Aims This study sought to compare healthcare quality and 30 day, 90 day, and 1 year mortality rates among patients admitted to secondary and tertiary hospitals for heart failure (HF) in Beijing. Methods and results This study retrospectively enrolled patients hospitalized with a primary discharge diagnosis of HF during January 2014 to December 2015, from five tertiary and four secondary hospitals, in Beijing, China. Mortality data were extracted from Beijing Death Surveillance Database. HF healthcare quality indices were used to evaluate in-hospital care. Associations between hospital level and mortality rates were assessed using generalized linear mixed models, adjusting for patients' baseline characteristics and intra-hospital correlation. Data from 1413 patients (median [interquartile range] age = 74 [65-80] years, 52.7% female) from secondary hospitals and 1250 patients (median [interquartile range] age = 72 [61-79] years, 43.3% female) from tertiary hospitals were collected. Rates of left ventricular ejection fraction assessment (73.2% vs. 90.1%) and combined use of β-blockers and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (30.1% vs. 49.3%) were lower in secondary hospitals than those in tertiary hospitals, respectively. Patients admitted to secondary hospitals had a higher 90 day mortality [10.8% vs. 5.0%; adjusted odds ratio (OR): 2.06; 95% confidence interval (CI): 1.10-3.84, P = 0.024 and a higher 1 year mortality rate [21.0% vs. 12.1%; adjusted OR: 1.64; 95% CI: 1.02-2.62, P = 0.039], but 30 day mortality rates were not significantly different (5.5% vs. 3.0%; adjusted OR: 1.49; 95% CI: 0.63-3.52, P = 0.368). Conclusions Worse quality of care for patients with HF in secondary hospitals was associated with higher 90 day and 1 year mortality rates. Improving care quality in secondary hospitals is crucial to improve prognosis of patients they served.
The paper focused on the seismic performance of ceramsite concrete frame—shear wall, which conducted the modal analysis and elasto-plastic time history analysis for 6 layers ceramsite concrete frame—shear wall and ordinary concrete frame—shear wall by software SAP2000. Then compared the results, which showed that the periods of ceramsite concrete frame—shear wall structure was longer than the ordinary concrete frame—shear wall structure, while the inter-storey drift ratio and the maximum absolute acceleration are less than ordinary concrete frame—shear wall. Besides, the largest base shear of ceramsite concrete frame—shear wall structure was less than ordinary concrete frame—shear wall structure. And the seismic performance of ceramsite concrete frame—shear wall showed was better than ordinary concrete frame—shear wall structure.
In order to study the aerated cavity length and negative pressure on stepped spillway which combined with Y-shape asymmetric flaring gate pier body type, this paper applied RNG turbulence model,VOF model of water vapor two-phase, iterative solution of geometry reconstruction format of unsteady flow to generate free surface. Numerically simulated the length of aerated cavity and negative pressure of stepped spillway which combined with asymmetrical Y-shape flaring gate pier that with the contraction ratio respectively of 598, 0.497 and 0.445, the range from the upstream reservoir to downstream stilling basin. And compared the simulation results with experimental results, found that the aerated cavity length on steps basically consistent with the measured cavity length, the maximum error is 9.7%. The simulation results shows that the aeration cavity length on steps increases with asymmetric flaring gate pier contraction ratio decreases, and the aerated cavity length of lateral side with smaller contraction angle is larger 4 to 5 times than lateral side with larger contraction angle.
Cavitation is a phenomenon that occurs easily during rotation of fluid machinery and can decrease the performance of a pump, thereby resulting in damage to flow passage components. To study the influence of wall roughness on the cavitation performance of a centrifugal pump, a three-dimensional model of internal flow field of a centrifugal pump was constructed and a numerical simulation of cavitation in the flow field was conducted with ANSYS CFX software based on the Reynolds normalization group k-epsilon turbulence model and Zwart cavitation model. The cavitation can be further divided into four stages: cavitation inception, cavitation development, critical cavitation, and fracture cavitation. Influencing laws of wall roughness of the blade surface on the cavitation performance of a centrifugal pump were analyzed. Research results demonstrate that in the design process of centrifugal pumps, decreasing the wall roughness appropriately during the cavitation development and critical cavitation is important to effectively improve the cavitation performance of pumps. Moreover, a number of nucleation sites on the blade surface increase with the increase in wall roughness, thereby expanding the low-pressure area of the blade. Research conclusions can provide theoretical references to improve cavitation performance and optimize the structural design of the pump.
The energy dissipater of stepped spillway combined with flaring gate pier is widely used in china's hydraulic engineering. The finite volume method is applied to discrete analysis, with the RNG turbulence model and VOF model of water vapor two-phase, iterative solution of geometry reconstruction format unsteady flow to generate free surface. Adopting structured grid for geometric shape, numerically simulated the water vapor two-phase flow from the reservoir to stilling basin. The parabolic water-vapor interface , overall flow pattern, water wings, section depth and other hydraulic characteristics was produced by simulating the three-dimensional flow field.Compared the simulated results of water depth, flow velocity in stilling pool, the board pressure with experiment data, the average error is: the left side depth of 3 # table hole of 7.1%, and the right of 7.4%; the underside flow velocity of 3 # table hole of 5%;1 # table hole stilling pool board pressure of 7.6%,3 # table hole stilling pool board pressure of 6.6%.
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