Patient expectation is the most important predictor of discharge destination after primary total joint arthroplasty.

The purpose of this study was to identify preoperative predictors of discharge destination after total joint arthroplasty. A retrospective study of three hundred and seventy-two consecutive patients who underwent primary total hip and knee arthroplasty was performed. The mean length of stay was 2.9 days and 29.0% of patients were discharged to extended care facilities. Age, caregiver support at home, and patient expectation of discharge destination were the only significant multivariable predictors regardless of the type of surgery (total knee versus total hip arthroplasty). Among those variables, patient expectation was the most important predictor (P < 0.001; OR 169.53). The study was adequately powered to analyze the variables in the multivariable logistic regression model, which had a high concordance index of 0.969.

What the brain stem tells the frontal cortex. II. Role of the SC-MD-FEF pathway in corollary discharge.

One way we keep track of our movements is by monitoring corollary discharges or internal copies of movement commands. This study tested a hypothesis that the pathway from superior colliculus (SC) to mediodorsal thalamus (MD) to frontal eye field (FEF) carries a corollary discharge about saccades made into the contralateral visual field. We inactivated the MD relay node with muscimol in monkeys and measured corollary discharge deficits using a double-step task: two sequential saccades were made to the locations of briefly flashed targets. To make second saccades correctly, monkeys had to internally monitor their first saccades; therefore deficits in the corollary discharge representation of first saccades should disrupt second saccades. We found, first, that monkeys seemed to misjudge the amplitudes of their first saccades; this was revealed by systematic shifts in second saccade end points. Thus corollary discharge accuracy was impaired. Second, monkeys were less able to detect trial-by-trial variations in their first saccades; this was revealed by reduced compensatory changes in second saccade angles. Thus corollary discharge precision also was impaired. Both deficits occurred only when first saccades went into the contralateral visual field. Single-saccade generation was unaffected. Additional deficits occurred in reaction time and overall performance, but these were bilateral. We conclude that the SC-MD-FEF pathway conveys a corollary discharge used for coordinating sequential saccades and possibly for stabilizing vision across saccades. This pathway is the first elucidated in what may be a multilevel chain of corollary discharge circuits extending from the extraocular motoneurons up into cerebral cortex.

Selection of Postacute Stroke Rehabilitation Facilities: A Survey of Discharge Planners From the Northeast Cerebrovascular Consortium (NECC) Region.

The process of determining the level of care and specific postacute care facility for stroke patients has not been adequately studied. The objective of this study was to better understand the factors that influence postacute care decisions by surveying stroke discharge planners. Requests were sent to discharge planners at 471 hospitals in the Northeast United States to complete an online survey regarding the factors impacting the selection of postacute care. Seventy-seven (16%) discharge planners completed the online survey. Respondents were mainly nurses and social workers and 73% reported ≥20 years healthcare experience. Patients and families were found to be significantly more influential than physicians (P < 0.001) and other clinicians (P = 0.04) in influencing postdischarge care. Other clinicians were significantly more influential than physicians (P < 0.001). Insurance and quality of postacute care were the factors likely to most affect the selection of postacute care facility. Insurance was also identified as the greatest barrier in the selection of level of postacute care (70%; P < 0.001) and specific postacute care facility (46%; P = 0.02). More than half reported that pressure to discharge patients quickly impacts a patients' final destination. Nonclinical factors are perceived by discharge planners to have a major influence on postacute stroke care decision making.

Modelling dosator filling and discharge of powder

Dosators and other dosing mechanisms operating on generally similar principles are very widely used in the pharmaceutical industry for capsule filling, and for dosing products that are delivered to the customer in powder form such as inhalers. This is a trend that is set to increase. However a significant problem for this technology is being able to predict how accurately and reliably, new drug formulations will be dosed from these machines prior to manufacture. This paper presents a review of the literature relating to powder dosators which considers mathematical models for predicting dosator performance, the effects of the dosator geometry and machine settings on the accuracy of the dose weight. An overview of a model based on classical powder mechanics theory that has been developed at The University of Greenwich is presented. The model uses inputs from a range of powder characterisation tests including, wall friction, bulk density, stress ratio and permeability. To validate the model it is anticipated that it will be trialled for a range of powders alongside a single shot dosator test rig.

Review of models for predicting the discharge rates of bulk particulates from silos and bins

Various models for predicting discharge rates have been developed over the last four decades by many research workers (notably Beverloo [1], Johanson [2], Brown [3], Carleton [4], Crewdson [5], Nedderman [6], Gu [7].). In many cases these models offer comparable approaches to the prediction of discharge rates of bulk particulates from storage equipment when solely gravity is acting to initiate flow (since they invariably consider the use of mass-flow design equipment). The models that have been developed consider a wide range of bulk particulates (coarse, incompressible, fine, cohesive) and most contemporary works have incorporated validation against test programmes. Research currently underway at The Wolfson Centre for Bulk Solids Handling Technology, University of Greenwich, has considered the relative performance of these models with respect to a range of bulk properties and with particular focus upon the flexibility of the models to cater for different geometrical factors for vessels.

Characterization of a dielectric barrier discharge operating in an open reactor with flowing helium

A dielectric barrier discharge (DBD) generated by flowing helium between the parallel-plate electrodes of an open air reactor has been characterized using time resolved optical and electrical measurements. A sinusoidal voltage of up to 5 kV (peak to peak) of frequencies from 3 to 50 kHz has been applied to the discharge electrodes. The helium flow rate is varied up to 10 litre min(-1). The adjustment of flow rate allows the creation of uniform DBDs with optimized input power equal to 120 +/- 10 mW cm(-3). At flow rates from 4 to 6 litre min(-1) a uniform DBD is obtained. The maxima in the line intensities of N-2(+) and helium at 391.4 nm and 706.5 nm, respectively, 2 under those conditions indicate the importance of helium metastables and He-2(+) in sustaining such a discharge. The power efficiency and discharge 2 current show maxima when the DBD In He/air is uniform. The gas temperature during the discharge has been measured as 360 +/- 20 K.