Main Discharge Research Articles

Focusing hospitalist roles on either admitting or rounding facilitates unit-based assignment and is associated with improved discharge efficiency

ABSTRACT Background Unit-based teams may improve care delivery for hospitalized patients but can be challenging to implement broadly across all acute care units in a hospital. Objective To determine the effect of a Lean-guided transition to hospital-wide unit-based assignment on care delivery outcomes. Design, setting, and participants The study was a retrospective time-series with primary outcomes of discharge efficiency, 30-day readmissions, and length of stay, performed at a 336-bed tertiary academic referral hospital in the Pacific Northwest with approximately 17,000 admissions annually. Intervention Implementation of a Lean-guided quality improvement intervention included division of hospitalist duties into ‘admitters’ and ‘rounders,’ with simulated patient flow exercises to determine the optimal staffing model. Main outcomes and measures Discharge efficiency (number of patients discharged by hospitalists divided by the number of hospitalist patient encounter days per month) and 30-day readmissions were compared using the t-test or chi-square, and length of stay was analyzed in a multivariate time-series regression model. Results The intervention was associated with a significant improvement in discharge efficiency, by 0.014 (from 0.168 to 0.181) discharges/encounter (95% CI = 0.024, 0.004), p = 0.009. Mean length of stay decreased by 0.98 days (95% CI 0.50, 1.47) after adjustment for patient age, patient type (medical versus surgical), critical care admissions, and discharge disposition, without a corresponding change in 30-day readmission rate (12.2% (1948/15,902) pre-intervention to 11.7% (397/3379) post-intervention (p = 0.42)). Conclusions Dividing hospitalist roles into admitters and rounders enabled implementation of unit-based teams across the hospital, with corresponding improvements in discharge efficiency and length of stay.

AM-PAC “6-clicks” Predicts Discharge Destination for Patients Hospitalized with COVID-19

Research ObjectivesTo investigate the ability of the initial Activity Measure for Post-Acute Care (AM-PAC) “6-clicks” mobility and activity scores to predict discharge disposition for patients hospitalized with COVID-19.DesignRetrospective cohort using data from a COVID-19 registry.SettingFive inpatient hospitals in a single academic Health System within the United States.ParticipantsAdults (> 17 years) who were urgently or emergently admitted to one of the five acute hospitals between March 1st and July 31st, 2020, tested positive for COVID-19 during their hospitalization, and had at least 1 AM-PAC “6-clicks” score in their medical record.InterventionsN/A.Main Outcome MeasuresDischarge destination, dichotomized as home vs. facility.ResultsOf the 2565 records in the registry, 1486 included AM-PAC “6-clicks” mobility scores and 1200 included activity scores. Median age was 64 years (IQR=26), COVID-19 was primary or admitting diagnosis for 47% (n = 700), and 61.6% (n = 915) were discharged home. Initial AM-PAC was assessed 1 (IQR=3) days after admission, and the median for both mobility and activity scores was 18 (IQR=14). Multivariate logistic regression analyses revealed that, after controlling for the influence of covariates, initial mobility and activity scores were both independent predictors of discharge destination. Each point decrease in initial AM-PAC score increased the odds of discharge to a faculty by 1.15 (95 CI% 1.12 - 1.19; p < 0.001) and 1.16 (95 CI% 1.11 - 1.22; p < 0.001) fold for mobility and activity scores, respectively. Receiver operating characteristic (ROC) curve analysis revealed that initial AM-PAC scores were strong predictors of discharge destination, with area under the curve (AUC) of 0.806 (95 CI% 0.781 - 0.831; p < 0.001) and 0.796 (95% CI 0.767 - 0.826; p < 0.001) for mobility and activity scores, respectively. A score of 17.5 predicted discharge with a sensitivity of .687 and specificity of 0.81 for mobility and 0.724 and 0.770 for activity.ConclusionsInitial AM-PAC “6-clicks” activity and mobility scores were both predictive of discharge destination in individuals hospitalized with COVID-19.Author(s) DisclosuresDr. Adler is a paid consultant for MedBridge Education.

Empirical regularities investigation of rock mass discharge by explosion on the free surface of a pit bench

Minimizing the discharge of blasted rock mass into the developed space of the pit is a very relevant area for study, as it allows to increase the processability of work and reduce the cost of mining. The article presents the results of experimental industrial explosions, during which the study of this issue was conducted. The main purpose of the work was to establish the key factors affecting the volume of rock mass discharge to the pit haulage berm. During the analysis of the world experience of research on this topic, the key factors affecting the formation of collapse and discharge – natural and technological – are identified. The method of conducting experiments and collecting data for analyzing the influence of technological parameters of location, charging and initiation of wells on the volume of rock mass discharge is described. It is established that the main discharge to the pit haulage berm is formed by the volume of rock mass limited by the prism of the slope angle. With a sufficient rock mass displacement from the edge of the bench crest towards the center of the block, only the wells of the 1st and 2nd rows participate in the discharge formation. Empirical dependences of the total volume of rock mass discharge on the length of the block along the bench crest, the specific consumption of explosives, the size of a rock piece P50 and the rate of rock breaking are obtained. The obtained results can be used to design the parameters of the drilling and blasting operations (DBO), as well as to predict and evaluate the possible consequences of a mass explosion in similar mining and geological conditions.

A Sealed-Off Pseudospark Switch With Nanosecond Stability of Triggering

This article describes the modified version of the commercially produced pseudospark switch TPI1-10k/50 (pulsed current-10 kA and anode voltage-up to 50 kV) and the results of testing. The main idea of the modification was to use the high-voltage electrode system of this switch but to incorporate the novel trigger unit in the main cathode cavity. This unit uses the auxiliary glow discharge with hollow cathode and hollow anode. The modified switch is intentionally developed for parallel operation of a large number of the switches to a common load. In such conditions, the nanosecond triggering stability of the switches is required. The results of tests demonstrate that the minimum delay time of triggering (the time interval between the instant of arrival of the trigger pulse and the instant of starting the main discharge current) amounts to 80 ns with a jitter of 3 ns. At a decreased hydrogen pressure, the delay time is not increased essentially and amounts to 105 ns with a jitter of 6 ns.

Discharge characteristics and reactive species production of unipolar and bipolar nanosecond pulsed gas–liquid discharge generated in atmospheric N2

In this paper, unipolar pulse (including positive pulse and negative pulse) and bipolar pulse voltage are employed to generate diffuse gas–liquid discharge in atmospheric N2 with a trumpet-shaped quartz tube. The current–voltage waveforms, optical emission spectra of excited state active species, FTIR spectra of exhaust gas components, plasma gas temperature, and aqueous H2O2, and production are compared in three pulse modes, meanwhile, the effects of pulse peak voltage and gas flow rate on the production of reactive species are studied. The results show that two obvious discharges occur in each voltage pulse in unipolar pulse driven discharge, differently, in bipolar pulse driven discharge, only one main discharge appears in a single voltage pulse time. The intensities of active species (OH(A), and O(3p)) in all three pulsed discharge increase with the rise of pulse peak voltage and have the highest value at 200 ml min−1 of gas flow rate. The absorbance intensities of NO2 and N2O increase with the increase of pulse peak voltage and decrease with the increase of gas flow rate. Under the same discharge conditions, the bipolar pulse driven discharge shows lower breakdown voltage, and higher intensities of excited species (N2(C), OH(A), and O(3p)), nitrogen oxides (NO2, NO, and N2O), and higher production of aqueous H2O2, and compared with both unipolar positive and negative discharges.

MIL-53 Metal-Organic Framework as a Flexible Cathode for Lithium-Oxygen Batteries.

Li-air batteries possess higher specific energies than the current Li-ion batteries. Major drawbacks of the air cathode include the sluggish kinetics of the oxygen reduction (OER), high overpotentials and pore clogging during discharge processes. Metal–Organic Frameworks (MOFs) appear as promising materials because of their high surface areas, tailorable pore sizes and catalytic centers. In this work, we propose to use, for the first time, aluminum terephthalate (well known as MIL-53) as a flexible air cathode for Li-O2 batteries. This compound was synthetized through hydrothermal and microwave-assisted routes, leading to different particle sizes with different aspect ratios. The electrochemical properties of both materials seem to be equivalent. Several behaviors are observed depending on the initial value of the first discharge capacity. When the first discharge capacity is higher, no OER occurs, leading to a fast decrease in the capacity during cycling. The nature and the morphology of the discharge products are investigated using ex situ analysis (XRD, SEM and XPS). For both MIL-53 materials, lithium peroxide Li2O2 is found as the main discharge product. A morphological evolution of the Li2O2 particles occurs upon cycling (stacked thin plates, toroids or pseudo-spheres).

Application of an Artificial Neural Network Model for estimating of Water Quality Parameters in the Karun River, Iran

Population growth and increasing agricultural and industrial activities result in reducing water quality, climate change, and changed the rainfall pattern as well as the hydrological cycle. In the present study, artificial neural networks (ANN) applied deduced and expand models to predict the monthly values of dissolved oxygen (DO), and electrical conductivity (EC) in the Karun River at stations positioned at Ahwaz and Gotvand sites in Iran. To analyze the water quality, the monthly data of four main parameters and discharge between 1998 and 2010 were selected. The correlation coefficient, root mean square error, and mean absolute error as statistical criteria were utilized for evaluating the model performance. Finally, the potential of ANN on simulating relevancy between water quality parameters is examined. Results indicated the neural networks can discern the pattern of water quality parameters to offer an appropriate prediction of changes in water quality data of the Karun River.

Assessing the Impact of Lining Polluted Streams on Groundwater Quality: A Case Study of the Eastern Nile Delta Aquifer, Egypt

Groundwater is considered to be an important water supply for domestics, industry, and irrigation in many areas of the world. Renewable groundwater is recharged by rainfall and seepage from canals and open drain networks. Agricultural and industrial drainage, as well as domestic drainage, represent the main discharges into open drains. Therefore, these drains are considered to be a source of recharge as well as a source of pollution. In this study, we aim to evaluate the impact of the Bahr El Baqar drain system on groundwater quality in the Eastern Nile Delta, Egypt. MODFLOW was used to create a numerical model to simulate groundwater flow in an aquifer and MT3DS was used to simulate solute transport from the open contaminated Bahr El Baqar drain to the groundwater. Two approaches were developed in the study area. The first approach was applied to investigate the impact of increasing the abstraction rates on the contaminant transport into the aquifer, the second approach was developed to identify the effect of lining the drain using different materials on contaminant extension in the aquifer to protect groundwater quality in the east Nile Delta Aquifer. The results showed that the TDS values increased by 18.23%, 23.29%, and 19.24% with increased abstraction rates of 15%, 34%, and 70%, resulting from population increases in 2010, 2025, and 2040, respectively; however, the TDS in the aquifer decreased from 0.6%, to 6.36%, 88.35%, and 90.47% by using lining materials.

Is it Unjustified to Perform Segmentectomy in Surgical Treatment of Lung Adenocarcinoma?

The aim of our study differs from similar studies since we compared superiority and similarity of segmentectomy performed for early-stage lung cancer over lobectomy in terms of clinical and oncological results. The data from 294 patients who underwent anatomical resection due to primary lung cancer were retrospectively reviewed. Data from 99 patients who underwent lobectomy and segmentectomy due to early-stage lung adenocarcinoma were analyzed. Patients were divided into two groups: 84 patients undergoing lobectomy and 15 patients undergoing segmentectomy. Both groups were analyzed in terms of epidemiological, surgical and oncological results, by comparing several parameters. The most common postoperative complication was observed in the respiratory system. In total, 25 complication (29.8%) in the lobectomy group and 3 complications (20%) in the segmentectomy group were observed related to the postoperative respiratory system (P = 0.546). There was no statistically significant difference between the two groups in terms of recurrence-metastasis during follow-up, chemotherapy-radiotherapy condition and mortality. Main discharge time and thorax drain termination time were shorter in the segmentectomy group (P = 0.011 and P = 0.033, respectively). There was no statistically significant difference between the two groups in terms of postoperative survival or disease-free time (P = 0.361 and P = 0.461, respectively). If there is no contraindication, segmentectomy can be considered as the surgical treatment for lung adenocarcinomas with tumor size of 2 cm or less and a minimum 1 cm clean surgical margin.

Characteristics of fluid potential and division of hydrocarbon migration and accumulation units in the Shijiazhuang Sag

In this paper, the Hubbert fluid potential model is used to restore the fluid potential of the key reservoir forming period at the end of Paleogene in Shijiazhuang Sag. At the end of Paleogene, the high potential area of Shijiazhuang Sag is mainly located in the Western trough belt of the sag, which is the main flow supply area. The low potential area of the sag is mainly distributed in the Gao cheng tectonic belt in the middle, which is the main discharge area. The overall performance is the distribution law of the trough to the central buried hill belt, and the potential energy gradually decreases. The sag is further divided into three major oil and gas migration and accumulation units, namely, the southern oil and gas migration and accumulation unit (III), the central oil and gas migration and accumulation unit (I), and the northern oil and gas migration and accumulation unit (II). Among them, the central oil and gas migration and accumulation unit (I) is the best oil and gas migration and accumulation unit, which receives multi-source hydrocarbon supply and has favorable reservoir forming conditions.

Effect Mechanism of Surface Roughness of Solid Dielectrics to Surface Discharge Voltage in Liquid Nitrogen Under Lightning Impulse

The surface discharge of solid dielectric in liquid nitrogen has become one of the key problems in the development of high-temperature superconducting power devices. It is necessary to study the mechanism of surface discharge of the solid dielectric in liquid nitrogen. This article chose polytetrafluoroethylene and DW-3 epoxy resin as specimens, tested the surface discharge voltages of two kinds of specimens with different surface roughness under lightening impulse voltages in liquid nitrogen, and discussed the effect mechanism. The experimental results showed that the surface discharge voltage and discharge time of both materials in liquid nitrogen increased as the surface roughness increasing under lightning impulses. The surface roughness affects the surface discharge voltage of the solid dielectric in liquid nitrogen under lightning impulse, mainly in the charge left on the grinding surfaces of solid dielectrics, the heights of projections, and the creepage distance on the dielectric surfaces. The main discharge process is in the gasification path, and the effect of solid dielectric on surface discharge in liquid nitrogen is smaller. These reasons make the surface discharge in the liquid nitrogen less affected by the surface roughness. The results further explore the characteristics of surface discharge in liquid nitrogen and could provide methodological guidance to improve the surface discharge voltages in liquid nitrogen.

Clinical characteristics and sociodemographic features of psychotic major depression

BackgroundPsychotic major depression (PMD) is a subtype of depression with a poor prognosis. Previous studies have failed to find many differences between patients with PMD and those with non-psychotic major depression (NMD) or schizophrenia (SZ). We compared sociodemographic factors (including season of conception) and clinical characteristics between patients with PMD, NMD, and schizophrenia. Our aim was to provide data to help inform clinical diagnoses and future etiology research.MethodsThis study used data of all patients admitted to Shandong Mental Health Center from June 1, 2016 to December 31, 2017. We analyzed cases who had experienced an episode of PMD (International Classification of Diseases, Tenth Revision codes F32.3, F33.3), NMD (F32.0–2/9, F33.0–2/9), and SZ (F20–20.9). Data on sex, main discharge diagnosis, date of birth, ethnicity, family history of psychiatric diseases, marital status, age at first onset, education, allergy history, and presence of trigger events were collected. Odds ratios (OR) were calculated using logistic regression analyses. Missing values were filled using the k-nearest neighbor method.ResultsPMD patients were more likely to have a family history of psychiatric diseases in their first-, second-, and third-degree relatives ([OR] 1.701, 95% confidence interval [CI] 1.019–2.804) and to have obtained a higher level of education (OR 1.451, 95% CI 1.168–1.808) compared with depression patients without psychotic features. Compared to PMD patients, schizophrenia patients had lower education (OR 0.604, 95% CI 0.492–0.741), were more often divorced (OR 3.087, 95% CI 1.168–10.096), had a younger age of onset (OR 0.934, 95% CI 0.914–0.954), less likely to have a history of allergies (OR 0.604, 95% CI 0.492–0.741), and less likely to have experienced a trigger event 1 year before first onset (OR 0.420, 95% CI 0.267–0.661). Season of conception, ethnicity, and sex did not differ significantly between PMD and NMD or schizophrenia and PMD.ConclusionsPMD patients have more similarities with NMD patients than SZ patients in terms of demographic and clinical characteristics. The differences found between PMD and SZ, and PMD and NMD correlated with specificity of the diseases. Furthermore, allergy history should be considered in future epidemiological studies of psychotic disorders.

Analysis of the ESD Reconstruction Methodology Based on Current Probe Measurements and Frequency Response Compensation for Different ESD Generators and Severity Test Levels

System-level electrostatic discharge testing according to IEC 61000-4-2 has been the main standardized electrostatic discharge immunity testing procedure for the last few decades. The correlation between a failed test result and the injected electrostatic discharge current waveform characteristics, as well as the reduced reproducibility of the standard methodology, have always concerned product manufacturers and test engineers. In an effort to accurately reconstruct the electrostatic discharge current during immunity testing, researchers are focusing more and more on the usability of current probes in capturing the injected current in “real time”. In this article, the results of a proposed methodology, based on current probe measurements and a frequency response compensation method, published in recent bibliography, for different test levels and electrostatic discharge generators are presented, aiming to highlight the advantages and disadvantages of the method, investigate its universal applicability, and introduce points of future work toward the current reconstruction during system-level electrostatic discharge testing effort.

Sulphur-fuelled Surface Arc Thruster for Propelling Nanosatellites

Pulsed electrothermal thrusters use kiloampere discharge currents for polytetrafluoroethylene (PTFE) ablation and sublimation. However, higher arc currents cause higher electromagnetic interference (EMI). A 10 J surface arc thruster (SAT), which adopts current regulating diodes (CRD), was developed that enables significant reduction in EMI. A CRD limits the discharge currents to 5 A in spite of the applied voltage. A low-melting-point sulphur propellant has been used that enables low-discharge currents to efficiently ablate it and accelerate it electrothermally. In this paper, the near-term potential for elemental sulphur propellant in SAT is investigated. The advantages of sulphur with respect to PTFE are presented. First, we measured the pulse width of the main discharge. Then sulphur propellant proved superior to PTFE propellant in discharge duration. The mean pulse widths of PTFE and sulphur are 3.38 and 22.1 ms, respectively. Second, we measured the pressure rise in the vacuum chamber after each discharge. The mean pressure rises of PTFE, sulphur powder and sulphur solid are 0.43, 0.94 and 1.9 mPa, respectively. Sulphur powder experienced the least intensity of discoloration in comparison with other propellants. The discharge initiator misfired frequently during PTFE ablation, but it ignited successively during sulphur ablation. Experimental results indicate sulphur is a suitable propellant for surface discharge propulsion, and for low arc currents is superior to PTFE.

Admission rates and care pathways in patients with atrial fibrillation during the COVID-19 pandemic-insights from the German-wide Helios hospital network.

IntroductionSeveral reports indicate lower rates of emergency admissions in the cardiovascular sector and reduced admissions of patients with chronic diseases during the COVID-19 pandemic. The aim of this study was therefore to evaluate numbers of admissions in incident and prevalent atrial fibrillation and flutter (AF) and to analyze care pathways in comparison to 2019.MethodsA retrospective analysis of claims data of 74 German Helios hospitals was performed to identify consecutive patients hospitalized with a main discharge diagnosis of AF. A study period including the start of the German national protection phase (13th March 2020 to 16th July 2020) was compared to a previous year control cohort (15th March 2019 to 18th July 2019), with further sub-division into early and late phase. Incidence rate ratios (IRR) were calculated. Numbers of admission per day (A/day) for incident and prevalent AF and care pathways including readmissions, numbers of transesophageal echocardiogram (TEE), electrical cardioversion (CV) and catheter ablation (CA) were analyzed.ResultsDuring the COVID-19 pandemic, there was a significant decrease of total AF admissions both in the early (44.4 vs. 77.5 A/day, IRR 0.57 [95% CI 0.54–0.61], p < 0.01) and late phase (59.1 vs. 63.5 A/day, IRR 0.93 [95% CI 0.90–0.96], p < 0.01), length of stay was significantly shorter (3.3 ± 3.1 nigths vs. 3.5 ± 3.6 nigths, p < 0.01), admissions were more frequently in high volume centers (77.0% vs. 75.4%, p = 0.02) and frequency of readmissions was reduced (21.7% vs. 23.6%, p < 0.01) compared to the previous year.Incident AF admission rates were significantly lower both in the early (21.9 admission per day vs. 41.1 A/day, IRR 0.53 [95% CI 0.48 − 0.58]) and late phase (35.5 vs. 39.3 A/day, IRR 0.90 [95% CI 0.86 − 0.95]), whereas prevalent admissions were only lower in the early phase (22.5 vs 36.4 A/day IRR 0.62 [95% CI 0.56 − 0.68]), but not in the late phase (23.6 vs. 24.2 A/day IRR 0.97 [95% CI 0.92 − 1.03]).Analysis of care pathways showed reduced numbers of TEE during the early phase (34.7% vs. 41.4%, OR 0.74 [95% CI 0.64 − 0.86], p < 0.01), but not during the late phase (39.9% vs. 40.2%, OR 0.96 [95% CI 0.88 − 1.03], p = 0.26). Numbers of CV were comparable during early (40.6% vs. 39.7%, OR 1.08 [95% CI 0.94 − 1.25], p = 0.27) and late phase (38.6% vs. 37.5%, OR 1.06 [95% CI 0.98 − 1.14], p = 0.17), compared to the previous year, respectively. Numbers of CA were comparable during the early phase (21.6% vs. 21.1%, OR 0.98 [95% CI 0.82 − 1.17], p = 0.82) with a distinct increase during the late phase (22.9% vs. 21.5%, OR 1.05 [95% CI 0.96–1.16], p = 0.28).ConclusionDuring the COVID-19 pandemic, AF admission rates declined significantly, with a more pronounced reduction in incident than in prevalent AF. Overall AF care was maintained during early and late pandemic phase with only minor changes, namely less frequent use of TEE. Confirmation of these findings in other study populations as well as identification of underlying causes are required to ensure optimal therapy in patients with AF during the COVID-19 pandemic.

Association of recent hospitalisation with antidepressant initiation among community dwellers with Alzheimer's disease.

Antidepressant are commonly prescribed to persons with cognitive disorders to treat depressive and other neuropsychiatric symptoms despite the inconclusive evidence on their effectiveness on this indication. We studied whether recent hospitalisation was associated with antidepressant initiation in people with Alzheimer's disease (AD). The register-based Finnish nationwide Medication use and Alzheimer's disease cohort includes community-dwelling persons diagnosed with AD during 2005-2011 in Finland (n=70,718). This study was restricted to people who initiated antidepressant use after AD diagnosis and had no active cancer treatment and schizophrenia or bipolar disorder diagnoses. We performed a nested case-control study with antidepressant initiators as cases. A matched noninitiator (sex, age and AD duration), was identified for each initiator (15,360 matched pairs). Recent hospitalisation was defined as hospital discharge within the past 14 days of initiation. Antidepressant initiators were four times more likely (adjusted odds ratio: 4.41, 95% confidence interval: 4.06-4.80) to have been hospitalised within the past 2 weeks before initiation (21.2%, n=3250) than matched noninitiators (5.4%, n=831) and the duration of hospital stay was significantly longer among initiators. Dementia was the most common main discharge diagnosis among both initiators (43.8%, n=1423) and noninitiators (24.8%, n=206). Recent hospitalisation was strongly associated with antidepressant initiation in persons with AD. Further studies are needed to investigate whether this is due to neuropsychiatric symptoms leading to hospital admission, inpatient care triggering or worsening neuropsychiatric symptoms or other indications. Nonpharmacological treatments for neuropsychiatric symptoms should be prioritised and the threshold for prescribing antidepressants should be high.

A rechargeable all-solid-state sodium peroxide (Na2O2) battery with low overpotential

Na–O2 batteries have been attracting attention owing to their intrinsically high theoretical energy density. Several Na–O2 systems can produce various discharge products with different electrochemical performances. For example, sodium superoxide (NaO2) batteries have a low overpotential, and sodium peroxide (Na2O2) batteries have a high capacity. Studies of Na2O2 batteries are relatively scarce, owing to the difficulty of forming pure Na2O2 discharge products. A pure Na2O2 battery system is highly desirable for fully exploring the formation and decomposition of Na2O2 in Na–O2 batteries and evaluating their potential. This model of a Na2O2 battery should also be compatible with in situ characterization. To this end, we constructed a simple rechargeable all-solid-state Na2O2 battery. Using a nanoporous gold film as the cathode and Na–β″-Al2O3 as a solid electrolyte, we assembled a Na–O2 battery that can produce and decompose Na2O2. The all-solid-state Na–O2 battery is a simple model for conducting in situ ambient-pressure x-ray photoelectron spectroscopy (APXPS) investigations. The battery can be cycled at a low overpotential (≈450 mV). Qualitative and quantitative analyses of the APXPS and Raman results demonstrated that Na2O2 was the main discharge product and its transformation occurred during the charge and discharge periods. The operando investigation of this type of all-solid-state Na2O2 battery can help in the comprehensive exploration of the potential of Na–O2 batteries.

Development of megawatt radiofrequency ion source for the neutral beam injector on HL-2A tokamak

A radiofrequency (RF) ion source with a megawatt power extraction, thunder I, has been developed for the neutral beam injector (NBI) on HL-2A tokamak. A full solid-state RF generator with output power of 80 kW and frequency of 2 MHz was built by an RF combiner using 8 modules of solid-state RF generator with power of P RF = 10 kW. The line electric efficiency of whole RF generator reaches 92% and its voltage standing wave ratio (VSWR) is 1.01, thus no water-cooling system is supplied. A quartz vessel with the inner diameter of 250 mm is directly adopted for resisting atmospheric pressure, which can dramatically simplify source structure. Nowadays, the extracted beam parameters of RF hydrogen ion source are 32 kV/20 A/0.1 s on a test bed, while the design parameters are 50 kV/20 A/3 s. The beam density profile measured by the infrared imaging technique at 1.3 m downstream from the grounded grid obeys a Gaussian distribution, and the corresponding half width of 1/e power decay at the matched condition is about 80 mm. Plasma homogeneity is over 90% at low RF power. The beam divergence angle meets the requirement of NBI system on HL-2A tokamak. The extractable current density increases almost linearly with the RF power. It reaches 2400 A m−2 at P RF = 32 kW. The ion density in front of plasma grid is about 1 × 1018 m−3, corresponding to an ionized fraction of about 1% at the gas pressure of 0.5 Pa. Single hydrogen ion fraction reaches 79% at the beam current of 12.4 A. Some improvements have been considered for optimizing ion source performance on next experimental campaign. One smaller auxiliary RF discharge chamber equipped with a gas feed path, driven by 13.56 MHz/3.5 kW generator, is connected to main discharge chamber driven by 2 MHz/40 kW generator. By this dual-driven configuration, the innovative RF plasma source with high-pressure density gradient solves the initial ignition problem of powerful RF ion source even if the gas pressure below 0.1 Pa. In addition, the RF negative hydrogen ion source of 200 kV/20 A/3600 s is also developed at SWIP for the China fusion engineering test reactor.

Cancer care near the end-of-life in Austria: A retrospective data analysis.

ObjectiveSince end‐of‐life care (EOL) is an internationally accepted indicator for the quality of oncological care we aimed to investigate the current EOL care situation for Austrian cancer patients especially concerning the place of death cancer treatment hospitalisation near death and palliative care.MethodsA retrospective data analysis was carried out based on Austrian routine inpatient data of the years 2012 to 2016. Data including the date of death of adult patients with a main hospital discharge diagnosis of a neoplasm were included. All analyses were source‐related and based on the place of residence.ResultsIn total 80818 cancer patients have died between 2012 and 2016 of whom 53.4% died in the inpatient setting. Palliative care at the EOL (last hospitalisation) was present in 12.9% of patients whereby more than 50% were admitted two to 14 days before death. Considering cancer treatment at the EOL (30 days before death) 6.9% of cancer patients have received chemotherapy 1.7% radiation therapy and 0.75% were treated with a monoclonal antibody.ConclusionIn international comparison Austria appears to do well on quality indicators concerning ICU‐admission and chemotherapy treatment average on hospital death and poorly on hospital admissions and timely referral for palliative care.

COVID-19 hospitalizations in children in the Autonomous Province of Trento (Northern Italy), year 2020.

hospitalization rate of patients with SARS-CoV-2 infection can be considered as an indicator of severe COVID-19 burden. In children, however, hospital admissions may overestimate such burden. to describe the hospitalizations with COVID-19-related discharge diagnoses in the population <18 years of age in the 545,000 inhabitants of the Autonomous Province of Trento (Trentino-Alto Adige Region, North-Eastern Italy) in year 2020. hospitalization characteristics and main and secondary discharge diagnosis codes were abstracted from anonymous hospital discharge records in all cases with at least one COVID-19-specific ICD-9-CM code.SETTING AND PARTICIPANTS: hospitalized patients 0-17 and >=18 years of age.MAIN OUTCOME MEASURES: in-hospital deaths, median length of stay and cost, frequency of main discharge diagnoses. from March to December 2020, 61 admissions with COVID-19-specific codes regarded patients 0-17 years and 3,811 patients >=18 years. No in-hospital deaths were observed in the younger group. Median hospital stay was not significantly different in the two groups, but cost was higher among patients >=18 years. In adult patients, more than 70% had a pneumonia or other lung or respiratory disease main discharge diagnosis; in children, they were only 6.5%. Almost half of the children admitted with SARS-CoV-2 infection had a main discharge diagnosis of either trauma or encounter with the health system for procedures and aftercare (ICD-9-CM V-codes). in the Province of Trento, a considerable proportion of hospitalizations of young patients with SARS-CoV-2 infection may be due to other underlying conditions requiring hospital care, supporting the hypothesis that hospitalization rate might overestimate the burden of serious COVID-19 in children.