Predischarge Processes Research Articles

Reversible Conversion between Lithium Superoxide and Lithium Peroxide: A Closed “Lithium–Oxygen” Battery

Lithium–air batteries have become a desirable research direction in the field of green energy due to their large specific capacity and high energy density. The current research mainly focuses on an open system continuously supplying high-purity oxygen or air. However, factors such as water and CO2 in the open system and liquid electrolytes’ evaporation will decrease battery performance. To improve the practical application of lithium–air batteries, developing a lithium–oxygen battery that does not need a gaseous oxygen supply is desirable. In this study, we designed a closed lithium–oxygen battery model based on the conversion of lithium superoxide and lithium peroxide (LiO2 + e− + Li+ ↔ Li2O2). Herein, the Pd-rGO as a catalyst will produce the LiO2 in the pre-discharge process, and the closed battery can cycle over 57 cycles stably. In addition to in situ Raman spectra, electrochemical quartz crystal microbalance (EQCM) and differential electrochemical mass spectrometry (DEMS) have been applied to explanation the conversion between LiO2 and Li2O2 during the charge–discharge process. This work paves the way to introduce a new closed “lithium–oxygen” battery system for developing large-capacity green energy.

Randomized trial of a brief peer support intervention for individuals with schizophrenia transitioning from hospital to community

This phase 2 randomized trial examined the outcomes of a brief, transitional, peer support intervention designed to address the poor outcomes that are common for individuals with schizophrenia spectrum illnesses in the period immediately following hospitalization. In the context of treatment-as-usual, participants were provided with a peer support intervention, ‘the Welcome Basket,’ in which participants received 1–2 sessions of peer support in the two weeks before discharge and met weekly for a month post-discharge. The study also piloted a brief version of this intervention with only one community session post-discharge with the same pre-discharge process. It was hypothesized that the full intervention would improve community transition outcomes, with community functioning (Multnomah Community Ability Scale) being the primary measure and secondary measures including symptomatology, community integration, personal recovery, quality of life, and social support. The examination of the brief intervention was exploratory. Measures were completed at baseline, 1-month post-discharge, and follow-up at 6 months. A total of 110 participants were randomized to one of three interventions, with outcome data obtained from 82 and follow-up from 74. While feasible, we did not find that the Welcome Basket intervention was superior to treatment as usual for any of our primary or secondary outcome measures. Future work is needed to determine whether a more extended intervention is required and whether specific subgroups of patients may benefit (e.g. those without access to immediate psychiatric care or those better able to engage with a peer).

Provider‐Hospital “Fit” and Patient Outcomes: Evidence from Massachusetts Cardiac Surgeons, 2002–2004

To examine whether the "fit" of a surgeon with hospital resources impacts cardiac surgery outcomes, separately from hospital or surgeon effects. Retrospective secondary data from the Massachusetts Department of Public Health's Data Analysis Center, on all 12,983 adult isolated coronary artery bypass surgical admissions in state-regulated hospitals from 2002 through 2004. Clinically audited chart data was collected using Society of Thoracic Surgeons National Cardiac Surgery Database tools and cross-referenced with administrative discharge data in the Division of Health Care Finance and Policy. Mortality was followed up through 2007 via the state vital statistics registry. Analysis was at the patient level for those receiving isolated coronary artery bypass surgery (CABG). Sixteen outcomes included 30-day mortality, major morbidity, indicators of perioperative, and predischarge processes of care. Hierarchical crossed mixed models were used to estimate fixed covariate and random effects at hospital, surgeon, and hospital × surgeon level. Hospital volume was associated with significantly reduced intraoperative durations and significantly increased probability of aspirin, β-blocker, and lipid-lowering discharge medication use. The proportion of outcome variability due to unobserved hospital × surgeon interaction effects was small but meaningful for intraoperative practices, discharge destination, and medication use. For readmissions and mortality within 30 days or 1 year, unobserved patient and hospital factors drove almost all variability in outcomes. Among Massachusetts patients receiving isolated CABG, consistent evidence was found that the hospital × surgeon combination independently impacted patient outcomes, beyond hospital or surgeon effects. Such distinct local interactions between a surgeon and hospital resources may play an important part in moderating quality improvement efforts, although residual patient-level factors generally contributed the most to outcome variability.

Fabrication of gas ionization sensors using well-aligned MWCNT arrays grown in porous AAO templates

Gas ionization sensors based on the field ionization from well-aligned MWCNT arrays grown in porous AAO templates were fabricated. The breakdown voltages were measured in different gases of different concentrations. The changes of the breakdown voltage were related to the type of detected gases and its concentration. At the same time, the pre-discharge processes had also been studied to test the responses of the gases sensors to several gases. It was found that the as-prepared gas ionization sensors using well-aligned MWCNT arrays grown in porous AAO templates have shown good sensitivity to acetic acid with short response or recovery time.

Section 7: Heart Failure in Patients With Left Ventricular Systolic Dysfunction

Section 7: Heart Failure in Patients With Left Ventricular Systolic Dysfunction

Early Initiation of β Blockade in Heart Failure: Issues and Evidence

Despite clinical trials demonstrating that inhibitors of the renin-angiotensin and sympathetic nervous systems can reduce the mortality and morbidity risk associated with heart failure, these drugs have remained underutilized in general clinical practice. In particular, many patients with heart failure due to left ventricular systolic dysfunction fail to receive beta blockers, although this class of drugs, as well as other antihypertensive agents such as angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, are recommended as part of routine heart failure therapy by national expert consensus guidelines. In-hospital initiation of beta-blocker therapy may improve long-term utilization by physicians and compliance by patients through obviating many of the misperceived dangers associated with beta blockade. The following review of the clinical trial data from the Randomized Evaluation of Strategies for Left Ventricular Dysfunction (RESOLVD) trial, the Metoprolol Controlled-Release Randomized Intervention Trial in Heart Failure (MERIT-HF), the Cardiac Insufficiency Bisoprolol Study II (CIBIS-II), the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial, and the Initiation Management Predischarge Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) trial on the efficacy, safety, and tolerability of beta blockers indicates that early initiation can be safely achieved and can improve patient outcomes.

Influence of waveform on the accumulation of charges along a particle contaminated spacer surface in SF6 stressed by impulse voltage

The influence of the waveform on the surface charging of a spacer stressed by impulse voltages is investigated in this paper. The experimental study was carried out using a simplified spacer with an adhering conducting particle under homogeneous conditions in SF6 gas. A capacitive probe was specially designed to yield the surface charge data through potential measurement. The results show that the impulse waveform has a significant influence on charge accumulation on the spacer surface. Also, the measurements of the optical signal occurring in the predischarge process can give an explanation for the mechanism of charge accumulation on the spacer surface in the presence of impulse.

Organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF): rationale and design

Heart failure (HF) affects >5 million patients in the United States, and its prevalence is increasing every year. Despite the compelling scientific evidence that angiotensin-converting enzyme inhibitors and β-blockers reduce hospitalizations and mortality rates in patients with HF, these lifesaving therapies continue to be underused. Several studies in a variety of clinical settings have documented that a significant proportion of eligible patients with HF are not receiving treatment with these guideline-recommended, evidence-based therapies. In patients hospitalized with HF, who are at particularly high risk for re-hospitalization and death, the initiation of β-blockers is often delayed because of concern that early initiation of these agents may exacerbate HF. Recent studies suggest that β-blockers can be safely and effectively initiated in patients with HF before hospital discharge and that clinical outcomes are improved. The Initiation Management Predischarge Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) trial demonstrated that pre-discharge initiation of carvedilol was associated with a higher rate of β-blocker use after hospital discharge, with no increase in hospital length of stay. In addition, there was no increase in the risk of worsening of HF. Studies of hospital-based management systems that rely on early (pre-discharge) initiation of evidence-based therapies for patients with cardiovascular disease have also found increases in post-discharge use of therapy and a reduction in the rates of mortality and hospitalization. On the basis of these pivotal studies, the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) program is designed to improve medical care and education of hospitalized patients with HF and accelerate the initiation of evidence-based HF guideline recommended therapies by administering them before hospital discharge. A registry component, planned as the most comprehensive database of the hospitalized HF population focusing on admission to discharge and 60- to 90-day follow-up, is designed to evaluate the demographic, pathophysiologic, clinical, treatment, and outcome characteristics of patients hospitalized with HF. The ultimate aim of this program is to improve the standard of HF care in the hospital and outpatient settings and increase the use of evidence-based therapeutic strategies to save lives.

Rationale and design of the Initiation Management Predischarge: Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) study

Am Heart J 2003;145:S60-1.

Rationale and Design of the Initiation Management Predischarge: Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) Study

β-Blockers for the treatment of heart failure are underprescribed in the United States despite the availability of extensive data and the current guidelines that support their use. The ongoing Initiation Management Predischarge Process for Assessment of Carvedilol Therapy for Heart Failure (IMPACT-HF) study was designed to determine if initiation of beta blockade prior to hospital discharge is safe and improves the long-term use of β-blockers. IMPACT-HF is a multicenter, randomized, open-label trial of carvedilol initiated before hospital discharge or to usual care in 363 patients hospitalized for worsening heart failure. The primary end point of the study is the number of patients treated with any β-blocker at 60 days. Secondary endpoints include β-blocker dose achieved and a composite clinical endpoint. The data from the IMPACT-HF trial will provide evidence to evaluate whether in-hospital initiation of β-blocker therapy is effective in improving the long-term use of β-blockers in this population.

Transient Impulse Breakdowns of SF6 Gas in Inhomogeneous Electric Fields

In this paper, we describe the dielectrics and predischarge developments of gaseous SF6 stressed by nonoscillating and oscillating impulse voltages in inhomogeneous fields caused by a metallic protrusion. The breakdown voltage-pressure curves and the formative time lags to breakdown were measured in the gas-pressure range extending from 0.05 to 0.3 MPa. The predischarge processes were simultaneously investigated through measurements of the current induced by moving space charges and photomultiplier records. The predischarge propagates into the gap with a stepwise leader, and the basic physical mechanisms leading to electrical breakdown are the same for nonoscillating and oscillating impulse voltage waveforms. While for the other, the quickly changing macroscopic electric field due to space charges in the gap affects the leader propagation under the oscillating impulse voltage waveform. In the case of negative polarity, the predischarge growth processes at the increasing and decreasing parts of the oscillating wave tail are not very similar. It is inferred that the breakdown at the decreasing part of the oscillating impulse voltage originates from ion depletion due to recombination.