scholarly journals The Impact of Transferring Stroke Patients: An Analysis of National Administrative Data

2016 ◽  
Vol 43 (6) ◽  
pp. 760-764 ◽  
Author(s):  
Charlotte Zerna ◽  
Noreen Kamal ◽  
M. Patrice Lindsay ◽  
Jiming Fang ◽  
Michael D. Hill
Keyword(s):  
Administrative Data ◽  
Discharge Rate ◽  
System Structure ◽  
Lower Mortality ◽  
Stroke Patients ◽  
High Discharge ◽  
High Discharge Rate ◽  
Transferred Patients ◽  
Stroke Center ◽  
The Impact

AbstractBackground: Interhospital transfer is an important but resource-intensive pattern of care. The use for stroke patients is highly dependent upon health system structure. We examined the impact of hospital transfers for stroke care in Canada. Methods: We analyzed hospital administrative data within the Canadian Institute for Health Information (CIHI) Database for the 3 fiscal years 2011/12, 2012/13 and 2013/14. Patients with clinical stroke syndrome (ischemic or hemorrhagic) were identified using International Classification of Diseases. Stroke centers were defined by Heart & Stroke Foundation of Canada stroke report. Results: During the 3-year period,397 patients in Canada (excluding Quebec) were admitted to hospital for clinical stroke syndrome. Median age was 75 (interquartile range [IQR] 64–84) years; 50.6 % were male. Less than 5% (n=4030) of patients were transferred. Patients transferred to stroke centers were younger (p<0.001) and had shorter median length of stay (p<0.001). The highest probability of discharge home was associated with sole care at stroke center (43.8%). Transfer to stroke center from community hospital had the highest probability for discharge to rehabilitation facility (25%) and lowest to either long-term (2.1%) or complex community care (2.0%). Transferred patients had lower mortality at discharge. Conclusion: Younger patients were transferred more frequently to stroke centers; older patients were more likely treated in community hospitals. Sole stroke center care was associated with high discharge rate to home; transfer to a stroke center was associated with high discharge rate to rehabilitation and lower mortality rates.

scholarly journals Nanocomposite multilayer capacitors comprising BaTiO3@TiO2 and poly(vinylidene fluoride-hexafluoropropylene) for dielectric-based energy storage

2014 ◽  
Vol 04 (02) ◽  
pp. 1450009 ◽  
Author(s):  
Mojtaba Rahimabady ◽  
Li Lu ◽  
Kui Yao
Keyword(s):  
Energy Storage ◽  
Energy Density ◽  
Vinylidene Fluoride ◽  
Discharge Rate ◽  
Low Cost ◽  
Breakdown Field ◽  
High Discharge ◽  
High Discharge Rate ◽  
Poly Vinylidene Fluoride ◽  
Multilayer Capacitors

Multilayer dielectric capacitors were fabricated from nanocomposite precursor comprised of BaTiO 3@ TiO 2 core–shell nanosized particles and poly(vinylidene fluoride–hexafluoropropylene) (P(VDF–HFP)) polymer matrix (20 vol%). The multilayer capacitors showed very high discharge speed and high discharged energy density of around 2.5 J/cm3 at its breakdown field (~ 166 MV/m). The energy density of the nanocomposite multilayer capacitors was substantially higher than the energy density of commercially used power capacitors. Low cost, flexible structure, high discharge rate and energy density suggest that the nanocomposite multilayer capacitors are promising for energy storage applications in many power devices and systems.

scholarly journals High Discharge Rate Lithium Ion Batteries with the Composite Cathode of LiFePO4/Mesocarbon Nanobead

2010 ◽  
Vol 177 ◽  
pp. 208-210
Author(s):  
Yi Jie Gu ◽  
Cui Song Zeng ◽  
Yu Bo Chen ◽  
Hui Kang Wu ◽  
Hong Quan Liu ◽  
...  
Keyword(s):  
Lithium Ion Batteries ◽  
Room Temperature ◽  
Discharge Rate ◽  
Rate Capability ◽  
Lithium Ion ◽  
Composite Cathode ◽  
Rate Performance ◽  
High Discharge ◽  
High Discharge Rate ◽  
Lifepo4 Cathode

Olivine compounds LiFePO4 were prepared by the solid state reaction, and the electrochemical properties were studied with the composite cathode of LiFePO4/mesocarbon nanobead. High discharge rate performance can be achieved with the designed composite cathode of LiFePO4/mesocarbon nanobead. According to the experiment results, batteries with the composite cathode deliver discharge capacity of 1087mAh for 18650 type cell at 20C discharge rate at room temperature. The analysis shows that the uniformity of mesocarbon nanobead around LiFePO4 can supply enough change for electron transporting, which can enhance the rate capability for LiFePO4 cathode lithium ion batteries. It is confirmed that lithium ion batteries with LiFePO4 as cathode are suitable to electric vehicle application.

scholarly journals EAST RIVER BATTLE FOR SHEEN: SKIMMING AN OIL SHEEN IN A 3- TO 5-KNOT CURRENT

2001 ◽  
Vol 2001 (2) ◽  
pp. 1431-1434
Author(s):  
Dennis E. Connelly ◽  
Dennis J. McCarthy ◽  
John E. Westerlind
Keyword(s):  
New York ◽  
Current Flow ◽  
Discharge Rate ◽  
Water Discharge ◽  
Cooling Water ◽  
High Discharge ◽  
East River ◽  
Discharge Canal ◽  
High Discharge Rate ◽  
Set Up

ABSTRACT This paper explores the challenges involved with the recovery of oil from a discharge canal with limited access and high relative currents. In March 1999, a sheen was observed in the cooling water discharge canal of Consolidated Edison's 2.5-million kilowatt generating station in Queens (New York City), New York At the time the sheen was discovered, the entire station had been shut down for several months for a maintenance outage. As the tide rose and fell in the East River, into which the discharge canal emptied, the oil sheen moved in and out of a 1,000-foot long tunnel connecting the generating station to the canal. The major challenges to the recovery and removal of the oil sheen were: (1) the low over head of the discharge tunnel and canal support girders, which prevented getting a skimmer into the tunnel and canal; (2) the high discharge rate of the station's cooling water pump; and (3) skimming the sheen in a 3-to 5-knot current. Consolidated Edison is a member of Clean Harbors Cooperative, L.L.C, which was brought in to remove the sheen. This was accomplished utilizing two JBF Scientific DIP Belt Skimmers, which were set up parallel to the current flow, and deflection booming.

scholarly journals The stroke mothership model survived during COVID-19 era: an observational single-center study in Emilia-Romagna, Italy

2020 ◽  
Vol 41 (12) ◽  
pp. 3395-3399
Author(s):  
Andrea Zini ◽  
Michele Romoli ◽  
Mauro Gentile ◽  
Ludovica Migliaccio ◽  
Cosimo Picoco ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Time ◽  
Combined Treatment ◽  
Temporal Trends ◽  
Stroke Care ◽  
Minor Stroke ◽  
Care Organization ◽  
Stroke Patients ◽  
Stroke Center ◽  
The Impact

Abstract Introduction A reduction of the hospitalization and reperfusion treatments was reported during COVID-19 pandemic. However, high variability in results emerged, potentially due to logistic paradigms adopted. Here, we analyze stroke code admissions, hospitalizations, and stroke belt performance for ischemic stroke patients in the metropolitan Bologna region, comparing temporal trends between 2019 and 2020 to define the impact of COVID-19 on the stroke network. Methods This retrospective observational study included all people admitted at the Bologna Metropolitan Stroke Center in timeframes 1 March 2019–30 April 2019 (cohort-2019) and 1 March 2020–30 April 2020 (cohort-2020). Diagnosis, treatment strategy, and timing were compared between the two cohorts to define temporal trends. Results Overall, 283 patients were admitted to the Stroke Center, with no differences in demographic factors between cohort-2019 and cohort-2020. In cohort-2020, transient ischemic attack (TIA) was significantly less prevalent than 2019 (6.9% vs 14.4%, p = .04). Among 216 ischemic stroke patients, moderate-to-severe stroke was more represented in cohort-2020 (17.8% vs 6.2%, p = .027). Similar proportions of patients underwent reperfusion (45.9% in 2019 vs 53.4% in 2020), although a slight increase in combined treatment was detected (14.4% vs 25.4%, p = .05). Door-to-scan timing was significantly prolonged in 2020 compared with 2019 (28.4 ± 12.6 vs 36.7 ± 14.6, p = .03), although overall timing from stroke to treatment was preserved. Conclusion During COVID-19 pandemic, TIA and minor stroke consistently reduced compared to the same timeframe in 2019. Longer stroke-to-call and door-to-scan times, attributable to change in citizen behavior and screening at hospital arrival, did not impact on stroke-to-treatment time. Mothership model might have minimized the effects of the pandemic on the stroke care organization.

scholarly journals Estimating the State of Health of Lithium-Ion Batteries with a High Discharge Rate through Impedance

Energies ◽  
2021 ◽  
Vol 14 (16) ◽  
pp. 4833
Author(s):  
Shida Jiang ◽  
Zhengxiang Song
Keyword(s):  
Lithium Ion Batteries ◽  
Relative Error ◽  
Discharge Rate ◽  
Lithium Ion ◽  
Impedance Spectrum ◽  
State Of Health ◽  
High Discharge ◽  
Characteristic Frequencies ◽  
Battery Model ◽  
High Discharge Rate

Lithium-ion batteries are an attractive power source in many scenarios. In some particular cases, including providing backup power for drones, frequency modulation, and powering electric tools, lithium-ion batteries are required to discharge at a high rate (2~20 C). In this work, we present a method to estimate the state of health (SOH) of lithium-ion batteries with a high discharge rate using the battery’s impedance at three characteristic frequencies. Firstly, a battery model is used to fit the impedance spectrum of twelve LiFePO4 batteries. Secondly, a basic estimation model is built to estimate the SOH of the batteries via the parameters of the battery model. The model is trained using the data of six batteries and is tested on another six. The RMS of relative error of the model is lower than 4.2% at 10 C and lower than 2.8% at 15 C, even when the low-frequency feature of the impedance spectrum is ignored. Thirdly, we adapt the basic model so that the SOH estimation can be performed only using the battery’s impedance at three characteristic frequencies without having to measure the entire impedance spectrum. The RMS of relative error of this adapted model at 10 C and 15 C is 3.11% and 4.25%, respectively.

Improved cycling properties of a Li-rich and Mn-based Li1.38Ni0.25Mn0.75O2.38 porous microspherical cathode material via micromorphological control

2020 ◽  
Vol 44 (30) ◽  
pp. 13074-13082
Author(s):  
Min Gao ◽  
Fengling Yun ◽  
Jinling Zhao ◽  
Wenjin Li ◽  
Fang Lian ◽  
...  
Keyword(s):  
Cathode Material ◽  
Discharge Rate ◽  
Cycling Performance ◽  
Side Reactions ◽  
Capacity Fading ◽  
High Discharge ◽  
High Discharge Rate ◽  
Primary Particles

The as-prepared LMNO-850 with 100–200 nm spherical-like shape primary particles exhibits superior cycling performance even at high discharge rate. The capacity fading in the first 50 cycles may be caused by interfacial side-reactions between electrode and electrolyte.

Abstract W P189: Characteristics of Rural Pre-Hospital Stroke Transports

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Charles Whiteman ◽  
Debra Paulson ◽  
Rosanna Sikora ◽  
Russell Doerr ◽  
Stephen Davis ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Life Support ◽  
The United States ◽  
Rural Setting ◽  
Care Hospital ◽  
Stroke Patients ◽  
Critical Access Hospital ◽  
Suspected Stroke ◽  
Stroke Center ◽  
The Impact

Introduction: West Virginia (WV) is the second most rural state and has a stroke prevalence of 3%. According to the United States Census Bureau, 97.3% of the land is considered rural and 51.3% of the population lives in a rural area. EMS transport times in Northern WV often exceed 20 minutes in rural counties. Little data has been published about EMS response to acute stroke patients in the rural setting. Methods: This was a retrospective cohort study of EMS response and interventions for patients with chief complaint of stroke in the MedCom database providing medical command for 26 northern WV counties. Stroke encounters from January 1, 2002 to December 31, 2011 were analyzed for EMS provider capability, receiving hospital capability, and pre-hospital interventions. Results: There were 7,594 transports available for analysis. Basic Life Support (BLS) responders provided 7.0% of the care. The majority of the patients, 51.6%, were transported to an acute care hospital, 11.6% to a critical access hospital, and 36.9% to a designated stroke center. Blood glucose was determined by glucometer in 66.4% of patients with 2.0% treated for hypoglycemia. Vascular access was attempted in 92.6% of the patients and was successful in 81.5%. Cardiac monitor was applied in 92.4% of the patients and oxygen saturation was determined by pulse oximetry in 95.8%. Oxygen therapy was administered to 96.5% of the patients. Discussion: In rural northern WV, 7% of the suspected stroke patients had care by only a BLS responder. Although evaluation at a designated stroke center has been shown to increase the chance for receiving acute thrombolytic intervention, less than 40% of patients in northern WV were initially seen at a designated stroke center and 11.6% were initially seen at a critical access hospital. Consequently, even critical access hospitals need to be prepared to rapidly evaluate and treat patients with suspected ischemic stroke. Blood glucose was not checked by EMS personnel in more than 30% of all transports. Additional studies are needed to assess the impact of these pre-hospital procedures and transport destination decisions on suspected stroke patient outcomes in the rural setting.

Abstract WP289: The Impact of Infection on Neurological Deterioration and Outcome in Acute Ischemic Stroke Patients

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Amelia K Boehme ◽  
Andre D Kumar ◽  
Adrianne M Dorsey ◽  
James E Siegler ◽  
Michael J Lyerly ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Symptom Onset ◽  
Neurological Deterioration ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Acute Hospitalization ◽  
Stroke Center ◽  
The Impact

Introduction: To date, few studies have assessed the influence of infection on neurological deterioration (ND) and other outcome measures in acute ischemic stroke. Methods: Patients admitted to our stroke center (07/08-12/10) were retrospectively assessed. Patients were excluded if they had an in-hospital stroke, unknown time of symptom onset, or delay from symptom onset to hospital arrival >48 hours. Positive blood or urine culture, or chest x-ray consistent with pneumonia were classified as infection and stratified according to whether the infection was diagnosed within the first 24 hours of admission or after 24 hours. ND was defined as an increase ≥2 points on the NIHSS score within a 24hr period. Poor functional outcome was defined as a mRS score of 3-6 on discharge. Results: Of the 334 patients included in this study, 78 had an infection (19 on admission). The majority of infections were found in the urinary tract (64%), while pneumonia (37%) and bacteremia (24%) were also common. Infection on admission was predictive of ND (Table 1; OR=2.79, 95% CI 1.18-6.64, p=0.0211) and poor functional outcome (OR=3.0, 95% CI 1.1-7.9, p=0.0182). Developing an infection during acute hospitalization was an even stronger predictor of ND (OR=11.9, 95% CI 5.8-24.5, p<0.0001) and poor functional outcome (OR=56.4, 95% CI 7.7-414, p<0.0001). After adjusting for age, NIHSS at baseline and glucose on admission, the development of an infection during acute hospitalization remained a significant predictor of ND (OR=8.9, 95% CI 4.2-18.6, p<0.0001) and poor functional outcome (OR=41.7, 95% CI 5.2-337.9, p=0.005) while an infection on admission was no longer predictive of ND (OR=1.5, 95%CI 0.59-3.99, p=0.3738) or poor functional outcome (OR=1.09, 95%CI 0.3-3.9, p=0.8984). Conclusion: Our data suggest that ischemic stroke patients who develop an infection during their acute hospitalization are at increased odds of experiencing ND and of being discharged with significant disability.

Abstract P149: Regional Transfer Protocols Can Improve Transfer Times and Reduce Length of Stay for Thrombectomy Candidates Seen on Telestroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michele M Joseph ◽  
Amanda L Jagolino-Cole ◽  
Alyssa D Trevino ◽  
Liang Zhu ◽  
Alicia M Zha ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Emergency Rooms ◽  
Stroke Patients ◽  
Arrival Times ◽  
Time Periods ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
One Year ◽  
The Impact ◽  
Transfer Times

Introduction: Our telestroke (TS) network instituted a regional transfer protocol (RTP) that allows for stroke patients in need of higher level of care to be pre-accepted and transferred to the nearest appropriate comprehensive stroke center (CSC). We studied the impact of the RTP on resource utilization and time metrics in patients transferred for evaluation of intra-arterial thrombectomy (IAT). Before the RTP, all potential IAT patients were transferred to one central CSC. After the RTP was initiated, the network had the capability to transfer to two additional CSCs within the same health system that are strategically located in the Houston area. Methods: We identified patients evaluated via TS in spoke emergency rooms that were subsequently transferred for IAT evaluation from 1/1/2016 to 12/31/2017 - one year prior and one year after the RTP. Baseline demographic characteristics, transfer and IAT metrics, and outcomes were compared for the two time periods. Results: Of 220 patients, 102 patients were transferred pre-RTP, and 120 were transferred to the three CSCs post-RTP. There were no significant differences in baseline characteristics, except fewer patients received tPA post-RTP (Table 1). In total, 30 patients (29%) pre-RTP and 42 patients (35%) post-RTP underwent IAT (p=0.38). Post-RTP, there was a trend toward faster travel times (median 40 vs 32 minutes, p=.07) and transfer initiation times to hub arrival times (median 109 vs 100.5 minutes, p=0.09). Door to groin puncture times were not statistically different between the two time periods. Post-RTP patients had a significantly shorter length of stay (median 6 vs 5 days, p=0.03). Conclusions: Regional transfer protocols can potentially help reduce transfer times and length of stay for stroke patients at CSCs that were initially seen by TS at community hospitals; however, larger sample size is needed to study its impact on other IAT-related metrics and clinical outcomes.

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