Discharge Record Research Articles

Gaussian process regression as a powerful tool for analysing time series in environmental geochemistry

Monitoring programs require more advanced data management for the registered time series. Classical temporal series decomposition cannot fulfil current needs regarding adequate data representation, optimization of the spatial-temporal sampling resolution and predictive power. In the manuscript at hand, we will demonstrate that Gaussian process regression (GPR) models are a vital machine-learning tool to interpret temporal series, improving understanding of geochemical cycles, providing input data for geochemical models and acting as a guide for future decisions in environmental monitoring. Firstly, we explore the impacts of sampling frequency in the GPR performance for temporal series with variable lengths and sampled frequencies of water discharges. On a second approach, we present the strengths and weaknesses between classical decomposition of temporal series and GPR results for a case study: a 14-year record of water discharge, suspended particulate matter and antimony concentrations in the Garonne River. Our results suggest that (i) even short temporal series with low sampling resolution can be accurately characterized by GPR when presenting well defined seasonal patterns, and (ii) GPR provides more detailed and robust support than classical statistics to identify processes responsible for multi-scale geochemical signals. This work provides a reference for researchers, engineers, and stakeholders for more reliable monitoring, understanding, and managing aquatic ecosystems.

Discharge estimation using a rating curve developed for the Upper Erer River, Wabisheble River Basin, Ethiopia

ABSTRACT The measurement of a stream flow is a vital component of water quality monitoring, geomorphology, and flooding investigations. However, the direct measurements of stream flow can be costly and challenging. To obtain a continuous record of discharge, typically the recorded stage and discharge are computed from the correlation of stage and discharge in the form of a rating curve. This study focused on the estimation of flow discharges using a rating curve equation based on data recorded at the Erer-Jijiga Bridge hydrometric station at the outlet of the upper Erer Sub-basin in Ethiopia for 2020–2021. The fitted rating curve was then used to estimate discharges from continuously recorded stages. The installation and operation of a gauging station in the Upper Erer Sub-basin will provide local and regional water sector administrators with more reliable estimates of discharge than would be available if the sub-basin was ungauged. This will also assist the local water sector to undertake water resource planning in the Upper Erer River Basin to better use the limited water resources in the region.

Forecasting Patient Early Readmission from Irish Hospital Discharge Records Using Conventional Machine Learning Models.

Predicting patient readmission is an important task for healthcare risk management, as it can help prevent adverse events, reduce costs, and improve patient outcomes. In this paper, we compare various conventional machine learning models and deep learning models on a multimodal dataset of electronic discharge records from an Irish acute hospital. We evaluate the effectiveness of several widely used machine learning models that leverage patient demographics, historical hospitalization records, and clinical diagnosis codes to forecast future clinical risks. Our work focuses on addressing two key challenges in the medical fields, data imbalance and the variety of data types, in order to boost the performance of machine learning algorithms. Furthermore, we also employ SHapley Additive Explanations (SHAP) value visualization to interpret the model predictions and identify both the key data features and disease codes associated with readmission risks, identifying a specific set of diagnosis codes that are significant predictors of readmission within 30 days. Through extensive benchmarking and the application of a variety of feature engineering techniques, we successfully improved the area under the curve (AUROC) score from 0.628 to 0.7 across our models on the test dataset. We also revealed that specific diagnoses, including cancer, COPD, and certain social factors, are significant predictors of 30-day readmission risk. Conversely, bacterial carrier status appeared to have minimal impact due to lower case frequencies. Our study demonstrates how we effectively utilize routinely collected hospital data to forecast patient readmission through the use of conventional machine learning while applying explainable AI techniques to explore the correlation between data features and patient readmission rate.

Threshold-dependent association between non-rapid eye movement obstructive sleep apnea and interictal epileptiform discharges: A hospital study.

Obstructive sleep apnea frequently coexists with epilepsy, potentially influencing its pathophysiology. However, the effect of obstructive sleep apnea severity on interictal epileptiform discharges is not well understood. To explore this, we studied 108 Asian patients with epilepsy who underwent single-night polysomnography. We utilized generalized linear models, adjusting for age, sex, epilepsy type (focal versus generalized), antiepileptic medication use and disease duration, to analyse the relationship between obstructive sleep apnea severity, as measured by the apnea-hypopnea index, and interictal epileptiform discharge frequency during non-rapid eye movement and rapid eye movement sleep. Our analysis revealed that severe obstructive sleep apnea (apnea-hypopnea index ≥ 30) was associated with a higher frequency of interictal epileptiform discharges during non-rapid eye movement sleep (p = 0.04), but no such association was observed during rapid eye movement sleep. Additionally, the frequency of interictal epileptiform discharges in non-rapid eye movement sleep was positively correlated with the wake time between sleep onset and offset (p = 0.03). Further studies are warranted to validate our findings across diverse ethnicities, and over multiple nights of sleep and interictal epileptiform discharge recordings.

Analysis of Energy Transfer in the Ignition System for High-Speed Combustion Engines

In order to produce reliable and reproducible ignition of lean fuel–air mixtures and highly stratified mixtures, it is necessary to ensure a high concentration of spark discharge energy and to provide a strong energy impulse for the triggering of chain processes of chemical decomposition of fuel molecules. For this reason, studies have been undertaken on the flow of electrical energy from the ignition system to the spark plug and on the formation of an electric discharge arc with a high concentration of thermal energy. The experimental results were obtained using an ignition coil energy test stand and a constant volume chamber with high-speed spark discharge recording capability. It was confirmed that increasing the charging time of the ignition coil from 0.5 ms to 5.0 ms increases the energy delivered to the coil from 9.5 mJ to 330 mJ. In the same range, the energy generated by the coil was recorded to range from 4.2 mJ to 70 mJ. The coil’s efficiency was found to decrease with increasing charging time from 45% up to 20.5%. Further energy losses were presented when the spark discharge energy was analyzed. In the paper, the results of investigations concerning electric discharge arc development have been presented, illustrated by a few exemplary photos, and discussed. The mathematical interpretation of the electrical energy flux in the ignition system resulting from the energy of the discharge arc has been conducted and illustrated by some functional independences and relationships.

Towards a new generation of fluvial facies models for the interpretation of ancient deposits, based on inter‐annual peak discharge variance of modern rivers

ABSTRACTFluvial facies models based on river planform are flawed and not fully fit for purpose. An alternative approach to classifying fluvial deposits is based on river discharge characteristics. A recent paper showed that the co‐efficient of variance of annual peak discharge (CVQp) correlates well with the characteristics of preserved alluvium for a suite of modern rivers. Here, the database of rivers is expanded and augmented, and the utility of this statistic confirmed. For modern rivers, plotting the running‐value of CVQp for a set interval (for example, 30 years) over a longer discharge record shows that the statistic varies both spatially and temporally. The CVQp can rise abruptly at a given location in response to a single flow event if that event is significantly larger than is common in that river. Such abrupt changes in CVQp are superimposed on longer‐term patterns of more gradual change stimulated by environmental factors or anthropogenic effects such as dam construction. If the period of calculation for CVQp is relatively short, ‘anomalous’ events appear more frequently. Sequential studies of modern rivers indicate that such anomalous events have a high probability of being preserved in the alluvial record of the river, and suggest that, over the timeframes of channel filling and abandonment, they may constitute the dominant (characteristic) portion of the record in high CVQp systems. Since flow events with strongly peaked hydrographs (flashy discharges) are more common in high CVQp systems and leave a record dominated by upper flow regime stratification styles, it follows that the alluvial record of high CVQp rivers will be dominated by upper flow regime stratification. In contrast, in lower CVQp systems the occurrence of an event that changes the running CVQp value significantly may form a distinct event deposit, and the temporarily changed CVQp is unrepresentative for the duration of the channel's life. The dominance of upper flow regime stratification, together with decreased preservation of identifiable macroform structure, increased lateral lithological heterogeneity, and in many cases increased preservation of in situ tree fossils in channel deposits of higher CVQp rivers, forms the basis for a series of new facies models for low, moderate, high and very high/ultra‐high CVQp alluvial systems and deposits. The new models can be applied to ancient successions either in combination with traditional, planform‐based models, or not. These models provide information about ancient palaeoenvironmental conditions, and changes in such conditions over time at various scales via stratigraphic investigations.

Trends and Changes in Treating Proximal Humeral Fractures in Italy: Is Arthroplasty an Increasingly Preferred Option? A Nation-Wide, Population-Based Study over a Period of 22 Years.

Background: Proximal humeral fractures (PHFs) are common, especially in the elderly, and account for 4% to 10% of all fractures, with women more often affected than men. Treatments include conservative methods, internal fixation and arthroplasty, with surgical approaches increasingly being used due to technological advancements. This study analyzes the evolution of PHF treatments in Italy from 2001 to 2022, using data from the Italian Hospital Discharge Records (HDRs) Database, and includes a stratified analysis by age and sex. Methods: Using HDR data from 2001 to 2022, records with ICD9-CM codes for proximal humeral fractures (812.0 and 812.1) among diagnoses were selected and categorized into three treatment groups: arthroplasty, fixation and conservative. Time series were analyzed with stratification by sex and age. Results: The extracted data included 486,368 records of PHFs, with 223,742 cases treated surgically (arthroplasty or internal fixation) and 262,626 treated conservatively; the average patient age was 66.6 years, with a higher proportion of women, especially among arthroplasty patients. Over time, the use of fixation and arthroplasty increased from 20% of treatments in 2001 to over 60% in 2022, with fixation becoming the most common treatment method by 2014 and arthroplasty significantly increasing among women, particularly in the 65-74 and 75-84 age groups. Conclusions: The study shows that in Italy, over the past two decades, treatment for PHFs has shifted from conservative methods to a preference for internal fixation and increasingly for arthroplasty, particularly among women and patients aged 65-84, reflecting evolving trends and technological improvements.

Temporal trends of suicidality among hospitalised adolescents during COVID-19 pandemic: A Bayesian framework

ObjectiveLiterature on temporal patterns of suicidality among youths during the COVID-19 pandemic is growing. The present work proposes a Bayesian approach to assess temporal patterns of suicide-related behaviours among inpatient adolescents during the COVID-19 pandemic. MethodologyData referred to the first hospital discharge record with ICD9-CM codes related to suicide-related behaviour and/or suicidal ideation among adolescents aged 13–19 between 1 January 2017 and 31 March 2021 were collected in the Piedmont region, Italy (n = 334; median age: 15 years, IQR: 14–16; 80% girls). A Poisson Bayesian regression model performed on pre-COVID-19 data (2017–2020), adjusted by seasonality and stratified by sex, was adopted to provide the probability that the predicted counts exceed the observed ones in each pandemic year quarter. ResultsA declining trend of suicidality was observed in April–June 2020 among both sex groups. Among females, an increasing pattern of suicidality was registered in early 2021 (January–March) compared to the pre-pandemic period. ConclusionThe present findings contributed to a growing literature on the COVID-19 pandemic's impact on adolescents' suicide-related behaviours from a gender perspective and encouraged wider adoption of Bayesian approaches as valuable tools to explore rare events and deeply enlighten open public health issues.

Trends of ankle arthroscopy in Italy: Analysis of an official national database

ObjectivesAnkle arthroscopy has become increasingly popular as a less invasive surgical diagnostic and therapeutic procedure for a variety ankle disorder previously managed with open surgery. Despite literature reports encouraging outcomes and low complication rates, nationwide trends in ankle arthroscopy have been poorly investigated. To fully understand the burden of an emerging surgical approach as well as helping to create global standards for the diagnosis and treatment of ankle diseases, this study aimed to evaluate the incidence and demographics of patients undergoing ankle arthroscopy in Italy from 2001 to 2016. MethodsData were obtained from the National Hospital Discharge Records (SDO) provided by the Italian Ministry of Health. The patient's age, gender, length of hospital stays, primary diagnosis, and primary procedure are among the anonymized data. Population data were obtained from the National Institute for Statistics (ISTAT). According to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) ankle arthroscopy was defined by the following procedure code: 80.27. ResultsA total of 23,644 procedures were performed in Italy. The 25 to 29 and 30 to 34 age groups underwent this type of surgery at most. The majority of patients were males. The median length of hospital stay was 2.1 ​± ​2.3 days. Each year in Italy, this surgery costs an average of 2,133,401€ ± 342,143€. The main primary codified diagnoses were: “contracture of joint, ankle and foot” (13.4 ​%), “articular cartilage disorder, ankle and foot” (8.6 ​%), “late effect of sprain and strain without mention of tendon injury” (7.5 ​%) and “other joint derangement, not elsewhere classified, ankle and foot” (6.4 ​%). ConclusionsThe present study evaluated the burden of ankle arthroscopy on the national health care system and the distribution of the main diseases requiring this type of surgery. Surgeons and policy makers can allocate healthcare resources more effectively and provide patients with high-quality care by having a better understanding of national practice patterns. Level of EvidenceIII.

Incidence, healthcare resource utilization and costs of hospitalized patients with tick-borne encephalitis (TBE) in Italy

ObjectiveOur study's objective was to assess the incidence trends and healthcare resource utilization of hospitalizations for Tick-Borne Encephalitis (TBE) and associated costs in Italy in order to improve public awareness and preventive measures. MethodsThis retrospective observational study was based on the Italian Ministry of Health's Hospital Discharge Record (HDR) database. Data were gathered across Italy from 2015 to 2019, selecting hospitalizations with ICD-9 code 063 related to TBE, both in primary and secondary diagnoses. For each year, we collected the following variables: number of hospitalizations, hospitalization rate, mortality rate, mean length of hospital stay, hospital ward, and cost of hospitalization. ResultsThere were a total of 237 hospitalizations from 2015 to 2019; 62 % of those were male. The lowest number of TBE hospitalizations was in 2015 (21 cases, corresponding to 0.35 per million inhabitants), the highest in 2019 (64 cases, 1.04 per million inhabitants). The summer months saw a greater than average number of hospitalizations. For the years analyzed, the cumulative number of cases peaked in June (54 cases), July (46 cases), and August (35 cases). There were only two deaths registered in our study sample. TBE cases were mostly localized in the North-Eastern regions of Italy. TBE incidence during the study period in the most affected areas were: Autonomous Province of Trento, ranging from 11.2 to 42.3 per million inhabitants, Autonomous Province of South Tyrol, from 0 to 21.1 per million inhabitants, and Veneto Region, from 2.6 to 4.5 per million inhabitants. In the study period, the average length of hospital stay was largely stable ranging from 10.6 days to 12.8 days, with related costs ranging from 5,813.7 € to 7,352.5 €. ConclusionsAccording to our data, the majority of TBE hospitalizations occur in North-East Italy with an increasing trend over the analyzed period. Even though Italy has fewer TBE cases than other neighboring European countries, the health and economic impact can be high in the affected areas.

Trends in hospitalizations of children with respiratory syncytial virus aged less than 1 year in Italy, from 2015 to 2019

BackgroundRespiratory syncytial virus (RSV) affects 60–80% of children below 1 year and it’s the first cause of acute bronchiolitis. The aim of this study was to assess the trend and characteristics of hospitalizations for RSV infections in Italy.MethodsThis is a retrospective study based on the Italian Hospital Discharge Record (HDR) database. We analysed HDRs from June 2015 to May 2019, considering two groups of infants: Group 1 had a confirmed diagnosis of RSV; Group 2 had a diagnosis of acute bronchiolitis not RSV-coded.ResultsThere were 67,746 overall hospitalizations (40.1% Group 1, and 59.9% Group 2). Hospitalization rate increased for Group 1 from 125 to 178 per 10,000 infants (+ 42.4%), and for Group 2 from 210 to 234 per 10,000 (+ 11.4%). The mean hospitalization length was 6.3 days in Group 1, longer than Group 2 (+ 1.0 day). A further analysis revealed that infants with heart disease or born premature had longer mean hospital stay compared to infants without risk factors (10.7 days versus 6.1 days, p < 0.0001; 34.0 days versus 6.1 days, p < 0.0001, respectively). Group 1 required more critical care (oxygen therapy and/or mechanical ventilation) than Group 2. We found that, in proportion to hospital admissions in pediatric and general hospitals, RSV was more frequently diagnosed in the first ones. The mean hospitalization cost increased for Group 1 (from € 2,483 to € 2,617) and Group 2 (from € 2,007 to € 2,180).ConclusionsOur results confirmed that RSV pulmonary disease in infants is seasonal and often requires hospitalization. Our study suggested that RSV is responsible for an increasing hospitalization rate and related costs during the study period.

Impact of the Affordable Care Act on access to accredited facilities for cancer treatment.

To examine differential changes in receipt of surgery at National Cancer Institute (NCI)-designated comprehensive cancer centers (NCI-CCC) and Commission on Cancer (CoC) accredited hospitals for patients with cancer more likely to be newly eligible for coverage under Affordable Care Act (ACA) insurance expansions, relative to those less likely to have been impacted by the ACA. Pennsylvania Cancer Registry (PCR) for 2010-2019 linked with discharge records from the Pennsylvania Health Care Cost Containment Council (PHC4). Outcomes include whether cancer surgery was performed at an NCI-CCC or a CoC-accredited hospital. We conducted a difference-in-differences analysis, estimating linear probability models for each outcome that control for residence in a county with above median county-level pre-ACA uninsurance and the interaction between county-level baseline uninsurance and cancer treatment post-ACA to capture differential changes in access between those more and less likely to become newly eligible for insurance coverage (based on area-level proxy). All models control for age, sex, race and ethnicity, cancer site and stage, census-tract level urban/rural residence, Area Deprivation Index, and year- and county-fixed effects. We identified adults aged 26-64 in PCR with prostate, lung, or colorectal cancer who received cancer-directed surgery and had a corresponding surgery discharge record in PHC4. We observe a differential increase in receiving care at an NCI-CCC of 6.2 percentage points (95% CI: 2.6-9.8; baseline mean = 9.8%) among patients in high baseline uninsurance areas (p = 0.001). Our estimate of the differential change in care at the larger set of CoC hospitals is positive (3.9 percentage points [95% CI: -0.5-8.2; baseline mean = 73.7%]) but not statistically significant (p = 0.079). Our findings suggest that insurance expansions under the ACA were associated with increased access to NCI-CCCs.

Comorbidities and Complications in People Admitted for Leprosy in Spain, 1997-2021.

This study aims to describe the epidemiological and clinical characteristics and trends of these admissions in Spain. This retrospective study drew data from the Hospital Discharge Records Database of the Spanish National Health System. We used the diagnostic codes for leprosy from the International Classification of Diseases, ninth and tenth revisions, to retrieve leprosy admissions from 1997 to 2021. There were 1387 hospitalizations for leprosy The number of annual cases decreased gradually, from 341 cases in 1997-2001 to 232 in 2017-2021 (p < 0.001). Patients' median age increased, from 65 years in 1997-2001 to 76 years in 2017-2021 (p < 0.001), as did the prevalence of some comorbidities, such as hypertension (15% in 1997-2001 to 27.6% in 2017-2021; p < 0.001). The mortality rate (6%) and the frequency of leprosy complications remained stable. After Spain (79.1%), the most common country of origin was Paraguay (4.4%). Admissions decreased significantly in Andalusia, from 42% in 1997-2001 to 10.8% in 2017-2021 (p < 0.001), and in the Canary Islands, from 7.9% in 1997-2001 to 2.6% in 2017-2021 (p = 0.001), whereas they increased in Madrid, from 5.9% in 1997-2001 to 12.1% in 2017-2021 (p = 0.005). Overall, leprosy admissions in Spain have declined, even in the regions with the highest prevalence. Patients admitted for leprosy have become older and sicker.

The assessment of flood hazard in Pondok Keumuning village of Langsa City, Aceh due to heavy rain in 2020

Langsa faces the recurring threat of floods every year, primarily caused by high rainfall resulting in surface runoff in the Langsa Watershed. However, there is uncertainty regarding the specific causes of flooding in the city. This research discusses the flood hazards generated by Langsa River due to high rainfall in Keumuning Village, Langsa City, in 2020. The data utilized in this study includes daily rainfall data obtained from PTPN I Langsa, specifically from the Kebun Lama (KLM), Kebun Baru (KBR), and Tualang Sawit (TWS) stations. Additionally, observed water level data is collected from the Keumuning water gauge station operated by the Aceh Irrigation Agency. Since there is no river discharge record at the Keumuning water gauge station, the Nreca method is used to analyze the direct runoff from the Langsa Watershed due to rainfall, linking it to the water level at Keumuning. Historical flood event data is compiled from the Regional Disaster Management Agency of Langsa City, online media sources, and interviews with flood-affected communities. The research findings indicate that floods in Keumuning Village, Langsa, are triggered by high rainfall, leading to increased river discharge as a result of heavy rainfall at the TWS station (located upstream in the Langsa Watershed) with a 2-year return period. This can result in flooding for the villages around the Langsa River. Similarly, suppose rainfall reaches a 2-year return period at the KLM and KBR stations situated within the middle and downstream of the Langsa Watershed. In that case, it poses a flood threat to the upstream villages along the estuary branches. However, further studies are necessary to assess compound floods triggered by tidal water levels, rainfall, and river discharge in the vicinity of these estuary branches.

Intraoperative ECoG in bottom-of-the-sulcus syndrome using a novel flexible strip electrode.

The recording of epileptiform discharges from bottom-of-sulcus focal cortical dysplasia (BOSD) is often difficult during intraoperative electrocorticography (ECoG) due to the deep localization. We describe the use in this scenario of a new-generation electrode strip with high flexibility, easily adapted to cortical gyri and sulci. A right-handed 20-year-old male with drug-resistant focal epilepsy due to BOSD of the inferior frontal gyrus and daily focal aware seizures was evaluated for epilepsy surgery. Based on electroclinical and neuroimaging results, a focal cortectomy guided by ECoG was proposed. ECoG recordings were performed with new-generation cortical strips (Wise Cortical Strip; WCS®) and standard cortical strips. ECoG, performed on the convexity of the frontal cortical surface, recorded only sporadic spikes with both types of strips. Then, after microsurgical trans-sulcal dissection, WCS was molded along the sulcal surface of the suspected BOSD based on 3D-imaging reconstruction, showing continuous/subcontinuous 3-4-Hz rhythmic spike activity from the deepest electrode. Registration after resection of the BOSD did not show any epileptiform activity. Pathology showed dysmorphic neurons and gliosis. No surgical complications occurred. The patient is seizure-free after 12 months. This single case experience shows that highly flexible electrode strips with adaptability to cortical gyrations can identify IEDs originating from deep location and could therefore be useful in cases of bottom of the sulcus dysplasia.

Excess hospitalizations and in-hospital mortality associated with seasonal influenza in Italy: a 11-year retrospective study

BackgroundInfluenza and flu-like syndromes are difficult to monitor because the symptoms are not specific, laboratory tests are not routinely performed, and diagnosis codes are often lacking or incompletely registered in medical records. This may result in an underestimation of hospital admissions, associated costs, and in-hospital mortality. Therefore, this study aimed to estimate the public health and economic burden of hospitalisations associated with influenza in Italy, at the national and regional levels.MethodsThis 11-year retrospective study included patients admitted to hospitals for influenza or diagnoses associated with influenza (including respiratory and cardiocirculatory conditions) from 2008/09 to 2018/19. Data on hospitalisations were extracted from the Italian Hospital Discharge Records. Information on weekly influenza-like syndrome incidence and weekly average temperature were used to estimate the burden of influenza in terms of hospital admissions in every Italian region and for different age groups by applying a negative binomial model. The model was also applied to estimate in-hospital mortality and the total costs of influenza and influenza-like hospital admissions.ResultsOver the study period, in addition to 3,970 average seasonal admissions coded as influenza, we estimated an average of 21,500 excess hospitalization associated with influenza per season, which corresponds to 36.4 cases per 100,000. Most of the excess hospitalisations concerned older individuals (> 65 years) and children (0–4 years) with 86 and 125 cases per 100,000, respectively. Large variations were observed across regions. Overall, the total estimated hospital burden associated with influenza (including respiratory and cardiocirculatory conditions) was approximately €123 m per year. While the in-hospital mortality for admissions with a primary diagnosis of influenza was very low (~ 150 cases per season), cases increased dramatically for primary diagnoses of influenza and pneumonia (about 9,500 cases per season). The average seasonal in-hospital deaths attributable to influenza were equal to 2,775 cases.ConclusionsOur findings suggest a remarkable underestimation of the burden of influenza, mostly in the older population but not neglectable in younger individuals. Our results may aid the management of current and future flu seasons and should be used for policy making (e.g., vaccine strategies) and operation management choices (e.g., planning and staffing beds during influenza peaks). Overall, the present study supports the need for increased testing for influenza in Italy to tackle the current underestimation of influenza burden.

Simultaneous recording of neuronal discharge and calcium activity reveals claustrum-cortex neurosynchrony under anesthesia

Neural information transmission between deep brain nuclei and the cortex is essential for brain function. Currently, high-resolution simultaneous detection of neural information between the deep brain nuclei and the large-scale cortex still poses challenges. We have developed the microelectrode arrays based on the Micro-Electro-Mechanical System technology, and modified the electrode surface with nanomaterials to improve the electrode performance. This study combined microelectrode arrays and extended-field-of-view microscopy to achieve simultaneous recording of claustrum (CLA) electrophysiology and wide-field cortical calcium imaging at single-cell resolution. This work investigated the synchronous changes of neural information in CLA and cortex of mice during the whole process from wakefulness to anesthesia and then to wakefulness, and summarized the characteristics of the CLA electrophysiology and cortical calcium signaling under different inhalation anesthesia concentrations. We found the synergy between microscopic spike and local field potential of CLA neurons under deep anesthesia, and the law that high inhalation anesthesia concentration enhanced the synchronization between neurons in CLA and cortex. The combination of microelectrode arrays and extended-field-of-view microscopy also gives a new method for synchronous detection of multimodal and multi-brain region neural information.

The effects of vegetative feedbacks on flood shape, sediment transport, and geomorphic change in a dryland river: Moenkopi Wash, AZ

Since the 1950s, Moenkopi Wash, in Arizona, United States, has been transformed from a relatively wide river at low flow, to a narrow, heavily vegetated river that is less than half of its former width. We analyzed a ~95-years-long instantaneous-discharge record, an extensive sediment-transport record, oblique and aerial photographs, historical channel surveys, and historical stage-discharge rating relations to determine the primary mechanisms responsible for this transformation.Frequent, large floods dominated the early part of the discharge record between 1926 and 1940. A dramatic ~30 % decrease in annual mean discharge, and ~27 % decrease in the mean of the partial-duration flood series occurred in 1941. This decline did not result in widespread channel change but provided an opportunity for vegetation to establish along the channel margins. Widespread channel narrowing began after a second decline in mean and peak discharge in 1956 at which time the channel banks became heavily vegetated. Between 1952 and 2019, the river channel narrowed by 57–59 %. Approximately 2–4 m of bed aggradation occurred at most study sites. As the channel narrowed and became more vegetated, large floods maintained the narrower channel width but did not cause rewidening. Suspended-sediment transport data illustrate the sediment trapping effects of vegetation that lead to channel narrowing; suspended-sand concentrations decline, thereby indicating sediment deposition, as vegetation becomes progressively inundated during floods. Furthermore, dense channel-margin and floodplain vegetation provide increased roughness, resulting in flood-peak attenuation and alteration of hydrograph shape. Vegetation expansion causes positive feedbacks whereby sediment deposition during floods is exacerbated by the roughness and sediment-trapping effects of vegetation leading to further narrowing. These positive feedbacks have reduced sediment delivery to the Little Colorado River downstream. Channel widening is not likely to occur unless there are very large floods that exceed the erosional threshold of the channel-margin vegetation, or unless large-scale vegetation removal efforts are undertaken.

Epidemiology of Bronchiolitis and Respiratory Syncytial Virus and Analysis of Length of Stay from 2015 to 2022: Retrospective Observational Study of Hospital Discharge Records from an Italian Southern Province before and during the COVID-19 Pandemic.

Severe respiratory infections, including pneumonia or bronchiolitis, caused by RSV can range from mild upper respiratory tract infections to those leading to hospitalization and serious complications such as respiratory failure in children. High-risk groups, such as premature infants and infants with underlying medical conditions, have a higher susceptibility to severe RSV disease. We conducted a retrospective study from years 2015 to 2022 in the Local Health Authority (LHA) of Pescara that counts about 320,000 inhabitants, with the aim to evaluate the burden of RSV infection, focusing on the incidence, hospitalization, and characteristics that may prolong hospital stays. All hospitalizations from 2015 to 2022 were extracted from the hospital discharge record. The monthly hospitalization rates were calculated and standardized by gender and age for the population resident in the Province of Pescara on 1 January 2015. During the study period, 31,837 admissions were reported among patients aged less than 6 years. Of those, 520 hospitalizations were referred for bronchiolitis. Monthly admission rates highlighted the seasonality of bronchiolitis admissions, with higher rates in the months from December to March in all study years included. The winter seasons of years 2021 and 2022 reported a surge in bronchiolitis incidence, with a rate of 4.0/1000 (95% CI 2.964-5.146) in December 2021 and 4.0 (95% CI 2.891-5.020) in December 2022. Bronchiolitis represents an important cause of hospitalization among patients aged less than 6 years. The incidence was particularly increased during the winter seasons in years 2021 and 2022.

Comorbidity of Type 2 Diabetes and Dementia among Hospitalized Patients in Los Angeles County: Hospitalization Outcomes and Costs, 2019–2021

Hospitalizations for diabetes and dementia can impose a significant health and economic toll on older adults in the United States. This study sought to examine differences in hospitalization characteristics and outcomes associated with diabetes and dementia, separately and together, using 2019–2021 discharge record data from the California Department of Health Care Access and Information. The sampled group were residents of Los Angeles County who were aged 50+ at the time of the study. The multivariable linear regression analysis showed that compared to those with no diabetes or dementia, patients with diabetes alone exhibited the highest total charges, while those with comorbid diabetes and dementia exhibited lower charges (p &lt; 0.05). The multinomial logistic regression found that patients with comorbid diabetes and dementia had the highest odds of having a length of stay of 7+ days (Adjusted Odds Ratio = 1.49; 95% Confidence Interval (CI) = 1.44–1.53). A matched case–control analysis revealed that comorbid diabetes and dementia were associated with significantly lower odds of hypertensive disease than diabetes alone (Matched Odds Ratio = 0.81; 95% CI = 0.67–0.97). Collectively, these results highlight the complex factors that may influence the variable hospitalization outcomes that are common occurrences in these three distinct disease profiles. Study findings suggest a need to consider these complexities when developing policies or strategies to improve hospitalization outcomes for these conditions.