Time Of Discharge Research Articles

An Integrated Model for Dam Break Flood Including Reservoir Area, Breach Evolution, and Downstream Flood Propagation

The reasonable and efficient prediction of dam failure events is of great significance to the emergency rescue operations and the reduction in dam failure losses. This work presents a model that is based on the physical mechanism. It is coupled with a multi-architecture (multi-CPU and GPU) open-source two-dimensional flood model, which is based on high-precision terrain and land use data. The aim is to enhance the accuracy of dam break flood process simulations. The model uses DEM data as a computational grid and updates it at each time step to reflect breach evolution. Simultaneously, the breach evolution model incorporates an analysis of stress on sediment particles, establishing the initial erosion state and lateral expansion model while accounting for seepage. The determination of the overflow of the breach is resolved through the application of a two-dimensional hydrodynamic model. This approach achieves a robust connection between the upstream reservoir, the dam structure, and the downstream inundation area. The coupled model is utilized to calculate the failure of earth-rock dams and landslide dams, and a sensitivity analysis is conducted. Taum Sauk Dam and Tangjiashan landslide dam were selected to represent earth dam break and barrier lake break, respectively, which are the main types of dam breaks. The obtained results demonstrate strong concurrence with the measured data, the relative errors of the four important parameters of the application case, the peak discharge of the breach, the top width of the final breach, the depth of the breach and the arrival time of the maximum peak discharge are all within ±10%. Although the relative error of the completion time of the final breach is greater than 10%, it is about 30% less than the relative error of the physical model.

Enhancing Stability of Glass Fiber Separators in Lithium-Ion Batteries through Sol-Gel Hybrid Coatings

Lithium ion batteries are largely divided into an anode, a cathode, and a separator impregnated with an electrolyte. It is well known that the battery separator is an important element in all batteries, as it physically separates the anode and cathode to prevent the direct flow of electrons, and allows the flow of charge through the movement of ions. Polyolefin-based separators, which are widely used in existing batteries, are vulnerable to rapid environmental changes, drastically reducing battery performance. Additionally, the thermal contraction and expansion that leads to a short circuit significantly reduces the stability of the battery. To overcome stability in such extreme environments, glass fiber separators are emerging as an alternative. To overcome stability in such extreme environments, glass fiber separators are emerging as an alternative. Glass fiber has excellent mechanical properties, electrical insulation, heat resistance, and chemical resistance, so it can drastically improve the stability of the battery. It can also improve electrolyte impregnation by controlling porosity to improve battery performance.In this study, a sol-gel hybrid coating solution was synthesized and coated on a glass fiber separator to enhance the ionic conductivity and stability. The coating on glass fiber was performed using a dip coating method. The optimization of the hybrid solution and coating conditions led to a reduction in the porosity and enhancement of the flexibility of the glass fiber separators. The adhesion of the coating was evaluated by measuring the hardness of the coating using pencil hardness, and the results showed that the tensile strength of the coated glass fiber separator was improved by about two times compared to before coating. Finally, as a result of evaluating the electrical performance according to the coating, the battery performance was similar at room temperature. On the other hand, it was confirmed that the operating voltage and discharge time at low temperatures were increased by the sol-gel hybrid coating. These results suggest that the coated glass fiber separators are promising candidates for overcoming the stability of battery operation in extreme environments.

Evaluation of Extremely Stable Redox Active Materials and Porous Electrodes for Redox Flow Batteries Using Static Cells and Physics-Based Modeling

Aqueous Organic Redox Flow Batteries (AORFBs) have shown growing potential as a stationary energy storage technology used to alleviate the issue of intermittencyi for renewable energy sources. For systems with charge/discharge duration of 10 or more hours, the capital cost of a flow battery asymptotically approaches the cost of the electroactive material.ii While the field has made many new materialsiii and developed proper protocols for evaluating their decompositioniv, uncertainty in the fade rates of extremely stableiii materials remains comparable to the fade rates themselvesv, frustrating the evaluation of prospects of the material for commercialization. Additionally, evaluation of new materials in flow cells requires a significant amount of material synthesis, whereas evaluation methods requiring less material could accelerate the development of AORFBs.vi To reduce noise in measurements by removing pumping, splashing, and bubbling of solutions that occurs in flow cells, and to reduce the amount of required active material, we use static cells composed solely of porous electrodes sandwiched about a membrane, gaskets, and graphitic current collectors with no flow. With reduced material consumption, increased cycling rate, and less noise in capacity measurements, we more rapidly and more accurately determine the capacity fade rates for extremely stable materials for AORFBs (Figure 1) and test the limits for cycle-denominated fade rates. In addition, we discuss relevant reporting statistics for making fair comparisons between extremely stable materials.To evaluate overpotentials in the system due to kinetics, mass transfer, and Ohmic resistance, we model the system using Newman’s porous electrode modelvii to ensure the use of proper cycling protocols to access all of the capacity of the system.Figure 1: (left) An example of potentiostatic cycling of 0.1 M 2,6-DPPEAQ at pH 14 in a volumetrically unbalanced compositionally symmetric static cell with an applied voltage square wave of amplitude 0.20 V across the cell, held until the current drops to 1 mA/cm2. After cycling for a day while the electrolyte equilibrates, a capacity fade rate is evaluated from the slope of the natural log of discharge capacity vs time. (right) A whisker and box plot for capacity fade measurements from several potentiostatic symmetric cell cycling experiments in a flow cell from Ref [5], static cells with no attention to temperature fluctuations, and static cells where temperature fluctuations are kept within 1 degree Celsius.[i] J. Rugolo and M. J. Aziz, “Electricity storage for intermittent renewable sources.” Energy Environ. Sci., 2012, 5, 7151[ii] F. R. Brushett, M. J. Aziz, and K. E. Rodby. ACS Energy Lett. 2020, 5, 879−884[iii] David G. Kwabi, Yunlong Ji, and Michael J. Aziz, “Electrolyte Lifetime in Aqueous Organic Redox Flow Batteries: A Critical Review.” Chemical Reviews 2020 120 (14), 6467-6489[iv]M.A. Goulet and M. J. Aziz, “Flow Battery Molecular Reactant Stability Determined by Symmetric Cell Cycling Methods”. J. Electrochem. Soc, 165 (7) A1466-A1477 (2018)[v] Eric M. Fell and Michael J. Aziz, “High-Throughput Electrochemical Characterization of Aqueous Organic Redox Flow Battery Active Material.” 2023 J. Electrochem. Soc. 170 100507[vi] Cao, Y., Aspuru-Guzik, A. “Accelerating discovery in organic redox flow batteries.” Nat Comput Sci 4, 89–91 (2024)[vii] J. Newman and C. W. Tobias, J. Electrochem. Soc., 1962, 109, 1183 Figure 1

Triple I: Electrochemically Rechargeable Liquids in Highly Flexible Energy Storage Systems

Hydrogen and electricity are expected to be the two major energy carriers of the future. Unfortunately, neither can be stored as an ambient-temperature liquid, which is the ideal energy-carrier medium. Electrochemically-rechargeable liquids (ERLs) are a low-maturity energy-storage paradigm that offer many compelling attributes over gases (e.g., H2), solid materials (e.g., batteries), or more conventional liquid fuels [1]. ERLs can be comprised of a wide variety of active materials, which may include conventional liquid-organic hydrogen carriers (i.e., LOHCs, such as organics that are liquids at room temperature, like methylcyclohexane), as well as aqueous solutions (e.g., diluted alcohols) or dissolved solids (e.g., redox-flow-battery electrolytes) [2]. An ERL-based system possesses the key attractive benefits of a redox flow battery (RFB), namely: fully decoupled power and energy (lower capital costs with longer durations, especially with a single, low-cost liquid), long cycle life (due to theoretically-invariant electrodes, which do not undergo morphology changes with charge-discharge cycles), and inherently superior safety (compared to conventional batteries). And, unlike a RFB system, an ERL system only requires the storage of a single liquid, which is especially attractive for long-duration energy storage (LDES) applications (i.e., > 10-h discharge times at rated power). The obvious disadvantage of any rechargeable-liquid paradigm relative to conventional fuels is the need to store and transport both the “charged” and “discharged” materials, but doing so is significantly easier and less expensive than recovering CO2 discharged into the atmosphere from conventional liquid hydrocarbons. The “charged” and “discharged” ERLs can be shipped in two parallel pipelines and the total transmission costs can still be far lower than electricity-transmission lines, since liquid-pipeline costs are an order-of-magnitude less than that of high-voltage electric lines [3], and pipelines are easier to get approved than overhead transmission lines. While ERLs are not a new concept, a primary focus of this talk will be on innovative conversion options and relevant developments since my presentation on this topic at the Fall 2021 ECS meeting[1]. The ERL conversion systems include combinations of the cell configurations shown in Fig. 1. In particular, it will be shown that ERLs that can be charged using either electrical and/or hydrogen energy, and which can also produce hydrogen or electricity on demand can enable highly flexible energy-storage systems that can potentially be used for both stationary and transportation applications, since ERL-based systems can have higher energy densities than state-of-the-art Li-ion battery packs. The goal of this short “Ideas, Interchange, and Initiative” (Triple-I) presentation will be to provide the audience with a sufficient overview of these high-level ERL concepts, such that a productive discussion can occur on additional improvements, potential end uses, and future collaborations. References M. L. Perry, “Electrochemically-Rechargeable Liquids in highly Flexible Energy Storage Systems,” ECS Trans., 104, 23 (2021).M. L. Perry and Z. Yang, “Rechargeable-Liquid Fuel Cells with a Novel Recharging Method: Exploratory Results with IPA and VII/VIII Solutions,” J. Electrochem. Soc., 166, A3045 (2019).D. DeSantis, et. al., “Cost of long-distance energy transmission by different carriers.” iScience, 24, 103495 (2021). Figure 1. Possible configurations of ERL-conversion systems during Discharging (A and C) and Charging (B and D) operations: (A) Dehydrogenation of ERL on anode with oxygen-reduction reaction (ORR) on cathode; (B) Hydrogenation of ERL on cathode with hydrogen-oxidation reaction (HOR) on anode; (C) Dehydrogenation of ERL on anode with hydrogen-evolution reaction (HER) on cathode; (D) Hydrogenation of ERL on cathode with oxygen-evolution reaction (OER) on anode. Only acidic systems are depicted, alkaline-chemistry options are also possible. Figure 1

The efficacy and safety of remimazolam in painless colonoscopy: a prospective, randomized clinical trial.

Remimazolam is a new type of ultra-short-effect intravenous anesthetic, that may provide adequate sedation for endoscopy while causing less cardiovascular or respiratory disturbance than propofol. The aim of this clinical study was to compare the efficacy and safety of two different doses of remimazolam with propofol for sedation during colonoscopy. 225 subjects, aged 18 to 80 years, with American Society of Anesthesiology physical status I-III, were scheduled to undergo colonoscopy. All the subjects were randomly assigned to three groups, Low-Rem group (low dose remimazolam, 0.15 mg/kg, iv, n = 75), High-Rem group (high dose remimazolam, 0.2 mg/kg, iv, n = 75), and Propofol group (propofol 2 mg/kg, iv, n = 75). Every individual in this trial was given nalbuphine hydrochloride (0.2 mg/kg, iv) before administration of remimazolam or propofol. The primary outcome was the success rate of sedation. Haemodynamic parameters and adverse events were recorded to evaluate safety. Satisfaction of sedation from patients, anesthesiologists and gastroenterologists were also recorded. The success rate of colonoscopy procedure was 100% in both High-Rem and Propofol groups, but it was 89% in Low-Rem group (p < 0.05). Furthermore, the induction time of anesthesia was shorter in Propofol group, when compared to the Low-Rem group and the High-Rem group (p < 0.05). The recovery time in Low-Rem group, High-Rem group, and Propofol group was 2.33, 2.43, and 3.21 min (p < 0.05) respectively, and the time of discharge was 25.00, 25.01, and 27.56 min (p < 0.05) respectively. Simultaneously, the incidence of adverse events such as hypotension, bradycardia, and respiratory depression in the remimazolam groups were significantly lower than that in the propofol group. No significant differences were observed among the three groups in Ramsay scale, BPS-NI scale, and Limb movement classification. Moreover, patients, anesthesiologists, and gastroenterologists were all satisfied with the sedation process. Remimazolam can be used safely and effectively for colonoscopy. 0.2 mg/kg remimazolam and propofol have the same sedation success rate and more stable hemodynamics and fewer side effects than propofol. ChiCTR2100054053.

Functional Outcomes and Complications of Carotid Tandem Lesions After Mechanical Thrombectomy for Treatment of Large-Vessel Occlusion Stroke.

Large Vessel Occlusion (LVO) stroke patients with tandem lesions (TLs) have been observed to have worse outcomes when compared to patients with simple isolated intracranial occlusions. To examine the difference in post-operative functional status at discharge for patients treated with mechanical thrombectomy for an acute LVO stroke based on the presence of a tandem carotid lesion. This is a retrospective cohort study of 589 patients presenting within the first 24hours of stroke onset who underwent mechanical thrombectomy. The primary outcome was functional status quantified by modified Rankin Score (mRS) at time of discharge. The secondary outcomes were presence of hemorrhagic conversion, midline shift >5cm, malignant cerebral edema, reocclusion, Thrombolysis in Cerebral Infarction Scale (TICI), and discharge location. Patients with tandem occlusions and those with isolated intracranial lesions had similar baseline demographics. However, in patients with TLs, there was a significantly higher NIH stroke scale at admission and a longer time to recanalization. Modified Rankin Score prior to admission was similar for both groups, but was significantly higher in patients with TLs at discharge. The secondary outcomes were similar for hemorrhagic conversion, discharge to hospice, and a TICI scale of 0, but were significantly worse for patients with TLs for in-hospital mortality, midline shift >5mm, and malignant cerebral edema. The presence of a tandem lesion predicted a higher modified Rankin Score at discharge in univariate regression modeling (β = .45; P-value = .006). The two groups were similar in baseline characteristics and cardiovascular risk factors, yet patients with tandem carotid lesions experienced more complications during their hospitalization and had greater functional disability at discharge. Patients with a TL had a longer mean time to recanalization, representing a potential explanation for these differences in outcomes.

Clinical Profile and Outcome of Burn Injuries amongst Children in a Tertiary Care Center of North India

Objectives: The study aims to describe the clinical characteristics and outcome of pediatric burn patients admitted to a tertiary care hospital. Patients and methods: This was a cross-sectional, retrospective study that reviewed the records of all burn victims aged 0 to 12 who were admitted in a tertiary care hospital in North India over one year. Collected data included patient demographics such as age, gender, burn causal agents, discharge time, Total body surface area (TBSA) burnt by using Lund and Brauder’s Rule, the duration of stay, the season and month of admission that burn occurred, and burn characteristics, such as region of body involved, percentage of area burnt, complications and outcome. Results: 129 paediatric burn patients under 12 were included with median age of 4 years. Scald caused the majority of burns (81.4%), followed by dry burns (14.7%) and electric injuries (3.9%). The Median burn percentage was 20 and most burn patients were encountered during the winter season. The face and neck (56.6%) were involved in majority of cases, with a 4.6% overall mortality rate. Conclusion: This retrospective study provides valuable insights into the clinical profile of burn patients admitted to a tertiary care center in North India. The study's findings can help guide the development of targeted interventions and resource allocation to improve burn care in this region, ultimately reducing morbidity and mortality among burn patients.

Optimizing energy conversion in direct carbon fuel cells based on brown coal char: Exploring the impacts of scandium substituted La0.6Sr0.4FeO3-δ anodes

Direct coal fuel cells (DCFCs) convert the chemical energy in coal directly into electricity, but their development has been hindered by insufficiently active anode materials and slow carbon oxidation kinetics. This study explores the use of scandium-doped B-site-deficient La0.6Sr0.4FeO3-δ (LSFScx, x = 0, 0.05, 0.10, 0.15) as anodes for brown coal char utilization in DCFCs. Our findings show that LSFScx (x≠0) anodes outperform the undoped LSF anode, with the LSFSc0.1 anode exhibiting the best performance. At 850 °C, the LSFSc0.1 anode achieves a maximum power density of 345.5 mW cm−2, a minimum polarization resistance of 0.18 Ω cm2, and an impressive discharge time of 13.23 h. These enhancements are attributed to scandium doping, which improves the three-phase reaction boundaries, enhances carbon oxidation through better oxide ion transport, and optimizes the electronic structure. Theoretical calculations indicate that scandium doping reduces the Bader charges of Fe atoms, weakens OFe bonds, lowers the oxygen vacancy formation energy, and maintains the electronic energy band structures. These results provide a new and effective pathway to improve the anode performance and efficiency of DCFCs, showcasing new possibilities for future research on scandium-based perovskite materials for DCFC applications.

Medication Reconciliation of Patients by Pharmacist at the Time of Admission and Discharge from Adult Nephrology Wards.

The aim of the present study was to investigate the impact of medication reconciliation by pharmacists at both admission and discharge in hospitalized patients with different kidney diseases. A prospective study was performed in adult nephrology wards of a teaching referral hospital in Iran from September 2020 to March 2021. All patients hospitalized in the nephrology ward for at least 1 day who received the minimum of one medication during their ward stay within the study period were considered eligible. Medication reconciliation was performed by taking a best-possible medication history from eligible patients during the first 24 h of ward admission. Medications were evaluated for possible intentional as well as unintentional discrepancies. Here, 178 patients at admission and 134 patients at discharge were included. The mean numbers of unintentional drug discrepancies for each patient at admission and discharge were 6.13 ± 4.13 and 1.63 ± 1.94, respectively. The mean ± SD numbers of prescribed medications for patients before ward admission detected by the nurse/physician and pharmacist were 6.06 ± 3.53 and 9.22 ± 4.71, respectively (p = 0.0001). The number of unintentional discrepancies at admission and discharge had a significant correlation with the number of drugs used and underlying diseases. The number of unintentional discrepancies at admission was also correlated with patients' age. The number of comorbidities was significantly associated with the number of unintentional medication discrepancies at both admission and discharge. At the time of ward discharge, all patients were given medication consultations. The rate of reconciliation errors was high in the adult nephrology ward. The active contribution of pharmacists in the process of medication reconciliation can be significantly effective in identifying these errors.

Magnesium sulphate and sodium bicarbonate as additives for periarticular local infiltration analgesia improve pain management after unicompartmental knee arthroplasty: a prospective, double-blind, randomized controlled trial

BackgroundPeriarticular local infiltration analgesia (LIA) has become a widely used method for postoperative pain management after unicompartmental knee arthroplasty (UKA). However, the efficacy of using magnesium sulphate or sodium bicarbonate in LIA cocktails during UKA is not yet clear. The present study aimed to evaluate whether the modified LIA has advantages in pain control and joint function recovery after UKA surgery.MethodsSixty-one patients who underwent UKA were enrolled and randomly assigned to receive periarticular infiltration of a modified cocktail (comprising ropivacaine, epinephrine, dexamethasone, magnesium sulphate, and sodium bicarbonate) or a conventional cocktail (comprising ropivacaine, epinephrine, dexamethasone, ketorolac, and morphine). The outcomes included the consumption of patient-controlled intravenous analgesia (PCIA) medication used for postoperative analgesia, pain score, early joint functional recovery, discharge time, and complication rates.ResultsIn the first 12 h after surgery, the conventional cocktail was not superior to the modified cocktail in terms of visual analogue scale (VAS) scores. However, beginning on the second postoperative day, the analgesic effect was significantly prolonged in the modified group, leading to lower VAS scores and better knee functional recovery. Additionally, patients in the modified group required less pain medication via PCIA, both within the first 24 h and cumulatively up to 48 h after surgery. Both groups had similar rates of complications.ConclusionsThe present modification of a conventional cocktail significantly prolonged the analgesic effect and reduced pain medication consumption after UKA surgery, which was associated with better functional recovery in the early postoperative days.Trial registrationChinese Clinical Trial Registry, ChiCTR2200060500. 21 March 2023.

Effect of an oral stimulation protocol on breastfeeding among preterm infants: a randomised controlled trial

ObjectivesThe objectives are to assess the effectiveness of a modified and adapted oral sensorimotor intervention (MA-OSMI) protocol for infants in India on the rate and performance of breastfeeding among preterm...

Smart Monitoring Method for Land-Based Sources of Marine Outfalls Based on an Improved YOLOv8 Model

Land-based sources of marine outfalls are a major source of marine pollution. The monitoring of land-based sources of marine outfalls is an important means for marine environmental protection and governance. Traditional on-site manual monitoring methods are inefficient, expensive, and constrained by geographic conditions. Satellite remote sensing spectral analysis methods can only identify pollutant plumes and are affected by discharge timing and cloud/fog interference. Therefore, we propose a smart monitoring method for land-based sources of marine outfalls based on an improved YOLOv8 model, using unmanned aerial vehicles (UAVs). This method can accurately identify and classify marine outfalls, offering high practical application value. Inspired by the sparse sampling method in compressed sensing, we incorporated a multi-scale dilated attention mechanism into the model and integrated dynamic snake convolutions into the C2f module. This approach enhanced the model’s detection capability for occluded and complex-feature targets while constraining the increase in computational load. Additionally, we proposed a new loss calculation method by combining Inner-IoU (Intersection over Union) and MPDIoU (IoU with Minimum Points Distance), which further improved the model’s regression speed and its ability to predict multi-scale targets. The final experimental results show that the improved model achieved an mAP50 (mean Average Precision at 50) of 87.0%, representing a 3.4% increase from the original model, effectively enabling the smart monitoring of land-based marine discharge outlets.

Evaluation of empirical antibiotic use in diabetic foot infections at a tertiary hospital in Vietnam: A retrospective study.

Empirical antibiotic prescription guidelines were developed at the University Medical Center Ho Chi Minh City in 2020, which included recommendations for the use of antibiotics to treat diabetic foot infections (DFIs). This study investigated the treatment outcomes when implementing empirical antibiotic guidelines. This retrospective study included 120 inpatients with DFIs at the Department of Endocrinology, University Medical Center Ho Chi Minh City. This study had 2 periods (before and after implementation of hospital antibiotic guidelines): Period 1 from July 2019 to June 2020 and Period 2 from July 2021 to June 2022, with 60 random patients in each period. Treatment outcomes were assessed as follows: improvement (defined as the absence of fever and a white blood cell count within the normal range) at 72 hours and 7 days; duration of hospitalization; and clinical status at hospital discharge. After implementing empirical antibiotic guidelines, a greater proportion of improvement in the first 7 days of hospitalization (75.0% vs 56.7%, P = .03), and a shorter median duration of hospitalization (12.5 days vs 15.0 days, P = .02) were observed in patients with DFIs. All the patients showed improvement at the time of hospital discharge. The study findings revealed the encouraging effects of implementing empirical antibiotic prescription guidelines for DFI treatment.

Timing of Neonatal Discharge and Unplanned Readmission to PICUs Among Infants Born Preterm

Children born very preterm (<32 weeks) are at risk of ongoing morbidity and admission to pediatric intensive care units (PICUs) in childhood. However, the influence of the timing of neonatal discharge on unplanned PICU admission has not been established. To examine whether the timing of neonatal discharge (postmenstrual age and season) is associated with subsequent unplanned PICU admission. This retrospective cohort study used linked national data from the National Neonatal Research Database and Paediatric Intensive Care Audit Network (PICANet) for children born from January 2013 to December 2018 at 22 to 31 weeks' gestational age who were admitted to a neonatal unit in England and Wales and were discharged home at 34 weeks' postmenstrual age or later. All National Health Service (NHS) neonatal units and PICUs in England and Wales were included. Children were followed up until 2 years of chronological age. Data analysis was conducted from October 2023 to August 2024. Timing of discharge. The primary outcome was unplanned PICU admission between neonatal discharge and chronological age 2 years to any PICU within England and Wales. Survival analysis using a flexible parametric model was conducted with season of discharge (time-dependent factor), gestation, sex, birth weight less than the 10th centile, bronchopulmonary dysplasia, necrotizing enterocolitis, brain injury, and earlier neonatal discharge (lower quartile of postmenstrual age at discharge for gestation) as variables. Of 39 938 children discharged home (median [IQR] gestational age, 29 [27-31] weeks; 21 602 [54.1%] male), 1878 (4.7%) had unplanned PICU admission. More than half of admissions occurred within 50 days of neonatal discharge (1080 [57.5%]). Compared with summer, the risk of unplanned PICU admission following neonatal discharge was 2.58 times higher in winter and 2.35 times higher in autumn (winter: adjusted hazard ratio [aHR], 2.58; 95% CI, 1.68-3.95; autumn: aHR, 2.35; 95% CI, 1.84-2.99). Among children born at 28 to 31 weeks' gestational age, earlier neonatal discharge was associated with increased risk (aHR, 1.30; 95% CI, 1.13-1.49), but this was not true for children born younger than 28 weeks' gestational age. In this retrospective cohort study of preterm children, autumn and winter discharge were associated with the highest risk of unplanned PICU admission following neonatal discharge. For children born at 28 to 31 weeks' gestational age, discharge at lower postmenstrual age was also associated with increased risk. Further work is required to understand whether delaying neonatal discharge for some children born at 28 to 31 weeks' gestational age is beneficial and to consider the wider costs and implications of prolonging neonatal care.

BN SO02 - Cholecystectomy HRG Coding Audit

Abstract Background Incorrect coding practices for elective surgical procedures carry significant financial implications at Trust level. In this project, we aimed to audit the current coding practices pertaining to laparoscopic cholecystectomies performed within the NHS WWL Foundation Trust during November 2021-October 2022 and calculate the financial burden resulting from this. Method A list of 194 patients undergoing a cholecystectomy and their allocated HRG coding at time of discharge was compiled by the coding department. A comorbidity and complication index (CCI) for each of these patients was calculated using the operation note together with hospital and GP records. With this information, the correct HRG coding for each patient was calculated and compared to their allocated coding at discharge to calculate the difference in tariffs generated. Results 69.23% of 194 procedures carried out during the reported time period were coded incorrectly. This amounted to a financial burden of £72,232 lost in potential tariffs, equating to £372.33 per cholecystectomy performed. Commonest CCI of 3 in 29% of patients with corresponding HRG code GA10J Commonest incorrectly allocated coding GA10K denotes a presumed CCI of 0 Conclusion High percentage of incorrectly coded procedures with significant financial implications at Trust level Currenty coding practice often incorrectly presumes a CCI index of 0 with subsequent incorrect GA10K coding. However, the appropriate coding for the vast majority of patients undergoing a laparoscopic cholecystectomy was GA10J. Education and awareness is underway to make improvements at a Trust level before re-auditing of data can commence.

Impact of proxymetacaine on the dynamics of cyclopentolate in White 6- to 7-year-olds.

This study compared the efficacy of cyclopentolate hydrochloride at 10-, 20- and 30-min post-instillation in White 6- to 7-year-olds, with and without prior instillation of proxymetacaine hydrochloride. The primary aim was to determine if accurate autorefraction values can be obtained sooner than the current standard of 30-min post-cycloplegia. The secondary aim was to investigate whether proxymetacaine hydrochloride enhances the efficiency of cyclopentolate. Participants were 112 White 6- to 7-year-olds from the Child Eye Health Study. The right eye received 0.5% proxymetacaine hydrochloride and 1.0% cyclopentolate hydrochloride, and the left eye received only 1.0% cyclopentolate hydrochloride. Non-cycloplegic and cycloplegic refractive error (at 0, 10, 20 and 30 min) was measured using a binocular, open-field autorefractometer. Data were analysed through paired t-tests, concordance analysis, linear regression, equivalence testing and Bland-Altman analysis, using the 95% limits of agreement. Mean spherical equivalent refraction (SER) (SD) in the right eye at 0-, 10-, 20- and 30-min post-instillation was 0.62 (1.45) D, 1.52 (1.80) D, 1.64 (1.81) D and 1.72 (1.80) D, respectively. Mean left eye SER (SD) were 0.68 (1.24) D, 1.42 (1.66) D, 1.56 (1.66) D and 1.68 (1.72) D, respectively. Bland-Altman analysis showed a high level of agreement, and equivalence testing confirmed that there was no clinically significant difference in SER at 20 and 30 min in both eyes (within ±0.50 D), with mean differences of 0.08 (0.23) D in the right eye and 0.13 (0.30) D in the left eye (p = 0.21). However, SER at 10 and 30 min were equivalent in the right eye only. Accurate autorefraction values can be obtained 20-min post-instillation of 1.0% cyclopentolate in white children aged 6-7 years, potentially reducing clinical testing times. Proxymetacaine pre-instillation allows for reliable measurements as early as 10-min post-instillation of cyclopentolate. Further research is needed to validate these findings in non-White populations and to determine the safe discharge time post-proxymetacaine instillation.

Health State Prediction of Lithium-Ion Battery Based on Improved Sparrow Search Algorithm and Support Vector Regression

The state of health (SOH) prediction of lithium-ion batteries is a pivotal function within the battery management system (BMS), and achieving accurate SOH predictions is crucial for ensuring system safety and prolonging battery lifespan. To enhance prediction performance, this paper introduces an SOH prediction model based on an improved sparrow algorithm and support vector regression (ISSA-SVR). The model uses nonlinear weight reduction (NWDM) to enhance the search capability of the Sparrow algorithm and combines a mixed mutation strategy to reduce the risk of local optimal traps. Then, by analyzing the characteristics of different voltage ranges, the charging time from 3.8 V to 4.1 V, the discharge time of the battery, and the number of cycles are selected as the feature set of the model. The model’s prediction capabilities are validated across various working environments and training sample sizes, and its performance is benchmarked against other algorithms. Experimental findings indicate that the proposed model not only confines SOH prediction errors to within 1.5% but also demonstrates robust adaptability and widespread applicability.

Dyspnea in COVID-associated lung disease

Introduction. Covid-associated lung disease has become one of the leading problems of the COVID-19 pandemic, and early diagnosis of complications is complicated. Assessment of dyspnoea as a significant symptom is important, but its diagnostic ability in this lesion is poorly understood.Aim. To study the features of dyspnoea in COVID-19-associated lung lesions and its diagnostic value.Materials and methods. The study included 134 patients with COVID-19-confirmed pneumonia. Demographic and anthropometric data, subjective condition, dyspnoea severity according to Borg scale, concomitant pathologies, multispiral computed tomography (MSCT) data, arterial blood gas composition, capnometry and spirometry data, as well as disease outcomes (transfer to ICU, support ventilation, fatal outcome) were analysed.Results. Dyspnoea was present in 43.3% of patients. Increased dyspnoea was associated with increased C-reactive protein (CRP), D-dimer, lung tissue damage (MSCT), decreased forced vital capacity (FVC), and increased alveolar-arterial gradient (P(A-a)O2). Dyspnoea correlated with duration of hospitalisation and need for oxygen therapy (OR = 1.307, p = 0.008). 57.4% of patients with hypoxaemia did not complain of dyspnoea, but their outcomes did not differ between patients with dyspnoea and hypoxaemia. 32.2% of patients without hypoxaemia complained of dyspnoea. These patients did not have a significant increase in FGEF by the time of discharge, and it remained lower than in patients without dyspnoea and hypoxaemia.Conclusion. Dyspnoea in COVID-19-associated lung disease is an important symptom correlating with clinical-functional, instrumental and laboratory characteristics of the disease. Comprehensive data analysis is necessary to identify patients requiring further observation.

Depression, anxiety and insomnia among isolated covid-19 patients: tele occupational therapy intervention vs. conventional one: a comparative study

BackgroundCOVID-19 is known to cause psychological problems. Psychological rehabilitation can be performed to reduce anxiety, depression, and insomnia. Facing patients with infectious diseases can be difficult for medical staff. Therefore, this study compared the effects of psychiatric tele-rehabilitation (TR) and conventional psychiatric rehabilitation (CR) in isolated patients with COVID-19.MethodsThis randomized controlled study, conducted at a single community-based hospital, included 40 patients (24 in the psychiatric tele-rehabilitation group [TRG] and 16 in the conventional psychiatric rehabilitation group [CRG]) with COVID-19 were recruited from November 18, 2021, to April 7, 2022. Psychiatric rehabilitation is an occupation-based intervention in which patients perform meaningful activities and tasks. Patients in the TRG selected activities, received counseling, and underwent monitoring over the phone, while those in the CRG participated in face-to-face sessions. The interventions were conducted for 50 min each day during an isolation period of 7 days in both groups, and all participants received the interventions individually. The primary outcome was anxiety assessed using the Visual Analog Scale (VAS) and the Zung Self-Rating Anxiety Scale (SAS). Secondary outcomes include the Visual Analog Scale (VAS) and the Patient Health Questionnaire-9 (PHQ-9) to evaluate depression, the Multidimensional State Boredom Scale-8 (MSBS-8) to assess boredom. The Korean version of the Insomnia Severity Index (ISI-K) was used to assess the quality of sleep, and the World Health Organization Quality of Life Assessment Instrument-BRIEF (WHOQOL-BREF) was used to evaluate quality of life. Questionnaires were administered at admission, discharge, and at the 6-month follow-up.ResultsIn the time × group analysis, the SAS total score (p = .033) and the VAS score for depression (p = .012) in the CRG were significantly lower than those in the TRG at the time of discharge. The VAS score for anxiety (p = .007), total SAS score (p = .050), and VAS score for depression (p = .003) in the CRG were also significantly lower than those in the TRG at the 6-month follow-up. The PHQ-9, MSBS-8, ISI-K, and WHOQOL-BREF scores showed no significant interactions in the time × group analysis.ConclusionsTR was effective in reducing anxiety and improving quality of life during hospitalization, but had no remained effects after discharge. Otherwise, CR was more effective than TR for anxiety and depression during hospitalization and had remained effects at 6-month follow-up. However, considering the characteristics of infectious conditions that involve risk in contact, TR will still play an important role, and efforts will be needed to improve the effect that remained.Trial registrationThe trial was registered with the Korea Clinical Trials Registry (KCT0006714, Date of registration 08/11/2021).

Implementation of Robotic-Assisted Sacrocervicopexy for Apical Organ Prolapse Using the Semitendinosus Tendon-Pilot Study and Analysis of Clinical Outcome.

This video demonstrates a robotic-assisted sacrocervicopexy using the semitendinosus tendon. Between June 2022 and February 2023, we performed the worldwide first Da Vinci robotic-assisted sacrocervicopexies (SCP) for apical organ prolapse using the semitendinosus tendon of the left knee. Analysis of safety, feasibility, and clinical outcome of the first ten patients operated on using this new surgical technique included the German pelvic floor questionnaire (GPFQ) as well as a clinical examination. Ten patients with a follow-up of 12months were included. There was a significant reduction of the patient's symptoms according to the GPFQ regarding the domain bladder (preoperatively versus 3 months postoperatively, mean 3.85 vs 1.61, p = 0.034), total score (preoperatively versus 3 months postoperatively, mean 12.79 vs 3.28, p = 0.034), and descensus symptoms (preoperatively versus 12months postoperatively, mean 4.74 vs 0.67, p = 0.022). POP-Q stage (point C) was significantly reduced between the preoperative period and at the time of discharge (mean 2.2 vs 0, p = 0.004). No serious intra- and postoperative complications occurred. This pilot study showed satisfying clinical outcomes after a follow-up of 12months, with a low mid-term complication rate.