Discharge Rate Research Articles

Endoscopic self-expandable metal stent versus endoscopy vacuum therapy for traumatic esophageal perforations: a retrospective cohort study

BackgroundTraumatic esophageal perforations (TEP) are a grave medical condition and require immediate intervention. Techniques such as Esophageal Self-Expandable Metal Stent (E-SEMS) and Endoscopic Vacuum Therapy (EVT) show promise in reducing tissue damage and controlling esophageal leakage. The present study aims to compare the application of EVT to E-SEMS placement in TEP.MethodsRetrospective cohort study valuated 30 patients with TEP. The E-SEMS and EVT groups were assessed for time of hospitalization, treatment duration, costs, and clinical outcome.ResultsPatients treated with EVT (24.4 ± 13.2) demonstrated significantly shorter treatment duration (p < 0.005) compared to the group treated with E-SEMS (45.8 ± 12.9) and patients submitted to E-SEMS demonstrated a significant reduction (p = 0.02) in the time of hospitalization compared to the EVT (34 ± 2 vs 82 ± 5 days). Both groups demonstrated a satisfactory discharge rate (E-SEMS 93.7% vs EVT 71.4%) but did not show statistically significant difference (p = 0.3155). E-SEMS treatment had a lower mean cost than EVT (p < 0.05). Descriptive statistics were utilized, arranged in table form, where frequencies, percentages, mean, median, and standard deviation of the study variables were calculated and counted. The Fisher's Exact Test was used to evaluate the relationship between two categorical variables. To evaluate differences between means and central points, the parametric t-test was utilized. Comparisons with p value up to 0.05 were considered significant.ConclusionE-SEMS showed a shorter time of hospitalization, but a longer duration of treatment compared to EVT. The placement of E-SEMS and EVT had the same clinical outcome. Treatment with E-SEMS had a lower cost compared with EVT.

High flame retardant composite phase change materials with triphenyl phosphate for thermal safety system of power battery module

The thermal safety of battery pack has attracted much attention accompany with the growth in electric vehicles (EVs) in recent years. Although various battery thermal management systems (BTMS) are investigated by many research, the thermal runaway propagation (TRP) of battery packs under extremely abused conditions is just at the level of structural design and theoretical model. How to explore an innovative technology to improve the integrated thermal safety including the BTMS and TRP is still a great challenge. In this study, a multifunctional flame-retardant paraffin (PA)/styrene-butadiene-styrene (SBS)/expanded graphite (EG)/methylphenyl silicone resin (MPS)/triphenyl phosphate (TPP) composite phase change material (PSEMT) has successfully prepared. Besides, it has applied in 26650 ternary power battery modules. When the proportion of MPS and TPP is 1:2, the experimental results reveal that PSEMT possesses high thermal stability, and excellent flame-retardant properties owing to synergistic flame-retardant effect with phosphorus and silicon. Further, the cylindrical 26650 battery module with PSEMT exhibits optimum thermal management performance. Even at 2C discharge rate after ten cycles, the maximum operating temperature of battery module can still be maintained below 50 °C, and the maximum temperature difference is controlled within 4.6 °C. Additionally, it displays an excellent thermal runaway suppression through triggering by multiple heat sources. What's more, the battery with PSEMT can suppress the peak temperature and delay the occurrence time of thermal runaway. Therefore, it can be induced that the battery module with PSEMT can effectively avoid heat accumulation and significantly reduce its thermal safety risk. This study offers a new solution with promising prospects from the perspectives of energy storage and EVs, for balancing the temperature inconsistencies in batteries and suppressing thermal runaway in the battery packs.

Numerical heat generation analysis of the tabbed and novel tabless designs of cylindrical-type lithium-ion batteries

The heat generation behaviours of a traditional tabbed cylindrical lithium-ion (Li-ion) battery are known to greatly affect its performance, cycle life, and safety. In this study, we explore the heat generation behaviours of the tabbed and novel tabless designs of a 21,700 cylindrical cell with graphite anode and NCA/LiNi0.8Co0.15Al0.05O2 cathode, by coupling the discreet layers of a three-dimensional (3D) disassembled electrochemical (EC) model with a two-dimensional (2D) axisymmetric heat transfer (HT) model. The respective heat generation mechanisms of each battery components of tabbed and tabless designs are first compared, and it is observed that the tabbed design generates significantly more heat than the tabless design, with the negative current collectors (NCC) in the tabbed design accounting for over 80 % of the total heats at 1C-rate. Also, the tabless design reduces the cell voltage drop due to its lower ohmic impedance and promotes a more homogenous cell temperature than the tabbed design. Next, the effects of particle size (ω) for the tabless design on the ohmic, reversible, and polarization heats of the battery’s electrodes are investigated at a high discharge rate of 10C, and the results show that polarisation heat decreases significantly in both electrodes as ω decreases. At the Negative Electrode (NE), the ohmic heating decreases initially as ω decreases because the battery is not drawing significant current. As the current drawn increases, Li-ion transport resistance also increases and at depth of discharge (DoD) = 36 %, a reverse in the trend is observed leading to an increase in Ohmic heating up to the end of life. In contrast, the ohmic heating at the Positive Electrode (PE) increases throughout the discharge process as ω decreases. For the reversible heat, the heat is negative in the NE side initially and fluctuates with ω towards the end of life (DOD = 88 %) when it changes from heat sink to heat source, whereas in the PE it remains unchanged for all ω throughout the discharge process. The resulting temperature drop is caused by the increase in the overall reversible heat sink effect in the NE side, as well as the weakened polarization heat in both electrodes. On the other hand, miniaturising the electrode thickness (η) causes a considerable decrease in ohmic heating in both electrodes resulting in larger temperature drops and elevated voltage curve. This study provides relevant insights in support of the development of battery thermal management systems (BTMS) for the tabbed and novel tabless batteries in a realistic environment.

Discharge Against Medical Advice from Neonatal Intensive Care Unit and Some Influencing Factors in an Academic Center

Background: Early discharge from the hospital against medical advice poses a significant threat to the health of patients, particularly neonates, who are a vulnerable population. Objectives: This study aimed to determine the frequency of neonatal discharge with personal consent and identify the most influential factors. Methods: This retrospective cross-sectional study was conducted at Alzahra Hospital in Rasht from 2020 to 2021. Using a census method, information on all infants discharged against medical advice was extracted from the hospital's clinical records available in the information system. Data on the reason for neonatal hospitalization and discharge against medical advice, neonatal age, weight, maternal education, and insurance status were recorded. Results: Among 2327 neonates, 581 (24.96%) were discharged from the hospital against medical advice. The primary cause of early discharge was related to family problems (64.4%), followed by dissatisfaction with the hospital and treatment process (15.3%), prolonged hospitalization (11%), and financial problems (9.3%). A significant association was found between neonatal age, weight, type of delivery, maternal education, insurance status, and the reason for hospitalization with the reason for discharge against medical advice (all P &lt; 0.001). Conclusions: The rate of discharge against medical advice in this study was notably higher compared to other studies, possibly due to the timing of the study coinciding with the peak of COVID-19 and the different reasons for hospitalization, such as icterus versus sepsis. Family problems were identified as the main cause of discharge against medical advice, while financial problems were the least common. Therefore, practical and preventive solutions should be provided to families whenever possible.

Silicon dioxide-enhanced composite phase change materials for the thermal management of retired lithium-ion batteries

Lithium-ion batteries (LIBs) have been regarded as the hearts of electric vehicles (EVs). However, the thermal safety of LIBs is considered to be a common and crucial technical issue, especially for large-scale retired LIBs. In this study, a novel composite phase change material (CPCM) based on paraffin (PA)/cubic boron nitride (CBN)/silicon dioxide (SiO2) was proposed and further utilized for decommissioned battery modules. First, CPCMs with different SiO2 ratios were prepared by employing a physical mixing melting method. Then the effects of different ratios of SiO2 on the thermal properties, thermal conductivity, thermal stability, mechanical strength, electrical insulation properties, and flow properties of the CPCMs were studied from macroscopic and microscopic perspectives. Eventually, the CPCM possessing 5 % SiO2 was used in the battery module for thermal management evaluation. The corresponding results indicated that even under the severe conditions of high temperature (40 °C) and a 1.5C higher discharge rate uninterrupted charge–discharge cycle, the maximum temperature and maximum temperature difference of the CPCM battery module were reduced by 8.45 and 5.40 °C, respectively compared with forced air cooling (FAC). This outcome can provide fundamental data and theoretical support for the thermal management strategy and thermal safety improvement of high energy density power systems.

Effect of ball milling on the structure and electrochemical hydrogen storage properties of a RE-Mg-Ni alloy

RE-Mg-Ni alloy is considered a highly promising anode material for the next generation of MH-Ni batteries. However, the low cycle life, fast performance, and high manufacturing cost of this ideal MH-Ni battery anode material have become obstacles to its optimization. In this work, an as-cast La0.7Sm0.3MgNi3.6Co0.4 superlattice alloy was prepared by vacuum medium frequency induction melting. Then, La0.7Sm0.3MgNi3.6Co0.4 + 10 wt% Ni (0–2 h) composite hydrogen storage alloys with excellent properties were prepared by adding a catalyst (Ni) and conducting ball milling. XRD, SEM, and HRTEM were conducted to analyse the phase compositions, microstructures and macrostructures of the samples. The experimental results showed that with the increase in ball milling time, the microstructural characteristics of the alloy changed, such as the phase abundance, grain refinement, particle size reduction, and amorphous structure increase, directly leading to the change in electrochemical performance. The discharge capacity (Cmax) of the sample decayed from 264.0 mAh/g to 219.1 mAh/g, the cycle stability (Sn) gradually increased with the extension of the grinding time, and the rate discharge performance first increased and then decreased. When the grinding time was 1 h, the best performance was HRD900 = 36.53%. The critical factors affecting the dynamic performance, such as the charge transfer resistance (Rct), limiting current density (IL), and hydrogen diffusion coefficient (D), all exhibited the same trend and reached their respective optimal values at 1 h.

Short term effects of contralateral tendon vibration on motor unit discharge rate variability and force steadiness in people with Parkinson's disease.

Vibration of one limb affects motor performance of the contralateral limb, and this may have clinical implications for people with lateralized motor impairments through vibration-induced increase in cortical activation, descending neural drive, or spinal excitability. The objective of this study was to evaluate the effects of acute biceps brachii tendon vibration on force steadiness and motor unit activity in the contralateral limb of persons with Parkinson's disease. Ten participants with mild to moderate Parkinson's disease severity performed a ramp, hold and de-ramp isometric elbow flexion at 5% of maximum voluntary contraction with the more-affected arm while vibration was applied to the distal biceps brachii tendon on the contralateral, less-affected arm. Using intramuscular fine wire electrodes, 33 MUs in the biceps brachii were recorded across three conditions (baseline, vibration, and post-vibration). Motor unit recruitment & derecruitment thresholds, discharge rates & variability, and elbow flexion force steadiness were compared between conditions with and without vibration. Coefficient of variation of force and discharge rate variability decreased 37 and 17%, respectively in post-vibration compared with baseline and vibration conditions. Although the motor unit discharge rates did not differ between conditions the total number of motor units active at rest after de-ramp were fewer in the post-vibration condition. Contralateral tendon vibration reduces MU discharge rate variability and enhances force control on the more affected side in persons with Parkinson's disease.

A structured programme to promote breastfeeding improved the rates in very preterm infants at discharge.

We developed the Promotion of Breastfeeding (PROBREAST) programme and evaluated what effect it had on the breastfeeding rate in infants born at less than 32 weeks of gestation or weighing ≤1500 grams. We compared the breastfeeding rate in two cohorts of patients who were born before (n = 72; January 2017 to June 2018) and after (n = 80; July 2018 to December 2019) the application of the programme. Moreover, we compared the correlation between type of feeding at discharge and post-discharge breastfeeding rate, between exclusive breastfeeding, postnatal growth and neurodevelopment. Infants in the PROBREAST group had an exclusive breastfeeding rate at discharge higher (42 vs. 16%, p < 0.001) than that in the historical control group. Exclusive breastfeeding was negatively correlated with weight z-score at discharge, but not at 12 and 24 months corrected age, and was positively correlated with cognitive score at 24 months corrected age. The application of a structured programme for the promotion of breastfeeding improved the breastfeeding rate in very preterm infants. We demonstrated that exclusive breastfeeding at discharge improved their neurodevelopment without impairing growth.

Characterization of the agonistic behavior of the weakly electric fish Gymnotus sylvius

AbstractElectric fish are good models in neuroethology as any behavior in electric fish involves both locomotor and electrical displays, which are experimentally accessible and controlled by well‐known neural circuits. The agonistic behavior within the genus Gymnotus has been evaluated in Gymnotus carapo and Gymnotus omarorum, providing an advantageous model system to address comparative analyses. Gymnotus sylvius is a weakly electric fish which occurs in sympatry with G. omarorum in freshwater environments of Argentina. Here, we describe the agonistic behavior of G. sylvius in laboratory conditions. All dyads engaged in intense fights, with a latency to the first attack of 8 ± 7.8 s and a contest phase of 42.71 ± 31.7 s. Individual initiative in the first attack predicted contest outcome with no apparent influence of body weight asymmetry between contenders. Contenders did not escalate in their aggression during the short contest; in turn, subordinates tended to retreat in response to dominants' attacks. Submission and dominance were expressed by electric signals: dominants increased their basal electric organ discharge (EOD) rate after contest resolution, resulting in a persistent EOD rate rank. Subordinates also emitted chirps and offs during the contest and post‐resolution phases without a clear temporal pattern. The agonistic behavior of G. sylvius presents some similarities with other species of the genus Gymnotus: EOD rank between dominants and subordinates, electric signals of submission, and the presence of attacks in the post‐resolution phase. On the other hand, it also presents differences: a shorter evaluation phase in G. sylvius, initiative as a determinant of outcome, a higher attack rate of dominants in G. sylvius, a different temporal pattern of chirps, and different mechanisms to separate EOD rate of dominants and subordinates. These facts open a promising road to analyze the evolution of different neuroendocrine strategies, operating on homologous neural pathways, to command the same behavior.

Characterizing long-term outcomes following AMA discharges after assault-related penetrating trauma.

Patients discharged against medical advice do not receive adequate treatment and have a greater risk of readmission. This study assessed the rate of discharges against medical advice following assault-related penetrating trauma, with secondary aims to evaluate long term pre/post-injury hospitalizations and mortality. Adult assault-related penetrating injuries admitted to a Level 1 Trauma Center were identified in the prospectively maintained database. Chart review was conducted for hospitalizations ± 5 years from index injury and statewide mortality data was used to identify deaths outside of hospital care. Out of a total of 1,744 assault-related penetrated injuries, 3.2% (52/1630) of survivors discharged against medical advice. Reasons for discharge against medical advice included: unknown (38%), home/child/family/pets (25%), unhappy with care/restrictions (23%), and work/money/other (13%). Post-discharge mortality did not differ between routine (6.5%) and against medical advice discharge (3.9%). Against medical advice and routine discharge had similar rates of any hospitalization (38.5 v 28.2%) and trauma hospitalization in prior 5-years (35 v 36%). However, significantly more against medical advice discharges had prior hospitalizations involving drug or alcohol abuse (65 v 38%), but not mental health diagnosis (55 v 55%). Significantly more against medical advice discharges have post-injury hospitalizations compared to routine discharges (48 vs 26.5%); however, include similar rates of repeat traumatic injury (36 v 32%). Those with against medical advice discharges were significantly more likely to have prior hospitalizations involving drug or alcohol abuse and significantly higher rates of post-injury hospitalizations. However, we did not see an increase in repeat traumatic injury or post-discharge mortality in those with against medical advice discharges when compared to those with routine discharges.

Chiral Molecular Coating of a LiNiCoMnO2 Cathode for High-Rate Capability Lithium-Ion Batteries.

The growing demand for energy has increased the need for battery storage, with lithium-ion batteries being widely used. Among those, nickel-rich layered lithium transition metal oxides [LiNi1-x-yCoxMnyO2 NCM (1 - x - y > 0.5)] are some of the promising cathode materials due to their high specific capacities and working voltages. In this study, we demonstrate that a thin, simple coating of polyalanine chiral molecules improves the performance of Ni-rich cathodes. The chiral organic coating of the active material enhances the discharge capacity and rate capability. Specifically, NCM811 and NCM622 electrodes coated with chiral molecules exhibit lower voltage hysteresis and better rate performance, with a capacity improvement of >10% at a 4 C discharge rate and an average improvement of 6%. We relate these results to the chirally induced spin selectivity effect that enables us to reduce the resistance of the electrode interface and to reduce dramatically the overpotential needed for the chemical process by aligning the electron spins.

The Lasting impact of the COVID-19 pandemic on outpatient neurology consultations

BackgroundThe COVID-19 pandemic prompted rapid changes in outpatient neurology services and there remain unanswered questions regarding its long-term impact. First, what are the lasting changes of the pandemic on demographics...

Lactate and Lactate Clearance Are Predictive Factors for Mortality in Patients with Extracorporeal Membrane Oxygenation.

Findings of inadequate tissue perfusion might be used to predict the risk of mortality. In this study, we evaluated the effects of lactate and lactate clearance on mortality of patients who had undergone extracorporeal membrane oxygenation (ECMO). Patients younger than 18 years old and who needed venoarterial ECMO support after surgery for congenital heart defects, from July 2010 to January 2019, were retrospectively analyzed. Patients successfully weaned from ECMO constituted Group 1, and patients who could not be weaned from ECMO were in Group 2. Postoperative clinics and follow-ups of the groups including mortality and discharge rates were evaluated. There were 1,844 congenital heart surgeries during the study period, and 55 patients that required ECMO support were included in the study. There was no statistically significant difference between the groups regarding demographics and operative variables. The sixth-, 12th-, and 24th-hour lactate levels in Group 1 were statistically significantly lower than those in Group 2 (P=0.046, P=0.024, and P<0.001, respectively). There were statistically significant differences regarding lactate clearance between the groups at the 24th hour (P=0.009). The cutoff point for lactate level was found as ≥ 2.9, with 74.07% sensitivity and 78.57% specificity (P<0.001). The cutoff point for lactate clearance was determined as 69.44%, with 59.26% sensitivity and 78.57% specificity (P=0.003). Prognostic predictive factors are important to initiate advanced treatment modalities in patients with ECMO support. In this condition, lactate and lactate clearance might be used as a predictive marker.

Impact of the implementation of the Intelligent Antimicrobial System (iAMS) on clinical outcomes among patients with bacteraemia caused by methicillin-resistant Staphylococcus aureus

ObjectivesThis study aimed to investigate the clinical impact of the Intelligent Antimicrobial System (iAMS) on patients with bacteraemia due to methicillin-resistant (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA). MethodsA total of 1008 patients with suspected SA infection were enrolled before and after the implementation of iAMS. Among them, 252 with bacteraemia caused by SA, including 118 in the iAMS and 134 in the non-iAMS groups, were evaluated. ResultsThe iAMS group exhibited a 5.2% (from 55.2% to 50.0%; P = 0.96) increase in the 1-year survival rate. For patients with MRSA and MSSA compared to the non-iAMS group, the 1-year survival rate increased by 17.6% (from 70.9% to 53.3%; P = 0.41) and 7.0% (from 52.3% to 45.3%; P = 0.57), respectively, both surpassing the rate of the non-iAMS group. The iAMS intervention resulted in a higher long-term survival rate (from 70.9% to 52.3%; P = 0.984) for MRSA patients than for MSSA patients. MRSA patients experienced a reduced length of hospital stay (from 23.3% to 35.6%; P = 0.038), and the 45-day discharge rate increased by 20.4% (P = 0.064). Furthermore, the intervention resulted in a significant 97.3% relative decrease in near miss medication incidents reported by pharmacists (P = 0.013). ConclusionsImplementation of iAMS platform improved long-term survival rates, discharge rates, hospitalization days, and medical cost (although no significant differences were observed) among patients with MRSA bacteraemia. Additionally, it demonstrated significant benefits in ensuring drug safety.

The association of ASA score and outcomes following to.tal ankle arthroplasty

BackgroundThis study seeks to evaluate the relationship between American Society of Anesthesiologist (ASA) score and postoperative outcomes following TAA. MethodsThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2007 to 2020 to identify 2210 TAA patients. Patients were stratified into low (n = 1328; healthy/mild systemic disease) or high (n = 881; severe/life-threatening systemic disease) ASA score cohorts. ResultsThere was no statistically significant difference in complications, readmission, or reoperation rate based on ASA score. Increased ASA score was significantly associated with longer length of stay (low = 1.69 days, high = 1.98 days; p < .001) and higher rate of adverse discharge (low = 95.3 %, high = 87.4 %; p < .001). ConclusionHigher ASA scores (3 and 4) were statically significantly associated with increased length of stay and non-home discharge disposition. These findings are valuable for physicians and patients to consider prior to TAA given the increased utilization of resources and cost associated with higher ASA scores. Level of EvidenceLevel III, Retrospective cohort study

Hydrological dynamics of the Kalisindh and Parbati Rivers: An integrated analysis in the context of the Eastern Rajasthan Canal Project (ERCP)

This study conducts a comprehensive analysis of hydrological patterns in the Kalisindh and Parbati Rivers, highlighting the Eastern Rajasthan Canal Project (ERCP) as pivotal for bolstering regional water security. Employing an array of data sources, this research utilizes Polynomial Regression and neural network forecasting to dissect flow patterns, identifying significant virgin flow peaks in the mid-1980s and early 2000s for the Kalisindh River, and a notable peak in 2006–2007 for the Parbati River. Analysis reveals that the specific discharge rate of the Parbati River is diminishing at twice the rate of the Kalisindh River, with annual decreases of approximately 0.0038 cumecs/km2 for Parbati, compared to 0.0019 cumecs/km2 for Kalisindh. Furthermore, runoff volumes indicate that the Parbati River, specifically at the Khatoli Gauge & Discharge (G&D) site, experiences significantly higher runoff—28,137.912 million cubic meters (MCM)—in contrast to 15,795.094 MCM for the Kalisindh River at the Barod G&D site. The findings accentuate the necessity for science-based water management strategies to effectively combat water scarcity and climate change impacts. The ERCP emerges as a crucial initiative for sustainable management of the Kalisindh and Parbati Rivers in Rajasthan, underscoring its potential to serve as a model for sustainable water and river basin management.

Architecture of Fluvial and Deltaic Deposits Exposed Along the Eastern Edge of the Western Fan of Jezero Crater, Mars

AbstractEarly observations from the Perseverance rover suggested a deltaic origin for the western fan of Jezero crater only from images of the Kodiak butte. Here, we use images from the SuperCam Remote Micro‐Imager and the Mastcam‐Z camera to analyze the western fan front along the rover traverse, and further assess its depositional origin. Outcrops in the middle to lower half of the hillslopes comprise planar and inclined beds of sandstone that are interpreted as foresets of deltaic deposits. Foresets are locally structured in ∼20–25 m thick, ∼80–100 m long, antiformal structures interpreted as deltaic mouth bars. Above these foresets, interbedded sandstones and boulder conglomerates are interpreted as fluvial topset beds. One well‐preserved lens of boulder conglomerate displays rounded clasts within well‐sorted sediment deposited in overall fining upward beds. We interpret these deposits as resulting from lateral accretion within fluvial channels. Estimations of peak discharge rates give a range between ∼100 and ∼500 m3 s−1. By contrast, boulder conglomerates exposed in the uppermost part of hillslopes are poorly sorted and truncate the underlying beds. The presence of these boulder deposits suggests that intense sediment‐laden flood episodes occurred after the deltaic foreset and topset beds were deposited, although the origin, timing, and relationship of these boulder deposits to the ancient lake that once filled Jezero crater remains undetermined. Overall, these observations confirm the deltaic nature of the fan front, and suggest a highly variable fluvial input.

The variation in preventable hospitalization in patients with type 2 diabetes in Kentucky before and after the Medicaid expansion.

Hospitalizations are more resource intensive and expensive than outpatient care. Therefore, type 2 diabetes-related preventable hospitalization are a major topic of research efficiency in the healthcare system. Analyze county level variation in type 2 diabetes-related preventable hospitalization rates in Kentucky before the Medicaid expansion (2010-2013) and after the Medicaid expansion (2014-2017). Geographic mapping and cluster analysis. Data for a state of the United States of America. We used the KID data to generate geographic mapping for type 2 diabetes-related preventable hospitalizations to visualize rates. We included all Kentucky discharges of age 18 years and older with the ICD9/10 principal diagnosis code for type 2 diabetes. Then, we conducted cluster analysis techniques to compare county-level variation in type 2 diabetes-related preventable hospitalization rates across Kentucky counties pre- and post-Medicaid expansion. County type 2 diabetes-related preventable hospitalization pre- and post-Medicaid expansion. From 2010-2017, type 2 diabetes-related preventable hospitalization discharge rates reduced significantly in the period of the post-Medicaid expansion (P=.001). The spatial statistics analysis revealed a significant spatial clustering of counties with similar rates of type 2 diabetes-related preventable hospitalization in the south, east, and southeastern Kentucky pre- and post-Medicaid expansion (positive z-score and positive Moran's Index value (P>.05). Also, there was a significant clustering of counties with low type 2 diabetes-related preventable hospitalization rates in the north, west, and central regions of the state pre-Medicaid expansion and post-Medicaid expansion (positive z-score and positive Moran's Index value (P>.05). Kentucky counties in the southeast have experienced a significant clustering of highly avoidable hospitalization rates during both periods. Focusing on the vulnerable counties and the economic inequality in Kentucky could lead to efforts to lowering future type 2 diabetes-related preventable hospitalization rates. We used de-identified data which does not provide insights into the frequency of hospitalizations per patient. An individual patient may be hospitalized several times and counted as several individuals.

Effects of COVID-19 on a mature citizen first responder system in the German district of Gütersloh: an observational study.

The aim of this study was to examine the impact of COVID-19 on the response rate of community-first-responders (CFR) and other out-of-hospital-cardiac-arrest (OHCA) outcomes using the smartphone-first-responder-system (SFRS) "Mobile Retter." All adult non-traumatic OHCA in the district of Gütersloh between 01.01.2018-31.12.2021 were included. Periods of interest were 1) prior to the first COVID-19-lockdown; to 2) both lockdowns; and 3) the time in between, as well as after the COVID-19-lockdowns (pre-COVID-19, COVID-19-lockdown and COVID-19-pandemic respectively). The primary outcome was the CFR response rate defined as proportion of CFR alerts that were accepted by a CFR and in which at least one CFR arrived on scene of the emergency out of all CFR alerts. Secondary outcomes included the rate of CFR alerts, defined as proportion of OHCA to which CFR were summoned by the emergency medical dispatcher, as well as the rate of return-of-spontaneous-circulation (ROSC) and rate of survival until hospital discharge. We also examined the incidence COVID-19-infection of CFR in context of the SFRS. A total of 1064 OHCA-patients (mean age: 71.4±14.5 years; female: 33.8%) were included in the study (Pre-COVID-19: 539; COVID-19-lockdown: 109; COVID-19-pandemic: 416). The response rate was 64.0% (pre-COVID-19: 58.7%; COVID-19-lockdown: 63.5%; COVID-19-pandemic: 71.8%, P=0.002 vs. pre-COVID-19). The alert rate was 52.7% (pre-COVID-19: 56.2%; COVID-19-lockdown: 47.7%, P=0.04 vs. Pre-COVID-19; COVID-19-Pandemic: 49.5%, P=0.02 vs. pre-COVID-19). The ROSC-rate was 40.4% (pre-COVID-19: 41.0%; COVID-19-lockdown: 33.9%; COVID-19-pandemic: 41.4%) and hospital discharge rate 31.2% (Pre-COVID-19: 33.0%; COVID-19-lockdown: 36.8%; COVID-19-pandemic: 28.7%). The use of CFR was associated with favorable effects in terms of hospital admission (odds ratio [OR]: 0.654 (CI95: 0.444-0.963), P=0.03), hospital discharge (OR: 2.343 (CI95: 1.002-5.475), P=0.04). None of the CFR became infected with COVID-19. "Mobile-Retter" was associated with high response rates, improved outcome in OHCA patients and no COVID-19-infections of CFR during the COVID-19-pandemic and -lockdowns.

Experimental investigation of batteries thermal management system using water cooling and thermoelectric cooling techniques

The booming electric vehicle industry seeks fast charging solutions to address the safety risks posed by high-power charging, including thermal runaway and other safety issues. This study investigates the impact of combining liquid with thermoelectric cooling on battery thermal management. A series of experiments were conducted using various thermal batteries, liquid flow rates and batteries temperature thermoelectric. The experimental results compared air cooling (AC), water cooling (WC), and thermoelectric cooling (TEC) with different water flow (WF) rate in system and revealed that TEC with WF at 4.0 l/min was the best cooling system. This system can decrease the temperature by about 41-52% from the maximum temperature at discharge rates of 1.0, 1.5, 2.0, 2.5, and 3.0 °C. However, TEC with WF 1.0 and 2.0 l/min can effectively lower the temperature and reduce energy consumption compared to other cooling systems, while still maintaining the battery temperature within appropriate ranges.