Potential Discharge Research Articles

Holocene history of the 79° N ice shelf reconstructed from epishelf lake and uplifted glaciomarine sediments

Abstract. Nioghalvfjerdsbrae, or 79∘ N Glacier, is the largest marine-terminating glacier draining the Northeast Greenland Ice Stream (NEGIS). In recent years, its ∼ 70 km long fringing ice shelf (hereafter referred to as the 79∘ N ice shelf) has thinned, and a number of small calving events highlight its sensitivity to climate warming. With the continued retreat of the 79∘ N ice shelf and the potential for accelerated discharge from NEGIS, which drains 16 % of the Greenland Ice Sheet (GrIS), it has become increasingly important to understand the long-term history of the ice shelf in order to put the recent changes into perspective and to judge their long-term significance. Here, we reconstruct the Holocene dynamics of the 79∘ N ice shelf by combining radiocarbon dating of marine molluscs from isostatically uplifted glaciomarine sediments with a multi-proxy investigation of two sediment cores recovered from Blåsø, a large epishelf lake 2–13 km from the current grounding line of 79∘ N Glacier. Our reconstructions suggest that the ice shelf retreated between 8.5 and 4.4 ka cal BP, which is consistent with previous work charting grounding line and ice shelf retreat to the coast as well as open marine conditions in Nioghalvfjerdsbrae. Ice shelf retreat followed a period of enhanced atmospheric and ocean warming in the Early Holocene. Based on our detailed sedimentological, microfaunal, and biomarker evidence, the ice shelf reformed at Blåsø after 4.4 ka cal BP, reaching a thickness similar to present by 4.0 ka cal BP. Reformation of the ice shelf coincides with decreasing atmospheric temperatures, the increased dominance of Polar Water, a reduction in Atlantic Water, and (near-)perennial sea-ice cover on the adjacent continental shelf. Along with available climate archives, our data indicate that the 79∘ N ice shelf is susceptible to collapse at mean atmospheric and ocean temperatures ∼ 2 ∘C warmer than present, which could be achieved by the middle of this century under some emission scenarios. Finally, the presence of “marine” markers in the uppermost part of the Blåsø sediment cores could record modern ice shelf thinning, although the significance and precise timing of these changes requires further work.

A17 EVIDENCE OF PROTEASE-MEDIATED PRO-NOCICEPTIVE EFFECTS OF FECAL SUPERNATANTS FROM CROHN'S DISEASE PATIENTS

Abstract Background Abdominal pain is a debilitating symptom of Crohn’s disease (CD). Despite the current treatment options for this disease, abdominal pain is an unresolved problem that commonly persists in the absence of active inflammation. This suggests that something other than inflammation is driving the pain during the quiescent phase. We have previously reported that microbial proteases can directly modulate the excitability of dorsal root ganglia (DRG) neurons, many of which are pain-sensing. We hypothesize that luminal proteases of CD patients are contributing to their abdominal pain. Purpose Determine whether luminal mediators in CD fecal samples induce changes in pain signalling. Method The effects of patient (active CD [n = 3] and healthy volunteer (HV) [n = 3]) fecal supernatant (FS) samples on pain-sensing neurons were assessed using ex-vivo single unit afferent nerve recordings from mouse colons. Each sample was tested in colonic preparations from a least 5 mice. To further examine cellular mechanisms, DRG neurons were isolated and incubated overnight in media containing CD FS or HV FS media. Changes in neuronal excitability were recorded by determining the rheobase (lower rheobase=increased excitability) using patch clamp recordings (n ≥ 9 DRG neurons/group). Protease inhibitors were applied in both bioassays to determine whether these inhibited the excitatory effect of FS. Lastly, total proteolytic activity in the CD and HV fecal samples was calculated using a casein colorimetric protease detection assay. Result(s) FS from HV had no effect on afferent nerve excitability (p = 0.8920). FS from active CD patients increased action potential discharge from colonic afferent nerves by 85% (p<0.0001) and selectively increased the activation of high-threshold units, which are putative nociceptors, by 44% (p=0.0074). A protease inhibitor cocktail (1:1000) and protease-activated receptor (PAR)-2 antagonist GB83 (10µM) both blocked the excitatory effects of CD FS (p<0.05). Overnight incubation with CD FS also had an excitatory effect on DRG neurons compared to HV FS (rheobase decreased by 46%, p<0.05). The effect of CD FS was blocked by GB83 (10µM) (p<0.001) and a serine protease inhibitor (FUT175; 100µM) (p<0.05) independently, but the activity was not blocked by E64 (30nM) a cysteine protease inhibitor. A 200-fold increase (p<0.0001) in total proteolytic activity was found in CD FS compared to HV FS. Conclusion(s) Luminal serine proteases, but not cysteine proteases, appear to be driving nociceptive signalling in CD patients. This provides insight into the generation of pain in CD patients and may be a potential target to mitigate this action. Further research is required to elucidate whether these pro-nociceptive proteases are of bacterial or host origin and their effects in the quiescent phase. Disclosure of Interest None Declared

Spatial-Temporal Characteristics and Influencing Factors of Lake Water and Groundwater Chemistry in Hulun Lake, Northeast China

Lakes in cold and arid regions are extremely vulnerable to global climate change, and the study of seasonal spatial and temporal fluctuations of lake-groundwater chemistry is of major significance for water resource management and environmental preservation. In this study, we combined hydrogeochemical, multivariate statistical, and spatial interpolation methods to assess spatial and temporal variations of lake and groundwater chemistry in Hulun Lake during the frozen and non-frozen periods. The results show that sodium (Na+) is the most abundant cation in the Hulun Lake area. Bicarbonate (HCO3−) and sulfate (SO42−) are the most predominant anions in the lake, river, and ground water during both seasons. The higher Na+ + K+ concentrations in the frozen season were related to longer circulation time and lower renewable rate. The water chemistry of the lake was of the HCO3-SO4-Cl-Na type and that of groundwater in the east and west regions was of the SO4-Cl-Na and HCO3-Na types, respectively. The chemical compositions of groundwater in the non-frozen season were mainly affected by evaporation and concentration, while rock weathering, evaporation, and human activities jointly controlled groundwater chemical component in the frozen period. Based on hierarchical cluster analysis (HCA) and principal component analysis (PCA) methods, Ca2+, NO3−, and SO42− were identified as the main controlling indicators of the chemical characteristics of groundwater and lake water. The increase of Ca2+ concentration in the center of the lake was related to groundwater discharge along the marginal tectonic fracture zone along the lake shores, which was the potential groundwater discharge area. The unconsolidated aquifer provides recharge channels for groundwater on the eastern side, which has a certain influence on the increase of nutrient concentration (NO3−) in the lake on the eastern shore. This research adds to our rough understanding of the lake-groundwater interaction in Hulun Lake, and provides a scientific foundation for the sustainable use of water resources, as well as the eco-logical integrity preservation in cold and arid regions.

Microplastics Removal from a Plastic Recycling Industrial Wastewater Using Sand Filtration

The removal of microplastic from wastewater collected from a plastic recycling facility was investigated, using a laboratory scale sand-filter. Wastewater samples were collected before and after the onsite sand-filter, for characterization for different polymer types, sizes, and shapes. A considerable difference in the characteristics and concentrations of microplastics was observed before and after onsite sand-filtration, demonstrating differences in the source of microplastics and/or potential contamination of the sand-filter operated at the facility. The distribution of different polymers showed polyethylene and polypropylene to be the main microplastics present in the wastewater samples. In the next stage, the samples were passed through a laboratory scale sand-filter column, to investigate the removal of microplastics. The laboratory scale sand-filter showed high efficiency (up to 100%) in removing microplastics of all polymer types, shapes, and sizes, demonstrating the effectiveness of this well-developed, and widely adopted, method for the removal of microplastics from wastewater. As the green shift and circular economy will result in more plastics being recycled, this study demonstrates the need for quantification of microplastic in effluents from plastic recycling facilities. This is important for devising appropriate microplastic removal strategies, and meeting potential discharge regulations that may come into effect in the future.

Role of NaV 1.9 in inflammatory mediator-induced activation of mouse airway vagal C-fibres.

The influence of NaV 1.9 on inflammatory mediator-induced activation of airway vagal nodose C-fibres was evaluated by comparing responses in wild-type versus NaV 1.9-/- mice. A single-cell RT-PCR analysis indicated that virtually all nodose C-fibre neurons expressed NaV 1.9 (SCN11A) mRNA. Using extracellular electrophysiological recordings in an isolated vagally innervated mouse trachea-lung preparation, it was noted that mediators acting via G protein-coupled receptors (PAR2), or ionotropic receptors (P2×3) were 70-85% less effective in evoking action potential discharge in the absence of NaV 1.9. However, there was no difference in action potential discharge between wild-type and NaV 1.9-/- when the stimulus was a rapid punctate mechanical stimulus. An analysis of the passive and active properties of isolated nodose neurons revealed no difference between neurons from wild-type and NaV 1.9-/- mice, with the exception of a modest difference in the duration of the afterhyperpolarization. There was also no difference in the amount of current required to evoke action potentials (rheobase) or the action potential voltage threshold. The inward current evoked by the chemical mediator by a P2×3 agonist was the same in wild-type versus NaV 1.9-/- neurons. However, the current was sufficient to evoke action potential only in the wild-type neurons. The data support the speculation that NaV 1.9 could be an attractive therapeutic target for inflammatory airway disease by selectively inhibiting inflammatory mediator-associated vagal C-fibre activation. KEY POINTS: Inflammatory mediators were much less effective in activating the terminals of vagal airway C-fibres in mice lacking NaV 1.9. The active and passive properties of nodose neurons were the same between wild-type neurons and NaV 1.9-/- neurons. Nerves lacking NaV 1.9 responded, normally, with action potential discharge to rapid punctate mechanical stimulation of the terminals or the rapid stimulation of the cell bodies with inward current injections. NaV 1.9 channels could be an attractive target to selectively inhibit vagal nociceptive C-fibre activation evoked by inflammatory mediators without blocking the nerves' responses to the potentially hazardous stimuli associated with aspiration.

Crystalline-Dependent Discharge Process of Locally Enhanced Electrooxidation Activity on Ni2P.

The state-of-the-art transition-based electrocatalysts in alkaline media generally suffer from unavoidable surface reconstruction during oxygen evolution reaction measurements, leading to the collapse and loss of the crystalline matrix. Low potential discharge offers a gentle way for surface reconstruction and thus realizes the manipulation of the real active site. Nevertheless, the absence of a fundamental understanding focus on this discharge region renders the functional phase, either the crystalline or amorphous matrix, for the controllable reconstruction still undecidable. Herein, we report a scenario to employ different crystalline matrices as electrocatalysts for discharge region reconstruction. The representative low crystalline Ni2P (LC-Ni2P) possesses a relatively weak surface structure compared with highly crystalline or amorphous Ni2P (HC-Ni2P or A-Ni2P), which contributes abundant oxygen vacancies after the discharge process. The fast discharge behavior of LC-Ni2P leads to the uniform distribution of these vacancies and thus endows the inner interface with reactant activating functionality. A high increase in current density of 36.7% is achieved at 2.32 V (vs RHE) for the LC-Ni2P electrode. The understanding of the discharge behavior in this study, on different crystalline matrices, presents insights into the establishment of controllable surface reconstruction for an effective oxygen evolution reaction.

Estimation of Lacustrine Groundwater Discharge (LGD) to an urban Himalayan lake using environmental tracers (222Rn, δ18O, EC)

Lacustrine Groundwater Discharge (LGD) is a complex process that controls lake characteristics and plays a dominant role in modifying the hydrological and chemical budget of a lake. The current study was carried out with the aim to assess the groundwater discharge component of the hydrological budget of an urban Himalayan lake. We used natural tracers including radioisotope of radon (222Rn), stable water isotopes (δ2H and δ18O), electrical conductivity and water temperature to identify the potential groundwater discharge zones in a lake. The obtained LGD results, based on radon mass balance model (RMB) and end member mixing analysis (EMMA) of stable water isotopes in combination with physical parameters, show temporal as well as spatial variation. The total LGD to the Dal Lake, estimated from RMB, was 62.25 ± 9 × 104 m3/d (24 ± 3 %) and 33 ± 6 × 104 m3/d (36 ± 4 %) during high and low flow periods, respectively. The results suggested that the stream water is the dominant contributor accounting for 75 % (±7) and 55 % (±8), followed by groundwater as 22 % (±5) and 40 % (±4), during high and low flow periods, respectively. However, the contribution from direct precipitation is very little (3–4 %). High groundwater flux towards northeastern side of the lake is substantiated by more aquifer thickness and high hydraulic gradient. The current study offers first in-depth understanding about LGD of an urban Himalayan lake and could be applicable for lake ecosystem protection policies and water resource management plans in the region and elsewhere.

Clinical Implications of a Moderate Positive Correlation Between the Braden Score and the AM-PAC Basic Mobility Score in the Acute Care Setting

Introduction: The Braden scale (Braden) is a scoring system used by bedside nursing staff to document a patient's risk of developing a pressure injury. This scale is completed immediately upon hospital admission and every 12 hours throughout the hospital course. The Activity Measure for Post-Acute Care inpatient basic mobility short form “6 clicks” (AM-PAC) is a scale used by physical therapists (PT) that provides a numerical value to help determine a patient's activity limitations and translates into a potential discharge destination from the acute care setting. The AM-PAC is scored on initial physical therapy evaluation and every physical therapy session during hospital course. The relationship between the 2 has yet to be hypothesized. Methods: A total of 212 patient medical charts met the inclusion criteria for this retrospective chart review study. Criteria incorporated patients with acute care admission to a large tertiary care teaching hospital between March 1, 2019, and March 31, 2021. All patients received at least 1 physical therapy visit during the course of their admission. The Braden admission score for this study is defined as the score documented on the same day and time as the first physical therapy evaluation during admission. Admission AM-PAC score was defined as the score recorded during physical therapy evaluation not admission to hospital. Discharge AM-PAC was defined as the final physical therapy note documented during the hospital admission (may not line up with acute hospital discharge date). Admission and discharge scores for both scoring systems were calculated for comparison. Results: The Spearman correlation for the Braden and AM-PAC was positive with an R value of 0.613 (P = .000) for admission and an R value of 0.555 (P = .000) for discharge, making it a statistically significant relationship with a moderate correlation. When the Braden score increased in value, the AM-PAC score increased in value at admission and discharge of physical therapy. In addition, as the values increased, the standard deviation decreased. Trends in discharge destination were recorded; in each of these relationships the discharge and admission Braden and AM-PAC continued to change together and a correlation for the numeric value was gathered. Discussion: Overall, when calculated for comparison between patient admission and discharge, the numerical results of the Braden and AM-PAC scores had a positive moderate relationship. The result of the present study suggests that the Braden score obtained on hospital admission may assist in determining discharge needs early in hospital admission. Additionally, this relationship may allow for reallocation of hospital resources to areas of greater mobility needs, and allow for monitoring of a decline in patient function. Conclusion: The relationship between the Braden and AM-PAC scores may assist in closing the knowledge gap between bedside nursing and PT in terms of patient mobility. The use of this data is a starting point for education and further research that may lead to further clinical implications. Through the early identification of patients ready and in need of physical therapy services, hospitals may be able to better allocate resources and improve patient outcomes.

Innovative discontinuous-SEI constructed in ether-based electrolyte to maximize the capacity of hard carbon anode

Compared with graphite, the lower sodiation potential and larger discharge capacity of hard carbon (HC) makes it the most promising anode material for sodium-ion battery. Utilizing ether-based electrolyte rather than conventional carbonate-based electrolyte, HC achieves superior electrochemical performance. Nevertheless, the mechanism by which ether-based electrolyte improves the properties of HC is still controversial, primarily focusing on whether it forms solid electrolyte interphase (SEI) film. In this work, according to the sodium storage mechanisms in HC at low voltage (<0.1 V), including Na+-diglyme co-interaction into the carbon layer (SEI forbidden) and desolvated Na+ insertion in the irregular carbon holes (SEI required), the NaPF6 concentration in ether-based electrolyte was regulated, so as to construct a discontinuous-SEI on the surface of the HC anode, which significantly enhances the electrochemical performances of HC. Specifically, with 0.2 M NaPF6 ether-based electrolyte, HC deliverers a discharge capacity of 459.7 mA h g−1 at 0.1 C and stays at 357.2 mA h g−1 after 500 cycles at 1 C, which is substantially higher than that of higher/lower salt concentration electrolytes.

In Situ Tracking of Crystal-Surface-Dependent Cu2O Nanoparticle Dissolution in an Aqueous Environment.

Metal-oxide-based nanoparticles (MONPs) such as Cu2O NPs have attracted growing attention, but the potential discharges of MONPs have raised considerable concern of their environmental fate including their dissolution behavior. The impacts of morphology on MONP dissolution are largely uncertain due to the lack of in situ tracking techniques. In this study, we combined a series of in situ technologies including liquid-cell transmission electron microscopy and fluorescence probes to reveal the in situ dissolution process of Cu2O NPs in freshwater. Our results suggest that cubic Cu2O NPs exhibit a higher dissolution quantity compared with spherical NPs of the same surface area. The difference was mainly related to the crystal surface, while other factors such as particle size or aggregation status showed minor effects. Importantly, we demonstrated the simultaneous growth of new small NPs and the dissolution of pristine Cu2O NPs during the dissolution of Cu2O NPs. Cubic Cu2O NPs became much less soluble under O2-limited conditions, suggesting that O2 concentration largely affected the dependence of dissolution on the NP morphology. Our findings highlight the potential application of in situ techniques to track the environmental fates of MONPs, which would provide important information for assessing the ecological risks of engineered NPs.

Spatial optimization of the economic benefits of the potential hydropower locations: study case upper citarum river

Hydropower is a renewable energy source that provides clean energy services and contributes to climate change mitigation by replacing fossil fuel energy production sources. The Upper Citarum Watershed in West Java, Indonesia, is described as a giant basin known as the Bandung Basin, which is type by mountainous relief with an elevation of 750-2300 meters above sea level, a slope of 30-90%, and a radiating river flow pattern. This study focuses on the potential of small hydropower with a run-of-river scheme that acts as a filler for the study of hydropower potential with a pump storage scheme by the Australian National University. Climate data in the study area were analyzed using the SWAT model to obtain Cumulative Discharge Frequency and identify potential discharge by adopting the method of previous studies. The results identified 7 SHPs with P exceeding 500 kW and below 2000 kW. BHUMI ATR BPN can predict land value and land cover in areas designated for hydropower development. The findings suggest improvements in aspects such as proper forecasting, on-the-ground valuation, and calculations relating to economically viable sustainability.

65 &amp;THRIVE: TRANSFORMING OLDER ADULT CARE IN THE EMERGENCY DEPARTMENT

Abstract Kaiser Permanente Los Angeles Medical Center’s (LAMC) Utilization Management Department expanded our geriatric initiative throughout the hospital with emphasis in the Emergency Department (ED). The ED is the first point of patient contact in the hospital, early identification and initiation of interventions needed for potential discharge barriers will assist in timely discharges. LAMC obtained Geriatric ED Accreditation (GEDA) Level 2 this year, the first in the Los Angeles County to achieve this title. This was done by implementing ten new policies with quality improvement (QI) metrics, conducting age sensitivity trainings for our staff, and enhancing our ED rooms to be geriatric friendly. Two of the ten interventions in our ED include 1) volunteers to provide support to our geriatric patients prevent functional decline, prevent delirium and readmission rates, and 2) palliative care consults initiated in the ED prevent suffering and promote the best possible quality of life for patients who are facing a serious illness. Between 2020 and 2021, there has been a 15% increase for the census of 65+ patients. 21% increase of number of older adults with ED readmissions, and a 13% increase in number of older adults staying in the ED for more than 8 hours. With the increasing older adult population, we see a rise in our admission and readmissions of older adults in our ED. This indicates a need for geriatric specialized care and Kaiser plans to obtain GEDA for all Southern California Hospitals.

Grey Water Footprint of Contaminants of Emerging Concern from Wasterwater in Sava River Basin

Water pollution by contaminants of emerging concern (CECs) causes risks to both the environment and human health. We assessed water pollution by CECs in the Sava River basin in two monitoring campaigns carried out in May and July 2017. The grey water footprint (GWF) is a tool that converts the level of pollution by particular substances into the volume of water needed for dilution to a harmless level. Therefore, it can serve as an indicator for comparing various pollutants. The results show that substances that determine the GWF differ in individual locations. The highest value of the GWF was associated with 17β-estradiol, however, found only in one wastewater sample. The study showed that the value of the GWF in individual locations fluctuates and does not depend on the size of the wastewater treatment plant from which the wastewater is discharged. At selected wastewater treatment plants, a sustainability assessment was carried out using the Water Pollution Level indicator. The values in all cases were below the level of 1.0, indicating sustainable discharge; only in two cases did values reach the defined threshold to question the potential of non-sustainable discharge. The study contributes to earlier studies on the GWF and enlarges knowledge regarding the GWF of CECs.

Probabilistic estimation of tunnel inflow from a karstic conduit network

When planning infrastructures such as tunnels in karstified formations, a risk assessment of groundwater inflow must be conducted. The aim of this paper is to present a workflow for the probabilistic estimation of the water inflow from karst conduits using a Monte-Carlo approach. The procedure involves three main steps. First, realistic stochastic karstic conduit network geometries are generated based on fracture and stratigraphic information using the Stochastic Karstic Simulation approach (SKS). To represent the geological uncertainty, different scenarios are considered. Then, a discrete–continuum numerical modeling approach is employed, allowing the flow calculation to account for the exchange between the matrix and the conduits as well as the transition between turbulent and laminar flow in the conduits. Because it is not known if and where (at which depths) the tunnel may hit a karst conduit, and what will be the pressure gradient in the system, different hydrogeological scenarios are considered in the uncertainty analysis phase including a randomized location of the tunnel, a range of possible pressure gradients, and a range of possible matrix permeability values. The final step consists of the statistical analysis of the results. The proposed workflow allows estimating the range of plausible inflows and studying how the inflows are related to the network geometry properties and to the hydrodynamic parameters of the aquifer. This method is illustrated in a simple synthetic but realistic case of a rather deep and confined karstic formation. In that situation, the results show that even if the pressure difference in the system and the matrix permeability value are important factors controlling the long-term inflow, the karstic conduit network geometry and connectivity also play a critical role in the determination of the potential discharge. Overall, this study demonstrates the possibility and advantages of using stochastic analysis in the early phases of project planning to predict possible long-term water inflow in tunnel after its construction.

Abstract 12816: Single High-Sensitivity Point of Care Whole Blood Cardiac Troponin I Measurement to Rule Out Acute Myocardial Infarction at Low Risk

Introduction: High-sensitivity cardiac troponin (hs-cTn) laboratory assays are used to rule out myocardial infarction (MI) on presentation, but prolonged result turn-around times can delay patient management. Hypothesis: Our aim was to identify patients at low risk of index MI using a rapid, point of care (POC), whole blood hs-cTnI assay at presentation, with potential early patient discharge, with &lt; 1% risk of adverse events. Methods: Consecutive emergency department patients from two prospective, observational studies with suspected acute coronary syndrome were enrolled. A POC hs-cTnI assay (Siemens Atellica ® VTLi) threshold using whole blood at presentation, that resulted in a negative predictive value (NPV) of ≥99.5% and sensitivity of &gt; 99% for index MI, was derived (SEIGE) and validated using plasma (SAMIE). Event adjudications were established using hs-cTnI assay results from usual clinical care. The primary outcome was MI at 30-days. Results: 1086 patients (8.1% MI) were enrolled in a US derivation cohort (SEIGE) and 1486 (5.5% MI) in an Australian validation cohort (SAMIE). A derivation whole blood POC hs-cTnI concentration of &lt;4ng/L provided a NPV of 99.5% (95% CI: 97.2-100%) and sensitivity of 98.9% (93.8-100%) for ruling out MI. In the validation cohort, NPV was 99.8% (99.1-100%) and sensitivity 98.8% (93.3-100%). 17.8% and 41.8%, respectively, were defined as low risk for discharge. 30-day adverse cardiac events were 0.1% (n=1) for SEIGE and 0.8% (n=5) for SAMIE. Conclusions: A point-of-care, whole blood hs-cTnI assay permits an accessible, rapid and safe exclusion of MI, and expedites discharge from the emergency department.

Early prediction of patient discharge disposition in acute neurological care using machine learning

BackgroundAcute neurological complications are some of the leading causes of death and disability in the U.S. The medical professionals that treat patients in this setting are tasked with deciding where (e.g., home or facility), how, and when to discharge these patients. It is important to be able to predict potential patient discharge outcomes as early as possible during the patient’s hospital stay and to know what factors influence the development of discharge planning. This study carried out two parallel experiments: A multi-class outcome (patient discharge targets of ‘home’, ‘nursing facility’, ‘rehab’, ‘death’) and binary class outcome (‘home’ vs. ‘non-home’). The goal of this study is to develop early predictive models for each experiment exploring which patient characteristics and clinical variables significantly influence discharge planning of patients based on the data that are available only within 24 h of their hospital admission. MethodOur methodology centers around building and training five different machine learning models followed by testing and tuning those models to find the best-suited predictor for each experiment with a dataset of 5,245 adult patients with neurological conditions taken from the eICU-CRD database.ResultsThe results of this study show XGBoost to be the most effective model for predicting between four common discharge outcomes of ‘home’, ‘nursing facility’, ‘rehab’, and ‘death’, with 71% average c-statistic. The XGBoost model was also the best-performer in the binary outcome experiment with a c-statistic of 76%. This article also explores the accuracy, reliability, and interpretability of the best performing models in each experiment by identifying and analyzing the features that are most impactful to the predictions.ConclusionsThe acceptable accuracy and interpretability of the predictive models based on early admission data suggests that the models can be used in a suggestive context to help guide healthcare providers in efforts of planning effective and equitable discharge recommendations.

New take on the post-take ward round: a quality improvement project undertaken in a district general hospital

A patient’s first encounter with a consultant clinician, known as the post-take ward round (PTWR), is a pivotal encounter at the start of their hospital journey. It is a chance...

Intrinsic and synaptic properties of adult mouse spinoperiaqueductal gray neurons and the influence of neonatal tissue damage.

The periaqueductal gray (PAG) represents a key target of projection neurons residing in the spinal dorsal horn. In comparison to lamina I spinoparabrachial neurons, little is known about the intrinsic and synaptic properties governing the firing of spino-PAG neurons, or whether such activity is modulated by neonatal injury. In this study, this issue was addressed using ex vivo whole-cell patch clamp recordings from lamina I spino-PAG neurons in adult male and female FVB mice after hindpaw incision at postnatal day (P)3. Spino-PAG neurons were classified as high output, medium output, or low output based on their action potential discharge after dorsal root stimulation. The high-output subgroup exhibited prevalent spontaneous burst firing and displayed initial burst or tonic patterns of intrinsic firing, whereas low-output neurons showed little spontaneous activity. Interestingly, the level of dorsal root-evoked firing significantly correlated with the resting potential and membrane resistance but not with the strength of primary afferent-mediated glutamatergic drive. Neonatal incision failed to alter the pattern of monosynaptic sensory input, with most spino-PAG neurons receiving direct connections from low-threshold C-fibers. Furthermore, primary afferent-evoked glutamatergic input and action potential discharge in adult spino-PAG neurons were unaltered by neonatal surgical injury. Finally, Hebbian long-term potentiation at sensory synapses, which significantly increased afferent-evoked firing, was similar between P3-incised and naive littermates. Collectively, these data suggest that the functional response of lamina I spino-PAG neurons to sensory input is largely governed by their intrinsic membrane properties and appears resistant to the persistent influence of neonatal tissue damage.

Evaluation of a liquid-phase plasma discharge process for ammonia oxidation in wastewater: Process optimization and kinetic modeling

Removing ammonia-nitrogen (NH3N) from wastewater is of paramount importance for wastewater treatment. In this study, a novel continuous liquid plasma process (CLPD) was evaluated to remove NH3N from synthetic wastewater. The Box–Behnken experimental design was used to optimize the main process parameters, including the initial NH3N concentration (50–200 mg/L), power input (150–300 W), and gas-flow rate (1.5–2.5 L/min), for efficient NH3N removal from wastewater. The gas-flow rate and power input were found to be significant factors affecting the removal efficiency of NH3N, whereas the initial concentration of NH3N played a vital role in determining the energy efficiency of the process. Under the optimal conditions of an initial NH3N concentration of 200 mg/L, applied power of 223 W, and gas-flow rate of 2.4 L/min, 98.91% of NH3N could be removed with a N2 selectivity of 92.91%, and the corresponding energy efficiency was 0.527 g/kWh after 2 hrs of treatment. A small fraction of undesirable NO3−-N (7.05 mg/L) and NO2−-N (2.83 mg/L) were also produced. Kinetic modeling revealed that NH3N degradation by the CLPD followed a pseudo-first-order reaction model, with a rate constant (k) of 0.03522 min−1. Optical emission spectroscopy (OES) was used to gather information about the active chemical species produced during the plasma discharge. The obtained spectra revealed the presence of several highly oxidative radicals, including ‧OH, ‧O, and ‧O2+. These results demonstrate the potential of liquid phase plasma discharge as a highly efficient technology for removing ammonia from aqueous solutions.

Sympathetic Action Potential Firing and Recruitment Patterns Are Abnormal in Gestational Hypertension.

We tested the hypothesis that women who develop gestational hypertension (GH) display abnormal sympathetic action potential (AP) discharge patterns during late pregnancy (32-36 weeks), both at supine rest and during postural stress. Thirteen nonpregnant, female controls (nonpregnant controls [CTRL]) and 32 pregnant women participated; 14 had low-risk (no personal history of GH) normal pregnancies (LR-NP), 10 had high-risk (personal history of GH) normal pregnancies (HR-NP), and 8 developed GH. We measured heart rate, blood pressure, and muscle sympathetic nerve activity (microneurography) at supine rest and 60° head-up tilt. Sympathetic AP patterns were studied using wavelet-based methodology. At rest, muscle sympathetic nerve activity burst frequency was elevated in LR-NP, HR-NP, and GH versus CTRL (all P≤0.01); however, the AP content per integrated burst was augmented only in GH (20±5 spikes/burst), compared with CTRL (8±3 spikes/burst), LR-NP (9±2 spikes/burst) and HR-NP (11±4 spikes/burst; all P<0.0001). Thus, total AP firing frequency was greater in GH versus each of CTRL, LR-NP, and HR-NP (all P<0.0001). In pregnancy, AP frequency is related directly to systolic (R2=46%) and diastolic (R2=20%) blood pressure (both P≤0.01). Unlike CTRL (both P<0.01), women who developed GH were unable to increase within-burst AP firing (P=0.71) or recruit latent subpopulations of larger-sized APs (P=0.72) in response to head-up tilt, perhaps related to a ceiling-effect; however, total AP firing frequency in the upright posture was elevated in the GH cohort versus CTRL, LR-NP, and HR-NP (all P<0.05). Women who develop GH display aberrant sympathetic AP firing patterns in both the supine and upright postures.