The Impact of Admissions for the Management of End-stage renal disease on hospital bed occupancy

BACKGROUND:

End-stage renal disease (ESRD) is increasingly prevalent but the inpatient costs associated with this condition are poorly defined due to limitations with data extraction and failure to differentiate between hospitalisation for renal and non-renal disease reasons. The impact of admissions primarily for the management of ESRD on hospital bed utilisation was assessed over a 5-year period in a large teaching hospital.

METHODS:

All admission episodes were reviewed and the ESRD group was identified by a primary International Classification of Diseases code for ESRD or a non-specific primary renal failure code with a secondary code for ESRD. The frequency and duration of hospitalisation and contribution to bed day occupancy of this group with ESRD was determined.

RESULTS:

There were 70,808 patients responsible for a total of 116,915 admissions and 919,212 bed days over the study period. Of these, 988 (1.4%) patients were admitted for the management of ESRD, accounting for 2,387 (2.0%) of admissions and utilisation of 23,011 (2.5%) bed days. After adjustment for age and gender, those admitted for ESRD management were significantly more likely to have a prolonged admission exceeding 30 days (odds ratio 1.46, 95% confidence interval 1.23-1.72, p < 0.001). When the admission was an emergency rather than an elective event, the patient was 4.6 times more likely to be hospitalised for over 30 days.

CONCLUSIONS:

Persons admitted for ESRD management are hospitalised more frequently and for longer than the overall inpatient population, occupying a substantial number of bed days.

Age and palaeoenvironmental significance of an inter-tidal peat bed at Ballywoolen, Bann estuary, Co. Londonderry.

A recently exposed inter-tidal peat bed at Ballywoolen, Bann estuary, Co. Londonderry, has yielded new information about mid-Holocene coastal environmental change in the northeast of Ireland. Pollen analytical data and wood detritus demonstrate that peat accumulation occurred in a terrestrial environment that was free from marine influence. Radiocarbon dates suggest that the peat accumulated rapidly during a period of low relative sea level subsequent to the maximum of Holocene relative sea-level rise along the north coast of Northern Ireland. The absence of marine/brackish indicator taxa at the site suggests that the tidal range was somewhat less than that at present and/or that the channel of the river was located some distance east of its present alignment. The dates indicate that the low stand lasted for at least ~0.2 ka and possibly for ~1.1 ka. Stable, woodland-dominated landscapes are indicated at both this site and neighbouring ones around ~6.4-5.3 cal ka BP. There is no evidence for large-scale aeolian sand movement or human impact on the landscape during the period of peat accumulation.

Screening wall effects of a thin fluidized bed by near-infrared imaging

Near-infrared (NIR) imaging was used to observe water vapour flow in a gas-solid fluidized bed reactor. The technique consisted of a broadband light, an optical filter with a bandwidth centred on strong water vapour absorptions, a Vidicon NIR camera, a nozzle from which an optically active mixture of gas and water vapour was trans-illuminated by an NIR beam and collected data of transmittance were normalized to actual optical path. The procedure was applied to a thin fluidized bed reactor with a low aspect ratio of tube to particle diameters (D-1/d(p)) in order to validate the wall effect on flow dynamics and mass transfer during the reduction of ceria-silica by hydrogen. High concentrations of water vapour emerged in the vicinity of the wall when the bed was operated at pseudo-static conditions but disappeared when the bed was run at minimum bubbling conditions. This result shows the capability of optical methods with affordable costs to 2D imaging opaque packed bed by using a spatially resolved probe located at the exit, which is of great benefit for in situ visualization of anisotropic concentrations in packed beds under industrially relevant conditions and thus for elucidation of the underlying reaction mechanism and diffusion interactions. Crown Copyright (c) 2011 Published by Elsevier B.V. All rights reserved.

Visualization of water vapour flow in a packed bed adsorber by near-infrared diffused transmittance tomography

This work presents a procedure based on spatially-resolved near-infrared imaging, in order to observe temperature and composition maps in gas-solid packed beds subjected to effects of aspect ratio and non-isothermal conditions. The technique was applied to the water vapour flow in a packed bed adsorber of low aspect ratio, filled with silica gel, using a tuneable diode laser, focal planar array detector and tomographic reconstruction. The 2D projected images from parallel scanning permitted data to be retrieved from the packing and above the packing sections of 12.0×12.0×18.2mm at a volume-resolution of 0.15×0.15×0.026mm and a time-resolution of less than 3min. The technique revealed uneven temperature and composition maps in the core packed bed and in the vicinity of the wall due to flow maldistribution. In addition, the heat uptake from the packed bed and local cross-mixing were experimentally ascertained by local profiles of the water vapour composition and temperature under various aspect ratios and feed flow rates. The relative deviations in temperature and compositions were 11.1% and 9.3%, respectively. The deviation in composition, which covers the packing and above the packing sections, was slightly higher than the deviation of 8% obtained up-to-date but was limited to the exit of a packed bed adsorber. © 2011.

Reynolds Number Effects on Fully-Developed Pulsed Jets Impinging on Flat Surfaces

A systematic study of the effect of the Reynolds number on the fluid dynamics and turbulence statistics of pulsed jets impinging on a flat surface is presented. It has been suggested that the influence of the Reynolds number may be somewhat different for a jet subjected to pulsation when compared to an equivalent steady jet. A comparative study of both steady and pulsating jets is presented for a Reynolds number range from Re = 4;730 to Re = 10;000. All the other factors that affect the flowfield are kept constant, which are H/d = 3, St = 0.25, and d = 30.5 mm. It was found that for the range of the Reynolds numbers tested, pulsation results in a shortening of the jet core, the centerline axial velocity component declines more rapidly, and higher values of the radial velocity component for r/d > 0.75are observed. As the Reynolds number increases, the jet spreads more rapidly, the turbulent kinetic energy and nondimensional turbulent fluctuations decrease, and the flowfield near the impinging surface changes drastically, which is evident with the development of a turbulent momentum exchange interaction away from the wall for r/d > 1.5.

Isolation of monocytes from human peripheral blood using immuno-affinity expanded-bed adsorption

A novel technique for the separation of monocytes from human peripheral blood preparations has been developed. The technique is based on the use of expanded-bed adsorption and a solid perfluorocarbon derivatized with avidin or streptavidin for the indirect positive or negative capture of cells labeled with biotinylated monoclonal antibodies. The perfluorocarbon support was prepared and characterized and the contactor design and operating conditions, that enable cells to be selectively isolated, were investigated. Experiments consisted of applying an immunolabeled pulse of 1 x 10(8) peripheral blood mononuclear cells (PBMCs), isolated by density gradient centrifugation, directly onto a refrigerated expanded bed. The major cell types remaining were T-lymphocytes, B-lymphocytes, and monocytes. Monocytes could be positively adsorbed, following labeling with anti-CD14 mAb, with a clearance of up to 89% and a depletion factor of 7.6. They could also be

Trends in reported sun bed use, sunburn, and sun care knowledge and attitudes in a UK region: results of a survey of the Northern Ireland population

Background Sunburn and sun bed use increase risk of malignant melanoma, the incidence of which continues to rise.

Assessing the image quality of pelvic MR images acquired with a flat couch for radiotherapy treatment planning

Objectives: To improve the integration of MRI with radiotherapy treatment planning, our department fabricated a flat couch top for our MR scanner. Setting up using this couch top meant that the patients were physically higher up in the scanner and, posteriorly, a gap was introduced between the patient and radiofrequency coil.