Time Of Discharge Research Articles

Prescription of Nicotine Replacement Therapy for Hospitalized Tobacco Users.

In hospitalized patients, cigarette smoking is linked to increased readmission rates, emergency department visits, and overall mortality. Smoking cessation reduces these risks, but many patients who smoke are unsuccessful in quitting. Nicotine replacement therapy (NRT) is an effective tool that assists patients who smoke with quitting. This study evaluates NRT prescriptions during and after hospitalization at a large health system for patients who smoke. A retrospective cohort study was conducted to determine the number of patients who were prescribed NRT during an inpatient admission and at time of discharge from a network of nine hospitals across South Carolina between January 1, 2019 and January 1, 2023. This study included 20,757 patients identified as actively smoking with at least one hospitalization during the study period. Of the cohort, 34.9% were prescribed at least one prescription for NRT during their admission to the hospital. Of the patients identified, 12.6% were prescribed NRT upon discharge from the hospital. This study identified significantly low rates of NRT prescribed to smokers during hospitalization and at discharge. Although the management of chronic conditions is typically addressed in the outpatient setting, hospitalization may provide an opportunity for patients to initiate health behavior changes. The low rates of prescriptions for NRT present an opportunity to improve tobacco treatment during hospitalization and beyond.

Statins use and recurrent venous thromboembolism in the direct oral anticoagulant era: insight from the COMMAND VTE Registry-2.

Statins were reported to have a potential effect of primary prevention of venous thromboembolism (VTE), although that of secondary prevention remains uncertain. To investigate the association between statins use and recurrent VTE in the current era. The COMMAND VTE Registry-2 is a multicenter registry enrolling 5,197 consecutive VTE patients among 31 centers in Japan between January 2015 and August 2020. We divided the entire cohort into 2 groups according to statins use at the time of discharge; the statins (N = 865) and no statins groups (N = 4332). The statins group was older (72.9 vs. 66.7 years, P < 0.001), and less often had active cancer (22.0% vs. 30.4%, P < 0.001). The cumulative incidence of discontinuation of anticoagulation was significantly lower in the statins group (60.3% vs. 52.6%, Log-rank P < 0.001). The cumulative 5-year incidence of recurrent VTE was significantly lower in the statins group (6.8% vs. 10.1%, Log-rank P = 0.01). Even after adjusting for the confounders, the lower risk of the statins group relative to the no statins group remained significant for recurrent VTE (HR 0.65, 95% CI 0.45-0.91, P = 0.01). The cumulative 5-year incidence of major bleeding was significantly lower in the statins group (12.2% vs. 14.1%, Log-rank P = 0.04), although, after adjusting for the confounders, the risk of the statins group relative to the no statins group turned to be insignificant (HR 0.77, 95% CI 0.59-1.00, P = 0.054). In this large real-world VTE registry, statins use was significantly associated with a lower risk for the recurrent VTE in the current era.

Association Between Low-Dose Ketamine After Periacetabular and/or Femoral Osteotomy and Postoperative Opioid Requirements.

Previous studies have sought to determine the effect of inpatient ketamine therapy on postoperative pain in a variety of surgical specialties. To determine the effects of postoperative ketamine analgesia after periacetabular osteotomy (PAO) and/or derotational femoral osteotomy (DFO) on opioid requirements, pain, and discharge time. Cohort study; Level of evidence, 3. Prospective data were collected on 145 patients who underwent PAO and/or DFO by the senior author between January 2021 and December 2022. Hip arthroscopy was performed 3 to 10 days before addressing any intra-articular pathology. In 2021, patients (n = 91 procedures; control group) received a traditional postoperative multimodal pain regimen. In 2022, postoperative low-dose ketamine (0.1-1 mg/kg/h) was added to the multimodal analgesic approach until 24 hours before discharge (n = 81 procedures; ketamine group). The ketamine and control groups were matched based on procedure type. Total opioid consumption was collected using milligram morphine equivalents (MMEs) for both groups. Postoperative pain was measured using the Defense and Veterans Pain Rating Scale (DVPRS), which was analyzed as the mean score per day. Data on the mean MME and DVPRS were analyzed for up to 7 days postoperatively. Linear mixed statistical analysis was performed to determine the significance of low-dose postoperative ketamine on postoperative pain and opioid utilization. Patients who did not receive ketamine after PAO and/or DFO utilized a mean of 181 ± 335 MMEs and had a mean DVPRS score of 4.18 ± 1.63. Patients who received postoperative ketamine required a mean of 119 ± 291 MMEs and had a mean DVPRS score of 4.34 ± 1.61. The ketamine group was found to consume a significantly lower total MME dose per day (P < .001). No significant difference was found in the mean DVPRS score between the ketamine and control groups (P = .42). Also, no significant difference was found on the day of discharge (P = .79). Patients who received postoperative ketamine after PAO and/or DFO had a significant decrease in MME dose when compared with a control group of patients who did not receive ketamine. Surgeons should consider adding ketamine to their postoperative multimodal pain control protocol to decrease opioid consumption while adequately addressing postoperative pain.

Etiology, Clinical Characteristics and Prognosis of Secondary Hemophagocytic Syndrome

To understand the etiology, clinical characteristics and prognosis of secondary hemophagocytic syndrome (HLH), so as to improve the understanding of HLH and reduce the rates of misdiagnosis and missed diagnosis of HLH. A retrospective study was conducted to analyze the cause, clinical characteristics, laboratory findings, therapy and outcomes of 75 adult patients with secondary HLH admitted to our hospital from January 2015 to December 2021. Follow-up continued until the last discharge time. Among 75 patients, infection-related HLH was the most common (45.33%), followed by lymphoma-related HLH (17.33%). Fever was the most common clinical manifestation (97.67%). Laboratory indicators such as NK cell activity (98.31% low or absent), sCD25 (93.22% increased), and serum ferritin (94.44% elevated) had higher sensitivity in diagnosis. By comparing the clinical manifestations and laboratory indicators of HLH patients with different causes, sex, lymph node enlargement and bone marrow morphology were more valuable for the diagnosis of primary disease (all P <0.05). By comparing the treatment and clinical outcomes of HLH patients with different causes, the highest clinical remission rate (83.3%) was achieved in patients with autoimmune disease-related HLH treated with hormone+cyclosporine (P <0.05). The overall 12-month survival rate of all patients was 26.7%, in which the infection-related HLH was the lowest (14.7%) while autoimmune disease-related HLH was the highest (63.6%). The causes and clinical characteristics of adult secondary HLH are varied, with poor prognosis and heterogeneity in disease severity. It is important to identify HLH cause early for diagnosis and needed to further understand HLH.

Design, implementation, and impact of a cirrhosis-specific remote patient monitoring program.

Remote patient monitoring (RPM) is an emerging focus in health care, and specialized programs may reduce medical costs, supplement in-office visits, and improve patient satisfaction. In this study, we describe the development, feasibility, and early outcomes of an RPM program for patients with decompensated cirrhosis. Forty-six patients were offered enrollment at the time of hospital discharge in the cirrhosis RPM program (CiRPM), of which 41 completed at least 30 days of monitoring. Participants were mailed remote monitoring equipment and a tablet to be used for patient-reported outcomes. Alerts were continuously monitored by virtual nursing staff who could perform targeted interventions. A cohort of historical controls (n = 74) was created for comparison using inverse probability of treatment weighting. Patients were enrolled in the program for a mean of 83.9 days, with 28 (68%) completing the full 90-day program. Participants uploaded vital signs and responded to symptom-based questionnaires on 93% of the monitored days. On end-of-program surveys, over 75% of patients expressed satisfaction with the program. Gender, age, and MELD-Na were similar between CiRPM and weighted control groups. The 90-day readmission rate was 34% in CiRPM and 47% in weighted controls. In the CiRPM group, 12% of subjects had 2 or more admissions, compared to 37% in the weighted control group. This study demonstrates the feasibility of a cirrhosis-specific RPM program. Overall, patient satisfaction and utilization of the CiRPM was high. Future studies are needed to confirm the impact of RPM on the reduction of hospital readmissions in decompensated cirrhosis.

Toxoplasma gondii rhoptry discharge factor 3 is essential for invasion and microtubule-associated vesicle biogenesis.

Rhoptries are specialized secretory organelles conserved across the Apicomplexa phylum, essential for host cell invasion and critical for subverting of host cellular and immune functions. They contain proteins and membranous materials injected directly into the host cells, participating in parasitophorous vacuole formation. Toxoplasma gondii tachyzoites harbor 8 to 12 rhoptries, 2 of which are docked to an apical vesicle (AV), a central element associated with a rhoptry secretory apparatus prior to injection into the host cell. This parasite is also equipped with 5 to 6 microtubule-associated vesicles, presumably serving as AV replenishment for iterative rhoptry discharge. Here, we characterized a rhoptry protein, rhoptry discharge factor 3 (RDF3), crucial for rhoptry discharge and invasion. RDF3 enters the secretory pathway, localizing near the AV and associated with the rhoptry bulb. Upon invasion, RDF3 dynamically delocalizes, suggesting a critical role at the time of rhoptry discharge. Cryo-electron tomography analysis of RDF3-depleted parasites reveals irregularity in microtubule-associated vesicles morphology, presumably impacting on their preparedness to function as an AV. Our findings suggest that RDF3 is priming the microtubule-associated vesicles for rhoptry discharge by a mechanism distinct from the rhoptry secretory apparatus contribution.

Ultrahigh efficiency and energy density in tri-layered ferroelectric polymer composites utilizing ultralow loading of micro-sized plates

Ferroelectric-based composites have demonstrated tremendous potential in electrostatic capacitor owing to their exceptional dielectric characteristics. However, it is extremely challenging to attain desirable energy density (Ue) and above 95% efficiency (η) under low electric fields in the ferroelectric polymer-based composites because of the dominating electrical conduction loss. Herein, ferroelectric polymer composites consisting of SrTiO3@SiO2 plates/(PVDF-co-HFP) as the inner layer and polycarbonate (PC) as the outer polymer layers are elaborately proposed. The vital role of the multiple interlaminar interfaces (electrode/dielectric interface and interlayer interface) on the reduction of conduction loss and improvement of corresponding energy storage properties of the ferroelectric polymer is verified by experimental and theoretical simulations. The resulting composite with an ultralow loading of SrTiO3@SiO2 plates (0.5 vol%) displays a record high capacitive performance (∼8.73 J/cm3) at above 95% η under the low electric field of 280 MV/m1, indicating an enormous ∼118% increment of the maximal Ue over the commercial bench-mark biaxially oriented polypropylene (∼4 J/cm3) and far outperforming those of the polymer-based dielectrics reported to date. Along with fast discharge time (9 ns), this contribution presents a versatile and competitive technology for fabricating composites with exceptional energy storage capabilities operating under low electric fields.

Evaluation of Add-On Individualized Homeopathic Medicines Products in the Treatment of Symptomatic COVID-19 Managed at Home: A Double Blind, Placebo-Controlled, Randomized, Exploratory Clinical Trial

Homeopathy has shown promise in fighting epidemics, leading to potential applications in the COVID-19 clinical cases. To assess the impact of add-on individualized homeopathic medicinal products (IHMP) in improving clinical outcomes and time to medical discharge in COVID-19 patients. A prospective, double-blind, randomized, placebo-controlled, parallel-group exploratory clinical trial was conducted in a São Paulo state municipality, Brazil, between February and July 2021. 82 (unvaccinated) patients with confirmed SARS-CoV-2 infection and manageable mild to moderate COVID-19 symptoms were randomly assigned to placebo or IHMP groups. Utilizing unique global COVID-19 symptom scores, a symptom assessment was performed. Statistical analysis involved 68 patients (36 IHMP; 32 placebo). No significant initial disparity existed in total COVID-19 symptom scores between the groups. The IHMP group exhibited a significantly shorter mean time from initial appointment to medical discharge compared to placebo (p &lt; 0.05: IHMP 74.5 hours (+/- 57.47, 95% CI: 55.73-93.27); placebo 137.42 hours (+/- 87.85, 95% CI: 106.98-167.86)). Employing the chi-square trend test at selected time points (74.5 and 137.42 hours, corresponding to mean discharge times), COVID-19 scores demonstrated sustained IHMP-associated reductions (p &lt; 0.05). COVID-19 symptom scores and time to medical discharge were significantly reduced by treatment with IHMP compared to placebo, suggesting a potential role for IHMP in managing mild to moderate COVID-19 symptoms at home.

Identifying manning roughness coefficient using automatic calibration method and simulation of pollution incidents in the Nile River, Egypt

Study regionA reach of the Nile River located between Naga Hammadi barrage and Asyut barrage, Egypt Study focusAn accurate representation of hydrodynamics of an important water source helps cope with expected future climate changes, pollution incidents and water quality problems. Here, a comparison between HEC-RAS 1D and TELEMAC-2D model was conducted by identifying different Manning coefficients. Moreover, an automatic calibration using Dual-Annealing optimization method was applied for first time to calibrate the model with non-uniform Manning coefficients. The transport of tracer (pollution) was simulated by computing tracer residence times. Pollution transport scenarios were discussed to draw a picture of pollution incidents which will continue to happen in the future. An equation indicating the relation between flow discharge and residence time was derived to hurriedly help decision makers in water management during sudden pollution incidents. New hydrological insights for the regionA model with spatially variable Manning coefficients using TELEMAC-2D was set up and calibrated achieving good accuracyies with average errors of approximately 4 cm and 7 cm between field and simulated water levels for two different discharge scenarios. Moreover, an equation for relation between flow discharge and residence time was derived producing a strong correlation coefficient of 0.95. This study, integrating advanced hydrodynamic models and automatic calibration techniques, provides a robust framework for assessing and managing water resource challenges under varying flow conditions.

Transforaminal lumbar interbody fusion with or without release of the anterior longitudinal ligament: A single-center, retrospective observational cohort study

Background: Transforaminal anterior release (TFAR) is a technical extension of the transforaminal lumbar interbody fusion (TLIF) procedure with deliberate release of the anterior longitudinal ligament (ALL). Methods: In a retrospective, single-center observational cohort study, consecutive adult patients undergoing TLIF surgery at L4/L5 and/or L5/S1 between 01/2018 – 12/2022 for degenerative disc disease or deformity were considered. The TFAR group (with ALL release) was compared to a standard TLIF group (without ALL release), matched in a 1:3 ratio. Uni- and multivariable logistic regression models were built to estimate the likelihood of any AE, reoperation, and excellent/good clinical outcome at 12 months. Results: Of 438 patients, 18 undergoing TFAR were matched to 53 undergoing standard TLIF. TFAR procedures were frequently part of extensive, anterior-posterior or multilevel fusion procedures with longer surgery time and higher blood loss. The rates of intraoperative surgical AEs were similar (16.7 vs. 11.3%, p=0.789). The rates and severities of surgical AEs, as well as reoperation rates and clinical outcomes were similar at time of discharge, 90 days, and 12 months postoperatively (all p>0.05). TFAR allowed for an increase in total lumbar lordosis of 16.1° and in lumbar lordosis between L4-S1 of 16.3° at discharge, which was maintained during follow-up. In both the uni- and multivariable models, patients undergoing TFAR were as likely as patients undergoing standard TLIF to experience any complication (adjusted OR 0.78, 95% CI 0.21 – 2.94), any reoperation (aOR 0.46, 95% CI 0.11 – 1.90) or excellent/good clinical outcome at 12 months (aOR 2.01, 95% CI 0.52 – 7.74). Conclusions: The TFAR technique has a safety profile which is comparable to the standard TLIF procedure, but it allows for a greater restoration of lumbar lordosis at L4-S1. We suggest considering the TFAR technique in selected patients with sagittal imbalance and mobile segments for restoration of lumbar lordosis.

Residual Dizziness Characteristics of Idiopathic Sudden Sensorineural Hearing Loss Patients with Benign Paroxysmal Positional Vertigo.

ISSNHL, a common clinical condition, can be accompanied by vertigo. Initially, research on sudden deafness primarily focused on the hearing loss itself, with less emphasis on episodic vertigo. However, as vertigo research has advanced, it has been recognized that BPPV is a frequent accompaniment to ISSNHL-associated vertigo. Even after treatment, some patients may experience residual dizziness. This study investigates the characteristics of patients with ISSNHL accompanied by BPPV and the impact of residual dizziness on their lives. This study is being conducted on patients with ISSNHL accompanied by BPPV, analyzing the characteristics of such patients and the impact of residual dizziness on their lives. Overall, 54 adult inpatients with ISSNHL and BPPV were included in this study. All patients received 50 mg of intravenous prednisolone for 5 consecutive days and hemodilution agents for 10 days. At the same time, BPPV was treated with repositioning by the same therapist using the SRM-IV vertigo diagnostic and treatment system, and different repositioning methods were used for different types of otolithiasis. Patients were grouped according to the absence of residual dizziness when the nystagmus disappeared at the time of discharge. There were 24 cases in the group with residual symptoms, including 10 males and 14 females. The proportion of females was 58.33%, with an average age of 46.75 ± 13.80. The group without residual symptoms consisted of 30 cases, including 13 males and 17 females. The female proportion was 56.67%, with an average age of 45.77 ± 11.86. There is no statistical significance between the two groups in the pre-treatment hearing status and DHI scores. The HAMA (Hamilton Anxiety Rating Scale) scores before treatment were compared, revealing a significant statistical difference. ISSNHL-associated BPPV may be caused by vascular embolism or thrombosis in the cochlear or spiral modiolar artery. This disrupts blood flow, leading to ischemia in the otolithic membrane and subsequent detachment of otoconia. Because this detachment often occurs within 24 h of the initial event, patients experience positional vertigo early in the course of the disease.

The Fate of the Left Ventricular Outflow Tract Following Interrupted Aortic Arch Repair.

Objectives: To examine the probability of left ventricular outflow tract (LVOT) reintervention following interrupted aortic arch (IAA) repair in neonates with LVOT obstruction (LVOTO) risk. Methods: This retrospective multicenter study included 150 neonates who underwent IAA repair (2003-2017); 100 of 150 (67%) had isolated IAA repair (with ventricular septal defect closure) and 50 of 150 (33%) had concomitant LVOT intervention: conal muscle resection (n = 16), Ross-Konno (n = 7), and Yasui operation (n = 27: single-stage n = 8, staged n = 19). Demographic and morphologic characteristics were reviewed. Factors associated with LVOT reoperation were explored using multivariable analysis. Results: Concomitant LVOT intervention was more likely in neonates with type B IAA, bicuspid aortic valve, aberrant right subclavian artery, smaller aortic valve annulus, and ascending aorta dimensions. On follow-up, five-year freedom from LVOT reoperation was highest following Ross-Konno (100%), 77% following Yasui (mainly for neo-aortic regurgitation), 77% following isolated IAA repair (mainly for LVOTO), and 47% following IAA repair with concomitant conal resection, P = .033. While all patients had low peak LVOT gradient at time of discharge, those who had conal resection developed higher gradients on follow-up (P = .007). Ross-Konno and Yasui procedures were associated with higher right ventricular outflow tract (RVOT) reoperation. In the cohort following isolated IAA repair, aortic sinus Z score was associated with LVOT reoperation. Conclusions: Both Yasui and Ross-Konno operations effectively mitigate late LVOTO risk. The highest risk of reintervention for LVOTO was associated with conal muscle resection while the lowest risk is associated with Ross-Konno. The RVOT reoperation risk in patients who had Ross-Konno or Yasui does not seem to affect survival.

Changes in the residence of elderly people after hospitalization in the Integrated Community Care Ward

When elderly people return to their daily lives after inpatient treatment, they may be offered a chance to change the residence to which they are accustomed. The present study clarified the changes in the residence of elderly patients through an Integrated Community Care Ward (ICCW). Patients were admitted to and discharged from the ICCW (53 beds) of Hospital A, located in a city with a population of 30,000 and an aging rate of 37%, for 2 years from April 1, 2018, to March 31, 2020. Patients ≥65 years old were included in the study. We conducted a retrospective survey of information recorded in the electronic medical record system and collected information on activities of daily living, medical procedures at the time of discharge, residence before and after hospitalization, and intentions regarding discharge destination within seven days of hospitalization. Of the 735 patients ≥65 years old who were admitted to the ICCW, 608 were included, excluding 127 patients admitted for scheduled surgeries. The average age was 82.9 years old, with 52% being over 85 years and 26% being over 90 years old. Of the 465 people hospitalized from home, 64% were discharged, 23% changed to a facility or hospital, and the remaining 13% died. More than 80% of the 143 discharged from facilities or hospitals returned to facilities, but 36 (25%) were discharged to a different facility from before admission. Of the 404 patients who were admitted from home and discharged alive, independence in eating, independence in movement, and having family members living with them were independently related factors for achieving discharge home. Regarding the intended discharge destination within 7 days after hospitalization, of the 246 hospitalized patients who wished to be discharged home, 56 said they wanted to be discharged to a facility or hospital, showing a discrepancy of 23%. Many elderly people changed their residences after admission to the ICCW. While coordinating disagreements within families as well as navigating medical and nursing care constraints, dialogue across multiple professions should be continued to help elderly patients live their own lives.

Evaluation and Comparison of Breach Parametric Model for Embankment Dams

Reliable approximations for breach parameters using a parametric model due to embankment dam failure are very significant factors in dam safety and mitigation measures. Therefore, utilizing information on historically unsuccessful embankment dams, several empirical models have been formulated by different researchers. There is still no universal method for calculating the occurrence of dam breaches. The main objective of this research is to evaluate and compare the selected parametric dam breach models that are available in the literature. Four models (Xu et al., Vescher et al., Froehlich, and USB Reclamation) were chosen to forecast the breach event's parameters and peak discharges. Historically, 59 failed embankment dams’ data in various countries around the world were used. In order to assess and compare the breach models and recommend the best-performing model for predicting the peak discharge, breach width, and failure time, ten (10) statistical quantitative indicators were used. The breach model developed by Xu et al. has good performance. Finally, to show the impacts of erodibility, validation, and sensitivity of the selected model, it was checked using eight dams’ data. During the validation, the calculated and observed results were in agreement. Sensitivity revealed that large fluctuations in the breach parameter and peak discharge were seen when the erodibility coefficient increased or decreased.

Early Burst Suppression Similarity Association with Structural Brain Injury Severity on MRI After Cardiac Arrest.

Identical bursts on electroencephalography (EEG) are considered a specific predictor of poor outcomes in cardiac arrest, but its relationship with structural brain injury severity on magnetic resonance imaging (MRI) is not known. This was a retrospective analysis of clinical, EEG, and MRI data from adult comatose patients after cardiac arrest. Burst similarity in first 72h from the time of return of spontaneous circulation were calculated using dynamic time-warping (DTW) for bursts of equal (i.e., 500ms) and varying (i.e., 100-500ms) lengths and cross-correlation for bursts of equal lengths. Structural brain injury severity was measured using whole brain mean apparent diffusion coefficient (ADC) on MRI. Pearson's correlation coefficients were calculated between mean burst similarity across consecutive 12-24-h time blocks and mean whole brain ADC values. Good outcome was defined as Cerebral Performance Category of 1-2 (i.e., independence for activities of daily living) at the time of hospital discharge. Of 113 patients with cardiac arrest, 45 patients had burst suppression (mean cardiac arrest to MRI time 4.3days). Three study participants with burst suppression had a good outcome. Burst similarity calculated using DTW with bursts of varying lengths was correlated with mean ADC value in the first 36h after cardiac arrest: Pearson's r: 0-12h: -0.69 (p = 0.039), 12-24h: - 0.54 (p = 0.002), 24-36h: - 0.41 (p = 0.049). Burst similarity measured with bursts of equal lengths was not associated with mean ADC value with cross-correlation or DTW, except for DTW at 60-72h (- 0.96, p = 0.04). Burst similarity on EEG after cardiac arrest may be associated with acute brain injury severity on MRI. This association was time dependent when measured using DTW.

Impaired Gastrointestinal Motility and Worsening Heart Failure in Patients Receiving Trans-Catheter Aortic Valve Replacement.

Background: Impaired gastric motility in the form of constipation may often occur in elderly patients with chronic heart failure. Candidates for trans-catheter aortic replacement (TAVR) are of old age and have multiple comorbidities, probably including constipation. However, the clinical implication of a history of constipation in patients receiving TAVR remains unknown. Methods: Patients who underwent TAVR at our large academic center between 2015 and 2022 were eligible. The prognostic impact of the prescribed laxative type and number, which was assumed as the severity of constipation, on the incidence of death or heart failure readmission two years after index discharge was investigated. Results: A total of 344 patients were included. Median age was 85 years, and 99 patients were men. Patients with any laxatives (N = 166) had higher systolic blood pressure, higher plasma B-type natriuretic peptide levels, and a lower prescription rate of renin-angiotensin system inhibitors at the time of index discharge after TAVR (p < 0.05 for all). The number of laxative types was independently associated with the composite primary outcome with an adjusted hazard ratio of 1.83 (95% confidence interval 1.27-2.63, p = 0.001) with a cutoff of one type of laxative used, which significantly stratified the 2-year cumulative incidence of the primary outcome (18% versus 7%, p = 0.001). Conclusions: The presence of constipation was associated with worse clinical outcomes following TAVR. The prognostic impact of an aggressive intervention for constipation remains a future concern in this cohort.

Gradient p‐Polyanion/n‐Polycation Heterojunction Endows Ionic Diodes with Vastly Boosted Output Voltage, Power Density and Sensitivity

AbstractIonic diode‐based generators show great superiority in harvesting low‐frequency mechanical energy from human motions for various wearable applications. The major challenge is to improve their extremely limited output voltage for the miniaturization/simplicity of ionic diode‐based self‐powered devices as well as further improvement of mechanoelectric conversion performance. Herein, the construction of gradient polycation/polyanion heterojunction is demonstrated to vastly boost the output voltage, energy‐harvesting efficiency, and sensing performance of ionic diode. Besides an inherent potential at the polyanion/polycation heterojunction interface, the additional transmembrane potentials can be generated across gradient polyanion and polycation conductors of ionic diodes due to their gradient charge distribution. Consequently, the gradient ionic diode‐based generators produce much higher output voltage (306.53 mV) than previously reported homogeneous ones (4.1–135 mV). Meanwhile, the high output voltage imparts gradient ionic diode‐based generator with ultrahigh power density (50.16 µW cm−2 or 250.8 µW cm−3) and pressure‐perception sensitivity (43582 mV/MPa), which are dramatically increased by 162.76% and 128.71%, respectively, compare to those of homogeneous one. Impressively, the resulting diode‐based generators can generate ultralarge current density (≈0.52 mA cm−2) with ultralong discharge time (&gt;400 s), thus enabling the continuous power generation under the low‐frequency pressure for various wearable and implantable applications.

Effective ignition energy for capacitor short-circuit discharge in explosive environments

Capacitors short-circuit discharge in an explosive environment can ignite and detonate the surrounding explosive media, causing dangerous accidents. At low voltages, this kind of discharge constitutes a micro-nano discharge; because the discharge gaps here are of the order of only microns to nanometers, the discharge process, electrode energy consumption, explosive media ignition energy, and other energy relationships are unclear. To study the relationships between the capacitor storage energy and various kinds of dissipation energies under short-circuit discharge, a model comprising conical and spherical cylinder microbumps is proposed based on the cathode surface morphology obtained by three-dimensional profiling and scanning electron microscopy, respectively. Then, the second-order non-chi-squared differential equations were established based on the principle of energy conservation and heat balance to deduce the relationships between the cathode surface temperature and height of the microbump, conical angle, and spherical radius; further, the energy consumed by the anode surface is calculated based on the theory of heat transfer. Using heat conduction theory, the energy consumed by the microbumps on the cathode surface is calculated, and the energy consumed on the anode surface is deduced using the surface heat source as the loading heat source. The residual energy of the capacitor is calculated from the discharge time and voltages before and after discharge, and the effective energy of the gas is calculated using the law of conservation of energy. Finally, the discharge channel energy, electrode energy consumption, and end residual energy of the discharge capacitor are used to derive the effective ignition energy of the explosive gas. This research is of great significance for the design of intrinsically safe circuits with high power.

Race as social determinant of growth and body composition among infants born very preterm.

Racism leads to disparities in health outcomes. Our objective was to determine if black race was independently associated with differences in fat accretion at discharge in a large cohort of very preterm infants (32 weeks of gestation or less). De-identified demographic, anthropometric and body composition data were collected from seven neonatal units around the United States. Weight, length, and head circumference z-scores at birth and at the time of body composition assessment or hospital discharge were calculated. The median gestational age and birthweight for this cohort (n = 888) were 29 weeks [IQR, 27-30] and 1167 g [SD, 354], respectively. The study population included 53% black preterm infants. Birthweight was lower in black preterm infants compared with white infants (1112 ± 334 g vs. 1228 ± 366 g; p < 0.0001). After adjusting for birthweight, gestational age, and birthweight-for-age z-score, black preterm infants had more weight gain (adjusted mean difference: 0.5 g/kg/day; p = 0.03) but not higher BF% z-scores at hospital discharge (adjusted mean: 1.2 vs. 1.3; p = 0.14) than white infants. After adjusting for covariates, black race was associated with higher weight gain velocity but not higher BF% z-scores. This study presents findings from a large-scale multicenter cohort. Racial differences were observed in birth weight and the rate of weight gain; however, these differences were not associated with dissimilarities in body composition outcomes. Understanding nutrition and growth outcomes across racial groups is necessary to combat racial disparities in the neonatal intensive care unit (NICU).

Medications for alcohol-use disorder and follow-up after hospitalization for alcohol withdrawal: A multicenter study.

Alcohol withdrawal is a common reason for admission to acute care hospitals. Prescription of medications for alcohol-use disorder (AUD) and close outpatient follow-up are commonly recommended, but few studies report their effects on postdischarge outcomes. The objective of this study is to evaluate the effects of medications for AUD and follow-up appointments on readmission and abstinence. This retrospective cohort study evaluated veterans admitted for alcohol withdrawal to medical services at 19 Veteran Health Administration hospitals between October 1, 2018 and September 30, 2019. Factors associated with all-cause 30-day readmission and 6-month abstinence were examined using logistic regression. Of the 594 patients included in this study, 296 (50.7%) were prescribed medications for AUD at discharge and 459 (78.5%) were discharged with follow-up appointments, including 251 (42.8%) with a substance-use clinic appointment, 191 (32.9%) with a substance-use program appointment, and 73 (12.5%) discharged to a residential program. All-cause 30-day readmission occurred for 150 patients (25.5%) and 103 (17.8%) remained abstinent at 6 months. Medications for AUD and outpatient discharge appointments were not associated with readmission or abstinence. Discharge to residential treatment program was associated with reduced 30-day readmission (adjusted odds ratio [AOR]: 0.39, 95% confidence interval [95% CI]: 0.18-0.82) and improved abstinence (AOR: 2.50, 95% CI: 1.33-4.73). Readmission and return to heavy drinking are common for patients discharged for alcohol withdrawal. Medications for AUD were not associated with improved outcomes. The only intervention at the time of discharge that improved outcomes was discharge to residential treatment program, which was associated with decreased readmission and improved abstinence.