Can we predict a national profile of non-attendance paediatric urology patients: a multi-institutional electronic health record study

Background Non-attendance at paediatric urology outpatient appointments results in the patient’s failure to receive medical care and wastes health care resources.Objective To determine the utility of using routinely collected electronic health record (EHR) data for multi-centre analysis of variables predictive of patient no-shows (NS) to identify areas for future intervention.Methods Data were obtained from Children’s Hospital Colorado, Rady Children’s Hospital San Diego and University of Virginia Hospital paediatric urology practices, which use the Epic® EHR system. Data were extracted for all urology outpatient appointments scheduled from 1 October 2010 to 30 September 2011 using automated electronic data extraction techniques. Data included appointment type; date; provider type and days from scheduling to appointment. All data were de-identified prior to analysis. Predictor variables identified using χ2 and analysis of variance were modelled using multivariate logistic regression.Results A total of 2994 NS patients were identified within a population of 28,715, with a mean NS rate of 10.4%. Multivariate logistic regression determined that an appointment with mid-level provider (odds ratio (OR) 1.70 95% CI (1.56, 1.85)) and an increased number of days between scheduling and appointment (15–28 days OR 1.24 (1.09, 1.41); 29+ days OR 1.70 (1.53, 1.89)) were significantly associated with NS appointments.Conclusion We demonstrated sufficient interoperability among institutions to obtain data rapidly and efficiently for use in 1) interventions; 2) further study and 3) more complex analysis. Demographic and potentially modifiable clinic characteristics were associated with NS to the outpatient clinic. The analysis also demonstrated that available data are dependent on the clinical data collection systems and practices

A 5-year retrospective cohort study of unplanned readmissions in an Australian tertiary paediatric hospital

Objective: The aim of this study was to examine the characteristics and prevalence of all-cause unplanned hospital readmissions at a tertiary paediatric hospital in Western Australia from 2010 to 2014. Methods: A retrospective cohort descriptive study was conducted. Unplanned hospital readmission was identified using both 28- and 30-day measurements from discharge date of an index hospital admission to the subsequent related unplanned admission date. This allowed international comparison. Results: In all, 73 132 patients with 134 314 discharges were identified. During the 5-year period, 4070 discharges (3.03%) and 3330 patients (4.55%) were identified as 30-day unplanned hospital readmissions. There were minimal differences in the rate of readmissions on Days 28, 29 and 30 (0.2%). More than 50% of readmissions were identified as a 5-day readmission. Nearly all readmissions for croup and epiglottitis occurred by Day 5 those for acute bronchiolitis and obstructive sleep apnoea requiring tonsillectomy and/or adenoidectomy occurred by Day 15 and those for acute appendicitis and abdominal and pelvic pain occurred by Day 30. Conclusion: This study highlights the variability in the distribution of time intervals from discharge to readmission among diagnoses, suggesting the commonly used 28- or 30-day readmission measurement requires review. It is crucial to establish an appropriate measurement for specific paediatric conditions related to readmissions for the accurate determination of the prevalence and actual costs associated with readmissions. What is known about this topic?: Unplanned hospital readmissions result in inefficient use of health resources. Australia has used 28 days to measure unplanned readmissions. However, the 30-day measurement is commonly used in the literature. Only five Australian studies were identified with a focus on readmissions associated with specific paediatric health conditions. What does this paper add?: This is the first known study examining paediatric all-cause unplanned same-hospital readmissions in Western Australia. The study used both 28- and 30-day measures from discharge to unplanned readmission to allow international comparison. More than half the unplanned hospital readmissions occurred between Day 0 and Day 5 following discharge from the index admission. Time intervals from discharge date to readmission date varied for diagnosis-specific readmissions of paediatric patients. What are the implications for practitioners?: Targeting the top principal index admission diagnoses identified for paediatric readmissions is critical for improvement in the continuity of discharge care delivery, health resource utilisation and associated costs. Because 52% of unplanned readmissions occurred in the first 5 days, urgent investigation and implementation of prevention strategies are required, especially when the readmission occurs on the date of discharge

Management of pediatric renal trauma: Results from the American Association for Surgery and Trauma Multi-Institutional Pediatric Acute Renal Trauma Study

BackgroundPediatric renal trauma is rare and lacks sufficient population-specific data to generate evidence-based management guidelines. A nonoperative approach is preferred and has been shown to be safe. However, bleeding risk assessment and management of collecting system injury are not well understood. We introduce the Multi-institutional Pediatric Acute Renal Trauma Study (Mi-PARTS), a retrospective cohort study designed to address these questions. This article describes the demographics and contemporary management of pediatric renal trauma at Level I trauma centers in the United States.MethodsRetrospective data were collected at 13 participating Level I trauma centers on pediatric patients presenting with renal trauma between 2010 and 2019. Data were gathered on demographics, injury characteristics, management, and short-term outcomes. Descriptive statistics were used to report on demographics, acute management, and outcomes.ResultsIn total, 1,216 cases were included in this study. Of all patients, 67.2% were male, and 93.8% had a blunt injury mechanism. In addition, 29.3% had isolated renal injuries, and 65.6% were high-grade (American Association for the Surgery of Trauma Grades III-V) injuries. The mean Injury Severity Score was 20.5. Most patients were managed nonoperatively (86.4%), and 3.9% had an open surgical intervention, including 2.7% having nephrectomy. Angioembolization was performed in 0.9%. Collecting system intervention was performed in 7.9%. Overall mortality was 3.3% and was only observed in patients with multiple injuries. The rate of avoidable transfer was 28.2%.ConclusionThe management and outcomes of pediatric renal trauma lack data to inform evidence-based guidelines. Nonoperative management of bleeding following renal injury is a well-established practice. Intervention for renal trauma is rare. Our findings reinforce differences from the adult population and highlights opportunities for further investigation. With data made available through Mi-PARTS, we aimed to answer pediatric specific questions, including a pediatric-specific bleeding risk nomogram, and better understanding indications for interventions for collecting system injuries.Level of evidencePrognostic and Epidemiological; Level IV

Interaction of a train of regular waves with a rigid submerged ellipsoid

This dissertation presents the practical and rigorous solution of the potential flow problem associated with the interaction of a train of regular surface gravity waves with a fixed rigid submerged half spheroid resting on the bottom. The linearized boundary-value problem is first formulated for a fixed semiellipsoid. The radiation problem of a rigid semi-ellipsoid oscillating in its various degrees of freedom, one degree at a time, in otherwise still water is also formulated simultaneously, so as to use its results to check the results of the first problem by Haskind's relations. In each case the solution is obtained by the Green's function approach. In this method the velocity potential is obtained by distributing unit wave sources over the surface of the object. The Green's function which represents the velocity potential for a unit wave source is chosen such that it satisfies all the conditions of the problem except the normal boundary condition on the surface of the object. When this condition is applied, the result is a Fredholm integral equation of the second kind which must be solved for the distribution function. In the numerical procedure the integral equation is replaced by a matrix equation which is solved on a digital computer. The numerical procedure is outlined in detail for the semiellipsoid and finally, numerical results are obtained for a half spheroid. ..

Erosion Control of Scour During Construction. Report 7: CURRENT ― A Wave-Induced Current Model

Source: https://erdc-library.erdc.dren.mil/jspui/Often, large-scale engineering structures such as jetties or breakwaters are constructed in the nearshore region to stabilize navigation channels or protect harbor entrances and beaches. During construction, these structures may alter waves and currents. Waves break on such structures and the resulting turbulence causes material to be tossed into suspension and be transported from the region by wave-induced and other currents. This results in erosion at the toe of the structure since natural influx of material may not exist to replace that removed from the region. In order to ensure structural stability, it is necessary to fill this area with nonerodible material. As a result, extra quantities of material may be required, and construction costs may be overrun. To minimize cost increases due to scour during construction, it is necessary to estimate the likelihood and amount of potential scour during construction. Since breaking waves and the currents induced by them play a vital role in transporting sediment away from coastal structures, thus resulting in scour, it is important to predict wave-induced currents, with and without structures. The purpose of this study is to develop a generalized numerical model that will predict currents induced by breaking waves at locations with or without coastal structures. The model should be applicable to real-life bathymetries that are often arbitrary and irregular and must be computationally efficient and economical in view of the large numerical grids often required in engineering projects. The numerical model called CURRENT developed in this study employs the radiation stress approach of Longuet-Higgins and solves the vertically integrated equations of momentum and continuity using an alternating direction implicit scheme. It includes mixing and advection terms. The model has been applied to a case of normally incident waves on a plane beach. Results for setup matched the experimental data of Bowen, Inman, and Simmons. For obliquely incident waves on a plane beach, model results for longshore currents were compared with the analytical solution of Longuet-Higgins, first neglecting the effect of setup and later including the effect of setup. Agreement was excellent. As the numerical grid was made finer, the numerical results tended to converge toward the analytical solution. The numerical model was applied to a field situation corresponding to Oregon Inlet, North Carolina. The bathymetry was very irregular and complex owing to the presence of channels, shoals, etc. A variable grid was used, and the significant wave during a part of the Ash Wednesday storm of March 1962 was simulated. The numerical results obtained for this case appeared to be reasonable, and the computer costs were modest. For user convenience, model input, output, and files are described and two sample applications are presented

User's Reference Manual for a Three-Dimensional Numerical Hydrodynamic and Transport Model of the New York Bight

Source: https://erdc-library.erdc.dren.mil/jspui/As a part of the New York (NY) Bight Feasibility Study, a three-dimensional, time-varying numerical hydrodynamic and transport model of the NY Bight was developed by the U.S. Army Engineer Waterways Experiment Station. For this purpose, the three-dimensional hydrodynamic model CH3D-WES was used, along with a boundary-fitted grid in the horizontal and 5-10 sigma layers in the vertical. The model was calibrated and verified with the field data measured in April and May 1976. As a demonstration of the feasibility of long-term simulation, hydrodynamics and transport were modeled for the period April-October 1976. Model results were furnished as input to a water quality model of the NY Bight, which reproduced successfully the hypoxic event of 1976. This user's reference manual presents a brief description of the theory of the numerical model and its various features. The structure of the computer code, the function of various subroutines, the formats of input data, various data files required, and available output options are described in detail. For illustrative purposes, sample listings of input files are furnished for an example case simulating hydrodynamics and transport in the NY Bight for the month of April 1976