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Journal articles on the topic 'Reheat burner'
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1
Lee, S., M. Svrcek, C. F. Edwards, and C. T. Bowman. "Mesoscale Burner Arrays for Gas-Turbine Reheat Applications." Journal of Propulsion and Power 22, no. 2 (March 2006): 417–24. http://dx.doi.org/10.2514/1.15667.
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Ren, Li Ming, Jing Xue An, Chun Yu Wang, and Lei Wang. "Influence of Low NOx Burner Retrofit on the Performances of a Boiler." Advanced Materials Research 1023 (August 2014): 116–24. http://dx.doi.org/10.4028/www.scientific.net/amr.1023.116.
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This paper presents the experimental investigation on the operational performances of a Boiler after a Low NOx burner retrofit. After the retrofit, several operational performances emerge a major change, including the unburned combustible in flying ash raise under higher load, the temperature of reheat steam drop greatly under lower load. As a result, the changes have an influence on the economy of boiler. As for it, a special experimental study was carried out to obtain the best operating mode, and the law of change on the several parameters. The research results are a significant reference to retrofit involved in Low NOx burner utilized to a boiler.
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Jansto, Steven G. "Reheat Furnace Thermodynamic, Kinetic and Combustion Considerations for TMCP Processing." Materials Science Forum 941 (December 2018): 608–13. http://dx.doi.org/10.4028/www.scientific.net/msf.941.608.
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The reheat furnace process step has a profound effect on the TMCP performance, final hot rolled steel quality and mechanical property consistency during the production of hot rolled steels. The uniformity of heating applied across the entire width and length of the slab or billet is critical in the achievement of customer properties regardless of the chemistry. The resultant ferrite grain size in the final hot rolled product is significantly governed by the initial prior austenite grain size. Numerous reheat furnace process metallurgy and combustion parameters in actual operation affect mill productivity, microstructure, austenite grain size, scrap rate and diverts. This reheating step in the steelmaking process often receives low priority in the evaluation of product quality and mechanical property performance, especially the toughness through the plate thickness. Heat transfer conditions of radiation, convection and conduction affect furnace heating efficiency. In laboratory studies, the furnace heating step is typically quite uniform resulting in a homogeneous and fine prior austenite grain size. During production, it is much more difficult to control the uniformity of heating and heat transfer consistency along the entire length and through the thickness of the work piece. The furnace conditions are correlated to product quality via furnace process variables such as the air to gas ratio, furnace burner condition, furnace pressure, energy efficiency, adiabatic flame temperature (AFT) and furnace refractory condition. Operational practice recommendations are presented to minimize inhomogeneous heating which results in inferior product quality, hot rolling model anomalies and toughness variations in the through-thickness-direction.
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Döbbeling, Klaus, Jaan Hellat, and Hans Koch. "25 Years of BBC/ABB/Alstom Lean Premix Combustion Technologies." Journal of Engineering for Gas Turbines and Power 129, no. 1 (September 28, 2005): 2–12. http://dx.doi.org/10.1115/1.2181183.
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The paper will show the development of lean premix combustion technologies in BBC, ABB, and Alstom gas turbines. Different technologies have been developed and applied in Brown Boveri Company (BBC) before 1990. Considerable improvements with respect to NOx emissions as compared to gas turbines with a single combustor and a single diffusion burner for liquid and gaseous fuel have been achieved with burners with extended premixing sections and with multi-injection burners for annular combustors. Between 1990 and 2005, burners with short but effective premixing zones (EV burners: environmentally friendly V-shaped burners) have been implemented in all new gas turbines of the ABB (and later Alstom) fleet with NOx levels well below 25 vppmd (@15% O2). In addition to this, three variants of premix technologies have been successfully developed and deployed into Alstom GT engines: the sequential EV burners—a technology that allows premixing of natural gas and oil into a hot exhaust stream to reheat the exhaust gases of a first high-pressure turbine; the MBtu EV burners that are used to burn syngas in a premix flame with low NOx emissions; and the advanced EV burners (AEV) that are capable to prevaporize and premix liquid fuel prior to combustion and burn it with very low NOx emissions without water injection. The paper will give an overview of these technologies and their usage in Alstom gas turbines over the last 25years.
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Ibrahim, Thamir, and M. M. Rahman. "Study on effective parameter of the triple-pressure reheat combined cycle performance." Thermal Science 17, no. 2 (2013): 497–508. http://dx.doi.org/10.2298/tsci111016143i.
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The thermodynamic analyses of the triple-pressure reheat combined cycle gas turbines with duct burner are presented and discussed in this paper. The overall performance of a combined cycle gas turbine power plant is influenced by the ambient temperature, compression ratio and turbine inlet temperature. These parameters affect the overall thermal efficiency, power output and the heat-rate. In this study a thermodynamic model was development on an existing actual combined cycle gas turbine (CCGT) (In this case study, an effort has been made to enhance the performance of the CCGT through a parametric study using a thermodynamic analysis. The effect of ambient temperature and operation parameter, including compression ratio and turbine inlet temperature, on the overall performance of CCGT are investigated. The code of the performance model for CCGT power plant was developed utilizing the THERMOFLEX software. The simulating results show that the total power output and overall efficiency of a CCGT decrease with increase the ambient temperature because increase the consumption power in the air compressor of a GT. The totals power of a CCGT decreases with increase the compression rate, while the overall efficiency of a CCGT increases with increase the compression ratio to 21, after that the overall efficiency will go down. Far there more the turbine inlet temperature increases the both total power and overall efficiency increase, so the turbine inlet temperature has a strong effect on the overall performance of CCGT power plant. Also the simulation model give a good result compared with MARAFIQ CCGT power plant. With these variables, the turbine inlet temperature causes the greatest overall performance variation.
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Sattelmayer, T., W. Polifke, D. Winkler, and K. Do¨bbeling. "NOx-Abatement Potential of Lean-Premixed GT Combustors." Journal of Engineering for Gas Turbines and Power 120, no. 1 (January 1, 1998): 48–59. http://dx.doi.org/10.1115/1.2818087.
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The influence of the structure of perfectly premixed flames on NOx formation is investigated theoretically. Since a network of reaction kinetics modules and model flames is used for this purpose, the results obtained are independent of specific burner geometries. Calculations are presented for a mixture temperature of 630 K, an adiabatic flame temperature of 1840 K, and 1 and 15 bars combustor pressure. In particular, the following effects are studied separately from each other: • molecular diffusion of temperature and species; • flame strain; • local quench in highly strained flames and subsequent reignition; • turbulent diffusion (no preferential diffusion); • small scale mixing (stirring) in the flame front. Either no relevant influence or an increase in NOx production over that of the one-dimensional laminar flame is found. As a consequence, besides the improvement of mixing quality, a future target for the development of low-NOx burners is to avoid excessive turbulent stirring in the flame front. Turbulent flames that exhibit locally and instantaneously near laminar structures (“flamelets”) appear to be optimal. Using the same methodology, the scope of the investigation is extended to lean-lean staging, since a higher NOx-abatement potential can be expected in principle. As long as the chemical reactions of the second stage take place in the boundary between the fresh mixture of the second stage and the combustion products from upstream, no advantage can be expected from lean-lean staging. Only if the primary burner exhibits much poorer mixing than the second stage can lean-lean staging be beneficial. In contrast, if full mixing between the two stages prior to afterburning can be achieved (lean-mix-lean technique), the combustor outlet temperature can in principle be increased somewhat without NO penalty. However, the complexity of such a system with a larger flame tube area to be cooled will increase the reaction zone temperatures, so that the full advantage cannot be realized in an engine. Of greater technical relevance is the potential of a lean-mixlean combustion system within an improved thermodynamic cycle. A reheat process with sequential combustion is perfectly suited for this purpose, since, first, the required low inlet temperature of the second stage is automatically generated after partial expansion in the high pressure turbine, second, the efficiency of the thermodynamic cycle has its maximum and, third, high exhaust temperatures are generated, which can drive a powerful Rankine cycle. The higher thermodynamic efficiency of this technique leads to an additional drop in NOx emissions per power produced.
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Fukuda, Yuji, and Masaru Shimizu. "Hot Corrosion and Steam Oxidation Properties of New Heat Resistant Steels for Ultra Super Critical Boilers." Materials Science Forum 522-523 (August 2006): 189–96. http://dx.doi.org/10.4028/www.scientific.net/msf.522-523.189.
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Achieving higher plant efficiency in thermal power plants is one of the major global challenges from the viewpoint of reducing carbon dioxide emission levels, particularly in coal-fired boilers, irrespective of the type of coal being burned. In recent times, it has been possible to increase the steam temperature in coal fired ultra supercritical (USC) plants without too much of a cost impact. The temperature has already been increased to 600 for main steam and 610 for reheat steam. The main enabling technology is the development of stronger high temperature materials such as newly developed high Cr ferritic steels and austenitic steels, capable of operating under high stresses at increasing high temperatures. Other key demands for those materials are hot corrosion resistance such as coal ash corrosion in superheater and reheater tubes and sulfidation of waterwall tubes, and steam oxidation resistance. This paper will mainly present the hot corrosion and steam oxidation properties of newly developed high strength heat resistant steels for their application to USC boilers and long-term experience in an actual plant.
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Stupar, Goran, Dragan Tucakovic, Ognjen Stamenkovic, Luka Petrovic, Borivoje Vujicic, Zarko Novakovic, and Zeljko Milanovic. "Possibilities of steam boiler process optimization in the TPP Ugljevik." Thermal Science 27, no. 1 Part A (2023): 133–49. http://dx.doi.org/10.2298/tsci2301133s.
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The paper presents a technical solution for modernization with the aim of increasing the efficiency of the steam boiler of TPP Ugljevik, which implies the reorganization of the combustion system. More efficient operation of the furnace can be achieved by replacing the existing burners, reducing the number of burner levels as well as the organization of tangential combustion. The flame formed in the shape of a tube around the two central combustion vortices provides a larger amount of heat transferred to the combustion furnace, less fouling of its screen walls and thus a lower average temperature of the combustion products at its outlet. As the chosen reorganization affects the increase of the temperature of the superheated steam and the decrease of the temperature of the reheated steam, it has been proposed to reduce the area of the semi-irradiated superheater and increase the area of the second reheater. Taking into consideration that the reorganization of the combustion system may lead to the change of the thermal load of the evaporator located in the furnace, the paper presents the work of the steam boiler operation under new operating conditions. Used calculation system enables reliable prediction of operating characteristics of the steam boiler in new operating conditions of combustion, and its application helps assess the quality of the boiler in terms of how effective, efficient, safe and environmentally friendly its operating mode is. In this way, it is possible to form a comprehensive description of the operating mode of the steam boiler.
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Ishii, T., C. Zhang, and S. Sugiyama. "Numerical Simulations of Highly Preheated Air Combustion in an Industrial Furnace." Journal of Energy Resources Technology 120, no. 4 (December 1, 1998): 276–84. http://dx.doi.org/10.1115/1.2795048.
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The numerical simulations of reactive turbulent flows and heat transfer in an industrial slab reheat furnace in which the combustion air is highly preheated have been carried out. The influence of the ratio of the air and fuel injection velocities on the NOx production rate in the furnace has also been studied numerically. A moment closure method with the assumed β probability density function (PDF) for mixture fraction was used in the present work to model the turbulent non-premixed combustion process in the furnace. The combustion model was based on the assumption of instantaneous full chemical equilibrium. The turbulence was modeled by the standard k-ε model with a wall function. The numerical simulations have provided complete information on the flow, heat, and mass transfer in the furnace. The results also indicate that a low NOx emission and high heating efficiency can be achieved in the slab reheat furnace by using low NOx regenerative burners. It is found that the air/fuel injection velocity ratio has a strong influence on the NOx production rate in the furnace.
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Seto, S. P., and T. F. Lyon. "Nitrogen Oxide Emissions Characteristics of Augmented Turbofan Engines." Journal of Engineering for Gas Turbines and Power 116, no. 3 (July 1, 1994): 478–82. http://dx.doi.org/10.1115/1.2906846.
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The exhaust plumes of modern military engines can be rendered visible at low augmentor power operation by the presence of nitrogen dioxide (NO2). Visible plumes have also been observed from some industrial gas turbines that have duct burners downstream of the power turbines. In 1986, gaseous emissions measurements were taken behind two F101 turbofan engines to determine the effect of reheat level on the degree of conversion of nitric oxide (NO) to nitrogen dioxide and to relate the plume visibility to nitrogen dioxide concentration.
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Wang, Ke, and Youli Song. "Experimental Study on Combustion Optimization of Supercritical 600MW Quadrangle Tangential Boiler." Journal of Physics: Conference Series 2418, no. 1 (February 1, 2023): 012015. http://dx.doi.org/10.1088/1742-6596/2418/1/012015.
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Abstract Given the problems existing in the operation of supercritical 600MW boiler, such as spiral pipe water cooling wall outlet, superheater and reheater wall surface overtemperature easily, the superheater and reheater cooling water amount are too large under high load, and the low load cooling water amount is too small to meet the need of cold reheater heating, the boiler combustion optimization and adjustment are carried out. Through the boiler pulverized coal fineness, air distribution characteristics, swinging Angle of burner and furnace outlet is optimized, such as oxygen level superheater heating surface overtemperature problems are solved, such as the reheater desuperheating water flow under different load can meet the needs of heat supply, at the same time, it also improves the boiler efficiency, effectively improve the safety and economy of the unit.
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Crawford, Mark C., and Thomas Romer. "Increasing Efficiency." Mechanical Engineering 139, no. 12 (December 1, 2017): 37. http://dx.doi.org/10.1115/1.2017-dec-5.
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This article discusses the technology used at the John W. Turk Jr. Power Plant in Fulton, Ark., to tackle the challenges of raising the pressure and temperature of the steam to new heights. The Turk plant is the first in the United States where the final steam conditions exceed both the critical pressure and a temperature of 1,100°F. Operating as an ultrasupercritical boiler, the Turk plant has the highest net plant efficiency of any solid fuel power plant in the United States. In this plant, Southwestern Electric Power Company tapped Babcock & Wilcox to design, supply, and erect the 600-MW advanced supercritical steam generator. To best optimize efficiency, the design team selected a single reheat cycle with elevated steam pressure and temperature. Babcock & Wilcox engineers also employed computational fluid dynamics modeling to place burners and overfire air ports to make the best use of low-sulfur coal.
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Nayak, Smrutiranjan, Sanjeeb Kumar Kar, and Subhransu Sekhar Dash. "Combined fuzzy PID regulator for frequency regulation of smart grid and conventional power systems." Indonesian Journal of Electrical Engineering and Computer Science 24, no. 1 (October 1, 2021): 12. http://dx.doi.org/10.11591/ijeecs.v24.i1.pp12-21.
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In continually increasing area and structure of modern power system having burden demand uncertainties, the use of knowledgeable and vigorous frequency power strategy is essential for the satisfactory functioning of the Power system. A combined fuzzy proportional-integral-derivative (CFPID) controller is suggested for frequency supervision of the power system. To optimize the controller parameters, a review of sine and cosine work adjusted improved whale optimization algorithm (SCiWOA) has been utilized. The next practical application of power-system frequency control is performed by designing a CFPID controller using the proposed SCiWOA technique for a smart grid system having inexhaustible sources like sun oriented, wind, photovoltaic and capacity gadgets like a battery, flywheel just as module electric vehicles. The first advantages of the SCiWOA tuned CFPID controller over hybrid-particle-swarm-optimization and pattern-search (hPSO-PS) adjusted fuzzy proportional-integral (FPI) controller, hybrid bacterial foraging optimization algorithm-particle swarm optimization (hBFOA-PSO) adjusted proportional-integral (PI) controller, genetic algorithm (GA) tuned proportional and integral (PI) controller, BFOA adjusted PI controller, jaya algoritm (JA) tuned PID with derivative filter (PIDN) controller and teaching learning based optimization (TLBO) tuned proportional-integral-derivative (PID) controller are demonstrated for the two-area non-reheat thermal power system. The second advantages of the SCiWOA tuned CFPID controller over artificial-bee-colony (ABC) tuned PID controller, SOSA tuned PID controller and Firefly algorithm (FA) tuned PID controller are demonstrated for two-area reheat thermal power system. It is seen that SCiWOA based CFPID controller is more effective in controlling the recurrence comparative with PID regulator.
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Abhinash, Koilada, and P. S. Kishore. "PERFORMANCE OF A TANGENTIALLY FIRED BOILER IN A THERMAL POWER PLANT." International Journal of Research -GRANTHAALAYAH 6, no. 5 (May 31, 2018): 391–406. http://dx.doi.org/10.29121/granthaalayah.v6.i5.2018.1467.
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The most effective method for producing intense turbulence is by the impingement of one flame on another. This action is secured through the use of burners located in each of the four corners of the furnace. The burner nozzles are so directed that the streams of coal and air are projected along a line tangent to a small circle, lying in a horizontal plane, at the centre of the furnace. A scrubbing action is present which assures contact between the combustible and oxygen, thus promoting rapid combustion and reducing carbon loss. The experimental results of this study can be summarized as the use of tangentially fired boiler which increase splendid air-fuel mixture and pulverized coal is entrained in Primary Air (PA), and in-addition to that the Secondary Air (SA) is also projected towards the mill, finally a rotating “FIRE BALL” is formed.
The present work analysis is carried out on Tangentially Fired Boiler by considering heat input through four burners. The heat output is determined by considering various losses from the boiler that is loss due to dry gas, loss due to moisture, loss due to H2 for combustion, heat loss due to combustile and refuse and losses due to radiation etc. In addition heat absorbed by economizer, boilers, superheater and reheater are studied, thus finally the net heat absorbed and thermal efficiency of tangentially fired boiler are determined.
Graphs are drawn to evaluate the various effects of heat input on output parameters in the boiler. Sankey diagrams are drawn to show the performance in the boiler. The values calculated are put and shown as tables in Appendix.
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Jadallah, Abdullateef A., and Adil A. Al-Kumait. "A Comparative Study on the Performance Augmentation of a Gas Turbine Power Plant." Tikrit Journal of Engineering Sciences 23, no. 1 (February 28, 2016): 1–9. http://dx.doi.org/10.25130/tjes.23.1.01.
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In the present work, a comparative performance analysis of the gas turbine power plant with and without power augmenting devices was carried out. The intercooler, turbine burner (reheater), and heat exchanger were inserted individually and together to reveal the effect of each device. A model for each addition was derived on the base of the simple cycle and adapted to reflect the effect of the performance parameters on the plant power and thermal efficiency. The heat exchanger with different effectiveness improves the thermal efficiency but for low pressure ratios, while the intercooler has low effect at low pressure ratios. Its effect increases with increasing of this ratio and this needs advanced materials. The intercooler cooling percent was considered as 50%, 75% and 100%. The use of turbine burner alone augments the output power by 19.4% but on the expense of thermal efficiency (dropped by 4%) and fuel price. The interstage compressor cooling augments the power by 1.3%, while the efficiency increases slowly and needs a large amount of compression. The combination of intercooling with turbine burner enhances the power by 13.4%. So the regeneration must be installed with them to ensure an enhancement in plant compatibility and thermal efficiency.
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Harwood, Lori, Darrin Pye, Elizabeth Clinton, Kyle Goettl, April Mullen, and Janice Qubty. "Innovations in Hemodialysis Care: An Evaluation of Quality and the Patient Experience." Journal of Patient Experience 7, no. 6 (April 26, 2020): 1278–85. http://dx.doi.org/10.1177/2374373520915133.
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Hemodialysis (HD) performed in a tertiary care facility is the most prevalent and costly treatment for end-stage renal disease in Canada. This life-sustaining treatment is usually performed thrice weekly in an in-center facility. When people on HD also require a rehabilitation/complex care inpatient program, the burden of transportation for dialysis is immense to both the patient and health-care system. To improve the patient experience, create efficiency, and reduce travel costs, the renal team and a team from a rehabilitation/complex care center collaborated to provide HD services in the rehab/complex care setting. A patient/family representative was involved in all aspects of the design through to evaluation of this project. This study used realistic evaluation to examine the efficacy of this program from the perspective of the patient experience, HD staff, rehab/complex care staff and costs. The decreased travel with having dialysis on-site and adequate resources in the HD unit were the mechanisms for success in improved patient experience, quality of life and rehabilitation patient outcomes, decreased costs as well as increased communication and satisfaction.
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Wasilewski, Andrea, Jennifer Serventi, Lily Kamalyan, Thomas Wychowski, and Nimish Mohile. "Acute care in glioblastoma: the burden and the consequences." Neuro-Oncology Practice 4, no. 4 (March 8, 2017): 248–54. http://dx.doi.org/10.1093/nop/npw032.
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Abstract Background The utilization of inpatient medical services by patients with glioblastoma (GBM) is not well studied. We sought to describe causes, frequency, and outcomes of acute care visits in GBM. Methods We conducted a retrospective study of 158 GBM patients at the University of Rochester over 5 years. Electronic medical records were reviewed to identify all local and outside acute care visits. Acute care visits were defined as any encounter resulting in an emergency department visit or inpatient admission. Results Seventy-one percent (112/158) of GBM patients had 235 acute care visits corresponding to 163 hospitalizations (69%) and 72 emergency department visits (31%). Sixty-three percent of patients had multiple visits. Admission diagnoses were seizure (33%), neurosurgical procedure (15%), infection (12%), focal neurologic symptoms (9%), and venous thromboembolism (VTE, 9%). Forty-six patients had 1 or more visits for seizures. Median time to first acute care visit was 65.6 days and 22% of patients had an acute care visit within 30 days of diagnosis. Median length of stay was 5 days. Thirty-five percent of admitted patients were discharged home; 62% required a higher level of care than prior to admission (23% were discharged home with services, 17% to a nursing facility, 16% to hospice, 6% to acute rehab) and 3% died. Thirty-eight percent of patients had ACV within 30 days of death. Median survival was 14 months for patients who had acute care visits and 22.2 months for patients who did not. Conclusion The majority of GBM patients utilize acute care, most commonly for seizures. The high number of emergency department visits, short length of stay, and many patients discharged home suggest that some acute care visits may be avoidable.
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Ansari, Fakhir. "PRIORITIZING FALL RISK MANAGEMENT: IRRESPECTIVE OF PARKINSON’S DISEASE PROGRESSION DURING REHABILITATION." Pakistan Journal of Rehabilitation 12, no. 1 (January 4, 2023): 84–92. http://dx.doi.org/10.36283/pjr.zu.12.1/013.
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Background and Aims: It has been established that the hazard of falling in Parkinson’s patients is a primary cause of loss of independence, and hence it is a significant component to the disease’s burden. As a result, the goal of this study is to evaluate the relationship between level of disease progression and the risk of falling in order to understand the critical need for rehab intervention in Parkinson’s disease. Methodology: A cross-sectional survey was conducted on 24 participants participated in study through convenience sampling technique from primary and tertiary care institutes/ hospitals. Tinetti balance and gait test was used to evaluate the risk of fall among patients while The Hoehn and Yahr Scale was used to track the progression of Parkinson’s symptoms and disability. Results: Total 24 (n=24) participants with idiopathic Parkinson’s disease were enrolled in the study in which the majority of the participants belong to age group 59-69 years. The balance and gait of Parkinson’s patient is strongly negative correlated i.e. -8.33 with the severity of Parkinson’s disease with .000 level of significance which is strongly negative correlated with the severity of Parkinson’s disease (p<0.05). Conclusion: This demonstrates that the balance and gait of a Parkinson’s person is not related to the severity level Parkinson’s disease thus fall management in PD patients must be kept in priority during the rehab intervention for ADL independence and social participation.
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Hariana, Adi Prismantoko, Ganda Arif Ahmadi, and Arif Darmawan. "Ash Evaluation of Indonesian Coal Blending for Pulverized Coal-Fired Boilers." Journal of Combustion 2021 (December 14, 2021): 1–15. http://dx.doi.org/10.1155/2021/8478739.
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Coal calorific value is one of the main considerations for using coal as a power plant fuel. In addition, the requirements for indications of slagging and fouling are also important to maintain combustion efficiency. However, coal power plants often experience problems in boiler operations due to the use of certain types of coal, even though they have a relatively high calorific value. This research investigates the effect of coal blending on ash fouling and slagging in an experimental investigation using a drop tube furnace with or without additives. Five different types of coal from different locations have been used in this study. Pulverized low-rank coal samples are burned in a drop tube furnace at 1,175°C with probe temperatures of 550°C and 600°C, corresponding to the combustion chamber of 600 MW power plants, including superheater and reheater areas. The ash particles’ characteristics and material composition were also analyzed using scanning electron microscopy with energy-dispersive X-ray (SEM-EDX) and X-ray diffraction (XRD), respectively. All coal mixture combinations demonstrated potential as a fuel for power plants that use pulverized coal-fired boilers. Because of its capacity to reduce slagging and fouling potentials, combining coal blending with the use of chemical additives yielded the greatest results.
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Todd, Megan, Kevin Pressley, and Meagan Pharis. "The Burden of Serious Falls Among Older Adults: Evidence from Hospitalizations in Philadelphia, PA." Innovation in Aging 4, Supplement_1 (December 1, 2020): 654. http://dx.doi.org/10.1093/geroni/igaa057.2254.
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Abstract Falls among older adults cause acute injury, are associated with subsequent mortality, and cost billions of dollars in medical expenses each year. However, research on falls is lacking compared to other causes of morbidity. In our rapidly aging world, a better understanding of the populations at greatest risk is urgently needed. In this paper, we used 2018 data on every inpatient hospitalization in Philadelphia and from the American Community Survey to estimate the prevalence of serious falls among older adults (60+) by age, sex, and race/ethnicity. We further assessed the relationship between age, sex, and race/ethnicity and fall outcomes (length of hospital stay (LOS), total medical charges) with linear regression models. In 2018, the rate of falls serious enough to warrant a hospital stay in Philadelphians aged 60+ was 243 per 10,000. This rate increased dramatically with age, from 116 per 10,000 (60-64) to 649 per 10,000 (85+). Men were at higher risk than women for each 5-year age group except those top-coded at 85+. Compared to white older adults, black older adults had greater risk at younger ages (60-69) and lower risk at older ages (70+). In linear models we found that charges and LOS decreased with increasing age. Both charges and LOS were higher for men than women. Hispanic patients had significantly higher charges than non-Hispanic patients, despite having similar lengths of stay. Future work will attempt to explain differences in charges and LOS by examining mortality, discharge location (e.g., home, hospice, rehab), and co-morbidities.
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Novy, Theresia CT, Grace Fonda, and Andrew Suwadi. "Cases, Prevalence and Treatment of Low Back Pain at Bandung Pain Rehab." Indonesian Journal of Physical Medicine and Rehabilitation 12, no. 01 (June 28, 2023): 52–60. http://dx.doi.org/10.36803/indojpmr.v12i01.338.
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Background: Low back pain (LBP) is one of the pain complaints that affects almost every aspect of a person's life, urging many patients to come for treatment. The incidence of LBP in Indonesia is estimated between 7,6% and 37%, but it is still precisely unknown. A clinician must be able to make an accurate diagnosis to treat patients according to the etiology. In this study, we aim to determine the distribution of prevalence, demographic data, and the success of LBP treatment in order to help clinicians in management of LBP to reduce the global burden.
Methods: This was a descriptive analytic study with a cross-sectional design. This research was conducted at the Bandung Pain Rehab Center (BPRC) clinic from July 2019 to December 2021. We included all patients complaining of low back pain who came for treatment at the BPRC. The data of this study were taken from medical records. The success of therapy in the interventional pain management (IPM) and non-IPM groups was assessed by comparing the VAS values before and after treatment. Statistical analysis was performed using the IBM SPSS Statistics 23 program with the Wilcoxon test.
Results: Of the 704 patients, the majority were female (59,2%), aged 51-60 years (23,6%), with obese body mass index (54,4%), and worked as housewives (35,5%). The most common etiology of LBP was piriformis syndrome (50,9%), followed by sacroiliac joint arthropathy (18,5%) and lumbar radiculopathy (14,8%). In the IPM and non-IPM groups, there was a significant decrease in pain intensity after therapy (p <0,001).
Conclusion: Our research shows that LBP is most common at the age of 51-60 years, female gender, with a body mass index classified as obese, and working as a housewife. Piriformis syndrome is the most common prevalent etiology of LBP. The use of therapy in both IPM and non-IPM showed significant improvements in alleviating pain experienced by the patients.
Keywords: Low back pain, case, prevalence, IPM, non-IPM, VAS score
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Byrd, J. W. T., K. S. Jones, and E. A. Bardowski. "A BIOINDUCTIVE PATCH FOR PARTIAL THICKNESS HIP ABDUCTOR TENDON TEARS: A PRELIMINARY REPORT." Orthopaedic Proceedings 105-B, SUPP_12 (June 23, 2023): 24. http://dx.doi.org/10.1302/1358-992x.2023.12.024.
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Partial thickness abductor tendon tears are a significant source of recalcitrant laterally based hip pain. For those that fail conservative treatment, the results of endoscopic repair are highly successful with minimal morbidity. The principal burden is the protracted rehabilitation that is necessary as part of the recovery process. There is a wide gap between failed conservative treatment and successful surgical repair. It is hypothesized that a non-repair surgical strategy, such as a bioinducitve patch, could significantly reduce the burden associated recovery from a formal repair. Thus, the purpose of this study is to report the preliminary results of this treatment strategy.Symptomatic partial thickness abductor tendon tears are treated conservatively, including activity modification, supervised physical therapy and ultrasound guided corticosteroid injections. Beginning in January 2022, patients undergoing hip arthroscopy for intraarticular pathology who also had persistently symptomatic partial thickness abductor tendon tears, were treated with adjunct placement of a bioinducitve (Regeneten) patch over the tendon lesion from the peritrochanteric space. The postop rehab protocol is dictated by the intraarticular procedure performed. All patients are prospectively assessed with a modified Harris Hip Score (mHHS) and iHOT and the tendon healing response examined by ultrasound.Early outcomes will be presented on nine consecutive cases.Conclusions - Will be summarized based on the preliminary outcomes to be reported.
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Ganesh, Aravind, David J. T. Campbell, Janette Hurley, and Scott Patten. "High Positive Psychiatrie Screening Rates in an Urban Homeless Population." Canadian Journal of Psychiatry 58, no. 6 (June 2013): 353–60. http://dx.doi.org/10.1177/070674371305800607.
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Objective: To carry out a preliminary assessment of the use of a psychiatric screening tool in an urban homeless population, and to estimate the potential prevalence of undiagnosed and (or) unmanaged mental illness in this population. Methods: Participants ( n = 166) were recruited from the Calgary Drop-in and Rehab Centre to complete a questionnaire containing 6 modules screening for common psychiatric disorders. Summary statistics were used in the analysis. Results: Only 12 respondents (7%) screened negative on each of the 6 modules. The screening process determined that 60.2% of the sample ( n = 100) had probable mental illness but reported no history of psychiatric diagnosis or treatment. Conclusions: A straightforward application of screening (in which screen-positive subjects are referred for assessment) would be difficult in this population as most will screen positive. The results highlight the tremendous burden of psychiatric symptoms in this population.
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Prayitno, Dedi. "Pelayanan Penanganan Penunggak Iuran BPJS Bagi Peserta JKN-KIS Kesehatan di Kantor Cabang Kota X." Jurnal Bisnis, Manajemen, dan Akuntansi 10, no. 1 (March 7, 2023): 55. http://dx.doi.org/10.54131/jbma.v10i1.150.
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Weak regulation of sanctions for BPJS participants regarding the obligation of contributions, BPJS for health resulted in a budget deficit. Projected budget deficit in 2018, the deficit will be Rp. 28.5 trillion. The expansion projection comes from diverting the 2018 deficit plus the burden of paying hospital bills since the beginning of 2018. BPJS Kesehatan finance director Kemal Imam Santoso said the company still has a carry over financial deficit of Rp. 9.1 trillion from last year. Based on the description of the discussion above regarding job descriptions on billing and finance, obstacles in billing JKN-KIS participant contributions, and efforts to handle participants who are in arrears at the Health Social Security Administering Body for City X branch offices Data and information is carried out by observing in the field of finance and billing by gathering information based on interviews, data review and existing financial / billing data. Observations made were 8 Billing and Finance staff at the BPJS Kesehatan City X branch office, having different but very related tasks starting from the Head of Billing and Finance who is fully responsible for staff performance and the smooth payment of participant contributions, two Staff participant contribution collection workers Billing is always attempted by contacting the company to find out the active status of participants by visiting, via WA, email or with JKN cadres. Sending the latest information regarding contribution payments, for example with REHAB to make it easier for participants. As well as developing the REHAB program. Meanwhile, there are 83,585 participants in BPJS Kota X Branch Offices who have arrears at the BPJS Kota X Branch Office until 2020 reaching Rp. 72,678,386,206. The need for employee job disks that are more specific and reliable considering the constraints of Covid 19 also have quite an effect on the contributions of independent participants, Keywords: dues; bills; arrears; billing; treatment
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Lannin, Natasha A., Lindy Clemson, Avril Drummond, Mandy Stanley, Leonid Churilov, Kate Laver, Sophie O'Keefe, et al. "Effect of occupational therapy home visit discharge planning on participation after stroke: protocol for the HOME Rehab trial." BMJ Open 11, no. 7 (July 2021): e044573. http://dx.doi.org/10.1136/bmjopen-2020-044573.
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Introduction After first stroke, the transition from rehabilitation to home can be confronting and fraught with challenges. Although stroke clinical practice guidelines recommend predischarge occupational therapy home visits to ensure safe discharge and provision of appropriate equipment, there is currently limited evidence to support this recommendation. Methods and analysis The HOME Rehab trial is a national, multicentre, phase III randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis being conducted in Australia. The trial aim is to determine the effect and potential cost-effectiveness of an enhanced occupational therapy discharge planning intervention that involves pre and postdischarge home visits, goal setting and occupational therapy in the home (the HOME programme) in comparison to an in-hospital predischarge planning intervention. Stroke survivors aged ≥45 years, admitted to a rehabilitation ward, expected to return to a community (private) dwelling after discharge, with no significant prestroke disability will be randomly allocated 1:1 to receive a standardised discharge planning intervention and the HOME programme or the standardised discharge planning intervention alone. The primary outcome is participation measured using the Nottingham Extended Activities of Daily Living. Secondary outcome areas include hospital readmission, disability, performance of instrumental activities of daily living, health-related quality of life, quality of care transition and carer burden. Resources used/costs will be collected for the cost-effectiveness analysis and hospital readmission. Recruitment commenced in 2019. Allowing for potential attrition, 360 participants will be recruited to detect a clinically important treatment difference with 80% power at a two-tailed significance level of 0.05. Ethics and dissemination This study is approved by the Alfred Health Human Research Ethics Committee and site-specific ethics approval has been obtained at all participating sites. Results of the main trial and the secondary endpoint of cost-effectiveness will be submitted for publication in peer-reviewed journals Trial registration number NCT12618001360202
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Rokhman, B. B., N. I. Dunaevska, and V. G. Vifatnyuk. "DEVELOPMENT OF CONCEPTUAL TECHNICAL SOLUTIONS AND METHODS OF THEIR IMPLEMENTATION DURING THE DESIGN OF A DUST COAL STEAM GENERATOR OF SUPER-SUPER CRITICAL PARAMETERS OF STEAM 28 MPA/600 °С/600 °С FOR 300 MW ENERGY UNIT. PART 1." Energy Technologies & Resource Saving, no. 4 (December 20, 2020): 4–19. http://dx.doi.org/10.33070/etars.4.2020.01.
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Increasing efficiency of power plant unit, reducing fuel costs, and CO2, NOx and SOx emissions can be achieved by increasing the pressure and temperature of the steam. Analysis carried out for boilers designed for supercritical steam parameters, showed that the increase in pressure and temperature is directly related to the stresses arising in the metal of the superheater, and, consequently, with the need of using high-temperature alloys. Thus, steam generators can be conventionally divided into three groups: supercritical (SC), super supercritical (SSC) and ultra supercritical (USC). The efficiency of the power units of the USC is 3–4 % higher than the efficiency of the SC units, and the efficiency of the power units of the USC is 6–8 % higher than the efficiency of the SC units. For the manufacture of USC boilers, steels based on nickel alloys are required, which are mainly at the stage of development and testing, while for the production of SSC steam generator, steels are manufactured on an industrial scale, therefore, currently, the best option is the construction of SSC power unites. The first part of the work describes the calculation method, the algorithm and the program with the help of which the design and verification thermal calculations of the SSC 28 MPa/600 °С/600 °С were carried out for a 300 MW power unit at rated loads. Two designs of vortex burners (coiled-blade and blade-blade) with a thermal power of 34.471 MJ/s and productivity (for coal) of 5902 kg/h have been developed. Original technical solutions have been developed to improve the reliability of the live steam output stage and to reduce the surface of the first stage of the reheater. Bibl. 5, Fig. 4, Tab. 1.
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O'Neil, Audrey, Cassandra Rush, David Roggy, and Brett Hartman. "562 Therapy Resources for Management of Large TBSA Burns: A Case Study." Journal of Burn Care & Research 44, Supplement_2 (May 1, 2023): S113. http://dx.doi.org/10.1093/jbcr/irad045.157.
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Abstract Introduction Therapy studies involving large percent TBSA burns ( >50% TBSA) are not well described. Studies show the highest predictor of preventing burn scar contracture is the amount of burn rehabilitation time received per cutaneous functional units involved, but what does “more therapy time” mean for larger burns in terms of therapy resources for burn centers? Methods A case study was completed on a 20-year-old male admitted after sustaining 85% TBSA full thickness flame burns to his face, neck, arms, legs, and trunk, along with an inhalation injury. He was admitted to the inpatient burn ICU for 113 days, undergoing 16 surgeries to achieve skin coverage prior to discharge to acute rehab. Therapy was initiated < 24 hours after admission to the Burn ICU. Direct therapy contact minutes were tracked during all session and divided into therapy treatment domains. (resource). If co-treating occurred, a single unit of time was used for the time of the session to avoid doubling the units provided. Results Therapy occurred on 106/113 days of admission, receiving 238 therapy sessions (113 PT, 125 OT). He received 21,027 minutes of direct therapy, averaging 196.5 min/rehab days. The highest number of therapy minutes were spent on ROM (9,032 min). Other domains of care included Mobilization (3,171 min), Positioning (2,298 min), Orthotic management (1,326 min), etc. (Table 1). Despite focus on ROM and positioning, he discharged with 7 moderate (left wrist extension, bilateral hip abduction, bilateral ankle dorsiflexion, left neck rotation, and left forearm supination) and 4 severe contractures (right wrist extension, bilateral hip extension, neck extension). He was able to transfer with moderate assistance and walk 150 ft with a platform walker at discharge. Conclusions Therapy interventions in the literature are often described in isolated “domains” of practice, however guidelines on a global approach to management of those with catastrophic injuries does not exist. Prioritization between domains with limited therapy resources when facing patients with extensive deficits is challenging. A dedicated burn therapy staff with availability to secure additional resources was required to ensure optimal outcomes in the management of this patient Applicability of Research to Practice This case study demonstrates the comprehensive burden of care and need for additional therapy resources in the management large TBSA burns.
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Ahmed, Faizan ,., and Mohsin Shabir. "Gender Differences in Percutaneous Coronary Intervention Insights from the Coronary Angiography." Pakistan Journal of Medical and Health Sciences 16, no. 5 (May 29, 2022): 1048–50. http://dx.doi.org/10.53350/pjmhs221651048.
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Background: The data from the prior studies have reported inconsistencies in the comorbidity burden, and baseline risk profile. Objective: The data provide insights into the sex difference in percutaneous coronary interventions. Study design: It is a retrospective study with statistical approach, conducted in the Department of Cardiology, Rehman Medical Institute Peshawar. Material and Methods: The study was conducted from December 2021 to May 2022. The 400 patients visited the cardiology department of the hospital were included in the study. The selected patients were enrolled in the coronary angiography. The data was collected from cardiology department of two hospitals and analyzed. The ethical and review committee of the hospital approved the study. The informed consent was taken from the selected patients. The data contains demographic features, baselines characteristics, hospital complications and PCI course. The patients having residual stenosis of less than 50% after balloon angioplasty were included in the groups rated as successful PCI groups. Results: Out of 400 patients taken from two hospitals there were 50% female. The women included in the study were 5 years older than the male patients. Women were on average 67 years old and men were 72 years old. Women in general had more cases of coronary angiography, also women were reported with cases like diabetes mellitus, and some of the cases reported congestive heart failure. The success of the procedure was more successful in case of women with 95% of female patients receiving successful procedure. Conclusions: The overview of sex linked variations in PCI was observed in this study. The hospital mortality was found to be high in case of women, there was also not significant differences found between hospital mortalities for NSTE-2CS in case of cardiogenic problems Keywords: Percutaneous coronary interventions (PCI), coronary angiography, cardiogenic shock, Non-ST elevation acute coronary syndrome (NSTE-ACS) and myocardial infraction.
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S.C., Nwosu, and Atulomah N.O.S. "Effect of Educational-Intervention Programme on Predisposing Factors Involved in Adherence to Ergonomic Principles among Janitorial Staff of Tertiary Educational Institutions in Ogun State, Nigeria." International Journal of Public Health and Pharmacology 3, no. 2 (August 23, 2023): 43–52. http://dx.doi.org/10.52589/ijphp-o9mgaet5.
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Adherence to workplace ergonomic principles protects against musculoskeletal disorders (MSDs). Musculoskeletal disorders (MSDs) are a leading cause of debility and early retirement of workers. They are a major contributor to the global burden of disease. The effects of MSDs are observed at the individual, organizational and societal levels and have implications on personal-level dispositions of workers involved. Due to the gradual and imperceptibility of onset of MSDs, early detection or diagnosis is impossible; therefore, ergonomic-based health educational programs offer the best mitigation (Khan, Rehman, & Ali, 2012). Janitorial occupation is fraught with recognized MSDs risk factors. This study evaluated the effect of an innovative theory-grounded health educational intervention program on the predisposing factors involved in adherence to ergonomic principles by the janitorial staff of selected universities in Ogun State, Nigeria. The study was a quasi-experimental intervention design that utilized a 42-item validated six-sections questionnaire with Cronbach’s alpha internal consistency coefficient ranging from 0.782 to 0.934 using a multistage sampling technique to derive participants. The study was for twelve weeks in which baseline and 12th week follow-up data was collected regarding information on predisposing factors of knowledge, attitudinal dispositions and perceptions involved in adherence to ergonomic principles from sixty janitorial workers who consented to participate in the study. Participants were categorized into a control group (CG) and an intervention group (IG). The mean age of participants in CG was 43.2 ± 9.35 while for IG was 39.83 ± 11.11. Data was analyzed using descriptive (mean, standard deviation, frequency, percentage) and inferential (paired t-test, effect size) statistics at 5% confidence level. The results show that educational intervention programs improved the predisposing factors of knowledge, perceptions and attitudinal dispositions.
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Canell, Anastasia, Hannah Bashian, and Grace Caskie. "Do the Reasons Emerging Adults Become Informal Caregivers Relate to Future Willingness to Care? A Mixed-Methods Study." Innovation in Aging 4, Supplement_1 (December 1, 2020): 357. http://dx.doi.org/10.1093/geroni/igaa057.1149.
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Abstract Approximately 12-18% of family caregivers to older adults in the U.S. are emerging adults (aged 18-25), yet minimal research focuses on this subgroup of caregivers (Levine, 2005). Although several theories have developed to explain the growing number of emerging adults assuming informal caregiving roles (e.g., alleviating burden on middle-aged caregivers, family obligation; Dellmann-Jenkins & Brittain, 2003), the reasons why emerging adults become caregivers have not been studied. In the current study, a sample of 248 emerging adult caregivers were asked to describe the circumstances that led to providing unpaid care to an older adult. Using discovery-oriented coding methodology, 11 themes emerged within participants’ responses: care-recipient illness (35.5%), familial relationship (35.5%), care-recipient became dependent (23.8%), proximity (13.7%), only option (10.1%), reciprocal care (8.9%), availability (8.5%), age-related decline (6.9%), monetary restrictions (6.9%), care-recipient desire (6.0%), and community service (4%). Follow-up analyses found that participants who identified familial relationships (e.g., “They are my parents so I felt obligated...”) were less likely to endorse willingness to provide nursing care in the future compared to those who did not identify familial relationships (p=.032). Participants who identified care-recipient dependency as a circumstance leading to caregiving (e.g., “My grandmother fell and was in rehab...”) were more likely to endorse willingness to provide instrumental (p=.034) and emotional (p=.047) care in the future than those who did not identify care-recipient dependency. These results demonstrate the unique reasons that may lead emerging adults to begin caregiving and how these reasons relate to future willingness to care for an older adult.
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Cervellione, Kelly L., Aashir Shah, Mahendra C. Patel, Laura Curiel Duran, Tofura Ullah, and Craig Thurm. "Alcohol and Drug Abuse Resource Utilization in the ICU." Substance Abuse: Research and Treatment 13 (January 2019): 117822181986932. http://dx.doi.org/10.1177/1178221819869327.
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Alcohol and drug abuse continue to be major causes of morbidity and mortality and have significant social and economic ramifications. Studies have shown that for every $1 spent on substance use disorder treatment, $4 are saved on healthcare costs. Characterizing the healthcare resource utilization of these patients may shed light on the burden of disease and opportunities for intervention. A retrospective chart review of all patients admitted to the ICU between July 1, 2017 and December 31, 2017 was completed. Variables regarding demographic and clinical characteristics as well as healthcare resource utilization were collected. Of 737 admissions to the ICU, 158 (21%) were due to acute or chronic complications of alcohol or drug abuse. Even though alcohol and drug users were significantly younger (average age 50 years) than the general ICU cohort (average age 66 years), resource utilization was similar between these patients. The median length of stay in the ICU was similar. The number of patients transferred to in-patient rehab was low (8%), and all of those were due to comorbid psychiatric illness. The total hospital charges for the alcohol and drug abuse cohort was over 7 million dollars for the 6 months observed. A significant number of patients had at least one ER visit (49%) during the previous year, and most of these had numerous visits. ICU resource utilization by patients with acute and chronic sequelae of drug or alcohol abuse disorders continues to be high. These patients utilize resources at rates similar to an older group with other disease processes. Patients are unlikely to receive intervention for their disorder unless they have a comorbid psychiatric illness. Patients admitted to the ICU with alcohol or drug-related illness were frequently seen in the ER or were admitted to the hospital in the year prior to ICU admission, providing opportunities for intervention.
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Revathi, Pydi, Duppala Sateesh Kumar, and Rahul Shaik. "Use of Xbox Kinect 360 Videogame for Rehabilitation of Sports Specific ACL Sprain During Lockdown Period Due to COVID-19 Pandemic." International Journal of Physiotherapy and Research 11, no. 4 (August 11, 2023): 4556–63. http://dx.doi.org/10.16965/ijpr.2023.130.
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Background: Anterior cruciate ligament is one of the two ligaments inside the middle section of the knee joint that forms an “X” shape. Its main function is to prevent the tibia from sliding forward relative to the femur. The ACL also assists with preventing excessive knee extension, knee varus and valgus movements, and tibial rotation. Kinect works in almost all room lighting conditions and can simultaneously track two active users. For full-body, head-to-feet tracking, the recommended user distance from the sensor is approximately 1.8 m for a single user; when two people are to track simultaneously, they should stand approximately 2.5 m away from the device. Kinect requires a minimum user height of 1 m. With the players themselves becoming the ‘game controller’ via their body movements and gestures, Kinect-enabled game titles lend themselves comfortably to the class of exergames (‘exercise games’), although the amount of physical activity involved and calories burned can vary significantly from title to title Materials and method: Twenty-six participated in the study. These subjects were divided into two groups, 13 subjects in each. Group A was administrated with the traditional training, and Group B was administrated with the X BOX Kinect training. Results: Comparison of mean and standard deviation of subjects aged (18-25) between Group A (Traditional Training) and Group B (X box Kinect 360 Training). The mean age of Group A was 20.7143±1.98278, and Group Bs was 20.6571±2.21711, respectively. The paired t-test value was 15.728. There was no significant difference between age groups. But in both Kujala score and muscle girth scores with p-value <0.001** (i.e., p <0.05 at 95 % confidence interval), the pre and post-values of Kujala score and muscle girth were statistically significant. Conclusion: Comparing traditional treatments with or without adding extra Kinect 360 training sessions would be very interesting, being that it may be a good addition to the treatment for post-operative ACL rehab, ACL sprains conservative management, and maintaining Knee joint fitness when sports players in a home without exposure of COVID -19. KEYWORDS: Xbox Kinect-360, ACL Sprain, Home-Based Exercises, Kujala Scale, COVID-19, Remote Rehabilitation.
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Rahman, Khalilur, KM Saiful Islam, Manirul Haque Tarafder, Rustam Ali, Ruhul Amin, and Mrinal Kanti Das. "Practices of Complementary Feeding of Mothers Attending a Tertiary Care Teaching Hospital in the Northern Part of Bangladesh." TAJ: Journal of Teachers Association 35, no. 1 (August 10, 2022): 83–90. http://dx.doi.org/10.3329/taj.v35i1.61160.
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Background: Adequate nutrition during infancy and early childhood are essential to ensure growth and development, and it depends significantly on the pattern of complementary feeding. As Bangladesh is a high burden of infant malnutrition, the present study was designed to assess the practices regarding complementary feeding among mothers attending a tertiary care hospital. Objective: To observe the attitude and practices of mothers regarding complementary feeding. Methodology: This cross-sectional study was conducted at the Department of Pediatrics in Rajshahi Medical Hospital for one year. A total of 227 mothers of children aged between 6 to 24 months attending pediatric OPD at Rajshahi Medical Hospital were included in this study. Data collection was conducted through a pre-designed questionnaire. After data collection of data, data were analyzed by SPSS 23.0.
Results: A total of 227 parents were interviewed. The mean age of the respondents was 26±8.42 (SD) years. Nearly half (45%) of the mothers belonged to lower-middle-income families. Of all, 82% of the mothers knew about the perception of complementary feeding, and about 21% knew the WHO recommended age for complimentary food initiation (at six months). About 71% and 60% had knowledge about iron-rich food and iodized salt accordingly. Half of them knew the appropriate consistency of complimentary food. About 64% of mothers gave complementary foods ≤2 times a day while 36% fed≥3 times a day. Regarding attitude, 78% of mothers approached the necessity of maintaining dietary diversity and variety of food for a balanced diet. In comparison, 52% preferred homemade food, 22% preferred commercially available food, and 26% preferred a combination of both. About 71.8% of mothers believed in different food taboos. In this study, dilution of cow's milk as a complementary food was done by 76% of mothers, while complementary feeding was discontinued by 80%. About 78% and 65% of the mothers reported washing their hands and utensils and baby's hand before feeding the child, 66% of them covered the food after cooking, and 43% reheated the food before serving.
Conclusion: This study shed light on existing knowledge, attitude, and practice among mothers attending a tertiary care hospital. But to get the exact scenario, further extensive study is recommended.
TAJ 2022; 35: No-1: 83-90
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Sahu, Kamal Kant, Ajay Mishra, Susan V. George, George Abraham, and Ahmad Daniyal Siddiqui. "Analyzing the outcome of clostridium difficile infection in cancer patients." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19340-e19340. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19340.
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e19340 Background: Clostridium difficile infection (CDI) is a considerable health burden, and now identified as the leading cause of acquired diarrhea in patients receiving antibiotics. Cancer patients are more prone to acquire CDI, owing to their frequent exposure to risk factors. This study aims to investigate the factors affecting the outcome of Clostridium Difficile Infection in patients with cancer at our community center. Methods: This is a retrospective study that included a total of 59 cancer patients who were hospitalized for clostridium difficile infection. Results: The median age of the study population was 79 years with 39 males and 20 females. The patients were suffering from cancer located at the following sites: Prostate (25), lung (19), colon (7), bladder (4), breast (3) and renal (1). There were 52 cases of 1st and 7 cases of recurrent CDI admissions. 40 patients detected to have CDI at presentation while 19 patients developed CDI during hospitalization. CDI categories were as follows: Non-severe (29), severe (28), and very severe (3). There were 33 and 20 patients on chemotherapy and radiotherapy respectively. 27 patients had a recent history of cancer care-related procedures or interventions. 29 patients were from either rehab or nursing facility. There were 39 recent hospitalizations with 29 patients receiving antibiotics. Almost half of the patients were on PPI (29) and 12 were on steroids (20.3%) at the time of developing CDI. Patients with a high-risk qSOFA Score of 2 or more (p-value = 0.008) or a high white blood cell count of > 15 X 109/L (p-value = 0.016) were found to have higher in-hospital mortality. Critical care data suggested that 9 patients required intensive care, 7 patients required vasopressor support, and 6 needed mechanical ventilation. Patients were treated with either vancomycin alone (13), or metronidazole alone (25), or combination therapy with vancomycin + metronidazole (21). The median duration of hospital stay was 6 days with 11 fatalities (18.64%). Conclusions: CDI causes significant morbidity in cancer patients. Factors like high qSOFA score and leukocytosis can help to prioritize and intensify the care and in prognosticating the patients.
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Chauhan, K. "AB1609 ECONOMIC IMPACT OF HOSPITAL STAYS FOR UVEITIS PATIENTS IN THE UNITED STATES: AN ANALYSIS OF THE NATIONAL INPATIENT DATABASE." Annals of the Rheumatic Diseases 82, Suppl 1 (May 30, 2023): 2039.1–2039. http://dx.doi.org/10.1136/annrheumdis-2023-eular.2817.
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BackgroundUveitis is the most common extraarticular manifestation in patients with spondyloarthritis. It may be the first presentation of spondyloarthritis. The combination of effects on vision, systemic disease and side effects of treatment have a significant impact on patient’s life. Uveitis affects all age groups and results in visual impairment over a long duration of the patient’s lifetime. Hence, treatment cost due to uveitis is similar to the common eye conditions such as cataract, age related macular degeneration and glaucoma.ObjectivesThere is a lack of national level data regarding the medical cost of hospital stay of uveitis patients. The objective of our study is to identify health care expenses for patients hospitalized with uveitis in the United States.MethodsThe National Inpatient Sample (NIS) is used for this study. It is a de-identified, random sample data of inpatient hospitalizations in the United States. It is the largest all-payer database containing data on more than seven million hospital stays. Its large sample size is ideal for examining national estimates.We collected data from 2016 to 2020 and ICD-10 codes were used to identify uveitis cases. NIS uses the Clinical Classifications Software Refined (CCSR) categories which aggregates ICD-10 codes into 530 clinical categories. ICD-10 codes for inflammatory eye conditions are assigned to the category uveitis and ocular inflammation. Patients hospitalized with primary diagnosis of uveitis were included. Length of hospital stay; hospital charge and cost were collected. Charge is the amount hospital billed and cost represents the actual cost of hospital stay.ResultsAverage charge for hospital stays for uveitis patient is approximately 60,000 US dollars and has increased from 2016-2020. Similarly, cost of hospital stays and length of stay increased during the study period. Majority of uveitis inpatients are discharged to home, smaller percentage are discharged to rehab, nursing home or to home health care. Results are shown in the Table 1.ConclusionEconomic burden of inpatient uveitis on health care is significant and has continued to increase from 2016 to 2020. Strategy and policy for providing better outpatient care for uveitis patients would help in reducing the number of hospital admissions and costs of stay.References[1] Bertrand PJ, Jamilloux Y, Ecochard R, Richard-Colmant G, Gerfaud-Valentin M, Guillaud M, Denis P, Kodjikian L, Sève P. Uveitis: Autoimmunit and beyond. Autoimmun Rev. 2019 Sep;18(9):102351.PMID: 31323361.[2] Rosenbaum JT. The eye in spondyloarthritis. Semin Arthritis Rheum. 2019 Dec;49(3S):S29-S31.PMID: 31779847.Table 1.Attributes of Hospital Stay for Uveitis patients in the United States: 2016-2020: National Inpatient Sample.20162017201820192020Estimate (Standard error)Estimate (Standard error)Estimate (Standard error)Estimate(Standard error)Estimate (Standard error)Number of discharges1270(111)1260(103)1340(114)1645(116)1290(109)Average Length of Stay(In days)5.8(0.361)6.7(0.451)6.2(0.319)7.2(0.57)7.1(0.667)Aggregate hospital charges*(In US $)64,574,007(7251445)69,891,369(8262178)8,4085,579(10294805)109,200,748(10618923)89,381,020(9376801)Aggregate hospital cost^(In US $)16,884,141(1924031)17,972,462(2122834)19,125,946(2158514)28,756,464(3008420)23,935,615(2628843)Average hospital charge per stay(In US $)50,846(4095)55,469(4611)62,750(5469)66,383(4659)69,288(5127)Average hospital cost per stay(In US $)13,295(1064)14,264(1151)14,273(1045)17,481(1394)18,555(1488)Number of discharges transferred to nursing home or rehab.125(26)175(34)140(26)190(32)170(32)Number of discharges to home health care.120(24)120(25)145(30)235(37)165(29)*Charges: Amount hospital billed. Aggregate Charges: The sum of all charges for all hospital stays in the U.S.^Costs: Actual costs of hospital stay.Charges are converted to costs using cost-to-charge ratios based on hospital accounting reports from the Centers for Medicare and Medicaid Services (CMS).Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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Awad, Ramez Heshmat, Seshan Subramanian, and Carlos f. Garcia. "Are We Doing Too Many HIT Tests? II." Blood 126, no. 23 (December 3, 2015): 2310. http://dx.doi.org/10.1182/blood.v126.23.2310.2310.
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Abstract Back Ground: Heparin Induced Thrombocytopenia is a complex immune disorder related to exposure to heparin that results in arterial and venous thrombosis and moderate to severe thrombocytopenia. Incidence is 0.8-1% in hospitalized patients exposed to heparin. However there is a problem with over testing for HIT syndrome that it is not only financially burdensome but that treating false positive patients with anticoagulation can increase their risk for bleeding. Objective: To determine the actual incidence of Type II-HIT compared to the frequency and necessity of testing in a single urban, teaching, community hospital in Chicago. Methods: A retrospective review of lab records for patients who were tested for HIT syndrome by H-PF4 -ELISA through 2 years Jan 2013-Dec 2014. Then each patient's chart was reviewed. Patients were categorized according to requesting department (i.e. ICU, ED, Medical and surgical floors) then screened for date of admission, date of onset of platelet drop, degree of platelet drop, incidence of DVT, PE, arterial thrombosis and bleeding and finally for possible reasons of platelet count drop other than HIT for calculation of Pretest probability by the 4T score. According to the 4T criteria patients were categorized as low (score 0-3), intermediate (score 4, 5) and high probability (score 6-8). All charts with positive ELISA were reviewed for SRA (Serotonin Release Assay) results. Also contacted lab and pharmacy for cost of HIT testing, confirmatory test with SRA and the cost of Argatroban to be able to determine the economic burden of over testing for HIT syndrome. Results: an average of about 20,000 admissions per year. Over the year 2013, 110 patients were screened for HIT. Over the year 2014, 87 patients were tested for HIT. Of total of 197 tests ordered over the 2 years period 19 Patients did not have enough data in the charts for determination of 4T score and were so excluded. Of the remaining 178, 85(45%) were sent from ICU, 61(32.6%) from Medical floors, 28(15%) from CCU, 9(4.8%) from Surgical floors, 1(0.5%) from Rehab unit, 1(0.5%) from ED and 1(0.5%) from Observation Unit. 17(9.5%) Patients had proven DVT, PE or arterial thrombosis. 2(1%) Patients had evidence of bleeding. According to 4T score139 (74.3%) of 178 were low, 34(18%) intermediate and 5(2.6%) were high probability. ELISA test was positive for only 34(19%) patients of the 178 of which only 3(1.6%) were proven true positive by SRA, 12(6%) had no SRA result in their chart and 19(10.6%) had negative SRA results. ELISA was positive in 22 cases with Low Probability score, 9 Intermediate probability and 3 high probability. Of the 22 low probability ELISA positive cases only 1 (4%) was SRA positive, 15(68%) were SRA negative and 6(27%) did not have SRA in the chart. ELISA test costs 233$, SRA test costs 50$ and one day of Argatroban costs average of 663.44$.Thus the calculated cost of testing for low probability patients reached 32,387 $ for ELISA and 800$ for SRA. Cost of treating false positive patients with Argatroban for an average of 3 days until SRA results are available is 43,758$. Conclusion: From this study we concluded that in our facility we continue to do too many HIT studies without appropriate prescreening with added cost of testing and treatment for low probability patients of almost 77,000$ over the period of two years. In planning to avoid unnecessary testing and treatment for false positive patients we plan to build a 4T score calculator into our Electronic Medical Record System that is started once a HIT test is ordered to improve the screening process. We will also continue work with the Internal Medicine residency program and medical staff to improve teaching on HIT syndrome and other conditions with similar presentations. Table 1. Number of Tests per Department Department Number of tests sent ICU 86(45%) CCU 28(15%) Medical Floors 61(32.6%) Surgical Floors 9(4.8%) Rehab Unit 1(0.5%) ED 1(0.5%) Observation Unit 1(0.5%) Total 187 Table 2. Tests Categorized into Low, Intermediate and High Probability according to 4T score Low Probability Intermediate Probability High Probability 139(74.3%) 34(18%) 5(2.6%) Table 3. SRA Results for ELISA positive patients per Each Probability Category Low Probability Intermediate Probability High Probability 22(64.7%) 9(26.4%) 3(8%) SRA Positive SRA Negative SRA Unavailable SRA Positive SRA Negative SRA Unavailable SRA Positive SRA Negative SRA Unavailable 1(4%) 15(68%) 6(27%) 2(22%) 4(44%) 3(33%) 0 1(33%) 2(66.6%) Disclosures No relevant conflicts of interest to declare.
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Guyot, Daniel, Gabrielle Tea, and Christoph Appel. "Low NOx Lean Premix Reheat Combustion in Alstom GT24 Gas Turbines." Journal of Engineering for Gas Turbines and Power 138, no. 5 (October 27, 2015). http://dx.doi.org/10.1115/1.4031543.
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Reducing gas turbine emissions and increasing their operational flexibility are key targets in today's gas turbine market. In order to further reduce emissions and increase the operational flexibility of its GT24 (60 Hz) and GT26 (50 Hz), Alstom has introduced an improved sequential environmental (SEV) burner and fuel lance into its GT24 and GT26 upgrades 2011 sequential reheat combustion system. Sequential combustion is a key differentiator of Alstom GT24/GT26 engines in the F-class gas turbine market. The inlet temperature for the SEV combustor is around 1000 °C and reaction of the fuel/oxidant mixture is initiated through auto-ignition. The recent development of the Alstom sequential combustion system is a perfect example of evolutionary design optimizations and technology transfer between Alstom GT24 and GT26 engines. Better overall performance is achieved through improved SEV burner aerodynamics and fuel injection, while keeping the main features of the sequential burner technology. The improved SEV burner/lance concept has been optimized toward rapid fuel/oxidant mixing for low emissions, improved fuel flexibility with regard to highly reactive fuels (higher C2+ and hydrogen content), and to sustain a wide operation window. The burner front panel features an improved cooling concept based on near-wall cooling as well as integrated acoustics damping devices designed to reduce combustion pulsations, thus extending the SEV combustor's operation window even further. After having been validated extensively in Alstom's high pressure (HP) sector rig test facility, the improved GT24 SEV burner has been retrofitted into a commercial GT24 field engine for full engine validation during long-term operation. This paper presents the obtained HP sector rig and engine validation results for the GT24 (2011) SEV burner/lance hardware with a focus on reduced NOx and CO emissions and improved operational behavior of the SEV combustor. The HP tests demonstrated robust SEV burner/lance operation with up to 50% lower NOx formation and a more than 70 K higher SEV burner inlet temperature compared to the GT24 (2006) hardware. For the GT24 engine with retrofitted upgrade 2011 SEV burner/lance, all validation targets were achieved including an extremely robust operation behavior, up to 40% lower GT NOx emissions, significantly lower CO emissions at partload and baseload, a very broad operation window (up to 100 K width in SEV combustor inlet temperature), and all measured SEV burner/lance temperatures in the expected range. Sector rig and engine validation results have confirmed the expected SEV burner fuel flexibility (up to 18 vol. % C2+ and up to 5 vol. % hydrogen as standard).
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Zellhuber, Mathieu, Christoph Meraner, Rohit Kulkarni, Wolfgang Polifke, and Bruno Schuermans. "Large Eddy Simulation of Flame Response to Transverse Acoustic Excitation in a Model Reheat Combustor." Journal of Engineering for Gas Turbines and Power 135, no. 9 (August 21, 2013). http://dx.doi.org/10.1115/1.4024940.
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The response of a perfectly premixed, turbulent jet flame at elevated inflow temperature to high frequency flow perturbations is investigated. A generic reheat burner geometry is considered, where the spatial distribution of heat release is controlled by autoignition in the jet core on the one hand, and kinematic balance between flow and flame propagation in the shear layers between the jet and the external recirculation zones on the other. To model autoignition and heat release in compressible turbulent flow, a progress variable/stochastic fields formulation adapted for the LES context is used. Flow field perturbations corresponding to transverse acoustic modes are imposed by harmonic excitation of velocity at the combustor boundaries. Simulations with single-frequency excitation are carried out in order to study the flame response to transverse fluctuations of velocity. Heat release fluctuations are observed predominantly in the shear layers, where flame propagation is important. The flow-flame coupling in these regions is analyzed in detail with a filter-based postprocessing approach, invoking a local Rayleigh index and providing insight into the interactions of flame wrinkling by vorticity and convection due to mean and fluctuating velocity.
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de Cataldo, Alessandro, Marco Astolfi, Paolo Chiesa, Stefano Campanari, Emanuele Martelli, Paolo Silva, Stefano Bedogni, Luca Ottolina, Marco Tappani, and Matteo C. Romano. "Power and Hydrogen Co-production in Flexible “Powdrogen” Plants." Journal of Engineering for Gas Turbines and Power, October 21, 2022. http://dx.doi.org/10.1115/1.4056045.
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Abstract This study investigates the potential of “Powdrogen” plants for blue hydrogen and decarbonized electric power production, conceived to operate flexibly depending on the electricity price and to increase the capacity factor of the hydrogen production and CO2 separation units. The Hydrogen production is based on fired tubular reforming or auto-thermal reforming technologies with pre-combustion CO2 capture by a MDEA process. The power island is based on a combined cycle with H2-fired gas turbine and a triple pressure reheat heat recovery steam generator (HRSG). The analysis considers three main plant operating modes: hydrogen mode (reformer at full load with hydrogen export and combined cycle off) and power mode (reformer at full load with all hydrogen burned in the combined cycle), plus an intermediate polygeneration mode, producing both hydrogen and electricity. The possibility of integrating the HRSG and the reformer heat recovery process to feed a single steam turbine has been explored to allow keeping the steam turbine hot also in hydrogen operating mode. The economic analysis investigates the competitivity of the plant for different operating hours in hydrogen and power modes. Results suggest that these plants are likely to be a viable way to produce flexibly low-carbon hydrogen and electricity following the market demand.
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Mohammed, Alqahtani Ibtesam. "Increasing Incidence of Hypertension in Females by Nasira, Maryam, Salman, and Rehan (2019)." International Journal of Innovative Research in Medical Science 4, no. 07 (July 10, 2019). http://dx.doi.org/10.23958/ijirms/vol04-i07/689.
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Hypertension is one of the cardio-metabolic risk factors that is associated with the increased burden of global morbidity and mortality. This disease is a silent threat to all individuals' health all over the world. Thus, early detection and management of this disease is critical.
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"Assessment of Mechanical Design Parameters for an Aero Gas Turbine Engine Jet Pipe Casing using Finite Element Analysis." International Journal of Engineering and Advanced Technology 9, no. 5 (June 30, 2020): 1197–201. http://dx.doi.org/10.35940/ijeat.e1072.069520.
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Aero Gas Turbine engines power aircrafts for civil transport application as well as for military fighter jets. Jet pipe casing assembly is one of the critical components of such an Aero Gas Turbine engine. The objective of the casing is to carry out the required aerodynamic performance with a simultaneous structural performance. The Jet pipe casing assembly located in the rear end of the engine would, in case of fighter jet, consist of an After Burner also called as reheater which is used for thrust augmentation to meet the critical additional thrust requirement as demanded by the combat environment in the war field. The combustion volume for the After burner operation together with the aerodynamic conditions in terms of pressure, temperature and optimum air velocity is provided by the Jet pipe casing. While meeting the aerodynamic requirements, the casing is also expected to meet the structural requirements. The casing carries a Convergent-Divergent Nozzle in the downstream side (at the rear end) and in the upstream side the casing is attached with a rear mount ring which is an interface between engine and the airframe. The mechanical design parameters involving Strength reserve factors, Fatigue Life, Natural Frequencies along with buckling strength margins are assessed while the Jet pipe casing delivers the aerodynamic outputs during the engine operation. A three dimensional non linear Finite Element analysis of the Jet pipe casing assembly is carried out, considering the up & down stream aerodynamics together with the mechanical boundary conditions in order to assess the Mechanical design parameters.
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"Optimized IDN-FOPD Controller based AGC Loop of a Wind-Solar-Thermal Interconnected Power System with HES and IPFC Units." International Journal of Innovative Technology and Exploring Engineering 9, no. 1 (November 10, 2019): 2937–45. http://dx.doi.org/10.35940/ijitee.a9112.119119.
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The current scenario of this version focuses on automatic generation control (AGC) exploration to a practical power system incorporating a versatile mixture of two-area generating multi-source units under a deregulated format. Each and every area will have two generating and distribution companies termed as Gencos and Discos. In Gencos, area-1 is a combination of wind energy power plant along with a thermal unit while area-2 is a solar power plant and thermal unit. In this research, the thermal plants are well thought-out with reheat tandem compound steam turbine rather than steam turbine dynamic representation constraint is believed to be expected. In this examination, another ID comprises filter with Fractional Order Proportional Derivative (IDN-FOPD) controller is prearranged and carry out for the AGC scheme. The control limits of the IDN-FOPD controller refrained using Lightning Search Algorithm (LSA) and its demonstration is dissimilarity and PI and Fractional Order Proportional Integral Derivative (FOPID) based controllers. Further to improve AGC execution, Hydrogen Energy Storage (HES) is included into its control area and Interline Power Flow Controller (IPFC) is integrated to dealt with Tie line. Simulated results demonstrate that the LSA tuned IDN-FOPD controller progress the vibrant yield reaction of the test system as far as less summit deviation, tie-line power oscillations and settling time of area frequencies in a variety of interactions of the deregulated power system. The implementation of HES and IPFC units successfully detain the initial descend in reappearance just as the tie line divergences in power while an unexpected burden upsetting influence. Subsequently, the coordinated activity of HES-IPFC units in the AGC circle could perk up the system implementation.
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Chauhan, Nabeel, Syed F. Ali, Archana Hinduja, Debra M. Johnson, and Nicolas Bianchi. "Abstract W MP105: Regionalization of Care and Increased Burden on Specialized Stroke Centers." Stroke 46, suppl_1 (February 2015). http://dx.doi.org/10.1161/str.46.suppl_1.wmp105.
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Introduction: Many patients are transferred to specialized stroke centers for advanced ischemic stroke (AIS) care, especially after tPA. We sought to determine differences in the baseline characteristics and outcomes between AIS cases presenting directly to our academic stroke center as compared to those transferred from outside facilities (OSH). Methods: Using our institutional GWTG stroke registry, we analyzed 1,726 AIS cases (01/09 - 02/14). Univariate and multivariable models explored differences in patients presenting directly at our center as compared to transferred from OSH. Results: 46% percent of all AIS were transferred patients. Compared to those presenting directly at our center, transferred patients were older, more often Caucasian, with more vascular risk factors. They had worse median NIHSS, more often had limb weakness or aphasia and received IV tPA. In-hospital mortality was nearly double in transferred patients. Transfer-in patients had a longer hospital length of stay and were more often discharged to inpatient rehab. Independent predictors of in-hospital mortality were increasing age, A. fib, coronary artery disease and initial NIHSS. Transfer status was not independently associated with in-hospital mortality. Conclusions: Transferred patients differed significantly from those presenting directly, they have more stroke risk factors and present with severe strokes. Accepting such patients increase the burden at specialized stroke centers. Despite having more severe strokes on arrival, transfer patients had similar in-hospital mortality after adjusting for stroke severity (NIHSS) lending support to the concept of regionalized stroke care.
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Shakir, Waqas, Abdur Rehman, M. Sohail Arshad, and Nazia Fatima. "Burden of cardiovascular dysfunction and outcome among term newborns having birth asphyxia." Pakistan Journal of Medical Sciences 38, no. 4 (March 5, 2022). http://dx.doi.org/10.12669/pjms.38.4.5160.
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Objectives: To find out the burden of cardiovascular dysfunction and outcome among term newborns having birth asphyxia.
Methods: This prospective observational study was conducted at The Department of Neonatology, Children’s Hospital and The Institute of Child Health, Multan from August 2020 to March 2021.A total of 171 term newborns having asphyxia were enrolled. Detailed history along with clinical and physical examination were done at the time of admission at Neonatal Intensive Care Unit (NICU). All neonates were followed up for duration of 14 days following birth. Echocardiographic patterns as well as electrocardiography grading were described among neonates with cardiovascular abnormalities.
Results: Out of a total of 171 neonates, there were 94 (55.0%) male and 77 (45.0%) female. Lowe segment cesarean section was the mode of delivery in 72 (42.1%) while normal vaginal delivery was noted in 99 (57.9%). Mean gestational age was noted to be 38.3±1.8 weeks. Mean birth weight was calculated to be 2574.10±122.30 grams. Cardiovascular dysfunction was noted among 60 (35.1%) neonates as exhibited by the use of inotropes while abnormal ECHO was observed in 52 (30.4%), abnormal ECG in 27 (15.8%) and elevated CK-MB in 31 (18.1%). A total of 29 (17.0%) asphyxiated neonates died while among 60 asphyxiated neonates with cardiovascular dysfunction, 23 (38.3%) died and all remaining survived and discharged (p<0.0001).
Conclusion: Cardiovascular dysfunction among asphyxiated neonates was found to be in high proportion of cases. Cardiovascular dysfunction was noted to have significant association with poor outcome.
doi: https://doi.org/10.12669/pjms.38.4.5160
How to cite this:Shakir W, Abdur-Rehman, Arshad MS, Fatima N. Burden of cardiovascular dysfunction and outcome among term newborns having birth asphyxia. Pak J Med Sci. 2022;38(4):---------. doi: https://doi.org/10.12669/pjms.38.4.5160
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Korya, Daniel, Kendra Drake, and Bruce Coull. "Abstract WMP93: Uninsured Patients have Longer Hospital Stays and are Less Likely to Receive Rehab than Insured Patients." Stroke 44, suppl_1 (February 2013). http://dx.doi.org/10.1161/str.44.suppl_1.awmp93.
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Background: In 2010 the estimated direct and indirect cost of stroke was $53.9 billion. The long-term burden to society is thought to be much more costly. Whether or not this sum can be reduced has been a subject of great debate. Recently, healthcare reform has been a priority for policy makers with health insurance as a prevailing issue. We examined the healthcare records of patients in the US who presented with stroke symptoms in a 10-year period from 2001-2011, and compared them to patients in the state of Arizona as well as our University Hospital in the same time period. We then looked for differences in the cost of stroke with regard to variations in insurance status. Methods: The records of 978,813 patients with stroke symptoms in the US from January 2001 through December 2011 were compared with 18,875 Arizona (AZ) patients. This data was evaluated and compared with data obtained from the records of 1,123 patients admitted to the University Medical Center (UMC), and separated by insurance status, discharge location and length of stay (LOS) for different stroke subtypes. The information was gathered from the get with the guidelines stroke database and only included hospitals that reported their information. Results: The mean LOS for stroke patients in the US, AZ and UMC were: 5.25 days, 4.69 and 4.75 days, respectively. When separated by insurance status, the mean LOS for patients at UMC with Medicare was 4.27 days (n=470), for Medicaid it was 6.17 days (n=150) and 5.13 days (n=464) for private insurance. Compared with insured patients, uninsured patients had a LOS of 8.18 days (n=39; p=.001). Uninsured patients were discharged home without rehab 24.4% of the time compared with only 8.8% of insured patients (p=.001), even though 93.5% of uninsured patients were considered for rehab. Conclusion: Uninsured patients had a LOS that was 3.3 days longer than insured patients and had an estimated 72% higher cost of hospitalization. Uninsured patients were almost 3 times less likely than insured patients to be discharged with rehab, and consequently were less likely to achieve long-term functional independence. Ultimately, the price of stroke in the uninsured is paid for by taxpayers, since these patients will require social services granted by the government for disability.
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Somani, Sana, Hely Nanavati, Xiaohua Zhou, and Chen Lin. "Abstract P446: African American Women Have Lower Functional Performance During Acute Inpatient Rehabilitation After Intracerebral Hemorrhagic Strokes." Stroke 52, Suppl_1 (March 2021). http://dx.doi.org/10.1161/str.52.suppl_1.p446.
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Introduction: Intracerebral hemorrhage (ICH), a subtype of stroke, leads to significant long-term disability. Research in stroke recovery and rehabilitation has focused on ischemic strokes. Identifying factors that impact the recovery of function for patients at an inpatient rehabilitation facility (IRF) following an ICH is necessary. Our purpose is to identify factors, including racial and gender disparities, associated with inpatient rehabilitation after ICH. Methods: We performed a retrospective analysis of a tertiary care academic hospital in the Stroke Belt of the US, the University of Alabama at Birmingham, and subsequently, admitted to an IRF from December 2016 through December 2019. Functional performance was measured using the Functional Independence Measure (FIM), an 18-item scale measuring the level of disability in terms of burden of care. Baseline clinical characteristics, demographics, admission and discharge FIM scores, and ICH characteristics including ICH scores and volumes were collected. FIM efficiency was calculated for all patients by dividing the difference in FIM scores at admission and discharge from the total number of days spent at rehab. The differences in FIM efficiency by gender and race were measured using multiple linear regression. Results: We evaluated 65 patients (54.4 ± 14.1 years, 61% males, 46% African American) with a median (interquartile range) ICH score of 1.0 (0.0, 2.0), median ICH volume of 13.4 (4.2, 33.0), and FIM efficiency of 1.6 (1.1, 2.4). In multiple regression, being male was positively associated with FIM efficiency (β=1.02, p = 0.0063) when adjusting for race and ICH score. The FIM efficiency was lower in African Americans (β =-0.95, p = 0.0092) when adjusting for gender and ICH volume. No significant differences were noted in ICH volumes and scores with respect to discharge FIM scores. Conclusions: FIM efficiency, is a good measure of improvement in motor function and ADLs over the rehab period. Our results indicate that African American women could potentially benefit from longer periods of rehabilitation intervention.
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Barnes, Olivia, Adela Santana, Beth L. Malina, Gary Myers, Amy Goldman, Tammy Storer, Gene McDowell, Sarah Schwarz, and Rebecca Frans. "Abstract P213: Identification of Rural Needs and Gaps of Stroke Care Rehabilitation: Results From a Statewide Healthcare Provider and Stroke Patient Survey." Stroke 52, Suppl_1 (March 2021). http://dx.doi.org/10.1161/str.52.suppl_1.p213.
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Introduction: Urban and rural stroke care disparities are pervasive for post-acute stroke rehabilitation. Mission:Lifeline Stroke conducted a needs assessment to identify needs and gaps in care for stroke rehabilitation throughout rural Nebraska (NE). Purpose: The assessment included surveys of healthcare providers (HCPs) and stroke survivors to inform a robust understanding of stroke rehabilitation needs across NE, addressing barriers and facilitators to care, including outpatient therapy, social support, equipment, and patient-facing resources. Methods: HCPs were recruited through the Nebraska Stroke Advisory Council to complete a 17-question online survey. Survivors in NE were recruited through social media and existing stroke support groups to complete a 26-question online survey. Results: Respondents of the HCP survey (N=260) identified the top barrier to providing care to survivors as lack of insurance (62%), lack of caregiver support (42%), and lack of specialized services (42%). Respondents of the survivor survey (N=30) identified top barriers as lack of insurance (74%), financial burden (64%), and lack of caregiver/social support (50%). Both HCPs’ and survivors identified lack of caregiver and social support as resources missing from their community, and survivors identified communication about support groups or sources of emotional support (n=4) as the top missing resource. In addition, 39% of survivors indicated an interest in attending a support group. HCPs indicated missing resources primarily include specialized rehab equipment, technology, and services (52%), and professional opportunities for staff (37%). Regarding resources provided to survivors, most HCPs indicated community resources (94%) are provided, proceeded by follow-up/continued outpatient therapy (88%). In slight contrast, survivors indicated the top resources they learned of when discharged were outpatient physical therapy (82%), outpatient occupational therapy (70%), and outpatient speech therapy (56%). Conclusion: Although both healthcare providers and survivors identified outpatient therapies are made available, there is a need for more communication about support groups and physical resources such as rehab equipment, technology, and services.
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Hossain, Md Shahriar, Suprio Kamal, Mahbub Chowdhury, Md Tariful Islam, and Kawnish Kirtania. "Parametric Study on Co-Feeding of Municipal Solid Waste and Coal in an IGCC Power Plant with Pre-Combustion Carbon Capture." Chemical Engineering Research Bulletin, June 23, 2021, 37–42. http://dx.doi.org/10.3329/cerb.v22i1.54297.
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Municipal solid waste (MSW) is one of the top contributors in greenhouse gas (i.e. methane) emissions - particularly from landfill disposals. However, it could be a remarkable source of renewable energy. In Bangladesh, generation of municipal solid waste is at least 2.7 million tonne per year in the major cities, implying a heavy environmental burden. On the other hand, there are several coal-based power plants are in the pipeline to meet the increasing energy demand in Bangladesh with the potential of significant CO2 emission. To find a remedy to the above situation, a power plant using Integrated Gasification and Combustion Cycle (IGCC) technology with pre-combustion carbon capture is considered in this study. IGCC has the advantage of producing high quality syngas from a wide variety of feed and assists in the capture of CO2 at a lower cost while providing high electric efficiency. The power plant was simulated by commercial simulation packages (Aspen PLUS™ and Aspen HYSYS™) using MSW and bituminous coal (Indonesian) as a combined feed. With a feed rate of 1800 tonne per day, Syngas produced from an entrained flow type gasifier was then treated for CO2 removal using mono-ethanol amine (MEA) solvent after necessary shift in a high temperature shift reactor. About 91% efficiency was achieved in the shift reactor while the CO2 capture efficiency was varied for this study from 30% to 85%. Further parametric variation was studied by varying the moisture content of MSW and MSW to coal feed ratio. Through combustion of the H2 rich syngas in a gas turbine and subsequent steam cycle with reheat resulted in 125 MW of electricity at an efficiency of 28.95% while capturing 50% of the CO2 generated in the process for an MSW to Coal feed ratio of 1:1. With variation in moisture content especially during monsoon season, the plant efficiency could be affected remarkably. On the other hand, it was observed that the energy requirement varied from 6 to 8 MW for every 10% increase in CO2 capture quantity. Overall, by capturing 50% of the generated CO2, it is possible to reduce the emission of a same size ultra-supercritical coal-based power plant from about 700 kg CO2/MWh to about 360 kg of net CO2/MWh incorporating co-feeding and pre-combustion capture in an IGCC power plant.
Chemical Engineering Research Bulletin 21(2020) 37-42
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Anand, Vidhu, and Thenappan Thenappan. "Abstract 16341: Trends of Inpatient Burden of Primary Pulmonary Hypertension in USA: Analysis of Nationwide Inpatient Sample Database From 2001-2012." Circulation 132, suppl_3 (November 10, 2015). http://dx.doi.org/10.1161/circ.132.suppl_3.16341.
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Background: Primary pulmonary hypertension (PPH) is a rare pulmonary vascular disease characterized by endothelial dysfunction and vascular remodeling of small pulmonary arteries, resulting in elevated pulmonary artery pressures. The cause of endothelial dysfunction is usually unknown. PPH is a progressive disease resulting in reduced cardiac output, right heart failure, and death. We aimed to evaluate the characteristics of hospitalizations for PPH in United States. Methods: We analyzed the National Inpatient Sample Database (NIS) for all subjects in which PPH (ICD code 416.0) was the principal discharge diagnosis from 2001-2012. Data is presented as mean ± SE. Results: In 2001, there were 3177 admissions with a principal discharge diagnosis of PPH as compared to 1345 in 2012 (p<0.001) (Figure). Rate of discharge per 100,000 persons decreased significantly from 1.1 ± 0.1 to 0.4± 0.0 (p<0.001). However, the mean length of stay (7.03±0.5 in 2001 vs 7.6±0.6 in 2001, p= 0.5) and in-patient mortality (7.75±1.07 % in 2001 vs 6.32±1.68 % in 2001, p= 0.47) has not changed significantly between 2001 and 2012. It is important to note that during this period the mean hospital charges increased by 269.8 % from $29507 per patient in 2001 to $79607 per patient in 2012 (p<0.0001). In 2012, 68% of patients were between ages 45-84 years and 72.9% were females. Medicare was billed for about half the hospital stays in 2012 (49.4%). The routine discharges constituted about 62.45% of total discharges, followed by home health care (18.6%) and nursing home/ rehab (6.7%). Conclusion: The number of inpatient admissions and rate of discharge for primary pulmonary hypertension has decreased significantly over the last 13 years. The cost associated with these admissions has however increased substantially, even though there is no significant change in the duration of inpatient stay and inpatient mortality rates.
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Ugwu, O., and L. Cheng. "700 Audit on Antibiotic Prescriptions in Neuro-Rehabilitation Wards (C2 And L1) Of Salford Royal Foundation Trust." British Journal of Surgery 108, Supplement_2 (May 1, 2021). http://dx.doi.org/10.1093/bjs/znab134.317.
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Abstract Background Antibiotic-guidelines protect patients by reducing the burden of antibiotic-resistant strains. Some also contain charts for safe dosage and monitoring. Adherence to guidelines promotes patient safety. Method Data was collected retrospectively. Electronic records of all in-patients in Neuro-rehab wards on 24/7/2020 were initially analysed. Patients who had not received antibiotics from 1/5/2020 to 24/7/2020 were excluded. Data was analysed using tally chart. Results 23 patients received antibiotics. Antibiotics were prescribed 45 times over study period. Urinary Tract Infections (UTIs) accounted for 37.8% of cases. Chest infections and skin infections accounted for 22% and 15% respectively. Sepsis of unknown origin and Other-Causes each accounted for 8.9%. In 95% of prescriptions, an indication was documented. Also, 100% compliance was recorded in Allergy status review and documentation of course-length of antibiotics. However, only 53.4% met clinical criteria for antibiotics administration. Of the cases which did not meet the clinical criteria, only 52.3% had been discussed with microbiology department /senior clinician. Conclusions Neuro-rehabilitation patients present with complex conditions and are sometimes non-communicative. This makes it difficult to adhere to clinical criteria as some of these require symptoms from patients. Such cases must be discussed with microbiologist/senior clinician.