Discharge Location Research Articles

Where the past meets the present: connecting nitrogen from watersheds to streams through groundwater flowpaths

Groundwater discharge to streams is a nonpoint source of nitrogen (N) that confounds N mitigation efforts and represents a significant portion of the annual N loading to watersheds. However, we lack an understanding of where and how much groundwater N enters streams and watersheds. Nitrogen concentrations at the end of groundwater flowpaths are the culmination of biogeochemical and physical processes from the contributing land area where groundwater recharges, within the aquifer system, and in the near-stream riparian area where groundwater discharges to streams. Our research objectives were to quantify the spatial distribution of N concentrations at groundwater discharges throughout a mixed land-use watershed and to evaluate how relationships among contributing and riparian land cover, modeled aquifer characteristics, and groundwater discharge biogeochemistry explain the spatial variation in groundwater discharge N concentrations. We accomplished this by integrating high-resolution thermal infrared surveys to locate groundwater discharge, biogeochemical sampling of groundwater, and a particle tracking model that links groundwater discharge locations to their contributing area land cover. Groundwater N loading from groundwater discharges within the watershed varied substantially between and within streambank groundwater discharge features. Groundwater nitrate concentrations were spatially heterogeneous ranging from below 0.03–11.45 mg-N/L, varying up to 20-fold within meters. When combined with the particle tracking model results and land cover metrics, we found that groundwater discharge nitrate concentrations were best predicted by a linear mixed-effect model that explained over 60% of the variation in nitrate concentrations, including aquifer chemistry (dissolved oxygen, Cl−, SO4 2−), riparian area forested land cover, and modeled physical aquifer characteristics (discharge, Euclidean distance). Our work highlights the significant spatial variability in groundwater discharge nitrate concentrations within mixed land-use watersheds and the need to understand groundwater N processing across the many spatiotemporal scales within groundwater cycling.

Identifying the distribution of groundwater discharge in a curved river

Groundwater discharge to rivers is crucial to river quality and aqueous ecosystem, and has increasingly drawn researchers’ attention. However, accurately identifying the locations of groundwater discharge in a curved river is still a challenge in hydrology and hydrogeology because the concave and convex banks cause the river-groundwater interaction complicated. This study applied spatial radon isotope (222Rn) continuous-monitoring and spatial high-precision measurements of multiple parameters (temperature, pH, and dissolved oxygen) to identify the groundwater discharge location in a ∼ 10 km curved reach in the lower Ganjiang River (LGJR). The river water influenced by groundwater discharge in the LGJR contained high 222Rn activity, low pH and high temperature. Six sections with groundwater discharge then were identified in the LGJR. Groundwater discharge is more significant on the east bank than on the west. On the concave and convex banks, the groundwater discharge generally occurs in the front neck, which is contrary to the results of most previous studies considering the hyporheic exchange. We inferred that the groundwater discharge in the LGJR is dominated by heterogeneity of regional groundwater flow. This work provides a new insight on the groundwater discharge in the curved river (a common natural morphology of rivers).

Effect of hospital length of stay on functional outcomes and readmission after total shoulder arthroplasty

BackgroundTotal shoulder arthroplasty (TSA) is a common orthopedic procedure for glenohumeral osteoarthritis, rotator cuff arthropathy, and other degenerative conditions. The current standard hospital length of stay (LOS) commonly accepted following TSA is 1-2 days before discharge to home or a private facility. To evaluate the association between LOS and readmissions, revisions, and outcomes. Additionally, risk factors for increased LOS (> 24 hours) following TSA will be determined. MethodsA retrospective review identified all patients who underwent TSA between 2010 and 2019. Patients were excluded for chronic kidney disease requiring dialysis, preoperative corticosteroid use, revision TSA, undergoing a TSA for a fracture, or having no recorded outcome measures. Demographic information, operative details, medical comorbidities, length of hospital stay, complications, location of discharge, readmissions, revisions, and outcome scores were collected. Patients were categorized into two groups: discharge within 24 hours of TSA and discharge over 24 hours after TSA. ResultsPatients discharged within 24 hours had an average LOS of 0.96 ± 0.19 days, and patients discharged after 24 hours had an average LOS of 2.71 ± 1 day (P < .001). There were no significant differences in the groups with regard to race, sex, and body mass index. Patients discharged within 24 hours were younger at the time of surgery compared to patients discharged after 24 hours (66.7 ± 8.10 years and 70.1 ± 10.4 years, respectively [P = .030]). There was a significant difference in discharge location between the groups with 86.2% of patients in the under-24 hour group being discharged to home compared to only 66.0% in the over-24 hour group (P = .006). There were no significant differences between the groups with regard to postoperative complication rate, 90-day readmission rate, and need for revision procedures. There was a significant difference in the Charlson comorbidity index between the groups with those discharged within 24 hours averaging an index score of 2.78 ± 1.33 and those discharged after 24 hours averaging an index score of 4.02 ± 2.07 (P < .001). No significant differences were found between preoperative and postoperative American Shoulder and Elbow Surgeons Shoulder Survey, Single Assessment Numeric Evaluation, or Simple Shoulder Test scores between the groups. ConclusionPatients who had a hospital LOS over 24 hours following TSA were significantly older and discharged to nonhome locations at a higher rate. Patients with Charlson comorbidity index scores over 3 are more likely to have a LOS over 24 hours following TSA. Postoperative outcome measures were not affected by LOS with no significant differences in readmission rate, revision rates, and complications.

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

BackgroundEarly mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave.MethodsThis is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs.ResultsMobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates.ConclusionsOur findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility.Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).

Development of a Computational Fluid Dynamics Simulation Framework for Aerothermal Analyses of Electric Vehicle Battery Packs

Abstract The rise of electric vehicles has driven the extensive adoption of lithium-ion batteries (LIBs) due to their favorable attributes—compactness, low resistance, high power density, and minimal self-discharge. To enhance LIB reliability, an efficient battery thermal management system is imperative. This paper introduces a finite volume-based aerothermal analysis framework for a 32-cell high-energy density LIB pack. We also explore the effectiveness of various turbulence models in capturing local hotspots, discharge rates, and current levels across different geometries and inlet velocities. Our approach involves modeling the battery using Simcenter Battery Design Studio and importing it into Simcenter star-ccm+ for aerothermal simulations in which temperature distribution, discharge rates, current levels, and maximum temperature across are monitored for aligned, cross, and staggered configurations of the battery pack under varying inlet velocities. Our findings highlight the significant impact of boundary condition modeling on simulation stability. Also we observed that the standard k–ε model provides the most accurate predictions, with prediction accuracy within 3–10% of experimental data. Moreover, we identify substantial dependencies between heat generation and discharge current, as well as thermal gradients and inlet velocity. Finally, we conclude that the aligned cell arrangement offers the best thermal uniformity and cooling efficiency.

Abstract 17891: Underutilization of Palliative Care Consults and End-of-Life Care Planning After Cardiogenic Shock

Background: Cardiogenic shock (CS) is associated with significant mortality. The 2022 ACC/AHA/HFSA guidelines discuss the importance of palliative care (PC) in advanced heart disease, but PC and end-of-life care (EOLC) integration after CS is not well characterized. We aimed to study the use of PC and EOLC planning after CS. Hypothesis: We assessed the hypothesis that PC consults and EOLC planning are underutilized after CS. Methods: This is a retrospective observational study of 63 consecutive patients at a quaternary care center in Boston diagnosed with CS between January and April 2022. CS onset and etiology were adjudicated by treating physicians. Results: Of 63 patients with CS (mean age 61±14 years, 30% Female, 73% White), 26 (41%) died during admission and 31 (49%) survived 1 year after CS onset. Only 6 patients (10%) received PC consults for EOLC considerations (consults placed on average 9 days from CS onset) (Table 1). Only 24 (38%) had documented advanced care plans after developing CS, of which 14 were documented by PC consultants. Of 44 patients with MCS or ICD placed, only 1 had a documented discussion about the option of discontinuing the therapy in the future. After CS, 28 (44%) had changes in resuscitation limits. Only 1 patient had their preferred location of death documented. Palliative inotropes were prescribed to 2 patients at discharge, and 3 patients were discharged to hospice. Readmission rates at 3 and 6 months were 24% and 36%, respectively. Conclusions: PC and EOLC planning are underutilized after CS, despite the significant mortality of CS. Secondary PC models may not be optimal for CS, given the acute presentation of CS and bimodal distribution of survival after onset. These data demonstrate a compelling need to address key considerations that impact EOLC after CS, such as resuscitation limits, duration of advanced therapies, and goal-concordant discharge locations. Further research is needed to explore optimal models of PC and EOLC integration after CS.

Abstract 063: Emergent versus delayed carotid artery stenting in tandem occlusion strokes treated with thrombectomy

Introduction It is controversial when to pursue carotid artery stenting (CAS) after acute tandem occlusion (TO) strokes treated with endovascular thrombectomy (EVT). We conducted a retrospective observational study to evaluate the clinical and safety outcomes of emergent versus delayed CAS in the first week of EVT. Methods In this retrospective cohort study, using 2016‐19 Nationwide Readmissions Database, we identified patients with acute ischemic stroke who had EVT for anterior circulation large vessel occlusions (LVOs) and CAS up to 7 days of EVT. CAS performed on day ‐1, 0 or 1 day after admission was considered as emergent CAS. CAS performed 2‐7 days after EVT was defined as delayed CAS. The primary clinical outcomes were all‐cause mortality during same admission. Secondary safety outcomes included intracranial hemorrhage (ICH), seizures, gastric tube (G‐tube) insertion, &gt; 24‐hours mechanical ventilation, tracheostomy, length of stay (LOS), and discharge location (home vs. others). Multivariate logistic regression analysis was used to compare outcomes in emergent CAS group in comparison to delayed CAS group. Age, sex, hypertension, diabetes mellitus, hyperlipidemia, and use of thromobolytics were considered as covariates. Results We identified total of 1990 hospitalizations meeting the study inclusion criteria (mean age: 67 years ± standard deviation:12 years, female 612 (31%). Of these, 1745 (87%) had undergone emergent CAS with EVT and 245 (13%) had delayed CAS (2‐7 days) pos‐EVT. Baseline characteristics were similar between the two cohorts. Delayed CAS cohort had significantly less mortality rates [6 vs 13%; OR 0.43, 95% CI 0.24‐0.78], less ICH [20 vs 30%; OR 0.6, 95% CI 0.43‐0.82¬¬], less cerebral edema [16 vs 23%; OR 0.65, 95% CI 0.44‐0.96], and less mechanical ventilation for &gt;24‐hours [11 vs 18%; OR 0.54, 95% CI 0.34‐0.85]. There was no significant difference between the two treatment groups for tracheostomy, G‐tube placements, new‐onset seizure, and mean LOS. Conclusion Delaying CAS for 2‐7 days after EVT might be a safer approach for endovascular revascularization in anterior circulation LVO strokes secondary to tandem lesions.

Exploring factors affecting the timely transition of ventilator assisted individuals in Ontario from acute to long-term care: Perspectives of healthcare professionals.

Ventilator Assisted Individuals (VAIs) frequently remain in intensive care units (ICUs) for a prolonged period once clinically stable due to a lack of transition options. These VAIs occupy ICU beds and resources that patients with more acute needs could better utilize. Moreover, VAIs experience improved outcomes and quality of life in long-term and community-based environments. To better understand the perspectives of healthcare providers (HCPs) working in an Ontario ICU regarding barriers and facilitators to referral and transition of VAIs from the ICU to a long-term setting. We conducted semi-structured interviews with ten healthcare providers involved in VAI transitions. Perceived barriers included long wait times for long-term care settings, insufficient bed availability at discharge locations, medical complexity of patients, long waitlists, and a lack of transparency of waitlists. Facilitators included strong partnerships and trusting relationships between referring and discharge locations, a centralized referral system, and utilization of community partnerships across care sectors. Insufficient resourcing of long-term care is a key barrier to transitioning VAIs from ICU to long-term settings; strong partnerships across care sectors are a facilitator. System-level approaches, such as a single-streamlined referral system, are needed to address key barriers to timely transition.

Gender versus sex in predicting outcomes of traumatic brain injury: a cohort study utilizing large administrative databases

Understanding the factors associated with elevated risks and adverse consequences of traumatic brain injury (TBI) is an integral part of developing preventive measures for TBI. Brain injury outcomes differ based on one’s sex (biological characteristics) and gender (social characteristics reflecting norms and relationships), however, whether it is sex or gender that drives differences in early (30-day) mortality and discharge location post-TBI is not well understood. In the absence of a gender variable in existing data, we developed a method for “measuring gender” in 276,812 residents of Ontario, Canada who entered the emergency department and acute care hospitals with a TBI diagnostic code between April 1st, 2002, and March 31st, 2020. We applied logistic regression to analyse differences in diagnostic codes between the sexes and to derive a gender score that reflected social dimensions. We used the derived gender score along with a sex variable to demonstrate how it can be used to separate the relationship between sex, gender and TBI outcomes after severe TBI. Sex had a significant effect on early mortality after severe TBI with a rate ratio (95% confidence interval (CI)) of 1.54 (1.24–1.91). Gender had a more significant effect than sex on discharge location. A person expressing more “woman-like” characteristics had lower odds of being discharged to rehabilitation versus home with odds ratio (95% CI) of 0.54 (0.32–0.88). The method we propose offers an opportunity to measure a gender effect independently of sex on TBI outcomes.

MSSA Infection Due to Cardiac Device

Background: we present a 67-year-old male with a history of coronary artery disease and congestive heart failure. He had undergone implantation of an ICD one year ago. Around a year later, he presented with localized discharge, erythema, and swelling around the ICD pocket site. He denied fever, fatigue, and increased shortness of breath. Infectious disease service performed US guided fluid aspirate and culture which tested positive for MSSA. He started him on prolong regimen of cephalexin for a month without improvement. Recommendations were made then for device removal. Case Report: After explanation, the patient’s symptoms improved with antibiotic therapy and the wound showed signs of healing. The infection was successfully eradicated, and the patient’s cardiac function stabilized. The patient was discharged on oral antibiotics for an additional four weeks and scheduled for regular follow-up visits. Conclusion: This case report highlights the occurrence of a cardiac implants pocket infection. Early diagnosis, prompt removal of the infected device, and targeted antibiotic therapy were crucial in achieving successful treatment outcomes. Surgical debridement and wound irrigation played a vital role in preventing further complications. Close monitoring and follow-up are essential to ensure complete resolution of the infection and prevent recurrence.

Frailty as a predictor of adverse outcomes in burn patients: a systematic review

BackgroundThe identification of new prognostic tools for the prediction of burn patients’ morbidity outcomes is necessary. Considering the feasibility of frailty assessment in the clinical setting, we aim to systematically review the literature on the associations between frailty and adverse outcomes in burn patients.MethodsStudies were retrieved from MEDLINE (through PubMed), Web of Science, Scopus, and Embase from their inception up to 8 September 2022. Included studies were those that used frailty indices to predict adverse outcomes in burn patients. The quality assessment was done using the National, Heart, Lung, and Blood Institute (NHLBI) checklist. The results were synthesized narratively.ResultsWe included 18 studies. The sample size among the included studies varied between 42–1615 patients. There were 12 research articles and 6 conference abstracts. Most of the studies were recently published in 2021 and 2022. Seven different frailty measures were evaluated. The following frailty measures were used: Canadian Study for Health and Ageing (CSHA) Clinical Frailty score (CFS), Modified frailty index-11 (mFI-11), Hospital frailty index, FRAIL scale, Emergency General Surgery Frailty Index (EGSFI), and Burn frailty index (BFI). There was only one report regarding a specific frailty index designed for the burn population (BFI). Except for one study (which used mFI-11), all included studies have shown a significant effect between assessing frailty and predicting worse outcomes. The CFS was an independent predictor of mortality among the burn population with high certainty of evidence. We found a significant association for other frailty indices as a predictor of mortality, however, the certainty of evidence regarding those was not high. Eight studies found a positive association between assessing frailty and unfavorable discharge location. There was no association between frailty and increased length of stay.ConclusionIn conclusion, the postadmission assessment of frailty can be a reliable tool for predicting unfavorable outcomes and mortalities among patients with burn injuries. In addition, future studies with various populations from other countries are required to evaluate the efficacy of frailty indices measurement in order to strengthen the available evidence.

Follicular conjunctivitis in dogs: A retrospective study (2007-2022).

To evaluate the incidence, clinical features, treatment, and outcome of canine follicular conjunctivitis (CFC). Medical records of dogs diagnosed with CFC were reviewed. Data recorded included signalment, duration of clinical signs and treatment details prior to presentation, concurrent ocular/systemic diseases, ocular clinical signs, cytology, treatment, follow-up, and outcome. Blepharospasm, signs of self-trauma, hyperemia, chemosis, ocular discharge, and follicle location and severity (0.5-4) were retrospectively evaluated. Based on severity, treatment consisted of topical 0.1% diclofenac or 0.1% dexamethasone sodium eyedrops. Dogs were classified into young (YD < 18 months) and adult (AD ≥ 18 months). One hundred and fifty-three dogs (276 eyes) were included in the study: 83YD (54%) and 70AD (46%). Males and bilateral disease were over-represented in both groups. Severity was associated with young age (p = .032) and bilaterality (p = .025), and not with dermatological diseases (p > .05). No differences in follicular location were observed except for more frequent involvement of the nictitating membrane (MN) in YD (p = .02). Response to treatment was faster in AD (p = .001), with complete resolution in 80.6% of the eyes (100/124) at 1 month. YD treated with diclofenac showed faster resolution than those treated with 0.1% dexamethasone (p = .009). Although CFC is a bilateral ocular disease occurring at any age, the clinical presentation is influenced by age. Follicular conjunctivitis in adult dogs is less sever, less commonly affects the NM, and responds more quickly to topical treatment. One month of topical diclofenac may be adequate for mild cases, and 1 month of topical 0.1% dexamethasone is recommended as initial therapy for moderate to severely affected cases.

Investigation of Plasma Propagation in Packed-Bed Dielectric Barrier Discharge Based on a Customized Particle-in-Cell/Monte Carlo Collision Model

This study investigates the propagation dynamics of plasma streamers in a packed-bed dielectric barrier discharge using a 2D particle-in-cell/Monte Carlo collision model. To accurately simulate the high-intensity discharge and streamer propagation mechanism at atmospheric pressure, additional algorithms for particle merging and a new electron mechanism are incorporated into the traditional particle-in-cell/Monte Carlo collision model. To validate the accuracy of this improved model, qualitative comparisons are made with experimental measurements from the existing literature. The results show that the speed of streamer propagation and the distribution of plasma are strongly influenced by the dielectric constant of the packed pellet, which is commonly used as a catalyst. In cases with a moderate dielectric constant, the presence of a strong electric field between the pellet and dielectric layer on the electrode significantly enhances the discharge. This enables the streamer to propagate swiftly along the pellet surface and results in a wider spread of plasma. Conversely, a very high dielectric constant impedes streamer propagation and leads to localized discharge with high intensity. The improved model algorithms derived from this research offer valuable insights for simulating high-density plasma discharge and optimizing plasma processing applications.

Terrestrial inputs and physical processes control the distributions of potentially toxic elements (PTEs) in the seawater of the large-range Beibu Gulf, the northern South China Sea

The potentially toxic elements (PTEs), Cu, Pb, Zn, Cd, Cr, Hg and As in the water from the Beibu Gulf, were investigated to reveal the contaminant characteristics and assess the risks to human health. The results showed that the concentration of PTEs in the Beibu Gulf varies significantly both seasonally and spatially, with higher concentrations in summer and in the northern and southern gulf. Terrestrial inputs and local anthropogenic discharge are responsible for the higher level in the northern gulf, and the transportation of water masses is also an important factor for the higher concentrations in the southern gulf. Ecological risk assessment suggested that Hg is the main ecological risk factor. The health risk assessment revealed that dermal exposure to PTEs in the gulf presents potentially carcinogenic health effects for humans. This study provides new insight into the transport of PTEs over a large area of the Beibu Gulf.

Disadvantaged Neighborhoods Continue to Bear the Burden of Gun Violence

IntroductionGun violence is a pervasive and dynamic public health crisis causing substantial burden on communities and healthcare systems in the United States. Risk factor and outcome analyses are crucial to develop effective interventions. The aim of this study was to assess firearm injury in a diverse community setting as it relates to neighborhood socioeconomic disadvantage and changes over time following large-scale local interventions. MethodsAll county residents with firearm injury presenting to a Level 1 Trauma Center from January 2012 to December 2021 were retrospectively reviewed. Area Deprivation Index (ADI) was used to measure neighborhood socioeconomic disadvantage based on a nine-digit zip code at patients’ home address. Injuries were also stratified by 5-year time periods, 2012-2016 and 2017-2021. Demographics and clinical data were analyzed including injury severity, hospital course, and discharge location. Data were compared by ADI quintile and between time periods using chi-squared, one-way analysis of variance, and Cochran-Armitage test. ResultsA total of 1044 injuries were evaluated. Patients were 93% male with mean age of 29 y (standard deviation 10.2) and were concentrated in the most disadvantaged neighborhoods (74% ADI Q5). Black or African American race was greater in the most disadvantaged ADI groups (76% versus 47%-66%; P <0.001). Percentage of total injuries in the most disadvantaged ADI group rose from 71% to 78% over time (P = 0.006). Mortality occurred in 154 (15%) patients overall, while most (71%) were discharged to home. Mortality declined from 18% to 11% over time (P <0.001). Medicaid utilization rose from 42% to 77% alongside a decrease in self-pay status from 44% to 4% (P <0.001). There were no clinically significant group differences in injury severity or clinical characteristics. ConclusionsFirearm injury remains concentrated in the most socioeconomically disadvantaged neighborhoods, and this disparity is increasing over time. Medicaid utilization rose and mortality decreased in this population over time. This research presents a method to inform and monitor local gun violence interventions using ADI to address public health equity.

Court-ordered inpatient psychiatric care in Switzerland: determinants of length of stay and treatment outcome.

IntroductionIn several European countries, offenders with decreased or abolished responsibility and high risk of recidivism due to long-lasting mental disorders are compulsory admitted for court-ordered treatments (COT) that take place in high and medium-security hospitals. As a rule, length of stay in these structures is very long implying major restrictions for the inmate and high societal cost. Despite intensive research, the predictors of length of stay and treatment outcome in long stay forensic services is still matter of debate.MethodsWe report here a detailed analysis of the demographic, psychiatric and offense predictors of length of stay and discharge locations of 204 mentally disordered offenders convicted to COT in a new medium-security forensic psychiatry clinic in Geneva, Switzerland. Kaplan-Meier survival estimates were performed to determine time to release. Length of stay was predicted by Cox regressions, and discharge locations were predicted by multinomial logistic regressions.ResultsThe typical inpatient was a 35-age single male re-offender, submitted to COT after a conviction for physical violence (78.9%) or property violation (64.2%), with drug trafficking (52.9%), in relation to psychotic (67.2%), antisocial or borderline personality disorder (35.8%) with comorbid substance use disorders (60.3%). Sex offenses were found in 24.5% of cases and were associated with Cluster B personality disorders. The median length of stay was of 2.5 years and was independent of demographic variables, severity of crime recidivism and psychiatric diagnosis. Longer COT at admission, and type of offense (in particular drug traffic and sexual violence) predicted longer stays. At discharge, 32.8% of cases were transferred to sheltered educational housing, 23.1% to open low-security wards, while 30.6% returned to regular prisons and 9.7% to their country of origin.DiscussionYounger age and conviction for property violation rather than physical violence increased the chances to be discharged to sheltered educational housing. Longer COT at admission, personality disorders, and conviction for sexual offense increased the risk to return to prison. These data suggest that sex offenses determine not only longer stays under COT but also drastically decreases the chance of freedom for inmates with Cluster B personality disorders.

Shielded ionisation discharge (SID) probe for spatiotemporal profiling of pulsed molecular beam.

Intense pulsed supersonic molecular beams are used in many applications such as tokamak fueling, edge plasma diagnostics, ion beam profile monitors, laser cluster experiments, chemical kinetics, etc. Measurement of absolute density is required to optimize beam sources used in these experiments. Absolute density measurement of a continuous molecular beam is challenging due to its small size and rarefied flow, which makes it even more difficult for a pulsed molecular beam due to its transient nature. In this work, we demonstrate a novel probe to measure the spatiotemporal evolution of the absolute number density of a pulsed supersonic molecular beam. The probe is named the Shielded Ionization Discharge probe. It measures density using localized discharge within the molecular beam created by the thermionic emission of electrons from a hot filament. We describe the design, calibration, and characterization of the developed probe. The performance of the probe is demonstrated by measuring the spatial and temporal profiles of a pulsed supersonic molecular beam of 1.5ms duration.

Do Salinity Variations Along the East Greenland Shelf Show Imprints of Increasing Meltwater Runoff?

AbstractAccelerated melting of the Greenland Ice Sheet is considered a tipping element in the freshwater balance of the subpolar North Atlantic (SPNA). The East Greenland Current (EGC) and Coastal Current (EGCC) are the major conduits for transporting Arctic‐sourced and Greenland glacial freshwater. Understanding freshwater changes in the EGC system and drivers thereof is crucial for connecting tipping elements in the SPNA. Using the eddy‐rich model VIKING20X (1/20°) and Copernicus GLORYS12 (1/12°), we find that from 1993 to 2019 freshwater remains close to the shelf with interannual extremes in freshwater content (FWC) attributable to the imprint of Greenland melt only in years 2010 and 2012. Runoff increased significantly from 1995 to 2005 and Arctic freshwater export after 2005. Overall, regional wind patterns, sea ice melt and increasingly glacial ice and snow meltwater runoff along with the Arctic‐sourced Polar Water set interannual FWC variations in the EGC system. We emphasize that these freshwater sources have different seasonal timing. South of 65°N sea ice melts year round and retreats to north of 65°N, where melt in summer prevails. Greenland runoff peaks in June–August with only some locations of year round discharge. Alongshore winds intensify in fall and winter where reduced onshore Ekman transport allows for freshwater to spread laterally in the EGC. We show that sea ice melt, runoff and wind can cause interannual variations of comparable magnitude. All of which makes attributing ocean freshening events to Greenland meltwater inflow at current magnitudes a major challenge.

Helium Gas Cooled and Insulated Superconducting Coaxial Dipole Cable for Electric Transport

The design concept, electric field distribution models, fabrication, and experimental characterization of a coaxial superconducting gas insulated dipole line (dipole SGIL) are discussed. Two different insulating spacers were explored to study the effect of the permittivity mismatch between the insulator material and the gas medium on the maximum electric field strength. Results of the experiments conducted at 77 K and 300 K under gas pressures up to 2 MPa are discussed. The dipole SGIL design developed showed promising results in breakdown strength. It was found that compact design coupled with the permittivity mismatches causes high electric field concentrations that lead to corona discharge activity below the target operating voltage. Potential design solutions for the SGIL to address the high electric field stress at the triple points that causes localized corona discharge activity in the gaseous cryogen are discussed. Future SGIL designs must address the large permittivity mismatch between gaseous helium and the insulator spacers to minimize the electric field stresses. Design optimizations need to consider the tradeoffs between the power density requirements and the operating voltage of superconducting dipole cables on electric aircraft and ships.

Safety and comparative efficacy of initiating low-molecular-weight heparin within 24 hours of injury or surgery for venous thromboembolism prophylaxis in patients with spinal cord injury: a prospective TRACK-SCI registry study.

Venous thromboembolism (VTE) following traumatic spinal cord injury (SCI) is a significant clinical concern. This study sought to determine the incidence of VTE and hemorrhagic complications among patients with SCI who received low-molecular-weight heparin (LMWH) within 24 hours of injury or surgery and identify variables that predict VTE using the prospective Transforming Research and Clinical Knowledge in SCI (TRACK-SCI) database. The TRACK-SCI database was queried for individuals with traumatic SCI from 2015 to 2022. Primary outcomes of interest included rates of VTE (including deep vein thrombosis [DVT] and pulmonary embolism [PE]) and in-hospital hemorrhagic complications that occurred after LWMH administration. Secondary outcomes included intensive care unit and hospital length of stay, discharge location type, and in-hospital mortality. The study cohort consisted of 162 patients with SCI. Fifteen of the 162 patients withdrew from the study, leading to loss of data for certain variables for these patients. One hundred thirty patients (87.8%) underwent decompression and/or fusion surgery for SCI. DVT occurred in 11 (7.4%) of 148 patients, PE in 9 (6.1%) of 148, and any VTE in 18 (12.2%) of 148 patients. The analysis showed that admission lower-extremity motor score (p = 0.0408), injury at the thoracic level (p = 0.0086), admission American Spinal Injury Association grade (p = 0.0070), and younger age (p = 0.0372) were significantly associated with VTE. There were 3 instances of postoperative spine surgery-related bleeding (2.4%) in the 127 patients who had spine surgery with bleeding complication data available, with one requiring return to surgery (0.8%). Thirteen (8.8%) of 147 patients had a bleeding complication not related to spine surgery. There were 2 gastrointestinal bleeds associated with nasogastric tube placement, 3 cases of postoperative non-spine-related surgery bleeding, and 8 cases of other bleeding complications (5.4%) not related to any surgery. Initiation of LMWH within 24 hours was associated with a low rate of spine surgery-related bleeding. Bleeding complications unrelated to SCI surgery still occur with LMWH administration. Because neurosurgical intervention is typically the limiting factor in initializing chemical DVT prophylaxis, many of these bleeding complications would have likely occurred regardless of the protocol.