine hydrokinetic resource in the continental United States. The assessment benefited from input obtained during two workshops attended by individuals with relevant expertise and from a National Research Council panel commissioned by DOE to provide guidance to this and other concurrent, DOE-funded assessments of water based renewable energy. These sources of expertise provided valuable advice regarding data sources and assessment methodology. Themore » assessment of the hydrokinetic resource in the 48 contiguous states is derived from spatially-explicit data contained in NHDPlus ?a GIS-based database containing river segment-specific information on discharge characteristics and channel slope. 71,398 river segments with mean annual flow greater than 1,000 cubic feet per second (cfs) mean discharge were included in the assessment. Segments with discharge less than 1,000 cfs were dropped from the assessment, as were river segments with hydroelectric dams. The results for the theoretical and technical resource in the 48 contiguous states were found to be relatively insensitive to the cutoff chosen. Raising the cutoff to 1,500 cfs had no effect on estimate of the technically recoverable resource, and the theoretical resource was reduced by 5.3%. The segment-specific theoretical resource was estimated from these data using the standard hydrological engineering equation that relates theoretical hydraulic power (Pth, Watts) to discharge (Q, m3 s-1) and hydraulic head or change in elevation (??, m) over the length of the segment, where ? is the specific weight of water (9800 N m-3): ??? = ? ? ?? For Alaska, which is not encompassed by NPDPlus, hydraulic head and discharge data were manually obtained from Idaho National Laboratory?s Virtual Hydropower Prospector, Google Earth, and U.S. Geological Survey gages. Data were manually obtained for the eleven largest rivers with average flow rates greater than 10,000 cfs and the resulting estimate of the theoretical resource was expanded to include rivers with discharge between 1,000 cfs and 10,000 cfs based upon the contribution of rivers in the latter flow class to the total estimate in the contiguous 48 states. Segment-specific theoretical resource was aggregated by major hydrologic region in the contiguous, lower 48 states and totaled 1,146 TWh/yr. The aggregate estimate of the Alaska theoretical resource is 235 TWh/yr, yielding a total theoretical resource estimate of 1,381 TWh/yr for the continental US. The technically recoverable resource in the contiguous 48 states was estimated by applying a recovery factor to the segment-specific theoretical resource estimates. The recovery factor scales the theoretical resource for a given segment to take into account assumptions such as minimum required water velocity and depth during low flow conditions, maximum device packing density, device efficiency, and flow statistics (e.g., the 5 percentile flow relative to the average flow rate). The recovery factor also takes account of ?back effects? ? feedback effects of turbine presence on hydraulic head and velocity. The recovery factor was determined over a range of flow rates and slopes using the hydraulic model, HEC-RAS. In the hydraulic modeling, presence of turbines was accounted for by adjusting the Manning coefficient. This analysis, which included 32 scenarios, led to an empirical function relating recovery factor to slope and discharge. Sixty-nine percent of NHDPlus segments included in the theoretical resource estimate for the contiguous 48 states had an estimated recovery factor of zero. For Alaska, data on river slope was not readily available; hence, the recovery factor was estimated based on the flow rate alone. Segment-specific estimates of the theoretical resource were multiplied by the corresponding recovery factor to estimate the technically recoverable resource. The resulting technically recoverable resource estimate for the continental United States is 120 TWh/yr.« less

38 CFR 4.30 - Convalescent ratings.

Code of Federal Regulations, 2010 CFR

2010-07-01

... RATING DISABILITIES General Policy in Rating § 4.30 Convalescent ratings. A total disability rating (100... by report at hospital discharge (regular discharge or release to non-bed care) or outpatient release... total ratings will not be subject to § 3.105(e) of this chapter. Such total rating will be followed by...

Predictors and variation of routine home discharge in critically ill adults with cystic fibrosis.

PubMed

Oud, Lavi; Chan, Yiu Ming

2018-06-01

The short-term outcomes of patients with cystic fibrosis (CF) surviving critical illness were not examined systematically. To determine the factors associated with and variation in rates of routine home discharge among ICU-managed adult CF patients. Predictors of routine home discharge and its hospital-level variation were examined in ICU-managed adults with cystic fibrosis in Texas during 2004-2013. Older age, rural residence, and severity of illness decreased odds of routine home discharge, while hospitalization in facilities accredited as part of the Cystic Fibrosis Foundation Care Center Network nearly doubled the odds of routine home discharge. The median (interquartile) adjusted rate of routine home discharge was 62.0% (31.5-82.5). The identified determinants of routine home discharge can inform clinical decision-making, while the demonstrated wide variation in adjusted across-hospital rates of routine home discharge of ICU-managed adults with CF can provide benchmark data for future quality improvement efforts. Published by Elsevier Inc.

Inappropriate prescribing for older people admitted to an intermediate-care nursing home unit and hospital wards.

PubMed

Bakken, Marit Stordal; Ranhoff, Anette Hylen; Engeland, Anders; Ruths, Sabine

2012-09-01

To identify inappropriate prescribing among older patients on admission to and discharge from an intermediate-care nursing home unit and hospital wards, and to compare changes during stay within and between these groups. Observational study. Altogether 400 community-dwelling people aged ≥ 70 years, on consecutive emergency admittance to hospital wards of internal medicine and orthopaedic surgery, were randomized to an intermediate-care nursing home unit or hospital wards; 290 (157 at the intermediate-care nursing home unit and 133 in hospital wards) were eligible for this sub-study. Prevalence on admission and discharge of potentially inappropriate medications (Norwegian general practice [NORGEP] criteria) and drug-drug interactions; changes during stay. The mean (SD) age was 84.7 (6.2) years; 71% were women. From admission to discharge, the mean numbers of drugs prescribed per person increased from 6.0 (3.3) to 9.3 (3.8), p < 0.01. The prevalence of potentially inappropriate medications increased from 24% to 35%, p < 0.01; concomitant use of ≥ 3 psychotropic/opioid drugs and drug combinations including non-steroid anti-inflammatory drugs (NSAIDs) increased significantly. Serious drug-drug interactions were scarce both on admission and discharge (0.7%). Inappropriate prescribing was prevalent among older people acutely admitted to hospital, and the prevalence was not reduced during stay at an intermediate-care nursing home unit specially designed for these patients.

Is a specific oncological scoring system better at predicting the prognosis of cancer patients admitted for an acute medical complication in an intensive care unit than general gravity scores?

PubMed

Berghmans, T; Paesmans, M; Sculier, J P

2004-04-01

To evaluate the effectiveness of a specific oncologic scoring system-the ICU Cancer Mortality model (ICM)-in predicting hospital mortality in comparison to two general severity scores-the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Simplified Acute Physiology Score (SAPS II). All 247 patients admitted for a medical acute complication over an 18-month period in an oncological medical intensive care unit were prospectively registered. Their data, including type of complication, vital status at discharge and cancer characteristics as well as other variables necessary to calculate the three scoring systems were retrospectively assessed. Observed in-hospital mortality was 34%. The predicted in-hospital mortality rate for APACHE II was 32%; SAPS II, 24%; and ICM, 28%. The goodness of fit was inadequate except for the ICM score. Comparison of the area under the ROC curves revealed a better fit for ICM (area 0.79). The maximum correct classification rate was 72% for APACHE II, 74% for SAPS II and 77% for ICM. APACHE II and SAPS II were better at predicting outcome for survivors to hospital discharge, although ICM was better for non-survivors. Two variables were independently predicting the risk of death during hospitalisation: ICM (OR=2.31) and SAPS II (OR=1.05). Gravity scores were the single independent predictors for hospital mortality, and ICM was equivalent to APACHE II and SAPS II.

Interdependency between mechanical parameters and afferent nerve discharge in remodeled diabetic Goto-Kakizaki rat intestine.

PubMed

Zhao, Jingbo; Yang, Jian; Liao, Donghua; Gregersen, Hans

2017-01-01

Gastrointestinal disorders are very common in diabetic patients, but the pathogenesis is still not well understood. Peripheral afferent nerves may be involved due to the complex regulation of gastrointestinal function by the enteric nervous system. We aimed to characterize the stimulus-response function of afferent fibers innervating the jejunum in the Goto-Kakizaki (GK) type 2 diabetic rat model. A key question is whether changes in afferent firing arise from remodeled tissue or from adaptive afferent processes. Seven 32-week-old male GK rats and seven age-matched normal Wistar rats were studied. Firing from mesenteric afferent nerves was recorded in excised jejunal segments of seven GK rats and seven normal Wistar rats during ramp test, stress relaxation test, and creep test. The circumferential stress-strain, spike rate increase ratio (SRIR), and single unit firing rates were calculated for evaluation of interdependency of the mechanical stimulations and the afferent nerve discharge. Elevated sensitivity to mechanical stimuli was found for diabetic nerve bundles and single unit activity ( P <0.05). The stress relaxed less in the diabetic intestinal segment ( P <0.05). Linear association between SRIR and the thickness of circumferential muscle layer was found at high stress levels as well as for SRIR and the glucose level. Altered viscoelastic properties and elevated mechanosensitivity were found in the GK rat intestine. The altered nerve signaling is related to muscle layer remodeling and glucose levels and may contribute to gastrointestinal symptoms experienced by diabetic patients.

A Geochemical and Geophysical Assessment of Coastal Groundwater Discharge at Select Sites in Maui and O’ahu, Hawai’i

USGS Publications Warehouse

Swarzenski, Peter W.; Storlazzi, Curt; M.L. Dalier,; C.R. Glenn,; C.G. Smith,

2015-01-01

Based on the submarine groundwater discharge tracer 222Rn, coastal groundwater discharge rates ranged from about 22–50 cm per day at Kahekili, a site in the Ka’anapali region north of Lahaina in west Maui, while at Black Point in Maunalua Bay along southern O’ahu, coastal groundwater discharge rates ranged up to 700 cm per day, although the mean discharge rate at this site was 60 cm per day. The water chemistry of the discharging groundwater can be dramatically different than ambient seawater at both coastal sites. For example, at Kahekili the average concentrations of dissolved inorganic nitrogen (DIN), dissolved silicate (DSi) and total dissolved phosphorus (TDP) were roughly 188-, 36-, and 106-times higher in the discharging groundwater relative to ambient seawater, respectively. Such data extend our basic understanding of the physical controls on coastal groundwater discharge and provide an estimate of the magnitude and physical forcings of submarine groundwater discharge and associated trace metal and nutrient loads conveyed by this submarine route.

Megawatt low-temperature DC plasma generator with divergent channels of gas-discharge tract

NASA Astrophysics Data System (ADS)

Gadzhiev, M. Kh.; Isakaev, E. Kh.; Tyuftyaev, A. S.; Yusupov, D. I.; Sargsyan, M. A.

2017-04-01

We have developed and studied a new effective megawatt double-unit generator of low-temperature argon plasma, which belongs to the class of dc plasmatrons and comprises the cathode and anode units with divergent gas-discharge channels. The generator has an efficiency of about 80-85% and ensures a long working life at operating currents up to 4000 A.

Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

ERIC Educational Resources Information Center

Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

2012-01-01

The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

Hospital Ownership of a Postacute Care Facility Influences Discharge Destinations After Emergent Surgery.

PubMed

Abdelsattar, Zaid M; Gonzalez, Andrew A; Hendren, Samantha; Regenbogen, Scott E; Wong, Sandra L

2016-08-01

The aim of the study was to identify hospital characteristics associated with variation in patient disposition after emergent surgery. Colon resections in elderly patients are often done in emergent settings. Although these operations are known to be riskier, there are limited data regarding postoperative discharge destination. We evaluated Medicare beneficiaries who underwent emergent colectomy between 2008 and 2010. Using hierarchical logistic regression, we estimated patient and hospital-level risk-adjusted rates of nonhome discharges. Hospitals were stratified into quintiles based on their nonhome discharge rates. Generalized linear models were used to identify hospital structural characteristics associated with nonhome discharges (comparing discharge to skilled nursing facilities vs home with/without home health services). Of the 122,604 patients surviving to discharge after emergent colectomy at 3012 hospitals, 46.7% were discharged to a nonhome destination. There was a wide variation in risk and reliability-adjusted nonhome discharge rates across hospitals (15% to 80%). Patients at hospitals in the highest quintile of nonhome discharge rates were more likely to have longer hospitalizations (15.1 vs 13.2; P < 0.001) and more complications (43.2% vs 34%; P < 0.001). On multivariable analysis, only hospital ownership of a skilled nursing facility (P < 0.001), teaching status (P = 0.025), and low nurse-to-patient ratios (P = 0.002) were associated with nonhome discharges. Nearly half of Medicare beneficiaries are discharged to a nonhome destination after emergent colectomy. Hospital ownership of a skilled nursing facility and low nurse-to-patient ratios are highly associated with nonhome discharges. This may signify the underlying financial incentives to preferentially utilize postacute care facilities under the traditional fee-for-service payment model.

Secondary cell with orthorhombic alkali metal/manganese oxide phase active cathode material

DOEpatents

Doeff, Marca M.; Peng, Marcus Y.; Ma, Yanping; Visco, Steven J.; DeJonghe, Lutgard C.

1996-01-01

An alkali metal manganese oxide secondary cell is disclosed which can provide a high rate of discharge, good cycling capabilities, good stability of the cathode material, high specific energy (energy per unit of weight) and high energy density (energy per unit volume). The active material in the anode is an alkali metal and the active material in the cathode comprises an orthorhombic alkali metal manganese oxide which undergoes intercalation and deintercalation without a change in phase, resulting in a substantially linear change in voltage with change in the state of charge of the cell. The active material in the cathode is an orthorhombic structure having the formula M.sub.x Z.sub.y Mn.sub.(1-y) O.sub.2, where M is an alkali metal; Z is a metal capable of substituting for manganese in the orthorhombic structure such as iron, cobalt or titanium; x ranges from about 0.2 in the fully charged state to about 0.75 in the fully discharged state, and y ranges from 0 to 60 atomic %. Preferably, the cell is constructed with a solid electrolyte, but a liquid or gelatinous electrolyte may also be used in the cell.

[Long-term outcomes of children treated with continuous renal replacement therapy].

PubMed

Almarza, S; Bialobrzeska, K; Casellas, M M; Santiago, M J; López-Herce, J; Toledo, B; Carrillo, Á

2015-12-01

The objective of this study is to analyze long-term outcomes and kidney function in children requiring continuous renal replacement therapy (CRRT) after an acute kidney injury episode. A retrospective observational study was performed using a prospective database of 128 patients who required CRRT admitted to the pediatric intensive care unit between years 2006 and 2012. The subsequent outcomes were assessed in those surviving at hospital discharge. Of the 128 children who required RRT in the pediatric intensive care unit, 71 survived at hospital discharge (54.4%), of whom 66 (92.9%) were followed up. Three patients had chronic renal failure prior to admission to the NICU. Of the 63 remaining patients, 6 had prolonged or relapses of renal function disturbances, but only one patient with atypical Hemolytic Uremic Syndrome developed end-stage renal failure. The rest had normal kidney function at the last check-up. Most of surviving children that required CRRT have a positive outcome later on, presenting low mortality rates and recovery of kidney function in the medium term. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

Secondary cell with orthorhombic alkali metal/manganese oxide phase active cathode material

DOEpatents

Doeff, M.M.; Peng, M.Y.; Ma, Y.; Visco, S.J.; DeJonghe, L.C.

1996-09-24

An alkali metal manganese oxide secondary cell is disclosed which can provide a high rate of discharge, good cycling capabilities, good stability of the cathode material, high specific energy (energy per unit of weight) and high energy density (energy per unit volume). The active material in the anode is an alkali metal and the active material in the cathode comprises an orthorhombic alkali metal manganese oxide which undergoes intercalation and deintercalation without a change in phase, resulting in a substantially linear change in voltage with change in the state of charge of the cell. The active material in the cathode is an orthorhombic structure having the formula M{sub x}Z{sub y}Mn{sub (1{minus}y)}O{sub 2}, where M is an alkali metal; Z is a metal capable of substituting for manganese in the orthorhombic structure such as iron, cobalt or titanium; x ranges from about 0.2 in the fully charged state to about 0.75 in the fully discharged state, and y ranges from 0 to 60 atomic %. Preferably, the cell is constructed with a solid electrolyte, but a liquid or gelatinous electrolyte may also be used in the cell. 11 figs.

Infant-Guided, Co-Regulated Feeding in the Neonatal Intensive Care Unit. Part I: Theoretical Underpinnings for Neuroprotection and Safety.

PubMed

Shaker, Catherine S

2017-04-01

The rapid progress in medical and technical innovations in the neonatal intensive care unit (NICU) has been accompanied by concern for outcomes of NICU graduates. Although advances in neonatal care have led to significant changes in survival rates of very small and extremely preterm neonates, early feeding difficulties with the transition from tube feeding to oral feeding are prominent and often persist beyond discharge to home. Progress in learning to feed in the NICU and continued growth in feeding skills after the NICU may be closely tied to fostering neuroprotection and safety. The experience of learning to feed in the NICU may predispose preterm neonates to feeding problems that persist. Neonatal feeding as an area of specialized clinical practice has grown considerably in the last decade. This article is the first in a two-part series devoted to neonatal feeding. Part 1 explores factors in NICU feeding experiences that may serve to constrain or promote feeding skill development, not only in the NICU but long after discharge to home. Part II describes approaches to intervention that support neuroprotection and safety. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Analysis of an ordinary bedload transport event in a mountain torrent (Rio Vanti, Verona, Italy)

NASA Astrophysics Data System (ADS)

Pastorello, Roberta; D'Agostino, Vincenzo

2016-04-01

The correct simulation of the sediment-transport response of mountain torrents both for extreme and ordinary flood events is a fundamental step to understand the process, but also to drive proper decisions on the protection works. The objective of this research contribution is to reconstruct the 'ordinary' flood event with the associated sediment-graph of a flood that caused on the 14th of October, 2014 the formation of a little debris cone (about 200-210 m3) at the junction between the 'Rio Vanti' torrent catchment and the 'Selva di Progno' torrent (Veneto Region, Prealps, Verona, Italy). To this purpose, it is important to notice that a great part of equations developed for the computation of the bedload transport capacity, like for example that of Schoklitsch (1962) or Smart and Jaeggi (1983), are focused on extraordinary events heavily affecting the river-bed armour. These formulas do not provide reliable results if used on events, like the one under analysis, not too far from the bankfull conditions. The Rio Vanti event was characterized by a total rainfall depth of 36.2 mm and a back-calculated peak discharge of 6.12 m3/s with a return period of 1-2 years. The classical equations to assess the sediment transport capacity overestimate the total volume of the event of several orders of magnitude. By the consequence, the following experimental bedload transport equation has been applied (D'Agostino and Lenzi, 1999), which is valid for ordinary flood events (q: unit water discharge; qc: unit discharge of bedload transport initiation; qs: unit bedload rate; S: thalweg slope): -qs-˜= 0,04ṡ(q- qc) S3/2 In particular, starting from the real rainfall data, the hydrograph and the sediment-graph have been reconstructed. Then, comparing the total volume calculated via the above cited equation to the real volume estimated using DoD techniques on post-event photogrammetric survey, a very satisfactory agreement has been obtained. The result further supports the thesis that the bedload transport in boulder-bed torrents is characterised by an important threshold, which corresponds to a high variation of the sediment discharge due to the bed-armour breaking.

Is There an Association Between Markers of Cardiovascular Autonomic Dysfunction at Discharge From Rehabilitation and Participation 1 and 5 Years Later in Individuals With Spinal Cord Injury?

PubMed

Rianne Ravensbergen, H J; de Groot, Sonja; Post, Marcel W; Bongers-Janssen, Helma M; van der Woude, Lucas H; Claydon, Victoria E

2016-09-01

To determine whether physical activity and participation 1 and 5 years after discharge are associated with measures of cardiovascular autonomic function: prevalence of hypotension and reduced peak heart rate at discharge from initial inpatient spinal cord injury (SCI) rehabilitation. Prospective cohort study. Rehabilitation centers. Individuals with SCI (N=146). Not applicable. We recorded markers of cardiovascular autonomic dysfunction (resting blood pressure and peak heart rate) and personal and lesion characteristics at the time of discharge from rehabilitation. Parameters for participation (social health status dimension of the Sickness Impact Profile) and physical activity (Physical Activity Scale for Individuals with Physical Disabilities [PASIPD]) were measured 1 and 5 years after discharge. Effects of prevalence of cardiovascular autonomic dysfunction were analyzed using linear regression analysis while correcting for possible confounders. We found no significant association between hypotension and social health status dimension of the Sickness Impact Profile or PASIPD, either at 1 or at 5 years after discharge. A significant association between peak heart rate and social health status dimension of the Sickness Impact Profile was found at 1 year after discharge, showing poorer participation in individuals with low peak heart rate (ie, cardiovascular autonomic dysfunction). The unadjusted relation between peak heart rate and the social health status dimension of the Sickness Impact Profile was significant at 5 years, but not when adjusted for confounders. We found associations between peak heart rate and PASIPD for both 1 and 5 years after discharge; however, these were not significant after correction for potential confounding factors. Autonomic dysfunction after SCI is a crucial factor influencing quality of life. We found that cardiovascular autonomic impairment, assessed from low peak heart rate, was associated with reduced participation after 1 year. The results suggest that peak heart rate at discharge from rehabilitation after SCI should be used to identify those needing additional support to facilitate physical activity and participation after discharge. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A coupled modeling framework of the co-evolution of humans and water: case study of Tarim River Basin, western China

NASA Astrophysics Data System (ADS)

Liu, D.; Tian, F.; Lin, M.; Sivapalan, M.

2014-04-01

The complex interactions and feedbacks between humans and water are very essential issues but are poorly understood in the newly proposed discipline of socio-hydrology (Sivapalan et al., 2012). An exploratory model with the appropriate level of simplification can be valuable to improve our understanding of the co-evolution and self-organization of socio-hydrological systems driven by interactions and feedbacks operating at different scales. In this study, a simple coupled modeling framework for socio-hydrology co-evolution is developed for the Tarim River Basin in Western China, and is used to illustrate the explanatory power of such a model. The study area is the mainstream of the Tarim River, which is divided into two modeling units. The socio-hydrological system is composed of four parts, i.e. social sub-system, economic sub-system, ecological sub-system, and hydrological sub-system. In each modeling unit, four coupled ordinary differential equations are used to simulate the dynamics of the social sub-system represented by human population, the economic sub-system represented by irrigated crop area, the ecological sub-system represented by natural vegetation cover and the hydrological sub-system represented by stream discharge. The coupling and feedback processes of the four dominant sub-systems (and correspondingly four state variables) are integrated into several internal system characteristics interactively and jointly determined by themselves and by other coupled systems. For example, the stream discharge is coupled to the irrigated crop area by the colonization rate and mortality rate of the irrigated crop area in the upper reach and the irrigated area is coupled to stream discharge through irrigation water consumption. In a similar way, the stream discharge and natural vegetation cover are coupled together. The irrigated crop area is coupled to human population by the colonization rate and mortality rate of the population. The inflow of the lower reach is determined by the outflow from the upper reach. The natural vegetation cover in the lower reach is coupled to the outflow from the upper reach and governed by regional water resources management policy. The co-evolution of the Tarim socio-hydrological system is then analyzed within this modeling framework to gain insights into the overall system dynamics and its sensitivity to the external drivers and internal system variables. In the modeling framework, the state of each subsystem is holistically described by one state variable and the framework is flexible enough to comprise more processes and constitutive relationships if they are needed to illustrate the interaction and feedback mechanisms of the human-water system.

Benchmarking outcomes in the Neonatal Intensive Care Unit: Cytogenetic and molecular diagnostic rates in a retrospective cohort.

PubMed

Malam, Faheem; Hartley, Taila; Gillespie, Meredith K; Armour, Christine M; Bariciak, Erika; Graham, Gail E; Nikkel, Sarah M; Richer, Julie; Sawyer, Sarah L; Boycott, Kym M; Dyment, David A

2017-05-09

Genetic disease and congenital anomalies continue to be a leading cause of neonate mortality and morbidity. A genetic diagnosis in the neonatal intensive care unit (NICU) can be a challenge given the associated genetic heterogeneity and early stage of a disease. We set out to evaluate the outcomes of Medical Genetics consultation in the NICU in terms of cytogenetic and molecular diagnostic rates and impact on management. We retrospectively reviewed 132 charts from patients admitted to the NICU who received a Medical Genetics diagnostic evaluation over a 2 year period. Of the 132 patients reviewed, 26% (34/132) received a cytogenetic or molecular diagnosis based on the Medical Genetics diagnostic evaluation; only 10% (13/132) received a diagnosis during their admission. The additional 16% (21 patients) received their diagnosis following NICU discharge, but based on a genetic test initiated during hospital-stay. Mean time from NICU admission to confirmed diagnosis was 24 days. For those who received a genetic diagnosis, the information was considered beneficial for clinical management in all, and a direct change to medical management occurred for 12% (4/32). For those non-diagnosed infants seen in out-patient follow-up clinic, diagnoses were made in 8% (3/37). The diagnoses made post-discharge from the NICU comprised a greater number of Mendelian disorders and represent an opportunity to improve genetic care. The adoption of diagnostic tools, such as exome sequencing, used in parallel with traditional approaches will improve rate of diagnoses and will have a significant impact, in particular when the differential diagnosis is broad. © 2017 Wiley Periodicals, Inc.

Trends in Outcomes and Hospitalization Charges of Infant Botulism in the United States: A Comparative Analysis Between Kids' Inpatient Database and National Inpatient Sample.

PubMed

Opila, Tamara; George, Asha; El-Ghanem, Mohammad; Souayah, Nizar

2017-02-01

New therapeutic strategies, including immune globulin intravenous, have emerged in the past two decades for the management of botulism. However, impact on outcomes and hospitalization charges among infants (aged ≤1 year) with botulism in the United States is unknown. We analyzed the Kids' Inpatient Database (KID) and National Inpatient Sample (NIS) for in-hospital outcomes and charges for infant botulism cases from 1997 to 2009. Demographics, discharge status, mortality, length of stay, and hospitalization charges were reported from the two databases and compared. Between 1997 and 2009, 504 infant hospitalizations were captured in KID', and 340 hospitalizations from NIS, for comparable years. A significant decrease was observed in mean length of stay for 'KID (P < 0.01); a similar decrease was observed for the NIS. The majority of patients were discharged to home. Despite an initial decrease after 1997, an increasing trend was observed for 'KID/NIS mean hospital charges from 2000 to 2009 (from $57,659/$56,309 to $143,171/$106,378; P < 0.001/P < 0.001). A linear increasing trend was evident when examining mean daily hospitalization charges for both databases. In conducting a subgroup analysis of the 'KID database, the youngest patients with infantile botulism (≤1.9 months) displayed the highest average number of procedures during their hospitalization (P < .001) and the highest rate of mechanical ventilation (P < .001), compared with their older counterparts. Infant botulism cases have demonstrated a significant increase in hospitalization charges over the years despite reduced length of stay. Additionally, there were significantly higher daily adjusted hospital charges and an increased rate of routine discharges for immune globulin intravenous-treated patients. More controlled studies are needed to define the criteria for cost-effective use of intravenous immune globulin in the population with infant botulism. Copyright © 2016 Elsevier Inc. All rights reserved.

The Relationship of Obesity to Increasing Health-Care Burden in the Setting of Orthopaedic Polytrauma.

PubMed

Licht, Heather; Murray, Mark; Vassaur, John; Jupiter, Daniel C; Regner, Justin L; Chaput, Christopher D

2015-11-18

With the rise of obesity in the American population, there has been a proportionate increase of obesity in the trauma population. The purpose of this study was to use a computed tomography-based measurement of adiposity to determine if obesity is associated with an increased burden to the health-care system in patients with orthopaedic polytrauma. A prospective comprehensive trauma database at a level-I trauma center was utilized to identify 301 patients with polytrauma who had orthopaedic injuries and intensive care unit admission from 2006 to 2011. Routine thoracoabdominal computed tomographic scans allowed for measurement of the truncal adiposity volume. The truncal three-dimensional reconstruction body mass index was calculated from the computed tomography-based volumes based on a previously validated algorithm. A truncal three-dimensional reconstruction body mass index of <30 kg/m(2) denoted non-obese patients and ≥ 30 kg/m(2) denoted obese patients. The need for orthopaedic surgical procedure, in-hospital mortality, length of stay, hospital charges, and discharge disposition were compared between the two groups. Of the 301 patients, 21.6% were classified as obese (truncal three-dimensional reconstruction body mass index of ≥ 30 kg/m(2)). Higher truncal three-dimensional reconstruction body mass index was associated with longer hospital length of stay (p = 0.02), more days spent in the intensive care unit (p = 0.03), more frequent discharge to a long-term care facility (p < 0.0002), higher rate of orthopaedic surgical intervention (p < 0.01), and increased total hospital charges (p < 0.001). Computed tomographic scans, routinely obtained at the time of admission, can be utilized to calculate truncal adiposity and to investigate the impact of obesity on patients with polytrauma. Obese patients were found to have higher total hospital charges, longer hospital stays, discharge to a continuing-care facility, and a higher rate of orthopaedic surgical intervention. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

The National Hospital Discharge Survey and Nationwide Inpatient Sample: the databases used affect results in THA research.

PubMed

Bekkers, Stijn; Bot, Arjan G J; Makarawung, Dennis; Neuhaus, Valentin; Ring, David

2014-11-01

The National Hospital Discharge Survey (NHDS) and the Nationwide Inpatient Sample (NIS) collect sample data and publish annual estimates of inpatient care in the United States, and both are commonly used in orthopaedic research. However, there are important differences between the databases, and because of these differences, asking these two databases the same question may result in different answers. The degree to which this is true for arthroplasty-related research has, to our knowledge, not been characterized. We tested the following null hypotheses: (1) there are no differences between the NHDS and NIS in patient characteristics, comorbidities, and adverse events in patients with hip osteoarthritis treated with THA, and (2) there are no differences between databases in factors associated with inpatient mortality, adverse events, and length of hospital stay after THA. The NHDS and NIS databases use different methods of data collection and weighting to provide data representative of all nonfederal hospital discharges in the United States. In 2006 the NHDS database contained 203,149 patients with hip arthritis treated with hip arthroplasty, and the NIS database included 193,879 patients. Multivariable analyses for factors associated with inpatient mortality, adverse events, and days of care were constructed for each database. We found that 26 of 42 of the factors in demographics, comorbidities, and adverse events after THA in the NIS and NHDS databases differed more than 10%. Age and days of care were associated with inpatient mortality with the NHDS and the NIS although the effect rates differ more than 10%. The NIS identified seven other factors not identified by the NHDS: wound complications, congestive heart failure, new mental disorder, chronic pulmonary disease, dementia, geographic region Northeast, acute postoperative anemia, and sex, that were associated with inpatient mortality even after controlling for potentially confounding variables. For inpatient adverse events, atrial fibrillation, osteoporosis, and female sex were associated with the NHDS and the NIS although the effect rates differ more than 10%. There were different directions for sources of payment, dementia, congestive heart failure, and geographic region. For longer length of stay, common factors differing more than 10% in effect rate included chronic pulmonary disease, atrial fibrillation, complication not elsewhere classified, congestive heart failure, transfusion, discharge nonroutine compared with routine, acute postoperative anemia, hypertension, wound adverse events, and diabetes mellitus, whereas discrepant factors included geographic region, payment method, dementia, sex, and iatrogenic hypotension. Studies that use large databases intended to be representative of the entire United States population can produce different results, likely related to differences in the databases, such as the number of comorbidities and procedures that can be entered in the database. In other words, analyses of large databases can have limited reliability and should be interpreted with caution. Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.

Computer calculated dose in paediatric prescribing.

PubMed

Kirk, Richard C; Li-Meng Goh, Denise; Packia, Jeya; Min Kam, Huey; Ong, Benjamin K C

2005-01-01

Medication errors are an important cause of hospital-based morbidity and mortality. However, only a few medication error studies have been conducted in children. These have mainly quantified errors in the inpatient setting; there is very little data available on paediatric outpatient and emergency department medication errors and none on discharge medication. This deficiency is of concern because medication errors are more common in children and it has been suggested that the risk of an adverse drug event as a consequence of a medication error is higher in children than in adults. The aims of this study were to assess the rate of medication errors in predominantly ambulatory paediatric patients and the effect of computer calculated doses on medication error rates of two commonly prescribed drugs. This was a prospective cohort study performed in a paediatric unit in a university teaching hospital between March 2003 and August 2003. The hospital's existing computer clinical decision support system was modified so that doctors could choose the traditional prescription method or the enhanced method of computer calculated dose when prescribing paracetamol (acetaminophen) or promethazine. All prescriptions issued to children (<16 years of age) at the outpatient clinic, emergency department and at discharge from the inpatient service were analysed. A medication error was defined as to have occurred if there was an underdose (below the agreed value), an overdose (above the agreed value), no frequency of administration specified, no dose given or excessive total daily dose. The medication error rates and the factors influencing medication error rates were determined using SPSS version 12. From March to August 2003, 4281 prescriptions were issued. Seven prescriptions (0.16%) were excluded, hence 4274 prescriptions were analysed. Most prescriptions were issued by paediatricians (including neonatologists and paediatric surgeons) and/or junior doctors. The error rate in the children's emergency department was 15.7%, for outpatients was 21.5% and for discharge medication was 23.6%. Most errors were the result of an underdose (64%; 536/833). The computer calculated dose error rate was 12.6% compared with the traditional prescription error rate of 28.2%. Logistical regression analysis showed that computer calculated dose was an important and independent variable influencing the error rate (adjusted relative risk = 0.436, 95% CI 0.336, 0.520, p < 0.001). Other important independent variables were seniority and paediatric training of the person prescribing and the type of drug prescribed. Medication error, especially underdose, is common in outpatient, emergency department and discharge prescriptions. Computer calculated doses can significantly reduce errors, but other risk factors have to be concurrently addressed to achieve maximum benefit.

Protracted immune disorders at one year after ICU discharge in patients with septic shock.

PubMed

Riché, Florence; Chousterman, Benjamin G; Valleur, Patrice; Mebazaa, Alexandre; Launay, Jean-Marie; Gayat, Etienne

2018-02-21

Sepsis is a leading cause of mortality and critical illness worldwide and is associated with an increased mortality rate in the months following hospital discharge. The occurrence of persistent or new organ dysfunction(s) after septic shock raises questions about the mechanisms involved in the post-sepsis status. The present study aimed to explore the immune profiles of patients one year after being discharged from the intensive care unit (ICU) following treatment for abdominal septic shock. We conducted a prospective, single-center, observational study in the surgical ICU of a university hospital. Eighty-six consecutive patients admitted for septic shock of abdominal origin were included in this study. Fifteen different plasma biomarkers were measured at ICU admission, at ICU discharge and at one year after ICU discharge. Three different clusters of biomarkers were distinguished according to their functions, namely: (1) inflammatory response, (2) cell damage and apoptosis, (3) immunosuppression and resolution of inflammation. The primary objective was to characterize variations in the immune status of septic shock patients admitted to ICU up to one year after ICU discharge. The secondary objective was to evaluate the relationship between these biomarker variations and patient outcomes. At the onset of septic shock, we observed a cohesive pro-inflammatory profile and low levels of inflammation resolution markers. At ICU discharge, the immune status demonstrated decreased but persistent inflammation and increased immunosuppression, with elevated programmed cell death protein-1 (PD-1) levels, and a counterbalanced resolution process, with elevated levels of interleukin-10 (IL-10), resolvin D5 (RvD5), and IL-7. One year after hospital discharge, homeostasis was not completely restored with several markers of inflammation remaining elevated. Remarkably, IL-7 was persistently elevated, with levels comparable to those observed after ICU discharge, and PD-1, while lower, remained in the elevated abnormal range. In this study, protracted immune disturbances were observed one year after ICU discharge. The study results suggested the presence of long-lasting immune illness disorders following a long-term septic insult, indicating the need for long-term patient follow up after ICU discharge and questioning the use of immune intervention to restore immune homeostasis after abdominal septic shock.

High Voltage SPT Performance

NASA Technical Reports Server (NTRS)

Manzella, David; Jacobson, David; Jankovsky, Robert

2001-01-01

A 2.3 kW stationary plasma thruster designed to operate at high voltage was tested at discharge voltages between 300 and 1250 V. Discharge specific impulses between 1600 and 3700 sec were demonstrated with thrust between 40 and 145 mN. Test data indicated that discharge voltage can be optimized for maximum discharge efficiency. The optimum discharge voltage was between 500 and 700 V for the various anode mass flow rates considered. The effect of operating voltage on optimal magnet field strength was investigated. The effect of cathode flow rate on thruster efficiency was considered for an 800 V discharge.

Ground-water recharge and flowpaths near the edge of the Decorah-Platteville-Glenwood confining unit, Rochester, Minnesota

USGS Publications Warehouse

Lindgren, Richard J.

2001-01-01

The water withdrawn by pumped wells or discharged to Bear Creek is derived predominantly from areal recharge near the edge of the Decorah-Platteville-Glenwood confining unit (0.47 ft3/s), rather than from water that has leaked downward through the Decorah unit (0.03 ft3/s). Model simulated discharge through springs and seeps in the lower part of the upper carbonate aquifer (0.21 ft3/s) represents a potential source of water to the St. Peter-Prairie du Chien-Jordan aquifer.

Transition from hospital to home: Parents' perception of their preparation and readiness for discharge with their preterm infant.

PubMed

Aydon, Laurene; Hauck, Yvonne; Murdoch, Jamee; Siu, Daphne; Sharp, Mary

2018-01-01

To explore the experiences of parents with babies born between 28-32 weeks' gestation during transition through the neonatal intensive care unit and discharge to home. Following birth of a preterm baby, parents undergo a momentous journey through the neonatal intensive care unit prior to their arrival home. The complexity of the journey varies on the degree of prematurity and problems faced by each baby. The neonatal intensive care unit environment has many stressors and facilitating education to assist parents to feel ready for discharge can be challenging for all health professionals. Qualitative descriptive design. The project included two phases, pre- and postdischarge, to capture the experiences of 20 couples (40 parents), whilst their baby was a neonatal intensive care unit inpatient and then after discharge. Face-to-face interviews, an online survey and telephone interviews were employed to gather parent's experiences. Constant comparative analysis was used to identify commonalities between experiences. Recruitment and data collection occurred from October 2014-February 2015. Overlapping themes from both phases revealed three overarching concepts: effective parent staff communication; feeling informed and involved; and being prepared to go home. Our findings can be used to develop strategies to improve the neonatal intensive care unit stay and discharge experience for parents. Proposed strategies would be to improve information transfer, promote parental contact with the multidisciplinary team, encourage input from fathers to identify their needs and facilitate parental involvement according to individual needs within families. Providing information to parents during their time in hospital, in a consistent and timely manner is an essential component of their preparation when transitioning to home. © 2017 John Wiley & Sons Ltd.

Clostridium difficile Infections among Hospitalized Children, United States, 1997–2006

PubMed Central

Tillotson, Glenn S.; McDonald, L. Clifford

2010-01-01

We evaluated the annual rate (cases/10,000 hospitalizations) of pediatric hospitalizations with Clostridium difficile infection (CDI; International Classification of Diseases, 9th revision, clinical modification code 008.45) in the United States. We performed a time-series analysis of data from the Kids’ Inpatient Database within the Health Care Cost and Utilization Project during 1997–2006 and a cross-sectional analysis within the National Hospital Discharge Survey during 2006. The rate of pediatric CDI-related hospitalizations increased from 7.24 to 12.80 from 1997 through 2006; the lowest rate was for children <1 year of age. Although incidence was lowest for newborns (0.5), incidence for children <1 year of age who were not newborns (32.01) was similar to that for children 5–9 years of age (35.27), which in turn was second only to incidence for children 1–4 years of age (44.87). Pediatric CDI-related hospitalizations are increasing. A better understanding of the epidemiology and outcomes of CDI is urgently needed. PMID:20350373

78 FR 45615 - Proposed Collection; Comment Request for Form 14134 and Form 14135

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-29

..., Application for Certificate of Discharge of Property from Federal Tax Lien. DATES: Written comments should be... Lien and Application for Certificate of Discharge of Property from Federal Tax Lien. OMB Number: 1545....6325-1(b)(5) for consideration of the United States discharging property from the federal tax lien and...

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.

Predictors of frequent withdrawal management unit use among chronically homeless, homeless, and housed men: a retrospective cohort study.

PubMed

Svoboda, Tomislav

2013-01-01

Reports suggest that repeat users of detoxification services are less likely to get rehabilitated. The goal of this study is to determine rates and predictors of detoxification unit visits among individuals who are chronically homeless with severe drinking problems compared to those who are housed and in the general homeless population. Visit records (n = 1027) from all inner city Toronto detoxification units (n = 5) by men (n = 169) over a 6 year period were analyzed and linked to structured interview data for three populations: chronically homeless individuals with severe drinking problems (CHDP, n = 50); members of the general homeless population (GH, n = 61); and low-income housed individuals (LIH, n = 58). The CHDP group had 4.13 (3.86, 4.39) detoxification unit admissions per year, 18.1 (95% CI 12.5-23.7) and 33 (95% CI 21-46) times higher than the GH and LIH groups respectively. Admission rates were 43.8 % (95% CI 32.7-54.9%) higher in the winter than summer months for the CHDP group. The proportions of stays that involved police, leaving without discharge, and staying two days or less were 74%, 75%, and 89% among CHDP, GH, and LIH subjects. Rather than being a resource for achieving abstinence, frequent short visits, treatment non-compliance, higher winter visit rates suggest that detoxification units are more likely used by individuals as shelter; high rates of admission related police involvement suggest that they continue to be used as an alternative to judicial intervention into public inebriation. Copyright © American Academy of Addiction Psychiatry.

Large wood, sediment, and flow regimes: Their interactions and temporal changes caused by human impacts in Japan

NASA Astrophysics Data System (ADS)

Nakamura, Futoshi; Seo, Jung Il; Akasaka, Takumi; Swanson, Frederick J.

2017-02-01

Water, sediment, and large wood (LW) are the three key components of dynamic river-floodplain ecosystems. We examined variations in sediment and LW discharge with respect to precipitation, the presence of dams, land and river use change, and related channel incision and forest expansion on gravel bars and floodplains across Japan. The results indicated that unit sediment discharge and unit LW discharge were smaller in southern Japan where precipitation intensity is generally much greater. Effective precipitation, an index that takes current and antecedent precipitation into account, was a strong predictor of discharge in small watersheds, but not in larger watersheds. However, precipitation intensities related to unit sediment discharge in intermediate and large watersheds were smaller than those associated with unit LW discharge, which we attribute to differences in particle shape and size and also transport mechanisms. The relationship between river flow and discharge of sediment and LW lead us to posit that discharges of these components are supply limited in southern Japan and transport limited in northern Japan. The cross-sectional mean low-flow bed elevation of gravel-bed and sand-bed rivers in Japan decreased by 0.71 and 0.74 m on average, respectively, over the period 1960-2000. Forest expansion on bars and floodplains has been prominent since the 1990s, and trees apparently began to colonize gravel bars 10 to 20 years after riverbed degradation began. Forest recovery in headwater basins, dam construction, gravel mining, and channelization over the past half century are likely the dominant factors that significantly reduced downstream sediment delivery, thereby promoting channel incision and forest expansion. Changes in rivers and floodplains associated with channel incision and forest expansion alter the assemblages of aquatic and terrestrial organisms in riverine landscapes of Japan, and climate change may contribute to this change by intensified precipitation. Additionally, regime shifts of water, sediment, and LW may continue or they may reach a dynamic state of quasi-equilibrium in the future. Continued monitoring of these three components, taking into account their geographic variation, is critical for anticipating and managing future changes in river-floodplain systems in Japan and around the world.

Laboratory Experiments Investigating Glacier Submarine Melt Rates and Circulation in an East Greenland Fjord

NASA Astrophysics Data System (ADS)

Cenedese, C.

2014-12-01

Idealized laboratory experiments investigate the glacier-ocean boundary dynamics near a vertical 'glacier' (i.e. no floating ice tongue) in a two-layer stratified fluid, similar to Sermilik Fjord where Helheim Glacier terminates. In summer, the discharge of surface runoff at the base of the glacier (subglacial discharge) intensifies the circulation near the glacier and increases the melt rate with respect to that in winter. In the laboratory, the effect of subglacial discharge is simulated by introducing fresh water at melting temperatures from either point or line sources at the base of an ice block representing the glacier. The circulation pattern observed both with and without subglacial discharge resembles those observed in previous studies. The buoyant plume of cold meltwater and subglacial discharge water entrains ambient water and rises vertically until it finds either the interface between the two layers or the free surface. The results suggest that the meltwater deposits within the interior of the water column and not entirely at the free surface, as confirmed by field observations. The submarine melt rate increases with the subglacial discharge rate. Furthermore, the same subglacial discharge causes greater submarine melting if it exits from a point source rather than from a line source. When the subglacial discharge exits from two point sources, two buoyant plumes are formed which rise vertically and interact. The results suggest that the distance between the two subglacial discharges influences the entrainment in the plumes and consequently the amount of submarine melting and the final location of the meltwater within the water column. Hence, the distribution and number of sources of subglacial discharge may play an important role in glacial melt rates and fjord stratification and circulation. Support was given by NSF project OCE-113008.