Discharge Location Research Articles

Groundwater discharge tracing for a large Ice-Covered lake in the Tibetan Plateau: Integrated satellite remote sensing data, chemical components and isotopes (D, 18O, and 222Rn)

It has been known that groundwater-lake water interaction plays an important role in mass exchange between land and lakes. However, most of the lakes in the world freeze during the winter, and few studies of groundwater and surface water interaction (groundwater discharge tracing) focus on ice-covered lakes. This study investigated groundwater discharge into a large ice-covered lake, Xiao Qaidam Lake in the Tibetan Plateau (TP), using satellite remote sensing and chemical and isotopic tracing. Analysis of chemical components, stable isotopes (D, 18O) and 222Rn revealed that groundwater discharge occurred in the western and southern portions of Xiao Qaidam Lake. Remote sensing data (the distribution of and variation in lake surface temperature, LST) revealed these locations of groundwater discharge and indicated additional groundwater discharge in areas of springs. Based on the regression model between LST and 222Rn activity in lake water and 222Rn mass balance model, the groundwater discharge into Xiao Qaidam Lake was estimated to be (2.77 ± 0.26) × 105 m3/d, which is slightly higher than river water input at summer. In addition, this study also suggests that ice melting process should be considered when tracing groundwater discharge into an ice-covered lake, and that the LST distribution during the icing period is better than the LST variation for tracing groundwater discharge because the ice eliminated noise from wind and surface water. The study provides insight into the tracing of groundwater discharge into large ice-covered lakes in the TP and elsewhere.

Effects of the COVID-19 pandemic on hip fracture volume, disposition, and readmission rates

Our study aimed to assess the effects COVID had on the incidence of hip fractures. Hip fracture cases (from March 1 to September 1) were compared in 2018, 2019, and 2020. Data were analyzed for surgical volume, discharge location, and readmission rates. There was a statistically significant decrease in hip fractures during 2020 (P < 0.01) and a decrease in patients placed in skilled nursing facilities (P = 0.04), with no increase in 30-day readmission (P = 0.776). Findings suggest that COVID-19 has impacted the volume and composition of hip fracture cases. Although additional research on the subsequent survival impact is necessary, these placement patterns of hip fracture patients into facilities may be an opportunity to optimize cost and care.

Long-term functional outcomes after traumatic spine fractures

BackgroundTraumatic spine fractures can result in chronic pain, disability, and prolonged rehabilitation. The purpose of this study is to determine the long-term effects of traumatic spine fractures on patients’ functional outcomes after nonoperative and operative management. MethodsPatients with traumatic spine fractures over a 5-year period were identified and stratified by management strategy (nonoperative and operative) and compared. Functional outcomes were measured using the Boston Activity Measure for PostAcute Care to assess basic mobility and daily activity. Multiple linear regression was used to identify predictors of functional outcome after traumatic spine fractures. ResultsIn total, 488 patients were identified: 271 nonoperative and 217 operative. Follow-up was obtained in 168 (34%) patients: 95 nonoperative and 73 operative. Mean follow-up was 5.7 years (range 3–8 years). Mean Activity Measure for PostAcute Care scores in patients managed nonoperatively for basic mobility (68 vs 64, P = .09) and daily activity (69 vs 66, P = .26) were clinically similar to those managed operatively. Multiple linear regression identified increasing age as a predictor of decreased basic mobility (β = –0.50, P < .0001, β = –0.17, P = .022) and daily activity (β = –0.58, P < .0001, β = –0.35, P = .003) in nonoperative and operative groups, respectively. In nonoperative patients, thoracic spine fracture was predictive of both decreased basic mobility (β = –5.88, P = .041) and daily activity (β = –8.62, P = .043). In operative patients, lower extremity fractures (β = –8.86, P = .012), discharge location (β = –6.91, P = .003), and time to operative fixation (β = –0.77, P = .040) were associated with decreased basic mobility. ConclusionAll patients with traumatic spine fractures displayed mild to moderate functional impairment. Age, thoracic fractures, lower extremity fractures, discharge location, and time to operative fixation were associated with poor functional outcomes.

No Differences Between White and Non-White Patients in Terms of Care Quality Metrics, Complications, and Death After Hip Fracture Surgery When Standardized Care Pathways Are Used.

No Differences Between White and Non-White Patients in Terms of Care Quality Metrics, Complications, and Death After Hip Fracture Surgery When Standardized Care Pathways Are Used.

Patient Functional Assessment in IRF: FIM vs CMS GG over the Last 4 Fiscal Years

<h3>Research Objectives</h3> For nearly 20 years CMS required Inpatient rehabilitation facilities (IRF) providing care to Medicare beneficiaries to complete the IRF-PAI on patients for reimbursement of services which include the FIM instrument for the assessment of patient function and outcomes. In Oct 2016 CMS changed the IRF-PAI tool to include CMS-derived GG items which also assessed patient functioning, however, the items were not required for reimbursement. In Oct 2019 CMS required submission of GG items for medical reimbursement. The purpose of this study was to examine the implications of the changes that have transpired over the past five years. The objective is to compare Reliability and Consistency between the items of the FIM and the new CMS Section GG Functional Abilities items included in the IRF-PAI instrument from Fiscal Year 2017 to 2020. <h3>Design</h3> A retrospective cohort study using data from the Uniform Data System for Medical Rehabilitation (UDSMR): cases discharged in the Fiscal Year 2017 - 2020. <h3>Setting</h3> IRFs located in the US subscribing to UDSMR; roughly 85% of all IRFs in the nation subscribe to UDSMR for benchmarking reporting. <h3>Participants</h3> All Medicare cases for patients admitted in IRFs which are subscribers of UDSMR from the fiscal year 2016 to 2020 <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Rehabilitation-related outcomes were compared; included were: average admission FIM® and average discharge FIM®, 16 GG self-care and mobility items plus bladder and bowel at admission and discharge which are included on CMS IRF-PAI instrument, Impairment conditions, CMG, LOS, discharge location. <h3>Results</h3> Forthcoming; patient outcomes as measured by the FIM and CMS GG items will be provided and trends examined over time The completion rates for items at admission and discharge by year will be analyzed including the reliability and validity of the items. Results may have policy implications in addition to possible impacts at the facility and patient level. <h3>Conclusions</h3> Presently the use of the following codes: -, ^, 7, 8, 9, 10, and 88 at admission or discharge is re-coded to a value of 1 for all GG functional items (except toilet transfer where a value of 2 is assigned) for reporting purposes per CMS. A value of 1 indicates the lowest level of function, in essence complete dependence, patient is unable to perform activity. CMS should reconsider assigning the value of 1 to patients with a code indicating the activity was not performed, as it is ultimately missing data and our analysis indicated the value of 1 may not be the most appropriate considering the discharge destination and the patient total length of stay in medical rehabilitation. Use of codes: -, ^, 7, 9, 10, 88 are missing values, where the patient's true level of functioning is unknown. This leads to uncertainty in the patient's true ability self-care and uncertainty regarding the most appropriate discharge setting to meet the patient's specific needs. Accuracy in assessment of patient's level of functioning is paramount in patient care and quality outcomes. CMS should consider removing the codes: -, ^, 7, 8, 9, 10 and 88 or advising clinicians to reserve use of the codes for the most atypical, rare exceptions. <h3>Author(s) Disclosures</h3> The authors declare that they have no relevant or material financial interests that relate to the research described in this poster

Comparing headwater stream thermal sensitivity across two distinct regions in Northern California

AbstractThermal regimes in headwater streams are critical for freshwater ecological condition and habitat resilience to disturbance, and to inform sustainable forest management. However, stream temperatures vary depending on characteristics of the stream, catchment, or region. To improve our knowledge of stream thermal regimes, we collected stream and air temperature data along eight headwater streams in two regions in Northern California. Five streams were in the Coast Range, which is characterized by permeable sandstone lithology, rain dominated precipitation regime, and dense coast redwood forests. Three streams were in the Cascade Range, which is characterized by fractured and resistant basalt lithology, snow dominated precipitation, and low to moderate density pine forests. We instrumented each stream with 12 stream temperature and four air temperature sensors during summer 2018. We compared stream thermal regimes and thermal sensitivity—slope of the linear regression between daily stream and air temperature—within and between study regions. Mean daily stream temperatures were ~4.7°C warmer in the Coast Range but were less variable (SD = 0.7°C) compared to the Cascade Range (SD = 2.3°C). Median thermal sensitivity was 0.33°C °C−1 in the Coast Range and 0.23°C °C−1 in the Cascade Range. We posit that the volcanic lithology underlying the Cascade streams likely supported discrete groundwater discharge locations of cold snowmelt water, which dampened thermal sensitivity. At locations of apparent groundwater discharge in these streams, median stream temperatures rapidly decreased by 2.0–7.0°C relative to locations 70–90 m upstream. In contrast, thin friable soils in the Coast Range likely contributed warmer, rain dominated baseflow from shallow subsurface sources, which strongly co‐varied with air temperature and generally warmed downstream (up to 2.1°C km−1). Our study revealed distinct longitudinal thermal regimes in streams with contrasting lithology, precipitation regimes, and stand densities suggesting that streams in these different regions may respond differentially to forest disturbances or climate change.

Mechanical Ventilator Liberation of Patients With COVID-19 in Long-term Acute Care Hospital

BackgroundMechanical ventilation (MV) via tracheostomy is performed commonly for patients who are in long-term acute care hospitals (LTACHs) after respiratory failure. However, the outcome of MV in COVID-19-associated respiratory failure in LTACHs is not known.Research QuestionWhat is the ventilator liberation rate of patients who have received tracheostomy with COVID-19-associated respiratory failure compared with those with respiratory failure unrelated to COVID-19 in LTACHs?Study Design and MethodsIn this retrospective cohort study, we examined mechanically ventilated patients discharged between June 2020 and March 2021. Of 242 discharges, 165 patients who had undergone tracheostomy arrived and were considered for ventilator liberation. One hundred twenty-eight patients did not have COVID-19 and 37 patients were admitted for COVID-19.ResultsThe primary outcome of the study was ventilator liberation; secondary outcomes were functional recovery, length of stay (LOS) at the LTACH, and discharge disposition. After controlling for demographics, the number of comorbidities, hemodialysis, vasopressor need, thrombocytopenia, and the LOS at the short-term acute care hospital, our results indicated that patients with COVID-19 showed a higher adjusted ventilator liberation rate of 91.4% vs 56.0% in those without COVID-19. Functional ability was assessed with the change of Functional Status Score for the Intensive Care Unit (FSS-ICU) between admission and discharge. The adjusted mean change in FSS-ICU was significantly higher in the COVID-19 group than in the non-COVID-19 group: 9.49 (95% CI, 7.38-11.6) vs 2.08 (95% CI, 1.05-3.11), respectively (P < .001). Patients with COVID-19 experienced a shorter adjusted LOS at the LTACH with an adjusted hazard ratio of 1.57 (95% CI, 1.0-2.46; P = .05) compared with patients without COVID-19. We did not observe significant differences between the two groups regarding discharge location, but a trend toward need for lower level of care was found in patients with COVID-19.InterpretationOur study suggests that patients with COVID-19 requiring MV and tracheostomy have a higher chance for recovery than those without COVID-19.

Race and birth country are associated with discharge location from hospital: A retrospective cohort study of demographic differences for patients receiving inpatient palliative care.

SummaryBackgroundWhile past studies investigated access to palliative care among marginalized groups, few assessed whether there are differences in clinical process indicators based on demographics among those receiving palliative care. We aimed to: describe demographics among patients receiving inpatient palliative care; and evaluate whether demographic variables are associated with differences in disposition (i.e., discharge location), length of stay (LOS), and timing of inpatient palliative care referral and consultation.MethodsRetrospective cohort study using electronic medical record data to study patients seen by inpatient palliative care at Mount Sinai Hospital in Toronto, Canada between April 2018 to March 2019. Primary outcome was disposition. Secondary outcomes were LOS, time from admission to palliative referral, and time from referral to consultation. We summarized quantitative data descriptively and used fisher exact tests to explore relationships between categorial variables. For continuous outcomes, we ran one-way ANOVA tests.FindingsA total of 187 patients were referred to palliative care and met inclusion criteria. Mean age was 68·8 and 55·6% were female. 46·7% were born in Canada, 58·2% were White and 78·4% preferred English communication. Variables significantly associated with disposition were: birth country (p = 0·04), and race/ethnicity (p = 0·03). Language (F ratio = 3·6, p = 0·004) was significantly associated with time from admission to palliative care referral. No variables were associated with LOS or time from referral to consult.InterpretationInequalities in disposition, and how long it takes to refer to palliative care may exist. Further studies should focus on understanding the underlying practices that constructed, and maintained these inequalities in care.FundingThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

The Key Impact on Water Quality of Coral Reefs in Kenting National Park

Southern Taiwan’s Kenting National Park is a popular retreating place for many domestic and international tourists, with increasing tourist numbers potentially over-burdening the coastal ecosystems. To better understand human impacts, a long-term ecological research program was initiated in 2001 to track water quality at 14 coral reef-abutting sites throughout the park since then. Extracting the data from this 20-year survey, we found that increasing in the nutrient levels during the summer rainy season, together with the drops in salinity led by freshwater inputs (land- &amp; rainfall-derived), was the main impact to coral reef ecosystem of Kenting. Cluster analysis further confirmed the nutrient influx was mainly attributed to the local discharge outlets with dense of villages and hotels at upstream. Therefore, more efforts are needed to input to control tourist number, treat waste water discharge and strengthen land protection facilities.

The Effects of Wastewater Treatment Plant Failure on the Gulf of Gdansk (Southern Baltic Sea).

In August 2019 and during August/September 2020, the main collection system of the Wastewater Treatment Plant (WWTP) in Warsaw, Poland, malfunctioned. During that system failure, over 4.8 million m3 of untreated wastewater was dropped directly into the Vistula River in just a few days. It is currently considered as one of the largest known failures of WWTP worldwide. In order to assess the environmental impact, water samples were collected from 2 spots at the Vistula river estuary (406 and 415 km from the discharge location, respectively), and 4 spots at the Gulf of Gdansk, situated on the southern shore of the Baltic Sea. The sampling was conducted before the wastewater wave reached the Vistula river’s mouth, followed by daily sampling during 21 days after the malfunction occurred. The study showed the decline in water quality at the Vistula river estuary and the Baltic shore waters as the wave of wastewater reached those points, despite being situated over 400 km downstream from the place of the accident. Those changes included the reduction in the dissolved oxygen content (by 0.69-fold at its peak), the increase in Total Organic Carbon (TOC) (by 1.28-fold at its peak), nitrate-nitrogen (N-NO3) (by 1.68-fold at its peak), phosphorous (P) (by 2.41-fold at its peak), conductivity (by 16.8-fold at its peak), and Chemical Oxygen Demand (COD) (by 1.84-fold). In the samples from the Vistula river, the decline in water quality was seen as incidental and lasted 2–3 days. Subsequently, the levels of physical and chemical parameters returned to the levels from before the accident. However, the changes in the Gulf of Gdańsk lasted significantly longer, especially on the West side of the Vistula river, where, even after 21 days from the initial accident, some parameters remained altered.

Prolonged hospital stay after arthroplasty for geriatric femoral neck fractures is associated with increased early mortality risk after discharge

BackgroundRecent studies show increasing mortality rates of geriatric femoral neck fracture patients with delays in operative treatment greater than 48 hours from injury. A less extensively studied area in this population is the effect of length of inpatient hospital stay (LOS) on outcomes. The purpose of this study was to determine the association of LOS after arthroplasty for geriatric femoral neck fractures with 30-day mortality risk. MethodsThis study is a retrospective review using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), a nationally validated, outcomes-based database incorporating data from over 700 geographically diverse medical centers. It included 9005 patients, 65 years of age or older, who underwent either hemiarthroplasty or total hip arthroplasty for a femoral neck fracture between 2011 and 2018. Using multivariate analysis, risk of 30-day mortality based on surgery-to-discharge time was determined, expressed as odds ratios (OR) with 95% confidence intervals (CI). ResultsAfter controlling for sex, BMI, age, surgical procedure, American Society of Anesthesiologists (ASA) classification, and discharge location, the risk of mortality after discharge was increased with longer post-surgical length of stay [OR 2.5, P < .001]. ConclusionProlonged LOS after arthroplasty for geriatric femoral neck fractures is associated with increased 30-day mortality risk. Efforts made to target and mitigate modifiable risk factors responsible for delaying discharge may improve early outcomes in this population.

The impact of discharge location on outcomes following radical cystectomy.

Hospital readmission is associated with adverse outcomes and increased cost, and as such, has been identified as a metric for surgical quality and a target for shifts in health policy. However, the disposition of patients who undergo radical cystectomy for bladder cancer and the association between discharge locations and readmission rates is poorly understood. Understanding the patterns and characteristics of readmission after radical cystectomy will help inform discharge planning and expectations and may have long-term impacts on quality and cost of care delivery. We hypothesize that patients will have varying readmission rates based on their discharge location. An observational analysis of the Nationwide Readmissions Database was performed for all patients who underwent elective radical cystectomy in 2016 to 2017. The patients were grouped by the following criteria: whether they were discharged home, home with care, or to a facility. Univariate analysis was performed using the Chi-square test for categorical variables and the Kruskal-Wallis test for continuous variables. A multivariable logistic regression was conducted to evaluate if discharge locations impact patient readmissions at 30- and 90-days. The final dataset included 4,947 patients discharged home with care, 2,127 patients discharged to home or self-care, and 1,232 patients discharged to a facility. Discharge to a facility was strongly associated with higher 30-day (OR 1.49, CI 1.26-1.76) and 90-day readmission rates (OR 1.46, CI 1.23-1.74). Additionally, home health care was strongly associated with increased 30-day readmission rates (OR 1.22, CI 1.08-1.37) relative to routine discharge home. Our analysis suggests that discharge location independently predicts readmission following RC. Further study with more granular patient- and system-level data may aid in identifying structural characteristics and processes that can reduce readmissions and their associated economic impact, while maintaining quality of care delivered.

Abstract 58: Adherence To Discharge Rehabilitation Recommendations May Decrease Unplanned Care And Improve Patient Outcomes

Adherence to Discharge Rehabilitation Recommendations May Decrease Unplanned Care and Improve Patient Outcomes Introduction Unplanned episodes of care result in increased cost to patients and institutions. Minimal data exist correlating discharge recommendation by rehabilitation specialists to patient outcomes. We aimed to evaluate the discharge recommendation of rehabilitation team (physiatry, occupational and physical therapies) versus actual discharge location and their relationship of unplanned episodes of care and ninety day outcomes. Method: A single center retrospective analysis of Acute Ischemic Stroke (AIS) patients discharged from January to September 2020. We excluded those that were discharged to hospice and expired during the initial encounter. Our primary outcome was to examine unplanned care episodes in comparison to the adherence of the rehabilitation team’s discharge recommendation. The secondary outcome examined the 90 day modified Rankin Score in comparison to the discharge recommendations. Stepwise logistic regression and ordinal regression models were utilized to analyze primary and secondary outcomes. Results: A total of 544 patients were evaluated. After exclusions we included 385 patients; 301 (78.2%) followed the discharge recommendation. Agreement on discharge location between physiatry and therapy modalities was 85.7%. When physiatrist final recommendations were unavailable, agreement between occupational and physical therapy decreased to 83.9%. Patients who adhered to rehabilitation recommendations were less likely to experience unplanned care compared to patients who did not (23.7% vs. 28.6%), although the difference was not statistically significant; adjusted odds ratio (aOR) = 0.63 [95%CI, 0.36 - 1.10], p = 0.10. Similarly, patients adhering to recommendations experienced less disability at 90 days compared to those who did not, although the difference was not statistically significant; aOR = 0.64 [95%CI, 0.39 - 1.06], p = 0.08. Conclusion: When the patients followed the recommendations of the rehabilitation team, a trend was found towards a decrease in unplanned care and better outcomes. Findings suggest additional research is warranted.

Illicit discharge detection in stormwater drains using an Arduino-based low-cost sensor network

Illicit discharges in urban stormwater drains are a major environmental concern that deteriorate downstream waterway health. Conventional detection methods such as stormwater drain visual inspection and dye testing have fundamental drawbacks and limitations which can prevent easy location and elimination of illegal discharges in a catchment. We deployed 22 novel low-cost level, temperature and conductivity sensors across an urban catchment in Melbourne for a year to monitor the distributed drainage network, thereby detecting likely illicit discharges ranging from a transitory flow with less than 10 minutes to persistent flows lasting longer than 20 hours. We discuss rapid deployment methods, real-time data collection and online processing. The ensemble analysis of all dry weather flow data across all sites indicates that: (i) large uncertainties are associated with discharge frequency, duration, and variation in water quality within industrial and residential land uses; (ii) most dry weather discharges are intermittent and transient flows which are difficult to detect and not simply due to cross-connections with the sewerage network; (iii) detectable diurnal discharge patterns can support mitigation efforts, including policies and regulatory measures (e.g., enforcement or education) to protect receiving waterways; and, (iv) that it is possible to cost effectively isolate sources of dry weather pollution using a distributed sensor network.

Abstract 116: Unmet Need In Acute Ischemic Stroke Patients Not Treated With Alteplase

Introduction: Early administration of intravenous tissue plasminogen activator (IV alteplase) improves functional outcomes in patients with acute ischemic stroke (AIS), yet many patients are not treated with IV alteplase. There is a need to understand the reasons for non-treatment and the short- and long-term outcomes in this patient population. Methods: We analyzed patients ≥65 years old with a primary diagnosis of AIS presenting within 24 hours of time last known well (LKW) but not treated with IV alteplase from 1,630 Get With The Guidelines-Stroke Hospitals in the United States between January 2016 and December 2016. We report clinical characteristics, reasons for withholding treatment, in-hospital mortality, 90-day and 1-year outcomes including Medicare costs, stratified by time from LKW to presentation (≤4.5 hours, &gt;4.5-6 hours and &gt;6-24 hours). Results: Of 39,760 patients (median age 80 [25 th -75 th quartiles: 73-87], 56.7% female), 19,391 (48.8%) presented within 4.5 hours of LKW. In those with documented reasons for withholding IV alteplase, the most common reasons were rapid improvement of symptoms (3,985/14,782, 27.0%) and mild symptoms (3,791/14,782, 25.6%). In 1,100 out of 1,174 (93.7%) patients presenting in the &gt;3.0-4.5-hour time window, the most common reason for not treating was a delay in patient arrival. The most common discharge location for those presenting ≤4.5 hours since LKW was home (8,660/19,391, 44.7%). The 90-day mortality and re-admission rates were 18.9% and 23.0% in those presenting ≤4.5 hours since LKW, 19.0% and 22.2% in those presenting between 4.5 and 6 hours, and 19.1% and 23.2% in those presenting between 6 and 24 hours. Median 90-day total in-hospital costs remained relatively high at $9,471 (IQR: $5,622-$21,356) in patients presenting ≤4.5 hours since LKW. Conclusions: Patients within the GWTG-Stroke registry not treated with IV alteplase have a high risk of re-admission and mortality and have high total in-hospital and post-discharge costs. This study may inform future efforts to address the unmet need to improve the scope of IV alteplase delivery along with other aspects of AIS care and, consequently, outcomes in this patient population.

Abstract 35: Unmet Need In Acute Ischemic Stroke Patients Arriving After 4.5 Hours

Introduction: Many patients arrive beyond the guideline-recommended time window for treatment with IV alteplase. For most of these patients, few treatment options exist. There is a need to understand the characteristics, outcomes, and healthcare costs of patients in this population in order to develop new treatments options. Methods: We analyzed patients ≥65 years old with a primary diagnosis of AIS arriving within 24 hours of time last known well (LKW) but not treated with IV alteplase at Get With The Guidelines-Stroke Hospitals in the United States (Jan 2016 - Dec 2016). We report clinical characteristics, 90-day and 1-year outcomes including Medicare costs, stratified by time from LKW to arrival (≤4.5 hours, &gt;4.5-6 hours and &gt;6-24 hours). Results: Of 39,760 patients (80.0% White, 10.5% Black, 4.1% Hispanic, 2.2% Asian), 20,369 (51.2%) presented from 4.5 - 24 hours of LKW. Compared to patients arriving within ≤4.5 hours, patients arriving within 4.5 - 24 hours of LKW were more likely to be Black, Hispanic, or Asian (≤4.5 hours: 9.4% Black, 3.8% Hispanic, 1.9% Asian; &gt;4.5 - 6 hours: 11.7% Black, 4.1% Hispanic, 2.4% Asian; &gt;6 - 24 hours since LKW: 11.6% Black, 4.4% Hispanic, 2.6% Asian; p &lt; 0.001). The most common discharge location for those arriving within ≤4.5 hours was home; for those arriving &gt;4.5 hours since LKW the most common discharge location was inpatient rehab (IRF) or skilled nursing facility (SNF) (≤4.5 hours: 44.7% home vs 42.3% IRF or SNF; &gt;4.5 - 6 hours: 35.4% home vs 51.7% IRF or SNF; &gt;6 - 24 hours: 35.8% home vs 51.0% IRF or SNF). The 90-day and 1-year mortality rates were 18.9% and 30.0% in those arriving within ≤4.5 hours, 19.0% and 29.8% in those arriving between 4.5 - 6 hours, and 19.1% and 29.1% in those arriving between 6 - 24 hours. Median 90-day inpatient costs were highest among those arriving 6 - 24 hours from LKW (≤4.5 hours: $9,471 [IQR: 5,622-21,356]; &gt;4.5 - 6 hours: $10,884 [IQR: 6,036-25,992]; 6 -24 hours: $11,162 [6,073-26,372]). Conclusions: Results show the importance of timely hospital arrival, as well as a need to address racial disparities in arrival times, reduce costs, and develop new treatment options for patients with AIS arriving after 4.5 hours from last known well time.

Optimization Design and Development of UHF Antenna for PD Detection in Substation

In this paper, a directional logarithmic periodic antenna is designed to meet the application requirements of local discharge detection in substation.The model of log-periodic dipole antenna was established by using high frequency electromagnetic wave simulation software, and the effects of dielectric substrate thickness, dielectric constant of dielectric substrate and patch size parameters on antenna return loss and standing wave ratio were analyzed.Finally, the dielectric substrate thickness of the antenna is 1.6mm, the material is TEflon, and the width of the assembly line is 4mm.According to the selected antenna type and size, the uHF signal receiving antenna is manufactured.

Patient prioritization of routine and patient-reported postoperative outcome measures: a prospective, nested cross-sectional study.

Understanding which outcomes matter most and improving outcomes for the growing population of older surgical patients are top priorities for Canadian anesthesia research. Nevertheless, there is little understanding of which outcomes older surgical patients prioritize most highly. We evaluated how older people prioritized six outcomes after elective noncardiac surgery. These outcomes were recommended in core outcome sets for perioperative medicine. Following ethical approval, we conducted a prospective, nested, cross-sectional study of people one year after they had major elective noncardiac surgery. Participants were asked to rate the importance of six commonly measured outcomes (complications, length of stay, discharge disposition, days at home, disability score, and developing a new disability) on an 11-point Likert scale. Open-ended questions elicited other preferences. Pairwise comparisons were evaluated using Bayesian multivariate regression. K-means clustering identified subgroups of patients based on overall prioritization. Thematic analysis was applied to open-ended responses. One hundred and one consecutive participants responded. All outcomes scored at least 7.7/10 on average. Complications and discharge location were most highly rated, but only days at home and length of stay had substantial probability (> 99%) of being rated lower than the other four outcomes. Thematic analysis identified the need for greater procedure-specific information, support services, and physical recovery measures. Commonly recorded and recommended outcomes are reassuringly relevant to older people; however, system-related measures are less highly valued than those more directly related to health and function. Outcomes may need to be personalized to properly evaluate the success of perioperative care.

Sociodemographic, geographic and clinical factors associated with functional outcome and discharge location in US inpatient rehabilitation settings

ABSTRACT Objective To assess the impact of sociodemographic factors, clinical factors and regional differences on both patients’ functional outcome and discharge location in U.S. inpatient rehabilitation settings. Methods Using eRehabData, 536,453 admissions was used for functional outcome analyses (based on FIM gain) while 259,308 admissions was used for the discharge location analyses. Regression models were used to look at both outcomes. Results Having private insurance and being young and male was associated with the higher FIM gains while being African American, widowed, and living in the Midwest was associated with the lower FIM gains. Furthermore, having private insurance, being young, male, married and African American or Hispanic was associated with the lower odds of being discharged to a skilled nursing facility while living in the Midwest was associated with the greatest odds of being discharged to a skilled nursing facility. Clinical factors such as days from onset and length of stay also had a significant effect on both outcomes. Conclusion Our findings suggest that, in the U.S., one of the challenges to successful recovery in the inpatient rehabilitation setting includes insurance status (Medicare/Medicaid), race (African American) but also regional differences (Midwest) and length of stay.

Relation of tranexamic acid therapy to length of stay in the hip fracture population

Tranexamic acid (TXA) is a medication that is routinely used to minimize blood loss during surgery. There is minimal literature evaluating the effects of TXA in hip fractures in regards to length of stay, readmission rates, and location of discharge. This study included adult patients who were admitted for hip fracture that required surgery over a 22-month period (May 2017–February 2019). A total of 525 hip fractures were operated on during this time period. Retrospective analysis was performed on patients treated with TXA (n = 27) vs those who were not (n = 498). Primary outcomes were length of stay, disposition after discharge, need for transfusion, mobilization with therapy, and readmission rates. TXA during hip fractures reduced median length of stay in the hip fracture cohort to 3 vs 5 days (P < 0.01). Patients were more likely to be discharged home as opposed to a nursing facility. Patients who received TXA during their hip fracture surgery were less likely to need transfusions while admitted (P < 0.01). No increased readmission rates were seen within 30 days after discharge (P = 0.59). In conclusion, when indicated, TXA appears to be safe for utilization in hip fracture surgery, resulting in decreased length of stay, less transfusions, and no increase in readmission rates.