Increased Resource Utilization Research Articles

Merchants of Death: The Effect of Credit Supply Shocks on Hospital Outcomes

This study examines the link between credit supply and hospital health outcomes. We use bank stress tests as exogenous shocks to credit access for hospitals that have lending relationships with tested banks. We find that affected hospitals shift their operations to increase resource utilization following a negative credit shock but reduce the quality of their care to patients across a variety of measures, including a significant increase in risk-adjusted readmission and mortality rates. The results indicate that access to credit can affect the quality of health care hospitals deliver, pointing to important spillover effects of credit market frictions on health outcomes. (JEL G21, G32, I11, I18)

Using Quality Improvement to Optimize Blood Product Utilization in a Pediatric Cardiac Catheterization Laboratory.

Packed red blood cells (PRBC) are frequently ordered for cardiac catheterization procedures, which increases resource utilization and patient charges. We applied the Plan-Do-Study-Act (PDSA) principle in order to optimize the ordering of PRBC for pediatric cardiac procedures and reducing charges. Our primary aim was to increase adherence to ordering guidelines to greater than 97%, with a global aim to reduce resource utilization. The existing PRBC ordering guidelines were revised and procedure reports were updated to include administration of PRBC. The rate of pre-procedure PRBC orders, adherence to the new protocol guidelines, presence of documentation and rate of blood transfusion within 24h post-procedure, frequency of emergency release blood during a procedure were monitored. During our study period, there was an increased adherence from 86 to 100% adherence following implementation of the updated guidelines. With improved adherence, we decreased PRBC ordering and hospital charges to the patient in low-risk cardiac catheterization procedures, without an increase in blood transfusions.

Attendance, Wellness, and Engagement: The AWE Model of Workplace Satisfaction.

The Attendance, Wellness, and Engagement (AWE) Model of Workplace Satisfaction is an innovative approach to promoting a sustainable, healthy, and engaged workforce. Implemented at Louis Brier Home and Hospital, the AWE Model encapsulates a people strategy aimed at nurturing a supportive and fulfilling work environment. Attendance promotion is accomplished by acknowledging absences while providing a comprehensive support system to address personal challenges faced by healthcare workers. The wellness component is underscored by increasing resource utilization, offering on-site health services, and cultivating social groups to enhance holistic well-being. Additionally, engagement is characterized by staff recognition rituals, community-building initiatives, and celebratory events. Importantly, this article presents a compelling position that the AWE Model creates a positive impact on reducing absenteeism, enhancing staff satisfaction, and transforming organizational culture. As health leaders grapple with workforce challenges, the AWE Model serves as a pragmatic framework to cultivate environments where employees regularly attend work healthy and engaged.

Independent Risk Factors and Economic Burden Associated With Delayed Extubation Following Pediatric Liver Transplantation.

Successful early extubation (EE) after liver transplant (LT) has been shown to reduce intensive care unit (ICU) and hospital length of stay and infectious, vascular, and sedation-related complications in adults. EE may not always be feasible in children, and many may require prolonged mechanical ventilation. Limited data exists regarding the candidacy of EE, risk factors, consequences, and hospital costs of delayed extubation (DE) in pediatric LT. We conducted a retrospective review to investigate predictive factors and associated costs of EE and DE in infants and children after orthotopic LT at our institution between 2011 and 2021. Of 338 LT (median age 39 months, 54% females), 246 (73%) had EE (within 24 h of LT), while 27% had DE. Age < 1 year (p = 0.0019), diagnosis of biliary atresia (0.02), abnormal pre-LT echocardiogram (0.02), and patients with ongoing hospital admission before LT (0.0001) were independently associated with DE. Hospital costs were significantly (∼3-fold) higher (p < 0.0001) in the DE group. In addition, factors associated with increased total hospital costs were age < 1 year and hospitalization before LT. EE post-LT is feasible and merits a trial. The prevalence of DE though modest is associated with increased resource utilization and hospital costs. Children who can be extubated early and those at risk for DE can be identified pre-operatively for optimal planning and allocation of resources.

Optimized irrigation practices with fertilizer utilization strategies to improve photo-fluorescence efficiency, vascular bundles and maize production in semi-arid regions

The mechanism of irrigation models combined with fertilizer utilization strategies under the biodegradable film mulching could greatly promote crop photosynthesis, vascular bundles structure; resource utilization and maize production are unclear in semi-arid areas. Unfortunately, this mechanism provides a scientific basis for improving irrigation and fertilizer utilization. A field study was carried out during 2021–2022 years. Seven treatments were established: two nitrogen levels: low-N (150 kg N ha−1) and high-N (300 kg N ha−1) combined with three different irrigation models: drip irrigation (DI), ridge irrigation (RI) and border irrigation (BI) under the biodegradable film mulching with (CK) treatment have no irrigation, fertilizer and mulching. Our results revealed that DIH treatment considerably increased soil water storage, enhanced photosynthesis rate (Pn) of maize by mainly to facilitate stomatal opening compared to the rest of all treatments. In addition, it also enhances the differentiation of the vascular bundle system and maintains its post silk function under better environmental conditions, greatly improving nitrogen storage in soil and plants, and enhancing maize productivity. DIH and RIH treatments significantly increased net photosynthesis rate (Pn), stomatal conductance (Gs), transpiration rate (Tr), maximum quantum yield of PSII photochemistry (Fv/Fm), and effective quantum yield of PSII photochemistry (ΦPSII), photochemical quenching (qP), non-photochemical quenching (NPQ), and yield were observed, but evapotranspiration (ET) decreased at different growth stages. The results showed that DIH treatment was an effective tillage strategy, which increased biomass yield by 32.6 %, grain yield by 46.0 %, water use efficiency (WUE) by 46.2 %, and nitrogen use efficiency (NUE) by 86.4 % compared to other treatments. Given these results, thus we recommend the drip irrigation combined with a high-N level under a biodegradable film mulching increase photo-fluorescence efficiency, maize production and resource utilization efficiency in semi-arid regions.

Feasibility Study of Marigold as Intercrop in Drumstick Cultivation for Interim Income Generation

Drumstick (Moringa oliefera Lam.) PKM-1(Annual) is an important perennial vegetable crop present cultivating in India not only as vegetable and for moringa leaf powder. India is the main producer of drumstick in the world because higher contribution is due to favourable temperature during flowering and fruit development stages. Even though encountered several production hurdles resulting greater yield loss due to existing climatic conditions during fruit developmental stages. But this crop gave them perfect assurance in giving good income in an average about 2-3 Lakhs rupees over a period of 2 years. Based on weather conditions farmers were being come forwarded by training programmes conducted by our KVK from 2017-till date, we have documented the farmers results by growing intercrops mainly marigold crop. Which gives good yield and good income to the farmers before pod formation of drumstick. Marigold is 110 days crop where drumstick gives first yield after 7 months. In between marigold crop not only giving accountable benefits to the farmers and it reduces the nematode problems in the field as well explained by Steiner, 1941 Marigold (Tagetes erecta) is one of the most widely studied plant genera due to its allelopathic potential against PPNs. Marigolds’ repressive impact on nematodes has been documented for over 50 years and some studies said that spiral (Helicotylenchus multicinctus) nematodes are responsible for yield losses of 30–60% in many banana-producing countries in the tropics (Davide, 1995, Speijer and Kajumba, 1996, Kashaija et al., 2004) . The partner crops of the intercropping system share space, water, and nutrients making the most efficient utilization of available resources (Xu et al., 2020). Earlier farmers were paddy growers where they didn’t see profits by selling paddy in IKP centers or as individual sales. So We conducted trails in Huzurabad Division and Errabelli villages of Karimnagar District (Old Karimnagar District), got successful results by doubling the farmer’s income. Raised marigold seedlings in KVK during June month and supplied to the farmers. Transplanted marigold and Drumstick in July month with 60cm x60cm and Drumstick spacing was 3mx3m where 444 plants were accommodated in one acre area, Intercropping is an agricultural system that improves land use efficiency through simultaneous cultivation of more different crops in the same field using functional complementarity to increase resources utilization, increase the productivity of crops and nutrient-use efficiency (Chifflot et al., 2006; Zhan and Li, 2003) Even went through many hurdles in marigold and drumstick crops in rainy season due to paddy growing soils and water logging conditions. In this, observed positive effects on soil carbon and nitrogen of intercropping found in previous intercropping studies (Makumba et al., 2007), [1]. Results are as follows we harvested 36.80Q per acre in 8 pickings and after drumstick pods harvested from February up to June 134 pods per tree. It shows C: B ratio as drumstick (PKM1) contribution 1:11.7 and marigold (Tanindo (Yellow and Orange) contribution 1:4.3 to the farmers. The demonstration plots reported that yield of marigold and drumsticks are 38.6Q and 49.58Q per acre. Farmers got good income Rs. 2, 74,160.00 through two crops in one acre area with Marigold as inter crop in Drumstick plantation. Based on this success story of the farmers, NABARD bank started giving loans to the farmers and they published this success story in their credit linkage plan 2018-19.

Hybrid group opportunistic maintenance strategy for offshore wind turbines considering maintenance resource allocation in harsh working environments

The intelligent maintenance of offshore wind turbines (OWTs) is vital for sustainable energy generation and utilization, as harsh working environments generally limit their application. As offshore wind farms expand into deeper waters, operational and maintenance costs continue to increase. Therefore, devising targeted maintenance strategies for offshore wind farms is crucial. Existing strategies often overlook the role of maintenance resources in controlling the operational and maintenance costs. To address this problem, this study proposes a hybrid group opportunistic maintenance strategy to implement resource allocation-based maintenance for OWTs under dynamic conditions. First, a failure rate model based on the life decline and system coupling is proposed to capture the evolution of failures in OWTs in harsh working environments, thereby enhancing the accuracy of fault maintenance. Subsequently, a hybrid linear and nonlinear deterioration model is proposed to identify the different deterioration trends owing to the various sensitivities of diverse components to harsh working environments, which enhances the precision of degradation maintenance. In addition, a maintenance resource allocation model is proposed to allocate resources in advance, thereby increasing resource utilization and reducing maintenance costs. A multi-objective optimization approach is proposed to maximize the mean maintenance level (MML) and minimize the per unit cycle expected maintenance cost rate (PECR) by considering harsh working environments. Finally, the nutcracker optimization algorithm is introduced into the maintenance model to generate the optimal solution in a multi-objective manner. The results show that the maintenance model is feasible and effective for practical adaptive maintenance applications of OWTs in harsh working environments in practical applications.

Efficient resource allocation in cloud computing environments using AI-driven predictive analytics

This paper proposes an innovative AI-driven approach for efficient resource allocation in cloud computing environments using predictive analytics. The study addresses the critical challenge of optimizing resource utilization while maintaining high quality of service in dynamic cloud infrastructures. A hybrid predictive model combining XGBoost and LSTM networks is developed to forecast workload patterns across various time horizons. The model leverages historical data from a large-scale cloud environment, encompassing 1000 servers and over 52 million data points. A dynamic resource scaling algorithm is introduced, which integrates the predictive model outputs with real-time system state information to make proactive allocation decisions. The proposed framework incorporates advanced techniques such as workload consolidation, resource oversubscription, and elastic resource pools to maximize utilization efficiency. Experimental results demonstrate significant improvements in key performance indicators, including increasing resource utilization from 65% to 83%, reducing SLA violation rates from 2.5% to 0.8%, and enhancing energy efficiency, with PUE improving from 1.4 to 1.18. Comparative analysis shows that the proposed model outperforms existing prediction accuracy and resource allocation efficiency methods. The study contributes to the field by presenting a comprehensive, AI-driven solution that addresses the complexities of modern cloud environments and paves the way for more intelligent and autonomous cloud resource management systems.

K-medoid clustering containerized allocation algorithm for cloud computing environment

Load balancing is critical for container-based cloud computing environments for several reasons. A lack of appropriate load balancing techniques could result in a decrease in performance and possible service interruptions as some nodes get overloaded, while others are left underutilized. Cloud service providers can reduce latency and boost system performance by strategically placing containers using clustering algorithms. These techniques aid in efficiently using resources and load balancing by clustering related containers together according to their shared attributes. Clustering strategies are effective in allocating and controlling resources to meet the demands of a changing workload. Algorithms for clustering combine related workloads or containers into clusters, improving performance isolation and maximizing resource usage. One popular methodology for data clustering is the K-Medoid Clustering Algorithm. It is especially helpful when working with categorical data or when the dataset contains outliers. K-medoids is an unsupervised clustering approach where the core of the cluster is made up of data points known as “medoids.” A medoid is a location in the cluster whose total distance to every object in the cluster—also known as its dissimilarity—is as small as possible. Any appropriate distance function may be used, such as the Manhattan distance, the Euclidean distance, or another one. Thus, by choosing K medoids from our data sample, the K-medoids method splits the data into K clusters. This work presents the K-Medoid clustering technique for containers, which can enhance load balancing, decrease resource execution times, and increase resource utilization rates all at the same time. The results of the experiment show that the proposed method outperforms MACO and FCFS in terms of throughput by about 70% when number of cloudlets increased. The relative improvement of execution time of the proposed K-medoid algorithm w.r.t FCFS is about 50%.

Targeted preparation for hydrocarbons through catalytic hydrodeoxygenation of co-pyrolysis bio-oil using bimetal-loaded Nb2O5 catalyst

The co-pyrolysis of industrial enzymatic hydrolysis of lignin residue with waste plastic to produce bio-oil can increase resource utilization and reduce pollution. However, the high concentration of oxygenated compounds, particularly phenolic compounds, limits the large-scale application of crude bio-oil. Bimetallic-loaded bifunctional catalysts have been prepared by loading different transition metals and Ru onto Nb2O5. We explored their performances in crude co-pyrolysis bio-oil hydrodeoxygenation (HDO). Compared to other transition metals, the selectivities for aromatic hydrocarbons, phenolic compounds, and other oxygenated compounds in the upgraded oil obtained by the catalytic HDO of Ni and Ru bimetallic-loaded Nb2O5 (Ni-Ru@Nb2O5) was the lowest, whereas the aliphatic hydrocarbons selectivity was the highest. The selectivities for other oxygenated compounds, phenolic compounds, and aromatic hydrocarbons in the upgraded oil decreased as the Ni loading increased, whereas the aliphatic hydrocarbons selectivity increased. Ni-Ru@Nb2O5 catalyzed HDO of crude bio-oil showed a maximum selectivity of 86.30 % for hydrocarbons in the upgraded oil at a reaction time of 2 h and a reaction temperature of 280 °C. The degree of deoxygenation of upgraded oil reached 68.87 % under optimal conditions, and the molar ratio of H-to-C was increased from 1.31 (crude bio-oil) to 2.37 (upgraded oil). Ni-Ru@Nb2O5 is an effective catalyst method for the HDO of crude bio-oil.

Fluoroamphiphilic polymers exterminate multidrug-resistant Gram-negative ESKAPE pathogens while attenuating drug resistance.

ESKAPE pathogens are a panel of most recalcitrant bacteria that could "escape" the treatment of antibiotics and exhibit high incidence of drug resistance. The emergence of multidrug-resistant (MDR) ESKAPE pathogens (particularly Gram-negative bacteria) accounts for high risk of mortality and increased resource utilization in health care. Worse still, there has been no new class of antibiotics approved for exterminating the Gram-negative bacteria for more than 50 years. Therefore, it is urgent to develop novel antibacterial agents with low resistance and potent killing efficacy against Gram-negative ESKAPE pathogens. Herein, we present a class of fluoropolymers by mimicking the amphiphilicity of cationic antimicrobial peptides. Our optimal fluoroamphiphilic polymer (PD45HF5) displayed selective antimicrobial ability for all MDR Gram-negative ESAKPE pathogens, low resistance, high in vitro cell selectivity, and in vivo curative efficacy. These findings implied great potential of fluoroamphiphilic cationic polymers as promising antibacterial agents against MDR Gram-negative ESKAPE bacteria and alleviating antibiotic resistance.

Readmission Outcomes in Kidney Transplant Recipients With and Without Delayed Graft Function

Delayed graft function (DGF) is a common post-transplant event associated with increased resource utilization. As a center with experience in DGF, we aimed to assess differences in readmissions and post-transplant outcomes between patients with and without DGF. This was a retrospective review of deceased donor kidney transplant recipients at Mayo Clinic Arizona between 2015 and 2020. Recipients with at least one early readmission following kidney transplantation were included in the study. Two groups were identified: (1) recipients with DGF who required early readmission and (2) recipients without DGF who required early readmission. Among recipients with DGF, 43.9% (n = 405) required early readmission compared to 29.1% (n = 179) without DGF (P < .0001). There were no differences in the initial hospital length of stay (P = .08), and most recipients in both groups only required a single readmission (61.7% vs 72.1%, P = .02). Recipients with DGF were more likely to have ≥2 readmissions (P = .02) and a higher total readmission rate (P = .006). Recipients with DGF who required readmission also required more outpatient clinic visits (P = .003). When comparing recipients with and without DGF who required readmission, there were no differences in patient (P = .22) or death-censored (P = .72) graft survival. When comparing patients with and without DGF requiring one versus ≥2 readmissions, there were no differences in patient survival (P = .15), however patients with DGF and ≥2 readmissions had lower death-censored graft survival (P = .001). Recipients with DGF are at increased risk of readmission. Transplant center-level changes to reduce readmissions and infections could have an important impact on DGF outcomes.

Management and Clinical Outcomes of Neonatal Hypothermia in the Newborn Nursery.

Neonatal hypothermia has been shown to be commonly detected among late preterm and term infants. In preterm and very low birth weight infants, hypothermia is associated with increased morbidity and mortality. Little is known about the clinical interventions and outcomes in hypothermic late preterm and term infants. This study fills this gap in the evidence. Single-center retrospective cohort study using electronic health record data on infants ≥35 weeks' gestation admitted to a newborn nursery from 2015 to 2021. Hypothermia was categorized by severity: none, mild (single episode, 36.0-36.4°C), and moderate or recurrent (<36.0°C and/or 2+ episodes lasting at least 2 hours). Bivariable and multivariable logistic regression examined associations between hypothermia and interventions or outcomes. Stratified analyses by effect modifiers were conducted when appropriate. Among 24 009 infants, 1111 had moderate or recurrent hypothermia. These hypothermic infants had higher odds of NICU transfer (adjusted odds ratio [aOR] 2.10, 95% confidence interval [CI] 1.68-2.60), sepsis evaluation (aOR 2.23, 95% CI 1.73-2.84), and antibiotic use (aOR 1.73, 95% CI 1.15-2.50) than infants without hypothermia. No infants with hypothermia had culture-positive sepsis, and receipt of antibiotics ≥72 hours (surrogate for culture-negative sepsis and/or higher severity of illness) was not more common in hypothermic infants. Hypothermic infants also had higher odds of blood glucose measurement and hypoglycemia, slightly higher percent weight loss, and longer lengths of stay. Late preterm and term infants with hypothermia in the nursery have potentially unnecessary increased resource utilization. Evidence-based and value-driven approaches to hypothermia in this population are needed.

An ecological population study of lampreys in the Lotka-Volterra tertiary trophic level based on sex differences

This study examines the adaptive changes in sex ratio on animal populations and its effects on ecosystem stability and interactions. The effects of sex ratio dynamics on the ecosystem were analyzed through mathematical modeling using lampreys as the study population. In this study, a two-stage tertiary trophic Lotka-Volterra mathematical model of ecological dynamics was developed, taking into account food preferences, ecological roles, and sex interactions of lampreys. The simulation results showed that a rapid adjustment in sex ratio led to a reduction in environmental loads, which triggered an early rebound increase in lampreys and predator populations. To assess the ability of lampreys populations to adjust sex ratios, this study used a combination of fuzzy integrated evaluation and hierarchical analysis methods. The results of the study revealed the importance of sex-adaptive traits for population development, including increased resource utilization efficiency and population fitness, as well as decreased reproductive success and reduced genetic diversity. Based on the RRT (resistance, resilience and temporal stability) method, this study constructed an ecosystem stability assessment model and investigated the effects of changes in the sex ratio of lampreys on ecosystem stability. The experimental results showed that ecosystem stability was highest when the sex ratio was 0.6 and lowest when the sex ratio was 0.2. Variation in sex ratio may affect the behavior and abundance of lampreys, thereby directly influencing their interactions with other species. Variability in sex ratio provides more resources for predators and parasites of lampreys, promotes their growth, and positively affects ecosystem balance. Simulation results showed that the model was highly stable under different interactions. In summary, this study reveals the important effects of sex ratio on ecosystem stability and interactions, and provides important insights into the understanding of adaptive evolutionary traits of species, ecosystem stability and ecological interactions.

Impact of pneumothorax on mortality, morbidity, and hospital resource utilization in COVID-19 patients: a propensity matched analysis of nationwide inpatient sample database

BackgroundSpontaneous pneumothorax (PTX) is more prevalent among COVID-19 patients than other critically ill patients, but studies on this are limited. This study compared clinical characteristics and in-hospital outcomes among COVID-19 patients with concomitant PTX to provide insight into how PTX affects health care utilization and complications, which informs clinical decisions and healthcare resource allocation.MethodsThe 2020 Nationwide Inpatient Sample was used analyze patient demographics and outcomes, including age, race, sex, insurance status, median income, length of hospital stay, mortality rate, hospitalization costs, comorbidities, mechanical ventilation, and vasopressor support. Propensity score matching was employed for additional analysis.ResultsAmong 1,572,815 COVID-19 patients, 1.41% had PTX. These patients incurred significantly higher hospitalization costs ($435,508 vs. $96,668, p < 0.001) and longer stays (23.6 days vs. 8.6 days, p < 0.001). In-hospital mortality was substantially elevated for PTX patients (65.8% vs. 14.4%, p < 0.001), with an adjusted odds ratio of 14.3 (95% CI 12.7–16.2). Additionally, these patients were more likely to require vasopressors (16.6% vs. 3.3%), mechanical circulatory support (3.5% vs. 0.3%), hemodialysis (16.6% vs. 5.6%), invasive mechanical ventilation (76.9% vs. 15.1%), non-invasive mechanical ventilation (19.1% vs. 5.8%), tracheostomy (13.3% vs. 1.1%), and chest tube placement (59.8% vs. 0.8%).ConclusionsOur findings highlight the severe impact of PTX on COVID-19 patients, characterized by higher mortality, more complications, and increased resource utilization. Also, being Hispanic, male, or obese increased the risk of developing concomitant PTX with COVID-19.

BMI ≥ 70: A Multi-Center Institutional Experience of the Safety and Efficacy of Metabolic and Bariatric Surgery Intervention.

With the escalating prevalence of obesity, healthcare providers are increasingly managing patients with a body mass index (BMI) exceeding 70. The aim of this study was to describe the perioperative experiences of this demographic group at two institutions. An analysis encompassing 84 patients presenting with BMI ≥ 70kg/m2 from two institutions was conducted. Data included patient demographics, 30-day postoperative outcomes, and weight-loss at different intervals (30days, 6months, 1year). Additionally, rates of emergency department (ED) utilization, readmission, and reoperation in the first postoperative year were examined. Most patients were black (66.7%) and female (86.9%) with a mean age of 41.7years. The majority underwent laparoscopic sleeve gastrectomy (SG, 88.1%). Patients exhibited a marked decrease in BMI (7.84% at 30days, 20.13% at 6months, and 26.83% at 1year). Average length of stay was comparable across procedure (F(3,80) = 0.016, p = .997). While 30-day complications were minimal (0.7%), 14.4% of patients experienced ED visits within 30days, escalating to 19.6% by six months and 25% at 1year. Readmission and reoperation rates at 1year were 6.45% and 4.83%, respectively. With global obesity rates rising, clinicians are being challenged to care for patients with BMI ≥ 70kg/m2. Analysis of two institutions demonstrated low rates of 30-days complications but increased readmission rates and ED utilization in this patient population. Despite increased resource utilization, the study suggests that BMI ≥ 70kg/m2 alone should not be a deterrent for surgery, emphasizing the need for nuanced care in this expanding demographic.

Evaluation of the safety and feasibility of outpatient colorectal endoscopic submucosal dissection

Background and AimsEndoscopic submucosal dissection (ESD) is increasingly utilized for resection of benign nonpedunculated colorectal polyps and early cancers. However, there is concern that adoption of ESD may be limited by increased resource utilization with routine post-procedure admission. As endoscopic closure of ESD wounds has improved, in 2022 we adopted an outpatient colorectal ESD protocol. MethodsThis study was a retrospective evaluation of adult patients that underwent colorectal ESD from 1/2022 to 4/2023. When technically feasible, the wound was closed by clips or suturing. Following the procedure, patients were observed for up to 2 hours and discharged if they had no abdominal pain and there was no intra-operative muscle injury. We evaluated for operative success (en bloc resection, R0 and curative resection) as well as safety (post-procedure pain, perforation, delayed bleeding). ResultsA total of 111 lesions were removed by ESD in 105 consecutive patients. 19/111 (17%) had prior endoscopic mucosal resection. All lesions were successfully removed: en bloc resection rate was 93%, R0 and curative resection rate was 90%. 99/111 (89%) of the wounds were closed, most commonly using clips (60/111; 54%). There were two small intraprocedural perforations, both managed with clip closure and the patients did not require admission. Among patients with defect closure, there were no delayed bleeds requiring hospitalization and only 1 episode of self-limited bleeding. In contrast, among 12 patients with resection sites not amenable to closure, there was 1 delayed bleed requiring hospitalization, 2 minor bleeds assessed at the emergency department and 2 self-limited bleeds. ConclusionsIn this retrospective study we demonstrate the feasibility of outpatient colorectal ESD. Among 105 patients, only 2 required hospital admission: one for post-procedure pain and one for delayed bleeding. We find that after endoscopic closure of ESD wounds, hospital admission is generally unnecessary and significant post-procedure bleeding is rare.

Epidemiology, Outcomes, and Trend Analysis of Hospitalized Infants With Respiratory Syncytial Virus (RSV) Bronchiolitis From 1997 to 2019.

Background Most children with respiratory syncytial virus (RSV) infection have a self-limiting course that can be managed with supportive care, and hospitalization is uncommon. The objectives of this study were to evaluate the epidemiology, outcomes, associated comorbidities, and temporal trends in the prevalence of infants one to 24 months of age who required hospitalization for RSV infection in the United States of America from 1997 to 2019. Methods In this retrospective cross-sectional study, we utilized the Kids' Inpatient Database (KID) to investigate the prevalence and outcomes of RSV bronchiolitis within a large cohort of discharged patients from 1997 to 2019. We included children one to 24 months of age admitted with a diagnosis of RSV bronchiolitis. Neonates were excluded from the analysis. A chi-square for linear trend was used to analyze trends in the prevalence of RSV bronchiolitis hospitalization, the presence of complex chronic conditions (CCC), congenital heart disease (CHD), the use of non-invasive and invasive mechanical ventilation (NIV and IMV), and hospital mortality. Results There were a total of 566,786 infants aged one to 24 months hospitalized with RSV infection out of a total of 9,309,597 discharges during the eight-year cohort, with a hospital prevalence of 60.9 per 1000 discharges and a hospital mortality rate of 0.09% (95% confidence interval (CI): 0.08%-0.1%). There was no trend in hospitalization rates of RSV infections per 100,000 U.S. population during the study period, with a decrease in hospital mortality trend. Children with RSV bronchiolitis were more likely to have government insurance and reside in zip codes with the lowest income quartile. There was a significant seasonal and regional variation in RSV-related hospitalizations. The presence of CCC was identified in 2.4% of the RSV group compared to 5.1% of non-RSV discharges (odds ratio (OR): 0.46, 95% CI: 0.45-0.47; p<0.001). The prevalence of RSV among all discharges has significantly increased over the study period, rising from 51.6 cases per 1000 discharges in 1997 to 180.1 cases per 1000 discharges in 2019 (p<0.001). The prevalence of CCC and CHD among RSV patients has also shown an upward trend, with CCC cases increasing from 1,411 in 1997 to 2,795 in 2019 and CHD cases rising from 1,795 to 3,622 during the same period. The use of invasive mechanical ventilation, non-invasive ventilation, and extracorporeal membrane oxygenation has consistently increased over time. Additionally, complications such as the need for cardiopulmonary resuscitation have demonstrated a similar increasing trend, although they have remained overall low. However, population-based hospitalization rates showed no significant trend. Conclusions The hospitalization rates at a population level in the United States for RSV infection in children aged one to 24 months remained steady from 1997 to 2019, while hospital mortality rates showed a declining trend. There is an increased proportion of comorbid conditions and increased resource utilization in children with RSV. These findings are important for monitoring the effectiveness of preventive strategies for severe RSV infections.

Termination of Resuscitation Rules and Survival Among Patients With Out-of-Hospital Cardiac Arrest

Termination of resuscitation (TOR) rules may help guide prehospital decisions to stop resuscitation, with potential effects on patient outcomes and health resource use. Rules with high sensitivity risk increasing inappropriate transport of nonsurvivors, while rules without excellent specificity risk missed survivors. Further examination of the performance of TOR rules in estimating survival of out-of-hospital cardiac arrest (OHCA) is needed. To determine whether TOR rules can accurately identify patients who will not survive an OHCA. For this systematic review and meta-analysis, the MEDLINE, Embase, CINAHL, Cochrane Library, and Web of Science databases were searched from database inception up to January 11, 2024. There were no restrictions on language, publication date, or time frame of the study. Two reviewers independently screened records, first by title and abstract and then by full text. Randomized clinical trials, case-control studies, cohort studies, cross-sectional studies, retrospective analyses, and modeling studies were included. Systematic reviews and meta-analyses were reviewed to identify primary studies. Studies predicting outcomes other than death, in-hospital studies, animal studies, and non-peer-reviewed studies were excluded. Data were extracted by one reviewer and checked by a second. Two reviewers assessed risk of bias using the Revised Quality Assessment Tool for Diagnostic Accuracy Studies. Cochrane Screening and Diagnostic Tests Methods Group recommendations were followed when conducting a bivariate random-effects meta-analysis. This review followed the Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) statement and is registered with the International Prospective Register of Systematic Reviews (CRD42019131010). Sensitivity and specificity tables with 95% CIs and bivariate summary receiver operating characteristic (SROC) curves were produced. Estimates of effects at different prevalence levels were calculated. These estimates were used to evaluate the practical implications of TOR rule use at different prevalence levels. This review included 43 nonrandomized studies published between 1993 and 2023, addressing 29 TOR rules and involving 1 125 587 cases. Fifteen studies reported the derivation of 20 TOR rules. Thirty-three studies reported external data validations of 17 TOR rules. Seven TOR rules had data to facilitate meta-analysis. One clinical study was identified. The universal termination of resuscitation rule had the best performance, with pooled sensitivity of 0.62 (95% CI, 0.54-0.71), pooled specificity of 0.88 (95% CI, 0.82-0.94), and a diagnostic odds ratio of 20.45 (95% CI, 13.15-31.83). In this review, there was insufficient robust evidence to support widespread implementation of TOR rules in clinical practice. These findings suggest that adoption of TOR rules may lead to missed survivors and increased resource utilization.

Assumption on the optimization direction of positive electrode materials and new methods for recycling electrode materials in lithium-ion batteries

Abstract With the increasing scarcity of non-recyclable resources such as international fossil energy and coal industries, representatives from various countries at the Paris Summit advocated the strategy of “carbon neutrality, carbon peaking” and promoted the use of recyclable resources, namely electricity. There are many ways to generate electricity, such as solar power, hydroelectric power, thermal power, tidal power and wind power. However, the method of mobile storage of electricity is relatively single - using batteries. The most widely used mobile battery currently is lithium-ion battery. This research will focus on the different choices of cathode materials for lithium-ion batteries, analysing and comparing their performance, functional stability, lifespan, capacity, price, and working conditions under extreme temperatures. At the same time, in-depth analysis will be conducted on existing electrode material recycling methods. Finally, the development direction of electrode materials with economic benefits and promising development prospects, as well as recycling methods that are more in line with economic benefits and increase resource utilization, are proposed.