Heat release rate estimation in laminar premixed flames using laser-induced fluorescence of CH2O and H-atom

The present work demonstrates the feasibility of heat release rate imaging using the laser-induced fluorescence (LIF) of atomic hydrogen (H-atom) and formaldehyde (CH2O) in laminar premixed flames. The product of H-atom LIF and CH2O LIF signals is evaluated on a pixel-by-pixel basis and is compared with that of the OH × CH2O technique. These results for equivalence ratio ranging from 0.8 to 1.1 are compared with computations of one-dimensional freely-propagating flames. The performance of these markers is studied based on the following two aspects: the spatial accuracy of the local heat release rate and the trend in the total heat release rate with equivalence ratio. The measured trend in the spatial distribution of radicals and the deduced heat release rate agree well with the computational values. The variation in the spatially integrated heat release rate as a function of equivalence ratio is also investigated. The results suggest that the trend in the variation of the integrated heat release rate and the spatial location of heat release rate can be evaluated by either of these markers. The OH-based marker showed certain sensitivity to the chemical mechanism as compared to the H-atom based marker. Both the OH-based and H-atom based techniques provide close estimates of heat release rate. The OH based technique has practical advantage when compared to the H-atom based method, primarily due to the fact that the H-atom LIF is a two-photon process

Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis

Background: Activity-based funding (ABF) of hospitals is a policy intervention intended to re-shape incentives across health systems through the use of diagnosis-related groups. Many countries are adopting or actively promoting ABF. We assessed the effect of ABF on key measures potentially affecting patients and health care systems: mortality (acute and post-acute care); readmission rates; discharge rate to post-acute care following hospitalization; severity of illness; volume of care.     Methods: We undertook a systematic review and meta-analysis of the worldwide evidence produced since 1980. We included all studies reporting original quantitative data comparing the impact of ABF versus alternative funding systems in acute care settings, regardless of language. We searched 9 electronic databases (OVID MEDLINE, EMBASE, OVID Healthstar, CINAHL, Cochrane CENTRAL, Health Technology Assessment, NHS Economic Evaluation Database, Cochrane Database of Systematic Reviews, and Business Source), hand-searched reference lists, and consulted with experts. Paired reviewers independently screened for eligibility, abstracted data, and assessed study credibility according to a pre-defined scoring system, resolving conflicts by discussion or adjudication.     Results: Of 16,565 unique citations, 50 US studies and 15 studies from 9 other countries proved eligible (i.e. Australia, Austria, England, Germany, Israel, Italy, Scotland, Sweden, Switzerland). We found consistent and robust differences between ABF and no-ABF in discharge to post-acute care, showing a 24% increase with ABF (pooled relative risk = 1.24, 95% CI 1.18–1.31). Results also suggested a possible increase in readmission with ABF, and an apparent increase in severity of illness, perhaps reflecting differences in diagnostic coding. Although we found no consistent, systematic differences in mortality rates and volume of care, results varied widely across studies, some suggesting appreciable benefits from ABF, and others suggesting deleterious consequences.     Conclusions: Transitioning to ABF is associated with important policy- and clinically-relevant changes. Evidence suggests substantial increases in admissions to post-acute care following hospitalization, with implications for system capacity and equitable access to care. High variability in results of other outcomes leaves the impact in particular settings uncertain, and may not allow a jurisdiction to predict if ABF would be harmless. Decision-makers considering ABF should plan for likely increases in post-acute care admissions, and be aware of the large uncertainty around impacts on other critical outcomes

Study Characteristics (Pooled and Non-Pooled).

<p>Study Characteristics (Pooled and Non-Pooled).</p

Summary of Findings of the Impact of ABF (Pooled and Non-Pooled).

<p>Summary of Findings of the Impact of ABF (Pooled and Non-Pooled).</p

Prisma flow diagram.

<p>Prisma flow diagram.</p

Readmission Forest Plot.

<p>Readmission Forest Plot.</p

Discharge Destination Forest Plot.

<p>Discharge Destination Forest Plot.</p