Characteristics and Outcomes of Patients Discharged Directly Home from a Medical Intensive Care Unit

Introduction: Discharging patients directly home from the ICU is becoming increasingly common, largely driven by decreased ward bed availability. We evaluated readmission patterns of ICU patients discharged directly home. Methods: Retrospective review was conducted of direct discharges from the ICU to home between June 2017 and June 2019. The primary outcome of interest was 30-day hospital readmission. Patients were dichotomized by “wait-time” between transfer order and hospital discharge (\u3c24 hours or ≥24 hours). Outcomes were compared using t-test, Fisher exact, and chi-squared. Risk-adjustment was performed using the Mortality Probability Model (MPM0-III). ICU workload was estimated using the nine equivalents of nursing manpower use score (NEMS). Results: 331 patients were identified, with a mean time of 0.72 [0 - 5.84] days between ICU transfer order and discharge to home. 68.3% (226/331) of patients waited \u3c24 hours for discharge. There was no difference in severity-of-illness or admission NEMS between the groups. 10.3% (45/331) of patients presented for evaluation within 30 days of discharge. 10.3% (34/331) of patients were readmitted. There was no significant difference in 30-day readmission between patients who were discharged after waiting \u3c24 hours vs. waiting ≥24 hours (p=0.70). Discussion: Patients returning directly home from the ICU without discharge delay were not readmitted more frequently within 30 days than those discharged after a delay exceeding 24 hours. Further investigation into identifying patients eligible for safe, early discharge may reduce unnecessary critical care resource utilization

Innovative trial approaches in immune-mediated inflammatory diseases: current use and future potential.

BACKGROUND: Despite progress that has been made in the treatment of many immune-mediated inflammatory diseases (IMIDs), there remains a need for improved treatments. Randomised controlled trials (RCTs) provide the highest form of evidence on the effectiveness of a potential new treatment regimen, but they are extremely expensive and time consuming to conduct. Consequently, much focus has been given in recent years to innovative design and analysis methods that could improve the efficiency of RCTs. In this article, we review the current use and future potential of these methods within the context of IMID trials. METHODS: We provide a review of several innovative methods that would provide utility in IMID research. These include novel study designs (adaptive trials, Sequential Multi-Assignment Randomised Trials, basket, and umbrella trials) and data analysis methodologies (augmented analyses of composite responder endpoints, using high-dimensional biomarker information to stratify patients, and emulation of RCTs from routinely collected data). IMID trials are now well-placed to embrace innovative methods. For example, well-developed statistical frameworks for adaptive trial design are ready for implementation, whilst the growing availability of historical datasets makes the use of Bayesian methods particularly applicable. To assess whether and how these innovative methods have been used in practice, we conducted a review via PubMed of clinical trials pertaining to any of 51 IMIDs that were published between 2018 and 20 in five high impact factor clinical journals. RESULTS: Amongst 97 articles included in the review, 19 (19.6%) used an innovative design method, but most of these were relatively straightforward examples of innovative approaches. Only two (2.1%) reported the use of evidence from routinely collected data, cohorts, or biobanks. Eight (9.2%) collected high-dimensional data. CONCLUSIONS: Application of innovative statistical methodology to IMID trials has the potential to greatly improve efficiency, to generalise and extrapolate trial results, and to further personalise treatment strategies. Currently, such methods are infrequently utilised in practice. New research is required to ensure that IMID trials can benefit from the most suitable methods

Characteristics and Outcomes of Patients Discharged Directly Home from a Medical Intensive Care Unit

RATIONALE: Discharging patients directly from ICUs is an increasingly common practice, largely due to decreased availability of ward beds. The purpose of this study was to describe the population and evaluate the outcomes of patients discharged directly from the MICU. METHODS: We conducted a retrospective chart review of direct discharges to home from June 2018 to June 2019 from two MICUs. Patients were separated into two groups based on wait time (\u3c24 hours or ≥ 24 hours) between ward transfer order and actual discharge. The primary outcome was 30-day hospital readmission. Risk was adjusted using Mortality Probability Model (MPM-III); ICU workload at admission and discharge was estimated using the nine equivalents of nursing manpower use score (NEMS). Patient characteristics were compared using t-test and Fisher exact or X2. RESULTS: There was no difference in severity-of-illness or admission NEMS between the two groups. Patients who waited \u3c24 hours for discharge were more likely to be admitted from home. Patients who waited ≥24 hours prior to discharge had significantly longer mean hospital LOS compared to those who waited \u3c24 hours (4.63 days vs. 2.65 days, p\u3c0.001). There was no significant difference in 30-day readmission between patients who were discharged after waiting \u3c24 hours vs. waiting ≥24 hours (p=0.70). CONCLUSION: Patients who returned directly home from the MICU without any discharge delay were not readmitted to the hospital more frequently within 30 days than those discharged to home after a delay exceeding 24 hours. Further investigation into identifying those patients for whom early discharge planning directly to home from the ICU is viable and safe may aid in reducing unnecessary critical care resource utilization

Unconventional quantum Hall effect and Berry’s phase 2pi in bilayer graphene.

There are known two distinct types of the integer quantum Hall effect. One is the conventional quantum Hall effect, characteristic of two-dimensional semiconductor systems, and the other is its relativistic counterpart recently observed in graphene, where charge carriers mimic Dirac fermions characterized by Berry’s phase pi, which results in a shifted positions of Hall plateaus. Here we report a third type of the integer quantum Hall effect. Charge carriers in bilayer graphene have a parabolic energy spectrum but are chiral and exhibit Berry’s phase 2pi affecting their quantum dynamics. The Landau quantization of these fermions results in plateaus in Hall conductivity at standard integer positions but the last (zero-level) plateau is missing. The zero-level anomaly is accompanied by metallic conductivity in the limit of low concentrations and high magnetic fields, in stark contrast to the conventional, insulating behavior in this regime. The revealed chiral fermions have no known analogues and present an intriguing case for quantum-mechanical studies

A liquid metal-based process for tuning the thermoelectric properties of bismuth indium systems

To obtain the optimum performance of thermoelectric materials, engineering their characteristics, such as crystal structures and phases, is critical. Liquid metal-based processes are great methods for controlling and tuning such properties. In this study, indium (In), of different concentrations, is introduced into bismuth (Bi) via a liquid metal-based process to tailor the crystallization arrangements and investigate the thermoelectric properties of the Bi-In systems. These systems were prepared by a liquid metal-based melting and solidification process. Thermoelectric properties, including the Seebeck coefficient, thermal conductivity, and resistivity, were analyzed using in-house built apparatus units. The sample with 2% indium concentration showed the highest Seebeck coefficient and electrical resistivity. Thermal conductivity was observed to decrease with increasing indium concentration up to 5%, followed by a reverse trend above this concentration. Dominated by the thermal conductivity effect, the sample with 5% indium concentration showed the highest average value for the figure of merit (zT) for the Bi-In systems. The zT value of this sample was nearly twice than that of the pristine bismuth. According to our analyses, this increase could be attributed to the crystal modalities of the formed BiIn crystals with optimum crystallite dimensions and distributions, along with the emergence of specific diffraction peaks, in the pool of bismuth. This study provides a facile and low-cost liquid metal-based pathway for designing thermoelectric materials by tuning their crystal structures and orientations using liquid metal-enabled processes

Electronic Devices Based on Purified Carbon Nanotubes Grown By High Pressure Decomposition of Carbon Monoxide

The excellent properties of transistors, wires, and sensors made from single-walled carbon nanotubes (SWNTs) make them promising candidates for use in advanced nanoelectronic systems. Gas-phase growth procedures such as the high pressure decomposition of carbon monoxide (HiPCO) method yield large quantities of small diameter semiconducting SWNTs, which are ideal for use in nanoelectronic circuits. As-grown HiPCO material, however, commonly contains a large fraction of carbonaceous impurities that degrade properties of SWNT devices. Here we demonstrate a purification, deposition, and fabrication process that yields devices consisting of metallic and semiconducting nanotubes with electronic characteristics vastly superior to those of circuits made from raw HiPCO. Source-drain current measurements on the circuits as a function of temperature and backgate voltage are used to quantify the energy gap of semiconducting nanotubes in a field effect transistor geometry. This work demonstrates significant progress towards the goal of producing complex integrated circuits from bulk-grown SWNT material.Comment: 6 pages, 4 figures, to appear in Nature Material

Transmit Power Minimization for MIMO Systems of Exponential Average BER with Fixed Outage Probability

This document is the Accepted Manuscript version of the following article: Dian-Wu Yue, and Yichuang Sun, ‘Transmit Power Minimization for MIMO Systems of Exponential Average BER with Fixed Outage Probability’, Wireless Personal Communications, Vol. 90 (4): 1951-1970, first available online on 20 June 2016. Under embargo. Embargo end date: 20 June 2017. The final publication is available at Springer via https://link.springer.com/article/10.1007%2Fs11277-016-3432-4This paper is concerned with a wireless multiple-antenna system operating in multiple-input multiple-output (MIMO) fading channels with channel state information being known at both transmitter and receiver. By spatiotemporal subchannel selection and power control, it aims to minimize the average transmit power (ATP) of the MIMO system while achieving an exponential type of average bit error rate (BER) for each data stream. Under the constraints on each subchannel that individual outage probability and average BER are given, based on a traditional upper bound and a dynamic upper bound of Q function, two closed-form ATP expressions are derived, respectively, which can result in two different power allocation schemes. Numerical results are provided to validate the theoretical analysis, and show that the power allocation scheme with the dynamic upper bound can achieve more power savings than the one with the traditional upper bound.Peer reviewe

Template Synthesis of Carbon Nanofibers Containing Linear Mesocage Arrays

Carbon nanofibers containing linear mesocage arrays were prepared via evaporation induced self-assembly method within AAO template with an average channel diameter of about 25 nm. The TEM results show that the mesocages have an elongated shape in the transversal direction. The results of N2 adsorption–desorption analysis indicate that the sample possesses a cage-like mesoporous structure and the average mesopore size of the sample is about 18 nm