Discharge Length Research Articles

Flow-control capability of electronic-substrate-sized power supply for a plasma actuator

Plasma actuators, which are very thin, light and flexible, are attractive fluid control devices; however, they require high voltage power supplies for driving. Installation of a high-voltage generation system on vehicles, such as cars and airplanes, which are separated from the fixed ground coordinate, is a big problem. In this study, a small and light electronic-substrate-sized high-voltage power supply was introduced for mounting a plasma actuator system on a small vehicle like a UAV. This small power supply generates high voltage by an LC series transient resonance circuit and a transformer and can output at least 7.3 kVpp with a base frequency of 6000 Hz for a plasma actuator with a discharge length of 1000 mm. This study investigated the capability of flow control of the present small power supply by focusing on the output voltage waveform, induced flow velocity in static gas, and separation control around the airfoil model, Also the small power supply is compared with a conventional large power supply which has been used in typical laboratory-scale experiments. The results indicate that the substrate-sized power supply is powerful enough for flow control around a small UAV.

Large wood as a confounding factor in interpreting the width of spring-fed streams

Abstract. Spring-fed streams throughout volcanic regions of the western United States exhibit larger widths than runoff-fed streams with similar discharge. Due to the distinctive damped hydrograph of spring-fed streams (as compared to large peaks visible in the hydrographs of runoff-fed streams), large wood is less mobile in spring-fed than runoff-fed stream channels, so wood is more likely to remain in place than form logjams as in runoff-fed streams. The consequent long residence time of wood in spring-fed streams allows wood to potentially have long-term impacts on channel morphology. We used high-resolution satellite imagery in combination with discharge and climate data from published reports and publicly available databases to investigate the relationship between discharge, wood length, and channel width in 38 spring-fed and 20 runoff-fed streams, additionally responding to a call for increased use of remote sensing to study wood dynamics and daylighting previously unpublished data. We identified an order of magnitude more logjams than single logs per unit length present in runoff-fed streams as compared to spring-fed streams. Histograms of log orientation in spring-fed streams additionally confirmed that single logs are immobile in the channel so that the impact of single logs on channel morphology could be pronounced in spring-fed streams. Based on these observed differences, we hypothesized that there should be a difference in channel morphology. A model for stream width in spring-fed streams based solely on length of wood is a better model than one derived from discharge or including both discharge and wood length. This study provides insights into controls on stream width in spring-fed streams.

53: Effect of preoperative depression on length of stay and disposition following pelvic reconstructive surgery

To evaluate the effect of preoperative depression on length of stay and disposition following pelvic reconstructive surgery (PRS). Data from the Healthcare Cost and Utilization Project National Inpatient Sample was used to identify women undergoing PRS between 2012 to 2016. Patient- and hospital-level demographic, procedural, and comorbidity data were collected. Patients were stratified into those with and those without pre-existing depression. Descriptive statistics are expressed as medians and interquartile ranges (IQR). Pairwise analysis was performed between groups using Wilcoxon rank-sum or Fisher’s exact test. Multivariable logistic regression was used to identify independent risk factors for non-home dispositions and for length of stay greater than the median for the cohort. Non-home disposition was defined as transfer to a different acute care facility, non-hospital care facility, skilled nursing facility or discharge with home health. During the study period 52,541 patients underwent PRS and 9.1% had depression. Patients with depression were younger median age (57 (IQR: 47-67) vs 58 (46-68), p <0.003), less likely to be white (14.0% vs 23.4%, p<0.001), and more likely to live in areas with more than 1 million people (22.5% vs 28.0%, p<0.001). They were also more likely to have higher Elixhauser comorbidity index (4 IQR: 4-12 vs 0 (IQR: -1 to 5, p<0.001). There were no differences between type of surgery, except that patients with depression were more likely to undergo an anterior or posterior repair (91.4% vs 87.6%, p=0.03). On pairwise analysis, patients with depression were more likely to be discharged to a non-home destination (6.5% vs 4.5%, p<0.001) and have a longer length of stay (2 days IQR: 1-3 vs 1-day IQR: 1-2, p=0.01). The median length of stay for the entire cohort was 1 day (IQR: 1-2). After logistic regression, depression was not found to be an independent predictor of non-home discharge. Colpocleisis was the strongest predictor, (aOR=2.72, 95% CI: 1.80-4.11), followed by transfusion (aOR=2.05, 95% CI: 1.29 – 3.23), having Medicare as primary payor (aOR=1.83, 95% CI: 1.32-2.54), an increasing Elixhauser index (aOR=1.05 per point, 95% CI: 1.03 – 1.06), and increasing age (aOR=1.04 per year, 95% CI: 1.02-1.06). Higher median household incomes were associated with a lower likelihood of non-home discharge (aOR=0.81, 95% CI: 0.73-0.90). Depression was not independently associated with a hospitalization greater than 1 day. Blood transfusion (aOR=4.47, 95% CI: 2.71-7.36), increasing age (aOR=1.06 per year 95% CI: 1.05-1.07), increasing Elixhauser index (aOR=1.04, 95% CI: 1.03-1.05), Medicare as primary payor (aOR=1.81, 95% CI: 1.52-2.14), and vaginal colpopexy (aOR: 1.21, 95% CI: 1.04-1.43) were associated prolonged stay. Pre-existing depression is not independently associated with non-home discharge or prolonged length of stay after PRS.

Spatial distribution of radiation emitted by pulsed surface dielectric barrier discharge in air

The dynamics of radiation intensity at 337 nm emitted by the surface dielectric barrier discharge driven by 50 ns duration and 8 kV amplitude voltage pulse of both polarities has been analyzed experimentally and numerically. The calculations were performed in a 2D approach for experimental conditions to check the existing numerical models and understand what processes manage the discharge length and the spatial distribution of the discharge radiation intensity. Experimentally measured and numerically simulated profiles of radiation intensity along the discharge length notably differ from each other and the performed modification of the discharge physical model does not essentially change this difference. Radiation intensity from the discharge channel has been shown to be extremely sensitive primarily to the value of reduced electric field. We suppose that the discrepancy between experiment and numerical simulation could be due to 2D instead of 3D simulation and corresponding incorrect estimation of electric field distribution along the discharge channel. The numerical simulation of discharge length is in good agreement with experiment for the discharge stroke at the leading front of the voltage pulse and gives few times less values for the backward discharge at the trailing edge of the voltage pulse.

The diagnosis \u201cfailure to thrive\u201d and its impact on the care of hospitalized older adults: a matched case-control study

Background“Failure to thrive” and associated diagnoses are non-specific terms applied to older adults when there is lack of diagnostic clarity and imply an absence of medical acuity. We investigated the effect of such admission diagnoses on delivery of patient care in a cohort of older adults admitted to a tertiary care teaching hospital.MethodsRetrospective matched cohort study conducted at a tertiary care hospital in Vancouver, BC. Cases identified were adults aged ≥65 years admitted to acute medical wards with an admission diagnosis of “failure to thrive”, “FTT”, “failure to cope”, or “FTC”, between January 1, 2016 and November 1, 2017 (n = 60, median age 80 years). Age-matched controls met the same inclusion criteria with admission diagnoses other than those of interest (n = 60, median age 79 years).ResultsThe primary outcome was time to admission, measured from time points in the emergency room that spanned from triage to completion of admission orders. Secondary outcomes were concordance of admission and discharge diagnoses and length of stay in hospital.The total time from triage to admission for older adults admitted with FTT and associated diagnoses was 10 h 40 min, compared to 6 h 58 min for controls (p = .02). Concordance of admission and discharge diagnoses was only 12% for the “failure to thrive” cohort, and 95% for controls. Notably, 88% of the “failure to thrive” cohort had an acute medical diagnosis at the time of discharge. Patients in this cohort stayed 18.3 days in hospital compared to 10.2 days (p = .001).ConclusionsPatients with an admission diagnosis of FTT or other associated diagnoses had significant delays in care when presenting to the emergency room, despite often having acute medical conditions on presentation. The use of this non-specific label can lead to premature diagnostic closure and should be avoided in clinical practice.

Naturalistic outcomes for a day-hospital programme in a mixed diagnostic sample of adolescents with eating disorders.

Despite initial data suggesting positive treatment outcomes for adolescent eating disorder day-hospital programmes (DHPs), existing studies have included limited follow-up, small samples, and a focus on restricting-type eating disorders. To address these gaps, we explored naturalistic outcomes for an adolescent eating disorders DHP. Adolescent participants (N = 265) completed measurements at treatment admission, discharge (n = 170), and various lengths of follow-up (n = 126; Mfollow up = 278.87 days). Results from multilevel models indicated significant increases in body weight for the anorexia nervosa group throughout treatment and maintenance of increased body weight from discharge to follow-up. In bulimic spectrum disorders, binge eating and purging significantly decreased from intake to discharge and did not change from discharge to follow-up. Across the entire sample, eating disorder symptoms decreased from intake to discharge and did not change from discharge to follow-up. Further, anxiety and depression decreased over the course of treatment and continued to decrease over the follow-up period. The current investigation represents the first study to explore longitudinal DHP outcomes within adolescent bulimic spectrum eating disorders. Our findings also highlight many challenges inherent in conducting naturalistic research; it is critical that the field continue to develop solutions to the barriers inherent in conducting longitudinal research on eating disorder treatment.

Maryland's Global Budget Revenue model associated with lower inpatient costs and 30-day readmissions in patients undergoing total hip arthroplasty.

BackgroundMaryland implemented the Global Budget Revenue (GBR) to reduce hospital costs, improve quality, and decrease readmissions. Studies assessing its impact on inpatient total hip arthroplasty (THA) procedures are lacking. This study compared before and after GBR changes in 1) patient characteristics; 2) discharge dispositions and lengths of stay (LOS); 3) costs and charges of inpatient stays; and 4) 30-day readmission rates (RR) for THA recipients.MethodsThe Maryland State Inpatient Database was queried for patients who underwent THA between 2010 and 2016 utilizing the ICD-9 and ICD-10 procedure codes (n = 43,251). Pre- and post-GBR periods were grouped as 2010 to 2013 and 2014 to 2016, respectively. Chi-square analyses were used to analyze patient characteristics. Student’s t-tests were utilized to compare ages, LOS, costs, charges, and RR.ResultsThere were no differences in the proportion of minorities undergoing THA between the pre- and post-GBR periods (18.3% vs 19.4% African American, 1.2% vs 1.3% Hispanic; P = .056). The number of THA patients with Medicaid insurances increased during post-GBR (4.0% vs 6.7%; P < .001). There was an increased rate of home discharges during post-GBR (33.1% vs 40.9%; P < .001). We found lower LOS (−0.50 days; 95% CI: −0.458 to −0.533; P < .001), mean inpatient costs (−$1417.44; 95% CI −$1143.76 to −$1150.32; P < .001), and mean inpatient charges (−$2196.50; 95% CI: −$1980.10 to −$2412.90; P < .001) during the post-GBR period. There were lower 30-day RR during the post-GBR period (−0.9%; P < .001).ConclusionsOur findings suggest favorable preliminary results for patients undergoing THA under the GBR model.

Delirium in a Tertiary PICU: Risk Factors and Outcomes*

To determine risk factors and outcomes associated with delirium in PICU patients. Retrospective cohort study. Thirty-two-bed PICU within a tertiary care academic children's hospital. All children admitted to the PICU March 1, 2014, to October 1, 2016, with at least one Cornell Assessment of Pediatric Delirium score (n = 2,446). None. Cornell Assessment of Pediatric Delirium score was performed twice daily as standard of care. We characterized delirium as: 1) presence of greater than or equal to 1 positive score (Cornell Assessment of Pediatric Delirium ≥ 9) and 2) number of days with a positive score. We built multivariable logistic and linear regression models using electronic medical records data. Many patients (n = 1,538; 63%) had a short length of stay (< 48 hr). Compared with patients with length of stay greater than or equal to 48 hours, fewer experienced delirium (30% vs 69%; p < 0.0001). Among 908 patients with length of stay greater than or equal to 48 hours, presence of delirium was independently associated with age less than 2 years old, baseline cognitive dysfunction, primary diagnosis, and duration of mechanical ventilation. Benzodiazepines demonstrated a dose-response effect (odds ratio for presence of delirium, 1.8 [p = 0.03], 3.4 [p < 0.001], and 9.7 [p = 0.005] for < 25th percentile, 25-75th percentile, and > 75th percentile of total dose, vs no exposure). In terms of outcomes, presence of delirium was independently associated with increased ICU length of stay (p < 0.001), whereas days of delirium were independently associated with decline in cognitive function from ICU admission to discharge (odds ratio, 1.06; p < 0.001), increased ICU (p < 0.001), and hospital length of stay (p < 0.001). Neither delirium presence nor total days were independently associated with mortality. Delirium is common in the PICU, particularly among patients with length of stay greater than or equal to 48 hours. It is independently associated with patient characteristics and PICU exposures, including benzodiazepines. The role of delirium as an independent causal factor in patient outcome requires further investigation.

Early Onset Fetal Growth Restriction: Does Path to Diagnosis Impact Outcomes and Pathology?

Objective:To evaluate demographics and outcomes of maternal-fetal pairs in early onset fetal growth restriction (FGR) requiring delivery prior to 34 weeks’ gestation based on ultrasound indication leading to diagnosis.Study Design:This is a descriptive study of maternal-fetal pairs with early FGR diagnosed prior to 30 weeks’ gestation and delivering between 22w0d and 34w0d under the care of Wake Forest University Perinatology 01/2012–12/2016. Serial ultrasounds to assess fetal growth and umbilical artery flow Doppler velocimetry were evaluated. Pairs were dichotomized into those with maternal comorbidities leading to ultrasound diagnosis, and those with ultrasound indicated only by appreciation of uterine size less than dates on exam. Patient characteristics and outcomes were tracked. Univariate and multivariate analyses were performed as appropriate.Results:56 pregnancies were identified with FGR prior to 30 weeks and subsequent delivery prior to 34 weeks. Common comorbidities present in the group with maternal comorbidities included chronic hypertension (30.5%), hypertensive disorders of pregnancy (36.1%), preexisting diabetes (13.9%), gestational diabetes (5.6%). None of the women in the S<D group developed hypertensive disorders of pregnancy or GDM. Other background characteristics were similar. Pregnancies evaluated for size less than dates were diagnosed on average 3 weeks later in gestation, had higher incidence of reverse end diastolic flow on Doppler evaluation both at diagnosis (80% vs. 22.9%, p=0.01, OR 0.08 (<0.01,0.74) and were more likely to be delivered for an urgent indication. Both groups of babies had similar survival to discharge rates and length of stay in the NICU. A subanalysis evaluating only babies with abnormal Doppler studies showed a shorter diagnosis to delivery interval and continued to show increased risk of urgent delivery due to fetal status in those pregnancies diagnosed based on size<dates.Conclusion:Women measuring size less than dates in the mid-trimester should be evaluated by ultrasound without delays. Early FGR carries a high mortality rate in all cases and in our pilot data, women measuring small were diagnosed later with fetal growth restriction and may represent a severe phenotype with poor fetal-placental circulation. These pregnancies often met criteria for urgent delivery in a short time frame, especially if abnormal umbilical artery Doppler velocimetry was noted.

Assessing factors associated with discharge from opioid agonist therapy due to incarceration in the United States

The following study investigates factors associated with discharge from OAT due to incarceration in a sample of 64,331 discharges in the United States. Multinomial regression investigated the association between demographic factors, prior arrest, referral source (i.e criminal justice agency) intravenous drug use, types of drug used, length of prior treatment and discharge due to incarceration compared to completing treatment or discharge due to other reasons. African Americans, Latinx, and Native Americans were at greater risk of discharge due to incarceration compared to whites. Referral to OAT from criminal justice agencies and self-referral was associated with increased risk of discharge from OAT due to incarceration compared to referral from a health care provider. Substance use of heroin, benzodiazepines, synthetic opioids, cocaine and non-prescription use of methadone were associated with discharge due to incarceration. Risk of discharge due to incarceration was higher for patients who reported intravenous drug use and who reported a co-morbid psychiatric problem. These findings enrich a nascent body of literature on mechanisms associated with attrition from OAT due to incarceration and emphasize the need for programs to divert people with OUD from incarceration to increase engagement and retention in OAT.

Advanced nurse practitioners can lead comprehensive geriatric assessment in acute hospitals.

With an increasingly ageing population comes a greater risk of frailty, a distinct health state in which multiple body systems gradually lose their inbuilt reserves. The ability to recognise important frailty markers and conduct specialist comprehensive assessments of potentially frail older people admitted to acute hospitals is important to improve their health and well-being. This article explores the role of the advanced nurse practitioner (ANP) in identifying frailty and leading comprehensive geriatric assessment (CGA) for older people admitted to acute hospital settings. A small evaluation of CGA led by an ANP in a district general hospital found that a well-rounded assessment of patients living with frailty could be carried out, and that such assessments reduced unscheduled readmission within 28 days of discharge and overall length of hospital stay by six days. In a challenging climate, in which healthcare services seek to deliver effective and efficient care to the frail older population, ANPs can ensure a timely and specialist approach to CGA.

Characteristics and Outcomes of Younger Adults with Embolic Stroke of Undetermined Source (ESUS): A Retrospective Study.

Introduction Embolic stroke of undetermined source (ESUS) in younger adults may have different risk factors compared with ESUS in elderly, and the approach to ESUS in young adults may require new therapies. We aimed to investigate the characteristics and outcomes in younger adults with ESUS at a single centre in Saudi Arabia. Patients and Methods A retrospective study was conducted using the medical records of younger adults with ESUS according to the criteria of the Cryptogenic Stroke/ESUS International Working Group. Younger adults (aged ≤50 years) with ESUS were compared with older patients, on admission and discharge from hospital, using the modified Rankin scale (mRS) and the National Institute of Health Stroke Scale (NIHSS). Results Among 147 patients with ESUS, 39 (26.5%) were younger adults. Younger adults compared with older adults with ESUS had fewer vascular risk factors, including lower rates of hypertension (43.6% vs. 70.3%; P = 0.004), diabetes (35.9% vs. 57.4%; P = 0.03), and dyslipidaemia (12.8% vs. 28.7%; P = 0.05). There was no significant difference in poor outcome at discharge (defined as mRS > 2), which was observed in 17.9% of younger adults and 28.7% of older adults. Further, there were no significant differences in stroke severity at discharge (NIHSS score ≤5) or median length of stay. Discussion Although the outcomes of ESUS do not differ between younger and older patients, younger patients have fewer identified risk factors. Conclusion This study showed that 26.5% of patients with ESUS were aged ≤50 years. Although younger adults with ESUS had fewer risk factors, there were no significant differences in neurologic disability or mortality at discharge, stroke severity, or median length of stay.

Substantiation of the device for electro-hydraulic treatment of solutions

Relevance of developing the equipment for electro-hydraulic treatment of water and its solutions was substantiated. The device that is one of the electro-hydraulic spark gap installation components has been developed in order to eliminate the drawbacks of similar devices used. The application field of the device for electro-hydraulic treatment of solutions is crop production in agriculture. Electro-hydraulic treatment can be used to produce fertilizers in conditions of irrigation of greenhouse vegetable crops in personal subsidiary and peasant (farmer) farms. The installation, in addition to the cylindrical tank, contains a voltage source, a high-voltage transformer, an autotransformer, energy storage devices, rectifying cells, start-control devices and means of control and measuring. Electrodes are installed in this device, one of which has a technical scientific novelty. The tip of the negative electrode is hemispherical, which allows increasing the stored energy in the capacitor, to increase it in the discharge channel, increasing the length of the spark discharge in the liquid. The model of the device has been developed in order to substantiate the design parameters and operation modes. The developed electric diagram required for installation, runup and control of technological modes of electro-hydraulic impact on liquid media is shown. Actual model of the device is presented in photo content. The perspectivity of studying the electro-hydraulic effect is determined.

Separation Control by Plasma Actuators: Effects of Direct Momentum Injection and Vortex Generation

In this work, Dielectric Barrier Discharge actuators with triangular tips on their exposed electrodes are applied on a NACA 0015 airfoil and tested in the wind tunnel at an airspeed of 20 m/s (Re = 330k); the actuator set has been defined after previous laboratory studies. Steady and pulsed actuation are tested on all devices, including a straight DBD as reference. Force coefficients and electrical power are measured for every actuator, evaluating their performance in terms of aerodynamic coefficients changes with respect to the smooth airfoil and to the unpowered case, which is also characterized by means of surface visualizations. The influence of discharge length and tip spacing is studied by image processing techniques. The local field of motion is characterized by means of boundary layer velocity profiles, acquired with plasma off and on. Boundary layer thickness and momentum coefficients are determined at different spanwise locations for all the devices. The results are discussed evaluating the different impacts of streamwise momentum injection and vortex generation on the actuators performance, assuming these mechanisms as proper models for the data interpretation. In turn, this leads to outline possible design rules for this kind of DBD.

Epidemiology of Pediatric Tracheostomy and Risk Factors for Poor Outcomes: An 11‐Year Single‐Center Experience

Children with long-term tracheostomies are at higher risk of complications. This study aims to describe the epidemiology, outcomes, and factors associated with successful decannulation in children undergoing tracheostomy. Case series with chart review. Tertiary hospital. A retrospective analysis was conducted on pediatric tracheostomies performed from 2006 to 2016. Demographics, preexisting comorbidities, indications for tracheostomy, and pretracheostomy ventilatory requirements were collected. A multivariate regression model with covariates of age, failure to thrive (FTT), and comorbidities was used to identify factors associated with successful decannulation. Secondary outcomes were ventilation and oxygen requirements at hospital discharge, hospital and intensive care unit length of stay, and complications. In total, 105 patients received a tracheostomy at a median age of 8.0 months (interquartile range, 2.0-45.0). The most common indication was anatomic airway obstruction (55 of 105, 52.5%). Forty-four (41.9%) patients had preexisting FTT. In-hospital mortality was 14 of 105 (13.3%). None were directly related to tracheostomy. At discharge, 40 of 91 (44.0%) and 12 of 91 (13.2%) required home mechanical ventilation and supplemental oxygen, respectively. Forty-one (39%) patients underwent successful decannulation at a median 408 days (interquartile range, 170-1153) posttracheostomy. On adjusted analysis, unsuccessful decannulation was more common in patients with FTT and neurologic comorbidities. Postoperative complications were more common in younger patients and those with a longer time to decannulation. Neurologic comorbidities and FTT were risk factors for unsuccessful decannulation after pediatric tracheostomy. Nutritional interventions may have a role in improving long-term outcomes following pediatric tracheostomies and should be investigated in future studies.

Non-local character of negative glow emission of a low pressure glow discharge

A beam electron energy distribution function (BEEDF) in the cathode regions of a low-pressure glow discharge in helium was calculated using a Monte-Carlo technique. Based on the obtained data on the distribution of the BEEDF along the discharge length, the excitation rate of the 1s3p 1P level was calculated assuming that the direct electron excitation of helium atoms from the ground state takes place. It is shown that the calculated excitation rates of the 1s3p 1P level along discharge path are in good agreement with the experimentally measured emission distribution of the 501.6 nm helium spectral line.

Compensation of phase drifts caused by ambient humidity, temperature and pressure changes for continuously operating interferometers

Fusion experiments rely heavily on the measurement of the line-integrated electron density by interferometry for density feed-back control. In recent years the discharge length has increased dramatically and is continuing to rise, resulting in environmentally induced phase drifts to become an increasingly worrisome subject, since they falsify the interferometer's measurement of the density. Especially in larger Tokamaks the loss of density control due to uncontrolled changes in the optical path length can have a disastrous outcome. The control of environmental parameters in large diagnostic/experimental halls is costly and sometimes infeasible and in some cases cannot be retro-fitted to an existing machine. In this report we present a very cheap (ca. €100), easily retro-fitted, real-time capable phase compensation scheme for interferometers measuring dispersive media over long time scales. The method is not limited to fusion, but can be applied to any continuously measuring interferometer measuring a dispersive medium. It has been successfully applied to the Wendelstein 7-X density feed-back interferometer.

Characterization of plasma based on the electrode size of atmospheric pressure plasma jet (APPJ)

Atmospheric Pressure Plasma Jet recognize as non-thermal plasma or cold plasma where known as APPJ which is generated under pressure of the atmospheric environment, currently APPJ using in many kind of application especially in biomedical application to reduce microbial activity. In APPJ, there are various type of configuration can be set to produce plasma discharge. This project began by changing the configuration of electrodes thickness, electrodes distance, and quartz tube’s inner and outer diameter to generate ideal plasma discharge. The ideal plasma discharge can be choose from Optical Emission Spectroscopy (OES) analysis by using SpectraWiz software and bacteria inactivation method. This OES analysis used to analyze the charged species and chemical reactive species that present in the plasma plume. The length and reactive species of plasma discharge is all depend on the APPJ configuration used. From the result of OES analysis, the best parameters can choose to perform the bacteria inactivation method. It was found that the bacterial inactivation depend on the oxygen radical was introduced into the plasma jet system. The ideal configuration that was choosen from this research can be applicable in future plasma process to get an effective result.

Volume-outcome relationship in pediatric neurotrauma care: analysis of two national databases.

Previous research has demonstrated the association between increased hospital volume and improved outcomes for a wide range of neurosurgical conditions, including adult neurotrauma. The authors aimed to determine if such a relationship was also present in the care of pediatric neurotrauma patients. The authors identified 106,146 pediatric admissions for traumatic intracranial hemorrhage (tICH) in the National Inpatient Sample (NIS) for the period 2002-2014 and 34,017 admissions in the National Trauma Data Bank (NTDB) for 2012-2015. Hospitals were stratified as high volume (top 20%) or low volume (bottom 80%) according to their pediatric tICH volume. Then the association between high-volume status and favorable discharge disposition, inpatient mortality, complications, and length of stay (LOS) was assessed. Multivariate regression modeling was used to control for patient demographics, severity metrics, hospital characteristics, and performance of neurosurgical procedures. In each database, high-volume hospitals treated over 60% of pediatric tICH admissions. In the NIS, patients at high-volume hospitals presented with worse severity metrics and more frequently underwent neurosurgical intervention over medical management (all p < 0.001). After multivariate adjustment, admission to a high-volume hospital was associated with increased odds of a favorable discharge (home or short-term facility) in both databases (both p < 0.001). However, there were no significant differences in inpatient mortality (p = 0.208). Moreover, high-volume hospital patients had lower total complications in the NIS and lower respiratory complications in both databases (all p < 0.001). Although patients at high-volume hospitals in the NTDB had longer hospital stays (β-coefficient = 1.17, p < 0.001), they had shorter stays in the intensive care unit (β-coefficient = 0.96, p = 0.024). To determine if these findings were attributable to the trauma center level rather than case volume, an analysis was conducted with only level I pediatric trauma centers (PTCs) in the NTDB. Similarly, treatment at a high-volume level I PTC was associated with increased odds of a favorable discharge (OR 1.28, p = 0.009), lower odds of pneumonia (OR 0.60, p = 0.007), and a shorter total LOS (β-coefficient = 0.92, p = 0.024). Pediatric tICH patients admitted to high-volume hospitals exhibited better outcomes, particularly in terms of discharge disposition and complications, in two independent national databases. This trend persisted when examining level I PTCs exclusively, suggesting that volume alone may have an impact on pediatric neurotrauma outcomes. These findings highlight the potential merits of centralizing neurosurgery and pursuing regionalization policies, such as interfacility transport networks and destination protocols, to optimize the care of children affected by traumatic brain injury.

Experimental study of gas dynamics caused by spark discharge near wall

Experimental research of the high-speed flow caused by the decay of the thermal cavern after spark discharge located on the wall in ambient air is performed using schlieren technique. Parametric investigations include varying of discharge length in a range of 3-7mm and energy in a range of 60-200mJ. It was found that the rise of discharge energy results in insignificant increase of the size of disturbance height. For tested spark gaps at fixed total energy impact the maximal height of disturbance corresponds to minimal length of discharge (3mm). The results obtained are in a good qualitative and quantitative agreement with the simulation data previously published by the authors.