Intensive Discharge Research Articles

Electrochemical Surface Treatment for Tailored Porous Structures

Plasma electrolytic oxidation (PEO) was used to establish a porous metal oxide layer on various titanium and zirconium workpieces in the form of wires, porous tubes, and 3D-printed structures. The ultimate goal of the work was to create a layer with the desired characteristics over a catalyst support or metal membrane structures to improve the performance of the targeted high-temperature catalytic conversion or separation applications. In doing so, it was ensured that the PEO-treated layer could provide the desired morphology, thickness, and porosity needed for the final processing step, which is usually a conventional coating method. This addresses the limitations of ceramic structures, including their mechanical resistance, thermal resistance, and conductivity, and their potential for being functionalized and utilized for high-temperature applications. The entire experimental run was carried out using a 2 kilowatt (maximum output) AC-power source with a maximum current limit of 6.5 Ampere while applying a constant potential (potentiostatic) and monitoring the current fluctuation. Depending on the surface areas of the PEO-treated samples, the applied potential ranged from 200 V to 260 V. The surface features of the fresh and PEO-treated composites, including their morphology and phases, were studied using conventional characterization techniques such as SEM, EDX, and XRD. The time required to observe the spark discharge was shortened by tuning the PEO parameters, such as gradually increasing the applied potential. This, in turn, allowed for longer surface treatment and, eventually, more control over the surface texture. The EDX analysis of the elemental composition of the PEO-treated surface indicated that the contribution of the electrolyte-deposited components increases when increasing the voltage and is accompanied by an increase in the extent of oxidation. The titanium samples displayed relatively intense discharges, especially in comparison to the Zirconium wires. The PEO-treated samples were coated via standard wet-coating techniques.

Predictive Models for Kidney Recovery and Death in Patients Continuing Dialysis as Outpatients after Starting in Hospital.

For patients who initiate dialysis during a hospital admission and continue to require dialysis after discharge, outpatient dialysis management could be improved by better understanding the future likelihood of recovery to dialysis independence and the competing risk of death. We derived and validated linked models to predict the subsequent recovery to dialysis independence and death within 1 year of hospital discharge using a population-based cohort of 7657 patients in Ontario, Canada. Predictive variables included age, comorbidities, length of hospital admission, intensive care status, discharge disposition, and prehospital admission eGFR and random urine albumin-to-creatinine ratio. Models were externally validated in 1503 contemporaneous patients from Alberta, Canada. Both models were created using proportional hazards survival analysis, with the "Recovery Model" using Fine-Gray methods. Probabilities generated from both models were used to develop 16 distinct "Recovery and Death in Outpatients" (ReDO) risk groups. ReDO risk groups in the derivation group had significantly distinct 1-year probabilities for recovery to dialysis independence (first quartile: 10% [95% confidence interval (CI), 9% to 11%]; fourth quartile: 73% [70% to 77%]) and for death (first quartile: 12% [11% to 13%]; fourth quartile: 46% [43% to 50%]). In the validation group, model discrimination was modest (c-statistics [95% CI] for recovery and for death quartiles were 0.70 [0.67 to 0.73] and 0.66 [0.62 to 0.69], respectively), but calibration was excellent (integrated calibration index [95% CI] was 7% [5% to 9%] and 4% [2% to 6%] for recovery and death, respectively). The ReDO models generated accurate expected probabilities of recovery to dialysis independence and death in patients who continued outpatient dialysis after initiating dialysis in hospital. An online tool on the basis of the models is available at https://qxmd.com/calculate/calculator_874 .

Risk Factors for Postpartum Depression and Severe Distress among Mothers of Very Preterm Infants at NICU Discharge.

To identify psychological, medical, and socioenvironmental risk factors for maternal postpartum depression (PPD) and severe psychological distress (SPD) at intensive care nursery discharge among mothers of very preterm infants. We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study (NOVI) conducted in nine university-affiliated intensive care nurseries. Enrollment interviews collected socioenvironmental data, depression, and anxiety diagnoses prior to and during the study pregnancy. Standardized medical record reviews ascertained prenatal substance use, maternal and neonatal medical complications. The Edinburgh Postnatal Depression Scale and Brief Symptom Inventory were administered at nursery discharge to screen for PPD and SPD symptoms, respectively. Unadjusted analyses indicated mothers with positive screens for depression (n = 76, 13.5%) or severe distress (n = 102, 18.1%) had more prevalent prepregnancy/prenatal depression/anxiety, and their infants were born at younger gestational ages, with more prevalent bronchopulmonary dysplasia, and discharge after 40 weeks postmenstrual age. In multivariable analyses, prior depression or anxiety was associated with positive screens for PPD (risk ratio [RR]: 1.6, 95% confidence interval [CI]: 1.1-2.2) and severe distress (RR: 1.6, 95% CI: 1.1-2.2). Mothers of male infants had more prevalent depression risk (RR: 1.7, 95% CI: 1.1-2.4), and prenatal marijuana use was associated with severe distress risk (RR: 1.9, 95% CI: 1.1-2.9). Socioenvironmental and obstetric adversities were not significant after accounting for prior depression/anxiety, marijuana use, and infant medical complications. Among mothers of very preterm newborns, these multicenter findings extend others' previous work by identifying additional indicators of risk for PPD and SPD associated with a history of depression, anxiety, prenatal marijuana use, and severe neonatal illness. Findings could inform designs for continuous screening and targeted interventions for PPD and distress risk indicators from the preconception period onward. · Preconceptional and prenatal screening for postpartum depression and severe distress may inform care.. · Prior depression, anxiety, and neonatal complications predicted severe distress and depression symptoms at NICU discharge.. · Readily identifiable risk factors warrant continuous NICU screening and targeted interventions to improve outcomes..

Aerosol Impacts on Storm Electrification and Lightning Discharges Under Different Thermodynamic Environments

AbstractThe impacts of aerosol and thermodynamics on electrification and lightning activities have been investigated in detail using the Weather Research and Forecasting Model coupled with a double‐moment microphysics parameterization and an explicit electrification lightning scheme. To obtain a varied combination of convective available potential energy (CAPE) values and aerosol concentrations, a sounding was modified consistently and initiated with five sets of aerosol concentrations that served as cloud condensation nuclei. The simulated electric processes respond to the varying dynamical and microphysical characteristics associated with the different CAPE and aerosol conditions. Under high CAPE circumstances, the augmentation of ice‐phase particle leads to the enhancement of non‐inductive charging primarily through the dynamic processes. Increased aerosol content further invigorates the electrification through microphysical processes. Elevated aerosol loading under low CAPE conditions increases cloud droplet and ice crystal numbers. Larger graupel particle size further leads to the enhanced electric intensity and lightning discharges.

Effect of ultrasonic vibration on the machining performance and mechanism of hybrid ultrasonic vibration/plasma oxidation assisted grinding

The effect of ultrasonic vibration on the machining performance in the hybrid ultrasonic vibration/plasma oxidation assisted grinding (UPOAG) of a titanium alloy (Ti-6Al-4V) is experimentally investigated. This novel machining technology, i.e., UPOAG, provides benefits to the grinding of Ti-6Al-4V by reducing the grinding forces and chip adhesion on the grinding wheel, and improving the surface quality and material removal ratio. The effects of such improvements can be enhanced by increasing the ultrasonic vibration amplitude. It is found that the intensity of plasma discharge increased with an increase in the vibration amplitude, which can reduce the microhardness of the plasma oxidized layer on the Ti-6Al-4V specimens. X-ray photoelectron spectroscopy revealed that the plasma oxidized layer is mainly composed of TiO2 and Al2O3. Based on these, the mechanisms behind which the applied ultrasonic vibration improves the machining performance were discussed. The research findings may provide an in-depth understanding on the mechanisms of the UPOAG machining processes, as well as theoretical guidance for the application of UPOAG in the high-efficiency and high-precision machining of titanium alloy parts.

Effects of soft sparking on micro/nano structure and bioactive components of microarc oxidation coatings on selective laser melted Ti6Al4V alloy

We used the soft sparking mode to fabricate microarc oxidation coatings containing micro/nano-scale pores and bioactive Ca/P components on Ti6Al4V alloy samples formed by selective laser melting. The effect of soft sparking on the microstructure and corrosion resistance of the coatings and the codeposition mechanism of the electrolyte anions in the soft sparking layer were investigated using different negative/positive charge ratios. The results showed that the negative charge significantly decreased the intensity of microarc discharge, resuling in the soft sparking phenomenon, which promotes the formation of a thin amorphous TiO2 layer at the barrier layer/substrate interface. In turn, this interface facilitated the electron tunneling and aggregation of the electrolyte anions, which leads to soft sparking at voltages significantly lower than the breakdown voltage of the anodic oxide film on the selective laser melted Ti alloys. Soft sparking promoted the codeposition of the electrolyte anions, including PO43− and Ca2+ ions, in the form of bulk amorphous phases in the coating formed by soft sparking. The soft sparking layer contained amorphous phases, which were corroded more readily than that the outer ceramic layer. However, the submicro/nano-scale pores in the soft sparking layer improved its corrosion resistance. With an increase in negative/positive charge ratio, the effect of soft sparking on the surface morphology of the MAO coating weakened, and the amounts of Ca and P codeposited in the soft sparking layer increased. Finally, the corrosion resistance of the coating was found to first increase and then decrease, reaching the maximum at the 1.1 ratio.

Evaluating the effectiveness of land use management as a natural flood management intervention in reducing the impact of flooding for an upland catchment

AbstractNatural flood management (NFM) is a method for reducing flooding by using a catchment‐based approach to managing flood risk. Understanding and quantifying the impact of implementing NFM at the catchment scale remains ambiguous with a clear need for robust empirical evidence. A combination of fieldwork, laboratory analysis and modelling was applied to quantify the impacts of land use management changes on catchment flood hazard. Soil hydraulic conductivity was measured under varying land management regimes and used to parameterize a physically based spatially distributed hydrological model (SD‐TOPMODEL). A suite of stakeholder informed land management scenarios was modelled, permitting the quantification of the impact of NFM interventions on the timing and the intensity of the peak discharge at the catchment outlet. The findings support the implementation of NFM interventions as a means of reducing flood hazard within a rural upland catchment. Improved soil infiltration provided the greatest reduction in the intensity and delayed timing of the flood peak for a 10‐year occurrence storm event (7% reduction in peak runoff and 8% increase in lag time) with similar reductions observed for a 100‐year storm event. Catchment wide woodland planting reduced peak flow by 11% during the 100‐year event but was not effective during the 10‐year event. Riparian buffer strips provided consistent reductions in peak flow and in the timing of the peak across both storm events with no significant differences relating to vegetation age. Critically, we observed that the effect of implementing multiple NFM interventions was not additive and that efficiencies can be made in using this modelling approach to prioritize the most effective outcomes.

Patient Safety: Cognitive Assessment at Intensive Care Unit Discharge

Topic Assessing functional cognition is a critical need for intensive care unit survivors transitioning to another level of care. Clinical Relevance Up to 62% of patients discharged from an intensive care unit have significant cognitive impairment that is not associated with severity of illness, number of comorbidities, or length of hospital stay. For more than 20 years, researchers have published an array of potentially effective interventions, including case management, patient and informal caregiver education, and home health care services. Purpose To describe the impact of and potential interventions for cognitive decline at intensive care unit discharge and discharge readiness on 30-day readmission rates. Content Covered Assessing the patient’s functional cognition assessment and advocating for appropriate resources are needed to improve patient and clinical outcomes.

Post Hospital Discharge Functional Recovery of Critical Illness Survivors. Systematic Review.

Millions of people face critical illnesses and need to be hospitalized in an Intensive Care Unit (ICU) annually worldwide. Despite the fact that survival rates of these patients have increased, they develop various cognitive, psychological and functional impairments. This study aims to investigate the significance of the recovery interventions following intensive care unit discharge, the effectiveness of the rehabilitative protocols and their possible deficits. MEDLINE (PubMed) and Physiotherapy Evidence Database (PEDro) were searched for studies analyzing the recovery potentials post-ICU among adults, who spent at least 48 hours at the ICU. Methodological quality of the studies was assessed via PEDro Scale. Nine randomized controlled trials were included. These took place mainly at specialized rehabilitation gyms as well as patients home environments. Studies analyses showed that treatment group showed improvement in functional ability in relation to control group. Nevertheless, differences between two groups were not statistically significant (P<0.05). The majority of studies assessed cardiorespiratory endurance and muscular strength. The included rehabilitation programs were determined to be effective. Although they didn't prove any statistically significant difference between groups, quality of life enhancements and stress reduction were reported. Hence, new randomized controlled trials are required in order to provide more accurate data on the potential benefits of rehabilitation strategies among post-ICU patients.

Postoperative Delirium After Intracranial Surgery: A Retrospective Cohort Study.

The clinical relevance of postoperative delirium (POD) in neurosurgery remains unclear and should be investigated because these patients are vulnerable. Hence, we investigated the impact of POD, by means of incidence and health outcomes, and identified independent risk factors. Adult patients undergoing an intracranial surgical procedure in the Erasmus Medical Center Rotterdam between June 2017 and September 2020 were retrospectively included. POD incidence, defined by a Delirium Observation Screening Scale (DOSS) ≥3 or antipsychotic treatment for delirium within 5 days after surgery, was calculated. Logistic regression analysis on the full data set was conducted for the multivariable risk factor and health outcome analyses. After including 2901 intracranial surgical procedures, POD was present in 19.4% with a mean onset in days of 2.62 (standard deviation, 1.22) and associated with more intensive care unit admissions and more discharge toward residential care. Onset of POD was not associated with increased length of hospitalization or mortality. We identified several independent nonmodifiable risk factors such as age, preexisting memory problems, emergency operations, craniotomy compared with burr-hole surgery, and severe blood loss. Moreover, we identified modifiable risk factors such as low preoperative potassium and opioid and dexamethasone administration. Our POD incidence rates and correlation with more intensive care unit admission and discharge toward residential care suggest a significant impact of POD on neurosurgical patients. We identified several modifiable and nonmodifiable risk factors, which shed light on the pathophysiologic mechanisms of POD in this cohort and could be targeted for future intervention studies.

Nonlinear Resonance Characteristics Analysis of DBD Load Based on State Plane Trajectory

Dielectric barrier discharge (DBD) loads and driving converters are widely utilized in low-temperature plasma generation, but their resonant tanks have typical nonlinear characteristics with control issues. The state plane trajectory analysis is used in this article to investigate the resonant behavior of a DBD load. The converter's working principle and state plane modeling are first discussed. The impact of a high-ratio step-up transformer with parasitic capacitance is then explored, and the updated trajectory model is examined. The DBD platform is created to verify the suggested model, and the associated experimental data are provided. The results of the experiment demonstrate that the discharge trajectory is a zone with distinct borders. The trajectory equations can be utilized to calculate the load equivalent capacitance, and the difference in the boundary equivalent capacitance represents the discharge intensity. The pattern of resonant frequency variation with discharge power is given. The impact mechanism of discharge phenomena and resonance characteristics is discussed.

Spectrum of motor responses elicited by electrical stimulation of primary motor cortex: A polygraphic study in patients with epilepsy

ObjectiveTo study the neurophysiology of motor responses elicited by electrical stimulation of the primary motor cortex. MethodsWe studied motor responses in four patients undergoing invasive epilepsy monitoring and functional cortical mapping via electrical cortical stimulation using surface EMG electrodes. In addition, polygraphic analysis of intracranial EEG and EMG during bilateral tonic-clonic seizures, induced by cortical stimulation, was performed in two patients. Results(a) Electrical cortical stimulation: The motor responses were classified as clonic, jittery, and tonic. The clonic responses were characterized by synchronous EMG bursts of agonist and antagonistic muscles, alternating with silent periods. At stimulation frequencies of <20 Hz, EMG bursts were of ≤50 ms duration (Type I clonic). At stimulation frequencies of 20–50 Hz, EMG bursts were of >50 ms duration and had a complex morphology (Type II clonic). Increasing the current intensity at a constant frequency converted clonic responses into jittery and tonic contractions.(b) Bilateral tonic-clonic seizures: The intracranial EEG showed continuous fast spiking activity during the tonic phase along with interference pattern on surface EMG. The clonic phase was characterized by a polyspike-and-slow wave pattern. The polyspikes were time-locked with the synchronous EMG bursts of agonists and antagonists and the slow waves were time-locked with silent periods. InterpretationThese results suggest that epileptic activity involving the primary motor cortex can produce a continuum of motor responses ranging from type I clonic, type II clonic, and tonic responses to bilateral tonic-clonic seizures. This continuum is related to the frequency and intensity of the epileptiform discharges with tonic seizures representing the highest end of the spectrum.

Decoupling research on dynamic effect of graphite addition for microwave-induced discharge with spherical biomass-based char

Microwave discharge is a special phenomenon under microwave irradiation, with higher energy efficiency over microwave heating. Microwave-induced discharge with carbon-based dielectrics is the common forms, but there are severe challenges for improving the discharge intensity. Relevant research confirmed the feasibility of microwave-induced discharge with spherical biomass-based char with graphite addition. However, the deep-stated dynamic effect of graphite addition on it is still unclear. Therefore, the work firstly studied the influence of graphite addition on the discharge intensity, and then conducted the decoupling research of the effects of dielectric properties on microwave discharge through simulation of electric field. The improvement of discharge intensity with graphite addition is related to more significant polarization of electric field. The influence of conductivity and permeability on the electric field outside and inside the dielectric is similar. Still, enhancing the conductivity was the first choice for improving the discharge intensity, particularly before an inflection point of 100 S/m. The relative permittivity and conductivity caused a coupling effect on electric field of the dielectric bed. Essentially, the increase of conductivity and relative permittivity resulted from graphite addition promotes the discharge intensity. The study offers evidence for optimizing the performance of microwave-induced discharge with carbon-based dielectrics.

Cathodic discharge plasma in electrochemical jet machining: Phenomena, mechanism and characteristics

An ultrahigh voltage is frequently required in electrochemical jet machining (EJM) to produce extreme current densities (>900 A/cm2 for this study) to achieve maximum dissolution rates. However, such a high electric field easily induces a cathodic discharge at the nozzle, and the generation mechanism and characteristics remain unexplored. For the first time, this study shows a direct visualisation of the hydrogen evolution and cathodic discharge in EJM using high-speed photography. An in-depth analysis of the discharge behaviour was carried out based on electrical monitoring, temperature measurement, and characterisation of the resulting changes in the electrode surface. It was revealed that the current density threshold determines the discharge ignition. Discharge occurs preferentially at the inner edge of the nozzle end face, which can cause nozzle wear and reduce localisation of anode workpiece dissolution. The discharge intensity can be controlled by varying the applied voltage and pulse frequency. The electrolyte flow velocity and gap distance influence the discharge behaviour. With appropriate process control, cathodic plasma can enhance the EJM performance while minimising its negative impact. Furthermore, cathodic discharge can be significantly suppressed by designing the geometry of the nozzle tip to avoid local electric field concentration.

Control principle of anodic discharge for enhanced performance in jet-electrochemical discharge machining of semiconductor 4H-SiC

Implementing anode discharge into electrochemical jet machining (EJM) makes it possible to process semiconductor material 4H-SiC. However, the characteristics and control principle of anodic discharge behavior in EJM remains unclear, while it significantly influences material removal and EJM precision. The present study reveals discharge behavior and its impact on material removal by controlling the imposed electrical and chemical conditions. The physicochemical properties and spatiotemporal distribution of discharges are discussed by analyzing the plasma region's temperature, luminescence, and material removal fashion. The findings reveal that discharges are preferentially ignited in certain areas where the current density is concentrated. The discharge intensity and location are controllable by the pulse cycle and electrical field distribution inside the jet (i.e., changing the jet angle). Reducing pulse duration leads to more localized and mild discharges, improving machining precision. A gas ionization-dominated anodic discharge model is proposed. Both discharge and electrolyte types exert significant influence on material removal. Using a DC supply provides a maximum machining rate of 1.44 mm/min. Meanwhile, an optimal surface finish Ra 170 nm and high shape precision with no overcut is achievable by applying high-frequency AC of 1000 Hz.

A temporal examination of inspiratory muscle strength and endurance in hospitalized COVID-19 patients

BackgroundThe two most common symptoms associated with COVID-19 are dyspnea and fatigue. One possible cause of such symptoms may be inspiratory muscle weakness. ObjectivesThe purpose of this study was to examine inspiratory muscle performance (IMP) from intensive care unit discharge (ICUD) to hospital discharge (HD) in patients with COVID-19 hypothesizing that IMP would be markedly depressed at both ICUD and HD. MethodsIMP was examined at ICUD and HD via the PrO2 device (PrO2 Health, Smithfield, RI) which provided the maximal inspiratory pressure (MIP), sustained MIP (SMIP), inspiratory duration (ID), and fatigue index test (FIT). Patient symptoms were assessed at ICUD, HD, and 1-month post-HD. Results30 patients (19 men, 11 women) with COVID-19 were included. The mean±SD age, BMI, and length of ICU and hospital stay was 71±11 yrs, 27.9 ± 6.3 kg/m, 9 ± 6 days, and 26±16 days, respectively. The mean±SD MIP, SMIP, ID, and FIT of the entire cohort at ICUD vs HD were 36±21 vs 40±20 cm H2O, 231±157 vs 297±182 PTU, 8.8 ± 4.2 vs 9.5 ± 4.6 s, and 9.0 ± 9.4 vs 13.1 ± 12.3, respectively, with only SMIP and FIT significantly greater at HD (p=.006 and 0.03, respectively). SMIP at HD was significantly related to resting dyspnea at HD (r=-0.40; p=.02). The SMIP and FIT of men were found to increase significantly from ICUD to HD, but no measure of IMP in the women increased significantly from ICUD to HD. At least one COVID-19-related symptom was present 1 month after HD with the most persistent symptoms being fatigue, cough, and dyspnea in 47%, 40%, and 37% of the patients, respectively. ConclusionsA significant reduction in IMP exists in patients with COVID-19 at both ICUD and HD and no measure of IMP in women was observed to increase significantly from ICUD to HD. Impaired inspiratory muscle endurance rather than strength was associated with greater dyspnea at HD.

Plasma‐enhanced evaporation and its impact on plasma properties and gaseous chemistry in a pin‐to‐water pulsed discharge

AbstractThe plasma in contact with liquids has led to various novel applications such as plasma biomedicine, material synthesis, and so on. However, the phenomenon of evaporation under plasma treatment and its impact on plasma–liquid interactions has a limited understanding. In this study, the spatially and temporally resolved behavior of water vapor production and its induced influences on plasma properties and gaseous chemistry were studied in detail in an atmospheric pressure pin‐to‐water pulsed He discharge. Diagnostic methods such as laser‐induced fluorescence (LIF) and high‐resolution optical emission spectroscopy (OES) were applied to determine the water vapor and OH radical densities, as well as key plasma parameters such as the gas temperature and electron density. It shows that the physicochemical properties of plasma vary among different discharge regions due to evaporation behavior stimulated during the pulsed discharge‐on phase. In addition, using simulation based on the experimental data, the mechanisms of how water vapor affects the observed spatiotemporal behaviors of OH radicals in different discharge regions are understood. Compared to the pin‐anode and liquid‐cathode sheath regions, proper electron parameters such as density and temperature, as well as water vapor density in the plasma‐positive column, significantly enhance the production of reactive OH radical through the dominant path of electron‐stimulated H2O dissociation. However, higher levels of electron parameters in the intense discharge region near the positive‐pin boundary enhance OH dissociation and finally result in the hollow distribution of OH density. From the global kinetic plasma simulation, the production of reactive hydroxide species playing key roles in plasma medicine treatments, such as O, H, HO2, H2O2, and hydrated ions including H+(H2O)4 and H+(H2O)5, are promoted noticeably as a result of the enhanced water evaporation process.

Numerical simulation study of ionization characteristics of argon dielectric barrier discharge

In order to better analyze the characteristics of particle distribution and its influencing factors in the ionized space during the process of coaxial dielectric barrier discharge, a self-designed two-dimensional axisymmetric structure exciter was used to carry out optical diagnosis, with the electron temperature calculated through Gaussian fitting. A plasma model was applied to conduct research on the discharge process through numerical simulation, with the changes in electron density and electron temperature were analyzed by using different discharge parameters. The research results show that with an increase in discharge voltage, pressure inside the reactor and relative permittivity, the discharge process is promoted. In addition, a rise in current density leads to an increase in the number of charged particles on the surface of the medium during the discharge process, while a rise in discharge intensity causes an increase in the electron density. Electron temperature decreases due to the increased loss of collision energy between particles. These results were confirmed by comparing experimental data with simulation results.

Assessment of pain and quality of life in patients undergoing cardiac surgery: a cohort study.

This study aimed to evaluate postoperative pain and quality of life in patients undergoing median sternotomy. A cohort study was carried out on a sample of 30 patients who underwent elective cardiac surgery by longitudinal median sternotomy. Patients were interviewed at Intensive Care Unit discharge and hospital discharge, when the Visual Numeric Scale and the Brief Pain Inventory were applied, and 2 weeks after hospital discharge, when the World Health Organization Quality of Life-Bref questionnaire was administered. The normality of the results was analyzed by the Shapiro-Wilk test, and Wilcoxon Rank Sum and McNemar tests were utilized for the analysis of numerical and categorical variables. For correlation between numerical variables, Spearman's linear correlation test was applied. To compare numerical variables, Mann-Whitney U and Kruskal-Wallis tests were applied. Differences between groups were considered significant when the p-value was <0.05. Between Intensive Care Unit and hospital discharge, there was a reduction in median pain intensity assessed by the Visual Numeric Scale from 5.0 to 2.0 (p<0.001), as well as in eight Brief Pain Inventory parameters: worst pain intensity in the last 24 h (p=0.001), analgesic relief (p=0.035), and pain felt right now (p=0.009); and in interference in daily activities (p<0.001), mood (p=0.017), ability to walk (p<0.001), relationship with other people (p=0.005), and sleep (p=0.006). Higher pain intensity at Intensive Care Unit discharge was associated with worse performance in the psychological domain of quality of life at out-of-hospital follow-up. Proper management of post-sternotomy pain in the Intensive Care Unit may imply better quality of life at out-of-hospital follow-up.

Improving Pediatric Intensive Care Unit Discharge Timeliness of Infants with Bronchiolitis Using Clinical Decision Support.

Identifying children ready for transfer out of the pediatric intensive care unit (PICU) is an area that may benefit from clinical decision support (CDS). We previously implemented a quality improvement (QI) initiative to accelerate the transfer evaluation of non-medically complex PICU patients with viral bronchiolitis receiving floor-appropriate respiratory support. Design a CDS tool adaptation of this QI initiative to further accelerate transfer evaluation of appropriate patients. The original initiative focused on identifying for transfer evaluation otherwise healthy children admitted to the PICU with bronchiolitis who had been receiving floor-appropriate levels of respiratory support for at least 6 hours. However, this initiative required that clinicians manually track the respiratory support of qualifying patients. We designed an electronic health record (EHR)-based CDS tool to automate identification of transfer-ready candidates. The tool parses EHR data to identify children meeting prior QI initiative criteria and alerts clinicians to assess transfer readiness once a child has been receiving floor-appropriate respiratory support for 6 hours. We compared time from reaching floor-appropriate support to placement of the transfer order ("time-to-transfer"), PICU length of stay (LOS), and hospital LOS between patients admitted prior to our QI initiative (December 1, 2018-October 19, 2019, "pre-QI phase"), during the initiative but before CDS tool implementation (October 20, 2019-February 7, 2022, "QI phase"), and after CDS implementation (February 8-November 11, 2022, "CDS phase"). CDS-phase patients (n = 131) had a shorter median time-to-transfer of 5.23 (interquartile range [IQR], 3.38-10.0) hours compared with QI-phase patients (n = 304) at 5.93 (IQR, 4.23-12.2) hours (p = 0.04). PICU and hospital LOS values decreased from the pre-QI (n = 150) to QI phase. Though LOS reductions were sustained during the CDS phase, further reductions from QI to CDS phase were not statistically significant. An EHR-based CDS adaptation of a prior QI initiative facilitated timely identification of PICU patients with bronchiolitis ready for transfer evaluation. Such tools might allow PICU clinicians to focus on other high-acuity tasks while accelerating transfer evaluation of appropriate patients.