Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 days.Methods:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were compiled.Univariate analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical associations.Results:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were available.Univariate and multivariable analysis exhibited similar results.For LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant associations.For hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant associations.Conclusion:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program data.Recognizing the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.

Reducing Extended Hospital Lengths of Stay

In the United States, the costs of health care have become a major burden for the health care system. In order to address this problem, the hospitals of Syracuse, New York, developed programs to provide subacute and complex care. The Subacute programs provided patient transportation services for dialysis and other types of care outside hospitals. They also developed programs for services such as intravenous therapy in nursing homes. The Complex Care Programs, such as intravenous therapy and mental health services, have provided alternatives to extended care in hospitals. During the past five years, utilization of these programs has varied, declining between 2019 and 2022, and then increasing between 2022 and 2024. The programs have avoided the need for 1530 - 2974 patient days in hospitals. The programs saved the Syracuse hospitals approximately $600 per inpatient day. This amounted to savings of $918,000 - $1,784,400 per year. These programs demonstrated how relatively small mechanisms can save large amounts of health care resources.

Comparative Study on Structural Redundancy of Cable-Stayed and Extradosed Bridges Through Safety Assessment of Their Stay Cables

This study provides new insights into the comparison of cable-stayed and extradosed bridges based on the safety assessment of their stay cables.These bridges are often regarded as identical structures owing to the use of inclined cables;however,the international standards for bridge design stipulate different safety factors for stay cables of both types of bridges.To address this misconception,a comparative study was carried out on the safety factors of stay cables under fatigue and ultimate limit states by considering the effects of various untoward and damaging factors,such as overloading,cable loss,and corrosion.The primary goal of this study is to describe the structural disparities between both types of bridges and evaluate their structural redundancies by employing deterministic and nondeterministic methods.To achieve this goal,three-dimensional finite-element models of both bridges were developed based on the current design guidelines for stay cables in Japan.After the balanced states of the bridge models were achieved,static analyses were performed for different safety factors of stay cables in a parametric manner.Finally,the first-order reliability method and Monte Carlo method were applied to determine the reliability index of stay cables.The analysis results show that cable-stayed and extradosed bridges exhibit different structural redundancies for different safety factors under the same loading conditions.Moreover,a significant increase in structural redundancy occurs with an incremental increase in the safety factors of stay cables.

Dynamic Characteristics Evaluation of Innovative UHPC Pedestrian Cable Stayed Bridge

KICT (Korea Institute of Construction Technology) is conducting a project called “SUPER BRIDGE 200—Development of Low Cost and Long Life Hybrid Cable Stayed Bridge”. This project aims to reduce the construction and main- tenance costs of long-span bridges by 20% and double their lifetime through the exploitation of ultra-high performance concrete (UHPC). This paper presents the design and construction of the first pedestrian cable stayed bridge using UHPC developed by KICT. UHPC, compared to conventional concrete, has not only high compressive and tensile strengths but also high ductility. The UHPC developed at KICT is a steel fiber-reinforced cement compound presenting design compressive strength larger than 180 MPa and design tensile strength exceeding 10 MPa with water-to-binder ratio below 0.24 and admixing of 2 volume percentage of steel fiber. To show the applicability of UHPC to structures, a pedestrian cable stayed bridge (Super Bridge I) exploiting the characteristics of the developed UHPC has been planned, designed and erected at KICT. The dimension of UHPC deck is 2.7 m × 7 m as a precast segment with a typical thickness of deck of only 7 cm. However, harmful crack was observed in the deck at the time of the fabrication of the deck segments. Accordingly, new fabrication method was conceived and applied to prevent cracking of the UHPC slender deck. Four UHPC deck segments were fabricated successfully without any crack. After construction, the dynamic characteristics (natural frequencies and mode shapes) were evaluated through vibration tests since several users felt excess vibration. A vertical tuned mass damper (TMD) was proposed and installed on the parapet of the bridge. The TMD reduces the acceleration by about 30% from 0.0316 g to 0.0244 g when two pedestrians are crossing the bridge.

NONLINEAR TRANSIENT RESPONSE OF STAY CABLE WITH VISCOELASTICITY DAMPER IN CABLE-STAYED BRIDGE

Taking the bending stiffness, static sag, and geometric non-linearity into consideration, the space nonlinear vibration partial differential equations were derived. The partical differential equations were discretized in space by finite center difference approximation, then the nonlinear ordinal differential equations were obtained. A hybrid method involving the combination of the Newmark method and the pseudo-force strategy was proposed to analyze the nonlinear transient response of the inclined cable-dampers system subjected to arbitrary dynamic loading. As an example, two typical stay cables were calculated by the present method. The results reveal both the validity and the deficiency of the viscoelasticity damper for vibration control of stay cables. The efficiency and accuracy of the proposed method is also verified by comparing the results with those obtained by using Runge-Kutta direct integration technique. A new time history analysis method is provided for the research on the stay cable vibration control.

Genetic Algorithms-based Optimization of Cable Stayed Bridges

Optimum design of cable stayed bridges depends on number of parameters. Design of Cable stayed bridge satisfying all practical constraints is challenging to the designers. Considering the huge number of design variables and practical constraints, Genetic Algorithms (GA) is most suitable for optimizing the cable stayed bridge. In the present work the optimum design is carried out by taking total material cost of bridge as objective function. During problem formulation most of the practical design variables and constraints are considered. Using genetic algorithms some parametric studies such as effect of geometric nonlinearity, effect of grouping of cables, effect of practical site constraints on tower height and side span, effect of bridge material, effect of cable layout, effect of extra-dosed bridges on optimum relative cost have been presented. Data base is prepared for new designers to estimate the relative cost of bridge.

Rolling Fatigue Test of Large-Sized UHPC Member for Cable Stayed Bridge

Recently, research strives to apply Ultra High Performance Concrete (UHPC) to large-sized structures owing to its remarkable mechanical performance and durability compared to normal concrete. The Korea Institute of Construction Technology proposed SuperBridge800, an edge girder type UHPC cable stayed bridge with central span of 800 m, through its detailed design. The bridge is designed to be erected through the connection of precast UHPC segments. The precast UHPC segment is monolithically composed of one ribbed deck slab and edge girders at each side. The connection between the precast segments is achieved by steel bars at the edge girders and by UHPC cast-in-place wet joint at the slab. Despite of the outstanding mechanical performance of UHPC, the fabrication of large-sized members is a difficult task since UHPC hardens faster than normal concrete and requires a special curing process. Therefore, the constructability of large-sized UHPC segment should be secured to achieve SuperBridge800. Besides, the performance of the connection between segments should also be guaranteed, especially in terms of the fatigue performance of the UHPC cast-in-place joint, which constitutes a weak point. To that goal, two half-scaled UHPC segments are manufactured and the constructability is examined by fabricating a large-sized UHPC member connected with respect to the design conditions. This study conducts rolling fatigue test on the so-fabricated large-sized UHPC member. Rolling fatigue test is carried out up to 2 million cycles considering actual vehicle load at each center and quarter points of the member. The test results confirm that the service limit state is satisfied.

The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study

BACKGROUND: We aimed to explore the impact of the emergency department length of stay(EDLOS) on the outcome of trauma patients.METHODS: A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS(<4 h, 4–12 h,12–24 h, and >24 h). Data were analyzed using Chi-square test(categorical variables), Student’s t-test(continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital mortality.RESULTS: The study involved 7,026 patients with a mean age of 32.1±15.6 years. Onefifth of patients had a short EDLOS(<4 h) and had higher level trauma team T1 activation(TTA-1), higher Injury Severity Score(ISS), higher shock index(SI), and more head injuries than the other groups(P=0.001). Patients with an EDLOS >24 h were older(P=0.001) and had more comorbidities(P=0.001) and fewer deaths(P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1(odds ratio [OR]=4.081, 95%CI: 2.364–7.045), head injury(OR=3.920, 95%CI: 2.413–6.368), blood transfusion(OR=2.773, 95%CI: 1.668–4.609), SI(OR=2.132, 95%CI: 1.364–3.332), ISS(OR=1.077, 95%CI: 1.057–1.096), and age(OR=1.040, 95%CI: 1.026–1.054). CONCLUSIONS: Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes;however, the burden of prolonged boarding in the ED needs further elaboration.

A simplified fragility analysis of fan type cable stayed bridges

A simplified fragility analysis of fan type cable stayed bridges usingProbabilistic Risk Analysis (PRA) procedure is presented for determining their failure probabilityunder random ground motion. Seismic input to the bridge support is considered to be a riskconsistent response spectrum which is obtained from a separate analysis. For the response analysis,the bridge deck is modeled as a beam supported on springs at different points. The stiffnesses ofthe springs are determined by a separate 2D static analysis of cable-tower-deck system. The analysisprovides a coupled stiffness matrix for the spring system. A continuum method of analysis usingdynamic stiffness is Used to determine the dynamic properties of the bridges .The response of thebridge deck is obtained by the response spectrum method of analysis as applied to multi-degree offreedom system which duly takes into account the quasi - static component of bridge deck vibration.The fragility analysis includes uncertainties arising due to the variation in ground motion,material property, modeling, method of analysis, ductility factor and damage concentration effect.Probability of failure of the bridge deck is determined by the First Order Second Moment (FOSM)method of reliability. A three span double plane symmetrical fan type cable stayed bridge of totalspan 689 m, is used as an illustrative example. The fragility curves for the bridge deck failure areobtained under a number of parametric variations. Some of the important conclusions of the studyindicate that (ⅰ) not only vertical component but also the horizontal component of ground motionhas considerable effect on the probability of failure; (ⅱ) ground motion with no time lag betweensupport excitations provides a smaller probability of failure as compared to ground motion with verylarge time lag between support excitation; and (ⅲ) probability of failure may considerablyincrease for soft soil condition.

Correlation of serum albumin level on postoperative day 2 with hospital length of stay in patients undergoing emergency surgery for perforated peptic ulcer

BACKGROUND Perforated peptic ulcer(PPU)is a common emergency surgical condition and a significant cause of morbidity and mortality worldwide.While advances in surgical techniques have improved outcomes for patients with PPU,many factors still affect postoperative hospital stay and overall prognosis.One potential factor is the serum albumin(SA)level,a widely utilized marker of nutritional status that has been associated with length of stay and complications in various surgical procedures.AIM To clarify the correlation of SA level on postoperative day 2 with hospital length of stay(HLOS)in patients undergoing emergency surgery for perforated peptic ulcer(PPU).METHODS We retrospectively collected and analyzed clinical baseline data,including blood routine and SA levels,of patients who underwent emergency PPU surgery and postoperative treatment at the Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University between December 2012 and September 2021.Patients were grouped according to HLOS with 7 d as the cut-off value,and relevant indicators were analyzed using SPSS 26.0.RESULTS Of the 37 patients undergoing emergency surgery for PPU referred to our department,33 had gastric and 4 had duodenal ulcer perforation.The median HLOS was 10 d.There were 8 patients in the≤7-d group(median HLOS:7 d)and 29 patients in the>7-d group(median HLOS:10 d).The≤7-d group had markedly higher SA on postoperative day 2 than the>7-d group(37.7 g/L vs 32.6g/L;P<0.05).The SA level on postoperative day 2 was a protective factor for patients with HLOS>7 d(Odds ratio=0.629,P=0.015).The cut-off of SA on postoperative day 2 was 30.6g/L,with an area under the curve of 0.86 and a negative predictive value of 100%for the prediction of HLOS≤7 d.CONCLUSION The SA level on postoperative day 2 was associated with the HLOS in patients undergoing emergency surgery for PPU.The pre-and post-operative albumin levels should be monitored,and infusion of human SA should be considered in a timely manner.

Study on Fatigue Behavior of Anchorage of Cable and Girder of Long Span Cable-Stayed Bridge

A full scale model test is done and a FEM model is established to investigate the fatigue behavior of the Nancha cable stayed bridge of the Nanjing Second Yangtz River Bridge, a long span steel bridge with a main span of 628 m. The results of test and FEM are analyzed and compared. It is shown that they are in good agreement. It is verified that the fatigue characteristic of the anchorage structure of cable and girder of the bridge satisfies the requirements specified by Chinese, British and American codes.

Concept Analysis: Emergency Department Crowding and Length of Stay before and after an Increase in Catchment Area

Several notable issues arise from overcrowding in an emergency department (ED) for both patients and staff. Longer wait times, higher ambulance diversion rates, longer stays, higher incidence of medical errors, higher rates of patient mortality, and greater harm to hospitals due to financial losses are some of these problems. Collaboration is crucial in the healthcare industry since it determines the team’s hourly performance in managing patient care. By using Walker and Avant’s (2011) concept analysis method, the author reviewed the literature to better understand ED crowding, to ensure that patients receive safe treatment in a timely manner, and to highlight best practices that can be identified through concept analysis and practice evaluations. In conducting this concept analysis, Walker and Avant’s framework was applied to examine the nature of the findings selected for the advancement of the concept. Everyone working in the ED, from those who determine policy to those on the front lines continually encounter new obstacles, but has little or no time to formulate fresh concepts or reconsider how ED treatment is provided. Overcrowding occurs when the number of patients requiring attention, awaiting transfer, or undergoing diagnosis and treatment exceeds the physical capacity of ED staff. If a clear plan is not in place to increase and improve services in proportion to a growing population, this situation will persist.

Comparison of Mortality, Length of Stay, and Hospitalization Costs of Hospitalized COVID-19 Patients with Cardiac and Non-Cardiac Disease

Background: The COVID-19 pandemic has presented unprecedented challenges to global healthcare systems. As the pandemic unfolded, it became evident that certain groups of individuals were at an elevated risk of experiencing severe disease outcomes. Among these high-risk groups, individuals with pre-existing cardiac conditions emerged as particularly vulnerable. Objective: This study aimed to investigate the relationship between the length of stay, mortality, and costs of COVID-19 patients with and without a history of cardiac disease. Design: This retrospective study was conducted in Jam Hospital in Tehran, Iran, from March 21, 2021, to March 21, 2022. All patients with laboratory-confirmed COVID-19 who were hospitalized during this period were included. Results: A total of 500 COVID-19 patients were hospitalized, with 31.6% having a history of cardiac disease and 68.4% without any cardiac disease. Patients with cardiac disease were significantly older (median [range] age, 69.35 [37 - 94] years) compared to non-cardiac patients (54.95 [13 - 97] years) (p Conclusion: Patients with cardiac disease who are hospitalized with COVID-19 have a higher mortality rate, longer hospital stays, greater disease severity, ICU admission, and higher costs. Therefore, improved prevention and management strategies are crucial for these patients.

Machine learning applications for the prediction of extended length of stay in geriatric hip fracture patients

BACKGROUND Geriatric hip fractures are one of the most common fractures in elderly individuals,and prolonged hospital stays increase the risk of death and complications.Machine learning(ML)has become prevalent in clinical data processing and predictive models.This study aims to develop ML models for predicting extended length of stay(eLOS)among geriatric patients with hip fractures and to identify the associated risk factors.AIM To develop ML models for predicting the eLOS among geriatric patients with hip fractures,identify associated risk factors,and compare the performance of each model.METHODS A retrospective study was conducted at a single orthopaedic trauma centre,enrolling all patients who underwent hip fracture surgery between January 2018 and December 2022.The study collected various patient characteristics,encompassing demographic data,general health status,injury-related data,laboratory examinations,surgery-related data,and length of stay.Features that exhibited significant differences in univariate analysis were integrated into the ML model establishment and subsequently cross-verified.The study compared the performance of the ML models and determined the risk factors for eLOS.RESULTS The study included 763 patients,with 380 experiencing eLOS.Among the models,the decision tree,random forest,and extreme Gradient Boosting models demonstrated the most robust performance.Notably,the artificial neural network model also exhibited impressive results.After cross-validation,the support vector machine and logistic regression models demonstrated superior performance.Predictors for eLOS included delayed surgery,D-dimer level,American Society of Anaesthesiologists(ASA)classification,type of surgery,and sex.CONCLUSION ML proved to be highly accurate in predicting the eLOS for geriatric patients with hip fractures.The identified key risk factors were delayed surgery,D-dimer level,ASA classification,type of surgery,and sex.This valuable information can aid clinicians in allocating resources more efficiently to meet patient demand effectively.

旅游小城镇规划中的Long Stay要素分析

根据小城镇具有发展Long Stay的条件,在进行小城镇规划建设中考虑Long Stay要素的体现,并对旅游小城镇的效益进行了分析。结果表明:小城镇具有发展Long Stay的条件,在城镇的总体规划中体现出其作用,并能对城镇产生经济效益与社会效益。

“Long Stay”与分时度假的比较分析

"Long Stay"与分时度假是休闲旅游的两种特殊形式,"Long Stay"刚进入国人视野,前景看好,而分时度假在国内的发展陷入困境。通过对比两者的主体、客体以及在我国发展的适应性,发现两者具备一定的互补优势,协同发展可以实现产品价值最大化和企业利润最大化。

旅游小城镇规划中的Long Stay要素分析

1 Long Stay的内涵2000年日本出版的《Long Stay白皮书》对Long Stay的定义为:"不是旅行,也非属移民(生活据点的迁移)的长期停留。不光是观光或购物之旅行,而是一方面将其生活源泉置于日本,同时在居住地地区接触当地文化,并与当地居民交流,发现生活意义之非属移民,亦非永久居留"。笔者认为,Long Stay在中国发展的具体表现形式及发展模式应该为线路长宿旅游、古镇长宿旅游、

Effects of integrated management on surgical outcomes and mental health of patients following endoscopic submucosal dissection

BACKGROUND Endoscopic submucosal dissection(ESD)is a less invasive local treatment for diseases throughout the gastrointestinal tract.AIM To develop an integrated management protocol and analyze its effects on surgical outcomes and mental health of patients after ESD.METHODS The study population consisted of patients undergoing ESD before implementation of integrated management and those undergoing ESD by the same pool of surgeons after implementation of integrated management.RESULTS The management group exhibited shortened fasting time and length of hospital stay compared to the control group(P<0.05).The management group exhibited a higher incidence rate of postoperative complications than the control group(3 cases vs 11 cases;P=0.043).The management group exhibited a lower uncertainty score for disease knowledge compared to the control group 12 h after surgery(P<0.05).The management group gave more scores on the domains of patient familiarity to the responsible nurses,professional skills of responsible nurses,and general evaluation compared to the control group.The management group had a higher total score of patient satisfaction towards the responsible nurses in term of health care than the control group(P<0.01).The management group exhibited lower Self-Rating Anxiety Scale and Self-Rating Depression Scale scores compared to the control group 12 h after surgery(P<0.01).CONCLUSION The study demonstrates that integrated management could improve surgical outcomes and mental health of patients undergoing ESD.

Sarcopenia adversely impacts clinical outcomes in patients undergoing pancreaticoduodenectomy: A systematic review and meta-analysis

BACKGROUND Sarcopenia is a syndrome marked by a gradual and widespread reduction in skeletal muscle mass and strength,as well as a decline in functional ability,which is associated with malnutrition,hormonal changes,chronic inflammation,distur-bance of intestinal flora,and exercise quality.Pancreatoduodenectomy is a com-monly employed clinical intervention for conditions such as pancreatic head cancer,ampulla of Vater cancer,and cholangiocarcinoma,among others,with a notably high rate of postoperative complications.Sarcopenia is frequent in patients undergoing pancreatoduodenectomy.However,data regarding the effects of sarcopenia in patients undergoing pancreaticoduodenectomy(PD)are both limited and inconsistent.The PubMed,Cochrane Library,Web of Science,and Embase databases were screened for studies published from the time of database inception to June 2023 that described the effects of sarcopenia on the outcomes and complications of PD.Two researchers independently assessed the quality of the data extracted from the studies that met the inclusion criteria.Meta-analysis using RevMan 5.3.5 and Stata 14.0 software was conducted.Forest and funnel plots were used,respectively,to demonstrate the outcomes of the sarcopenia group vs the non-sarcopenia group after PD and to evaluate potential publication bias.RESULTS Sixteen studies encompassing 2381 patients were included in the meta-analysis.The patients in the sarcopenia group(n=833)had higher overall postoperative complication rates[odds ratio(OR)=3.42,95%confidence interval(CI):1.95-5.99,P<0.0001],higher Clavien-Dindo class≥III major complication rates(OR=1.41,95%CI:1.04-1.90,P=0.03),higher bacteremia rates(OR=4.46,95%CI:1.42-13.98,P=0.01),higher pneumonia rates(OR=2.10,95%CI:1.34-3.27,P=0.001),higher pancreatic fistula rates(OR=1.42,95%CI:1.12-1.79,P=0.003),longer hospital stays(OR=2.86,95%CI:0.44-5.28,P=0.02),higher mortality rates(OR=3.17,95%CI:1.55-6.50,P=0.002),and worse overall survival(hazard ratio=2.81,95%CI:1.45-5.45,P=0.002)than those in the non-sarcopenia group(n=1548).However,no significant inter-group differences were observed regarding wound infections,urinary tract infections,biliary fistulas,or postoperative digestive bleeding.CONCLUSION Sarcopenia is a common comorbidity in patients undergoing PD.Patients with preoperative sarcopenia have increased rates of complications and mortality,in addition to a poorer overall survival rate and longer hospital stays after PD.

“play+stay”理念在营口理工学院网球课中的应用研究

2007年2月ITF正式发起了一项意在增加全球网球参与性的运动——play+stay。它的目标是使网球这项运动更容易、更有趣和更健康。并保证每一位初学者在第一堂课中都能够掌握发球、对打和得分的能力。"play+stay"的理念主要包括5部分:网球是简单的;网球是有趣的;网球比赛是有趣的;网球是健康的;网球适合所有人。营口理工学院于2012年开始设置了网球课程,并与2014—2015学年引入了"play+stay"理念并结合自身的特点和教学经验进行了教学实验,得出以下结论:(1)"play+stay"理念非常适合高校网球教学。(2)同学们的学习热情显著提高,网球技能水平达到了教学目标的要求。(3)"play+stay"理念应与高校自身的特点相结合才能发挥最大的优势。