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Background/objectives Heart failure (HF) is a growing clinical and economic burden for patients and health systems. The COVID-19 pandemic has led to avoidance and delay in care, resulting in increased morbidity and mortality among many patients with HF. The increasing burden of HF during the COVID-19 pandemic led us to evaluate the quality and safety of the Hospital at Home (HAH) for patients presenting to their community providers or emergency department (ED) with symptoms of acute on chronic HF (CHF) requiring admission.Design/outcomes A non-randomised prospective case–controlled of patients enrolled in the HAH versus admission to the hospital (usual care, UC). Primary outcomes included length of stay (LOS), adverse events, discharge disposition and patient satisfaction. Secondary outcomes included 30-day readmission rates, 30-day ED usage and ED dwell time.Results Sixty patients met inclusion/exclusion criteria and were included in the study. Of the 60 patients, 40 were in the HAH and 20 were in the UC group. Primary outcomes demonstrated that HAH patients had slightly longer LOS (6.3 days vs 4.7 days); however, fewer adverse events (12.5% vs 35%) compared with the UC group. Those enrolled in the HAH programme were less likely to be discharged with postacute services (skilled nursing facility or home health). HAH was associated with increased patient satisfaction compared with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score in North Carolina. Secondary outcomes of 30-day readmission and ED usage were similar between HAH and UC.Conclusions The HAH pilot programme was shown to be a safe and effective alternative to hospitalisation for the appropriately selected patient presenting with acute on CHF.

Adequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device's utility, precision and impact on pulmonary mechanics. Secondly- to measure the gas distribution in supine and lateral decubitus position.69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance.Our results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the non-dependent lung. The control system positively affected non-dependent and dependent lung ventilation by delivering equal tidal volumes into both lungs with no adverse effects, regardless of patient's position.We report that gas distribution is uneven during conventional ventilation using Robertshaw tube in the supine and lateral decubitus positions. However, this recently released control system enables precise and safe independent ventilation in the supine and the left and right lateral decubitus positions.

• Poland may play pivotal role in kick-starting offshore market in the Baltic Sea. • Inducement mechanisms: urgent move to clean technologies and well-developed industry. • Policy decision is a precondition for the adoption of technology in energy sector. • Knowledge exchange across geographical borders is critical IS function in a follower country. We assess the offshore wind innovation system in Poland using the Technological Innovation System (TIS) approach. This procedure has been widely used to describe the offshore wind innovation systems in Europe. However, the literature concerned European countries located at the technological frontier, while we examine this issue in a follower country, which is still waiting to deploy first offshore wind installation. The upcoming transition of energy system makes Poland a promising market for renewable technologies, and the geographical location places Poland as the main actor in kick-starting the offshore wind market on the Baltic Sea. However, in our study we identify a number of challenges for offshore wind technology deployment in Poland. Some of them include unpredictable public policies, limited grid infrastructure, rather poor quality of research and weak interactions between science and business. To address these issues, we propose a set of policy instruments. We also outline two main observations resulting from the TIS analysis applied to a follower country. First, the formulation of an appropriate policy decision is a precondition for the adoption of a new technology in a follower country, especially in sectors such as the energy sector. Second, due to the importance of imitation, we identify the relationship between entrepreneurial experimentation and knowledge exchange across geographical borders as critical for the innovation system's performance in a follower country. [ABSTRACT FROM AUTHOR]