Hospital Readmissions After Implementation of a Discharge Care Program for Patients with COVID-19 Illness.

BACKGROUND: The surge of coronavirus 2019 (COVID-19) hospitalizations in New York City required rapid discharges to maintain hospital capacity. OBJECTIVE: To determine whether lenient provisional discharge guidelines with remote monitoring after discharge resulted in safe discharges home for patients hospitalized with COVID-19 illness. DESIGN: Retrospective case series SETTING: Tertiary care medical center PATIENTS: Consecutive adult patients hospitalized with COVID-19 illness between March 26, 2020, and April 8, 2020, with a subset discharged home INTERVENTIONS: COVID-19 Discharge Care Program consisting of lenient provisional inpatient discharge criteria and option for daily telephone monitoring for up to 14 days after discharge MEASUREMENTS: Fourteen-day emergency department (ED) visits and hospital readmissions RESULTS: Among 812 patients with COVID-19 illness hospitalized during the study time period, 15.5% died prior to discharge, 24.1% remained hospitalized, 10.0% were discharged to another facility, and 50.4% were discharged home. Characteristics of the 409 patients discharged home were mean (SD) age 57.3 (16.6) years; 245 (59.9%) male; 27 (6.6%) with temperature ≥ 100.4 °F; and 154 (37.7%) with oxygen saturation < 95% on day of discharge. Over 14 days of follow-up, 45 patients (11.0%) returned to the ED, of whom 31 patients (7.6%) were readmitted. Compared to patients not referred, patients referred for remote monitoring had fewer ED visits (8.3% vs 14.1%; OR 0.60, 95% CI 0.31-1.15, p = 0.12) and readmissions (6.9% vs 8.3%; OR 1.15, 95% CI 0.52-2.52, p = 0.73). LIMITATIONS: Single-center study; assignment to remote monitoring was not randomized. CONCLUSIONS: During the COVID-19 surge in New York City, lenient discharge criteria in conjunction with remote monitoring after discharge were associated with a rate of early readmissions after COVID-related hospitalizations that was comparable to the rate of readmissions after other reasons for hospitalization before the COVID pandemic.

Assessment of the effects of release variables on the consequences of LNG spillage onto water using FERC models.

Liquefied natural gas (LNG) release, spread, evaporation, and dispersion processes are illustrated using the Federal Energy Regulatory Commission models in this paper. The spillage consequences are dependent upon the tank conditions, release scenarios, and the environmental conditions. The effects of the contributing variables, including the tank configuration, breach hole size, ullage pressure, wind speed and stability class, and surface roughness, on the consequence of LNG spillage onto water are evaluated using the models. The sensitivities of the consequences to those variables are discussed.

Food fears and raw-milk cheese.

This paper examines the debate over the safety of raw-milk cheese. Departing from Nestle's categories of "science-based" and "value-based" approaches to risk assessment, the author argues that raw-milk cheese advocates, as well as proponents of pasteurisation, invoke science to support their positions, and measure risk against potential costs and benefits. Additionally, the author argues, each position is animated by, albeit differing, values and their attendant fears. While artisan cheesemakers associations have successfully averted bans on raw-milk cheesemaking in various contexts in recent years, the author concludes that they remain vulnerable to future food scares unless consumer interest in raw-milk cheese is sustained.

Correlation of quantitative risk results for high hazard processes.

A quantitative risk analysis was conducted to evaluate the design of the VX neutralization subsystem and related support facilities of the U.S. Army Newport Chemical Agent Disposal Facility. Three major incidents including agent release, personnel injury, and system loss were studied using fault tree analysis methodology. Each incident was assigned a risk assessment code based on the severity level and probability of occurrence of the incident. Safety mitigations or design changes were recommended to bring the "undesired" risk level (typical agent release events) to be "acceptable with controls" or "acceptable."