Sample records for discharge planning process
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Birmingham, Jackie
2004-01-01
Discharge planning is a legally mandated function for hospitals and is one of the "basic" hospital roles as outlined in Medicare's Conditions of Participation. This article will define discharge planning; describe the steps in the discharge planning process; list rules and regulations that influence discharge planning in hospitals; and compare hospital-based actions with payer-based actions when planning discharges. Case managers who work for payers interact with hospital-based case managers to facilitate the discharge planning process for patients. Those who form this patient-provider-payer triangle will benefit by reviewing the dynamics of the discharge planning process.
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Alghzawi, Hamzah M.
2012-01-01
Background. Integration of research evidence into clinical nursing practice is essential for the delivery of high-quality nursing care. Discharge planning is an essential process in psychiatric nursing field, in order to prevent recurrent readmission to psychiatric units. Objective. The purpose of this paper is to perform literature overview on psychiatric discharge planning, in order to develop evidence-based practice guideline of psychiatric discharge plan. Methods. A search of electronic databases was conducted. The search process aimed to locate different levels of evidence. Inclusion criteria were studies including outcomes related to prevention of readmission as stability in the community, studies investigating the discharge planning process in acute psychiatric wards, and studies that included factors that impede discharge planning and factors that aid timely discharge. On the other hand, exclusion criteria were studies in which discharge planning was discussed as part of a multi faceted intervention and was not the main focus of the review. Result. Studies met inclusion criteria were mainly literature reviews, consensus statements, and descriptive studies. All of these studies are considered at the lower levels of evidence. Conclusion. This review demonstrated that discharge planning based on general principles (evidence based principles) should be applied during psychiatric discharge planning to make this discharge more effective. Depending on this review, it could be concluded that effective discharge planning includes main three stages; initial discharge meeting, regular discharge meeting(s), and leaving from hospital and discharge day. Each stage of them has requirements should be accomplished be go to the next stage. PMID:23762767
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Discharge planning, nursing home placement, and the Internet.
Collier, Eric J; Harrington, Charlene
2005-01-01
Effective discharge planning and well-coordinated case management related to nursing home (NH) placement are key services in acute-care hospitals. (1) identify the individuals and important factors involved in the discharge planning process; (2) describe the types/sources of information used by discharge planners to recommend specific nursing homes for patients and families; and (3) determine which methods are used to evaluate the quality of US nursing homes (NHs). Descriptive study, with a convenience sample of 41 discharge planners and case managers from California acute-care hospitals. This study found that patients, families, friends, and physicians are all involved in the discharge planning process along with discharge planners and/or case managers. Discharge planners/case managers were generally concerned about NH bed availability, geographic location, and financial considerations. Although the discharge planners and case managers were able to articulate important indicators of quality in NHs, such information was not routinely considered during discharge planning activities. Discharge planners and case managers need to play a more central role in the decision-making process related to the selection of a NH, especially because decisions are time-limited and can benefit from a well-planned discharge planning program that uses a variety of data on quality and costs. The widespread use of Internet-based information sources can be expanded to aid this process.
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ERIC Educational Resources Information Center
Soskolne, Varda; Kaplan, Giora; Ben-Shahar, Ilana; Stanger, Varda; Auslander, Gail. K.
2010-01-01
Objective: To examine the associations of patients' characteristics, hospitalization factors, and the patients' or family assessment of the discharge planning process, with their evaluation of adequacy of the discharge plan. Method: A prospective study. Social workers from 11 acute care hospitals in Israel provided data on 1426 discharged…
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Uyeno, Jennifer; Heck, Carol S.
2014-01-01
ABSTRACT Purpose: To examine discharge planning of patients in general internal medicine units in Ontario acute-care hospitals from the perspective of physiotherapists. Methods: A cross-sectional study using an online questionnaire was sent to participants in November 2011. Respondents' demographic characteristics and ranking of factors were analyzed using descriptive statistics; t-tests were performed to determine between-group differences (based on demographic characteristics). Responses to open-ended questions were coded to identify themes. Results: Mobility status was identified as the key factor in determining discharge readiness; other factors included the availability of social support and community resources. While inter-professional communication was identified as important, processes were often informal. Discharge policies, timely availability of other discharge options, and pressure for early discharge were identified as affecting discharge planning. Respondents also noted a lack of training in discharge planning; accounts of ethical dilemmas experienced by respondents supported these themes. Conclusions: Physiotherapists consider many factors beyond the patient's physical function during the discharge planning process. The improvement of team communication and resource allocation should be considered to deal with the realities of discharge planning. PMID:25125778
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Framework and components for effective discharge planning system: a delphi methodology
2012-01-01
Background To reduce avoidable hospital readmissions, effective discharge planning and appropriate post discharge support care are key requirements. This study is a 3-staged process to develop, pretest and pilot a framework for an effective discharge planning system in Hong Kong. This paper reports on the methodology of Delphi approach and findings of the second stage on pre-testing the framework developed so as to validate and attest to its applicability and practicability in which consensus was sought on the key components of discharge planning. Methods Delphi methodology was adopted to engage a group of experienced healthcare professionals to rate and discuss the framework and components of an effective discharge planning. The framework was consisted 36 statements under 5 major themes: initial screening, discharge planning process, coordination of discharge, implementation of discharge, and post discharge follow-up. Each statement was rated independently based on 3 aspects including clarity, validity and applicability on a 5-point Likert-scale. Statement with 75% or above of participants scoring 4–5 on all 3 aspects would be included in the discharge planning framework. For those statements not reaching 75% of consensus in any one of the aspect, it would be revised or discarded following the group discussion, and be re-rated in another round. Results A total of 24 participants participated in the consensus-building process. In round one rating, consensus was achieved in 25 out of 36 statements. Among those 11 statements not reaching consensus, the major concern was related to the “applicability” of the statements. The participants expressed a lack of manpower, skills and time in particular during weekends and long holidays in carrying out assessment and care plans within 24 h after admission. There were also timeliness and availability issue in providing transportation and necessary equipment to the patients. To make the statements more applicable, the wordings of some of the statements were revised to provide greater flexibility. Due to the lack of a statement in clarifying the role of the members of the healthcare professional team, one additional statement on the role and responsibility of the multidisciplinary team members was added. The first theme on “initial screening” was further revised to “initial screening and assessment” to better reflect the first stage of discharge planning process. After two rounds of rating process, all the 36 statements and the newly added statement reached consensus Conclusions A structured, systematic and coordinated system of hospital discharge system is required to facilitate the discharge process to ensure a smooth patient transition from the hospital to the community and improve patient health outcome in both clinical and social aspect. The findings of this paper provide a reference framework helping policymakers and hospital managers to facilitate the development of a coherent and systematized discharge planning process. Adopting a Delphi approach also demonstrates the values of the method as a pre-test (before the clinical run) of the components and requirements of a discharge planning system taking into account of the local context and system constraints, which would lead to improvements to its applicability and practicability. To confirm the applicability and practicability of this consensus framework for discharge planning system, the third stage of process of development of the discharge planning framework is to apply and pilot the framework in a hospital setting to evaluate its feasibility, applicability and impact in hospital including satisfaction from both the perspectives of staff and patients. PMID:23151173
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2016-03-01
Hospital providers voice concerns about a proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would require providers to devote more resources to discharge planning. The rule would apply to inpatients as well as emergency patients requiring comprehensive discharge plans as opposed to discharge instructions. CMS states that the rule would ensure the prioritization of patient preferences and goals in the discharge planning process, and also would prevent avoidable complications and readmissions. However, hospital and emergency medicine leaders worry that community resources are not yet in place to facilitate the links and follow-up required in the proposed rule, and that the costs associated with implementation would be prohibitive. The proposed rule would apply to acute care hospitals, EDs, long-term care facilities, inpatient rehabilitation centers, and home health agencies. Regardless of the setting, though, CMS is driving home the message that patient preferences should be given more weight during the discharge planning process. Under the rule, hospitals or EDs would need to develop a patient-centered discharge plan within 24 hours of admission or registration, and complete the plan prior to discharge or transfer to another facility. Under the rule, emergency physicians would determine which patients require a comprehensive discharge plan. Both the American Hospital Association and the American College of Emergency Physicians worry that hospitals will have to take on more staff, invest in training, and make changes to their electronic medical record systems to implement the provisions in the proposed rule.
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[Redesigning the hospital discharge process].
Martínez-Ramos, M; Flores-Pardo, E; Uris-Sellés, J
2016-01-01
The aim of this article is to show that the redesign and planning process of hospital discharge advances the departure time of the patient from a hospital environment. Quasi-experimental study conducted from January 2011 to April 2013, in a local hospital. The cases analysed were from medical and surgical nursing units. The process was redesigned to coordinate all the professionals involved in the process. The hospital discharge improvement process improvement was carried out by forming a working group, the analysis of retrospective data, identifying areas for improvement, and its redesign. The dependent variable was the time of patient administrative discharge. The sample was classified as pre-intervention, inter-intervention, and post-intervention, depending on the time point of the study. The final sample included 14,788 patients after applying the inclusion and exclusion criteria. The mean discharge release time decreased significantly by 50 min between pre-intervention and post-intervention periods. The release time in patients with planned discharge was one hour and 25 min less than in patients with unplanned discharge. Process redesign is a useful strategy to improve the process of hospital discharge. Besides planning the discharge, it is shown that the patient leaving the hospital before 12 midday is a key factor. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.
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Discharge planning in mental health care: an integrative review of the literature.
Nurjannah, Intansari; Mills, Jane; Usher, Kim; Park, Tanya
2014-05-01
To identify the evidence base related to discharge planning in the context of acute and community mental healthcare service provision to ascertain the need for future research. Discharge planning is an important activity when preparing consumers to transition from hospital to home. The efficiency of discharge planning for consumers living with a mental health issue can influence both the number of future readmissions to acute-care facilities and their quality of life at home. An integrative review of the peer-reviewed literature. This review uses specific search terms and a 21-year time frame to search two key nursing databases CINAHL (Cinahl Information Systems, Glendale, CA, USA) and PSYCHINFO (American Psychological Association, Washington, DC, USA) for research reports investigating the substantive area of enquiry. Hand searches of reference lists and author searches were also conducted. Nineteen peer-reviewed journal articles met the inclusion criteria for this review. Research findings about discharge planning for people living with a mental health issue identify the importance of communication between health professionals, consumers and their families to maximise the effectiveness of this process. The complexity of consumer's healthcare needs influences the discharge planning process and impacts on aftercare compliance and readmission rates. There is a limited amount of research findings relating to differences between health professionals and families' perceptions of the level of information required for effective discharge planning, and the appropriate level of involvement of individuals living with a mental health issue in their own discharge planning. Results from this integrative review will inform future research related to this topic. Discharge planning for consumers living with a mental health issue involves many stakeholders who have different expectations regarding the type of information required and the necessary level of involvement of people living with a mental health issue in this process. Comprehensive discharge planning can result in reduced readmissions to both acute and community mental health services. Understanding the impact of effective communication on the outcomes of discharge planning is an important step in promoting success. © 2013 John Wiley & Sons Ltd.
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42 CFR 482.43 - Condition of participation: Discharge planning.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Discharge planning. 482.43 Section 482.43 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND... effect a discharge planning process that applies to all patients. The hospital's policies and procedures...
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Improving Hospital Discharge Planning for Elderly Patients
Potthoff, Sandra; Kane, Robert L.; Franco, Sheila J.
1997-01-01
Hospital discharge planning has become increasingly important in an era of prospective payment and managed care. Given the changes in tasks, decisions, and environments involved, it is important to identify how to move such planning from an art to an empirically based decisionmaking process. The authors use a decision-sciences framework to review the state-of-the-art of hospital discharge planning and to suggest methods for improvement. PMID:10345406
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Multiple perceptions of discharge planning in one urban hospital.
Clemens, E L
1995-11-01
Since the advent of diagnosis-related groups (DRGs), advocacy groups have claimed that although hospital discharge planners perceive the discharge planning process as helpful, elderly patients and their families do not. This article explores how the discharge planning process was perceived by 40 discharge planners and 40 family caregivers. Planners greatly overrated caregiver influence and the amount adequacy of information shared about posthospital health care, choice of discharge to home or nursing home, and time to decide. Caregivers perceived that nursing homes were forced on patients by social workers and physicians. DRGs, physicians, and hospital administrators appeared to pressure social workers to coerce mentally competent patients into nursing homes. Excessive concern by hospital staff about patient safety after discharge may override patients' rights to autonomy and self-determination, violating the NASW Code of Ethics. Implications for practice, policy, and future research are discussed.
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Lin, Li-En; Lo, Su-Chen; Liu, Chieh-Yu; Chen, Shing-Chia; Wu, Wen-Cheng; Liu, Wen-I
2018-04-01
Hospital discharge planning for clients with schizophrenia reduces client rehospitalization rates and improves their medication adherence. The effectiveness of caregiver participation in hospital discharge planning has seldom been explored. The purpose of this study was to examine the effectiveness of caregiver participation in hospital discharge planning for clients with schizophrenia in reducing caregiver burden and improving health status. A quasi-experimental research design was adopted. The research location was in a psychiatric hospital in Northern Taiwan. The target population was caregivers of inpatients with schizophrenia. Nurses served as care coordinators and provided six-step hospital discharge planning services to caregivers. Structured questionnaires were employed to measure caregiver burden and health status. Intervention effect was tested using analysis of covariance in which outcome measure at pretest and selected demographic variables were treated as covariates. A total of 114 caregivers completed pretest and posttest evaluations, with 57 people in each group. A significant difference was found between the experimental and the control group regarding the caregiver burden and health status (P<0.001) The caregiver burden and health status of the experimental group improved more significantly compared with the control group. The caregiver-involved discharge planning process developed in this study effectively reduced the burden placed on caregivers and improved their health status. Mental health nurses can serve as the main care coordinators for assessment, planning, referral and provision of the required services. Caregiver-involved hospital discharge planning should become part of the routine care process. Copyright © 2017 Elsevier Inc. All rights reserved.
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Illuminating hospital discharge planning: staff nurse decision making.
Rhudy, Lori M; Holland, Diane E; Bowles, Kathryn H
2010-11-01
This qualitative study proposed to examine staff RN's decision making related to discharge planning and perceptions of their role. Themes resulting from interviews were "following the script" and "RN as coordinator." The decision to consult a discharge planner occurred when the patient's situation did not follow the RN's expectations. Discharge planning for nonroutine situations was considered disruptive to the RN's workflow. The RN's role was limited to oversight when a discharge planner was involved. Understanding RNs' decision making in this key process provides valuable insights into differentiating routine from nonroutine patient situations and deploying appropriate resources in a timely fashion. Copyright © 2010 Elsevier Inc. All rights reserved.
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Nordmark, Sofi; Zingmark, Karin; Lindberg, Inger
2016-04-27
Discharge planning is a care process that aims to secure the transfer of care for the patient at transition from home to the hospital and back home. Information exchange and collaboration between care providers are essential, but deficits are common. A wide range of initiatives to improve the discharge planning process have been developed and implemented for the past three decades. However, there are still high rates of reported medical errors and adverse events related to failures in the discharge planning. Using theoretical frameworks such as Normalization Process Theory (NPT) can support evaluations of complex interventions and processes in healthcare. The aim of this study was to explore the embedding and integration of the DPP from the perspective of registered nurses, district nurses and homecare organizers. The study design was explorative, using the NPT as a framework to explore the embedding and integration of the DPP. Data consisted of written documentation from; workshops with staff, registered adverse events and system failures, web based survey and individual interviews with staff. Using the NPT as a framework to explore the embedding and integration of discharge planning after 10 years in use showed that the staff had reached a consensus of opinion of what the process was (coherence) and how they evaluated the process (reflexive monitoring). However, they had not reached a consensus of opinion of who performed the process (cognitive participation) and how it was performed (collective action). This could be interpreted as the process had not become normalized in daily practice. The result shows necessity to observe the implementation of old practices to better understand the needs of new ones before developing and implementing new practices or supportive tools within healthcare to reach the aim of development and to accomplish sustainable implementation. The NPT offers a generalizable framework for analysis, which can explain and shape the implementation process of old practices, before further development of new practices or supportive tools.
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Rodakowski, Juleen; Rocco, Philip B; Ortiz, Maqui; Folb, Barbara; Schulz, Richard; Morton, Sally C; Leathers, Sally Caine; Hu, Lu; James, A Everette
2017-08-01
To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all English-language articles published between 1990 and April 2016. Hospital or skilled nursing facility. Older adults with informal caregivers discharged to a community setting. Readmission rates, length of and time to post-discharge rehospitalizations, costs of postdischarge care. Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62-0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64-0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.
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Rehabilitation as "destination triage": a critical examination of discharge planning.
Durocher, Evelyne; Gibson, Barbara E; Rappolt, Susan
2017-06-01
In this paper we examine how the intersection of various social and political influences shapes discharge planning and rehabilitation practices in ways that may not meet the espoused aims of rehabilitation programs or the preferences of older adults and their families. Taking a critical bioethics perspective, we used microethnographic case study methods to examine discharge-planning processes in a well-established older adult inpatient rehabilitation setting in Canada. The data included observations of discharge-planning family conferences and semi-structured interviews conducted with older adults facing discharge, their family members and rehabilitation professionals involved in discharge planning. From the time of admission, a contextual push to focus on discharge superseded program aims of providing interventions to increase older adults' functional capabilities. Professionals' primary commitment to safety limited consideration of discharge options and resulted in costly and potentially unnecessary recommendations for 24-hour care. The resulting "rehabilitation" stay was more akin to an extended process of "destination triage" biased towards the promotion of physical safety than optimizing functioning. The resulting reduction of rehabilitation into "destination triage" has significant social, financial and occupational implications for older adults and their families, and broader implications for healthcare services and overarching healthcare systems. Implications for Rehabilitation Current trends promoting consideration of discharge planning from the point of admission and prioritizing physical safety are shifting the focus of rehabilitation away from interventions to maximize recovery of function, which are the stated aims of rehabilitation. Such practices furthermore promote assessments to determine prognosis early in the rehabilitation stay when accurate prognosis is difficult, which can lead to overly conservative recommendations for discharge from rehabilitation services, thus further negating the impact of rehabilitation. Further work is required to examine the social, occupational and functional implications of superseding rehabilitation interventions to maximize capabilities with practices that prioritize safety over quality of life for older adults and their family members.
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Discharging patients earlier in the day: a concept worth evaluating.
Kravet, Steven J; Levine, Rachel B; Rubin, Haya R; Wright, Scott M
2007-01-01
Patient discharges from the hospital often occur late in the day and are frequently clustered after 4 PM. When inpatients leave earlier in the day, quality is improved because new admissions awaiting beds are able to leave the emergency department sooner and emergency department waiting room backlog is reduced. Nursing staff, whose work patterns traditionally result in high activity of discharge and admission between 5 PM and 8 PM, benefit by spreading out their work across a longer part of the day. Discharging patients earlier in the day also has the potential to increase patient satisfaction. Despite multiple stakeholders in the discharge planning process, physicians play the most important role. Getting physician buy-in requires an ability to teach physicians about the concept of early-in-the-day discharges and their impact on the process. We defined a new physician-centered discharge planning process and introduced it to an internal medicine team with an identical control team as a comparison. Discharge time of day was analyzed for 1 month. Mean time of day of discharge was 13:39 for the intervention group versus 15:45 for the control group (P<.001). If reproduced successfully, this process could improve quality at an important transition point in patient care.
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Hofflander, Malin; Nilsson, Lina; Eriksén, Sara; Borg, Christel
2016-03-01
This article describes healthcare managers' experiences of leading the implementation of video conferencing in discharge planning sessions as a new tool in everyday practice. Data collection took place through individual interviews and the interviews were analyzed using qualitative content analysis with an inductive approach. The results indicate that managers identified two distinct leadership perspectives when they reflected on the implementation process. They described a desired way of leading the implementation and communicating about the upcoming change, understanding and securing support for decisions, as well as ensuring that sufficient time is available throughout the change process. They also, however, described how they perceived that the implementation process was actually taking place, highlighting the lack of planning and preparation as well as the need for support and to be supportive, and having the courage to adopt and lead the implementation. It is suggested that managers at all levels require more information and training in how to encourage staff to become involved in designing their everyday work and in the implementation process. Managers, too, need ongoing organizational support for good leadership throughout the implementation of video conferencing in discharge planning sessions, including planning, start-up, implementation, and evaluation.
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Mola, Ana; Rosenfeld, Peri; Ford, Shauna
2016-01-01
Background/Methods: Readmission prevention is a marker of patient care quality and requires comprehensive, early discharge planning for safe hospital transitions. Effectively performed, this process supports patient satisfaction, efficient resource utilization, and care integration. This study developed/tested the utility of a predictive early discharge risk assessment with 366 elective orthopedic/cardiovascular surgery patients. Quality improvement cycles were undertaken for the design and to inform analytic plan. An 8-item questionnaire, which includes patient self-reported health, was integrated into care managers’ telephonic pre-admission assessments during a 12-month period. Results: Regression models found the questionnaire to be predictive of readmission (p ≤ .005; R2 = .334) and length-of-stay (p ≤ .001; R2 = .314). Independent variables of “lives-alone” and “self-rated health” were statistically significant for increased readmission odds, as was “self-rated health” for increased length-of-stay. Quality measures, patient experience and increased rates of discharges-to-home further supported the benefit of embedding these questions into the pro-active planning process. Conclusion: The pilot discharge risk assessment was predictive of readmission risk and length-of-stay for elective orthopedic/cardiovascular patients. Given the usability of the questionnaire in advance of elective admissions, it can facilitate pro-active discharge planning essential for producing quality outcomes and addressing new reimbursement methodologies for continuum-based episodes of care. PMID:27616965
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Cadilhac, Dominique A; Andrew, Nadine E; Stroil Salama, Enna; Hill, Kelvin; Middleton, Sandy; Horton, Eleanor; Meade, Ian; Kuhle, Sarah; Nelson, Mark R; Grimley, Rohan
2017-08-04
Provision of a discharge care plan and prevention therapies is often suboptimal. Our objective was to design and pilot test an interdisciplinary, organisational intervention to improve discharge care using stroke as the case study using a mixed-methods, controlled before-after observational study design. Acute care public hospitals in Queensland, Australia (n=15). The 15 hospitals were ranked against a benchmark based on a composite outcome of three discharge care processes. Clinicians from a 'top-ranked' hospital participated in a focus group to elicit their success factors. Two pilot hospitals then participated in the organisational intervention that was designed with experts and consumers. Hospital clinicians involved in discharge care for stroke and patients admitted with acute stroke or transient ischaemic attack. A four-stage, multifaceted organisational intervention that included data reviews, education and facilitated action planning. Three discharge processes collected in Queensland hospitals within the Australian Stroke Clinical Registry were used to select study hospitals: (1) discharge care plan; (2) antihypertensive medication prescription and (3) antiplatelet medication prescription (ischaemic events only). Primary measure: composite outcome. Secondary measures: individual adherence changes for each discharge process; sensitivity analyses. The performance outcomes were compared 3 months before the intervention (preintervention), 3 months postintervention and at 12 months (sustainability). Data from 1289 episodes of care from the two pilot hospitals were analysed. Improvements from preintervention adherence were: antiplatelet therapy (88%vs96%, p=0.02); antihypertensive prescription (61%vs79%, p<0.001); discharge planning (72%vs94%, p<0.001); composite outcome (73%vs89%, p<0.001). There was an insignificant decay effect over the 12-month sustainability period (composite outcome: 89% postintervention vs 85% sustainability period, p=0.08). Discharge care in hospitals may be effectively improved and sustained through a staged and peer-informed, organisational intervention. The intervention warrants further application and trialling on a larger scale. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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[Integration of the nursing process in the electronic health record in an university hospital].
Guadarrama-Ortega, D; Delgado-Sánchez, P; Martínez-Piedrola, M; López-Poves, E M; Acevedo-García, M; Noguera-Quijada, C; Camacho-Pastor, J L
To describe the process of implementation of Individualized Care Plan in the Electronic Health Record and its impact on the University Hospital Alcorcón Foundation. Working groups of staff nurses who analyzed activities usually performed to create a catalog of diagnoses, outcomes and interventions. A group of referents that refined the catalog to make it manageable was created. A training plan, nursing assessment forms and the Nursing Discharge Report were designed. In February 2016 the new methodology was implemented in inpatient units of adults. Between 74.86 and 88.18% of the patients underwent a care plan with the new methodology. Between 69.41 and 76.25% of patients are discharged with a Nursing Discharge Report accordance with regulations. An increase of 24.1% of patients with Nursing Discharge Report after implantation is observed (P=.000; RR: 1.46; 95% CI 1.36-1.56). A total of 116 nurses has been trained. In the study conditions, the use of nursing taxonomies has generated thinking skills and allowed nurses to issue judgments, ensure quality of care, and implementing interventions with a planned results. The nursing taxonomy and care plan in the Electronic Health Record have increased interprofessional communication to improve continuity of care through improved Nursing Discharge Report. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-11-01
...The Secretary amends the Federal Perkins Loan (Perkins Loan) program, Federal Family Education Loan (FFEL) program, and William D. Ford Federal Direct Loan (Direct Loan) program regulations. These final regulations implement a new Income-Contingent Repayment (ICR) plan in the Direct Loan program based on the President's ``Pay As You Earn'' repayment initiative, incorporate recent statutory changes to the Income-Based Repayment (IBR) plan in the Direct Loan and FFEL programs, and streamline and add clarity to the total and permanent disability (TPD) discharge process for borrowers in loan programs under title IV of the Higher Education Act of 1965, as amended (HEA). These final regulations implementing a new ICR plan and the statutory changes to the IBR plan will assist borrowers in repaying their loans while the changes to the TPD discharge process will reduce burden for borrowers who are disabled and seeking a discharge of their title IV debt.
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Gregory, Jonathan M.; Sukhera, Javeed; Taylor-Gates, Melissa
2017-01-01
Objective As smartphone technology becomes an increasingly important part of youth mental health, there has been little to no examination of how to effectively integrate smartphone-based safety planning with inpatient care. Our study sought to examine whether or not we could effectively integrate smartphone-based safety planning into the discharge process on a child and adolescent inpatient psychiatry unit. Method Staff members completed a survey to determine the extent of smartphone ownership in a population of admitted child and adolescent inpatients. In addition to quantifying smartphone ownership, the survey also tracked whether youth would integrate their previously-established safety plan with a specific safety planning application on their smartphone (Be Safe) at the time of discharge. Results Sixty-six percent (50/76) of discharged youth owned a smartphone, which is consistent with prior reports of high smartphone ownership in adult psychiatric populations. A minority of youth (18%) downloaded the Be Safe app prior to discharge, with most (68%) suggesting they would download the app after discharge. Notably, all patients who downloaded the app prior to discharge were on their first admission to a psychiatric inpatient unit. Conclusion Child and adolescent psychiatric inpatients have a clear interest in smartphone-based safety planning. Our results suggest that integrating smartphone-related interventions earlier in an admission might improve access before discharge. This highlights the tension between restricting and incorporating smartphone access for child and adolescent inpatients and may inform future study in this area. PMID:28331503
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Stover, Pamela R; Harpin, Scott
2015-12-01
Limited capacity in a psychiatric unit contributes to long emergency department (ED) admission wait times. Regulatory and accrediting agencies urge hospitals nationally to improve patient flow for better access to care for all types of patients. The purpose of the current study was to decrease psychiatric admission wait time from 10.5 to 8 hours and increase the proportion of patients discharged by 11 a.m. from 20% to 50%. The current study compared pre- and post-intervention data. Plan-Do-Study-Act cycles aimed to improve discharge processes and timeliness through initiation of new practices. Admission wait time improved to an average of 5.1 hours (t = 3.87, p = 0.006). The proportion of discharges occurring by 11 a.m. increased to 46% (odds ratio = 3.42, p < 0.0001). Improving discharge planning processes and timeliness in a psychiatric unit significantly decreased admission wait time from the ED, improving access to psychiatric care. Copyright 2015, SLACK Incorporated.
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Ingram, Jenny; Redshaw, Maggie; Manns, Sarah; Beasant, Lucy; Johnson, Debbie; Fleming, Peter; Pontin, David
2017-08-01
Preparing families and preterm infants for discharge is relatively unstructured in many UK neonatal units (NNUs). Family-centred neonatal care and discharge planning are recommended but variable. Qualitative interviews with 37 parents of infants in NNUs, and 18 nursing staff and 5 neonatal consultants explored their views of discharge planning and perceptions of a planned family-centred discharge process (Train-to-Home). Train-to-Home facilitates communication between staff and parents throughout the neonatal stay, using a laminated train and parent booklets. Parents were overwhelmingly positive about Train-to-Home. They described being given hope, feeling in control and having something visual to show their baby's progress. They reported positive involvement of fathers and families, how predicted discharge dates helped them prepare for home and ways staff engaged with Train-to-Home when communicating with them. Nursing staff reactions were mixed-some were uncertain about when to use it, but found the visual images powerful. Medical staff in all NNUs were positive about the intervention recognizing that it helped in communicating better with parents. Using a parent-centred approach to communication and informing parents about the needs and progress of their preterm infant in hospital is welcomed by parents and many staff. This approach meets the recommended prioritization of family-centred care for such families. Predicted discharge dates helped parents prepare for home, and the ways staff engaged with Train-to-Home when communicating with them helped them feel more confident as well as having something visual to show their baby's progress. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.
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1945-08-08
Personnel released for discharge are processed in accordance with the Administrative Provisions for Discharge (Inclosure #8). The place where this is...Appendix 6b ADMIINISTRATIVE PRCVIS-iOS FOR DISCHARGE 1. Gcneral (a) The following regulations are intended to govern the administrativo provisions for the...on their seizure, exploitation, and processing . In the "BLACXLISTt" period, the general principles of the inter-Service handling of documents hitherto
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Code of Federal Regulations, 2011 CFR
2011-07-01
... oil that may have resulted from any small discharge. You must promptly remove any accumulations of oil...-through process vessels (excluding discharges that are the result of natural disasters, acts of war, or... discharges that are the result of natural disasters, acts of war, or terrorism) then you must, within six...
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Code of Federal Regulations, 2013 CFR
2013-07-01
... oil that may have resulted from any small discharge. You must promptly remove any accumulations of oil...-through process vessels (excluding discharges that are the result of natural disasters, acts of war, or... discharges that are the result of natural disasters, acts of war, or terrorism) then you must, within six...
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Code of Federal Regulations, 2010 CFR
2010-07-01
... oil that may have resulted from any small discharge. You must promptly remove any accumulations of oil...-through process vessels (excluding discharges that are the result of natural disasters, acts of war, or... discharges that are the result of natural disasters, acts of war, or terrorism) then you must, within six...
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Code of Federal Regulations, 2012 CFR
2012-07-01
... oil that may have resulted from any small discharge. You must promptly remove any accumulations of oil...-through process vessels (excluding discharges that are the result of natural disasters, acts of war, or... discharges that are the result of natural disasters, acts of war, or terrorism) then you must, within six...
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Code of Federal Regulations, 2014 CFR
2014-07-01
... oil that may have resulted from any small discharge. You must promptly remove any accumulations of oil...-through process vessels (excluding discharges that are the result of natural disasters, acts of war, or... discharges that are the result of natural disasters, acts of war, or terrorism) then you must, within six...
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Psychiatric Inpatient Discharge Planning Practices and Attendance at Aftercare Appointments.
Smith, Thomas E; Abraham, Maria; Bolotnikova, Natalia V; Donahue, Sheila A; Essock, Susan M; Olfson, Mark; Shao, Wenjun S; Wall, Melanie M; Radigan, Marleen
2017-01-01
This study examined discharge planning practices by hospital providers for 17,053 psychiatric discharges in New York's statewide Medicaid program. Claims data were linked to information reported to New York State by managed behavioral health care organizations (MBHOs) conducting inpatient utilization reviews. MBHOs documented hospital providers' reports of the presence of three discharge planning practices for each discharge: communicating with an outpatient provider prior to discharge, scheduling an aftercare appointment, and forwarding a discharge summary. Hospital providers reported completing at least one of the three discharge planning practices for 85% of discharges. Individuals who received all three discharge planning practices had a higher likelihood of follow-up and kept their first outpatient follow-up visit at almost twice the speed compared with individuals who received none of the practices (hazard ratio=1.96, p<.001). This study provided baseline information concerning routine discharge planning practices and their relationship to timeliness of care transitions.
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Fields, Christina J.; Fernandez, Natalia
2010-01-01
Background Acute care physical therapists contribute to the complex process of patient discharge planning. As physical therapists are experts at evaluating functional abilities and are able to incorporate various other factors relevant to discharge planning, it was expected that physical therapists’ recommendations of patient discharge location would be both accurate and appropriate. Objective This study determined how often the therapists’ recommendations for patient discharge location and services were implemented, representing the accuracy of the recommendations. The impact of unimplemented recommendations on readmission rate was examined, reflecting the appropriateness of the recommendations. Design This retrospective study included the discharge recommendations of 40 acute care physical therapists for 762 patients in a large academic medical center. The frequency of mismatch between the physical therapist's recommendation and the patient's actual discharge location and services was calculated. The mismatch variable had 3 levels: match, mismatch with services lacking, or mismatch with different services. Regression analysis was used to test whether mismatch status, patient age, length of admission, or discharge location predicted patient readmittance. Results Overall, physical therapists’ discharge recommendations were implemented 83% of the time. Patients were 2.9 times more likely to be readmitted when the therapist's discharge recommendation was not implemented and recommended follow-up services were lacking (mismatch with services lacking) compared with patients with a match. Limitations This study was limited to one facility. Limited information about the patients was collected, and data on patient readmission to other facilities were not collected. Conclusions This study supports the role of physical therapists in discharge planning in the acute care setting. Physical therapists demonstrated the ability to make accurate and appropriate discharge recommendations for patients who are acutely ill. PMID:20299410
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Mabire, Cédric; Dwyer, Andrew; Garnier, Antoine; Pellet, Joanie
2018-04-01
To determine the effectiveness of nursing discharge planning interventions on health-related outcomes for older inpatients discharged home. Inadequate discharge planning for the ageing population poses significant challenges for health services. Effective discharge planning interventions have been examined in several studies, but little information is available on nursing interventions for older people. Despite the research published on the importance of discharge planning, the impact on patient's health outcomes still needs to be evaluated in practice. Systematic review and meta-analysis. A systematic search was undertaken across 13 databases to retrieve published and unpublished studies in English between 2000-2015. Critical appraisal, data extraction and meta-analysis followed the methodology of the Joanna Briggs Institute. Thirteen studies were included in the review, 2 of 13 were pilot studies and one had a pre-post design. Included studies involved 3,964 participants with a median age of 77 years. Nurse discharge planning did not significantly reduce hospital readmission or quality of life, except readmission was lower across studies conducted in the USA. The overall effect score for nurse discharge planning on length of stay was statistically significant and positive. Nursing discharge planning is a complex intervention and difficult to evaluate. Findings suggest that nursing discharge planning for older inpatients discharged home increases the length of stay yet neither reduces readmission rate nor improves quality of life. © 2017 John Wiley & Sons Ltd.
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ERIC Educational Resources Information Center
Auslander, Gail K.; Soskolne, Varda; Stanger, Varda; Ben-Shahar, Ilana; Kaplan, Giora
2008-01-01
This study aimed to examine the implementation, adequacy, and outcomes of discharge planning. The authors carried out a prospective study of 1,426 adult patients discharged from 11 acute care hospitals in Israel. Social workers provided detailed discharge plans on each patient. Telephone interviews were conducted two weeks post-discharge. Findings…
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Nyborg, Ingrid; Danbolt, Lars J; Kirkevold, Marit
2017-12-01
The purpose of this multiple case study was to compare and contrast older people's and their relatives' experiences of participation in decision-making processes regarding the planning of everyday life after discharge from hospital. Internationally, patient involvement in health services is established to benefit patient health and to improve quality of the services. The literature shows that at hospital discharge, older people would benefit from better communication and more active participation of relatives in the discharge planning. Little research has been carried out on the experiences of patients and relatives as a family in this context, and even less has investigated their participation. This study used a qualitative design with a comparative multicase approach. Participants were recruited from two hospitals in Norway using a purposive sampling strategy. Semi-structured interviews were conducted with five patients and with six of their relatives. Three patterns of experiences were identified: contradicting experiences; consistent experiences of nonpreferred participation; similar, but separate experiences of user participation. User participation in the planning of everyday life following discharge appeared to be random and limited for both patients and their relatives, and conflicting for the families as a whole. The decision-making processes seemed to be limited to the hospital context and did not include the broader context of everyday life following discharge. The results underscore the importance of taking a family perspective when caring for older people. Family meetings might be a useful tool to ensure systematic assessment and integration of the perspectives of both older people and their family in the planning of follow-up care. © 2017 The Authors. Journal of Clinical Nursing Published by John Wiley & Sons Ltd.
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Improving the quality of vascular surgical discharge planning in a hub centre
Wariyapola, C; Littlehales, E; Abayasekara, K; Fall, D; Parker, V; Hatton, G
2016-01-01
Introduction Discharge planning improves patient outcomes, reduces hospital stay and readmission rates, and should involve a multidisciplinary team (MDT) approach. The efficacy of MDT meetings in discharge planning was examined, as well as reasons for delayed discharge among vascular surgical inpatients. Methods Dedicated weekly MDT meetings were held on the vascular ward in Royal Derby Hospital for three months. Each patient was presented to the discharge planning meeting and an expected date of discharge was decided prospectively. Patients who were discharged after this date were considered ‘delayed’ and reasons for delay were explored at the next meeting. Results Overall, 193 patients were included in the study. Of these, 42 patients (22%) had a delayed discharge while 29 (15%) had an early discharge. The main reasons for delay were awaiting beds (30%), social (14%) and medical (45%). In 64%, the cause for delay was avoidable. Two-thirds (67%) of all delays were >24 hours. This totalled 115 bed days, of which 67 could have been avoided. However, 32 bed days were saved by early discharge. This equates to a net loss of 35 bed days, at a net cost of £2,936 per month or £35,235 per year. The MDT meetings also improved the quality of discharge planning; the variability between expected and actual discharge dates decreased after the first month. Conclusions Discharge planning meetings help prepare for patient discharge and are most effective with multidisciplinary input. The majority of delayed discharges from hospital are preventable. The main causes are awaiting transfers, social services input and medical reasons (eg falls). There is an obvious financial incentive to improve discharge planning. The efficiency of the MDT at discharge planning improves with time and this should therefore be continued for best results. PMID:26924480
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Improving the quality of vascular surgical discharge planning in a hub centre.
Wariyapola, C; Littlehales, E; Abayasekara, K; Fall, D; Parker, V; Hatton, G
2016-04-01
Introduction Discharge planning improves patient outcomes, reduces hospital stay and readmission rates, and should involve a multidisciplinary team (MDT) approach. The efficacy of MDT meetings in discharge planning was examined, as well as reasons for delayed discharge among vascular surgical inpatients. Methods Dedicated weekly MDT meetings were held on the vascular ward in Royal Derby Hospital for three months. Each patient was presented to the discharge planning meeting and an expected date of discharge was decided prospectively. Patients who were discharged after this date were considered 'delayed' and reasons for delay were explored at the next meeting. Results Overall, 193 patients were included in the study. Of these, 42 patients (22%) had a delayed discharge while 29 (15%) had an early discharge. The main reasons for delay were awaiting beds (30%), social (14%) and medical (45%). In 64%, the cause for delay was avoidable. Two-thirds (67%) of all delays were >24 hours. This totalled 115 bed days, of which 67 could have been avoided. However, 32 bed days were saved by early discharge. This equates to a net loss of 35 bed days, at a net cost of £2,936 per month or £35,235 per year. The MDT meetings also improved the quality of discharge planning; the variability between expected and actual discharge dates decreased after the first month. Conclusions Discharge planning meetings help prepare for patient discharge and are most effective with multidisciplinary input. The majority of delayed discharges from hospital are preventable. The main causes are awaiting transfers, social services input and medical reasons (eg falls). There is an obvious financial incentive to improve discharge planning. The efficiency of the MDT at discharge planning improves with time and this should therefore be continued for best results.
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Preventing readmissions through comprehensive discharge planning.
Hunter, Tabitha; Nelson, James Rex; Birmingham, Jackie
2013-01-01
Case managers, including nurses and social workers, provide essential services to hospitalized patients, including mandated discharge planning that has been shown to impact patient safety and patient outcomes. The heightened attention to readmission is evident in both reimbursement and accreditation initiatives. The Centers for Medicare & Medicaid Services, Office of Clinical Standards & Quality/Survey & Certification Group, is revising worksheets to be used by surveyors to review how hospitals are complying with the Medicare Conditions of Participation with a focus on discharge planning as it relates to patient safety. This is an opportunity for case managers to apply the principles of case management to the targeted problem of readmissions. Now case managers must identify the reasons for readmission on a patient-by-patient basis, collect data, analyze processes, and then change practice in the hospital and work more closely with community-based providers. The purpose of this article is to recommend improvement in a consistent case management practice that will positively influence patient readmissions. Hospital-based case managers who are responsible for discharge planning functions. Hospital administrators will also find this information valuable as a tool to assess strategies to control preventable readmissions and to comply with the Medicare Conditions of Participation for discharge planning. Hospital-based case managers, responsible for discharge planning, have a unique opportunity to interact face-to-face with patients who are readmitted to determine factors that lead to the readmission. Case managers need to change their practice to include assessing patients on the basis of their prior level of care. Pharmacists need to play a bigger role in discharge planning, especially for patients who have experienced a potentially avoidable readmission. Working closely with community-based providers is essential to target reasons for readmission. The Medicare Conditions of Participation for Discharge Planning can be used not only to show compliance but as tools to evaluate current practice and identify areas of improvement. Preventable readmissions or rehospitalizations directly affect patient safety, patient outcome, hospital reimbursement, and hospital accreditation. Preventable readmissions can be controlled by comprehensive discharge planning. Case managers are directly involved in discharge planning and thus have direct accountability regarding readmissions; therefore, they must refine the admission assessment screening to include specific information based on a patient's preadmission level of care. Collaboration with community-based providers is essential to managing readmissions or rehospitalizations. Hospitals will find it beneficial to track readmissions by using specific data points unique to readmissions such as source of admission and previous length of stay. Self-assessment of compliance will help identify opportunities for quality improvement in the case management department. PLEASE NOTE: Rules and regulations are constantly changing. It is critical to monitor changes in standards. Information contained in this article is current at the time of submission, and readers are encouraged to review the content of this article with administration before implementing changes.
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Discharge Planning Revisited: What Do Social Workers Actually Do in Discharge Planning?
ERIC Educational Resources Information Center
Kadushin, Goldie; Kulys, Regina
1993-01-01
Interviewed 80 social workers in 36 acute care hospitals concerning amount of time they spent on and importance of 73 discharge planning tasks. Findings suggest that discharge planning comprises primarily concrete resource provision with counseling component focused on decision making. Time spent on tasks was influenced by prospective payment…
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Discharge Planning in Chronic Conditions
McMartin, K
2013-01-01
Background Chronically ill people experience frequent changes in health status accompanied by multiple transitions between care settings and care providers. Discharge planning provides support services, follow-up activities, and other interventions that span pre-hospital discharge to post-hospital settings. Objective To determine if discharge planning is effective at reducing health resource utilization and improving patient outcomes compared with standard care alone. Data Sources A standard systematic literature search was conducted for studies published from January 1, 2004, until December 13, 2011. Review Methods Reports, randomized controlled trials, systematic reviews, and meta-analyses with 1 month or more of follow-up and limited to specified chronic conditions were examined. Outcomes included mortality/survival, readmissions and emergency department (ED) visits, hospital length of stay (LOS), health-related quality of life (HRQOL), and patient satisfaction. Results One meta-analysis compared individualized discharge planning to usual care and found a significant reduction in readmissions favouring individualized discharge planning. A second meta-analysis compared comprehensive discharge planning with postdischarge support to usual care. There was a significant reduction in readmissions favouring discharge planning with postdischarge support. However, there was significant statistical heterogeneity. For both meta-analyses there was a nonsignificant reduction in mortality between the study arms. Limitations There was difficulty in distinguishing the relative contribution of each element within the terms “discharge planning” and “postdischarge support.” For most studies, “usual care” was not explicitly described. Conclusions Compared with usual care, there was moderate quality evidence that individualized discharge planning is more effective at reducing readmissions or hospital LOS but not mortality, and very low quality evidence that it is more effective at improving HRQOL or patient satisfaction. Compared with usual care, there was low quality evidence that the discharge planning plus postdischarge support is more effective at reducing readmissions but not more effective at reducing hospital LOS or mortality. There was very low quality evidence that it is more effective at improving HRQOL or patient satisfaction. Plain Language Summary Chronically ill people experience frequent changes in their health status and multiple transitions between care settings and care providers (e.g., hospital to home). Discharge planning provides support services, follow-up activities and other interventions that span pre-hospital discharge to post-hospital settings. A review of the effects of different discharge plans was conducted. After searching for relevant studies, 11 studies were found that compared discharge planning with routine discharge care. This review indicates that: Individualized discharge planning reduces initial hospital length of stay and subsequent readmission to hospital but does not reduce mortality. The effect on health-related quality of life (HRQOL) or patient satisfaction is uncertain. Discharge planning plus postdischarge support reduces readmissions but does not reduce the initial hospital length of stay or mortality after discharge. The effect on HRQOL or patient satisfaction is uncertain. PMID:24167538
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Advance identification of disposal areas (ADID), a planning process used to identify wetlands and other waters that are generally suitable or unsuitable for the discharge of dredged and fill material.
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Rehabilitation Practitioners' Prioritized Care Processes in Hip Fracture Post-Acute Care
Kim, Lauren H.; Leland, Natalie E.
2017-01-01
Aims Occupational and physical therapy in post-acute care (PAC) has reached the point where quality indicators for hip fracture are needed. This study characterizes the practitioners' prioritized hip fracture rehabilitation practices, which can guide future quality improvement initiatives. Methods Ninety-two practitioners participating in a parent mixed methods study were asked to rank a series of evidence-based best practices across five clinical domains (assessment, intervention, discharge planning, caregiver training and patient education). Results Prioritized practices reflected patient-practitioner collaboration, facilitating an effective discharge, and preventing adverse events. The highest endorsed care processes include: developing meaningful goals with patient input (84%) in assessment, using assistive devices in intervention (75%) and patient education (65%), engaging the patient and caregiver (50%) in discharge planning, and fall prevention (60%) in caregiver education. Conclusions Practitioners identified key care priorities. This study lays the foundation for future work evaluating the extent to which these practices are delivered in PAC. PMID:28989216
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Implementation of Discharge Plans for Chronically Ill Elders Discharged Home.
ERIC Educational Resources Information Center
Proctor, Enola K.; And Others
1996-01-01
Addresses the extent to which discharge plans for elderly patients with congestive heart failure were implemented as planned, tested the consequences of implementation problems, and identified factors associated with implementation problems. Implications for hospital discharge planners and home health care are discussed. (KW)
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40 CFR 233.31 - Coordination requirements.
Code of Federal Regulations, 2010 CFR
2010-07-01
... discharge may affect the biological, chemical, or physical integrity of the waters of any State(s) other... coordinated with Federal and Federal-State water related planning and review processes. ...
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Discharge planning in a cardiology out-patient clinic: a clinical audit.
Ingram, Shirley; Khan, Barkat
2014-01-01
The purpose of this paper is to audit the active discharge (DC) planning process in a general cardiology clinic, by pre-assessing patients' medical notes and highlighting those suitable for potential DC to the clinic physician. The cardiology clinical nurse specialist (CNS) identified patients' for nine- to 12-month return visits one week prior to attendance. The previous consultation letter was accessed and information was documented by the CNS in the medical record. The key performance indicator (KPI) used was patient DCs for each clinic visit. The process was audited at three separate times to reflect recommended action carried out. The CNS pre-assessment and presence at the clinics significantly increased total DCs during the first period compared to usual care, 11 vs 34 per cent (p < 0.0001). During the third audit period, DCs fell (9 per cent) with a reduction in CNS pre-assessed DCs (10 per cent). Recommendations were implemented. The process was continued by clinic administration staff, colour coding all nine- to 12-month returns, resulted in a 19 per cent DC rate in 2012. CNS pre-assessment and highlighting DC suitability increased the number of patient DCs. As the CNS presence at the clinic reduced so did the rate of DC. Specific personnel need to be responsible for monitoring and reminding staff of the process; this does not always have to be medical or nursing. Implementing positive discharging procedures is aimed at improving quality, increasing efficiency and accessibility of services for patients. This audit describes a process to promote DC planning from cardiology outpatients.
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Parental Understanding of Hospital Course and Discharge Plan.
Bhansali, Priti; Washofsky, Anne; Romrell, Evan; Birch, Sarah; Winer, Jeffrey C; Hoffner, Wendy
2016-08-01
Hospital discharge marks an important transition in care from the inpatient team to the family and primary care provider. Parents must know the hospital course and discharge plan to care for their child at home and provide background for future providers. Our study aimed to determine parental knowledge of key aspects of their child's hospital course and discharge plan and to identify markers of increased risk for incomplete or incorrect knowledge among participants. We conducted a descriptive prospective cohort study of parents within 24 hours of hospital discharge. The primary outcome was concordance of parent responses to verbal interview questions about their child's hospital treatment, laboratory testing, imaging, procedures and discharge plan with the medical record. Of 174 participants, 15% felt less than "completely prepared" to explain the hospital course to their primary care provider or to provide care after discharge. There was >83% overall concordance with interview responses and the medical record, with concordance higher for hospital course events than discharge plan. There were few significant differences in understanding between trainee-based teams and the attending physician-run unit. No patient or family characteristics were consistently associated with poor understanding of hospital course or discharge plan. Although parents were generally knowledgeable about hospital course and discharge plan, areas for improved communication were identified. Individualized counseling about hospital course and discharge plan should be initiated for all parents early during hospitalization. Methods that assess and bolster caregiver comprehension and minimize dependence on written instructions may help with transition to outpatient care. Copyright © 2016 by the American Academy of Pediatrics.
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Leaving the hospital - your discharge plan
... patientinstructions/000867.htm Leaving the hospital - your discharge plan To use the sharing features on this page, ... once you leave. This is called a discharge plan. Your health care providers at the hospital will ...
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Barriers to discharge from inpatient rehabilitation: a teamwork approach.
Cruz, Lisanne Catherine; Fine, Jeffrey S; Nori, Subhadra
2017-03-13
Purpose In order to prevent adverse events during the discharge process, coordinating appropriate community resources, medication reconciliation, and patient education needs to be implemented before the patient leaves the hospital. This coordination requires communication and effective teamwork amongst staff members. In order to address these concerns, the purpose of this paper is to incorporate the TeamSTEPPS principles to develop a discharge plan that would best meet the needs of the patients as they return to the community. Design/methodology/approach Through a gap analysis, barriers to discharge were identified from the following disciplines: nursing, social work, physical and occupational therapy, psychology, and rehabilitation physician. To improve communication, weekly meetings and twice-weekly huddles were implemented so that concerns regarding discharge obstacles could be identified and resolved. Visibility of discharge dates were improved by use of graduation certificates in patient rooms and green ribbons on patient wheelchairs. Findings After implementation of this discharge intervention, length of stay was reduced providing cost savings to the hospital, patient satisfaction on HCAHP surveys improved and demonstrated patient satisfaction with the discharge process, and readmission rates improved. Originality/value This study demonstrated that effective teamwork and communication can improve patient safety and satisfaction during the discharge period.
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Delayed transfer from hospital to community settings: the older person's perspective.
Swinkels, Annette; Mitchell, Theresa
2009-02-01
Prevention and management of delayed transfer of older people from hospital to community settings is an enduring issue in industrialised societies and is the subject of many recent policies in the United Kingdom. A deeper, evidence-based understanding of the complex organizational and interprofessional issues which contribute to delays in transfer has emerged in recent years. Despite this, and the relative success of recent policies, two recent reviews of the area highlight the lack of studies on patients' perspectives. We sought to address this deficit by using conversational interviews and a phenomenological approach to explore and interpret participants' perceptions of delayed transfer from hospital into the community. A purposive sampling strategy was employed to incorporate participants from different categories of delay identified on weekly Situation Reports. Participants aged 65 years and over (mean age 82 +/- 5.4 years) and with a mean delay of 32 days (+/- 26) were recruited from three hospitals based in two NHS Trusts in the South of England. This paper focuses on their perceptions of the effects of delayed transfer into the community, their involvement in discharge planning and future community care needs. Our findings show that participants actively or passively relinquished their involvement in the processes of discharge planning because of the perceived expertise of others and also feelings of disempowerment secondary to poor health, low mood, dependency, lack of information and the intricacies of discharge planning processes for complex community care needs. Participants expressed a longing for continuity, emphasised the importance of social contact and sometimes appeared unrealistic about their future care needs. While current policies may have helped reduce overall numbers of delayed patients in the UK, our study suggests that there is scope for improvement in the involvement of delayed patients in planning their discharge into the community.
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Chen, Hsiao-Mei; Han, Tung-Chen; Chen, Ching-Min
2014-04-01
Population aging has caused significant rises in the prevalence of chronic diseases and the utilization of healthcare services in Taiwan. The current healthcare delivery system is fragmented. Integrating medical services may increase the quality of healthcare, enhance patient and patient family satisfaction with healthcare services, and better contain healthcare costs. This article introduces two continuing care models: discharge planning and case management. Further, the effectiveness and essential components of these two models are analyzed using a systematic review method. Articles included in this systematic review were all original articles on discharge-planning or case-management interventions published between February 1999 and March 2013 in any of 6 electronic databases (Medline, PubMed, Cinahl Plus with full Text, ProQuest, Cochrane Library, CEPS and Center for Chinese Studies electronic databases). Of the 70 articles retrieved, only 7 were randomized controlled trial studies. Three types of continuity-of-care models were identified: discharge planning, case management, and a hybrid of these two. All three models used logical and systematic processes to conduct assessment, planning, implementation, coordination, follow-up, and evaluation activities. Both the discharge planning model and the case management model were positively associated with improved self-care knowledge, reduced length of stay, decreased medical costs, and better quality of life. This study cross-referenced all reviewed articles in terms of target clients, content, intervention schedules, measurements, and outcome indicators. Study results may be referenced in future implementations of continuity-care models and may provide a reference for future research.
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The inpatient evaluation and treatment of a self-professed budding serial killer.
Reisner, Andrew D; McGee, Mark; Noffsinger, Stephen G
2003-02-01
The authors present the case of a man who was hospitalized after claiming that he was about to become a serial killer. The patient presented with extensive written homicidal fantasies and homicidal intentions without evidence of actual homicidal acts. In addition to routine assessments, hospital staff members used case conferences, psychological testing, outside forensic consultation, and a forensic review process to make decisions regarding diagnosis, treatment planning, and discharge. The patient was discharged after 8 months of inpatient treatment and was apparently free of homicidal impulses or symptoms of severe mental illness. A 2-year court commitment allowed for the enactment and potential enforcement of a discharge plan that was endorsed by the patient, the hospital, and community care providers. The authors review diagnostic and risk management issues. Comparisons with known features of typical serial killers are made.
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Families’ Priorities Regarding Hospital-to-Home Transitions for Children With Medical Complexity
O’Brien, Emily R.; Leslie, Laurel K.; Lindenauer, Peter K.; Mangione-Smith, Rita M.
2017-01-01
BACKGROUND: National health care policy recommends that patients and families be actively involved in discharge planning. Although children with medical complexity (CMC) account for more than half of pediatric readmissions, scalable, family-centered methods to effectively engage families of CMC in discharge planning are lacking. We aimed to systematically examine the scope of preferences, priorities, and goals of parents of CMC regarding planning for hospital-to-home transitions and to ascertain health care providers’ perceptions of families’ transitional care goals and needs. METHODS: We conducted semistructured interviews with parents and health care providers at a tertiary care hospital. Interviews were continued until thematic saturation was reached. Interviews were audio recorded, transcribed verbatim, and analyzed to identify emergent themes via a general inductive approach. RESULTS: Thirty-nine in-depth interviews were conducted, including 23 with family caregivers of CMC and 16 with health care providers. Families’ priorities, preferences, and goals for hospital-to-home transitions aligned with 7 domains: effective engagement with health care providers, respect for families’ discharge readiness, care coordination, timely and efficient discharge processes, pain and symptom control, self-efficacy to support recovery and ongoing child development, and normalization and routine. These domains also emerged in interviews with health care providers, although there were minor differences in themes discussed. CONCLUSIONS: Although CMC have diverse transitional care needs, their families’ priorities, preferences, and goals aligned with 7 domains that bridged their hospital admission with reestablishment of a home routine. This research provides essential foundational data to engage families in discharge planning, guiding the operationalization of national health policy recommendations. PMID:27940509
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Verhaegh, K J; Buurman, B M; Veenboer, G C; de Rooij, S E; Geerlings, S E
2014-07-01
Hospitalised patients are especially vulnerable in times of transitions in care. Structured discharge planning might improve patient outcomes. We implemented and assessed the effect of a multidisciplinary discharge bundle to reduce 30-day readmission. A pre-post-test design study with a follow-up of one month at four internal medicine wards in a Dutch university teaching hospital. Eligible patients were 18 years and older, acutely admitted and hospitalised for at least 48 hours. The discharge bundle consisted of (1) planning the date of discharge within 48 hours after admission, (2) a discharge checklist, (3) a personalised patient discharge letter, and (4) multidisciplinary patient education. The primary outcome measure was unplanned 30-day readmission. Participants in the post-test group (n = 204) did not have a lower rate of unplanned hospital readmission than those receiving usual care (n = 224) (12.9 vs. 13.2%, p = 0.93). The medical discharge summaries were sent to the general practitioner faster in the post-test period (median of 14 days pre-test vs. 5 days post-test, p < 0.001) and this group also had a trend towards a longer time to first readmission (14 vs. 10 days, p = 0.06). Patient satisfaction was high in both groups (7.5 and 7.4 points, (p = 0.49)). The comprehensive discharge bundle was not effective in reducing the rate of readmission and increasing patient satisfaction, but medical discharge summaries were sent faster to the general practitioner and a trend to a longer time to readmission was present.
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Erwin, Kim; Martin, Molly A; Flippin, Tara; Norell, Sarah; Shadlyn, Ariana; Yang, Jie; Falco, Paula; Rivera, Jaime; Ignoffo, Stacy; Kumar, Rajesh; Margellos-Anast, Helen; McDermott, Michael; McMahon, Kate; Mosnaim, Giselle; Nyenhuis, Sharmilee M; Press, Valerie G; Ramsay, Jessica E; Soyemi, Kenneth; Thompson, Trevonne M; Krishnan, Jerry A
2016-01-01
To present the methods and outcomes of stakeholder engagement in the development of interventions for children presenting to the emergency department (ED) for uncontrolled asthma. We engaged stakeholders (caregivers, physicians, nurses, administrators) from six EDs in a three-phase process to: define design requirements; prototype and refine; and evaluate. Interviews among 28 stakeholders yielded themes regarding in-home asthma management practices and ED discharge experiences. Quantitative and qualitative evaluation showed strong preference for the new discharge tool over current tools. Engaging end-users in contextual inquiry resulted in CAPE (CHICAGO Action Plan after ED discharge), a new stakeholder-balanced discharge tool, which is being tested in a multicenter comparative effectiveness trial.
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A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children.
Wu, Susan; Tyler, Amy; Logsdon, Tina; Holmes, Nicholas M; Balkian, Ara; Brittan, Mark; Hoover, LaVonda; Martin, Sara; Paradis, Melisa; Sparr-Perkins, Rhonda; Stanley, Teresa; Weber, Rachel; Saysana, Michele
2016-08-01
To assess the impact of a quality improvement collaborative on quality and efficiency of pediatric discharges. This was a multicenter quality improvement collaborative including 11 tertiary-care freestanding children's hospitals in the United States, conducted between November 1, 2011 and October 31, 2012. Sites selected interventions from a change package developed by an expert panel. Multiple plan-do-study-act cycles were conducted on patient populations selected by each site. Data on discharge-related care failures, family readiness for discharge, and 72-hour and 30-day readmissions were reported monthly by each site. Surveys of each site were also conducted to evaluate the use of various change strategies. Most sites addressed discharge planning, quality of discharge instructions, and providing postdischarge support by phone. There was a significant decrease in discharge-related care failures, from 34% in the first project quarter to 21% at the end of the collaborative (P < .05). There was also a significant improvement in family perception of readiness for discharge, from 85% of families reporting the highest rating to 91% (P < .05). There was no improvement in unplanned 72-hour (0.7% vs 1.1%, P = .29) and slight worsening of the 30-day readmission rate (4.5% vs 6.3%, P = .05). Institutions that participated in the collaborative had lower rates of discharge-related care failures and improved family readiness for discharge. There was no significant improvement in unplanned readmissions. More studies are needed to evaluate which interventions are most effective and to assess feasibility in non-children's hospital settings. Copyright © 2016 by the American Academy of Pediatrics.
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Spill Prevention and Countermeasures Plan
1984-08-01
THE DISCHARGE OF OiIL AND HAZARDOUS SUBSTANCES AT RMA. THE SPCC PLAN IDENTIFIES POTENTIAL SOURCES OF OIL AND HAZARDOUS SUBSTANCES AND THE MEASURES...Control and Countermeasure (SPCC) Plan is to prevent and control the discharge of oil and hazardous sub- stances at Rocky Mountain Arsenal (RYA). The...SPCC Plan identifies potential sources of oil and hazardous substances and the measures required to prevent an accidental discharge resulting from
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Heinz, Adrienne J.; Bui, Leena; Thomas, Katherine M.; Blonigen, Daniel M.
2015-01-01
Impulsivity, a multi-faceted construct characterized by rash, unplanned actions and a disregard for long-term consequences, is associated with poor substance use disorder (SUD) treatment outcomes. Little is known though about the influence of impulsivity on treatment process variables critical for initiating and maintaining behavioral change. This knowledge gap is important as different aspects of impulsivity may be susceptible to diverse cognitive, behavioral and pharmacological influences. The present study examined two distinct facets of impulsivity (lack of planning and immoderation - a proxy of urgency) as predictors of processes that impact SUD treatment success (active coping, avoidant coping, self-efficacy, and interpersonal problems). Participants were 200 Veterans who completed impulsivity and treatment process assessments upon entering a SUD treatment program and treatment process assessments at treatment discharge. Results from multivariate models revealed that lack of planning was associated with lower active coping and higher avoidant coping and interpersonal problems at intake, though not with lower self-efficacy to abstain from substances. Immoderation was associated with higher avoidant coping and lower self-efficacy to abstain from substances at intake, but not with lower active coping or higher interpersonal problems. Higher immoderation, but not lack of planning, predicted lower self-efficacy to abstain from substances at treatment discharge. These findings suggest that different facets of impulsivity confer risk for different SUD treatment process indicators and that clinicians should consider the behavioral expression of patients’ impulse control problems in treatment planning and delivery. PMID:25770869
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Evaluating hospital discharge planning: a randomized clinical trial.
Evans, R L; Hendricks, R D
1993-04-01
To select patients for early discharge planning, a randomized clinical trial evaluated a protocol that used risk factors identified upon hospital admission. The goal of the study was to determine if intervention with high-risk patients could reduce the need for hospital admission or skilled care. Of 13,255 patients screened, 835 study participants were identified as "at risk" for frequent health care resource use. Half of the high-risk patients were randomly assigned to the experimental group (n = 417) and received discharge planning from day 3 of their hospital stay, while the control group (n = 418) received discharge planning only if there was a written physician request. Those patients receiving early, systematic discharge planning experienced an increased likelihood of successful return to home after hospital admission and a decreased chance of unscheduled readmission for the 9-month study period. Length of the index hospital stay was not affected by early planning, however. The major clinical implication is the potential for discharge planners to decrease the need for, and use of, health care resources after hospital admission.
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Kisely, Steve; Wyder, Marianne; Dietrich, Josie; Robinson, Gail; Siskind, Dan; Crompton, David
2017-02-01
Improving the input of people with mental illness into their recovery plans can potentially lead to better outcomes. In the present study, we evaluated the introduction of motivational aftercare planning (MAP) into the discharge planning of psychiatric inpatients. MAP is a manualized intervention combining motivational interviewing with advance directives. We measured changes in the level of patient input into discharge planning following training staff in the use of MAP. This included the following: (i) documentation of early relapse signs along with successful past responses; (ii) evidence of aftercare planning; and (iii) the use of the patients' own words in the plan. We used a ward-level controlled before-and-after design comparing one intervention ward with two control wards. We used anonymized recovery plans, with a goal of 50 plans per ward before and after the intervention, to look for evidence of patient input into care planning with a standardized checklist. There were also qualitative interviews with individuals discharged from the unit. We reviewed 100 intervention ward plans and 197 control ones (total n = 297). There were no significant differences in recovery plans from intervention and control wards at baseline. Following MAP training, the intervention ward improved significantly (e.g. identification of triggers increased from 52 to 94%, χ 2 = 23.3, d.f. =1, P < 0.001). This did not occur in the control wards. The qualitative data (n = 20 interviews) showed improvements in participants' experiences of discharge planning. MAP increased inpatient input into discharge planning and was valued by participants. The effect on subsequent health service use needs evaluation. © 2016 Australian College of Mental Health Nurses Inc.
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Negarandeh, Reza; Nayeri, Nahid Dehghan; Shirani, Farimah; Janani, Leila
2012-12-01
Grafting coronary arteries and post operative recovery has many challenges, which can be ameliorated through continues care and an appropriate discharge plan. Therefore, the current study was undertaken aiming to evaluate the impact of discharge plan on satisfaction with nursing care, ability to self-care, and incidence of re-admission. This is a quasi experimental study involving patients who were due to undergo coronary artery bypass graft in Chamran Hospital in 2010. In the intervention group, the discharge plan was initiated at the time of admission and continued for 2 weeks after discharge by home visit and telephone follow ups. Satisfaction with nursing care was assessed 2 days after discharge, whilst patients' ability for self-care was measured 6 weeks and 3 months post discharge and the incidence of re-admission was determined at the 3 months point. Satisfaction levels with nursing care and the ability to take self-care were higher in intervention group comparing with control group (p < 0.001). There was a significant difference for self-care ability between pre test and post test in both groups but the improvement was more pronounced for the intervention group (p = 0.04). There was no significant difference between the two groups in terms of re-admission incidence after 3 months (p = 0.15). The results indicate that the discharge plan, as a method of continual care plan, can lead to higher satisfaction levels and enhanced self-care abilities of patients. Such discharge plan can therefore be utilised as an effective method of continuous care for patients who are going to undergo coronary artery bypass graft.
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Erwin, Kim; Martin, Molly A; Flippin, Tara; Norell, Sarah; Shadlyn, Ariana; Yang, Jie; Falco, Paula; Rivera, Jaime; Ignoffo, Stacy; Kumar, Rajesh; Margellos-Anast, Helen; McDermott, Michael; McMahon, Kate; Mosnaim, Giselle; Nyenhuis, Sharmilee M; Press, Valerie G; Ramsay, Jessica E; Soyemi, Kenneth; Thompson, Trevonne M; Krishnan, Jerry A
2016-01-01
Aim: To present the methods and outcomes of stakeholder engagement in the development of interventions for children presenting to the emergency department (ED) for uncontrolled asthma. Methods: We engaged stakeholders (caregivers, physicians, nurses, administrators) from six EDs in a three-phase process to: define design requirements; prototype and refine; and evaluate. Results: Interviews among 28 stakeholders yielded themes regarding in-home asthma management practices and ED discharge experiences. Quantitative and qualitative evaluation showed strong preference for the new discharge tool over current tools. Conclusion: Engaging end-users in contextual inquiry resulted in CAPE (CHICAGO Action Plan after ED discharge), a new stakeholder-balanced discharge tool, which is being tested in a multicenter comparative effectiveness trial. PMID:26690579
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Rhynas, Sarah J; Garrido, Azucena Garcia; Burton, Jennifer K; Logan, Gemma; MacArthur, Juliet
2018-03-24
To gain an in-depth understanding of the decision-making processes involved in the discharge of older people admitted to hospital from home and discharged to a care home, as described in the case records. The decision for an older person to move into a care home is significant and life-changing. The discharge planning literature for older people highlights the integral role of nurses in supporting and facilitating effective discharge. However, little research has been undertaken to explore the experiences of those discharged from hospital to a care home or the processes involved in decision-making. A purposive sample of 10 cases was selected from a cohort of 100 individuals admitted to hospital from home and discharged to a care home. Cases were selected to highlight important personal, relational and structural factors thought to affect the decision-making process. Narrative case studies were created and were thematically analysed to explore the perspectives of each stakeholder group and the conceptualisations of risk which influenced decision-making. Care home discharge decision-making is a complex process involving stakeholders with a range of expertise, experience and perspectives. Decisions take time and considerable involvement of families and the multidisciplinary team. There were significant deficits in documentation which limit the understanding of the process and the patient's voice is often absent from case records. The experiences of older people, families and multidisciplinary team members making care home decisions in the hospital setting require further exploration to identify and define best practice. Nurses have a critical role in the involvement of older people making discharge decisions in hospital, improved documentation of the patient's voice is essential. Health and social care systems must allow older people time to make significant decisions about their living arrangements, adapting to changing medical and social needs. © 2018 John Wiley & Sons Ltd.
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Chen, Yu; Zhu, Li; Xu, Fei; Chen, Jun
2016-02-01
Heart failure is a major public health concern which contributes significantly to rising healthcare costs. Comprehensive discharge planning can improve health outcomes and reduce readmission rates which, in turn, can lead to cost savings. The aim of this project was to promote best practice in the discharge planning of heart failure patients admitted in the coronary care unit of Zhongshan Hospital. A clinical audit was undertaken using the Joanna Briggs Institute Practical Application of Clinical Evidence System tool. Five audit criteria that represent best practice recommendations for heart failure discharge planning were used. A baseline audit was conducted followed by the implementation of multiple strategies, and the project was finalized with a follow-up audit to determine change in practice. Improvements in practice were observed for all five criteria. The most significant improvements were in the following: completion of a discharge checklist (from 0% to 100% compliance), comprehensive (i.e. inclusion of six topics for self-care) discharge education for patients (from 7% to 100% compliance), and conducting a telephone follow-up (from 0% to 76% compliance). The compliance rates for the two remaining criteria, completion of a structured education for patients and scheduling an outpatient clinic visit, both increased from 93% to 100%.Strategies that were implemented to achieve change in practice included development of a local discharge planning checklist, provision of training for nurses, and development of resources. The project demonstrated positive changes in the discharge planning practices of nurses in the coronary care unit of Zhongshan Hospital. A formalized discharge planning is currently in place and plans for sustaining practice change are underway. A continuous cycle of audit and re-audit will need to be carried out in the future to determine the impact of this evidence implementation activity on heart failure patient outcomes.
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Lean methodology for performance improvement in the trauma discharge process.
O'Mara, Michael Shaymus; Ramaniuk, Aliaksandr; Graymire, Vickie; Rozzell, Monica; Martin, Stacey
2014-07-01
High-volume, complex services such as trauma and acute care surgery are at risk for inefficiency. Lean process improvement can reduce health care waste. Lean allows a structured look at processes not easily amenable to analysis. We applied lean methodology to the current state of communication and discharge planning on an urban trauma service, citing areas for improvement. A lean process mapping event was held. The process map was used to identify areas for immediate analysis and intervention-defining metrics for the stakeholders. After intervention, new performance was assessed by direct data evaluation. The process was completed with an analysis of effect and plans made for addressing future focus areas. The primary area of concern identified was interservice communication. Changes centering on a standardized morning report structure reduced the number of consult questions unanswered from 67% to 34% (p = 0.0021). Physical therapy rework was reduced from 35% to 19% (p = 0.016). Patients admitted to units not designated to the trauma service had 1.6 times longer stays (p < 0.0001). The lean process lasted 8 months, and three areas for new improvement were identified: (1) the off-unit patients; (2) patients with length of stay more than 15 days contribute disproportionately to length of stay; and (3) miscommunication exists around patient education at discharge. Lean process improvement is a viable means of health care analysis. When applied to a trauma service with 4,000 admissions annually, lean identifies areas ripe for improvement. Our inefficiencies surrounded communication and patient localization. Strategies arising from the input of all stakeholders led to real solutions for communication through a face-to-face morning report and identified areas for ongoing improvement. This focuses resource use and identifies areas for improvement of throughput in care delivery.
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Caliskan Yilmaz, Medine; Ozsoy, Suheyla A
2010-02-01
The purpose of this study was to investigate the effectiveness of a discharge-planning program on helping caregivers meet the physical care needs of children with cancer. This research is a quasi-experimental type of study in a pediatric oncology clinic at a university hospital in Izmir/Turkey. The control group had 25 and the experimental group had 24 patients with their caregivers. For the experimental group, discharge planning, discharge teaching, home visits, and telephone consultation were provided and has been planned to investigate the effectiveness of a discharge-planning program on helping caregivers meet the physical care needs of children with cancer between 0-18 years of age. In the third assessment, the number of patients that needed physical care needs in the experimental and control groups was decreased, and children in the experimental group had a lower number of physical care needs. A decreased number of unplanned admissions to the hospital at the first and third follow-up times, a decrease in unplanned admissions, and higher satisfaction rate were seen in the experimental group caregivers. A discharge-planning program and a hospital-based home care model had a very significant effect on the care needs of children with cancer and their caregivers. Our findings indicate that a discharge-planning program and a hospital-based home care model had a very significant effect on the care needs of children with cancer and their caregivers.
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Challenges in Patient Discharge Planning in the Health System of Iran: A Qualitative Study
Gholizadeh, Masumeh; Delgoshaei, Bahram; Gorji, Hasan Abulghasem; Torani, Sogand; Janati, Ali
2016-01-01
Background: One of the main factors relating to quality of hospitals is effective discharge planning. Discharge planning promotes the quality of inpatient care and reduces unplanned hospital readmission. The current study investigated the challenges of discharge planning observed in the health system of Iran. Methods: This qualitative research was conducted using a thematic and framework analyses to identify the challenges under each themes defined by the World Health Organization (WHO), to understand barriers in developing an effective discharge planning system in Iran health system. The data was collected from detailed semi-structured interviews and sessions of focus group discussions. This study involved 51 participants including health policy makers, hospital and health managers, faculty members, nurses, practitioners, community medicine specialists and other professionals of the Ministry of Health and Medical Education (MOHME). To reduce the bias and to increase the credibility of the study, evaluation criteria from Lincoln and Guba were used. All interviews and FGDs were recorded and transcribed, then analyzed by the software MAXQDA-11 and also manually. Results: According to the WHO health systems framework, challenges of effective hospital discharge planning were divided into six areas, leadership/governance, service delivery, information, financing, health workforce, and medical production(themes), in which there were 5,3,2,2,3,1 subthemes respectively. Conclusion: It is evident from the findings of this study that changes in the perspective of policy makers, health staff and managers, strengthening of systematic approach, and establishment of required infrastructures are essential for successful implementation of effective discharge planning in health systems in Iran. PMID:26755460
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Kageyama, Yoko; Asano, Midori
2017-12-01
The accelerating trend towards shorter hospital stays in Japan has made modes of decision-making essential for effective patient transition from the hospital to recuperation in the regional community, and the ageing of the population has brought a rise in surrogate decision-making by the families of patients lacking decision-making ('self-decision') capacity. To verbalise and elucidate the practical wisdom of discharge planning nurses by focusing on the perceptions and judgements, they apply in practice and describing their methodology in concrete terms. Participants were six discharge planning nurses and one person with previous experience as a discharge planning nurse, all working at discharge planning departments of acute care hospitals. Separate, semi-structured, interactive interviews were conducted with each participant. The study design was qualitative descriptive in form with qualitative content analysis. All participants provided written informed consent to participate in the study, which was approved by the study institution. Three concepts were extracted as the basis for discharge planning nurses' perception and judgement at acute care hospitals: working for mutual envisionment of the available postdischarge options; helping the family act as spokesperson(s) for the patient's wishes; and understanding the family inclusive of the patient as a relationship of strongly interaffecting interests. The practical wisdom of the nurse, working in mutual envisionment with the family, and collaborative decision-making through discussion with those who know the patient, leads to rational discharge assistance. © 2017 Nordic College of Caring Science.
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1987-08-01
in the hope that Army hospitals could begin to develop discharge planning programs in advance of the publica- tion of the proposed JCAH standard (see... Ostomy patients 24. Coronary bypass patients 11 BAMC Memo 40-25 94 APPENDIX C Discharge Planning Screen for Drug-Nutrient Interactions JCAH requires
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Discharge planning for a patient with a new ostomy: best practice for clinicians.
Prinz, Anita; Colwell, Janice C; Cross, Heidi H; Mantel, Janet; Perkins, Jacqueline; Walker, Cynthia A
2015-01-01
A comprehensive discharge plan for a patient with a new stoma is needed to ensure the individual receives the necessary ostomy education prior to discharge. The plan should include teaching basic skills and providing information about how to manage the ostomy (ie, emptying and changing the pouch, how to order supplies, available manufacturers, dietary/fluid guidelines, potential complications, medications, and managing gas and odor), assisting with transitions in care, and providing information about resources for support and assistance. The purpose of this best practice guideline is to provide clinicians with a brief overview of the essential elements that should be included in the discharge plan to facilitate patient education and the transition of care from hospital to home.
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W-007H B Plant Process Condensate Treatment Facility. Revision 3
DOE Office of Scientific and Technical Information (OSTI.GOV)
Rippy, G.L.
1995-01-20
B Plant Process Condensate (BCP) liquid effluent stream is the condensed vapors originating from the operation of the B Plant low-level liquid waste concentration system. In the past, the BCP stream was discharged into the soil column under a compliance plan which expired January 1, 1987. Currently, the BCP stream is inactive, awaiting restart of the E-23-3 Concentrator. B Plant Steam Condensate (BCS) liquid effluent stream is the spent steam condensate used to supply heat to the E-23-3 Concentrator. The tube bundles in the E-23-3 Concentrator discharge to the BCS. In the past, the BCS stream was discharged into themore » soil column. Currently, the BCS stream is inactive. This project shall provide liquid effluent systems (BCP/BCS/BCE) capable of operating for a minimum of 20 years, which does not include the anticipated decontamination and decommissioning (D and D) period.« less
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... discharge; Tube tying - discharge; Tying the tubes - discharge; Contraception - tubal ... chap 23. Jensen JT, Mishell DR. Family planning: contraception, sterilization, and pregnancy termination. In: Lentz GM, Lobo ...
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Does activity limitation predict discharge destination for postacute care patients?
Chang, Feng-Hang; Ni, Pengsheng; Jette, Alan M
2014-09-01
This study aimed to examine the ability of different domains of activity limitation to predict discharge destination (home vs. nonhome settings) 1 mo after hospital discharge for postacute rehabilitation patients. A secondary analysis was conducted using a data set of 518 adults with neurologic, lower extremity orthopedic, and complex medical conditions followed after discharge from a hospital into postacute care. Variables collected at baseline include activity limitations (basic mobility, daily activity, and applied cognitive function, measured by the Activity Measure for Post-Acute Care), demographics, diagnosis, and cognitive status. The discharge destination was recorded at 1 mo after being discharged from the hospital. Correlational analyses revealed that the 1-mo discharge destination was correlated with two domains of activity (basic mobility and daily activity) and cognitive status. However, multiple logistic regression and receiver operating characteristic curve analyses showed that basic mobility functioning performed the best in discriminating home vs. nonhome living. This study supported the evidence that basic mobility functioning is a critical determinant of discharge home for postacute rehabilitation patients. The Activity Measure for Post-Acute Care-basic mobility showed good usability in discriminating home vs. nonhome living. The findings shed light on the importance of basic mobility functioning in the discharge planning process.
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Wallace, Andrea; Papke, Todd; Davisson, Erica; Spooner, Kara; Gassman, Laura
Despite over three decades of research linking social support and optimal health outcomes, social support is not systematically assessed or addressed during clinical care. This study sought input from health care providers to inform the design of an intervention intended to facilitate assessment of social support in a way that could aid in anticipatory planning during the process of hospital discharge. Using a purposive sampling strategy, data were collected from providers in two acute care settings serving rural patients, one academic and one community based. Opinions about what an assessment of social support would seek to accomplish, what is currently done and by whom, and the preferred format for delivery were elicited during a series of individual and group interviews. During phase two, feasibility was assessed with three inpatient nurses over 3 clinical days. Field notes were analyzed throughout the project using rapid data analysis techniques. Health care providers endorsed the creation of an assessment and stated that target users would include all members of the discharge team (e.g., clinical nurses, case managers, discharge coordinators, hospitalists, and specialty care). They identified the need for a patient-family resource (vs. a traditional provider-facing assessment). Participants stated that, although both the information collected and the interview process would meet a need to increase patient engagement in inpatient settings, competing clinical demands would require a tool that was easily completed by patients and family and seen as directly informing clinical activities. To this end, although focusing on the eventual development of an electronic tool seemed valuable, a hard-copy resource was considered more feasible for patient use at the present time. The preliminary test of the resulting hard-copy "Going Home Toolkit" demonstrated potential feasibility and usefulness during clinical practice. There is need for not only assessing patients' supportive networks during discharge planning, but to do so in a way that would facilitate directed communication between, and engagement with, team members, patients, and families. Especially in light of new legislation focusing on involvement of caregivers, a tool such as the "Going Home Toolkit" may facilitate important conversations about, and planning around, patients' supportive resources at home.
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Patient participation in discharge planning conference
Bångsbo, Angela; Dunér, Anna; Lidén, Eva
2014-01-01
Introduction There is a need for individualized discharge planning to support frail older persons at hospital discharge. In this context, active participation on their behalf cannot be taken for granted. The aim of this study was to elucidate patient participation in discharge planning conferences, with a focus on frail older persons, supported by the theory of positioning described by Harré & van Langenhove. Methods The study was designed as a case study based on audio-recordings of multidisciplinary discharge planning conferences and interviews with health professionals elucidating their opinions on preconditions for patient participation in discharge planning. The analysis has been performed using qualitative content analysis and discourse analysis. Data collection took place during 2008–2009 and included 40 health professionals and 13 frail older persons in hospital or municipal settings. Results Findings revealed four different positions of participation, characterized by the older person's level of activity during the conference and his/her appearance as being reduced (patient) or whole (person). The positions varied dynamically from being an active person, passive person, active patient, or passive patient and the health professionals, next-of-kin, and the older persons themselves contributed to the positioning. Conclusions The findings showed how the institutional setting served as a purposeful structure or a confinement to patient participation. PMID:25411572
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Reid, Rebecca; Escott, Phil; Isobel, Sophie
2018-04-14
This qualitative study explores inpatient mental health consumer perceptions of how collaborative care planning with mental health nurses impacts personal recovery. Semi-structured interviews were conducted with consumers close to discharge from one unit in Sydney, Australia. The unit had been undertaking a collaborative care planning project which encouraged nurses to use care plan documentation to promote person-centred and goal-focussed interactions and the development of meaningful strategies to aid consumer recovery. The interviews explored consumer understandings of the collaborative care planning process, perceptions of the utility of the care plan document and the process of collaborating with the nurses, and their perception of the impact of collaboration on their recovery. Findings are presented under four organizing themes: the process of collaborating, the purpose of collaborating, the nurse as collaborator and the role of collaboration in wider care and recovery. Consumers highlighted the importance of the process of developing their care plan with a nurse as being as helpful for recovery as the goals and strategies themselves. The findings provide insights into consumers' experiences of care planning in an acute inpatient unit, the components of care that support recovery and highlight specific areas for mental health nursing practice improvement in collaboration. © 2018 Australian College of Mental Health Nurses Inc.
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Kennelty, Korey A.; Chewning, Betty; Wise, Meg; Kind, Amy; Roberts, Tonya; Kreling, David
2015-01-01
Background Community pharmacists play a vital part in reconciling medications for patients transitioning from hospital to community care, yet their roles have not been fully examined in the extant literature. Objectives The objectives of this study were to: 1) examine the barriers and facilitators community pharmacists face when reconciling medications for recently discharged patients; and 2) identify pharmacists’ preferred content and modes of information transfer regarding updated medication information for recently discharged patients. Methods Community pharmacists were purposively and conveniently sampled from the Wisconsin (U.S. state) pharmacist-based research network, Pharmacy Practice Enhancement and Action Research Link (PEARL Rx). Community pharmacists were interviewed face-to-face, and transcriptions from audio recordings were analyzed using directed content analysis. The Theory of Planned Behavior (TPB) guided the development of questions for the semi-structured interviews. Results Interviewed community pharmacists (N = 10) described the medication reconciliation process to be difficult and time-consuming for recently discharged patients. In the context of the TPB, more barriers than facilitators of reconciling medications were revealed. Themes were categorized as organizational and individual-level themes. Major organizational-level factors affecting the medication reconciliation process included: pharmacy resources, discharge communication, and hospital resources. Major individual-level factors affecting the medication reconciliation process included: pharmacists’ perceived responsibility, relationships, patient perception of pharmacist, and patient characteristics. Interviewed pharmacists consistently responded that several pieces of information items would be helpful when reconciling medications for recently discharged patients, including the hospital medication discharge list and stop-orders for discontinued medications. Conclusions The TPB was useful for identifying barriers and facilitators of medication reconciliation for recently discharged patients from community pharmacists’ perspectives. The elucidation of these specific facilitators and barriers suggest promising avenues for future research interventions to improve exchange of medication information between the community pharmacy, hospitals, and patients. PMID:25586885
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Kennelty, Korey A; Chewning, Betty; Wise, Meg; Kind, Amy; Roberts, Tonya; Kreling, David
2015-01-01
Community pharmacists play a vital part in reconciling medications for patients transitioning from hospital to community care, yet their roles have not been fully examined in the extant literature. The objectives of this study were to: 1) examine the barriers and facilitators community pharmacists face when reconciling medications for recently discharged patients; and 2) identify pharmacists' preferred content and modes of information transfer regarding updated medication information for recently discharged patients. Community pharmacists were purposively and conveniently sampled from the Wisconsin (U.S. state) pharmacist-based research network, Pharmacy Practice Enhancement and Action Research Link (PEARL Rx). Community pharmacists were interviewed face-to-face, and transcriptions from audio recordings were analyzed using directed content analysis. The Theory of Planned Behavior (TPB) guided the development of questions for the semi-structured interviews. Interviewed community pharmacists (N = 10) described the medication reconciliation process to be difficult and time-consuming for recently discharged patients. In the context of the TPB, more barriers than facilitators of reconciling medications were revealed. Themes were categorized as organizational and individual-level themes. Major organizational-level factors affecting the medication reconciliation process included: pharmacy resources, discharge communication, and hospital resources. Major individual-level factors affecting the medication reconciliation process included: pharmacists' perceived responsibility, relationships, patient perception of pharmacist, and patient characteristics. Interviewed pharmacists consistently responded that several pieces of information items would be helpful when reconciling medications for recently discharged patients, including the hospital medication discharge list and stop-orders for discontinued medications. The TPB was useful for identifying barriers and facilitators of medication reconciliation for recently discharged patients from community pharmacists' perspectives. The elucidation of these specific facilitators and barriers suggest promising avenues for future research interventions to improve exchange of medication information between the community pharmacy, hospitals, and patients. Published by Elsevier Inc.
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40 CFR 300.210 - Federal contingency plans.
Code of Federal Regulations, 2010 CFR
2010-07-01
... contingency plans under the national response system: The National Contingency Plan, RCPs, and ACPs. These... discharge under § 300.324, and to mitigate or prevent a substantial threat of such a discharge, from a vessel, offshore facility, or onshore facility operating in or near the area. (2) The areas of...
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Allen, Kyle; Hazelett, Susan; Jarjoura, David; Hua, Keding; Wright, Kathy; Weinhardt, Janice; Kropp, Denise
2009-01-01
Objective To evaluate whether comprehensive post-discharge care management for stroke survivors is superior to organized acute stroke unit care with enhanced discharge planning in improving a profile of health and well-being. Methods This was a randomized trial of a comprehensive post-discharge care management intervention for ischemic stroke patients with NIH Stroke Scale scores ≥1 discharged from an acute stroke unit. An Advanced Practice Nurse (APN) performed an in-home assessment for the intervention group from which an Interdisciplinary Team developed patient-specific care plans. The APN worked with the primary care physician (PCP) and patient to implement the plan over the next 6 months. Main outcome measures The intervention and usual care groups were compared using a global and closed hypothesis testing strategy. Outcomes fell into 5 domains: 1) Neuromotor Function, 2) Institution Time or Death, 3) Quality of Life, 4) Management of Risk, and 5) Stroke Knowledge and Lifestyle. Results Treatment effect was near zero standard deviations for all but the stroke knowledge and lifestyle domain which showed a significant effect of the intervention (p=0.0003). Conclusions Post discharge care management was not more effective than organized stroke unit care with enhanced discharge planning in most domains in this population. The intervention did, however, fill a post-discharge knowledge gap. PMID:19900646
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Brief scale measuring patient preparedness for hospital discharge to home: Psychometric properties.
Graumlich, James F; Novotny, Nancy L; Aldag, Jean C
2008-01-01
Adverse events occur when patients transition from the hospital to outpatient care. For quality improvement and research purposes, clinicians need appropriate, reliable, and valid survey instruments to measure and improve the discharge processes. The object was to describe psychometric properties of the Brief PREPARED (B-PREPARED) instrument to measure preparedness for hospital discharge from the patient's perspective. The study was a prospective cohort of 460 patient or proxy telephone interviews following hospital discharge home. We administered the Satisfaction with Information about Medicines Scale and the PREPARED instrument 1 week after discharge. PREPARED measured patients' perceptions of quality and outcome of the discharge-planning processes. Four weeks after discharge, interviewers elicited emergency department visits. The main outcome was the B-PREPARED scale value: the sum of scores from 11 items. Internal consistency, construct, and predictive validity were assessed. : The mean B-PREPARED scale value was 17.3 +/- 4.2 (SD) with a range of 3 to 22. High scores reflected high preparedness. Principal component analysis identified 3 domains: self-care information, equipment/services, and confidence. The B-PREPARED had acceptable internal consistency (Cronbach's alpha 0.76) and construct validity. The B-PREPARED correlated with medication information satisfaction (P < 0.001). Higher median B-PREPARED scores appropriately discriminated patients with no worry about managing at home from worriers (P < 0.001) and predicted patients without emergency department visits after discharge from those who had visits (P = 0.011). The B-PREPARED scale measured patients' perceptions of their preparedness for hospital discharge home with acceptable internal consistency and construct and predictive validity. Brevity may potentiate use by patients and proxies. Clinicians and researchers may use B-PREPARED to evaluate discharge interventions. (c) 2008 Society of Hospital Medicine.
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Facilitating emergency hospital evacuation through uniform discharge criteria.
Sandra, Keret; Meital, Nahari; Ofer, Merin; Limor, Aharonson-Daniel; Sara, Goldberg; Bruria, Adini
2017-05-01
Though hospitals' operational continuity is crucial, full institutional evacuation may at times be unavoidable. The study's objective was to establish criteria for discharge of patients during complete emergency evacuation and compare scope of patients suitable for discharge pre/post implementation of criteria. Standards for patient discharge during an evacuation were developed based on literature and disaster managers. The standards were reviewed in a two-round Delphi process. All hospitals in Israel were requested to identify inpatients' that could be released home during institutional evacuation. Potential discharges were compared in 2013-2014, before and after formulation of discharge criteria. Consensus exceeding 80% was obtained for four out of five criteria after two Delphi cycles. Average projected discharge rate before and after formulation of criteria was 34.2% and 42.9%, respectively (p<0.001). Variance in potential dischargeable patients was 31-fold less in 2014 than in 2013 (MST=8,452 versus MST=264,366, respectively; p<0.001). Differences were found between small, medium and large hospitals in mean rate of dischargeable patients: 52.1%, 41.5% and 42.2%, respectively (p=0.001). The study's findings enable to forecast the extent of patients that may be released home during full emergency evacuation of a hospital; thereby facilitating preparedness of contingency plans. Copyright © 2016 Elsevier Inc. All rights reserved.
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Smailes, Sarah T; Engelsman, Kayleen; Dziewulski, Peter
2013-02-01
Determining the discharge outcome of burn patients can be challenging and therefore a validated objective measure of functional independence would assist with this process. We developed the Functional Assessment for Burns (FAB) score to measure burn patients' functional independence. FAB scores were taken on discharge from ICU (FAB 1) and on discharge from inpatient burn care (FAB 2) in 56 patients meeting the American Burn Association criteria for major burn. We retrospectively analysed prospectively collected data to measure the progress of patients' physical functional outcomes and to evaluate the predictive validity of the FAB score for discharge outcome. Mean age was 38.6 years and median burn size 35%. Significant improvements were made in the physical functional outcomes between FAB 1 and FAB 2 scores (p<0.0001). 48 patients were discharged home, 8 of these with social care. 8 patients were transferred to another hospital for further inpatient rehabilitation. FAB 1 score (≤ 9) is strongly associated with discharge outcome (p<0.006) and as such can be used to facilitate early discharge planning. FAB 2 score (≤ 26) independently predicts discharge outcome (p<0.0001) and therefore is a valid outcome measure to determine discharge outcome of burn patients. Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.
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Reistetter, Timothy A; Graham, James E; Deutsch, Anne; Granger, Carl V; Markello, Samuel; Ottenbacher, Kenneth J
2010-03-01
To evaluate the ability of patient functional status to differentiate between community and institutional discharges after rehabilitation for stroke. Retrospective cross-sectional design. Inpatient rehabilitation facilities contributing to the Uniform Data System for Medical Rehabilitation. Patients (N=157,066) receiving inpatient rehabilitation for stroke from 2006 and 2007. Not applicable. Discharge FIM rating and discharge setting (community vs institutional). Approximately 71% of the sample was discharged to the community. Receiver operating characteristic curve analyses revealed that FIM total performed as well as or better than FIM motor and FIM cognition subscales in differentiating discharge settings. Area under the curve for FIM total was .85, indicating very good ability to identify persons discharged to the community. A FIM total rating of 78 was identified as the optimal cut point for distinguishing between positive (community) and negative (institution) tests. This cut point yielded balanced sensitivity and specificity (both=.77). Discharge planning is complex, involving many factors. Identifying a functional threshold for classifying discharge settings can provide important information to assist in this process. Additional research is needed to determine if the risks and benefits of classification errors justify shifting the cut point to weight either sensitivity or specificity of FIM ratings. Copyright 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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Temple, Michael W; Lehmann, Christoph U; Fabbri, Daniel
2016-01-01
Discharging patients from the Neonatal Intensive Care Unit (NICU) can be delayed for non-medical reasons including the procurement of home medical equipment, parental education, and the need for children's services. We previously created a model to identify patients that will be medically ready for discharge in the subsequent 2-10 days. In this study we use Natural Language Processing to improve upon that model and discern why the model performed poorly on certain patients. We retrospectively examined the text of the Assessment and Plan section from daily progress notes of 4,693 patients (103,206 patient-days) from the NICU of a large, academic children's hospital. A matrix was constructed using words from NICU notes (single words and bigrams) to train a supervised machine learning algorithm to determine the most important words differentiating poorly performing patients compared to well performing patients in our original discharge prediction model. NLP using a bag of words (BOW) analysis revealed several cohorts that performed poorly in our original model. These included patients with surgical diagnoses, pulmonary hypertension, retinopathy of prematurity, and psychosocial issues. The BOW approach aided in cohort discovery and will allow further refinement of our original discharge model prediction. Adequately identifying patients discharged home on g-tube feeds alone could improve the AUC of our original model by 0.02. Additionally, this approach identified social issues as a major cause for delayed discharge. A BOW analysis provides a method to improve and refine our NICU discharge prediction model and could potentially avoid over 900 (0.9%) hospital days.
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Psychosocial Adjustment and Life Satisfaction until 5 Years after Severe Brain Damage
ERIC Educational Resources Information Center
Sorbo, Ann K.; Blomqvist, Maritha; Emanuelsson, Ingrid M.; Rydenhag, Bertil
2009-01-01
The objectives of this study were to describe psychosocial adjustment and outcome over time for severely brain-injured patients and to find suitable outcome measures for clinical practice during the rehabilitation process and for individual rehabilitation planning after discharge from hospital. The methods include a descriptive, prospective,…
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High specific energy, high capacity nickel-hydrogen cell design
NASA Technical Reports Server (NTRS)
Wheeler, James R.
1993-01-01
A 3.5 inch rabbit-ear-terminal nickel-hydrogen cell has been designed and tested to deliver high capacity at a C/1.5 discharge rate. Its specific energy yield of 60.6 wh/kg is believed to be the highest yet achieved in a slurry-process nickel-hydrogen cell, and its 10 C capacity of 113.9 AH the highest capacity yet made at a discharge rate this high in the 3.5 inch diameter size. The cell also demonstrated a pulse capability of 180 amps for 20 seconds. Specific cell parameters, performance, and future test plans are described.
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Hospital Discharge Planning: A Guide for Families and Caregivers
... others familiar with your situation. Discharge to a Facility If the patient is being discharged to a ... hospital? Questions when discharge is to a rehab facility or nursing home: How long is my relative ...
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NASA Astrophysics Data System (ADS)
Apel, Heiko; Gafurov, Abror; Gerlitz, Lars; Unger-Shayesteh, Katy; Vorogushyn, Sergiy; Merkushkin, Aleksandr; Merz, Bruno
2016-04-01
The semi-arid regions of Central Asia crucially depend on the water resources supplied by the mountainous areas of the Tien-Shan and Pamirs. During the summer months the snow and glacier melt water of the rivers originating in the mountains provides the only water resource available for agricultural production but also for water collection in reservoirs for energy production in winter months. Thus a reliable seasonal forecast of the water resources is crucial for a sustainable management and planning of water resources.. In fact, seasonal forecasts are mandatory tasks of national hydro-meteorological services in the region. Thus this study aims at a statistical forecast of the seasonal water availability, whereas the focus is put on the usage of freely available data in order to facilitate an operational use without data access limitations. The study takes the Naryn basin as a test case, at which outlet the Toktogul reservoir stores the discharge of the Naryn River. As most of the water originates form snow and glacier melt, a statistical forecast model should use data sets that can serve as proxy data for the snow masses and snow water equivalent in late spring, which essentially determines the bulk of the seasonal discharge. CRU climate data describing the precipitation and temperature in the basin during winter and spring was used as base information, which was complemented by MODIS snow cover data processed through ModSnow tool, discharge during the spring and also GRACE gravimetry anomalies. For the construction of linear forecast models monthly as well as multi-monthly means over the period January to April were used to predict the seasonal mean discharge of May-September at the station Uchterek. An automatic model selection was performed in multiple steps, whereas the best models were selected according to several performance measures and their robustness in a leave-one-out cross validation. It could be shown that the seasonal discharge can be predicted with exceptionally high skill reaching explained variances of 86% in the cross validation using ModSnow processed snow cover data and CRU temperature and precipitation data, i.e. freely available data only. Using antecedent discharge information from the Uchterek station over the period January to April the skill can be improved even further. Also the addition of latest EGSIEM GRACE products can improve this skill to > 90% explained variance by replacing the CRU temperature data in the forecast model. From all variables the ModSnow processed MODIS snow cover data proved to be the most important predictor. However, although the prediction models proved to be robust in the cross validation, it has to be mentioned that the models are based on a limited time spanning the period 2000-2012 only. Nevertheless it is believed that the models are reliable, as this time period shows a high variability in seasonal water availability spanning from exceptionally dry to wet years. In summary, the developed forecast model may be a valuable complementary tool for the seasonal discharge prediction in Central Asia for water resources planning, that does not suffer from limited data access required for other forecast methods.
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Early Discharge and Home Care After Unplanned Cesarean Birth: Nursing Care Time
Brooten, Dorothy; Knapp, Helen; Borucki, Lynne; Jacobsen, Barbara; Finkler, Steven; Arnold, Lauren; Mennuti, Michael
2013-01-01
Objective This study examined the mean nursing time spent providing discharge planning and home care to women who delivered by unplanned cesarean birth and examined differences in nursing time required by women with and without morbidity. Design A secondary analysis of nursing time from a randomized trial of transitional care (discharge planning and home follow-up) provided to women after cesarean delivery. Setting An urban tertiary-care hospital. Patients The sample (N = 61) of black and white women who had unplanned cesarean births and their full-term newborns was selected randomly. Forty-four percent of the women had experienced pregnancy complications. Interventions Advanced practice nurses provided discharge planning and 8-week home follow-up consisting of home visits, telephone outreach, and daily telephone availability. Outcome Measure Nursing time required was dictated by patient need and provider judgment rather than by reimbursement plan. Results More than half of the women required more than two home visits; mean home visit time was 1 hour. For women who experienced morbidity mean discharge planning time was 20 minutes more and mean home visit time 40 minutes more. Conclusions Current health care services that provide one or two 1-hour home visits to childbearing women at high risk may not be meeting the education and resource needs of this group. PMID:8892128
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NASA Astrophysics Data System (ADS)
Prabhakaran, A.; Jawahar Raj, N.
2018-03-01
The present study attempts to understand the form and geomorphic/hydrologic processes of the 20 watersheds of the Pachamalai hills and its adjoinings located in Tamil Nadu State of southern India from the analysis of its drainage morphometric characteristics. Survey of India's topographic sheets of 1:50,000 is the data source from which stream networks and watersheds of the study area were demarcated followed by the analysis of their morphometric characteristics using ArcGIS software. The results of the analysis formed the basis for deducing the form and processes of the watersheds of the study area. The form of the watersheds inferred from the analysis includes shape, length, slope steepness and length, degree of branching of streams, dissection and elongation of watersheds. The geomorphic/hydrologic processes inferred include denudation rate, potential energy, intensity of erosion, mean annual run off, mean discharge, discharge rate, rock resistivity and infiltration potential, amount of sediment transported, mean annual rainfall, rainfall intensity, lagtime, flash flood potential, flood discharge per unit area, sediment yield and speed of the water flow in the streams. The understanding of variations of form and processes mentioned can be used towards prioritizing the watersheds for development, management and conservation planning.
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Murphy, David; Crowley, Rebecca; Spencer, Anthony; Birch, Mark
2015-04-17
This study aimed to improve our ability to communicate with patients with regard to four key issues. Their diagnosis, treatment plan, clinical criteria for discharge and estimated discharge date. This was a prospective case control study. It involved 200 general medical patients admitted to Christchurch Public Hospital. Each day there were two general medical admitting teams. One team formed the control group and the other team the intervention group. The 100 patients in the control group had their consultant ward round as normal. The 100 patients in the intervention group had a consultant ward round and were provided with additional written information answering the following four points: (1) their diagnosis (2) management plan for the day (3) clinical criteria for discharge and (4) estimated date of discharge. This was a laminated sheet that remained attached to their bedside locker. At four or more hours after the ward round every new patient would undergo a questionnaire based interview addressing their ability to correctly answer the points listed above. A comparison was then made between the intervention and control groups. A subgroup (n=30) were selected to obtain feedback on the initiative. 90% of respondents from the intervention group knew their diagnosis versus 59% of the control group (p<0.01). 76% knew their treatment plan for the day versus 41% (p<0.01). 76% knew some of the clinical criteria for safe discharge versus 25% (p<0.01) and 83% of the intervention group knew their estimated discharge date versus 52% of the control group (p<0.01). The median age of the patients in the intervention group was 78 years of age and 74 for the control group (p>0.05). Of those that gave feedback 70% believed the intervention was helpful in helping them understand their diagnosis and 70% believed knowing their likely discharge date was useful. The use of a card with written information for the patient regarding their diagnosis, treatment plan, clinical criteria for safe discharge and estimated discharge date at the bedside helped improve the patients understanding of their care and aided effective communication.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Todorov, D.; Shivarova, A., E-mail: ashiva@phys.uni-sofia.bg; Paunska, Ts.
2015-03-15
The development of the two-dimensional fluid-plasma model of a low-pressure hydrogen discharge, presented in the study, is regarding description of the plasma maintenance in a discharge vessel with the configuration of the SPIDER source. The SPIDER source, planned for the neutral-beam-injection plasma-heating system of ITER, is with localized high RF power deposition to its eight drivers (cylindrical-coil inductive discharges) and a large-area second chamber, common for all the drivers. The continuity equations for the charged particles (electrons and the three types of positive ions) and for the neutral species (atoms and molecules), their momentum equations, the energy balance equations formore » electrons, atoms and molecules and the Poisson equations are involved in the discharge description. In addition to the local processes in the plasma volume, the surface processes of particle reflection and conversion on the walls as well as for a heat exchange with the walls are included in the model. The analysis of the results stresses on the role of the fluxes (particle and energy fluxes) in the formation of the discharge structure. The conclusion is that the discharge behavior is completely obeyed to non-locality. The latter is displayed by: (i) maximum values of plasma parameters (charged particle densities and temperatures of the neutral species) outside the region of the RF power deposition, (ii) shifted maxima of the electron density and temperature, of the plasma potential and of the electron production, (iii) an electron flux, with a vortex structure, strongly exceeding the total ion flux which gives evidence of a discharge regime of non-ambipolarity and (iv) a spatial distribution of the densities of the neutral species resulting from their fluxes.« less
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Jódar, J; Carpintero, E; Martos-Rosillo, S; Ruiz-Constán, A; Marín-Lechado, C; Cabrera-Arrabal, J A; Navarrete-Mazariegos, E; González-Ramón, A; Lambán, L J; Herrera, C; González-Dugo, M P
2018-06-01
Assessing water resources in high mountain semi-arid zones is essential to be able to manage and plan the use of these resources downstream where they are used. However, it is not easy to manage an unknown resource, a situation that is common in the vast majority of high mountain hydrological basins. In the present work, the discharge flow in an ungauged basin is estimated using the hydrological parameters of an HBV (Hydrologiska Byråns Vattenbalansavdelning) model calibrated in a "neighboring gauged basin". The results of the hydrological simulation obtained in terms of average annual discharge are validated using the VI-ETo model. This model relates a simple hydrological balance to the discharge of the basin with the evaporation of the vegetal cover of the soil, and this to the SAVI index, which is obtained remotely by means of satellite images. The results of the modeling for both basins underscore the role of the underground discharge in the total discharge of the hydrological system. This is the result of the deglaciation process suffered by the high mountain areas of the Mediterranean arc. This process increases the infiltration capacity of the terrain, the recharge and therefore the discharge of the aquifers that make up the glacial and periglacial sediments that remain exposed on the surface as witnesses of what was the last glaciation. Copyright © 2017. Published by Elsevier B.V.
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Cajanding, Ruff Joseph
Cardiovascular diseases remain the leading cause of morbidity and mortality among Filipinos and are responsible for a very large number of hospital readmissions. Comprehensive discharge planning programs have demonstrated positive benefits among various populations of patients with cardiovascular disease, but the clinical and psychosocial effects of such intervention among Filipino patients with acute myocardial infarction (AMI) have not been studied. In this study we aimed to determine the effectiveness of a nurse-led structured discharge planning program on perceived functional status, cardiac self-efficacy, patient satisfaction, and unexpected hospital revisits among Filipino patients with AMI. A true experimental (randomized control) 2-group design with repeated measures and data collected before and after intervention and at 1-month follow-up was used in this study. Participants were assigned to either the control (n = 68) or the intervention group (n = 75). Intervention participants underwent a 3-day structured discharge planning program implemented by a cardiovascular nurse practitioner, which is comprised of a series of individualized lecture-discussion, provision of feedback, integrative problem solving, goal setting, and action planning. Control participants received standard routine care. Measures of functional status, cardiac self-efficacy, and patient satisfaction were measured at baseline; cardiac self-efficacy and patient satisfaction scores were measured prior to discharge, and perceived functional status and number of revisits were measured 1 month after discharge. Participants in the intervention group had significant improvement in functional status, cardiac self-efficacy, and patient satisfaction scores at baseline and at follow-up compared with the control participants. Furthermore, participants in the intervention group had significantly fewer hospital revisits compared with those who received only standard care. The results demonstrate that a nurse-led structured discharge planning program is an effective intervention in improving perceived functional health status, cardiac self-efficacy, and patient satisfaction, while reducing the number of unexpected hospital revisits, among Filipino patients with AMI. It is recommended that this intervention be incorporated in the optimal care of patients being discharged with an AMI.
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Improving discharge planning communication between hospitals and patients.
New, P W; McDougall, K E; Scroggie, C P R
2016-01-01
A potential barrier to patient discharge from hospital is communication problems between the treating team and the patient or family regarding discharge planning. To determine if a bedside 'Leaving Hospital Information Sheet' increases patient and family's knowledge of discharge date and destination and the name of the key clinician primarily responsible for team-patient communication. This article is a 'before-after' study of patients, their families and the interdisciplinary ward-based clinical team. Outcomes assessed pre-implementation and post-implementation of a bedside 'Leaving Hospital Information Sheet' containing discharge information for patients and families. Patients and families were asked if they knew the key clinician for team-patient communication and the proposed discharge date and discharge destination. Responses were compared with those set by the team. Staff were surveyed regarding their perceptions of patient awareness of discharge plans and the benefit of the 'Leaving Hospital Information Sheet'. Significant improvement occurred regarding patients' knowledge of their key clinician for team-patient communication (31% vs 75%; P = 0.0001), correctly identifying who they were (47% vs 79%; P = 0.02), and correctly reporting their anticipated discharge date (54% vs 86%; P = 0.004). There was significant improvement in the family's knowledge of the anticipated discharge date (78% vs 96%; P = 0.04). Staff reported the 'Leaving Hospital Information Sheet' assisted with communication regarding anticipated discharge date and destination (very helpful n = 11, 39%; a little bit helpful n = 11, 39%). A bedside 'Leaving Hospital Information Sheet' can potentially improve communication between patients, families and their treating team. © 2016 Royal Australasian College of Physicians.
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77 FR 18151 - Discharge Removal Equipment for Vessels Carrying Oil
Federal Register 2010, 2011, 2012, 2013, 2014
2012-03-27
... Facility Response Plans for Oil: 2003 Removal Equipment Requirements and Alternative Technology Revisions... ``Vessel and Facility Response Plans for Oil: 2003 Removal Equipment Requirements and Alternative... CGD 90-068] RIN 1625-AA02, Formerly 2115-AD66 Discharge Removal Equipment for Vessels Carrying Oil...
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Lost in translation: reviewing the role of the discharge liaison nurse in Wales.
Chandler, Lynda; Wyatt, Matt; Roberts, Iain
2010-02-01
In Wales, the National Leadership and Innovation Agency in Healthcare (NLIAH) Change Agent Team (CAT) has found that its service improvement methodology of Communities of Practice (CoP), where motivated frontline staff in health and social care come together to share issues and develop solutions to mutual problems, is a highly effective and informative tool. Health and social care organizations in Wales are in the process of working to develop processes and solutions to remedy the challenges they have over patients with long lengths of stay. This article shows how by speaking to the frontline staff, whose role it is to help people whose discharge is likely to be complex or problematic, they often have most insight into the solutions required to alleviate the situation. The learning in this article is that there is no one solution to improve the discharge process; however there are a number of small changes and improvements required, which if done consistently can have a significant impact. The findings here have been shared with Welsh government policy leads and health and social care executive teams to inform their planning and actions on how to resolve the challenge of reducing length of stay.
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Rodgers, Cheryl C.; Stegenga, Kristin; Withycombe, Janice S.; Sachse, Karen; Kelly, Katherine Patterson
2016-01-01
Parents of a child newly diagnosed with cancer must receive an extensive amount of information before their child’s initial hospital discharge; however, little is known about best practices for providing this education. An interpretive descriptive study design was used to describe actual and preferred educational content, timing, and methods among parents of children newly diagnosed with cancer prior to their child’s first hospital discharge. Twenty parents of children diagnosed with various malignancies participated in individual interviews 2 to 12 months after their child’s diagnosis. Data were analyzed using constant comparative analysis. Education delivery occurred in a telling manner at diagnosis transitioning to a reciprocal process of teaching during the inpatient stay, then primarily back to telling immediately before discharge. Parents expressed a variety of preferred learning styles but noted that their preferences were rarely assessed by healthcare providers. Multiple factors influenced parents’ ability to process educational information received during their child’s initial hospitalization. Findings suggest that nursing practices should include assessing for influencing factors, providing anticipatory guidance, and incorporating parents’ preferred learning style into the educational plan. PMID:28084180
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NASA Astrophysics Data System (ADS)
Khanna, Rajesh; Kumar, Anish; Garg, Mohinder Pal; Singh, Ajit; Sharma, Neeraj
2015-12-01
Electric discharge drill machine (EDDM) is a spark erosion process to produce micro-holes in conductive materials. This process is widely used in aerospace, medical, dental and automobile industries. As for the performance evaluation of the electric discharge drilling machine, it is very necessary to study the process parameters of machine tool. In this research paper, a brass rod 2 mm diameter was selected as a tool electrode. The experiments generate output responses such as tool wear rate (TWR). The best parameters such as pulse on-time, pulse off-time and water pressure were studied for best machining characteristics. This investigation presents the use of Taguchi approach for better TWR in drilling of Al-7075. A plan of experiments, based on L27 Taguchi design method, was selected for drilling of material. Analysis of variance (ANOVA) shows the percentage contribution of the control factor in the machining of Al-7075 in EDDM. The optimal combination levels and the significant drilling parameters on TWR were obtained. The optimization results showed that the combination of maximum pulse on-time and minimum pulse off-time gives maximum MRR.
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Jardine, E.; Wallis, C.
1998-01-01
Paediatric home ventilation is a feasible option and can be successful in a wide range of conditions and ages. Advances in ventilator technology and an ethos of optimism for home care has increased the possibilities for discharging chronically ventilated children from intensive care units and acute medical beds. With careful planning the process can succeed, but difficulties often thwart the responsible team, especially when attempting discharge for the first time. These core guidelines aim to assist a smooth, swift and successful transfer. They were developed by a working party of interested professionals spanning a wide range of health care disciplines and represent a synthesis of views accumulated from the experiences of individual teams throughout the UK. Three case scenarios provide further illustrative detail and guidance. PMID:10319058
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NIX, JACQUELINE; COMANS, TRACY
2017-01-01
This article reports upon an initiative to improve the timeliness of occupational therapy home visits for discharge planning by implementing technology solutions while maintaining patient safety. A community hospital in Queensland, Australia, hosted a process evaluation that examined which aspects of home visiting could be replaced or augmented by alternative technologies. Strategies were trialled, implemented and assessed using the number of home visits completed and the time from referral to completion as outcomes. A technology-enhanced solution called “Home Quick” was developed using technology to facilitate pre-discharge home visits. The implementation of Home Quick resulted in an increase in the number of home visits conducted prior to discharge (50% increase from 145 to 223) and significantly increased the number of patients seen earlier following referral (X2=69.3; p<0.001). The substitution of direct home visits with technology-enabled remote visits is suitable for a variety of home visiting scenarios traditionally performed by occupational therapists. PMID:28814994
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Not Available
1989-01-01
This bill would amend the Federal Water Pollution Control Act to empower the President to determine areas for which a oil or hazardous material discharge contingency plan is necessary and to require terminal operators, vessel operators, and other parties directly involved in the transport of oil or hazardous materials to prepare a contingency plan and to submit this plan for approval to the President on a periodic basis. In the event of a discharge, the President is responsible for seeing that the removal plan is implemented and for requiring any changes as he may determine to be necessary. The Presidentmore » can deny entry to any port to any vessel or deny movement of substances through any terminal facility, if the vessel or facility operators do not have a current and approved contingency plan in effect.« less
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Streamflow variation of forest covered catchments
NASA Astrophysics Data System (ADS)
Gribovszki, Z.; Kalicz, P.; Kucsara, M.
2003-04-01
Rainfall concentration and runoff, otherwise rainfall-runoff processes, which cause river water discharge fluctuation, is one of the basic questions of hydrology. Several social-economy demands have a strong connection with small or bigger rivers from the point of view both quantity and quality of the water. Gratification or consideration of these demands is complicated substantially that we have still poor knowledge about our stream-flow regime. Water resources mainly stem from upper watersheds. These upper watersheds are the basis of the water concentration process; therefore we have to improve our knowledge about hydrological processes coming up in these territories. In this article we present runoff regime of two small catchments on the basis of one year data. Both catchments have a similar magnitude 0.6 and 0.9 km^2. We have been analyzed in detail some hydrological elements: features of rainfall, discharge, rainfall induced flooding waves and basic discharge in rainless periods. Variances of these parameters have been analyzed in relation to catchments surface, vegetation coverage and forest management. Result data set well enforce our knowledge about small catchments hydrological processes. On the basis of these fundamentals we can plan more established the management of these lands (forest practices, civil engineering works, and usage of natural water resources).
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Altfeld, Susan J; Shier, Gayle E; Rooney, Madeleine; Johnson, Tricia J; Golden, Robyn L; Karavolos, Kelly; Avery, Elizabeth; Nandi, Vijay; Perry, Anthony J
2013-06-01
To identify needs encountered by older adult patients after hospital discharge and assess the impact of a telephone transitional care intervention on stress, health care utilization, readmissions, and mortality. Older adult inpatients who met criteria for risk of post-discharge complications were randomized at discharge through the electronic medical record. Intervention group participants received the telephone-based Enhanced Discharge Planning Program intervention that included biopsychosocial assessment and an individualized plan following program protocols to address identified transitional care needs. All patients received a follow-up call at 30 days post discharge to assess psychosocial needs, patient and caregiver stress, and physician follow-up. 83.3% of intervention group participants experienced significant barriers to care. For 73.3% of this group, problems did not emerge until after discharge. Intervention patients were more likely than usual care patients to have scheduled and completed physician visits by 30 days post discharge. There were no differences between groups on patient or caregiver stress or hospital readmission. At-risk older adults may benefit from transitional care programs to ensure delivery of care as ordered and address unmet needs. Although patients who received the intervention were more likely to communicate and follow up with their physicians, the absence of impact on readmission suggests that more intensive efforts may be indicated to affect this outcome.
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NASA Astrophysics Data System (ADS)
Neupane, Ram P.; Kumar, Sandeep
2015-10-01
Land use and climate are two major components that directly influence catchment hydrologic processes, and therefore better understanding of their effects is crucial for future land use planning and water resources management. We applied Soil and Water Assessment Tool (SWAT) to assess the effects of potential land use change and climate variability on hydrologic processes of large agriculture dominated Big Sioux River (BSR) watershed located in North Central region of USA. Future climate change scenarios were simulated using average output of temperature and precipitation data derived from Special Report on Emission Scenarios (SRES) (B1, A1B, and A2) for end-21st century. Land use change was modeled spatially based on historic long-term pattern of agricultural transformation in the basin, and included the expansion of corn (Zea mays L.) cultivation by 2, 5, and 10%. We estimated higher surface runoff in all land use scenarios with maximum increase of 4% while expanding 10% corn cultivation in the basin. Annual stream discharge was estimated higher with maximum increase of 72% in SRES-B1 attributed from higher groundwater contribution of 152% in the same scenario. We assessed increased precipitation during spring season but the summer precipitation decreased substantially in all climate change scenarios. Similar to decreased summer precipitation, discharge of the BSR also decreased potentially affecting agricultural production due to reduced future water availability during crop growing season in the basin. However, combined effects of potential land use change with climate variability enhanced for higher annual discharge of the BSR. Therefore, these estimations can be crucial for implications of future land use planning and water resources management of the basin.
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Which Reasons Do Doctors, Nurses, and Patients Have for Hospital Discharge? A Mixed-Methods Study
Ubbink, Dirk T.; Tump, Evelien; Koenders, Josje A.; Kleiterp, Sieta; Goslings, J. Carel; Brölmann, Fleur E.
2014-01-01
Background The decision to discharge a patient from a hospital is a complex process governed by many medical and non-medical factors, while the actual reasons for discharge frequently remain ill-defined. Aim To define relevant discharge criteria as perceived by doctors, nurses and patients for the development of a standard hospital discharge policy, we collected actual reasons and most pivotal medical and organisational criteria for discharge among all stakeholders. Setting A tertiary referral university teaching hospital. Methods We conducted a mixed methods analysis, using patient questionnaires, interviews and a focus group with caregivers, and observations during the daily rounds of doctors, nurses and patients during their hospital stay. Fourteen wards of the Surgery, Paediatrics and Neurology departments contributed. Results We observed 426 patients during their hospital stay. Forty doctors and nurses were interviewed, and 7 senior nurses attended a focus group. The most commonly used discharge criteria were clinical factors, organisational discharge issues and patient-related factors. A total of 269 patients returned their questionnaires. About one third of the adult patients and nearly half of the children (or their parents) felt their personal situation and assistance needed at home was insufficiently taken into account before discharge. Patients were least satisfied with the information given about what they were allowed to do or should avoid after discharge and their involvement in the planning of their discharge. Thus, besides obvious medical reasons for discharge, several non-medical reasons were signalled by all stakeholders as important issues to be improved. Conclusions A set of discharge criteria could be defined that is useful for a more uniform hospital discharge policy that may help reduce unnecessary length of stay and improve patient satisfaction. PMID:24625666
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Byrnes, Michelle; Beilby, Janet; Ray, Patricia; McLennan, Renee; Ker, John; Schug, Stephan
2012-12-01
To evaluate the process and outcome of a multidisciplinary inpatient goal planning rehabilitation programme on physical, social and psychological functioning for patients with spinal cord injury. Clinical audit: quantitative and qualitative analyses. Specialist spinal injury unit, Perth, Australia. Consecutive series of 100 newly injured spinal cord injury inpatients. MAIN MEASURE(S): The Needs Assessment Checklist (NAC), patient-focused goal planning questionnaire and goal planning progress form. The clinical audit of 100 spinal cord injured patients revealed that 547 goal planning meetings were held with 8531 goals stipulated in total. Seventy-five per cent of the goals set at the first goal planning meeting were achieved by the second meeting and the rate of goal achievements at subsequent goal planning meetings dropped to 56%. Based on quantitative analysis of physical, social and psychological functioning, the 100 spinal cord injury patients improved significantly from baseline to discharge. Furthermore, qualitative analysis revealed benefits consistently reported by spinal cord injury patients of the goal planning rehabilitation programme in improvements to their physical, social and psychological adjustment to injury. The findings of this clinical audit underpin the need for patient-focused goal planning rehabilitation programmes which are tailored to the individual's needs and involve a comprehensive multidisciplinary team.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Kelly, B.A.
1984-07-01
Since their inception, the DOE facilities on the Oak Ridge Reservation have been the source of a variety of airborne, liquid, and solid wastes which are characterized as nonhazardous, hazardous, and/or radioactive. The major airborne releases come from three primary sources: steam plant emissions, process discharge, and cooling towers. Liquid wastes are handled in various manners depending upon the particular waste, but in general, major corrosive waste streams are neutralized prior to discharge with the discharge routed to holding or settling ponds. The major solid wastes are derived from construction debris, sanitary operation, and radioactive processes, and the machining operationsmore » at Y-12. Nonradioactive hazardous wastes are disposed in solid waste storage areas, shipped to commercial disposal facilities, returned in sludge ponds, or sent to radioactive waste burial areas. The radioactive-hazardous wastes are treated in two manners: storage of the waste until acceptable disposal options are developed, or treatment of the waste to remove or destroy one of the components prior to disposal. 5 references, 4 figures, 13 tables.« less
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Process auditing in long term care facilities.
Hewitt, S M; LeSage, J; Roberts, K L; Ellor, J R
1985-01-01
The ECC tool development and audit experiences indicated that there is promise in developing a process audit tool to monitor quality of care in nursing homes; moreover, the tool selected required only one hour per resident. Focusing on the care process and resident needs provided useful information for care providers at the unit level as well as for administrative personnel. Besides incorporating a more interdisciplinary focus, the revised tool needs to define support services most appropriate for nursing homes, includes items related to discharge planning and increases measurement of significant others' involvement in the care process. Future emphasis at the ECC will focus on developing intervention plans to maintain strengths and correct deficiencies identified in the audits. Various strategies to bring about desired changes in the quality of care will be evaluated through regular, periodic monitoring. Having a valid and reliable measure of quality of care as a tool will be an important step forward for LTC facilities.
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Using Arden Syntax for the Generation of Intelligent Intensive Care Discharge Letters.
Kraus, Stefan; Castellanos, Ixchel; Albermann, Matthias; Schuettler, Christina; Prokosch, Hans-Ulrich; Staudigel, Martin; Toddenroth, Dennis
2016-01-01
Discharge letters are an important means of communication between physicians and nurses from intensive care units and their colleagues from normal wards. The patient data management system (PDMS) used at our local intensive care units provides an export tool to create discharge letters by inserting data items from electronic medical records into predefined templates. Local intensivists criticized the limitations of this tool regarding the identification and the further processing of clinically relevant data items for a flexible creation of discharge letters. As our PDMS supports Arden Syntax, and the demanded functionalities are well within the scope of this standard, we set out to investigate the suitability of Arden Syntax for the generation of discharge letters. To provide an easy-to-understand facility for integrating data items into document templates, we created an Arden Syntax interface function which replaces the names of previously defined variables with their content in a way that permits arbitrary custom formatting by clinical users. Our approach facilitates the creation of flexible text sections by conditional statements, as well as the integration of arbitrary HTML code and dynamically generated graphs. The resulting prototype enables clinical users to apply the full set of Arden Syntax language constructs to identify and process relevant data items in a way that far exceeds the capabilities of the PDMS export tool. The generation of discharge letters is an uncommon area of application for Arden Syntax, considerably differing from its original purpose. However, we found our prototype well suited for this task and plan to evaluate it in clinical production after the next major release change of our PDMS.
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Determining the Side Channel Area in the Ciliwung Watershed for Decreasing the Hydrograph Flood
NASA Astrophysics Data System (ADS)
Yayuk Supomo, Fani; Saleh Pallu, Muh.; Arsyad Thaha, Muh.; Tahir Lopa, Rita
2018-04-01
The condition of Jakarta with high population density and green open space switch function, causing the condition of flooding to be one of the risks that occur when the rainy season. Ciliwung River that flows from Katulampa into Jakarta bay, is considered as the largest contributor to flood discharge. This study will analyze the flood discharge plan on the side channel area to lower the flood hydrograph peaks and extend the detention time. The area to be side channel is Ciparigi with an area of 608.7 hectare and the slope of 8-10%. The result of flood discharge planning analysis at Ciparigi region (Sub watershed of Middle Ciliwung), obtained the amount of flood discharge for return period 2 yearly equal to 10.10 m3/sec, 5 yearly equal to 12.77 m3/sec, 10 yearly equal to 14.17 m3/sec, 25 yearly equal to 15.32 m3/sec, 50 yearly equal to 16.63 m3/sec and 100 yearly equal to 17.52 m3/sec. The percentage of flood discharge plans that will be reduced by 10% of the total flood discharge plan in sub watershed observation is 1.28 m3/sec with reservoir volume of 4.608 m3 which will be fully charged for 1 hour. This will extend the flow time from the control point in Depok to the Manggarai waterway to approximately 5 hours.
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Hidaka, Kumi; Matsuoka, Mio; Kajiwara, Kanako; Hinokiyama, Hiromi; Mito, Saori; Doi, Seiko; Konishi, Eriko; Ibata, Takeshi; Komuro, Ryutaro; lijima, Shohei
2013-12-01
Our nutrition support team (NST) designed the NST summary for cooperation among personnel providing medical care for nutritional management of high-need patients in our area. After the introduction of the NST fee under the health care system, the number of summary publications decreased. The requested NST fee is necessary for publication of a nutritional care plan and report upon patient discharge. We hypothesized that the nutritional care plan and discharge report were being substituted for the NST summary at the time of patient discharge. We retrospectively investigated 192 cases with NST fee. There were only 13 cases of overlapping publication, and the NST summary was necessary for 107 of 179 cases in which no NST summary had been prepared. Since the space on the report form is limited, it can provide only limited information. However, the NST summary can convey detailed supplementary information. Therefore, there is a high need for the NST summary, and publication of NST summaries for the appropriate cases must continue.
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Lexell, Eva Månsson; Lexell, Jan; Larsson-Lund, Maria
2016-01-01
To explore how the rehabilitation plan influences the rehabilitation process and its outcome in people with late effects of polio participating in an individualised goal-oriented interdisciplinary rehabilitation programme. Four women and two men with late effects of polio were interviewed before rehabilitation, at discharge, and at follow-up. Data were analysed according to the constant comparative method of grounded theory. The participants' experiences formed one core category: "The same starting point but different rehabilitation processes". Before rehabilitation, all participants experienced a similar starting point: Naïve understanding of rehabilitation. During rehabilitation, two separate processes followed. Four participants experienced their rehabilitation as being a mutually shared process that led to a process of change. They were actively engaged, using the rehabilitation plan, and working towards goals targeting a broad perspective of daily activities. The remaining two participants experienced their rehabilitation as a staff-directed process, with limited use of the rehabilitation plan, focusing on goals mainly related to body functions and self-care, not leading to any substantial changes. When clients experience that they develop a mutually shared rehabilitation process, based on a rehabilitation plan, they became more engaged in their rehabilitation and gained a better understanding of their participation during the process. Knowledge of the differences in how clients use the rehabilitation plan during the rehabilitation process can support their active engagement during rehabilitation. This, in turn, can promote a more holistic view among clients and professionals during the rehabilitation for people with late effects of polio. Implications for Rehabilitation Clients who experience a rehabilitation that is mutually shared with professionals, have a better understanding of their engagement during the rehabilitation process. When clients and professionals use the rehabilitation plan as a mutual tool, clients become more actively engaged in their rehabilitation process. A structured rehabilitation plan can serve as a map, and support clients' process of change during the rehabilitation process, also after the rehabilitation period is completed.
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Code of Federal Regulations, 2011 CFR
2011-07-01
... of all persons, organizations or agencies which are to be involved or could be involved in planning... the organizations and agencies to be notified when an oil discharge is discovered. (3) Provisions for access to a reliable communications system for timely notification of an oil discharge and incorporation...
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40 CFR Appendix D to Part 112 - Determination of a Worst Case Discharge Planning Volume
Code of Federal Regulations, 2013 CFR
2013-07-01
... 40 Protection of Environment 23 2013-07-01 2013-07-01 false Determination of a Worst Case Discharge Planning Volume D Appendix D to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. D Appendix D to Part 112—Determination of a...
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40 CFR Appendix D to Part 112 - Determination of a Worst Case Discharge Planning Volume
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Determination of a Worst Case Discharge Planning Volume D Appendix D to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. D Appendix D to Part 112—Determination of a...
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40 CFR Appendix D to Part 112 - Determination of a Worst Case Discharge Planning Volume
Code of Federal Regulations, 2014 CFR
2014-07-01
... 40 Protection of Environment 22 2014-07-01 2013-07-01 true Determination of a Worst Case Discharge Planning Volume D Appendix D to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. D Appendix D to Part 112—Determination of a...
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40 CFR Appendix D to Part 112 - Determination of a Worst Case Discharge Planning Volume
Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Determination of a Worst Case Discharge Planning Volume D Appendix D to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. D Appendix D to Part 112—Determination of a...
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40 CFR Appendix D to Part 112 - Determination of a Worst Case Discharge Planning Volume
Code of Federal Regulations, 2012 CFR
2012-07-01
... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Determination of a Worst Case Discharge Planning Volume D Appendix D to Part 112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS OIL POLLUTION PREVENTION Pt. 112, App. D Appendix D to Part 112—Determination of a...
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ERIC Educational Resources Information Center
AL Khayya, Hatem; El Geneidy, Moshera; Ibrahim, Hanaa; Kassem, Mohamed
2016-01-01
Hip fracture is considered one of the most fatal fractures for elderly people, resulting in increased morbidity and mortality and impaired functional capacity, particularly for basic and instrumental activities of daily living. The aim of this study was to determine the effect of implementing a discharge plan on functional abilities of geriatric…
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NASA Astrophysics Data System (ADS)
Jutla, A.; Akanda, A. S.; Colwell, R. R.
2014-12-01
Prediction of conditions of an impending disease outbreak remains a challenge but is achievable if the associated and appropriate large scale hydroclimatic process can be estimated in advance. Outbreaks of diarrheal diseases such as cholera, are related to episodic seasonal variability in river discharge in the regions where water and sanitation infrastructure are inadequate and insufficient. However, forecasting river discharge, few months in advance, remains elusive where cholera outbreaks are frequent, probably due to non-availability of geophysical data as well as transboundary water stresses. Here, we show that satellite derived water storage from Gravity Recovery and Climate Experiment Forecasting (GRACE) sensors can provide reliable estimates on river discharge atleast two months in advance over regional scales. Bayesian regression models predicted flooding and drought conditions, a prerequisite for cholera outbreaks, in Bengal Delta with an overall accuracy of 70% for upto 60 days in advance without using any other ancillary ground based data. Forecasting of river discharge will have significant impacts on planning and designing intervention strategies for potential cholera outbreaks in the coastal regions where the disease remain endemic and often fatal.
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Improving Quality and Efficiency of Postpartum Hospital Education
Buchko, Barbara L.; Gutshall, Connie H.; Jordan, Elizabeth T.
2012-01-01
The purpose of this study was to investigate the implementation of an evidence-based, streamlined, education process (comprehensive education booklet, individualized education plan, and integration of education into the clinical pathway) and nurse education to improve the quality and efficiency of postpartum education during hospitalization. A one-group pretest–posttest design was used to measure the quality of discharge teaching for new mothers and efficiency of the education process for registered nurses before and after implementation of an intervention. Results indicated that a comprehensive educational booklet and enhanced documentation can improve efficiency in the patient education process for nurses. PMID:23997552
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An Audit of Nursing Documentation at Three Public Hospitals in Jamaica.
Lindo, Jascinth; Stennett, Rosain; Stephenson-Wilson, Kayon; Barrett, Kerry Ann; Bunnaman, Donna; Anderson-Johnson, Pauline; Waugh-Brown, Veronica; Wint, Yvonne
2016-09-01
Nursing documentation provides an important indicator of the quality of care provided for hospitalized patients. This study assessed the quality of nursing documentation on medical wards at three hospitals in Jamaica. This cross-sectional study audited a multilevel stratified sample of 245 patient records from three type B hospitals. An audit instrument which assessed nursing documentation of client history, biological data, client assessment, nursing standards, discharge planning, and teaching facilitated data collection. Descriptive statistics were conducted using IBM SPSS, Version 19 (IBM Inc., Armonk, NY, USA). Records from three hospitals (Hospital 1, n = 119, 48.6%; Hospital 2, n = 56, 22.9%; Hospital 3, n = 70, 28.6%) were audited. Documented evidence of the patient's chief complaint (81.6%), history of present illness (78.8%), past health (79.2%), and family health (11.0%) were noted; however, less than a third of the dockets audited recorded adequate assessment data (e.g., occupation or living accommodations of patients). The audit noted 90% of records had a physical assessment completed within 24 hr of admission and entries timed, dated, and signed by a nurse. Less than 5% of dockets had evidence of patient teaching, and 13.5% had documented evidence of discharge planning conducted within 72 hr of admission. This study highlights the weakness in nursing documentation and the need for increased training and continued monitoring of nursing documentation at the hospitals studied. Additional research regarding the factors that affect nursing documentation practice could prove useful. The study provides valuable information for the development of strategic risk management programs geared at improving the quality of care delivered to clients and presents an opportunity for nurse leaders to implement structured interventions geared at improving nursing documentation in Jamaica. In light of Jamaica's epidemiologic transition of chronic diseases, gaps in nurses' documentation of client assessment, patient teaching, and discharge planning should be addressed with urgency. Patient teaching and discharge planning enable the clients to participate more effectively in their health maintenance process. © 2016 Sigma Theta Tau International.
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Strunin, Lee; Stone, Meg; Jack, Brian
2007-09-01
A high rate of unnecessary rehospitalization has been shown to be related to a poorly managed discharge processes. A qualitative study was conducted in order to understand the phenomenon of frequent rehospitalization from the perspective of discharged patients and to determine if activities at the time of discharge could be designed to reduce the number of adverse events and rehospitalization. Semistructured, open-ended interviews were conducted with 21 patients during their hospital stay at Boston Medical Center. Interviews assessed continuity of care after discharge, need for and availability of social support, and ability to obtain follow-up medical care. Difficult life circumstances posed a greater barrier to recuperation than lack of medical knowledge. All participants were able to describe their medical condition, the reasons they were admitted to the hospital, and the discharge instructions they received. All reported the types of medications being taken or the conditions for which the medications were prescribed. Recuperation was compromised by factors that contribute to undermining the ability of patients to follow their doctors' recommendations including support for medical and basic needs, substance use, and limitations in the availability of transportation to medical appointments. Distress, particularly depression, further contributed to poor health and undermined the ability to follow doctors' recommendations and the discharge plans. Discharge interventions that assess the need for social support and provide access and services have the potential to reduce chronic rehospitalization. (c) 2007 Society of Hospital Medicine.
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Satterthwaite, Peter S; Atkinson, Carol J
2012-02-01
This report analyses the impact of reverse triage, as described by Kelen, to rapidly assess the need for continuing inpatient care and to expedite patient discharge to create surge capacity for disaster victims. The Royal Darwin Hospital was asked to take up to 30 casualties suffering from blast injuries from a boat carrying asylum seekers that had exploded 840 km west of Darwin. The hospital was full, with a backlog of cases awaiting admission in the emergency department. The Disaster Response Team convened at 10:00 to develop the surge capacity to admit up to 30 casualties. By 14:00, 56 beds (16% of capacity) were predicted to be available by 18:00. The special circumstances of a disaster enabled staff to suspend their usual activities and place a priority on triaging inpatients' suitability for discharge. The External Disaster Plan was activated and response protocols were followed. Normal elective activity was suspended. Multidisciplinary teams immediately assessed patients and completed the necessary clinical and administrative requirements to discharge them quickly. As per the Plan there was increased use of community care options: respite nursing home beds and community nursing services. Through a combination of cancellation of all planned admissions, discharging 19 patients at least 1 day earlier than planned and discharging all patients earlier in the day surge capacity was made available in Royal Darwin Hospital to accommodate blast victims. Notably, reverse triage resulted in no increase in clinical risk with only one patient who was discharged early returning for further treatment.
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Streamflow model of the six-country transboundary Ganges-Bhramaputra and Meghna river basin
NASA Astrophysics Data System (ADS)
Rahman, K.; Lehmann, A.; Dennedy-Frank, P. J.; Gorelick, S.
2014-12-01
Extremely large-scale river basin modelling remains a challenge for water resources planning in the developing world. Such planning is particularly difficult in the developing world because of the lack of data on both natural (climatological, hydrological) processes and complex anthropological influences. We simulate three enormous river basins located in south Asia. The Ganges-Bhramaputra and Meghna (GBM) River Basins cover an area of 1.75 million km2 associated with 6 different countries, including the Bengal delta, which is the most densely populated delta in the world with ~600 million people. We target this developing region to better understand the hydrological system and improve water management planning in these transboundary watersheds. This effort uses the Soil and Water Assessment Tool (SWAT) to simulate streamflow in the GBM River Basins and assess the use of global climatological datasets for such large scale river modeling. We evaluate the utility of three global rainfall datasets to reproduce measured river discharge: the Tropical Rainfall Measuring Mission (TRMM) from NASA, the National Centers for Environmental Prediction (NCEP) reanalysis, and the World Metrological Organization (WMO) reanalysis. We use global datasets for spatial information as well: 90m DEM from the Shuttle Radar Topographic Mission, 300m GlobCover land use maps, and 1000 km FAO soil map. We find that SWAT discharge estimates match the observed streamflow well (NSE=0.40-0.66, R2=0.60-0.70) when using meteorological estimates from the NCEP reanalysis. However, SWAT estimates diverge from observed discharge when using meteorological estimates from TRMM and the WMO reanalysis.
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Attitudes of rehabilitation medicine doctors toward medical ethics in Malaysia.
Mazlina, M; Julia, P E
2011-06-01
Medical ethics issues encountered in rehabilitation medicine differ from those in an acute care setting due to the complex relationships among the parties involved in rehabilitative care. The study examined the attitudes of Malaysian rehabilitation doctors toward medical ethics issues commonly encountered during patient care. We surveyed 74 rehabilitation physicians and residents in Malaysia using a self-administered descriptive questionnaire. The questions covered medical ethics issues on allocation of resources, patient confidentiality, discharge planning, goal-setting, reimbursement documentation, decision-making capacity and withdrawal of life support. The overall response rate was 69 percent. More than 80 percent of respondents would disclose confidential information to their team members if it would affect the rehabilitation process. More than two-thirds of respondents would not allocate scarce rehabilitation resources if the functional outcome is marginally positive. Issues involving patients' autonomy in decision-making, both in life-threatening and non-life-threatening situations, showed mix responses. The least common response was on the issue of discharge planning, where 51 percent of respondents would send a patient back to a nursing home with suboptimal care if there were no other alternatives. The attitude of Malaysian rehabilitation doctors toward ethical issues is reflective of the level of maturity of rehabilitation medicine in Malaysia. Issues on allocation of resources, discharge planning and decision-making capacity are significantly influenced by limited rehabilitation facilities in parts of the country. The lack of influence from external factors, such as a developed health insurance system, contributes to the difference in attitude between rehabilitation doctors in Malaysia and those in developed countries.
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Wang, Ching-Yi; Graham, James E; Karmarkar, Amol M; Reistetter, Timothy A; Protas, Elizabeth J; Ottenbacher, Kenneth J
2014-06-01
To assess the utility of functional status in classifying patients by discharge setting after inpatient rehabilitation for hip fracture. Retrospective cohort study. A total of 1257 inpatient rehabilitation facilities in the United States. Medicare beneficiaries (N = 117,168) receiving inpatient rehabilitation for hip fracture from 2007 to 2009. Receiver operating characteristic curve analyses to assess the overall discriminatory ability of functional status scores (Functional Independence Measure [FIM] total, FIM cognition, and FIM motor) and to identify the functioning threshold that best differentiates patients by discharge setting. Discharge setting (community versus institutional). Approximately 68% of patients were discharged to the community after inpatient rehabilitation for hip fracture. Receiver operating characteristic curve analyses indicate that discharge FIM motor ratings (area under the curve: 0.84) alone are as effective as a multivariable model (area under the curve: 0.85), including sociodemographic and clinical factors, in discriminating patients discharged to the community from those discharged to an institution. A discharge FIM motor rating of 58 yielded the best balance in sensitivity and specificity for classifying patients by discharge setting. Discharge FIM motor ratings demonstrated good discriminatory ability for classifying discharge setting. An FIM motor rating of 58 may serve as a clinical tool to guide treatment plans and/or as additional information in complex discharge planning decisions for patients with hip fracture. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
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Zilberberg, Marya D; Shorr, Andrew F
2008-01-01
Background Adult patients on prolonged acute mechanical ventilation (PAMV) comprise 1/3 of all adult MV patients, consume 2/3 of hospital resources allocated to MV population, and are nearly twice as likely to require a discharge to a skilled nursing facility (SNF). Their numbers are projected to double by year 2020. To aid in planning for this growth, we projected their annualized days and costs of hospital use and SNF discharges in year 2020 in the US. Methods We constructed a model estimating the relevant components of hospital utilization. We computed the total days and costs for each component; we also applied the risk for SNF discharge to the total 2020 PAMV population. The underlying assumption was that process of care does not change over the time horizon. We performed Monte Carlo simulations to establish 95% confidence intervals (CI) for the point estimates. Results Given 2020 projected PAMV volume of 605,898 cases, they will require 3.6 (95% CI 2.7–4.8) million MV, 5.5 (95% CI 4.3–7.0) million ICU and 10.3 (95% CI 8.1–13.0) million hospital days, representing an absolute increase of 2.1 million MV, 3.2 million ICU and 6.5 million hospital days over year 2000, at a total inflation-adjusted cost of over $64 billion. Expected discharges to SNF are 218,123 (95% CI 177,268–266,739), compared to 90,928 in 2000. Conclusion Our model suggest that the projected growth in the US in PAMV population by 2020 will result in annualized increases of more than 2, 3, and 6 million MV, ICU and hospital days, respectively, over year 2000. Such growth requires careful planning efforts and attention to efficiency of healthcare delivery. PMID:19032766
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Nursing assistance at the hospital discharge after cardiac surgery: integrative review
de Jesus, Daniela Fraga; Marques, Patrícia Figueiredo
2013-01-01
The study aimed to analyze the available evidence in the literature on nursing care in the hospital post-cardiac surgery. Data were collected from electronic databases LILACS, SciELO, MEDLINE, via DeCS thoracic surgery, hospital, nursing care, in the period 2001 to 2011. Ten articles were selected that showed the need to develop a plan of nursing discharge focusing on prevention of complications and coping with physical limitations resulting from heart surgery. Thus, the discharge should be considered from the time of admission, with carefully planned actions involving patient and family. PMID:24598961
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Gabay, Gillie
2016-05-01
Although health promotion calls for patient empowerment, it is not integrated in reducing re-admissions. This study examines the link among patient perceived control, self-rated health and fewer hospital re-admissions. An empirical explorative retrospective cross-sectional study with 208 respondents aged 40-65 with poor health and identical health plans. All measures hold good psychometric properties. Self-rated health was strongly related to fewer re-admissions. Perceived control moderated the relationship between self-rated health and fewer re-admissions. Perceived control and self-rated health, together, contributed 5.2% to the variance in re-admissions. Perceived control and perceived health status each explained a different share of the variance of re-admissions. Together, these perceptions reduced re-admissions by .40. Patient-clinician communication upon discharge may be a new direction to reduce re-admissions, improve delivery of care and promote health. To reduce re-admissions, managements need to invest in restructuring the patient discharge process. A physician-patient dialogue shaping patient perceptions about their health status, perceived room for health improvement, and available internal and external resources may make a difference. Findings stress the need to allocate more time and resources for discharge communication processes and for physician training on psycho-social skills that may empower patients upon discharge. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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40 CFR 52.1988 - Air contaminant discharge permits.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 4 2010-07-01 2010-07-01 false Air contaminant discharge permits. 52... (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Oregon § 52.1988 Air contaminant... other provisions contained in Air Contaminant Discharge Permits issued by the State in accordance with...
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Manuel, Jennifer I; Lee, Jane
2017-05-30
Drug use-related visits to the emergency department (ED) can undermine discharge planning and lead to recurrent use of acute services. Yet, little is known about where patients go post discharge. We explored trends in discharge dispositions of drug-involved ED visits, with a focus on gender differences. We extracted data from the 2004-2011 Drug Abuse Warning Network, a national probability sample of drug-related visits to hospital EDs in the U.S. We computed weighted multinomial logistic regression models to estimate discharge dispositions over time and to examine associations between gender and the relative risk of discharge dispositions, controlling for patient characteristics. The final pooled sample included approximately 1.2 million ED visits between 2004 and 2011. Men accounted for more than half (57.6%) of all ED visits involving drug misuse and abuse. Compared with women, men had a greater relative risk of being released to the police/jail, being referred to outpatient detox or other treatment, and leaving against medical advice than being discharged home. The relative risk of being referred to outpatient detox/drug treatment than discharged home increased over time for men versus women. Greater understanding of gender-based factors involved in substance-related ED visits and treatment needs may inform discharge planning and preventive interventions.
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Multiple Group Counseling with Discharged Schizophrenic Adolescents and their Parents.
ERIC Educational Resources Information Center
Lurie, Abraham; Harold, Ron
Discharged adolescent schizophrenics (17) and their families participated in a pilot program of multiple group counseling, planned to help ex-patients reintegrate into the community. Patients were selected prior to discharge and randomly divided into three multiple-family groups. Each participating family had had a severe breakdown in the…
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Gaskin, Kerry L
2017-12-04
The purpose of this study was to explore parents' experiences of one specific timepoint in their infant's journey: the transition from hospital to home, following the first stage of their infant's cardiac surgery for complex congenital heart disease. A prospective longitudinal mixed methods study, underpinned with Middle Range Transition Theory (Meleis, Sawyer, Im, Hilfinger Messias, & Schumacher, 2000). Face to face and telephone interviews were conducted and self-report forms completed by parents at four-time points: before discharge (T0), 2weeks after discharge (T1), 8weeks after discharge (T2) and after stage two surgery (T3). Interviews were transcribed verbatim before inductive thematic analysis. Parents were recruited over a 15-month period from 2013 to 2015. Twelve mothers and 4 fathers took part. The infants had functionally univentricular heart (left n=10, right n=1) and a systemic shunt dependent lesion, tetralogy of Fallot (n=1). Dynamic constructivist and constructionist social processes occurred for all parents, involving physical, physiological, psychological and cognitive elements within four 'patterns of experience', two of which 'safety and security' and 'love and support' are presented in this paper. Parental support is essential; parents need to be engaged in discharge planning process and given the opportunity to express their needs to ensure that discharge care is truly patient and family centered. Transition from hospital to home was complex and multi-faceted, with unanticipated physical and emotional transitions superimposed upon those that were expected. Copyright © 2017 Elsevier Inc. All rights reserved.
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Coombs, Maureen A; Parker, Roses; de Vries, Kay
2017-07-01
Increasing importance is being placed on the coordination of services at the end of life. To describe decision-making processes that influence transitions in care when approaching the end of life. Qualitative study using field observations and longitudinal semi-structured interviews. Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand. The Supportive and Palliative Care Indicators Tool was used to identify participants with advanced and progressive illness. Patients and family members were interviewed on recruitment and 3-4 months later. Four weeks of fieldwork were conducted in each site. A total of 40 interviews were conducted: 29 initial interviews and 11 follow-up interviews. Thematic analysis was undertaken. Managing risk was an important factor that influenced transitions in care. Patients and health care staff held different perspectives on how such risks were managed. At home, patients tolerated increasing risk and used specific support measures to manage often escalating health and social problems. In contrast, decisions about discharge in hospital were driven by hospital staff who were risk-adverse. Availability of community and carer services supported risk management while a perceived need for early discharge decision making in hospital and making 'safe' discharge options informed hospital discharge decisions. While managing risk is an important factor during care transitions, patients should be able to make choices on how to live with risk at the end of life. This requires reconsideration of transitional care and current discharge planning processes at the end of life.
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Innovative applications of artificial intelligence
NASA Astrophysics Data System (ADS)
Schorr, Herbert; Rappaport, Alain
Papers concerning applications of artificial intelligence are presented, covering applications in aerospace technology, banking and finance, biotechnology, emergency services, law, media planning, music, the military, operations management, personnel management, retail packaging, and manufacturing assembly and design. Specific topics include Space Shuttle telemetry monitoring, an intelligent training system for Space Shuttle flight controllers, an expert system for the diagnostics of manufacturing equipment, a logistics management system, a cooling systems design assistant, and a knowledge-based integrated circuit design critic. Additional topics include a hydraulic circuit design assistant, the use of a connector assembly specification expert system to harness detailed assembly process knowledge, a mixed initiative approach to airlift planning, naval battle management decision aids, an inventory simulation tool, a peptide synthesis expert system, and a system for planning the discharging and loading of container ships.
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Improving medication titration in heart failure by embedding a structured medication titration plan.
Hickey, Annabel; Suna, Jessica; Marquart, Louise; Denaro, Charles; Javorsky, George; Munns, Andrew; Mudge, Alison; Atherton, John J
2016-12-01
To improve up-titration of medications to target dose in heart failure patients by improving communication from hospital to primary care. This quality improvement project was undertaken within three heart failure disease management (HFDM) services in Queensland, Australia. A structured medication plan was collaboratively designed and implemented in an iterative manner, using methods including awareness raising and education, audit and feedback, integration into existing work practice, and incentive payments. Evaluation was undertaken using sequential audits, and included process measures (use of the titration plan, assignment of responsibility) and outcome measures (proportion of patients achieving target dose) in HFDM service patients with reduced left ventricular ejection fraction. Comparison of the three patient cohorts (pre-intervention cohort A n=96, intervention cohort B n=95, intervention cohort C n=89) showed increase use of the titration plan, a shift to greater primary care responsibility for titration, and an increase in the proportion of patients achieving target doses of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) (A 37% vs B 48% vs C 55%, p=0.051) and beta-blockers (A 38% vs B 33% vs C 51%, p=0.045). Combining all three cohorts, patients not on target doses when discharged from hospital were more likely to achieve target doses of ACEI/ARB (p<0.0001) and beta blockers (p<0.0001) within six months if they received a medication titration plan. A medication titration plan was successfully implemented in three HFDM services and improved transitional communication and achievement of target doses of evidence-based therapies within six months of hospital discharge. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Singh, R.K.; Chowdhury, S.
The aim of this paper is to access the influence of water quality both on the occurrence of, and utilization by, elephants (Elephas maximus) in a riverine habitat. Mining operations and other anthropogenic changes to natural river systems have caused degradation of the ecosystem for elephants. A decline in their numbers has been seen throughout the Singhbhum Forests, India due to fragmentation and loss of habitat. The need to preserve and restore the habitat of the elephant is accepted, but until the factors that influence their distribution are known and understood, suitable management plans cannot be implemented. The study areamore » was the catchment of the river Koina where waste discharge from an iron oremine and processing plant impact upon water quality. The study period from April 1995 to March 1996 looked at sections of the river where unregulated mine discharge was made, and where regulation through tailing ponds controlled total suspended solids (TSS) output from the mine waste water to the river system. Various physico-chemical parameters recorded at seven sampling stations were quantified. Principal Component Analysis (PCA) segregated the key parameters in determining the discharge levels of both regulated and unregulated discharge at various sites.« less
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Communication between hospitals and isolated aboriginal community health clinics.
Mackenzie, G; Currie, B J
1999-04-01
This study described the communication dynamics, identified problems and recommended changes to improve patient follow-up and communication between Royal Darwin Hospital (RDH) and isolated Aboriginal community health clinics (CHC) in the Northern Territory (NT). In 1995, staff interviews were conducted and an audit of isolated Aboriginal patients' RDH discharge summaries (DS). Eighteen per cent of RDH DSs never arrived in CHCs. DSs were often prepared late and more likely to be in CHC records if written on time and if the referral source was specified. Interviews revealed discontent between CHCs and RDH regarding: communication, DS documentation, the supply of discharge medication, as well as different hospital and community perceptions of Aboriginies' reliability to carry a DS and CHC desire for patients to be given DSs at discharge. Aboriginal patients should be given a DS at discharge and resident medical officers should be educated as to the function and importance of the DS. In 18 months following this study, RDH appointed unit-based Aboriginal health workers and a policy was produced for written communication between hospital and CHCs, as well as a discharge planning manual for Aboriginal communities. Projects investigating communication between hospitals and isolated Aboriginal clinics and patient follow-up may result in significant policy changes concerning these processes.
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Planning primary health-care services for South Australian young offenders: a preliminary study.
Wilson, Anne
2007-10-01
Although many young offenders receive health care during periods of detention, addressing their health needs after release from secure care is a key strategy for successful rehabilitation and reintegration into the community. The purpose of this preliminary study was to examine current discharge planning practices for young offenders in Youth Training Centres in South Australia with a view to improving offenders' connection with primary health-care services on discharge. To determine the strengths and weaknesses of current discharge planning practices, this exploratory study involved in-depth review of literature and a semistructured focus group of stakeholders. Findings were discussed with an expert advisory group before final recommendations were made. This study identified a service model approach to discharge planning that recommended a nurse located within the Divisions of General Practice as the coordinator. The study found that trusted staff in detention centres, with an awareness of services available in the location of release, influence young offenders' decision-making in relation to health-care services. Awareness and recognition of young offenders' health beyond periods of juvenile detention and into their adult lives is valuable in that it has the potential to establish lifelong healthy behaviours. Bonding with young offenders and gaining their trust increases their likelihood of attending primary health-care services.
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Older veterans and emergency department discharge information.
Hastings, Susan; Stechuchak, Karen; Oddone, Eugene; Weinberger, Morris; Tucker, Dana; Knaack, William; Schmader, Kenneth
2012-10-01
Study goals were to assess older veterans' understanding of their emergency department (ED) discharge information and to determine the association between understanding discharge information and patient assessment of overall quality of care. Telephone interviews were conducted with 305 patients aged 65 or older (or their proxies) within 48 h of discharge from a Veterans Affairs Medical Center ED. Patients were asked about their perceived understanding (at the time of ED discharge) of information about their ED diagnosis, expected course of illness, contingency plan (ie, return precautions, who to call if it got worse, potential medication side effects) and follow-up care. Overall quality of ED care was rated on a four-point scale of poor, fair, good or excellent. Patients or their proxies reported not understanding information about their ED diagnosis (21%), expected course of illness (50%), contingency plan (43%), and how soon they needed to follow-up with their primary care provider (25%). In models adjusted for age and race, a positive association was observed between perceived understanding of the cause of the problem (OR 2.3; 95% CI 1.3 to 4.0), expected duration of symptoms (OR 1.6; 95% CI 1.0 to 2.5) and the contingency plan (OR 2.2; CI 1.3 to 3.4), and rating overall ED care as excellent. Older veterans may not understand key items of information at the time ED discharge, and this may have an impact on how they view the quality of ED care. Strategies are needed to improve communication of ED discharge information to older veterans and their families.
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Simmons, Sandra F; Schnelle, John F; Saraf, Avantika A; Simon Coelho, Chris; Jacobsen, J Mary Lou; Kripalani, Sunil; Bell, Susan; Mixon, Amanda; Vasilevskis, Eduard E
2016-12-01
Approximately 20% of hospitalized Medicare beneficiaries are discharged from the hospital to skilled nursing facilities (SNFs); and up to 23% of SNF patients return to the hospital within 30 days of hospital discharge, with pain as one of the most common symptoms precipitating hospital readmission. We sought to examine the prevalence of moderate to severe pain at hospital discharge to SNF, the incidence of new moderate to severe pain (relative to prehospitalization), and satisfaction with pain management among older acute care patients discharged to SNF. Structured patient interviews were conducted with 188 Medicare beneficiaries discharged to 23 area SNFs from an academic medical center. Pain level (0-10) and satisfaction with pain management were assessed upon hospital admission, discharge, and within 1 week after transition to SNF. There was a high prevalence of moderate to severe pain at each time point including prehospital (51%), hospital discharge (38%), and following SNF admission (53%). Twenty-eight percent of participants reported new moderate to severe pain at hospital discharge, whereas 44% reported new moderate to severe pain following SNF admission. Most participants reported being "satisfied" with their pain treatment, even in the context of moderate to severe pain. Moderate to severe pain is a common problem among hospitalized older adults discharged to SNF and continues during their SNF stay. Pain assessment and management should involve a specific, planned process between hospital and SNF clinicians at the point of care transition, even if patients express "satisfaction" with current pain management. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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The utility of the functional independence measure (FIM) in discharge planning for burn patients.
Choo, Benji; Umraw, Nisha; Gomez, Manuel; Cartotto, Robert; Fish, Joel S
2006-02-01
Determining burn patients' need for inpatient rehabilitation at discharge is difficult and an objective clinical indicator might aid in this decision. The functional independence measure (FIM) is a validated outcome measure that predicts the need for rehabilitation services. This study evaluated the utility of the FIM score for discharge planning in burn patients. A retrospective chart review and FIM score determination was performed on all major burn patients discharged from a regional adult burn centre between July 1, 1999 and June 30, 2000. From 164 adult burn patients discharged, 37 met the American Burn Association criteria for major burns. One patient had insufficient data. Therefore, 36 patients were studied (mean age 47.3 +/- 17.4 years, and mean body area burned 27.4 +/- 12.9%). All 17 patients with FIM scores greater than 110 were discharged home, and patients with FIM score of 110 or lower were discharged to another institution (rehabilitation hospital n = 14, other acute care hospital n = 4, or a nursing home n = 1) p < 0.0001. A discharge FIM score of 110 or lower was strongly associated with the need for inpatient rehabilitation, while a FIM score greater than 110 indicates the patient is independent enough to manage at home. Further prospective studies will be necessary to validate these findings.
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ERIC Educational Resources Information Center
Altfeld, Susan J.; Shier, Gayle E.; Rooney, Madeleine; Johnson, Tricia J.; Golden, Robyn L.; Karavolos, Kelly; Avery, Elizabeth; Nandi, Vijay; Perry, Anthony J.
2013-01-01
Purpose of the Study: To identify needs encountered by older adult patients after hospital discharge and assess the impact of a telephone transitional care intervention on stress, health care utilization, readmissions, and mortality. Design and Methods: Older adult inpatients who met criteria for risk of post-discharge complications were…
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The English Translation and Testing of the Problems after Discharge Questionnaire
ERIC Educational Resources Information Center
Holland, Diane E.; Mistiaen, Patriek; Knafl, George J.; Bowles, Kathryn H.
2011-01-01
The quality of hospital discharge planning assessments determines whether patients receive the health and social services they need or are sent home with unmet needs and without services. There is a valid and reliable Dutch instrument that measures problems and unmet needs patients encounter after discharge. This article describes the translation…
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Prioritising and planning of urban stormwater treatment in the Alna watercourse in Oslo.
Nordeidet, B; Nordeide, T; Astebøl, S O; Hvitved-Jacobsen, T
2004-12-01
The Oslo municipal Water and Sewage Works (VAV) intends to improve the water quality in the Alna watercourse, in particular, with regards to the biological diversity. In order to reduce existing discharges of polluted urban stormwater, a study has been carried out to rank subcatchment areas in descending order of magnitude and to assess possible measures. An overall ranking methodology was developed in order to identify and select the most suitable subcatchment areas for further assessment studies (74 subcatchment/drainage areas). The municipality's comprehensive geographical information system (GIS) was applied as a base for the ranking. A weighted ranking based on three selected parameters was chosen from several major influencing factors, namely total yearly discharge (kg pollution/year), specific pollution discharge (kg/area/year) and existing stormwater system (pipe lengths/area). Results show that the highest 15 ranked catchment areas accounted for 70% of the total calculated pollution load of heavy metals. The highest ranked areas are strongly influenced by three major highways. Based on the results from similar field studies, it would be possible to remove 75-85% of total solids and about 50-80% of heavy metals using wet detention ponds as Best Available Technology (BAT). Based on the final ranking, two subcatchment areas were selected for further practical assessment of possible measures. VAV plans to use wet detention ponds, in combination with other measures when relevant, to treat the urban runoff. Using calculated loading and aerial photographs (all done in the same GIS environment), a preliminary sketch design and location of ponds were performed. The resulting GIS methodology for urban stormwater management will be used as input to a holistic and long-term planning process for the management of the watercourse, taking into account future urban development and other pollution sources.
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Dolan, R; Broadbent, P
2016-02-01
Ward round documentation provides one of the most important means of communication between healthcare professionals. We aimed to establish if the use of a problem based standardised proforma can improve documentation in acute surgical receiving. Gold standards were established using the RCSE record keeping guidelines. We audited documentation for seven days using the following headings: patient name/identification number, subjective findings, objective findings, clinical impression/diagnosis, plan, diet status, discharge decision, discharge planning, signature, and grade. After the initial audit cycle, a ward round proforma was introduced using the above headings and re-audited over a seven day period. The pre-intervention arm contained 50 patients and the post intervention arm contained 47. The following headings showed an improvement in documentation compliance to 100%: patient name/identification number vs 96%, subjective findings vs 84%, objective findings vs 48%, plan vs 98%, signature vs 96%, and grade vs 62%. Documentation of the clinical impression/diagnosis improved to 98% vs 30%, diet status rose to 83% vs 16%, discharge decision to 66% vs 16%, and discharge planning to 40% vs 20%. Standardised proformas improve the documentation of post-take ward round notes. This helps to clarify the onward management plan for all aspects of a patient's care and will help avoid adverse events and litigation. This should improve the quality and safety of Patient Care.
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Planning an outing from hospital for ventilator-dependent children.
Gilgoff, I S; Helgren, J
1992-10-01
Returning ventilator-dependent children to the home environment has become a well-accepted occurrence. The success of a home program depends on careful pre-discharge planning in order to ensure the child's medical safety, and adequate preparation to ensure the child's and family's adjustment to an active community life after discharge. To achieve this, involvement in community activities must begin while the child is still in hospital. As part of a complete rehabilitation program, nine ventilator-dependent children were taken on an inpatient outing to Disneyland. The planning and goals of the outing are described.
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Reporting of Sepsis Cases for Performance Measurement Versus for Reimbursement in New York State.
Prescott, Hallie C; Cope, Tara M; Gesten, Foster C; Ledneva, Tatiana A; Friedrich, Marcus E; Iwashyna, Theodore J; Osborn, Tiffany M; Seymour, Christopher W; Levy, Mitchell M
2018-05-01
Under "Rory's Regulations," New York State Article 28 acute care hospitals were mandated to implement sepsis protocols and report patient-level data. This study sought to determine how well cases reported under state mandate align with discharge records in a statewide administrative database. Observational cohort study. First 27 months of mandated sepsis reporting (April 1, 2014, to June 30, 2016). Hospitalizations with sepsis at New York State Article 28 acute care hospitals. Sepsis regulations with mandated reporting. We compared cases reported to the New York State Department of Health Sepsis Clinical Database with discharge records in the Statewide Planning and Research Cooperative System database. We classified discharges as 1) "coded sepsis discharges"-a diagnosis code for severe sepsis or septic shock and 2) "possible sepsis discharges," using Dombrovskiy and Angus criteria. Of 111,816 sepsis cases reported to the New York State Department of Health Sepsis Clinical Database, 105,722 (94.5%) were matched to discharge records in Statewide Planning and Research Cooperative System. The percentage of coded sepsis discharges reported increased from 67.5% in the first quarter to 81.3% in the final quarter of the study period (mean, 77.7%). Accounting for unmatched cases, as many as 82.7% of coded sepsis discharges were potentially reported, whereas at least 17.3% were unreported. Compared with unreported discharges, reported discharges had higher rates of acute organ dysfunction (e.g., cardiovascular dysfunction 63.0% vs 51.8%; p < 0.001) and higher in-hospital mortality (30.2% vs 26.1%; p < 0.001). Hospital characteristics (e.g., number of beds, teaching status, volume of sepsis cases) were similar between hospitals with a higher versus lower percent of discharges reported, p values greater than 0.05 for all. Hospitals' percent of discharges reported was not correlated with risk-adjusted mortality of their submitted cases (Pearson correlation coefficient 0.11; p = 0.17). Approximately four of five discharges with a diagnosis code of severe sepsis or septic shock in the Statewide Planning and Research Cooperative System data were reported in the New York State Department of Health Sepsis Clinical Database. Incomplete reporting appears to be driven more by underrecognition than attempts to game the system, with minimal bias to risk-adjusted hospital performance measurement.
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Effective discharge analysis of ecological processes in streams
Doyle, Martin W.; Stanley, Emily H.; Strayer, David L.; Jacobson, Robert B.; Schmidt, John C.
2005-01-01
Discharge is a master variable that controls many processes in stream ecosystems. However, there is uncertainty of which discharges are most important for driving particular ecological processes and thus how flow regime may influence entire stream ecosystems. Here the analytical method of effective discharge from fluvial geomorphology is used to analyze the interaction between frequency and magnitude of discharge events that drive organic matter transport, algal growth, nutrient retention, macroinvertebrate disturbance, and habitat availability. We quantify the ecological effective discharge using a synthesis of previously published studies and modeling from a range of study sites. An analytical expression is then developed for a particular case of ecological effective discharge and is used to explore how effective discharge varies within variable hydrologic regimes. Our results suggest that a range of discharges is important for different ecological processes in an individual stream. Discharges are not equally important; instead, effective discharge values exist that correspond to near modal flows and moderate floods for the variable sets examined. We suggest four types of ecological response to discharge variability: discharge as a transport mechanism, regulator of habitat, process modulator, and disturbance. Effective discharge analysis will perform well when there is a unique, essentially instantaneous relationship between discharge and an ecological process and poorly when effects of discharge are delayed or confounded by legacy effects. Despite some limitations the conceptual and analytical utility of the effective discharge analysis allows exploring general questions about how hydrologic variability influences various ecological processes in streams.
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Integrated modeling of temperature and rotation profiles in JET ITER-like wall discharges
NASA Astrophysics Data System (ADS)
Rafiq, T.; Kritz, A. H.; Kim, Hyun-Tae; Schuster, E.; Weiland, J.
2017-10-01
Simulations of 78 JET ITER-like wall D-D discharges and 2 D-T reference discharges are carried out using the TRANSP predictive integrated modeling code. The time evolved temperature and rotation profiles are computed utilizing the Multi-Mode anomalous transport model. The discharges involve a broad range of conditions including scans over gyroradius, collisionality, and values of q95. The D-T reference discharges are selected in anticipation of the D-T experimental campaign planned at JET in 2019. The simulated temperature and rotation profiles are compared with the corresponding experimental profiles in the radial range from the magnetic axis to the ρ = 0.9 flux surface. The comparison is quantified by calculating the RMS deviations and Offsets. Overall, good agreement is found between the profiles produced in the simulations and the experimental data. It is planned that the simulations obtained using the Multi-Mode model will be compared with the simulations using the TGLF model. Research supported in part by the US, DoE, Office of Sciences.
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Plans for a sensitivity analysis of bridge-scour computations
Dunn, David D.; Smith, Peter N.
1993-01-01
Plans for an analysis of the sensitivity of Level 2 bridge-scour computations are described. Cross-section data from 15 bridge sites in Texas are modified to reflect four levels of field effort ranging from no field surveys to complete surveys. Data from United States Geological Survey (USGS) topographic maps will be used to supplement incomplete field surveys. The cross sections are used to compute the water-surface profile through each bridge for several T-year recurrence-interval design discharges. The effect of determining the downstream energy grade-line slope from topographic maps is investigated by systematically varying the starting slope of each profile. The water-surface profile analyses are then used to compute potential scour resulting from each of the design discharges. The planned results will be presented in the form of exceedance-probability versus scour-depth plots with the maximum and minimum scour depths at each T-year discharge presented as error bars.
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Efficacy of a Transition Theory-Based Discharge Planning Program for Childhood Asthma Management.
Ekim, Ayfer; Ocakci, Ayse Ferda
2016-02-01
This study tested the efficacy of a nurse-led discharge planning program for childhood asthma management, based on transition theory. A quasi-experimental design was used. The sample comprised 120 children with asthma and their parents (intervention group n = 60, control group n = 60). The asthma management self-efficacy perception level of parents in the intervention group increased significantly and the number of triggers their children were exposed to at home was reduced by 60.8%. The rates of admission to emergency departments and unscheduled outpatient visits were significantly lower in the intervention group compared with the control group. Transition theory-based nursing interventions can provide successful outcomes on childhood asthma management. Transition theory-based discharge planning program can guide nursing interventions to standardize care of the child with asthma. Combining care at home with hospital care strengthens ongoing qualified asthma management. © 2015 NANDA International, Inc.
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Lu, Minmin; Tang, Jun; Wu, Jianjin; Yang, Jie; Yu, Jiangyue
2015-08-14
Acute coronary syndromes threaten the lives of patients, and pose a high risk for morbidity and mortality despite advances in treatment. Evidence highlights that effective discharge planning is associated with long-term prognosis of patients. The aim of this project was to improve local practice in discharge planning for acute coronary syndrome patients in Huadong Hospital, Shanghai. Five criteria identified by the Joanna Briggs Institute were used to conduct an audit in the Cardiovascular Ward and Coronary Care Unit of Huadong Hospital, Shanghai. Forty-two nurses and 65 patients were involved. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in health practice were used to ascertain compliance with the criteria before and after the implementation of best practice. The program included three phases and was conducted over five months. The project showed that the compliance rates of in-house education, advice on lifestyle changes, education on discharge medication and left ventricular assessment reached 100%. Psychological screening also attained 97% compliance. There were improvements in the compliance rates of four criteria from 38% to 100%, excluding in-house education which was already 100% compliant. The project achieved significant improvements in establishing evidence-based practice of discharge planning for acute coronary syndrome patients in the Cardiovascular Ward and Coronary Care Unit. Strategies for sustaining best practice will continue to be developed in the future. The Joanna Briggs Institute.
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Redesigning the ICU nursing discharge process: a quality improvement study.
Chaboyer, Wendy; Lin, Frances; Foster, Michelle; Retallick, Lorraine; Panuwatwanich, Kriengsak; Richards, Brent
2012-02-01
To evaluate the impact of a redesigned intensive care unit (ICU) nursing discharge process on ICU discharge delay, hospital mortality, and ICU readmission within 72 hours. A quality improvement study using a time series design and statistical process control analysis was conducted in one Australian general ICU. The primary outcome measure was hours of discharge delay per patient discharged alive per month, measured for 15 months prior to, and for 12 months after the redesigned process was implemented. The redesign process included appointing a change agent to facilitate process improvement, developing a patient handover sheet, requesting ward staff to nominate an estimated transfer time, and designing a daily ICU discharge alert sheet that included an expected date of discharge. A total of 1,787 ICU discharges were included in this study, 1,001 in the 15 months before and 786 in the 12 months after the implementation of the new discharge processes. There was no difference in in-hospital mortality after discharge from ICU or ICU readmission within 72 hours during the study period. However, process improvement was demonstrated by a reduction in the average patient discharge delay time of 3.2 hours (from 4.6 hour baseline to 1.0 hours post-intervention). Involving both ward and ICU staff in the redesign process may have contributed to a shared situational awareness of the problems, which led to more timely and effective ICU discharge processes. The use of a change agent, whose ongoing role involved follow-up of patients discharged from ICU, may have helped to embed the new process into practice. ©2011 Sigma Theta Tau International.
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Rossetto, Jorge
2009-01-01
Since 2004, a profound transformation of the asylum care model, characterized by overcrowding, lack of discharge and absence of rehabilitation programs, and social reinsertion, has been developed at National Colony "Dr. Manuel A. Montes de Oca". During this period, a plan that contemplates several programs and projects aimed at restoring the rights of institutionalized people with mental disabilities and promoting opportunities for social inclusion has been implemented.
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Code of Federal Regulations, 2010 CFR
2010-07-01
... drainage from diked storage areas by valves to prevent a discharge into the drainage system or facility... facility drainage systems from undiked areas with a potential for a discharge (such as where piping is... pumps. Whatever techniques you use, you must engineer facility drainage systems to prevent a discharge...
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Code of Federal Regulations, 2011 CFR
2011-07-01
... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What solid and liquid wastes and discharges... of Exploration Plans (ep) § 250.217 What solid and liquid wastes and discharges information and cooling water intake information must accompany the EP? The following solid and liquid wastes and...
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Venkatasalu, Munikumar Ramasamy; Clarke, Amanda; Atkinson, Joanne
2015-06-01
To explore and critically examine stakeholders' views and perceptions concerning the nurse-led Palliative Care Discharge Service in an acute hospital setting and to inform sustainability, service development and future service configuration. The drive in policy and practice is to enable individuals to achieve their preferred place of care during their last days of life. However, most people in UK die in acute hospital settings against their wishes. To facilitate individuals' preferred place of care, a large acute hospital in northeast England implemented a pilot project to establish a nurse-led Macmillan Palliative Care Discharge Facilitator Service. A pluralistic evaluation design using qualitative methods was used to seek stakeholders' views and perceptions of this service. In total, 12 participants (five bereaved carers and seven health professionals) participated in the evaluation. Semi-structured interviews were conducted with bereaved carers who used this service for their relatives. A focus group and an individual interview were undertaken with health professionals who had used the service since its inception. Individual interviews were also conducted with the Discharge Facilitator and service manager. Analysis of all data was guided by Framework Analysis. Four key themes emerged relating to the role of the Discharge Facilitator Service: achieving preferred place of care; the Discharge Facilitator as the 'conduit' between hospital and community settings; delays in hospital discharge and stakeholders' perceptions of the way forward for the service. The Discharge Facilitator Service acted as a reliable resource and support for facilitating the fast-tracking of end-of-life patients to their preferred place of care. Future planning for hospital-based palliative care discharge facilitating services need to consider incorporating strategies that include: increased profile of the service, expansion of service provision and the Discharge Facilitator's earlier involvement in the discharge process. © 2015 John Wiley & Sons Ltd.
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Cadilhac, Dominique A; Andrew, Nadine E; Lannin, Natasha A; Middleton, Sandy; Levi, Christopher R; Dewey, Helen M; Grabsch, Brenda; Faux, Steve; Hill, Kelvin; Grimley, Rohan; Wong, Andrew; Sabet, Arman; Butler, Ernest; Bladin, Christopher F; Bates, Timothy R; Groot, Patrick; Castley, Helen; Donnan, Geoffrey A; Anderson, Craig S
2017-04-01
Uncertainty exists over whether quality improvement strategies translate into better health-related quality of life (HRQoL) and survival after acute stroke. We aimed to determine the association of best practice recommended interventions and outcomes after stroke. Data are from the Australian Stroke Clinical Registry during 2010 to 2014. Multivariable regression was used to determine associations between 3 interventions: received acute stroke unit (ASU) care and in various combinations with prescribed antihypertensive medication at discharge, provision of a discharge care plan, and outcomes of survival and HRQoL (EuroQoL 5-dimensional questionnaire visual analogue scale) at 180 days, by stroke type. An assessment was also made of outcomes related to the number of processes patients received. There were 17 585 stroke admissions (median age 77 years, 47% female; 81% managed in ASUs; 80% ischemic stroke) from 42 hospitals (77% metropolitan) assessed. Cumulative benefits on outcomes related to the number of care processes received by patients. ASU care was associated with a reduced likelihood of death (hazard ratio, 0.49; 95% confidence interval, 0.43-0.56) and better HRQoL (coefficient, 21.34; 95% confidence interval, 15.50-27.18) within 180 days. For those discharged from hospital, receiving ASU+antihypertensive medication provided greater 180-day survival (hazard ratio, 0.45; 95% confidence interval, 0.38-0.52) compared with ASU care alone (hazard ratio, 0.64; 95% confidence interval, 0.54-0.76). HRQoL gains were greatest for patients with intracerebral hemorrhage who received care bundles involving discharge processes (range of increase, 11%-19%). Patients with stroke who receive best practice recommended hospital care have improved long-term survival and HRQoL. © 2017 American Heart Association, Inc.
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Rossitsa River Basin: Flood Hazard and Risk Identification
NASA Astrophysics Data System (ADS)
Mavrova-Guirguinova, Maria; Pencheva, Denislava
2017-04-01
The process of Flood Risk Management Planning and adaptation of measures for flood risk reduction as the Early Warning provoke the necessity of surveys involving Identification aspects. This project presents risk identification combining two lines of analysis: (1) Creation a mathematical model of rainfall-runoff processes in a watershed based on limited number of observed input and output variables; (2) Procedures for determination of critical thresholds - discharges/water levels corresponding to certain consequences. The pilot region is Rossitsa river basin, Sevlievo, Bulgaria. The first line of analysis follows next steps: (a) Creation and calibration of Unit Hydrograph Models based on limited number of observed data for discharge and precipitation; The survey at the selected region has 22 observations for excess rainfall and discharge. (b) The relations of UHM coefficients from the input parameters have been determined statistically, excluding the ANN model of the run-off coefficient as a function of 3 parameters (amount of precipitation two days before, soil condition, intensity of the rainfall) where a feedforward neural network is used. (c) Additional simulations with UHM aiming at generation of synthetic data for rainfall-runoff events, which extend the range of observed data; (d) Training, validation and testing a generalized regional ANN Model for discharge forecasting with 4 input parameters, where the training data set consists of synthetic data, validation and testing data sets consists of observations. A function between consequences and discharges has been reached in the second line of analysis concerning critical hazard levels determination. Unsteady simulations with the hydraulic model using three typical hydrographs for determination of the existing time for reaction from one to upper critical threshold are made. Correction of the critical thresholds aiming at providing necessary time for reaction between the thresholds and probability analysis of the finally determined critical thresholds are made. The result of the described method is a Catalogue for off-line flood hazard and risk identification. It can be used as interactive computer system, based on simulations of the ANN "Catalogue". Flood risk identification of the future rainfall event is made in a multi-dimensional space for each kind of soil conditions (dry, average wet and wet condition) and observed amount of precipitation two days before. Rainfall-runoff scenarios in case of intensive rainfall or sustained rainfall (more than 6 hours) are taken into account. Critical thresholds and hazard zones needed of specific operative activities (rescue and recovery) corresponded to each of the regulated flood protection levels (unite, municipality, regional or national) are presented. The Catalogue gives the opportunity for flood hazard scenarios extraction. Regarding that, the Catalogue is useful on the prevention stage of flood protection planning (emergency operations, measures and resources for their implementation planning) and creation of scenarios for training the Emergency Plans. Concerning application for Early Warning, it gives approximate forecast for flood hazard. The Catalogue supplies the necessary time for reaction of about 24 hours. Thus, Early Warning is possible to the responsible authorities, all parts if the Unified Rescue System, members of suitable Headquarters for disaster protection (on municipality, region or national level).
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The 1965 Mississippi River flood in Iowa
Schwob, Harlan H.; Myers, Richard E.
1965-01-01
Flood data compiled for the part of the River along the eastern border include flood discharges, flood elevations, and the frequency of floods of varying magnitudes. They also include the daily or more frequent stage and discharge data for both the Mississippi River and the downstream gaging stations on Iowa tributaries for the period March-May 1965. Sufficient data are presented to permit studied for preparation of plans for protective works and plans for zoning or for flood plain regulation.
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-12-27
... develop standards for wastewater discharges produced by natural gas extraction from underground coalbed and shale formations as well as mercury discharges from dental offices. EPA is also accepting...
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Wong, Eliza Mi Ling; Lo, Shuk Man; Ng, Ying Chu; Lee, Larry Lap Yip; Yuen, T M Y; Chan, Jimmy Tak Shing; Chair, Sek Ying
2016-07-01
To evaluate the effectiveness of a discharge program for patients with chronic obstructive pulmonary disease (COPD) patients on discharge from an emergency medical ward on discharge home rate, hospital length of stay (LOS), inpatient admission rate and cost. Frequent visits to the emergency department (ED) and subsequent hospital admission are common among patients with COPD, which adds a burden to ED and hospital care. A discharge program was implemented in an ED emergency medical ward. The program consisted of multidisciplinary care, discharge planning, discharge health education on disease management, and continued support from the community nursing services. A retrospective case-control study was used. Data were retrieved and compared between 478 COPD program cases and 478 COPD non-program cases. No significant difference was found in age, gender, and triage category, LOS in ED, and readmission rate between the program and non-program groups. The program group demonstrated a significantly higher discharge home rate from the ED (33.89% vs. 20.08%) and fewer medical admissions (40.59% vs. 55.02%) compared with the non-program group, resulting in lower total medical costs after the program was implemented. The program provides insight on the strategic planning for discharge care in a short stay unit of emergency department. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Focus on patient safety all day, every day.
2015-06-01
Case managers may think their job doesn't involve patient safety, but they promote safety by ensuring a safe discharge and are in a position to see safety breaches and mistakes all over the hospital. CMS includes discharge planning in its worksheets for surveyors to use to assess a hospital's compliance with Medicare Conditions of Participation. Because they work with patients from admission to discharge, case managers know which clinicians are competent, those who are not, and may observe safety breaches like failure to wash hands and leaving the catheter in too long. Case managers should spend enough time with their patients to know their situations at home and their support systems and use the information to create workable and safe discharge plans. Hospitals should create an environment and a culture where case managers and other clinicians feel comfortable speaking up when they see safety breaches.
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Salt Storage Fact Sheet QUICK LINKS 2015-2019 Strategic Action Plan 2010-2014 Strategic Action Plan 2006 Strategic Action Plan OWRC Bylaws For More Information Brian Hall OWRC - State Agency Coordinating Program (Indirect Discharge) Primary Headwater Habitat Streams Remedial Action Plans (RAP) River Mile Maps
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30 CFR 254.21 - How must I format my response plan?
Code of Federal Regulations, 2010 CFR
2010-07-01
... divide your response plan for OCS facilities into the sections specified in paragraph (b) and explained in the other sections of this subpart. The plan must have an easily found marker identifying each.... (ii) Contractual agreements. (iii) Worst case discharge scenario. (iv) Dispersant use plan. (v) In...
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MacWilliams, Kate; Curran, Janet; Racek, Jakub; Cloutier, Paula; Cappelli, Mario
2017-12-01
This study sought to identify barriers and facilitators to the implementation of the HEADS-ED, a screening tool appropriate for use in the emergency department (ED) that facilitates standardized assessments, discharge planning, charting, and linking pediatric mental health patients to appropriate community resources. A qualitative theory-based design was used to identify barriers and facilitators to implementing the HEADS-ED tool. Focus groups were conducted with participants recruited from 6 different ED settings across 2 provinces (Ontario and Nova Scotia). The Theoretical Domains Framework was used as a conceptual framework to guide data collection and to identify themes from focus group discussions. The following themes spanning 12 domains were identified as reflective of participants' beliefs about the barriers and facilitators to implementing the HEADS-ED tool: knowledge, skills, beliefs about capabilities, social professional role and identity, optimism, beliefs about consequences, reinforcement, environmental context and resources, social influences, emotion, behavioral regulation and memory, and attention and decision process. The HEADS-ED has the potential to address the need for better discharge planning, complete charting, and standardized assessments for the increasing population of pediatric mental health patients who present to EDs. This study has identified potential barriers and facilitators, which should be considered when developing an implementation plan for adopting the HEADS-ED tool into practice within EDs.
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19 CFR 151.28 - Gauging of sirup or molasses discharged into storage tanks.
Code of Federal Regulations, 2011 CFR
2011-04-01
... 19 Customs Duties 2 2011-04-01 2011-04-01 false Gauging of sirup or molasses discharged into... Sugars, Sirups, and Molasses § 151.28 Gauging of sirup or molasses discharged into storage tanks. (a) Plans of storage tank to be filed. When sirup or molasses is imported in bulk in tank vessels and is to...
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2007 SB14 Source Reduction Plan/Report
DOE Office of Scientific and Technical Information (OSTI.GOV)
Chang, L
2007-07-24
Aqueous solutions (mixed waste) generated from various LLNL operations, such as debris washing, sample preparation and analysis, and equipment maintenance and cleanout, were combined for storage in the B695 tank farm. Prior to combination the individual waste streams had different codes depending on the particular generating process and waste characteristics. The largest streams were CWC 132, 791, 134, 792. Several smaller waste streams were also included. This combined waste stream was treated at LLNL's waste treatment facility using a vacuum filtration and cool vapor evaporation process in preparation for discharge to sanitary sewer. Prior to discharge, the treated waste streammore » was sampled and the results were reviewed by LLNL's water monitoring specialists. The treated solution was discharged following confirmation that it met the discharge criteria. A major source, accounting for 50% for this waste stream, is metal machining, cutting and grinding operations in the engineering machine shops in B321/B131. An additional 7% was from similar operations in B131 and B132S. This waste stream primarily contains metal cuttings from machined parts, machining coolant and water, with small amounts of tramp oil from the machining and grinding equipment. Several waste reduction measures for the B321 machine shop have been taken, including the use of a small point-of-use filtering/tramp-oil coalescing/UV-sterilization coolant recycling unit, and improved management techniques (testing and replenishing) for coolants. The recycling unit had some operational problems during 2006. The machine shop is planning to have it repaired in the near future. A major source, accounting for 50% for this waste stream, is metal machining, cutting and grinding operations in the engineering machine shops in B321/B131. An additional 7% was from similar operations in B131 and B132S. This waste stream primarily contains metal cuttings from machined parts, machining coolant and water, with small amounts of tramp oil from the machining and grinding equipment. Several waste reduction measures for the B321 machine shop have been taken, including the use of a small point-of-use filtering/tramp-oil coalescing/UV-sterilization coolant recycling unit, and improved management techniques (testing and replenishing) for coolants. The recycling unit had some operational problems during 2006. The machine shop is planning to have it repaired in the near future. Quarterly waste generation data prepared by the Environmental Protection Department's P2 Team are regularly provided to engineering shops as well as other facilities so that generators can track the effectiveness of their waste minimization efforts.« less
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Safety and feasibility of endovascular aortic aneurysm repair as day surgery.
Hanley, Stephen C; Steinmetz, Oren; Mathieu, Eva S; Obrand, Daniel; Mackenzie, Kent; Corriveau, Marc-Michel; Abraham, Cherrie Z; Gill, Heather L
2018-06-01
The adoption of endovascular aneurysm repair (EVAR) during the past two decades has led to significantly shorter length of stay as well as lower hospital resource use. Currently, most patients are admitted to the hospital after EVAR; however, there are no standard observation periods, and timing of discharge is based on clinical judgment. The aim of this study was to confirm the safety and feasibility of performing EVAR as outpatient surgery. We developed criteria to identify patients for potential same-day discharge (infrarenal aneurysm, low perioperative risk, to be accompanied for first 24 hours). We then implemented a prospective trial that observed patients planned for same-day discharge and compared them with a historical control group (patients who had undergone EVAR during the previous 2 years and met same-day discharge criteria). Basic demographic and operative data as well as length of stay, inpatient and perioperative complications, emergency department visits, readmissions, reinterventions, and deaths were collected. The primary outcome was the 30-day complication rate, and the study was powered to assess noninferiority. Prospectively, we assessed 266 patients and planned 110 (41%) for outpatient EVAR (62% of historical controls met outpatient criteria). Demographic characteristics were similar between planned outpatients and historical controls. In planned outpatients, hospital stay was significantly shorter (0.7 ± 2.6 days vs 2.5 ± 6.9 days; P < .01), and 79% were discharged the same day of surgery. The 30-day follow-up was available for all study patients and 94% of control patients; there were no differences in complication (11% vs 9%), readmission (2% vs 4%), reintervention (4% vs 4%), or mortality (1% vs 1%) rates, but study patients had significantly more emergency department visits (15% vs 6%; P < .05). Unsuccessful same-day discharge was associated with longer operative times, increased blood loss, and use of general anesthesia. In selected patients undergoing elective EVAR, same-day discharge is feasible without increasing complication rates. Health resource utilization remains a challenge in transitioning to an outpatient model. Copyright © 2018. Published by Elsevier Inc.
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Bowles, Kathryn H; Hanlon, Alexandra; Holland, Diane; Potashnik, Sheryl L; Topaz, Maxim
2014-01-01
Hospital clinicians are overwhelmed with the volume of patients churning through the health care systems. The study purpose was to determine whether alerting case managers about high-risk patients by supplying decision support results in better discharge plans as evidenced by time to first hospital readmission. Four medical units at one urban, university medical center. A quasi-experimental study including a usual care and experimental phase with hospitalized English-speaking patients aged 55 years and older. The intervention included using an evidence-based screening tool, the Discharge Decision Support System (D2S2), that supports clinicians' discharge referral decision making by identifying high-risk patients upon admission who need a referral for post-acute care. The usual care phase included collection of the D2S2 information, but not sharing the information with case managers. The experimental phase included data collection and then sharing the results with the case managers. The study compared time to readmission between index discharge date and 30 and 60 days in patients in both groups (usual care vs. experimental). After sharing the D2S2 results, the percentage of referral or high-risk patients readmitted by 30 and 60 days decreased by 6% and 9%, respectively, representing a 26% relative reduction in readmissions for both periods. Supplying decision support to identify high-risk patients recommended for postacute referral is associated with better discharge plans as evidenced by an increase in time to first hospital readmission. The tool supplies standardized information upon admission allowing more time to work with high-risk admissions.
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Harun, N A; Salek, S
2017-01-01
Objective To observe the influences on clinicians when discharging patients, to explore patients' perspectives concerning their discharge or follow-up decision and to identify what patients think is important for clinicians to consider when taking a discharge decision. Design Qualitative study involving observations of consultations and semistructured interviews with outpatients. Setting National Health Service outpatient clinics at a university hospital secondary referral centre. Participants 64 consultations were observed followed by 56 interviews with patients aged over 18 years. Main outcome measure Analysis of patients' perspectives and expectations concerning whether or not they were discharged. Results 25 types of influences were observed to be influencing the discharge decision process. All 31 discharged patients appeared to accept the clinicians' decision; however, 10 (22%) of those patients later expressed disappointment. Patients' discontent was due to perceived clinicians' uncertainty in diagnosis (patients mentioning=2), poor acceptance of the diagnosis (2), disease not ‘cured’ (4), differing perception on medical needs (2), lack of concern for job demands (1), felt uninvolved in the decision-making (4), feeling rushed (3), prolonged open appointment (2), pushed to seek private care due to healthcare budget constraints (2), language barrier (1) and not keen to continue follow-up with general practitioner (2). Patients were happy when there was certainty of the diagnosis (19), clear treatment plan (16), advised on treatment side effects (7), given a contact number if symptoms recurred (4), considering their travelling and job demands (3). Conclusions This study highlights the importance of accurately perceiving patients' perspectives in ensuring the appropriateness of outpatient discharge. There was a disparity between patients' and clinicians' perception on what was an appropriate discharge. This included discrepancies concerning diagnostic certainties, private healthcare as an alternative, need for easy reaccess and choice of words surrounding discharge. Medical education should include handling these issues. PMID:28264822
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1982-08-01
Trajectory and Concentration of Various Plumes 59 IV.2 Tank and Cargo Geometry Assumed for Discharge Rate Calculation Using HACS Venting Rate Model 61...Discharge Rate Calculation Using HACS Venting Rate Model 62 IV.4 Original Test Plan for Validation of the Continuous Spill Model 66 IV.5 Final Test Plan...at t= 0. exEyEz = turbulent diffusivities. p = water density. Pc = chemical density. Symbols Used Only in Continuous-Spill Models for a Steady River b
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The role of discharge variability in the formation and preservation of alluvial sediment bodies
NASA Astrophysics Data System (ADS)
Fielding, Christopher R.; Alexander, Jan; Allen, Jonathan P.
2018-03-01
Extant, planform-based facies models for alluvial deposits are not fully fit for purpose, because they over-emphasise plan form whereas there is little in the alluvial rock record that is distinctive of any particular planform, and because the planform of individual rivers vary in both time and space. Accordingly, existing facies models have limited predictive capability. In this paper, we explore the role of inter-annual peak discharge variability as a possible control on the character of the preserved alluvial record. Data from a suite of modern rivers, for which long-term gauging records are available, and for which there are published descriptions of subsurface sedimentary architecture, are analysed. The selected rivers are categorized according to their variance in peak discharge or the coefficient of variation (CVQp = standard deviation of the annual peak flood discharge over the mean annual peak flood discharge). This parameter ranges over the rivers studied between 0.18 and 1.22, allowing classification of rivers as having very low (< 0.20), low (0.20-0.40), moderate (0.40-0.60), high (0.60-0.90), or very high (> 0.90) annual peak discharge variance. Deposits of rivers with very low and low peak discharge variability are dominated by cross-bedding on various scales and preserve macroform bedding structure, allowing the interpretation of bar construction processes. Rivers with moderate values preserve mostly cross-bedding, but records of macroform processes are in places muted and considerably modified by reworking. Rivers with high and very high values of annual peak discharge variability show a wide range of bedding structures commonly including critical and supercritical flow structures, abundant in situ trees and transported large, woody debris, and their deposits contain pedogenically modified mud partings and generally lack macroform structure. Such a facies assemblage is distinctively different from the conventional fluvial style recorded in published facies models but is widely developed both in modern and ancient alluvial deposits. This high-peak-variance style is also distinctive of rivers that are undergoing contraction in discharge over time because of the gradual annexation of the channel belt by the establishment of woody vegetation. We propose that discharge variability, both inter-annual peak variation and "flashiness" may be a more reliable basis for classifying the alluvial rock record than planform, and we provide some examples of three classes of alluvial sediment bodies (representing low, intermediate, and high/very high discharge variability) from the rock record that illustrate this point.
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Selfconsistent vibrational and free electron kinetics for CO2 dissociation in cold plasmas
NASA Astrophysics Data System (ADS)
Capitelli, Mario
2016-09-01
The activation of CO2 by cold plasmas is receiving new theoretical interest thanks to two European groups. The Bogaerts group developed a global model for the activation of CO2 trying to reproduce the experimental values for DBD and microwave discharges. The approach of Pietanza et al was devoted to understand the dependence of electron energy distribution function (eedf) of pure CO2 on the presence of concentrations of electronically and vibrationally excited states taken as parameter. To understand the importance of the vibrational excitation in the dissociation process Pietanza et al compared an upper limit to the dissociation process from a pure vibrational mechanism (PVM) with the corresponding electron impact dissociation rate, the prevalence of the two models depending on the reduced electric field and on the choice of the electron molecule cross section database. Improvement of the Pietanza et al model is being considered by coupling the time dependent Boltzmann solver with the non equilibrium vibrational kinetics of asymmetric mode and with simplified plasma chemistry kinetics describing the ionization/recombination process and the excitation-deexcitation of a metastable level at 10.5eV. A new PVM mechanism is also considered. Preliminary results, for both discharge and post discharge conditions, emphasize the action of superelastic collisions involving both vibrationally and electronically excited states in affecting the eedf. The new results can be used to plan a road map for future developments of numerical codes for rationalizing existing experimental values, as well as, for indicating new experimental situations.
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40 CFR 230.94 - Planning and documentation.
Code of Federal Regulations, 2010 CFR
2010-07-01
...-sections), watershed size, design discharge, and riparian area plantings. (8) Maintenance plan. A... sustainability of the resource, including long-term financing mechanisms and the party responsible for long-term...
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Dror, Sima; Kohn, Yoav; Avichezer, Mazal; Sapir, Benjamin; Levy, Sharon; Canetti, Laura; Kianski, Ela; Zisk-Rony, Rachel Yaffa
2015-10-01
Treatment for adolescents with eating disorders (ED) is multidimensional and extends after hospitalization. After participating in a four-step reintegration plan, treatment success including post-discharge community and social reintegration were examined from perspectives of patients, family members, and healthcare providers. Six pairs of patients and parents, and seven parents without their children were interviewed 2 to 30 months following discharge. All but two adolescents were enrolled in, or had completed school. Five worked in addition to school, and three completed army or national service. Twelve were receiving therapeutic care in the community. Adolescents with ED can benefit from a systematic reintegration program, and nurses should incorporate this into care plans. © 2015, Wiley Periodicals, Inc.
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Xie, Y L; Li, Y P; Huang, G H; Li, Y F; Chen, L R
2011-04-15
In this study, an inexact-chance-constrained water quality management (ICC-WQM) model is developed for planning regional environmental management under uncertainty. This method is based on an integration of interval linear programming (ILP) and chance-constrained programming (CCP) techniques. ICC-WQM allows uncertainties presented as both probability distributions and interval values to be incorporated within a general optimization framework. Complexities in environmental management systems can be systematically reflected, thus applicability of the modeling process can be highly enhanced. The developed method is applied to planning chemical-industry development in Binhai New Area of Tianjin, China. Interval solutions associated with different risk levels of constraint violation have been obtained. They can be used for generating decision alternatives and thus help decision makers identify desired policies under various system-reliability constraints of water environmental capacity of pollutant. Tradeoffs between system benefits and constraint-violation risks can also be tackled. They are helpful for supporting (a) decision of wastewater discharge and government investment, (b) formulation of local policies regarding water consumption, economic development and industry structure, and (c) analysis of interactions among economic benefits, system reliability and pollutant discharges. Copyright © 2011 Elsevier B.V. All rights reserved.
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77 FR 35396 - Agency Information Collection Activities: Proposed Collection; Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2012-06-13
... on transitional care, including needs assessment, discharge planning, post-discharge intervention... test modifications to address the particular circumstances related to Medicaid readmissions and safety... and test existing strategies to reduce avoidable readmissions for their adequacy and applicability to...
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Environmental concerns of desalinating seawater using reverse osmosis.
Tularam, Gurudeo Anand; Ilahee, Mahbub
2007-08-01
This Critical Review on environmental concerns of desalination plants suggests that planning and monitoring stages are critical aspects of successful management and operation of plants. The site for the desalination plants should be selected carefully and should be away from residential areas particularly for forward planning for possible future expansions. The concerning issues identified are noise pollution, visual pollution, reduction in recreational fishing and swimming areas, emission of materials into the atmosphere, the brine discharge and types of disposal methods used are the main cause of pollution. The reverse osmosis (RO) method is the preferred option in modern times especially when fossil fuels are becoming expensive. The RO has other positives such as better efficiency (30-50%) when compared with distillation type plants (10-30%). However, the RO membranes are susceptible to fouling and scaling and as such they need to be cleaned with chemicals regularly that may be toxic to receiving waters. The input and output water in desalination plants have to be pre and post treated, respectively. This involves treating for pH, coagulants, Cl, Cu, organics, CO(2), H(2)S and hypoxia. The by-product of the plant is mainly brine with concentration at times twice that of seawater. This discharge also includes traces of various chemicals used in cleaning including any anticorrosion products used in the plant and has to be treated to acceptable levels of each chemical before discharge but acceptable levels vary depending on receiving waters and state regulations. The discharge of the brine is usually done by a long pipe far into the sea or at the coastline. Either way the high density of the discharge reaches the bottom layers of receiving waters and may affect marine life particularly at the bottom layers or boundaries. The longer term effects of such discharge concentrate has not been documented but it is possible that small traces of toxic substances used in the cleaning of RO membranes may be harmful to marine life and ecosystem. The plants require saline water and thus the construction of input and discharge output piping is vital. The piping are often lengthy and underground as it is in Tugun (QLD, Australia), passing below the ground. Leakage of the concentrate via cracks in rocks to aquifers is a concern and therefore appropriate monitoring quality is needed. Leakage monitoring devices ought to be attached to such piping during installation. The initial environment impact assessment should identify key parameters for monitoring during discharge processes and should recommend ongoing monitoring with devices attached to structures installed during construction of plants.
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Code of Federal Regulations, 2012 CFR
2012-07-01
... the discovery of a discharge in higher volume port areas and the Great Lakes; (ii) 24 hours of the discovery of a discharge in all rivers and canals, inland, nearshore and offshore areas; and (iii) 24 hours of the discovery of a discharge plus travel time from shore for open ocean areas. (2) The necessary...
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Code of Federal Regulations, 2013 CFR
2013-07-01
... the discovery of a discharge in higher volume port areas and the Great Lakes; (ii) 24 hours of the discovery of a discharge in all rivers and canals, inland, nearshore and offshore areas; and (iii) 24 hours of the discovery of a discharge plus travel time from shore for open ocean areas. (2) The necessary...
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Code of Federal Regulations, 2014 CFR
2014-07-01
... the discovery of a discharge in higher volume port areas and the Great Lakes; (ii) 24 hours of the discovery of a discharge in all rivers and canals, inland, nearshore and offshore areas; and (iii) 24 hours of the discovery of a discharge plus travel time from shore for open ocean areas. (2) The necessary...
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California nearshore processes - ERTS 1. [coastal currents and sediments
NASA Technical Reports Server (NTRS)
Steller, D. D.; Pirie, D. M.
1974-01-01
The detectability of many nearshore processes from ERTS is made possible due to the suspended sediment present in the coastal waters. From viewing and analyzing the California coastal imagery collected during the last year and a half, the overall current patterns and their changes have become evident. It is now possible to map monthly and seasonal changes that occur throughout the year. The original objectives of detecting currents, sediment transport, estuaries and river discharge have now been expanded to include the use of ERTS information in operational problems of the U.S. Army Corps of Engineers. This incorporates the detected nearshore features into planning and organizing shore protection facilities.
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Trotta, L.C.
1988-01-01
The Minnesota Water-Use Data System stores data on the quantity of withdrawals and discharge in Minnesota. To transfer these data into the U.S. Geological Survey 's National Water-Use Data System properly, certain procedures must be followed. Uniform data categorization and entry allows comparison of water use from State to State. The data in the National Water-Use Data System are aggregated by county and by watershed (hydrologic unit). This report documents the data aggregation and transfer process as developed by the Minnesota Department of Natural Resources, the Minnesota State Planning Agency/Planning Information Center, and the U.S. Geological Survey as part of the National Water-Use Information Program.
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Modelling mortality and discharge of hospitalized stroke patients using a phase-type recovery model.
Jones, Bruce; McClean, Sally; Stanford, David
2018-05-01
We model the length of in-patient hospital stays due to stroke and the mode of discharge using a phase-type stroke recovery model. The model allows for three different types of stroke: haemorrhagic (the most severe, caused by ruptured blood vessels that cause brain bleeding), cerebral infarction (less severe, caused by blood clots) and transient ischemic attack or TIA (the least severe, a mini-stroke caused by a temporary blood clot). A four-phase recovery process is used, where the initial phase depends on the type of stroke, and transition from one phase to the next depends on the age of the patient. There are three differing modes of absorption for this phase-type model: from a typical recovery phase, a patient may die (mode 1), be transferred to a nursing home (mode 2) or be discharged to the individual's usual residence (mode 3). The first recovery phase is characterized by a very high rate of mortality and very low rates of discharge by the other two modes. The next two recovery phases have progressively lower mortality rates and higher mode 2 and 3 discharge rates. The fourth recovery phase is visited only by those who experience a very mild TIA, and they are discharged to home after a short stay. The novelty of our approach to phase representation is two-fold: first, it aligns the phases with labelled diagnosis states, representing stages of illness severity; second, the model allows us to obtain expressions for Key Performance Indicators that are of use to healthcare professionals. This allows us to use a backward estimation process where we leverage the fact that we know the phase of admission (the diagnosis), but not which phases are subsequently entered or when this happens; this strategy improves both computational efficiency and accuracy. The model has clear practical value as it yields length of stay distributions by age and type of stroke, which are useful in resource planning. Also, inclusion of the three modes of discharge permits analyses of outcomes.
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30 CFR 784.23 - Operation plan: Maps and plans.
Code of Federal Regulations, 2011 CFR
2011-07-01
... waste storage area; (6) Each water diversion, collection, conveyance, treatment, storage and discharge... structure, permanent water impoundment, refuse pile, and coal mine waste impoundment for which plans are...; (12) Location of each water and subsidence monitoring point; (13) Location of each facility that will...
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Biogeochemical behaviour and bioremediation of uranium in waters of abandoned mines.
Mkandawire, Martin
2013-11-01
The discharges of uranium and associated radionuclides as well as heavy metals and metalloids from waste and tailing dumps in abandoned uranium mining and processing sites pose contamination risks to surface and groundwater. Although many more are being planned for nuclear energy purposes, most of the abandoned uranium mines are a legacy of uranium production that fuelled arms race during the cold war of the last century. Since the end of cold war, there have been efforts to rehabilitate the mining sites, initially, using classical remediation techniques based on high chemical and civil engineering. Recently, bioremediation technology has been sought as alternatives to the classical approach due to reasons, which include: (a) high demand of sites requiring remediation; (b) the economic implication of running and maintaining the facilities due to high energy and work force demand; and (c) the pattern and characteristics of contaminant discharges in most of the former uranium mining and processing sites prevents the use of classical methods. This review discusses risks of uranium contamination from abandoned uranium mines from the biogeochemical point of view and the potential and limitation of uranium bioremediation technique as alternative to classical approach in abandoned uranium mining and processing sites.
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Measuring discharge with acoustic Doppler current profilers from a moving boat
Mueller, David S.; Wagner, Chad R.; Rehmel, Michael S.; Oberg, Kevin A.; Rainville, Francois
2013-01-01
The use of acoustic Doppler current profilers (ADCPs) from a moving boat is now a commonly used method for measuring streamflow. The technology and methods for making ADCP-based discharge measurements are different from the technology and methods used to make traditional discharge measurements with mechanical meters. Although the ADCP is a valuable tool for measuring streamflow, it is only accurate when used with appropriate techniques. This report presents guidance on the use of ADCPs for measuring streamflow; this guidance is based on the experience of U.S. Geological Survey employees and published reports, papers, and memorandums of the U.S. Geological Survey. The guidance is presented in a logical progression, from predeployment planning, to field data collection, and finally to post processing of the collected data. Acoustic Doppler technology and the instruments currently (2013) available also are discussed to highlight the advantages and limitations of the technology. More in-depth, technical explanations of how an ADCP measures streamflow and what to do when measuring in moving-bed conditions are presented in the appendixes. ADCP users need to know the proper procedures for measuring discharge from a moving boat and why those procedures are required, so that when the user encounters unusual field conditions, the procedures can be adapted without sacrificing the accuracy of the streamflow-measurement data.
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Treatment of chromium contaminated plating shop rinsewater streams by reverse osmosis
DOE Office of Scientific and Technical Information (OSTI.GOV)
Walker, J.F.; Brown, C.H. Jr.; Wilson, J.H.
1988-01-01
Wastewater is discharged to the local sanitary sewer, which is regulated by a Metropolitan Sewer District (MSD). The MSD has established discharge limits and reports have indicated that the major source of wastewater and primary area of concern is the discharge from the industrial plating shop within the plant complex. This plating shop generates /approximately/1100 m/sup 3/ (300,000 gal) of wastewater per day. Because construction of a new plating shop is currently planned, a complete renovation of the existing plating shop is not economically feasible. The sponsor demonstrated the use of innovative wastewater treatment technologies that will minimize the amountmore » of wastewater generated from the plating processes and maintain compliance with MSD discharge limits until the new plating shop is constructed. The problems at the facility have been analyzed and a treatment system utilizing reverse osmosis (RO), with volume reduction of the RO concentrate by evaporation, has been recommended. The utilization of RO meets the specification for the demonstration of innovative technology. This paper discusses the problem analysis at the plant as well as the results of a pilot scale RO test program currently being conducted. The installation of the full scale unit is dependent on the successful completion of the RO pilot tests. 1 ref., 6 figs., 3 tabs.« less
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ESD prevention, combating ESD problem — Solutions
NASA Astrophysics Data System (ADS)
Duban, M.
2002-12-01
In today's Electronic equipment manufacturing, managing an ESD (Electro static Discharge) plan is an integral part of a complete quality program. Every body has been in presence of static electricity one day or an other. But a discharge on a body of man is only felt when the potential of charge before the discharge is higher than 3000 volts but components can have a sensitivity less than 20 Volts !
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40 CFR 52.1988 - Air contaminant discharge permits.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 40 Protection of Environment 4 2013-07-01 2013-07-01 false Air contaminant discharge permits. 52.1988 Section 52.1988 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF IMPLEMENTATION PLANS (CONTINUED) Oregon § 52.1988 Air contaminant...
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40 CFR 300.135 - Response operations.
Code of Federal Regulations, 2010 CFR
2010-07-01
... PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS NATIONAL OIL AND HAZARDOUS SUBSTANCES POLLUTION CONTINGENCY... discharge is a worst case discharge as discussed in § 300.324; the pathways to human and environmental exposure; the potential impact on human health, welfare, and safety and the environment; whether the...
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40 CFR 300.324 - Response to worst case discharges.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 28 2011-07-01 2011-07-01 false Response to worst case discharges. 300.324 Section 300.324 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS NATIONAL OIL AND HAZARDOUS SUBSTANCES POLLUTION...
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40 CFR 300.324 - Response to worst case discharges.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 40 Protection of Environment 29 2012-07-01 2012-07-01 false Response to worst case discharges. 300.324 Section 300.324 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS NATIONAL OIL AND HAZARDOUS SUBSTANCES POLLUTION...
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40 CFR 300.324 - Response to worst case discharges.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 40 Protection of Environment 29 2013-07-01 2013-07-01 false Response to worst case discharges. 300.324 Section 300.324 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS NATIONAL OIL AND HAZARDOUS SUBSTANCES POLLUTION...
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40 CFR 300.324 - Response to worst case discharges.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 40 Protection of Environment 28 2014-07-01 2014-07-01 false Response to worst case discharges. 300.324 Section 300.324 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SUPERFUND, EMERGENCY PLANNING, AND COMMUNITY RIGHT-TO-KNOW PROGRAMS NATIONAL OIL AND HAZARDOUS SUBSTANCES POLLUTION...
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Carrat, Fabrice; Hejblum, Gilles
2015-01-01
Background Hospital discharge, a critical stage in the hospital-to-home transition of patient care, is a complex process with potential dysfunctions having an impact on patients’ health on their return home. No study has yet reported the feasibility and usefulness of an information system that would directly collect and transmit, via the Internet, volunteer patients’ opinions on their satisfaction concerning the organization of hospital discharge. Objective Our primary objective was to compare patients’ opinions on the discharge process collected with 2 different methods: self-questionnaire completed on a dedicated website versus a telephone interview. The secondary goal was to estimate patient satisfaction. Methods We created a questionnaire to examine hospital discharge according to 3 dimensions: discharge logistics organization, preplanned posthospital continuity-of-care organization, and patients’ impressions at the time of discharge. A satisfaction score (between 0 and 1) for each of those dimensions and an associated total score were calculated. Taking advantage of the randomized SENTIPAT trial that questioned patients recruited at hospital discharge about the evolution of their health after returning home and randomly assigned them to complete a self-questionnaire directly online or during a telephone interview, we conducted an ancillary study comparing satisfaction with the organization of hospital discharge for these 2 patient groups. The questionnaire was proposed to 1141 patients included in the trial who were hospitalized for ≥2 days, among whom 867 eligible patients had access to the Internet at home and were randomized to the Internet or telephone group. Results Of the 1141 patients included, 755 (66.17%) completed the questionnaire. The response rates for the Internet (39.1%, 168/430) and telephone groups (87.2%, 381/437) differed significantly (P<.001), but their total satisfaction scores did not (P=.08) nor did the satisfaction subscores (P=.58 for discharge logistics organization, P=.12 for preplanned posthospital continuity-of-care organization, and P=.35 for patients’ impressions at the time of discharge). The total satisfaction score (median 0.83, IQR 0.72-0.92) indicated the patients’ high satisfaction. Conclusions The direct transmission of personal health data via the Internet requires patients’ active participation and those planning surveys in the domain explored in this study should anticipate a lower response rate than that issued from a similar survey conducted by telephone interviews. Nevertheless, collecting patients’ opinions on their hospital discharge via the Internet proved operational; study results indicate that conducting such surveys via the Internet yields similar estimates to those obtained via a telephone survey. The results support the establishment of a permanent dedicated website that could also be used to obtain users’ opinions on other aspects of their hospital stay and follow-up. Trial Registration Clinicaltrials.gov NCT01769261; http://clinicaltrials.gov/ct2/show/NCT01769261 (Archived by WebCite at http://www.webcitation.org/6ZDF5bdQb). PMID:26109261
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Plasma Discharge Process in a Pulsed Diaphragm Discharge System
NASA Astrophysics Data System (ADS)
Duan, Jianjin; Hu, Jue; Zhang, Chao; Wen, Yuanbin; Meng, Yuedong; Zhang, Chengxu
2014-12-01
As one of the most important steps in wastewater treatment, limited study on plasma discharge process is a key challenge in the development of plasma applications. In this study, we focus on the plasma discharge process of a pulsed diaphragm discharge system. According to the analysis, the pulsed diaphragm discharge proceeds in seven stages: (1) Joule heating and heat exchange stage; (2) nucleated site formation; (3) plasma generation (initiation of the breakdown stage); (4) avalanche growth and plasma expansion; (5) plasma contraction; (6) termination of the plasma discharge; and (7) heat exchange stage. From this analysis, a critical voltage criterion for breakdown is obtained. We anticipate this finding will provide guidance for a better application of plasma discharges, especially diaphragm plasma discharges.
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43 CFR 11.32 - How does the authorized official develop the Assessment Plan?
Code of Federal Regulations, 2012 CFR
2012-10-01
... briefly describe, to the extent known, the site, vessel, or facility involved, the discharge of oil or... Assessment Plan available for review by any identified potentially responsible parties, other natural... until after this review period. (2) Any comments concerning the Assessment Plan received from identified...
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43 CFR 11.32 - How does the authorized official develop the Assessment Plan?
Code of Federal Regulations, 2013 CFR
2013-10-01
... briefly describe, to the extent known, the site, vessel, or facility involved, the discharge of oil or... Assessment Plan available for review by any identified potentially responsible parties, other natural... until after this review period. (2) Any comments concerning the Assessment Plan received from identified...
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43 CFR 11.32 - How does the authorized official develop the Assessment Plan?
Code of Federal Regulations, 2014 CFR
2014-10-01
... briefly describe, to the extent known, the site, vessel, or facility involved, the discharge of oil or... Assessment Plan available for review by any identified potentially responsible parties, other natural... until after this review period. (2) Any comments concerning the Assessment Plan received from identified...
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33 CFR 155.1230 - Response plan development and evaluation criteria.
Code of Federal Regulations, 2011 CFR
2011-07-01
... VESSELS Response plan requirements for vessels carrying animal fats and vegetable oils as a primary cargo... carry animal fats or vegetable oils as a primary cargo must provide information in their plan that identifies— (1) Procedures and strategies for responding to a worst case discharge of animal fats or...
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33 CFR 155.1230 - Response plan development and evaluation criteria.
Code of Federal Regulations, 2010 CFR
2010-07-01
... VESSELS Response plan requirements for vessels carrying animal fats and vegetable oils as a primary cargo... carry animal fats or vegetable oils as a primary cargo must provide information in their plan that identifies— (1) Procedures and strategies for responding to a worst case discharge of animal fats or...
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33 CFR 155.1230 - Response plan development and evaluation criteria.
Code of Federal Regulations, 2013 CFR
2013-07-01
... VESSELS Response plan requirements for vessels carrying animal fats and vegetable oils as a primary cargo... carry animal fats or vegetable oils as a primary cargo must provide information in their plan that identifies— (1) Procedures and strategies for responding to a worst case discharge of animal fats or...
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33 CFR 155.1230 - Response plan development and evaluation criteria.
Code of Federal Regulations, 2014 CFR
2014-07-01
... VESSELS Response plan requirements for vessels carrying animal fats and vegetable oils as a primary cargo... carry animal fats or vegetable oils as a primary cargo must provide information in their plan that identifies— (1) Procedures and strategies for responding to a worst case discharge of animal fats or...
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33 CFR 155.1230 - Response plan development and evaluation criteria.
Code of Federal Regulations, 2012 CFR
2012-07-01
... VESSELS Response plan requirements for vessels carrying animal fats and vegetable oils as a primary cargo... carry animal fats or vegetable oils as a primary cargo must provide information in their plan that identifies— (1) Procedures and strategies for responding to a worst case discharge of animal fats or...
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Leone, Robert P; Walker, Charles A; Curry, Linda Cox; Agee, Elizabeth J
2012-04-03
Increasing numbers of patients are being treated for heart failure each year. One out of four of the heart failure patients who receives care in a hospital is readmitted to the hospital within 30 days of discharge. Effective discharge instruction is critical to prevent these patient readmissions. Co-production is a marketing concept whereby the customer is a partner in the delivery of a good or service. For example, a patient and nurse may partner to co-produce a patient-centered health regimen to improve patient outcomes. In this article we review the cost of treating heart failure patients and current strategies to decrease hospital readmissions for these patients along with the role of the nurse and the concept of co-producing health as related to heart failure patients. Next we describe our study assessing the degree to which discharge processes were co-produced on two hospital units having a preponderance of heart failure patients, and present our findings indicating minimal evidence of co-production. A discussion of our findings, along with clinical implications of these findings, recommendations for change, and suggestions for future research are offered. We conclude that standardized discharge plans lead to a mindset of 'one size fits all,' a mindset inconsistent with the recent call for patient-centered care. We offer co-production as a patient-centered strategy for customizing discharge teaching and improving health outcomes for heart failure patients.
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NASA Astrophysics Data System (ADS)
Wang, Difeng; Pan, Delu; Li, Ning
2009-07-01
The State Development and Planning Commission has approved nuclear power projects with the total capacity of 23,000 MW. The plants will be built in Zhejiang, Jiangsu, Guangdong, Shandong, Liaoning and Fujian Province before 2020. However, along with the nuclear power policy of accelerated development in our country, the quantity of nuclear plants and machine sets increases quickly. As a result the environment influence of thermal discharge will be a problem that can't be slid over. So evaluation of the environment influence and engineering simulation must be performed before station design and construction. Further more real-time monitoring of water temperature need to be arranged after fulfillment, reflecting variety of water temperature in time and provided to related managing department. Which will help to ensure the operation of nuclear plant would not result in excess environment breakage. At the end of 2007, an airborne thermal discharge monitoring experiment has been carried out by making use of MAMS, a marine multi-spectral scanner equipped on the China Marine Surveillance Force airplane. And experimental subject was sea area near Qin Shan nuclear plant. This paper introduces the related specification and function of MAMS instrument, and decrypts design and process of the airborne remote sensing experiment. Experiment showed that applying MAMS to monitoring thermal discharge is viable. The remote sensing on a base of thermal infrared monitoring technique told us that thermal discharge of Qin Shan nuclear plant was controlled in a small scope, never breaching national water quality standard.
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Cain, Carol H; Neuwirth, Estee; Bellows, Jim; Zuber, Christi; Green, Jennifer
2012-01-01
Little is known about patient perspectives of the transition from hospital to home. To develop a richly detailed, patient-centered view of patient and caregiver needs in the hospital-to-home transition. An ethnographic approach including participant observation and in-depth, semi-structured video recorded interviews. Kaiser Permanente's Southern California, Colorado, and Hawaii regions. Twenty-four adult inpatients hospitalized for a range of acute and chronic conditions and characterized by variety in diagnoses, illness severity, planned or unplanned hospitalization, age, and ability to self manage. During the hospital-to-home transition, patients and caregivers expressed or demonstrated experiences in 6 domains: 1) translating knowledge into safe, health-promoting actions at home; 2) inclusion of caregivers at every step of the transition process; 3) having readily available problem-solving resources; 4) feeling connected to and trusting providers; 5) transitioning from illness-defined experience to "normal" life; and 6) anticipating needs after discharge and making arrangements to meet them. The work of transitioning occurs for patients and caregivers in the hours and days after they return home and is fraught with challenges. Reducing readmissions will remain challenging without a broadened understanding of the types of support and coaching patients need after discharge. We are piloting strategies such as risk stratification and tailoring of care, a specialized phone number for recently discharged patients, standardized same-day discharge summaries to primary care providers, medication reconciliation, follow-up phone calls, and scheduling appointments before discharge. Copyright © 2012 Society of Hospital Medicine.
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Scale Dependence in the Species-Discharge Relationship for Fishes of the Southeastern U.S.A.
Species-discharge relationships (SDR) are aquatic analogues of species-area relationships, and are increasingly used in both basic research and conservation planning. SDR studies are often limited, however, by two shortcomings. First, they do not determine whether the reported ...
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33 CFR 159.317 - Sampling and reporting.
Code of Federal Regulations, 2012 CFR
2012-07-01
...) POLLUTION MARINE SANITATION DEVICES Discharge of Effluents in Certain Alaskan Waters by Cruise Vessel... cruise vessel that discharges treated sewage and/or graywater in the applicable waters of Alaska shall.../Quality Control Plan (QA/QCP) accepted by the COTP for sampling and analysis of treated sewage and/or...
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33 CFR 159.317 - Sampling and reporting.
Code of Federal Regulations, 2014 CFR
2014-07-01
...) POLLUTION MARINE SANITATION DEVICES Discharge of Effluents in Certain Alaskan Waters by Cruise Vessel... cruise vessel that discharges treated sewage and/or graywater in the applicable waters of Alaska shall.../Quality Control Plan (QA/QCP) accepted by the COTP for sampling and analysis of treated sewage and/or...
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33 CFR 159.317 - Sampling and reporting.
Code of Federal Regulations, 2013 CFR
2013-07-01
...) POLLUTION MARINE SANITATION DEVICES Discharge of Effluents in Certain Alaskan Waters by Cruise Vessel... cruise vessel that discharges treated sewage and/or graywater in the applicable waters of Alaska shall.../Quality Control Plan (QA/QCP) accepted by the COTP for sampling and analysis of treated sewage and/or...
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Chiang, Li-Chi; Chen, Wan-Chou; Dai, Yu-Tzu; Ho, Yi-Lwun
2012-10-01
Telehealth care was developed to provide home-based monitoring and support for patients with chronic disease. The positive effects on physical outcome have been reported; however, more evidence is required concerning the effects on family caregivers and family function for heart failure patients transitioning from the hospital to home. To evaluate the effectiveness of nursing-led transitional care combining discharge plans and telehealth care on family caregiver burden, stress mastery and family function in family caregivers of heart failure patients compared to those receiving traditional discharge planning only. This is a quasi-experimental study design. Sixty-three patients with heart failure were assessed for eligibility and invited to participate in either telehealth care or standard care in a medical centre from May to October 2010. Three families refused to participate in data collection. Thirty families who chose telehealth care after discharge from the hospital to home comprised the experimental group; the others families receiving discharge planning only comprised the comparison group. Telenursing specialist provided the necessary family nursing interventions by 24-h remote monitoring of patients' health condition and counselling by telephone, helping the family caregivers successfully transition from hospital to home. Data on caregiver burden, stress mastery and family function were collected before discharge from the hospital and one month later at home. Effects of group, time, and group×time interaction were analysed using Mixed Model in SPSS (17.0). Family caregivers in both groups had significantly lower burden, higher stress mastery, and better family function at one-month follow-up compared to before discharge. The total score of caregiver burden, stress mastery and family function was significantly improved for the family caregivers in the experimental group compared to the comparison group at posttest. Two subscales of family function-Relationships between family and subsystems and Relationships between family and society were improved in the experimental group compared to the comparison group, but Relationships between family and family members was not different. The results provide evidence that telehealth care combined with discharge planning could reduce family caregiver burden, improve stress mastery, and improve family function during the first 30 days at home after heart failure patients are discharged from the hospital. Telenursing specialists cared caregivers with the concepts of providing transitional care to help them successful cross the critical transition stage. Copyright © 2012 Elsevier Ltd. All rights reserved.
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NASA Astrophysics Data System (ADS)
Liang, Yimin; Lan, Junkang; Wen, Zhixiong
2018-01-01
In order to predict the pollution of underground aquifers and rivers by the proposed project, Specialized hydrogeological investigation was carried out. After hydrogeological surveying and mapping, drilling, and groundwater level monitoring, the scope of the hydrogeological unit and the regional hydrogeological condition were found out. The permeability coefficients of the aquifers were also obtained by borehole water injection tests. In order to predict the impact on groundwater environment by the project, a GMS software was used in numerical simulation. The simulation results show that when unexpected sewage leakage accident happened, the pollutants will be gradually diluted by groundwater, and the diluted contaminants will slowly spread to southeast with groundwater flow, eventually they are discharged into Gantang River. However, the process of the pollutants discharging into the river is very long, the long-term dilution of the river water will keep Gantang River from being polluted.
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Electrical description of N2 capacitively coupled plasmas with the global model
NASA Astrophysics Data System (ADS)
Cao, Ming-Lu; Lu, Yi-Jia; Cheng, Jia; Ji, Lin-Hong; Engineering Design Team
2016-10-01
N2 discharges in a commercial capacitively coupled plasma reactor are modelled by a combination of an equivalent circuit and the global model, for a range of gas pressure at 1 4 Torr. The ohmic and inductive plasma bulk and the capacitive sheath are represented as LCR elements, with electrical characteristics determined by plasma parameters. The electron density and electron temperature are obtained from the global model in which a Maxwellian electron distribution is assumed. Voltages and currents are recorded by a VI probe installed after the match network. Using the measured voltage as an input, the current flowing through the discharge volume is calculated from the electrical model and shows excellent agreement with the measurements. The experimentally verified electrical model provides a simple and accurate description for the relationship between the external electrical parameters and the plasma properties, which can serve as a guideline for process window planning in industrial applications.
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Mine waters: Acidic to circumneutral
Nordstrom, D. Kirk
2011-01-01
Acid mine waters, often containing toxic concentrations of Fe, Al, Cu, Zn, Cd, Pb, Ni, Co, and Cr, can be produced from the mining of coal and metallic deposits. Values of pH for acid mine waters can range from –3.5 to 5, but even circumneutral (pH ≈ 7) mine waters can have high concentrations of As, Sb, Mo, U, and F. When mine waters are discharged into streams, lakes, and the oceans, serious degradation of water quality and injury to aquatic life can ensue, especially when tailings impoundments break suddenly. The main acid-producing process is the exposure of pyrite to air and water, which promotes oxidative dissolution, a reaction catalyzed by microbes. Current and future mining should plan for the prevention and remediation of these contaminant discharges by the application of hydrogeochemical principles and available technologies, which might include remining and recycling of waste materials.
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Louis Simonet, Martine; Kossovsky, Michel P; Chopard, Pierre; Sigaud, Philippe; Perneger, Thomas V; Gaspoz, Jean-Michel
2008-01-01
Background Early identification of patients who need post-acute care (PAC) may improve discharge planning. The purposes of the study were to develop and validate a score predicting discharge to a post-acute care (PAC) facility and to determine its best assessment time. Methods We conducted a prospective study including 349 (derivation cohort) and 161 (validation cohort) consecutive patients in a general internal medicine service of a teaching hospital. We developed logistic regression models predicting discharge to a PAC facility, based on patient variables measured on admission (day 1) and on day 3. The value of each model was assessed by its area under the receiver operating characteristics curve (AUC). A simple numerical score was derived from the best model, and was validated in a separate cohort. Results Prediction of discharge to a PAC facility was as accurate on day 1 (AUC: 0.81) as on day 3 (AUC: 0.82). The day-3 model was more parsimonious, with 5 variables: patient's partner inability to provide home help (4 pts); inability to self-manage drug regimen (4 pts); number of active medical problems on admission (1 pt per problem); dependency in bathing (4 pts) and in transfers from bed to chair (4 pts) on day 3. A score ≥ 8 points predicted discharge to a PAC facility with a sensitivity of 87% and a specificity of 63%, and was significantly associated with inappropriate hospital days due to discharge delays. Internal and external validations confirmed these results. Conclusion A simple score computed on the 3rd hospital day predicted discharge to a PAC facility with good accuracy. A score > 8 points should prompt early discharge planning. PMID:18647410
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Wallace, Neal T; McConnell, K John
2013-10-01
This study assessed the impact of Oregon's 2007 parity law, which required behavioral health insurance parity, on rates of follow-up care provided within 30 days of psychiatric inpatient care. Data sources were claims (2005-2008) for 737 individuals with inpatient stays for a mental disorder who were continuously enrolled in insurance plans affected by the parity law (intervention group) or in commercial, self-insured plans that were not affected by the law (control group). A difference-in-difference analysis was used to compare rates of follow-up care before and after the parity law between discharges of individuals in the intervention group and the control group and between discharges of individuals in the intervention group who had or had not met preparity quantitative coverage limits during a coverage year. Estimates of the marginal effects of the parity law were adjusted for gender, discharge diagnosis, relationship to policy holder, and calendar quarter of discharge. The study included 353 discharges in the intervention group and 535 discharges in the control group. After the parity law, follow-up rates increased by 11% (p=.042) overall and by 20% for discharges of individuals who had met coverage limits (p=.028). The Oregon parity law was associated with a large increase in the rate of follow-up care, predominantly for discharges of individuals who had met preparity quantitative coverage limits. Given similarities between the law and the 2008 Mental Health Parity and Addiction Equity Act, the results may portend a national effect of more comprehensive parity laws.
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Kerstenetzky, Luiza; Birschbach, Matthew J; Beach, Katherine F; Hager, David R; Kennelty, Korey A
2018-02-01
Patients transitioning from the hospital to a skilled nursing home (SNF) are susceptible to medication-related errors resulting from fragmented communication between facilities. Through continuous process improvement efforts at the hospital, a targeted needs assessment was performed to understand the extent of medication-related issues when patients transition from the hospital into a SNF, and the gaps between the hospital's discharge process, and the needs of the SNF and long-term care (LTC) pharmacy. We report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to SNF and LTC pharmacy staff. Applying the Intervention Mapping (IM) framework, a targeted needs assessment was performed using quantitative and qualitative methods. Using the hospital discharge medication list as reference, medication discrepancies in the SNF and LTC pharmacy lists were identified. SNF and LTC pharmacy staffs were also interviewed regarding the continuity of medication information post-discharge from the hospital. At least one medication discrepancy was discovered in 77.6% (n = 45/58) of SNF and 76.0% (n = 19/25) of LTC pharmacy medication lists. A total of 191 medication discrepancies were identified across all SNF and LTC pharmacy records. Of the 69 SNF staff interviewed, 20.3% (n = 14) reported patient care delays due to omitted documents during the hospital-to-SNF transition. During interviews, communication between the SNF/LTC pharmacy and the discharging hospital was described by facility staff as unidirectional with little opportunity for feedback on patient care concerns. The targeted needs assessment guided by the IM framework has lent to several planned process improvements initiatives to help reduce medication discrepancies during the hospital-to-SNF transition as well as improve communication between healthcare entities. Opening lines of communication along with aligning healthcare entity goals may help prevent medication-related errors. Copyright © 2017 Elsevier Inc. All rights reserved.
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Discharge transient coupling in large space power systems
NASA Technical Reports Server (NTRS)
Stevens, N. John; Stillwell, R. P.
1990-01-01
Experiments have shown that plasma environments can induce discharges in solar arrays. These plasmas simulate the environments found in low earth orbits where current plans call for operation of very large power systems. The discharges could be large enough to couple into the power system and possibly disrupt operations. Here, the general concepts of the discharge mechanism and the techniques of coupling are discussed. Data from both ground and flight experiments are reviewed to obtain an expected basis for the interactions. These concepts were applied to the Space Station solar array and distribution system as an example of the large space power system. The effect of discharges was found to be a function of the discharge site. For most sites in the array discharges would not seriously impact performance. One location at the negative end of the array was identified as a position where discharges could couple to charge stored in system capacitors. This latter case could impact performance.
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Wai, A; Pulver, L K; Oliver, K; Thompson, A
2012-05-01
Evidence-practice gaps exist in the continuum of care for patients with acute coronary syndromes (ACS), particularly at hospital discharge. We aimed to describe the methodology and baseline results of the Discharge Management of Acute Coronary Syndromes (DMACS) project, focusing on the prescription of guideline-recommended medications, referral to cardiac rehabilitation and communication between the hospital, patient and their primary healthcare professionals. DMACS employed Drug Use Evaluation methodology involving data collection, evaluation and feedback, and targeted educational interventions. Adult patients with ACS discharged during a 4-month period were eligible to participate. Data were collected (maximum 50 patients) at each site through an inpatient medical record review, a general practitioner (GP) postal/fax survey conducted 14 days post discharge and a patient telephone survey 3 months post discharge. Forty-nine hospitals participated in the audit recruiting 1545 patients. At discharge, 57% of patients were prescribed a combination of antiplatelet agent(s), beta-blocker, statin and angiotensin-converting enzyme inhibitor and/or angiotensin II-antagonist. At 3 months post discharge, 48% of patients reported using the same combination. Some 67% of patients recalled being referred to cardiac rehabilitation; of these, 33% had completed the programme. In total, 83% of patients had a documented ACS management plan at discharge. Of these, 90% included a medication list, 56% a chest pain action plan and 54% risk factor modification advice. Overall, 65% of GPs rated the quality of information received in the discharge summary as 'very good' to 'excellent'. The findings of our baseline audit showed that despite the robust evidence base and availability of national guidelines, the management of patients with ACS can be improved. These findings will inform a multifaceted intervention strategy to improve adherence to guidelines for the discharge management of patients with ACS. © 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.
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Nursing needs of acutely ill older people.
Hancock, Karen; Chang, Esther; Chenoweth, Lynn; Clarke, Marie; Carroll, Adrian; Jeon, Yun-Hee
2003-12-01
Investigating older acutely ill hospitalized patients' nursing needs and quality of care is paramount, given the growing pressure on nurses to provide increasingly intensive levels of care to a growing older population while at the same time working with reduced staffing levels. The aims of this study were to determine: (1) important aspects of nursing care as perceived by older patients, their family member/carer who observed care during hospitalization, and nurses; (2) satisfaction levels of patients, family/carers and nurses on nursing care received; and (3) mismatches between nursing care priorities and satisfaction with nursing care. Two hundred and thirty-two acutely ill patients aged over 65 years, 99 carers/family members and 90 nurses completed the Caregiving Activities Survey, which measures importance of and satisfaction with various aspects of nursing care. Qualitative data, which qualified responses to survey items, were also obtained from participants. Patients, carers and nurses perceived that carrying out doctors' orders was the most important aspect of nursing care, followed by physical care, psychosocial care and discharge planning. Nurses and carers rated physical care, psychosocial care and discharge planning more highly than patients. Physical care was rated highly by patients in terms of importance, but rated moderately in terms of satisfaction. Carers' and patients' ratings of satisfaction with physical care were lower than nurses' ratings of opportunities to provide it. The importance of discharge planning was rated highly by nurses but all groups were only moderately satisfied with this aspect of care. The findings do not apply to acutely ill older patients with confusion, mental illness or more than early stage dementia. Patients, nurses and family/carers were generally in agreement about the relative importance of particular aspects of nursing care. Nurses may need to communicate more effectively with older patients and their family carers about the particular roles they will play during the patient's hospital episode, the expectations they have of patients in the process of healing and recovery, and the reasons for the actions they take in aiding this process. The findings are useful in making nurses more aware of the expectations and needs of older hospital patients and their carers. They provide evidence for developing both new models of nursing care for this patient group, and nursing education programmes.
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Flink, Benjamin J; Long, Chandler A; Duwayri, Yazan; Brewster, Luke P; Veeraswamy, Ravi; Gallagher, Katherine; Arya, Shipra
2016-06-01
Women undergoing vascular surgery have higher morbidity and mortality. Our study explores gender-based differences in patient-centered outcomes such as readmission, length of stay (LOS), and discharge destination (home vs nonhome facility) in aortic aneurysm surgery. Patients were identified from the American College of Surgeons National Surgical Quality Improvement Project database (2011-2013) undergoing abdominal, thoracic, and thoracoabdominal aortic aneurysms (N = 17,763), who were discharged and survived their index hospitalization. The primary outcome was unplanned readmission, and secondary outcomes were discharge to a nonhome facility, LOS, and reasons for unplanned readmission. Univariate, multivariate, and stratified analyses based on gender and discharge destination were used. Overall, 1541 patients (8.7%) experienced an unplanned readmission, with a significantly higher risk in women vs men (10.8% vs 8%; P < .001) overall (Procedure subtypes: abdominal aortic aneurysm [10.1% vs 7.7%; P < .001], thoracic aortic aneurysm [14.1% vs 13.5%; P = .8], and thoracoabdominal aortic aneurysm [14.8% vs 10%; P = .051]). The higher odds of readmission in women compared with men persisted in multivariate analysis after controlling for covariates (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.05-1.4). Similarly, the rate of discharge to a nonhome facility was nearly double in women compared with men (20.6% vs 10.7%; P < .001), but discharge to a nonhome facility was not a significant predictor of unplanned readmission. Upon stratification by discharge destination, the higher odds of readmissions in women compared with men occurred in patients who were discharged home (OR, 1.2; 95% CI, 1.02-1.4) but not in those who were discharged to a nonhome facility (OR, 1.06; 95% CI, 0.8-1.4). Significant differences in LOS were seen in patients who were discharged home. No gender differences were found in reasons for readmission with the three most common reasons being thromboembolic events, wound infections, and pneumonia. Gender disparity exists in the risk of unplanned readmission among aortic aneurysm surgery patients. Women who were discharged home have a higher likelihood of unplanned readmission despite longer LOS than men. These data suggest that further study into the discharge planning processes, social factors, and use of rehabilitation services is needed for women undergoing aortic procedures to decrease readmissions. Published by Elsevier Inc.
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Hines, Walter G.
1973-01-01
The San Francisco Bay region has suffered adverse environmental effects related to the discharge of municipal-, industrial-, and agricultural- wastewater and storm-water runoff. Specific pollutional properties of theses discharges are not well understood in all cases although the toxic materials and aquatic-plant nutrients (biostimulants) found in municipal and industrial waterwater are considered to be a major cause of regional water-quality problems. Other water-quality problems in the region are commonly attributed to pesticides found in agricultural wastewater and potentially pathogenic bacteria in municipal-wastewater discharges and in storm-water runoff. The geographical distribution and magnitude of wastewater discharges in the bay region, particularly those from municipalities and industries, is largely a function of population, economic growth, and urban development. As might be expected, the total volume of wastewater has increased in a trend paralleling this growth and development. More significant, perhaps, is the fact that the total volume parameters such as BOD (biochemical oxygen demand), biostimulant concentrations, and toxicity, has increased despite large expenditures on new and improved municipal- and industrial-wastewater-treatment plants. Also, pollutant loadings from other major source, such as agriculture and storm-water runoff, have increased. At the time of writing (1972), many Federal, State, regional, and local agencies are engaged in a comprehensive wastewater-management-planning effort for the entire bay region. Initial objectives of this planning effort are: (1) the consolidation and coordination of loosely integrated wastewater-management facilities and (2) the elimination of wastewater discharges to ecologically sensitive areas, such as fresh-water streams and shallow extremities of San Francisco Bay. There has been some investigation of potential long-range wastewater-management alternatives based upon disposal in deep water in the bay, in the Pacific Ocean, or on land. Also, wastewater-reclamation and water-reuse concepts seem to be growing in favor with the public and should become and important part of future wastewater-management plans. Because most wastewater-reclamation and water-reuse systems would involve the use of land (that is agricultural irrigation, ground-water recharge, recreational reservoirs) local and regional lang-use planners can ass much to wastewater-management planning by identifying local and subregional waterwater-reclamation and water-reuse possibilities within their jurisdictions and integrating them with future land-use plans. The timely participation of planner is essential because Federal and State planning and funding deadlines for a regional wastewater-management system become effective in July 1973 and 1974, respectively.
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42 CFR 423.2430 - Activities that improve health care quality.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 42 Public Health 3 2014-10-01 2014-10-01 false Activities that improve health care quality. 423... Requirements for a Minimum Medical Loss Ratio § 423.2430 Activities that improve health care quality. (a... discharge planning, and post-discharge reinforcement by an appropriate health care professional. (iii) To...
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42 CFR 423.2430 - Activities that improve health care quality.
Code of Federal Regulations, 2013 CFR
2013-10-01
... 42 Public Health 3 2013-10-01 2013-10-01 false Activities that improve health care quality. 423... Requirements for a Minimum Medical Loss Ratio § 423.2430 Activities that improve health care quality. (a... discharge planning, and post-discharge reinforcement by an appropriate health care professional. (iii) To...
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42 CFR 422.2430 - Activities that improve health care quality.
Code of Federal Regulations, 2013 CFR
2013-10-01
... 42 Public Health 3 2013-10-01 2013-10-01 false Activities that improve health care quality. 422... Minimum Medical Loss Ratio § 422.2430 Activities that improve health care quality. (a) Activity... discharge planning, and post-discharge reinforcement by an appropriate health care professional. (iii) To...
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42 CFR 422.2430 - Activities that improve health care quality.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 42 Public Health 3 2014-10-01 2014-10-01 false Activities that improve health care quality. 422... Minimum Medical Loss Ratio § 422.2430 Activities that improve health care quality. (a) Activity... discharge planning, and post-discharge reinforcement by an appropriate health care professional. (iii) To...
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The Electrostatic Environments of Mars: Atmospheric Discharges
NASA Technical Reports Server (NTRS)
Calle, Carlos I.; Mackey, Paul J.; Johansen, Michael R.; Hogue, Michael D.; Phillips, James, III; Cox, Rachel E.
2016-01-01
The electrostatic environment on Mars is controlled by its ever present atmospheric dust. Dust devils and dust storms tribocharge this dust. Theoretical studies predict that lightning and/or glow discharges should be present on Mars, but none have been directly observed. Experiments are planned to shed light on this issue.
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Code of Federal Regulations, 2010 CFR
2010-10-01
... uninspected vessel must meet the garbage discharge, waste management plan, and placard requirements of 33 CFR part 151 applicable to the vessel. Note: 33 CFR 151.67 prohibits the discharge of plastic or garbage mixed with plastic into the sea or the navigable waters of the United States. “Plastic” and “garbage...
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National Oil and Hazardous Substances Pollution Contingency Plan
DOT National Transportation Integrated Search
1996-07-01
The purpose of the National Oil and Hazardous Substances Pollution Contingency Plan (NCP) is to provide the organizational structure and procedures for preparing for and responding to discharges of oil and releases of hazardous substances, pollutants...
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National Contingency Plan Subpart J
Subpart J of the National Oil and Hazardous Substances Pollution Contingency Plan (NCP) directs EPA to prepare a schedule of dispersants, other chemicals, and oil spill mitigating devices and substances that may be used to remove or control oil discharges.
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Greysen, S. Ryan; Hoi-Cheung, Doug; Garcia, Veronica; Kessell, Eric; Sarkar, Urmimala; Goldman, Lauren; Schneidermann, Michelle; Critchfield, Jeffrey; Pierluissi, Edgar; Kushel, Margot
2014-01-01
Background Recent interventions to improve transitions in care for older adults focus on hospital discharge processes. Limited data exists on patient concerns for care at home after discharge, particularly for vulnerable older adults. Design We used in-depth, in-person interviews to describe barriers to recovery at home after leaving the hospital for vulnerable, older adults. We purposefully sampled by age, gender, race, and English proficiency to ensure a wide breadth of experiences. Interviews were independently coded by two investigators using the constant comparative method. Thematic analysis was performed by the entire research team with diverse backgrounds in primary care, hospital medicine, geriatrics, and nursing. Setting and Participants We interviewed vulnerable older adults (low income/health literacy, and/or Limited English Proficiency) who were enrolled in a larger discharge interventional study within 30 days of discharge from an urban public hospital. All participants were interviewed in their native language (English, Spanish, or Chinese). Results We interviewed 24 patients: mean age 63 (55–84), 66% male, 67% Non-white, 16% Spanish-speaking, 16% Chinese-speaking. We identified an overarching theme of “missing pieces” in the plan for post-discharge recovery at home from which three specific sub-themes emerged: (1) functional limitations and difficulty with mobility and self-care tasks; (2) social isolation and lack of support from family and friends; (3) challenges from poverty and the built environment at home. In contrast, patients described mostly supportive experiences with traditional focuses of transition care such as following prescribed medication and diet regimens. Conclusion Hospital-based discharge interventions that focus on traditional aspects of care may overlook social and functional gaps in post-discharge care at home for vulnerable older adults. Post-discharge interventions that address these challenges may be necessary to reduce readmissions in this population. PMID:24934494
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Study of oxygen gas production phenomenon during stand and discharge in silver-zinc batteries
NASA Technical Reports Server (NTRS)
1973-01-01
The effects of a number of cell process and performance variables upon the oxygen evolution rate of silver/silver oxide cathodes are studied to predict and measure the conditions which would result in the production of a minimum of oxygen. The following five tasks comprise the study: the design and fabrication of two pilot test cells to be used for electrode testing; the determination of the sensitivity and accuracy of the test cell; the determination of total volumes and rates of generation by cathodes of standard production procedures; the construction of a sequential test plan; and the construction of a series of positive formation cells in which formation process factors can be controlled.
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STRUCTURAL INEQUALITY AND SOCIAL SUPPORT FOR WOMEN PRISONERS RELEASED TO RURAL COMMUNITIES
Nicdao, Ethel G.; Trott, Elise M.; Kellett, Nicole C.
2016-01-01
Incarceration and community reentry for rural women reflect gendered processes. We draw upon in-depth semi-structured interviews and focus groups to examine the return of women prisoners to underserved rural communities, while attending to the perspectives of their closest social supporters. Our findings underscore the complexity of the reentry process for rural women and its particular impact on their families. We challenge dominant discourses of personal responsibility that detract from the structura violence and injustice shaping reentry experiences for women and their social supporters. We also consider the policy implications of discharge and reentry planning for rural women and their families, as well as strategies to reduce recidivism. PMID:27274615
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Carson, Matthew B; Lee, Young Ji; Benacka, Corrine; Mutharasan, R. Kannan; Ahmad, Faraz S; Kansal, Preeti; Yancy, Clyde W; Anderson, Allen S; Soulakis, Nicholas D
2017-01-01
Objective: Using Failure Mode and Effects Analysis (FMEA) as an example quality improvement approach, our objective was to evaluate whether secondary use of orders, forms, and notes recorded by the electronic health record (EHR) during daily practice can enhance the accuracy of process maps used to guide improvement. We examined discrepancies between expected and observed activities and individuals involved in a high-risk process and devised diagnostic measures for understanding discrepancies that may be used to inform quality improvement planning. Methods: Inpatient cardiology unit staff developed a process map of discharge from the unit. We matched activities and providers identified on the process map to EHR data. Using four diagnostic measures, we analyzed discrepancies between expectation and observation. Results: EHR data showed that 35% of activities were completed by unexpected providers, including providers from 12 categories not identified as part of the discharge workflow. The EHR also revealed sub-components of process activities not identified on the process map. Additional information from the EHR was used to revise the process map and show differences between expectation and observation. Conclusion: Findings suggest EHR data may reveal gaps in process maps used for quality improvement and identify characteristics about workflow activities that can identify perspectives for inclusion in an FMEA. Organizations with access to EHR data may be able to leverage clinical documentation to enhance process maps used for quality improvement. While focused on FMEA protocols, findings from this study may be applicable to other quality activities that require process maps. PMID:27589944
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NASA Technical Reports Server (NTRS)
Schubert, Matthew R.; Moore, Andrew J.
2015-01-01
Electron cascades from electrical discharge produce secondary emissions from atmospheric plasma in the ultraviolet band. For a single point of discharge, these emissions exhibit a stereotypical discharge morphology, with latent information about the discharge location. Morphological processing can uncover the location and therefore can have diagnostic utility.
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Schubert, Matthew; Moore, Andrew J
2016-03-01
Electron cascades from electrical discharge produce secondary emissions from atmospheric plasma in the ultraviolet band. For a single point of discharge, these emissions exhibit a stereotypical discharge morphology, with latent information about the discharge location. Morphological processing can uncover the location and therefore have diagnostic utility.
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Code of Federal Regulations, 2010 CFR
2010-10-01
..., and medical supervision. Patients are accepted for treatment on the basis of a reasonable expectation... a doctor of medicine, osteopathy, or podiatric medicine. (a) Standard: Plan of care. The plan of... treatments, any safety measures to protect against injury, instructions for timely discharge or referral, and...
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100-D Ponds closure plan. Revision 1
DOE Office of Scientific and Technical Information (OSTI.GOV)
Petersen, S.W.
1997-09-01
The 100-D Ponds is a Treatment, Storage, and Disposal (TSD) unit on the Hanford Facility that received both dangerous and nonregulated waste. This Closure Plan (Rev. 1) for the 100-D Ponds TSD unit consists of a RCRA Part A Dangerous Waste Permit Application (Rev. 3), a RCRA Closure Plan, and supporting information contained in the appendices to the plan. The closure plan consists of eight chapters containing facility description, process information, waste characteristics, and groundwater monitoring data. There are also chapters containing the closure strategy and performance standards. The strategy for the closure of the 100-D Ponds TSD unit ismore » clean closure. Appendices A and B of the closure plan demonstrate that soil and groundwater beneath 100-D Ponds are below cleanup limits. All dangerous wastes or dangerous waste constituents or residues associated with the operation of the ponds have been removed, therefore, human health and the environment are protected. Discharges to the 100-D Ponds, which are located in the 100-DR-1 operable unit, were discontinued in June 1994. Contaminated sediment was removed from the ponds in August 1996. Subsequent sampling and analysis demonstrated that there is no contamination remaining in the ponds, therefore, this closure plan is a demonstration of clean closure.« less
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Tamblyn, Robyn; Huang, Allen R; Meguerditchian, Ari N; Winslade, Nancy E; Rochefort, Christian; Forster, Alan; Eguale, Tewodros; Buckeridge, David; Jacques, André; Naicker, Kiyuri; Reidel, Kristen E
2012-08-27
Adverse drug events are responsible for up to 7% of all admissions to acute care hospitals. At least 58% of these are preventable, resulting from incomplete drug information, prescribing or dispensing errors, and overuse or underuse of medications. Effective implementation of medication reconciliation is considered essential to reduce preventable adverse drug events occurring at transitions between community and hospital care. An electronically enabled discharge reconciliation process represents an innovative approach to this problem. Participants will be recruited in Quebec and are eligible for inclusion if they are using prescription medication at admission, covered by the Quebec drug insurance plan, admitted from the community, 18 years or older, admitted to a general or intensive care medical or surgical unit, and discharged alive. A sample size of 3,714 will be required to detect a 5% reduction in adverse drug events. The intervention will comprise electronic retrieval of the community drug list, combined with an electronic discharge reconciliation module and an electronic discharge communication module. The primary outcomes will be adverse drug events occurring 30 days post-discharge, identified by a combination of patient self-report and chart abstraction. All emergency room visits and hospital readmission during this period will be measured as secondary outcomes. A cluster randomization approach will be used to allocate 16 medical and 10 surgical units to electronic discharge reconciliation and communication versus usual care. An intention-to-treat approach will be used to analyse data. Logistic regression will be undertaken within a generalized estimating equation framework to account for clustering within units. The goal of this prospective trial is to determine if electronically enabled discharge reconciliation will reduce the risk of adverse drug events, emergency room visits and readmissions 30 days post-discharge compared with usual care. We expect that this intervention will improve adherence to medication reconciliation at discharge, the accuracy of the community-based drug history and effective communication of hospital-based treatment changes to community care providers. The results may support policy-directed investments in computerizing and training of hospital staff, generate key requirements for future hospital accreditation standards, and highlight functional requirements for software vendors. NCT01179867.
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Shim, Sung J; Kumar, Arun; Jiao, Roger
2016-01-01
A hospital is considering deploying a radiofrequency identification (RFID) system and setting up a new "discharge lounge" to improve the patient discharge process. This study uses computer simulation to model and compare the current process and the new process, and it assesses the impact of the RFID system and the discharge lounge on the process in terms of resource utilization and time taken in the process. The simulation results regarding resource utilization suggest that the RFID system can slightly relieve the burden on all resources, whereas the RFID system and the discharge lounge together can significantly mitigate the nurses' tasks. The simulation results in terms of the time taken demonstrate that the RFID system can shorten patient wait times, staff busy times, and bed occupation times. The results of the study could prove helpful to others who are considering the use of an RFID system in the patient discharge process in hospitals or similar processes.
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Charge Management in LISA Pathfinder: The Continuous Discharging Experiment
NASA Astrophysics Data System (ADS)
Ewing, Becca Elizabeth
2018-01-01
Test mass charging is a significant source of excess force and force noise in LISA Pathfinder (LPF). The planned design scheme for mitigation of charge induced force noise in LISA is a continuous discharge by UV light illumination. We report on analysis of a charge management experiment on-board LPF conducted during December 2016. We discuss the measurement of test mass charging noise with and without continuous UV illumination, in addition to the dynamic response in the continuous discharge scheme. Results of the continuous discharge system will be discussed for their application to operating LISA with lower test mass charge.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Specht, W.L.
2000-02-28
The Savannah River Site currently has 33 permitted NPDES outfalls that have been permitted by the South Carolina Department of Health an Environmental Control to discharge to SRS streams and the Savannah River. In order to determine the cumulative impacts of these discharges to the receiving streams, a study plan was developed to perform in-stream assessments of the fish assemblages, macroinvertebrate assemblages, and habitats of the receiving streams.
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Smith-Merry, Jennifer; Caple, Andrew
2014-03-01
Adverse events in mental health care occur frequently and cause significant distress for those who experience them, derailing treatment and sometimes leading to death. These events are clustered around particular aspects of care and treatment and are therefore avoidable if practices in these areas are strengthened. The research reported in this article takes as its starting point coronial recommendations made in relation to mental health. We report on those points and processes in treatment and discharge where coronial recommendations are most frequently made. We then examine the legislative requirements around these points and processes in three Australian States. We find that the key areas that need to be strengthened to avoid adverse events are assessment processes, communication and information transfer, documentation, planning and training. We make recommendations for improvements in these key areas.
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Belleli, Esther; Naccarella, Lucio; Pirotta, Marie
2013-12-01
Timeliness and quality of hospital discharge summaries are crucial for patient safety and efficient health service provision after discharge. We audited receipt rates, timeliness and the quality of discharge summaries for 49 admissions among 38 patients in an urban general practice. For missing discharge summaries, a hospital medical record search was performed. Discharge summaries were received for 92% of identified admissions; 73% were received within three days and 55% before the first post-discharge visit to the general practitioner (GP). Administrative information and clinical content, including diagnosis, treatment and follow-up plans, were well reported. However, information regarding tests, referrals and discharge medication was often missing; 57% of summaries were entirely typed and 13% had legibility issues. Completion rates were good but utility was compromised by delays, content omissions and formatting. Digital searching enables extraction of information from rich existing datasets contained in GP records for accurate measurement of discharge summary receipt rate and timing.
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Code of Federal Regulations, 2011 CFR
2011-10-01
..., DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION ON DEVELOPMENTAL DISABILITIES, DEVELOPMENTAL... such acts as: Verbal, nonverbal, mental and emotional harassment; rape or sexual assault; striking; the... treatment plan (including a discharge plan); provide adequate nutrition, clothing, or health care to an...
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Development of Partial Discharging Simulation Test Equipment
NASA Astrophysics Data System (ADS)
Kai, Xue; Genghua, Liu; Yan, Jia; Ziqi, Chai; Jian, Lu
2017-12-01
In the case of partial discharge training for recruits who lack of on-site work experience, the risk of physical shock and damage of the test equipment may be due to the limited skill level and improper operation by new recruits. Partial discharge simulation tester is the use of simulation technology to achieve partial discharge test process simulation, relatively true reproduction of the local discharge process and results, so that the operator in the classroom will be able to get familiar with and understand the use of the test process and equipment.The teacher sets up the instrument to display different partial discharge waveforms so that the trainees can analyze the test results of different partial discharge types.
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Developing an evaluation framework for clinical redesign programs: lessons learnt.
Samaranayake, Premaratne; Dadich, Ann; Fitzgerald, Anneke; Zeitz, Kathryn
2016-09-19
Purpose The purpose of this paper is to present lessons learnt through the development of an evaluation framework for a clinical redesign programme - the aim of which was to improve the patient journey through improved discharge practices within an Australian public hospital. Design/methodology/approach The development of the evaluation framework involved three stages - namely, the analysis of secondary data relating to the discharge planning pathway; the analysis of primary data including field-notes and interview transcripts on hospital processes; and the triangulation of these data sets to devise the framework. The evaluation framework ensured that resource use, process management, patient satisfaction, and staff well-being and productivity were each connected with measures, targets, and the aim of clinical redesign programme. Findings The application of business process management and a balanced scorecard enabled a different way of framing the evaluation, ensuring measurable outcomes were connected to inputs and outputs. Lessons learnt include: first, the importance of mixed-methods research to devise the framework and evaluate the redesigned processes; second, the need for appropriate tools and resources to adequately capture change across the different domains of the redesign programme; and third, the value of developing and applying an evaluative framework progressively. Research limitations/implications The evaluation framework is limited by its retrospective application to a clinical process redesign programme. Originality/value This research supports benchmarking with national and international practices in relation to best practice healthcare redesign processes. Additionally, it provides a theoretical contribution on evaluating health services improvement and redesign initiatives.
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NASA Astrophysics Data System (ADS)
Hassouni, Khaled
2013-09-01
In this paper we present two examples that illustrate two different contexts of the interplay between plasma-surface interaction process and discharge physics and gas phase chemistry in hydrocarbon discharges. In the first example we address the case of diamond deposition processes and illustrate how a detailed investigation of the discharge physics, collisional processes and transport phenomena in the plasma phase make possible to accurately predict the key local-parameters, i.e., species density at the growing substrate, as function of the macroscopic process parameters, thus allowing for a precise control of diamond deposition process. In the second example, we illustrate how the interaction between a rare gas pristine discharge and carbon (graphite) electrode induce a dramatic change on the discharge nature, i.e., composition, ionization kinetics, charge equilibrium, etc., through molecular growth and clustering processes, solid particle formation and dusty plasma generation. Work done in collaboration with Alix Gicquel, Francois Silva, Armelle Michau, Guillaume Lombardi, Xavier Bonnin, Xavier Duten, CNRS, Universite Paris 13.
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The POP Program: the patient education advantage.
Claeys, M; Mosher, C; Reesman, D
1998-01-01
In 1992, a preoperative education program was developed for total joint replacement patients in a small community hospital. The goals of the program were to increase educational opportunities for the joint replacement patients, prepare patients for hospitalization, plan for discharge needs, and increase efficiency of the orthopaedic program. Since 1992, approximately 600 patients have attended the education program. Outcomes have included positive responses from patients regarding their preparedness for surgery, increased participation in their plan of care, coordinated discharge planning, decreased length of stay, and progression across the continuum of care. A multidisciplinary approach to preparing patients for surgery allows for a comprehensive and efficient education program. Marketing of successful programs can enhance an institution's competitive advantage and help ensure the hospital's viability in the current health care arena.
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Ma, Shuangchen; Chai, Jin; Wu, Kai; Xiang, Yajun; Jia, Shaoguang; Li, Qingsong
2018-03-20
Zero liquid discharge (ZLD) of wastewater has become the trend of environmental governance after the implementation of 'The Action Plan for Prevention and Treatment of Water Pollution' in China, desulfurization wastewater has gained more attention due to its complex composition and heavy metals. However, current technologies for ZLD have some shortcomings such as high cost and insufficient processing capacity, ZLD cannot be achieved actually. This paper proposes a new evaporation drying technology. An independent bypass evaporation tower was built, part of the hot flue gas before the air preheater was introduced into the evaporation tower for desulfurization wastewater evaporation, and the generated dust after evaporation was discharged back to the flue duct before electrostatic precipitator. This paper reports on the performance of desulfurization wastewater evaporation and the characteristics of evaporation products in depth and makes a comprehensive discussion of the impact on the existing equipment based on the self-designed evaporation tower. Research suggests that this technology has high system reliability and little effect on subsequent equipment and provides theoretical and practical data. Due to environmental policies and huge market demand for ZLD of desulfurization wastewater, bypass evaporation tower technology has a great application prospect in the future.
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Mapping (dis)agreement in hydrologic projections
NASA Astrophysics Data System (ADS)
Melsen, Lieke A.; Addor, Nans; Mizukami, Naoki; Newman, Andrew J.; Torfs, Paul J. J. F.; Clark, Martyn P.; Uijlenhoet, Remko; Teuling, Adriaan J.
2018-03-01
Hydrologic projections are of vital socio-economic importance. However, they are also prone to uncertainty. In order to establish a meaningful range of storylines to support water managers in decision making, we need to reveal the relevant sources of uncertainty. Here, we systematically and extensively investigate uncertainty in hydrologic projections for 605 basins throughout the contiguous US. We show that in the majority of the basins, the sign of change in average annual runoff and discharge timing for the period 2070-2100 compared to 1985-2008 differs among combinations of climate models, hydrologic models, and parameters. Mapping the results revealed that different sources of uncertainty dominate in different regions. Hydrologic model induced uncertainty in the sign of change in mean runoff was related to snow processes and aridity, whereas uncertainty in both mean runoff and discharge timing induced by the climate models was related to disagreement among the models regarding the change in precipitation. Overall, disagreement on the sign of change was more widespread for the mean runoff than for the discharge timing. The results demonstrate the need to define a wide range of quantitative hydrologic storylines, including parameter, hydrologic model, and climate model forcing uncertainty, to support water resource planning.
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Ingram, Jenny C; Powell, Jane E; Blair, Peter S; Pontin, David; Redshaw, Maggie; Manns, Sarah; Beasant, Lucy; Burden, Heather; Johnson, Debbie; Rose, Claire; Fleming, Peter J
2016-03-10
To implement parent-oriented discharge planning (Train-to-Home) for preterm infants in neonatal care. Before and after study, investigating the effects of the intervention during two 11-month periods before and after implementation. Four local neonatal units (LNUs) in South West England. Infants without major anomalies born at 27-33 weeks' gestation admitted to participating units, and their parents. A family-centred discharge package to increase parents' involvement and understanding of their baby's needs, comprising a train graphic and supporting care pathways to facilitate parents' understanding of their baby's progress and physiological maturation, combined with improved estimation of the likely discharge date. Perceived Maternal Parenting Self-Efficacy (PMP S-E) scores, infant length of stay (LOS) and healthcare utilisation for 8 weeks following discharge. Parents reported that the Train-to-Home improved understanding of their baby's progress and their preparedness for discharge. Despite a lack of change in PMP S-E scores with the intervention, the number of post-discharge visits to emergency departments (EDs) fell from 31 to 20 (p<0.05), with a significant reduction in associated healthcare costs (£3400 to £2200; p<0.05) after discharge. In both study phases, over 50% of infants went home more than 3 weeks before their estimated date of delivery (EDD), though no reduction in LOS occurred. Despite the lack of measurable effect on the parental self-efficacy scores, the reduction in ED attendances and associated costs supports the potential value of this approach. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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Purdy, Isabell B.; Singh, Namrata; Le, Cindy; Bell, Cynthia; Whiteside, Christy; Collins, Mara
2012-01-01
Objective To determine influences on incidence of breast milk feeding (BMF) at time of discharge and 6 months later among infants cared for in the neonatal intensive care unit (NICU). Design A 2-year prospective descriptive NICU hospital-based cohort design. Setting Academic Center Level III–IV NICU. Participants Five hundred and thirty-five infants cared for in NICU and a subgroup of one hundred twenty-nine participant mothers who answered questionnaires. Methods Pre-discharge data were collected using maternal and infant medical records. Post discharge data were collected from maternal questionnaires. Results At NICU discharge, biophysiologic stressors predictive of not receiving BMF included birth weight < 1500 grams (p<0.035), heart surgery (p= 0.014), and inhaled nitric oxide treatment (p=.002). Teenage mothers were less likely to BMF (p= 0.022). After discharge, BMF duration correlated with BMF duration of a prior infant (p<0.009). Most mothers reported BMF > 4 months, 91% continued pumping, and 89% indicated an interest in a hospital support group. Logistic regression analysis (R2 0.45) identified factors that significantly increased the likelihood of BMF > 4 months: BMF plan (p<0.001), convenience (p=0.018), and family as resource (p=0.025). Negative associations were: awareness of immune benefits (p=0.025), return to work (p=0.002), and infants requiring surgical ligation of the patent ductus arterious (p=0.019). Conclusions Social and medical stressors contribute to BMF duration pre and post NICU discharge. We speculate that active NICU BMF support targeting vulnerable infants and their families and assisting with plans for BMF pre and post discharge will help overcome barriers. PMID:22834882
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-01-22
... Administration (``NOAA''); the United States Department of the Interior (``DOl''), acting through the National... restoration planning, (2) Ephemeral data, and/or (3) Information needed to design or implement anticipated...
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The Clean Water Act (CWA) Action Plan Implementation Priorities describes the new approaches to revamp the National Pollutant Discharge Elimination System (NPDES) permitting, compliance and enforcement program.Issued May 11, 2011
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Bikmoradi, Ali; Masmouei, Behnam; Ghomeisi, Mohammad; Roshanaei, Ghodratollah
2016-02-01
Coronary artery bypass graft is a major surgery and has complications that require professional and long term follow-up and nursing care that if do not properly handled, could reduce the quality of life and increase post-operative complications. On the other hand Tele-nursing is a cost-effective way to educate and follow-up of patients. This study aimed to assess the impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft. A quasi-experimental study was carried out at Ekbatan Therapeutic and Educational Center of Hamadan University of Medical Sciences at Hamadan, Iran, in 2013. In this study, 71 patients who had undergone coronary artery bypass graft surgery and had inclusion criteria were randomly divided into two experimental group (n=36), and control group (n=35). They completed questionnaire before discharging from Therapeutic and Educational Center. In the experimental group on days 2, 4, 7, second week (day 11), third week (day 18) and fourth week (day 25) after discharge, follow-up interventions and nursing education with Tele-nursing was done, but in the in the control groups, patients received only routine interventions. After completion of the intervention period, both groups completed the questionnaire and the results were compared. Adherence of treatment plan in both groups did not have significant difference before intervention (P=0.696), but had a significant difference with regard to baseline after intervention in aromatherapy group (P< 0.01) and with control group after intervention (P<0.01). Adherence to treatment plan in the aromatherapy group was better in compared to control group (P<0.01). Tele-nursing is a convenient way, cost effective training and follow-up care for patients after coronary artery bypass surgery, which can improve patients' adherence to treatment plan in developing countries such as Iran. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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Understanding the distributed cognitive processes of intensive care patient discharge.
Lin, Frances; Chaboyer, Wendy; Wallis, Marianne
2014-03-01
To better understand and identify vulnerabilities and risks in the ICU patient discharge process, which provides evidence for service improvement. Previous studies have identified that 'after hours' discharge and 'premature' discharge from ICU are associated with increased mortality. However, some of these studies have largely been retrospective reviews of various administrative databases, while others have focused on specific aspects of the process, which may miss crucial components of the discharge process. This is an ethnographic exploratory study. Distributed cognition and activity theory were used as theoretical frameworks. Ethnographic data collection techniques including informal interviews, direct observations and collecting existing documents were used. A total of 56 one-to-one interviews were conducted with 46 participants; 28 discharges were observed; and numerous documents were collected during a five-month period. A triangulated technique was used in both data collection and data analysis to ensure the research rigour. Under the guidance of activity theory and distributed cognition theoretical frameworks, five themes emerged: hierarchical power and authority, competing priorities, ineffective communication, failing to enact the organisational processes and working collaboratively to optimise the discharge process. Issues with teamwork, cognitive processes and team members' interaction with cognitive artefacts influenced the discharge process. Strategies to improve shared situational awareness are needed to improve teamwork, patient flow and resource efficiency. Tools need to be evaluated regularly to ensure their continuous usefulness. Health care professionals need to be aware of the impact of their competing priorities and ensure discharges occur in a timely manner. Activity theory and distributed cognition are useful theoretical frameworks to support healthcare organisational research. © 2013 John Wiley & Sons Ltd.
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Thoma, Jorun E; Waite, Marion A
2018-03-01
To gain knowledge of nurse case managers' experiences within the German acute care context of collaboration with patients and physicians in a discharge planning role; further to learn about patients' assignment to the management of the nurse case managers; and explicitly to explore critical incidences of interactions between nurse case managers, patients and healthcare practitioner in discharge planning to understand the factor that contributes to effective collaboration. The defined role of nurse case managers in many contexts is a patient-centred responsibility for a central task of discharge management of patients with complex physical and social needs. Some studies have indicated that the general impact of the role reduces readmission rates. Given the necessity to work interprofessionally to achieve a safe discharge, little is known about how nurse case managers achieve this collaboratively. A qualitative case study within a German teaching hospital of nurse case managers (N = 8). Data were collected through semi-structured interviews prompted by a critical incident technique and rigorously analysed through the lenses of sociocultural theory. Consistent object being worked upon was a safe and effective discharge from hospital with a focus on patient advocacy. Significant themes were a self-value or recognition by others of professional expertise, reciprocal value on the capabilities of others thorough relational expertise and negotiation with patients and an identification of case trajectories. More continuity of nurse case managers' care and management, clarity of role and transparency to peers, physicians and other professionals would be beneficial in ensuring appropriate referral of complex patients to nurse case managers responsibility. Clearer role description and benefit realisation of the nurse case managers could be achieved by interventions that are interprofessional and focus on the tasks that matter from a collaborative perspective. This could lead to refinement of available indicators and policy developments. © 2018 John Wiley & Sons Ltd.
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CMS keeps raising the stakes on quality improvement.
2014-10-01
A significant portion of the Centers for Medicare & Medicaid Services (CMS) 2015 Inpatient Prospective Payment System final rule focuses on quality and raises the percentage of the Medicare base payment hospitals can lose if they perform poorly. Case managers must be involved with patients from the minute they come in the door, through the hospital stay, and after discharge, experts say. Reimbursement is affected by risk-adjustment, which means case managers must make sure the documentation is as complete and specific as possible to show the full picture of the patient's severity of illness as well as any conditions that were present on admission. As the readmission reduction program expands to add new diagnoses and the penalties for poor performance increase, case managers must change their focus from discharge planning to transition planning that takes into account what resources patients need after discharge, experts say.
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Loram, Ian D.; Muceli, Silvia; Merletti, Roberto; Farina, Dario
2012-01-01
The recruitment and the rate of discharge of motor units are determinants of muscle force. Within a motoneuron pool, recruitment and rate coding of individual motor units might be controlled independently, depending on the circumstances. In this study, we tested whether, during human quiet standing, the force of the medial gastrocnemius (MG) muscle is predominantly controlled by recruitment or rate coding. If MG control during standing was mainly due to recruitment, then we further asked what the trigger mechanism is. Is it determined internally, or is it related to body kinematics? While seven healthy subjects stood quietly, intramuscular electromyograms were recorded from the MG muscle with three pairs of wire electrodes. The number of active motor units and their mean discharge rate were compared for different sway velocities and positions. Motor unit discharges occurred more frequently when the body swayed faster and forward (Pearson R = 0.63; P < 0.0001). This higher likelihood of observing motor unit potentials was explained chiefly by the recruitment of additional units. During forward body shifts, the median number of units detected increased from 3 to 11 (P < 0.0001), whereas the discharge rate changed from 8 ± 1.1 (mean ± SD) to 10 ± 0.9 pulses/s (P = 0.001). Strikingly, motor units did not discharge continuously throughout standing. They were recruited within individual, forward sways and intermittently, with a modal rate of two recruitments per second. This modal rate is consistent with previous circumstantial evidence relating the control of standing to an intrinsic, higher level planning process. PMID:21994258
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Vieira, Taian M M; Loram, Ian D; Muceli, Silvia; Merletti, Roberto; Farina, Dario
2012-01-01
The recruitment and the rate of discharge of motor units are determinants of muscle force. Within a motoneuron pool, recruitment and rate coding of individual motor units might be controlled independently, depending on the circumstances. In this study, we tested whether, during human quiet standing, the force of the medial gastrocnemius (MG) muscle is predominantly controlled by recruitment or rate coding. If MG control during standing was mainly due to recruitment, then we further asked what the trigger mechanism is. Is it determined internally, or is it related to body kinematics? While seven healthy subjects stood quietly, intramuscular electromyograms were recorded from the MG muscle with three pairs of wire electrodes. The number of active motor units and their mean discharge rate were compared for different sway velocities and positions. Motor unit discharges occurred more frequently when the body swayed faster and forward (Pearson R = 0.63; P < 0.0001). This higher likelihood of observing motor unit potentials was explained chiefly by the recruitment of additional units. During forward body shifts, the median number of units detected increased from 3 to 11 (P < 0.0001), whereas the discharge rate changed from 8 ± 1.1 (mean ± SD) to 10 ± 0.9 pulses/s (P = 0.001). Strikingly, motor units did not discharge continuously throughout standing. They were recruited within individual, forward sways and intermittently, with a modal rate of two recruitments per second. This modal rate is consistent with previous circumstantial evidence relating the control of standing to an intrinsic, higher level planning process.
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Code of Federal Regulations, 2012 CFR
2012-04-01
... in its strategic plan; (C) Surplus from urban renewal settlements; (D) Grant funds returned to the...) Being discharged from publicly funded institutions and systems of care, such as health-care facilities, mental health facilities, foster care and other youth facilities, and corrections programs and...
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Code of Federal Regulations, 2013 CFR
2013-04-01
... in its strategic plan; (C) Surplus from urban renewal settlements; (D) Grant funds returned to the...) Being discharged from publicly funded institutions and systems of care, such as health-care facilities, mental health facilities, foster care and other youth facilities, and corrections programs and...
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40 CFR 300.105 - General organization concepts.
Code of Federal Regulations, 2013 CFR
2013-07-01
... PLAN Responsibility and Organization for Response § 300.105 General organization concepts. (a) Federal agencies should: (1) Plan for emergencies and develop procedures for addressing oil discharges and releases... activated during a response. RRT membership consists of designated representatives from each federal agency...
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40 CFR 300.105 - General organization concepts.
Code of Federal Regulations, 2012 CFR
2012-07-01
... PLAN Responsibility and Organization for Response § 300.105 General organization concepts. (a) Federal agencies should: (1) Plan for emergencies and develop procedures for addressing oil discharges and releases... activated during a response. RRT membership consists of designated representatives from each federal agency...
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40 CFR 412.46 - New source performance standards (NSPS).
Code of Federal Regulations, 2010 CFR
2010-07-01
... production areas. There must be no discharge of manure, litter, or process wastewater pollutants into waters... practice effluent limitations designed to ensure no discharge of manure, litter, or process wastewater... such effluent limitations, “no discharge of manure, litter, or process wastewater pollutants,” as used...
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ERIC Educational Resources Information Center
Boutin-Foster, Carla; Euster, Sona; Rolon, Yvette; Motal, Athena; BeLue, Rhonda; Kline, Robin; Charlson, Mary E.
2005-01-01
Early identification of patients who need a social work evaluation is integral to effective discharge planning. This article describes the development and application of the Social Work Admission Assessment Tool (SWAAT), a six-item scale that identifies patients with complicated discharge needs who require a social work evaluation. It addresses…
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Evans, R Scott; Benuzillo, Jose; Horne, Benjamin D; Lloyd, James F; Bradshaw, Alejandra; Budge, Deborah; Rasmusson, Kismet D; Roberts, Colleen; Buckway, Jason; Geer, Norma; Garrett, Teresa; Lappé, Donald L
2016-09-01
Develop and evaluate an automated identification and predictive risk report for hospitalized heart failure (HF) patients. Dictated free-text reports from the previous 24 h were analyzed each day with natural language processing (NLP), to help improve the early identification of hospitalized patients with HF. A second application that uses an Intermountain Healthcare-developed predictive score to determine each HF patient's risk for 30-day hospital readmission and 30-day mortality was also developed. That information was included in an identification and predictive risk report, which was evaluated at a 354-bed hospital that treats high-risk HF patients. The addition of NLP-identified HF patients increased the identification score's sensitivity from 82.6% to 95.3% and its specificity from 82.7% to 97.5%, and the model's positive predictive value is 97.45%. Daily multidisciplinary discharge planning meetings are now based on the information provided by the HF identification and predictive report, and clinician's review of potential HF admissions takes less time compared to the previously used manual methodology (10 vs 40 min). An evaluation of the use of the HF predictive report identified a significant reduction in 30-day mortality and a significant increase in patient discharges to home care instead of to a specialized nursing facility. Using clinical decision support to help identify HF patients and automatically calculating their 30-day all-cause readmission and 30-day mortality risks, coupled with a multidisciplinary care process pathway, was found to be an effective process to improve HF patient identification, significantly reduce 30-day mortality, and significantly increase patient discharges to home care. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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Gesell, Sabina B; Klein, Karen Potvin; Halladay, Jacqueline; Bettger, Janet Prvu; Freburger, Janet; Cummings, Doyle M; Lutz, Barbara J; Coleman, Sylvia; Bushnell, Cheryl; Rosamond, Wayne; Duncan, Pamela W
2017-04-01
The Comprehensive Post-Acute Stroke Services (COMPASS) Study is one of the first large pragmatic randomized-controlled clinical trials using comparative effectiveness research methods, funded by the Patient-Centered Outcomes Research Institute. In the COMPASS Study, we compare the effectiveness of a patient-centered, transitional care intervention versus usual care for stroke patients discharged home from acute care. Outcomes include stroke patient post-discharge functional status and caregiver strain 90 days after discharge, and hospital readmissions. A central tenet of Patient-Centered Outcomes Research Institute-funded research is stakeholder engagement throughout the research process. However, evidence on how to successfully implement a pragmatic trial that changes systems of care in combination with robust stakeholder engagement is limited. This combination is not without challenges. We present our approach for broad-based stakeholder engagement in the context of a pragmatic trial with the participation of patients, caregivers, community stakeholders, including the North Carolina Stroke Care Collaborative hospital network, and policy makers. To maximize stakeholder engagement throughout the COMPASS Study, we employed a conceptual model with the following components: (1) Patient and Other Stakeholder Identification and Selection; (2) Patient and Other Stakeholder Involvement Across the Spectrum of Research Activities; (3) Dedicated Resources for Patient and Other Stakeholder Involvement; (4) Support for Patient and Other Stakeholder Engagement Through Organizational Processes; (5) Communication with Patients and Other Stakeholders; (6) Transparent Involvement Processes; (7) Tracking of Engagement; and (8) Evaluation of Engagement. In this paper, we describe how each component of the model is being implemented and how this approach addresses existing gaps in the literature on strategies for engaging stakeholders in meaningful and useful ways when conducting pragmatic trials.
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Numerical analysis of effects of ion-neutral collision processes on RF ICP discharge
NASA Astrophysics Data System (ADS)
Nishida, K.; Mattei, S.; Lettry, J.; Hatayama, A.
2018-01-01
The discharge process of a radiofrequency (RF) inductively coupled plasma (ICP) has been modeled by an ElectroMagnetic Particle-in-Cell Monte Carlo Collision method (EM PIC-MCC). Although the simulation had been performed by our previous model to investigate the discharge mode transition of the RF ICP from a kinetic point of view, the model neglected the collision processes of ions (H+ and H2+) with neutral particles. In this study, the RF ICP discharge process has been investigated by the latest version of the model which takes the ion-neutral collision processes into account. The basic characteristics of the discharge mode transition provided by the previous model have been verified by the comparison between the previous and present results. As for the H-mode discharge regime, on the other hand, the ion-neutral collisions play an important role in evaluating the growth of the plasma. Also, the effect of the ion-neutral collisions on the kinetic feature of the plasma has been investigated, which has highlighted the importance of kinetic perspective for modeling the RF ICP discharge.
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Consolidation of materials by pulse-discharge processes
NASA Astrophysics Data System (ADS)
Strizhakov, E. L.; Nescoromniy, S. V.
2017-07-01
The article presents the research and the analysis of the pulse-discharge processes of capacitor discharge sintering: CD Stud Welding, capacitor discharge percussion welding (CDPW), high-voltage capacitor welding with an inductive-dynamic drive (HVCW with IDD), pulse electric current sintering (PECS) of powders. The comparative analysis of the impact parameter is presented.
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Code of Federal Regulations, 2012 CFR
2012-07-01
... of my knowledge and belief, no dumping of concentrated toxic organics into the wastewaters has... implementing the solvent management plan submitted to the permitting authority.” (b) In requesting that no monitoring of TTO be required, the direct discharger shall submit a solvent management plan that specifies to...
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Code of Federal Regulations, 2014 CFR
2014-07-01
... of my knowledge and belief, no dumping of concentrated toxic organics into the wastewaters has... implementing the solvent management plan submitted to the permitting authority.” (b) In requesting that no monitoring of TTO be required, the direct discharger shall submit a solvent management plan that specifies to...
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Code of Federal Regulations, 2013 CFR
2013-07-01
... of my knowledge and belief, no dumping of concentrated toxic organics into the wastewaters has... implementing the solvent management plan submitted to the permitting authority.” (b) In requesting that no monitoring of TTO be required, the direct discharger shall submit a solvent management plan that specifies to...
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Successful reentry: the perspective of private correctional health care providers.
Mellow, Jeff; Greifinger, Robert B
2007-01-01
Due to public health and safety concerns, discharge planning is increasingly prioritized by correctional systems when preparing prisoners for their reintegration into the community. Annually, private correctional health care vendors provide $3 billion of health care services to inmates in correctional facilities throughout the U.S., but rarely are contracted to provide transitional health care. A discussion with 12 people representing five private nationwide correctional health care providers highlighted the barriers they face when implementing transitional health care and what templates of services health care companies could provide to state and counties to enhance the reentry process.
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Mussman, Grant M; Vossmeyer, Michael T; Brady, Patrick W; Warrick, Denise M; Simmons, Jeffrey M; White, Christine M
2015-09-01
Timely and reliable verbal communication between hospitalists and primary care physicians (PCPs) is critical for prevention of medical adverse events but difficult in practice. Our aim was to increase the proportion of completed verbal handoffs from on-call residents or attendings to PCPs within 24 hours of patient discharge from a hospital medicine service to ≥90% within 18 months. A multidisciplinary team collaborated to redesign the process by which PCPs were contacted following patient discharge. Interventions focused on the key drivers of obtaining stakeholder buy-in, standardization of the communication process, including assigning primary responsibility for discharge communication to a single resident on each team and batching calls during times of maximum resident availability, reliable automated process initiation through leveraging the electronic health record (EHR), and transparency of data. A run chart assessed the impact of interventions over time. The percentage of calls initiated within 24 hours of discharge improved from 52% to 97%, and the percentage of calls completed improved to 93%. Results were sustained for 18 months. Standardization of the communication process through hospital telephone operators, use of the discharge order to ensure initiation of discharge communication, and batching of phone calls were associated with improvements in our measures. Reliable verbal discharge communication can be achieved through the use of a standardized discharge communication process coupled with the EHR. © 2015 Society of Hospital Medicine.
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Uniform National Discharge Standards (UNDS): Rulemaking Process
The EPA and Department of Defense used a batch rulemaking process for establishing the discharge standards for vessels of the Armed Forces. They identified and evaluated the discharges and determined which require marine pollution control devices.
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NASA Astrophysics Data System (ADS)
Cvecek, Kristian; Gröschel, Benjamin; Schmidt, Michael
Remote processing of metallic workpieces by techniques based on electric arc discharge or laser irradiation for joining or cutting has a long tradition and is still being intensively investigated in present-day research. In applications that require high power processing, both approaches exhibit certain advantages and disadvantages that make them specific for a given task. While several hybrid approaches exist that try to combine the benefits of both techniques, none were as successful in providing a fixed electric discharge direction as discharges triggered by plasma filaments generated by ultra-short pulsed lasers. In this work we investigate spatial and temporal aspects of laser filament guided discharges and give an upper time delay between the filament creation and the electrical build-up of a dischargeable voltage for a successful filament triggered discharge.
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Moving from hospital into a care home--the nurse's role in supporting older people.
Morgan, D; Reed, J; Palmer, A
1997-11-01
Discharge planning has received much attention in the nursing literature over the past few years, and there has been particular concern over the discharge of older people back into their domestic environment. The practical and logistical problems of managing such a discharge are considerable, but in this paper we argue that discharging older people from hospital to care homes is equally problematic, though in different ways. This is a neglected area of research, perhaps because discharge into a care home seems to present fewer organizational problems. There is, however, an extensive body of literature from a range of different disciplines which suggests that the loss of home and entry into a strange environment can be very stressful. This paper outlines this literature and explores the implications for nursing practice.
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Discharge processes and an electrical model of atmospheric pressure plasma jets in argon
NASA Astrophysics Data System (ADS)
Fang, Zhi; Shao, Tao; Yang, Jing; Zhang, Cheng
2016-01-01
In this paper, an atmospheric pressure plasma discharge in argon was generated using a needle-to-ring electrode configuration driven by a sinusoidal excitation voltage. The electric discharge processes and discharge characteristics were investigated by inspecting the voltage-current waveforms, Lissajous curves and lighting emission images. The change in discharge mode with applied voltage amplitude was studied and characterised, and three modes of corona discharge, dielectric barrier discharge (DBD) and jet discharge were identified, which appeared in turn with increasing applied voltage and can be distinguished clearly from the measured voltage-current waveforms, light-emission images and the changing gradient of discharge power with applied voltage. Based on the experimental results and discharge mechanism analysis, an equivalent electrical model and the corresponding equivalent circuit for characterising the whole discharge processes accurately was proposed, and the three discharge stages were characterised separately. A voltage-controlled current source (VCCS) associated with a resistance and a capacitance were used to represent the DBD stage, and the plasma plume and corona discharge were modelled by a variable capacitor in series with a variable resistor. Other factors that can influence the discharge, such as lead and stray capacitance values of the circuit, were also considered in the proposed model. Contribution to the Topical Issue "Recent Breakthroughs in Microplasma Science and Technology", edited by Kurt Becker, Jose Lopez, David Staack, Klaus-Dieter Weltmann and Wei Dong Zhu.
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Understanding and enhancing the value of hospital discharge data.
Schoenman, Julie A; Sutton, Janet P; Elixhauser, Anne; Love, Denise
2007-08-01
This work summarizes how hospital discharge data are used, identifies strengths and shortcomings, and presents suggestions for enhancing usefulness of the data. Results demonstrate that discharge data are used in a wide range of applications by diverse users. Uses include public health and population-based applications, as well as quality assessment, informed purchasing, strategic planning, and policy making. Strategies to enhance the utility of discharge data include: improving the quality of existing data elements and adding new data elements that will support more advanced analyses, improving linkages with data from nonhospital settings and databases outside health care, and developing a technical assistance network to support statewide data organizations in their efforts to collect and analyze discharge data. As our nation moves toward universal electronic medical records, it will be important to keep in mind the many uses of discharge data in order to maintain the data capacity to fill these needs.
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The who, what, why, and how-to guide for gastrostomy tube placement in infants.
Burd, Angela; Burd, Randall S
2003-08-01
The decision to place a gastrostomy tube in an infant can be confusing and difficult for both parents and professionals. A unified team approach is critical to communication and collaboration. Once the decision is made, coordinated parent education, discharge planning, and community integration are essential to facilitate a safe discharge. This article reviews the indications and options for gastrostomy placement, outlines current concepts in gastrostomy tube care, and answers the most frequently asked questions about the discharge and home care of infants with a gastrostomy tube.
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Code of Federal Regulations, 2010 CFR
2010-07-01
... with the permit limitation for total toxic organics (TTO), I certify that, to the best of my knowledge... management plan submitted to the permitting authority.” (b) In requesting that no monitoring of TTO be required, the direct discharger shall submit a solvent management plan that specifies to the permitting...
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Purdy, Isabell B; Singh, Namrata; Le, Cindy; Bell, Cynthia; Whiteside, Christy; Collins, Mara
2012-01-01
To determine influences on incidence of breast milk feeding (BMF) at time of discharge and 6 months later among infants cared for in the neonatal intensive care unit (NICU). A 2-year prospective descriptive NICU hospital-based cohort design. Academic Center Level III-IV NICU. Five hundred and thirty-five infants cared for in NICU and a subgroup of one hundred twenty-nine participant mothers who answered questionnaires. Predischarge data were collected using maternal and infant medical records. Post-discharge data were collected from maternal questionnaires. At NICU discharge, biophysiologic stressors predictive of not receiving BMF included birth weight <1500 grams (p < .035), heart surgery (p = .014), and inhaled nitric oxide treatment (p = .002). Teenage mothers were less likely to BMF (p = .022). After discharge, BMF duration correlated with BMF duration of a prior infant (p < .009). Most mothers reported BMF >4 months, 91% continued pumping, and 89% indicated an interest in a hospital support group. Logistic regression analysis (R(2) 0.45) identified factors that significantly increased the likelihood of BMF > 4 months: BMF plan (p < .001), convenience (p = .018), and family as resource (p = .025). Negative associations were: awareness of immune benefits (p = .025), return to work (p = .002), and infants requiring surgical ligation of the patent ductus arterious (p = .019). Social and medical stressors contribute to BMF duration pre- and post-NICU discharge. We speculate that active NICU BMF support targeting vulnerable infants and their families and assisting with plans for BMF pre- and post-discharge will help overcome barriers. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
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2014-01-01
Background The period following hospital discharge is a vulnerable time for patients when errors and poorly coordinated care are common. Suboptimal care transitions for patients admitted with cardiovascular conditions can contribute to readmission and other adverse health outcomes. Little research has examined the role of health literacy and other social determinants of health in predicting post-discharge outcomes. Methods The Vanderbilt Inpatient Cohort Study (VICS), funded by the National Institutes of Health, is a prospective longitudinal study of 3,000 patients hospitalized with acute coronary syndromes or acute decompensated heart failure. Enrollment began in October 2011 and is planned through October 2015. During hospitalization, a set of validated demographic, cognitive, psychological, social, behavioral, and functional measures are administered, and health status and comorbidities are assessed. Patients are interviewed by phone during the first week after discharge to assess the quality of hospital discharge, communication, and initial medication management. At approximately 30 and 90 days post-discharge, interviewers collect additional data on medication adherence, social support, functional status, quality of life, and health care utilization. Mortality will be determined with up to 3.5 years follow-up. Statistical models will examine hypothesized relationships of health literacy and other social determinants on medication management, functional status, quality of life, utilization, and mortality. In this paper, we describe recruitment, eligibility, follow-up, data collection, and analysis plans for VICS, as well as characteristics of the accruing patient cohort. Discussion This research will enhance understanding of how health literacy and other patient factors affect the quality of care transitions and outcomes after hospitalization. Findings will help inform the design of interventions to improve care transitions and post-discharge outcomes. PMID:24397292
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Planning Of Drainage Channel Dimension In The Core Zone Of Muara Takus Temple
NASA Astrophysics Data System (ADS)
Saleh, Alfian
2017-12-01
Preservation of Cultural Heritage is a dynamic effort to maintain the existence of cultural heritage by protecting, developing, and utilizing the cultural heritage in the contemporary context. To protect the cultural heritage in term of conservation called protection of which the effort to prevent and overcome from damage, it needs to do destruction or obliteration through rescue, security, zoning, maintenance, and restoration of cultural heritage. The most fundamental issue is the hydrological impact of the existence of Hydroelectric Power Koto Panjang located around Muara Takus temple that could threaten the sustainability of the region. In this case, hydroelectric dam frequently causes Kampar Kanan River overflowed thus potentially floods, especially in the rainy season that could eventually submerges Muara Takus area. The total area of the region Muara Takus enshrinement is ± 94.5 hectares that are divided into two main parts. Those are the terrestrial land of ± 56.44 m², and PLTA Koto Panjang lake of ± 38.06 m². Consequently, it is necessary for drainage planning of economical dimension in the core zone of Muara Takus temple. Furthermore, from the data of the maximum rainfall of 101 mm/day obtained a discharge of rainfall of 0.38 m3/second so that this discharge of rainfall can be designed drainage channel dimension to accommodate the discharge of rainfall. From the analysis of dimension designed drainage is the size of 30 cm x 45 cm. this dimension can accommodate the discharge rainfall that is equal to 0.43 m3 / second. Regarding the finding, it can be concluded that the discharge of rainfall that occurred less than discharge calculation of dimensional analysis of drainage channel so that the size of this dimension can accommodate discharge rainfall occurs.
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Code of Federal Regulations, 2011 CFR
2011-07-01
...), or discharged more than 42 U.S. gallons of oil in each of two discharges as described in § 112.1(b), occurring within any twelve month period, submit the following information to the Regional Administrator...) Your name; (3) Location of the facility; (4) Maximum storage or handling capacity of the facility and...
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Code of Federal Regulations, 2010 CFR
2010-07-01
...), or discharged more than 42 U.S. gallons of oil in each of two discharges as described in § 112.1(b), occurring within any twelve month period, submit the following information to the Regional Administrator...) Your name; (3) Location of the facility; (4) Maximum storage or handling capacity of the facility and...
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Code of Federal Regulations, 2013 CFR
2013-07-01
...), or discharged more than 42 U.S. gallons of oil in each of two discharges as described in § 112.1(b), occurring within any twelve month period, submit the following information to the Regional Administrator...) Your name; (3) Location of the facility; (4) Maximum storage or handling capacity of the facility and...
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Code of Federal Regulations, 2014 CFR
2014-07-01
...), or discharged more than 42 U.S. gallons of oil in each of two discharges as described in § 112.1(b), occurring within any twelve month period, submit the following information to the Regional Administrator...) Your name; (3) Location of the facility; (4) Maximum storage or handling capacity of the facility and...
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Code of Federal Regulations, 2014 CFR
2014-07-01
... Item 11, Guidelines and Specifications for Oil Discharge Monitoring and Control Systems for Oil Tankers... Monitoring and Control Systems for Oil Tankers (“A.586(14)”), incorporation by reference approved for § 157... 1983, Guidelines for Plan Approval and Installation Survey of Oil Discharge Monitoring and Control...
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Code of Federal Regulations, 2011 CFR
2011-07-01
... Item 11, Guidelines and Specifications for Oil Discharge Monitoring and Control Systems for Oil Tankers... Monitoring and Control Systems for Oil Tankers (“A.586(14)”), incorporation by reference approved for § 157... 1983, Guidelines for Plan Approval and Installation Survey of Oil Discharge Monitoring and Control...
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Code of Federal Regulations, 2012 CFR
2012-07-01
... Item 11, Guidelines and Specifications for Oil Discharge Monitoring and Control Systems for Oil Tankers... Monitoring and Control Systems for Oil Tankers (“A.586(14)”), incorporation by reference approved for § 157... 1983, Guidelines for Plan Approval and Installation Survey of Oil Discharge Monitoring and Control...
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Code of Federal Regulations, 2013 CFR
2013-07-01
... Item 11, Guidelines and Specifications for Oil Discharge Monitoring and Control Systems for Oil Tankers... Monitoring and Control Systems for Oil Tankers (“A.586(14)”), incorporation by reference approved for § 157... 1983, Guidelines for Plan Approval and Installation Survey of Oil Discharge Monitoring and Control...
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19 CFR 151.28 - Gauging of sirup or molasses discharged into storage tanks.
Code of Federal Regulations, 2010 CFR
2010-04-01
... storage tanks. 151.28 Section 151.28 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF... Sugars, Sirups, and Molasses § 151.28 Gauging of sirup or molasses discharged into storage tanks. (a) Plans of storage tank to be filed. When sirup or molasses is imported in bulk in tank vessels and is to...
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The coach program - a "joint" approach to patient education and support.
Shaked, Yael; Dickson, Patricia; Workman, Kathy
2016-12-01
Hospital lengths of stay for orthopaedic procedures are declining internationally. Discharge home from hospital following total joint replacement surgery can be stressful due to pain and physical restrictions. Thus, many patients report experiencing increased anxiety and feeling a sudden withdrawal of support from their medical team. The Coach Program maximizes human resources and family-centred care by formally integrating an individual whom the patient identifies as their primary support into their health care team. This unique and innovative program was designed to decrease patient anxiety, increase patient confidence, enhance coping with shorter hospital lengths of stay, and smooth the discharge planning process. Anecdotal feedback from patients and staff has been overwhelmingly positive. A pilot self-reported patient survey was conducted. Future steps include distribution and analysis of a more detailed survey to a broader patient population and finding ways to address the needs of patients with limited social support. Copyright © 2016 Elsevier Inc. All rights reserved.
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A Multidisciplinary Initiative to Increase Inpatient Discharges Before Noon.
Kane, Marlena; Weinacker, Ann; Arthofer, Rudolph; Seay-Morrison, Timothy; Elfman, Wesley; Ramirez, Mark; Ahuja, Neera; Pickham, David; Hereford, James; Welton, Mark
2016-12-01
The aim of this study is to evaluate the effect of 2 hospital-wide interventions on achieving a discharge-before-noon rate of 40%. A multidisciplinary team led by administrative and physician leadership developed a plan to diminish capacity constraints by minimizing late afternoon hospital discharges using 2 patient flow management techniques. The study was a preintervention/postintervention retrospective analysis observing all inpatients discharged across 19 inpatient units in a 484-bed, academic teaching hospital measuring calendar month discharge-before-noon percentage, patient satisfaction, and readmission rates. Patient satisfaction and readmission rates were used as baseline metrics. The discharge-before-noon percentage increased from 14% in the 11-month preintervention period to an average of 24% over the 11-month postintervention period, whereas patient satisfaction scores and readmission rates remained stable. Implementation of the 2 interventions successfully increased the percentage of discharges before noon yet did not achieve the goal of 40%. Patient satisfaction and readmission rates were not negatively impacted by the program.
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Managing uncertainty in flood protection planning with climate projections
NASA Astrophysics Data System (ADS)
Dittes, Beatrice; Špačková, Olga; Schoppa, Lukas; Straub, Daniel
2018-04-01
Technical flood protection is a necessary part of integrated strategies to protect riverine settlements from extreme floods. Many technical flood protection measures, such as dikes and protection walls, are costly to adapt after their initial construction. This poses a challenge to decision makers as there is large uncertainty in how the required protection level will change during the measure lifetime, which is typically many decades long. Flood protection requirements should account for multiple future uncertain factors: socioeconomic, e.g., whether the population and with it the damage potential grows or falls; technological, e.g., possible advancements in flood protection; and climatic, e.g., whether extreme discharge will become more frequent or not. This paper focuses on climatic uncertainty. Specifically, we devise methodology to account for uncertainty associated with the use of discharge projections, ultimately leading to planning implications. For planning purposes, we categorize uncertainties as either
visible
, if they can be quantified from available catchment data, orhidden
, if they cannot be quantified from catchment data and must be estimated, e.g., from the literature. It is vital to consider thehidden uncertainty
, since in practical applications only a limited amount of information (e.g., a finite projection ensemble) is available. We use a Bayesian approach to quantify thevisible uncertainties
and combine them with an estimate of the hidden uncertainties to learn a joint probability distribution of the parameters of extreme discharge. The methodology is integrated into an optimization framework and applied to a pre-alpine case study to give a quantitative, cost-optimal recommendation on the required amount of flood protection. The results show that hidden uncertainty ought to be considered in planning, but the larger the uncertainty already present, the smaller the impact of adding more. The recommended planning is robust to moderate changes in uncertainty as well as in trend. In contrast, planning without consideration of bias and dependencies in and between uncertainty components leads to strongly suboptimal planning recommendations. -
Sediment discharge into a subsiding Louisiana deltaic estuary through a Mississippi River diversion
Snedden, G.A.; Cable, J.E.; Swarzenski, C.; Swenson, E.
2007-01-01
Wetlands of the Mississippi River deltaic plain in southeast Louisiana have been hydrologically isolated from the Mississippi River by containment levees for nearly a century. The ensuing lack of fluvial sediment inputs, combined with natural submergence processes, has contributed to high coastal land loss rates. Controlled river diversions have since been constructed to reconnect the marshes of the deltaic plain with the river. This study examines the impact of a pulsed diversion management plan on sediment discharge into the Breton Sound estuary, in which duplicate 185 m3 s-1-diversions lasting two weeks each were conducted in the spring of 2002 and 2003. Sediment delivery during each pulse was highly variable (11,300-43,800 metric tons), and was greatest during rising limbs of Mississippi River flood events. Overland flow, a necessary transport mechanism for river sediments to reach the subsiding backmarsh regions, was induced only when diversion discharge exceeded 100 m3 s-1. These results indicate that timing and magnitude of diversion events are both important factors governing marsh sediment deposition in the receiving basins of river diversions. Though the diversion serves as the primary source of river sediments to the estuary, the inputs observed here were several orders of magnitude less than historical sediment discharge through crevasses and uncontrolled diversions in the region, and are insufficient to offset present rates of relative sea level rise. ?? 2006 Elsevier Ltd. All rights reserved.
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NASA Astrophysics Data System (ADS)
Olsson, Oliver; Gassmann, Matthias; Wegerich, Kai; Bauer, Melanie
2010-09-01
SummaryQuantitative estimates of the hydrologic effects of climate change are essential for understanding and solving potential transboundary water conflicts in the Zerafshan river basin, Central Asia. This paper introduces an identification of runoff generation processes and a detection of changes in hydrological regimes supporting Mann-Kendall trend analysis for streamflows. By this, the effective available and future water resources are identified for the Zerafshan. The results for the subbasins in the upper Zerafshan and for the reference station at the upper catchment outlet indicate that glacier melt is the most significant component of river runoff. The Mann-Kendall trend analysis confirms the regime analysis with the shift in the seasonality of the discharge. Furthermore, the results of the Kendall-Theil Robust Line for predicted long-term discharge trends show a decreasing annual discharge. The experience gained during this study emphasizes the fact that the summer flood, urgently required for the large irrigation projects downstream in Uzbekistan, is reduced and more water will be available in spring. Additionally, following the estimation of future discharges in 50 and 100 years the hydrological changes are affecting the seasonal water availability for irrigation. This analysis highlighted that water availability is decreasing and the timing of availability is changing. Hence, there will be more competition between upstream Tajikistan and downstream Uzbekistan. Planned projects within the basin might have to be reconsidered and the changed scenario of water availability needs to be properly taken into account for long-term basin scale water management.
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Hesselink, Gijs; Vernooij-Dassen, Myrra; Pijnenborg, Loes; Barach, Paul; Gademan, Petra; Dudzik-Urbaniak, Ewa; Flink, Maria; Orrego, Carola; Toccafondi, Giulio; Johnson, Julie K; Schoonhoven, Lisette; Wollersheim, Hub
2013-01-01
Organizational culture is seen as having a growing impact on quality and safety of health care, but its impact on hospital to community patient discharge is relatively unknown. To explore aspects of organizational culture to develop a deeper understanding of the discharge process. A qualitative study of stakeholders in the discharge process. Grounded Theory was used to analyze the data. In 5 European Union countries, 192 individual and 25 focus group interviews were conducted with patients and relatives, hospital physicians, hospital nurses, general practitioners, and community nurses. Three themes emerged representing aspects of organizational culture: a fragmented hospital to primary care interface, undervaluing administrative tasks relative to clinical tasks in the discharge process, and lack of reflection on the discharge process or process improvement. Nine categories were identified: inward focus of hospital care providers, lack of awareness to needs, skills, and work patterns of the professional counterpart, lack of a collaborative attitude, relationship between hospital and primary care providers, providing care in a "here and now" situation, administrative work considered to be burdensome, negative attitude toward feedback, handovers at discharge ruled by habits, and appreciating and integrating new practices. On the basis of the data, we hypothesize that the extent to which hospital care providers value handovers and the outreach to community care providers is critical to effective hospital discharge. Community care providers often are insufficiently informed about patient outcomes. Ongoing challenges with patient discharge often remain unspoken with opportunities for improvement overlooked. Interventions that address organizational culture as a key factor in discharge improvement efforts are needed.
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Driscoll, Molly; Gurka, David
2015-01-01
The fast-paced environment of hospitals contributes to communication failures between health care providers while impacting patient care and patient flow. An effective mechanism for sharing patients' discharge information with health care team members is required to improve patient throughput. The communication of a patient's discharge plan was identified as crucial in alleviating patient flow delays at a tertiary care, academic medical center. By identifying the patients who were expected to be discharged the following day, the health care team could initiate discharge preparations in advance to improve patient care and patient flow. The patients' electronic medical record served to convey dynamic information regarding the patients' discharge status to the health care team via conditional discharge orders. Two neurosciences units piloted a conditional discharge order initiative. Conditional discharge orders were designed in the electronic medical record so that the conditions for discharge were listed in a dropdown menu. The health care team was trained on the conditional discharge order protocol, including when to write them, how to find them in the patients' electronic medical record, and what actions should be prompted by these orders. On average, 24% of the patients discharged had conditional discharge orders written the day before discharge. The average discharge time for patients with conditional discharge orders decreased by 83 minutes (0.06 day) from baseline. Qualitatively, the health care team reported improved workflows with conditional orders. The conditional discharge orders allowed physicians to communicate pending discharges electronically to the multidisciplinary team. The initiative positively impacted patient discharge times and workflows.
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45 CFR 302.14 - Fiscal policies and accountability.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 45 Public Welfare 2 2010-10-01 2010-10-01 false Fiscal policies and accountability. 302.14 Section... HUMAN SERVICES STATE PLAN REQUIREMENTS § 302.14 Fiscal policies and accountability. The State plan shall provide that the IV-D agency, in discharging its fiscal accountability, will maintain an accounting system...
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A Decision Framework to Protect Coral Reefs in Guánica Bay, Puerto Rico
A Watershed Management Plan (WMP) for Guánica Bay, Puerto Rico, was introduced in 2008 by a nonprofit organization, the Center for Watershed Protection, with the intent of protecting coral reefs from damage related to watershed discharges. The plan was initially generated with th...
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Applying WEPP technologies to western alkaline surface coal mines
J. Q. Wu; S. Dun; H. Rhee; X. Liu; W. J. Elliot; T. Golnar; J. R. Frankenberger; D. C. Flanagan; P. W. Conrad; R. L. McNearny
2011-01-01
One aspect of planning surface mining operations, regulated by the National Pollutant Discharge Elimination System (NPDES), is estimating potential environmental impacts during mining operations and the reclamation period that follows. Practical computer simulation tools are effective for evaluating site-specific sediment control and reclamation plans for the NPDES....
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USDA-ARS?s Scientific Manuscript database
We show that spatial data on soils, land use, and high-resolution topography, combined with knowledge of conservation practice effectiveness, can be leveraged to identify and assess alternatives to reduce nutrient discharge from small (HUC12) agricultural watersheds. Databases comprising soil attrib...
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300 area TEDF NPDES Permit Compliance Monitoring Plan
DOE Office of Scientific and Technical Information (OSTI.GOV)
Loll, C.M.
1995-09-05
This document presents the 300 Area Treated Effluent Disposal Facility (TEDF) National Pollutant Discharge Elimination System (NPDES) Permit Compliance Monitoring Plan (MP). The MP describes how ongoing monitoring of the TEDF effluent stream for compliance with the NPDES permit will occur. The MP also includes Quality Assurance protocols to be followed.
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Hydrologic data and description of a hydrologic monitoring plan for the Borax Lake area, Oregon
Schneider, Tiffany Rae; McFarland, William D.
1995-01-01
Information from field visits was used to develop a monitoring plan. The plan would include monitoring Borax Lake by measuring discharge, stage, evaporation, temperature, and specific conductance; water-quality sampling and analysis; and monitoring shallow ground-water levels near Borax Lake using shallow piezometers. Minimally, one hot spring in North Borax Lake Spring Group 1 would be monitored for temperature and specific conductance and sampled for water-quality analysis. In addition, two flowing wells would be monitored for water levels, temperature, specific conductance, and discharge and sampled for water-quality analysis. The construction characteristics of these wells must be verified before long-term data collection begins. In the future, it may be helpful to monitor shallow and (or) deep observation wells drilled into the thermal aquifer to understand the possible effects of geothermal development on Borax Lake and nearby springs.
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A Different Approach to Studying the Charge and Discharge of a Capacitor without an Oscilloscope
ERIC Educational Resources Information Center
Ladino, L. A.
2013-01-01
A different method to study the charging and discharging processes of a capacitor is presented. The method only requires a high impedance voltmeter. The charging and discharging processes of a capacitor are usually studied experimentally using an oscilloscope and, therefore, both processes are studied as a function of time. The approach presented…
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Pinelli, Vincent; Stuckey, Heather L; Gonzalo, Jed D
2017-09-01
In hospital-based medicine units, patients have a wide range of complex medical conditions, requiring timely and accurate communication between multiple interprofessional providers at the time of discharge. Limited work has investigated the challenges in interprofessional collaboration and communication during the patient discharge process. In this study, authors qualitatively assessed the experiences of internal medicine providers and patients about roles, challenges, and potential solutions in the discharge process, with a phenomenological focus on the process of collaboration. Authors conducted interviews with 87 providers and patients-41 providers in eight focus-groups, 39 providers in individual interviews, and seven individual patient interviews. Provider roles included physicians, nurses, therapists, pharmacists, care coordinators, and social workers. Interviews were audio-recorded and transcribed verbatim, followed by iterative review of transcripts using qualitative coding and content analysis. Participants identified several barriers related to interprofessional collaboration during the discharge process, including systems insufficiencies (e.g., medication reconciliation process, staffing challenges); lack of understanding others' roles (e.g., unclear which provider should be completing the discharge summary); information-communication breakdowns (e.g., inaccurate information communicated to the primary medical team); patient issues (e.g., patient preferences misaligned with recommendations); and poor collaboration processes (e.g., lack of structured interprofessional rounds). These results provide context for targeting improvement in interprofessional collaboration in medicine units during patient discharges. Implementing changes in care delivery processes may increase potential for accurate and timely coordination, thereby improving the quality of care transitions.
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Lawrence, Laurie M; Jenkins, Cathy A; Zhou, Chuan; Givens, Timothy G
2009-11-01
The number of patients returning to the pediatric emergency department (PED) within 72 hours of discharge is frequently cited as a benchmark for quality patient care. The purpose of this study was to determine whether the introduction of diagnosis-specific computer-generated discharge instructions would decrease the number of medically unnecessary return visits to the PED. A retrospective chart review of patients who returned to the PED within 72 hours of discharge was performed. Charts were reviewed from 2 comparable periods: September 2004 to February 2005, when handwritten discharge instructions were issued to each patient, and September 2005 to February 2006, when each patient received computer-generated diagnosis-specific discharge instructions. The patient's age, primary care provider, insurance status, chief complaint, vital signs, history, physical examination, plan of care, and diagnosis at each visit were recorded. Cases were excluded if the patient left against medical advice or without being seen, was admitted to the hospital on the first visit, or had incomplete or missing records. The medical necessity of the return visit was rated as "yes," "no," or "indeterminate" based on review of the visit noting reason for return, history and physical examination, diagnosis, and interventions or changes in the initial care plan. Of all return visits to the PED within 72 hours of discharge, 13% were deemed unnecessary for patients receiving handwritten instructions compared with 15% for patients receiving computer-generated instructions (P = 0.5, not significant). For each additional year of age, the return visit was 1.07 times as likely to be medically appropriate (95% confidence interval, 1.03-1.12; P = 0.002). Patients who returned to the PED more than once were 2.69 times more likely to have a medically appropriate visit as were those with only 1 return visit (95% confidence interval, 0.95-7.58; P = 0.062). Computer-generated diagnosis-specific discharge instructions do not decrease the number of medically unnecessary repeat visits to the PED.
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Ocean outfall plume characterization using an Autonomous Underwater Vehicle.
Rogowski, Peter; Terrill, Eric; Otero, Mark; Hazard, Lisa; Middleton, William
2013-01-01
A monitoring mission to map and characterize the Point Loma Ocean Outfall (PLOO) wastewater plume using an Autonomous Underwater Vehicle (AUV) was performed on 3 March 2011. The mobility of an AUV provides a significant advantage in surveying discharge plumes over traditional cast-based methods, and when combined with optical and oceanographic sensors, provides a capability for both detecting plumes and assessing their mixing in the near and far-fields. Unique to this study is the measurement of Colored Dissolved Organic Matter (CDOM) in the discharge plume and its application for quantitative estimates of the plume's dilution. AUV mission planning methodologies for discharge plume sampling, plume characterization using onboard optical sensors, and comparison of observational data to model results are presented. The results suggest that even under variable oceanic conditions, properly planned missions for AUVs equipped with an optical CDOM sensor in addition to traditional oceanographic sensors, can accurately characterize and track ocean outfall plumes at higher resolutions than cast-based techniques.
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Stormwater Pollution Prevention Plan - TA-60 Material Recycling Facility
DOE Office of Scientific and Technical Information (OSTI.GOV)
Sandoval, Leonard Frank
This Storm Water Pollution Prevention Plan (SWPPP) was developed in accordance with the provisions of the Clean Water Act (33 U.S.C. §§1251 et seq., as amended), and the Multi-Sector General Permit for Storm Water Discharges Associated with Industrial Activity (U.S. EPA, June 2015) issued by the U.S. Environmental Protection Agency (EPA) for the National Pollutant Discharge Elimination System (NPDES) and using the industry specific permit requirements for Sector P-Land Transportation and Warehousing as a guide. This SWPPP applies to discharges of stormwater from the operational areas of the TA- 60 Material Recycling Facility at Los Alamos National Laboratory. Los Alamosmore » National Laboratory (also referred to as LANL or the “Laboratory”) is owned by the Department of Energy (DOE), and is operated by Los Alamos National Security, LLC (LANS). Throughout this document, the term “facility” refers to the TA-60 Material Recycling Facility. The current permit expires at midnight on June 4, 2020.« less
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Stormwater Pollution Prevention Plan - TA-60 Asphalt Batch Plant
DOE Office of Scientific and Technical Information (OSTI.GOV)
Sandoval, Leonard Frank
This Storm Water Pollution Prevention Plan (SWPPP) was developed in accordance with the provisions of the Clean Water Act (33 U.S.C. §§1251 et seq., as amended), and the Multi-Sector General Permit for Storm Water Discharges Associated with Industrial Activity (U.S. EPA, June 2015) issued by the U.S. Environmental Protection Agency (EPA) for the National Pollutant Discharge Elimination System (NPDES) and using the industry specific permit requirements for Sector P-Land Transportation and Warehousing as a guide. This SWPPP applies to discharges of stormwater from the operational areas of the TA-60-01 Asphalt Batch Plant at Los Alamos National Laboratory. Los Alamos Nationalmore » Laboratory (also referred to as LANL or the “Laboratory”) is owned by the Department of Energy (DOE), and is operated by Los Alamos National Security, LLC (LANS). Throughout this document, the term “facility” refers to the TA-60 Asphalt Batch Plant and associated areas. The current permit expires at midnight on June 4, 2020.« less
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Wastewater reclamation and recharge: A water management strategy for Albuquerque
DOE Office of Scientific and Technical Information (OSTI.GOV)
Gorder, P.J.; Brunswick, R.J.; Bockemeier, S.W.
1995-12-31
Approximately 61,000 acre-feet of the pumped water is annually discharged to the Rio Grande as treated wastewater. Albuquerque`s Southside Water Reclamation Plant (SWRP) is the primary wastewater treatment facility for most of the Albuquerque area. Its current design capacity is 76 million gallons per day (mgd), which is expected to be adequate until about 2004. A master plan currently is being prepared (discussed here in Wastewater Master Planning and the Zero Discharge Concept section) to provide guidelines for future expansions of the plant and wastewater infrastructure. Construction documents presently are being prepared to add ammonia and nitrogen removal capability tomore » the plant, as required by its new discharge permit. The paper discusses water management strategies, indirect potable reuse for Albuquerque, water quality considerations for indirect potable reuse, treatment for potable reuse, geohydrological aspects of a recharge program, layout and estimated costs for a conceptual reclamation and recharge system, and work to be accomplished under phase 2 of the reclamation and recharge program.« less
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Planning guidance for nuclear-power-plant decontamination. [PWR; BWR
DOE Office of Scientific and Technical Information (OSTI.GOV)
Munson, L.F.; Divine, J.R.; Martin, J.B.
1983-06-01
Direct and indirect costs of decontamination are considered in the benefit-cost analysis. A generic form of the benefit-cost ratio is evaluated in monetary and nonmonetary terms, and values of dollar per man-rem are cited. Federal and state agencies that may have jurisiction over various aspects of decontamination and waste disposal activities are identified. Methods of decontamination, their general effectiveness, and the advantages and disadvantages of each are outlined. Dilute or concentrated chemical solutions are usually used in-situ to dissolve the contamination layer and a thin layer of the underlying substrate. Electrochemical techniques are generally limited to components but show highmore » decontamination effectiveness with uniform corrosion. Mechanical agents are particularly appropriate for certain out-of-system surfaces and disassembled parts. These processes are catagorized and specific concerns are discussed. The treatment, storage, and disposal or discharge or discharge of liquid, gaseous, and solid wastes generated during the decontamination process are discussed. Radioactive and other hazardous chemical wastes are considered. The monitoring, treatment, and control of radioactive and nonradioactive effluents, from both routine operations and possible accidents, are discussed. Protecting the health and safety of personnel onsite during decontamination is of prime importance and should be considered in each facet of the decontamination process. The radiation protection philosophy of reducing exposure to levels as low as reasonably achievable should be stressed. These issues are discussed.« less
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Collaboration of hospital case managers and home care liaisons when transitioning patients.
Kelly, Margaret M; Penney, Erika D
2011-01-01
Hospital case managers frequently collaborate with home care liaisons when coordinating special discharge plans. This article focuses on the collaborative relationship between the hospital case manager and on-site liaison whose primary role centers around care coordination and patient teaching. Ineffective collaboration between hospital case managers and these clinical on-site liaisons can lead to serious lapses in care and services for patients, families, and the health care team when transitioning from hospital to home care. In a review of literature, little detail was found about the collaborative practice between hospital case managers and home care liaisons. This article discusses how collegiality, collaboration, and role clarification between hospital case managers and on-site home care liaisons can improve coordination of care and services for patients and their families in the transition from hospital to home care. Included is a set of guidelines developed by case managers at a major metropolitan acute care hospital to inform and improve their practice with home care liaisons. The authors are nursing case managers who practice in a major metropolitan teaching hospital. They met by telephone and in person with case managers from 3 metropolitan medical centers as well as on-site liaisons from 2 skilled nursing facilities and 5 home care agencies to develop practice recommendations for their department regarding work with home care liaisons. Conversations between hospital case managers and on-site home care liaisons revealed that all had experiences in which suboptimal collaboration negatively impacted home care coordination for patients and their families. Furthermore, outcomes in similar patient scenarios varied widely based on the individual practices of the case managers and liaisons involved in discharge coordination. Multiple issues were discussed, including blurred role and responsibility delineations, variations in communication styles and practices, and different levels of experience and training. Consensus regarding the implementation of the hospital's guidelines was achieved through a series of discussions within the workgroup in developing practice guidelines. Multiple revisions and secondary reviews by colleagues and directors took place before the guidelines were accepted and implemented. Recommendations for improving collaboration with liaisons included (1) taking time to become familiar with one another's practices and backgrounds; (2) ensuring clear discussions of roles, responsibilities, and expectations with liaisons related to individual cases and organizational requirements and limitations; (3) providing time and forums for ongoing communication and follow-up; and (4) recognizing that responsibility for certain aspects of the discharge planning process may be shared but that the case manager, in partnership with the multidisciplinary team, is ultimately accountable for the effectiveness and outcomes of the discharge plan.
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Plasma processes in water under effect of short duration pulse discharges
NASA Astrophysics Data System (ADS)
Gurbanov, Elchin
2013-09-01
It is very important to get a clear water without any impurities and bacteria by methods, that don't change the physical and chemical indicators of water now. In this article the plasma processes during the water treatment by strong electric fields and short duration pulse discharges are considered. The crown discharge around an electrode with a small radius of curvature consists of plasma leader channels with a high conductivity, where the thermo ionization processes and UV-radiation are taken place. Simultaneously the partial discharges around potential electrode lead to formation of atomic oxygen and ozone. The spark discharge arises, when plasma leader channels cross the all interelectrode gap, where the temperature and pressure are strongly grown. As a result the shock waves and dispersing liquid streams in all discharge gap are formed. The plasma channels extend, pressure inside it becomes less than hydrostatic one and the collapse and UV-radiation processes are started. The considered physical processes can be successfully used as a basis for development of pilot-industrial installations for conditioning of drinking water and to disinfecting of sewage.
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Code of Federal Regulations, 2010 CFR
2010-07-01
... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What solid and liquid wastes and discharges information and cooling water intake information must accompany the EP? 250.217 Section 250.217 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Plans...
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Acute hospital dementia care: results from a national audit.
Timmons, Suzanne; O'Shea, Emma; O'Neill, Desmond; Gallagher, Paul; de Siún, Anna; McArdle, Denise; Gibbons, Patricia; Kennelly, Sean
2016-05-31
Admission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland. Across all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76). Inclusion criteria included a diagnosis of dementia, and a length of stay greater than 5 days. Most patients received physical assessments, including mobility (89 %), continence (84 %) and pressure sore risk (87 %); however assessment of pain (75 %), and particularly functioning (36 %) was poor. Assessment for cognition (43 %) and delirium (30 %) was inadequate. Most wards have access at least 5 days per week to Liaison Psychiatry (93 %), Geriatric Medicine (84 %), Occupational Therapy (79 %), Speech & Language (81 %), Physiotherapy (99 %), and Palliative Care (89 %) Access to Psychology (9 %), Social Work (53 %), and Continence services (34 %) is limited. Dementia awareness training is provided on induction in only 2 hospitals, and almost half of hospitals did not offer dementia training to doctors (45 %) or nurses (48 %) in the previous 12 months. Staff cover could not be provided on 62 % of wards for attending dementia training. Most wards (84 %) had no dementia champion to guide best practice in care. Discharge planning was not initiated within 24 h of admission in 72 % of cases, less than 40 % had a single plan for discharge recorded, and 33 % of carers received no needs assessment prior to discharge. Length of stay was significantly greater for new discharges to residential care (p < .001). Dementia care relating to assessment, access to certain specialist services, staffing levels, training and support, and discharge planning is sub-optimal, which may increase the risk of adverse patient outcomes and the cost of acute care. Areas of good practice are also highlighted.
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Rigotti, Nancy A; Chang, Yuchiao; Tindle, Hilary A; Kalkhoran, Sara M; Levy, Douglas E; Regan, Susan; Kelley, Jennifer H K; Davis, Esa M; Singer, Daniel E
2018-05-01
Many smokers report using e-cigarettes to help them quit smoking, but whether e-cigarettes aid cessation efforts is uncertain. To determine whether e-cigarette use after hospital discharge is associated with subsequent tobacco abstinence among smokers who plan to quit and are advised to use evidence-based treatment. Secondary data analysis of a randomized controlled trial. (ClinicalTrials.gov: NCT01714323 [parent trial]). 3 hospitals. 1357 hospitalized adult cigarette smokers who planned to stop smoking, received tobacco cessation counseling in the hospital, and were randomly assigned at discharge to a tobacco treatment recommendation (control) or free tobacco treatment (intervention). Self-reported e-cigarette use (exposure) was assessed 1 and 3 months after discharge; biochemically validated tobacco abstinence (outcome) was assessed 6 months after discharge. Twenty-eight percent of participants used an e-cigarette within 3 months after discharge. In an analysis of 237 propensity score-matched pairs, e-cigarette users were less likely than nonusers to abstain from tobacco use at 6 months (10.1% vs. 26.6%; risk difference, -16.5% [95% CI, -23.3% to -9.6%]). The association between e-cigarette use and quitting varied between intervention patients, who were given easy access to conventional treatment (7.7% vs. 29.8%; risk difference, -22.1% [CI, -32.3% to -11.9%]), and control patients, who received only treatment recommendations (12.0% vs. 24.1%; risk difference, -12.0% [CI, -21.2% to 2.9%]) (P for interaction = 0.143). Patients self-selected e-cigarette use. Unmeasured confounding is possible in an observational study. During 3 months after hospital discharge, more than a quarter of smokers attempting to quit used e-cigarettes, mostly to aid cessation, but few used them regularly. This pattern of use was associated with less tobacco abstinence at 6 months than among smokers who did not use e-cigarettes. Additional study is needed to determine whether regular use of e-cigarettes aids or hinders smoking cessation. National Heart, Lung, and Blood Institute.
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Schneider, Tiffany Rae; McFarland, W.D.
1996-01-01
A hydrologic reconnaissance of the Medicine Lake Volcano area was done to collect data needed for the design of a hydrologic monitoring plan. The reconnaissance was completed during two field trips made in June and September 1992, during which geothermal and hydrologic features of public interest in the Medicine Lake area were identified. Selected wells, springs, and geothermal features were located and documented, and initial water-level, discharge, temperature, and specific-conductance measurements were made. Lakes in the study area also were surveyed during the September field trip. Temperature, specific- conductance, dissolved oxygen, and pH data were collected by using a multiparameter probe. The proposed monitoring plan includes measurement of water levels in wells, discharge from springs, and lake stage, as well as analysis of well-,spring-, and lake-water quality. In determining lake-water quality, data for both stratified and unstratified conditions would be considered. (Data for stratified conditions were collected during the reconnaissance phase of this project, but data for unstratified conditions were not.) In addition, lake stage also would be monitored. A geothermal feature near Medicine Lake is a "hot spot" from which hot gases discharge from two distinct vents. Gas chemistry and temperature would be monitored in one of these vents.
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Facilitating the Timely Discharge of Well Newborns by Using Quality Improvement Methods.
Rochester, Nicole T; Banach, Laurie P; Hoffner, Wendy; Zeltser, Deena; Lewis, Phyllis; Seelbach, Elizabeth; Cuzzi, Sandra
2018-05-01
Discharges are a key driver of hospital throughput. Our pediatric hospitalist team sought to improve newborn nursery throughput by increasing the percentage of newborns on our service with a discharge order by 11 am. We hypothesized that implementing a discharge checklist would result in earlier discharge times for newborns who met discharge criteria. We identified barriers to timely discharge through focus groups with key stakeholders, chart reviews, and brainstorming sessions. We subsequently created and implemented a discharge checklist to identify and address barriers before daily rounds. We tracked mean monthly discharge order times. Finally, we performed chart reviews to determine causes for significantly delayed discharge orders and used this information to modify rounding practices during a second plan-do-study-act cycle. During the 2-year period before the intervention, 24% of 3224 newborns had a discharge order entered by 11 am. In the 20 months after the intervention, 39% of 2739 newborns had a discharge order by 11 am, a 63% increase compared with the baseline. Observation for group B Streptococcus exposure was the most frequent reason for a late discharge order. There are many factors that affect the timely discharge of well newborns. The development and implementation of a discharge checklist improved our ability to discharge newborns on our pediatric hospitalist service by 11 am. Future studies to identify nonphysician barriers to timely newborn discharges may lead to further improvements in throughput between the labor and delivery and maternity suites units. Copyright © 2018 by the American Academy of Pediatrics.
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Kataoka, Yu; Tamaki, Yukimichi; Miyazaki, Takashi
2011-01-01
Wire-type electric discharge machining has been applied to the manufacture of endosseous titanium implants as this computer associated technique allows extremely accurate complex sample shaping with an optimal micro textured surface during the processing. Since the titanium oxide layer is sensitively altered by each processing, the authors hypothesized that this technique also up-regulates biological responses through the synergistic effects of the superficial chemistry and micro topography. To evaluate the respective in vitro cellular responses on the superficial chemistry and micro topography of titanium surface processed by wire-type electric discharge, we used titanium-coated epoxy resin replica of the surface. An oxide layer on the titanium surface processed by wire-type electric discharge activated the initial responses of osteoblastic cells through an integrin-mediated mechanism. Since the mRNA expression of ALP on those replicas was up-regulated compared to smooth titanium samples, the micro topography of a titanium surface processed by wire-type electric discharge promotes the osteogenic potential of cells. The synergistic response of the superficial chemistry and micro topography of titanium processed by wire-type electric discharge was demonstrated in this study.
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Gandara, Esteban; Ungar, Jonathan; Lee, Jason; Chan-Macrae, Myrna; O'Malley, Terrence; Schnipper, Jeffrey L
2010-06-01
Effective communication among physicians during hospital discharge is critical to patient care. Partners Healthcare (Boston) has been engaged in a multi-year process to measure and improve the quality of documentation of all patients discharged from its five acute care hospitals to subacute facilities. Partners first engaged stakeholders to develop a consensus set of 12 required data elements for all discharges to subacute facilities. A measurement process was established and later refined. Quality improvement interventions were then initiated to address measured deficiencies and included education of physicians and nurses, improvements in information technology, creation of or improvements in discharge documentation templates, training of hospitalists to serve as role models, feedback to physicians and their service chiefs regarding reviewed cases, and case manager review of documentation before discharge. To measure improvement in quality as a result of these efforts, rates of simultaneous inclusion of all 12 applicable data elements ("defect-free rate") were analyzed over time. Some 3,101 discharge documentation packets of patients discharged to subacute facilities from January 1, 2006, through September 2008 were retrospectively studied. During the 11 monitored quarters, the defect-free rate increased from 65% to 96% (p < .001 for trend). The largest improvements were seen in documentation of preadmission medication lists, allergies, follow-up, and warfarin information. Institution of rigorous measurement, feedback, and multidisciplinary, multimodal quality improvement processes improved the inclusion of data elements in discharge documentation required for safe hospital discharge across a large integrated health care system.
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Effect of actuating voltage and discharge gap on plasma assisted detonation initiation process
NASA Astrophysics Data System (ADS)
Siyin, ZHOU; Xueke, CHE; Wansheng, NIE; Di, WANG
2018-06-01
The influence of actuating voltage and discharge gap on plasma assisted detonation initiation by alternating current dielectric barrier discharge was studied in detail. A loose coupling method was used to simulate the detonation initiation process of a hydrogen–oxygen mixture in a detonation tube under different actuating voltage amplitudes and discharge gap sizes. Both the discharge products and the detonation forming process assisted by the plasma were analyzed. It was found that the patterns of the temporal and spatial distributions of discharge products in one cycle keep unchanged as changing the two discharge operating parameters. However, the adoption of a higher actuating voltage leads to a higher active species concentration within the discharge zone, and atom H is the most sensitive to the variations of the actuating voltage amplitude among the given species. Adopting a larger discharge gap results in a lower concentration of the active species, and all species have the same sensitivity to the variations of the gap. With respect to the reaction flow of the detonation tube, the corresponding deflagration to detonation transition (DDT) time and distance become slightly longer when a higher actuating voltage is chosen. The acceleration effect of plasma is more prominent with a smaller discharge gap, and the benefit builds gradually throughout the DDT process. Generally, these two control parameters have little effect on the amplitude of the flow field parameters, and they do not alter the combustion degree within the reaction zone.
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Interprofessional Communication Patterns During Patient Discharges: A Social Network Analysis.
Pinelli, Vincent A; Papp, Klara K; Gonzalo, Jed D
2015-09-01
Optimal care delivery requires timely, efficient, and accurate communication among numerous providers and their patients, especially during hospital discharge. Little is known about communication patterns during this process. Our aim was to assess the frequency and patterns of communication between patients and providers during patient discharges from a hospital-based medicine unit. On the day of the patient's discharge, the patient and all healthcare providers involved in the discharge were interviewed using structured questions related to information exchange during the discharge process. Each interview identified the frequency and method of communication between participants, including synchronous (e.g., face-to-face) and asynchronous (e.g., through electronic medical record) routes. Communication patterns were visually diagramed using social network analysis. Forty-six patients were screened for inclusion in the network analysis. Of those, seven patients who were fully oriented and able to complete an interview and all providers who participated in their care during the discharge were selected for inclusion in the analysis. In all, 72 healthcare professionals contributing to the discharge process were interviewed, including physicians, nurses, therapists, pharmacists, care coordinators, social workers, and nutritionists. Patients' mean age was 63, length-of-stay was 7.8 days, and most (86 %) were discharged to home. On average, 11 roles were involved with each discharge. The majority of communication was synchronous (562 events vs. 469 asynchronous events, p = 0.004). Most communication events occurred between the primary nurse and patient and the care coordinator and primary nurse (mean 3.9 and 2.3 events/discharge, respectively). Participants identified intern physicians as most important in the discharge process, followed by primary nurses and care coordinators. In patients being discharged from the medicine service, communication was more frequently synchronous, and occurred between intern physicians, primary nurses, and patients. Potential improvements in coordinating patients' discharges are possible by reorganizing systems to optimize efficient communication.
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A requirements index for information processing in hospitals.
Ammenwerth, E; Buchauer, A; Haux, R
2002-01-01
Reference models describing typical information processing requirements in hospitals do not currently exist. This leads to high hospital information system (HIS) management expenses, for example, during tender processes for the acquisition of software application programs. Our aim was, therefore, to develop a comprehensive, lasting, technology-independent, and sufficiently detailed index of requirements for information processing in hospitals in order to reduce respective expenses. Two-dozen German experts established an index of requirements for information processing in university hospitals. This was done in a consensus-based, top-down, cyclic manner. Each functional requirement was derived from information processing functions and sub-functions of a hospital. The result is the first official German version of a requirements index, containing 233 functional requirements and 102 function-independent requirements, focusing on German needs. The functional requirements are structured according to the primary care process from admission to discharge and supplemented by requirements for handling patient records, work organization and resource planning, hospital management, research and education. Both the German version and its English translation are available in the Internet. The index of requirements contains general information processing requirements in hospitals which are formulated independent of information processing tools, or of HIS architectures. It aims at supporting HIS management, especially HIS strategic planning, HIS evaluation, and tender processes. The index can be regarded as a draft, which must, however, be refined according to the specific aims of a particular project. Although focused on German needs, we expect that it can also be useful in other countries. The high amount of interest shown for the index supports its usefulness.
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Rydeman, IngBritt; Törnkvist, Lena
2006-10-01
The aim of the study was to obtain a deeper understanding of the experiences of the discharge process among different professionals. An optimal discharge process for hospitalized elderly to other forms of care is of crucial importance, especially since health and medical policies encourages shorter hospital stays and increased healthcare service in outpatient care. Nurses and social workers from inpatient care, outpatient care, municipal care and social services were interviewed. Eight focus-group interviews with a total of 31 persons were conducted. The subsequent analyses followed a phenomenological approach. The findings revealed three themes, Framework, Basic Values and Patient Resources, which influenced the professionals' actions in the discharge process. The overall emerging structure comprised the patient's vulnerability, dependence and exposed situation in the discharge process. In conclusion some factors are of special importance for the co-operation and the actions of professionals involved in the discharge process. Firstly, a distinct and common framework, with conscious and organizationally based values. Secondly the need to take the patient resources into consideration. Together these factors could contribute to secure the patients involvement in the discharge process and to design an optimal, safe and good care. Collaborative approaches among a range of professionals within a variety of organizations are common, especially in the care of the elderly. The role and support of both the organizations and the educational units are decisive factors in this area.
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Trend analyses of sediment data for the DEC project
Rebich, Richard Allen
1995-01-01
Daily stream discharge, suspended-sediment concentration, and suspended-sediment discharge data were collected at eight sites in six watersheds of the Demonstration Erosion Control project in the Yazoo River Basin in north-central Mississippi during the period July 1985 through September 1991. The project is part of an ongoing interagency program of planning, design, construction, monitoring, and evaluation to alleviate flooding, erosion, sedimentation, and water-quality problems for watersheds located in the bluff hills upstream of the Mississippi River alluvial plain. This paper presents preliminary results of trend analyses for stream discharge and sediment data for the eight project sites. More than 550 stream discharge measurements and 20,000 suspended-sediment samples have been collected at the eight sites since 1985.
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Theuer, D; Dillschneider, J; Mieth, M; Büchler, M W
2012-01-01
The spectacular increase in liability processes in the field of surgery and in particular in visceral surgery, necessitates an objectification of the conflict between surgical medical professionals and medico-legal institutions, firms of solicitors and courts. Out of court settlements assisted by expert opinion commissions of the Medical Council can avoid many legal conflicts. For improvement of the legal standpoint of a defendant medical professional an unambiguous, extensive and detailed documentation of medical examination findings, the indications for the planned operative intervention, extensive and detailed documentation on disclosure and informed consent of the patient for the planned operative intervention, an extensive, detailed careful and responsibly guided report of the operation as well as a systematic, orderly well-planned postoperative complication management are necessary to counter the accusation of an organizational failure of medical professionals and the accused hospital. The mutual building of confidence between surgical medical professionals and legal institutions is safeguarded by a comprehensive documentation and an unambiguous description and formulation of the medical discharge report on termination of inpatient treatment.
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A Proposal for the Unification of Vermont's Mental Retardation Service System.
ERIC Educational Resources Information Center
Vermont State Dept. of Mental Health, Montpelier. Div. of Mental Retardation.
This planning document proposes that services to Vermonters with mental retardation be unified around the community mental retardation service system, in order to provide community placements for residents of the Brandon Training School (BTS) who are under court order for discharge between 1989 and 1993. The Department of Mental Health plans to…
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-04-20
... control is necessary based on wasteload allocations in the Lower Charles River Phosphorus TMDL (``the TMDL... management plan and a phosphorus reduction plan, as the mechanisms to achieve the required pollutant... Consistent with the wasteload allocation of the Lower Charles River Phosphorus TMDL, Part IV and Appendix D...
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Code of Federal Regulations, 2011 CFR
2011-07-01
... “economically targeted investments,” that is, investments selected for the economic benefits they create apart... course of discharging their duties, fiduciaries may never subordinate the economic interests of the plan... economic interest of the plan except in very limited circumstances enumerated below. With regard to...
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40 CFR 125.72 - Early screening of applications for section 316(a) variances.
Code of Federal Regulations, 2010 CFR
2010-07-01
... necessary; (3) A general description of the type of data, studies, experiments and other information which... filed, the discharger shall submit for the Director's approval a detailed plan of study which the... nature and extent of the following type of information to be included in the plan of study: Biological...
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40 CFR 125.72 - Early screening of applications for section 316(a) variances.
Code of Federal Regulations, 2011 CFR
2011-07-01
... necessary; (3) A general description of the type of data, studies, experiments and other information which... filed, the discharger shall submit for the Director's approval a detailed plan of study which the... nature and extent of the following type of information to be included in the plan of study: Biological...
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Goldman, Joanne; Reeves, Scott; Wu, Robert; Silver, Ivan; MacMillan, Kathleen; Kitto, Simon
2016-01-01
Patient discharge is a key concern in hospitals, particularly in acute care, given the multifaceted and challenging nature of patients' healthcare needs. Policies on discharge have identified the importance of interprofessional collaboration, yet research has described its limitations in this clinical context. This study aimed to extend our understanding of interprofessional interactions related to discharge in a general internal medicine setting by using sociological theories to illuminate the existence of, and interplay between, structural factors and microlevel practices. An ethnographic approach was employed to obtain an in-depth insight into healthcare providers' perspectives, behaviours, and interactions regarding discharge. Data collection involved observations, interviews, and document analysis. Approximately 65 hours of observations were undertaken, 23 interviews were conducted with healthcare providers, and government and hospital discharge documents were collected. Data were analysed using a directed content approach. The findings indicate the existence of a medically dominated division of healthcare labour in patient discharge with opportunities for some interprofessional negotiations; the role of organizational routines in facilitating and challenging interprofessional negotiations in patient discharge; and tensions in organizational priorities that impact an interprofessional approach to discharge. The findings provide insight into the various levels at which interventions can be targeted to improve interprofessional collaboration in discharge while recognizing the organizational tensions that challenge an interprofessional approach.
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[Study on the discharge properties of xeon flash lamp and experimental measurement].
Zhao, You-Quan; Miao, Pei-Liang; He, Feng; Gu, Jian; Zhai, Rui-Wei
2014-07-01
The Xenon flash lamp is a new type of light source for analytical instrument. The present paper analyzed the discharge process of xenon flash lamp, presented the discharge test system, and conducted experimental measurement of the voltage, current and optical pulse signal in the process of discharge. The results show that in the preliminary discharge, the free electron concentration was at a low level, so the energy was at a low level, then following the gas discharge, numerous free electrons formed in the lamp, resultin in the increase in the concentration of free electrons, therefore discharge current rised rapidly and voltage reduced. The lamp released photons to generate light pulse in the moment of ionic recombination, The pulse xenon lamp light energy output and spectral characteristic is related to electron energy in recombination and combination level of xenon, if the input energy and the energy consumption of the xenon lamp is inconsistent, it will lead to repeated capacitor charging and discharging and produce oscillation waveform. This paper is very useful for understanding the process of xenon lamp discharge, optimizing the driver circuit and the production of xenon flash lamp.
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Water purification by electrical discharges
NASA Astrophysics Data System (ADS)
Arif Malik, Muhammad; Ghaffar, Abdul; Akbar Malik, Salman
2001-02-01
There is a continuing need for the development of effective, cheap and environmentally friendly processes for the disinfection and degradation of organic pollutants from water. Ozonation processes are now replacing conventional chlorination processes because ozone is a stronger oxidizing agent and a more effective disinfectant without any side effects. However, the fact that the cost of ozonation processes is higher than chlorination processes is their main disadvantage. In this paper recent developments targeted to make ozonation processes cheaper by improving the efficiency of ozone generation, for example, by incorporation of catalytic packing in the ozone generator, better dispersion of ozone in water and faster conversion of dissolved ozone to free radicals are described. The synthesis of ozone in electrical discharges is discussed. Furthermore, the generation and plasma chemical reactions of several chemically active species, such as H2O2, Obullet, OHbullet, HO2bullet, O3*, N2*, e-, O2-, O-, O2+, etc, which are produced in the electrical discharges are described. Most of these species are stronger oxidizers than ozone. Therefore, water treatment by direct electrical discharges may provide a means to utilize these species in addition to ozone. Much research and development activity has been devoted to achieve these targets in the recent past. An overview of these techniques and important developments that have taken place in this area are discussed. In particular, pulsed corona discharge, dielectric barrier discharge and contact glow discharge electrolysis techniques are being studied for the purpose of cleaning water. The units based on electrical discharges in water or close to the water level are being tested at industrial-scale water treatment plants.}
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Lightning and middle atmospheric discharges in the atmosphere
NASA Astrophysics Data System (ADS)
Siingh, Devendraa; Singh, R. P.; Kumar, Sarvan; Dharmaraj, T.; Singh, Abhay K.; Singh, Ashok K.; Patil, M. N.; Singh, Shubha
2015-11-01
Recent development in lightning discharges including transient luminous events (TLEs) and global electric circuit are discussed. Role of solar activity, convective available potential energy, surface temperature and difference of land-ocean surfaces on convection process are discussed. Different processes of discharge initiation are discussed. Events like sprites and halos are caused by the upward quasi-electrostatic fields associated with intense cloud-to-ground discharges while jets (blue starter, blue jet, gigantic jet) are caused by charge imbalance in thunderstorm during lightning discharges but they are not associated with a particular discharge flash. Elves are generated by the electromagnetic pulse radiated during lightning discharges. The present understanding of global electric circuit is also reviewed. Relation between lightning activity/global electric circuit and climate is discussed.
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Marcus, Logan P; McCutcheon, Brandon A; Noorbakhsh, Abraham; Parina, Ralitza P; Gonda, David D; Chen, Clark; Chang, David C; Carter, Bob S
2014-05-01
Hospital readmission within 30 days of discharge is a major contributor to the high cost of health care in the US and is also a major indicator of patient care quality. The purpose of this study was to investigate the incidence, causes, and predictors of 30-day readmission following craniotomy for malignant supratentorial tumor resection. The longitudinal California Office of Statewide Health Planning & Development inpatient-discharge administrative database is a data set that consists of 100% of all inpatient hospitalizations within the state of California and allows each patient to be followed throughout multiple inpatient hospital stays, across multiple institutions, and over multiple years (from 1995 to 2010). This database was used to identify patients who underwent a craniotomy for resection of primary malignant brain tumors. Causes for unplanned 30-day readmission were identified by principle ICD-9 diagnosis code and multivariate analysis was used to determine the independent effect of various patient factors on 30-day readmissions. A total of 18,506 patients received a craniotomy for the treatment of primary malignant brain tumors within the state of California between 1995 and 2010. Four hundred ten patients (2.2%) died during the index surgical admission, 13,586 patients (73.4%) were discharged home, and 4510 patients (24.4%) were transferred to another facility. Among patients discharged home, 1790 patients (13.2%) were readmitted at least once within 30 days of discharge, with 27% of readmissions occurring at a different hospital than the initial surgical institution. The most common reasons for readmission were new onset seizure and convulsive disorder (20.9%), surgical infection of the CNS (14.5%), and new onset of a motor deficit (12.8%). Medi-Cal beneficiaries were at increased odds for readmission relative to privately insured patients (OR 1.52, 95% CI 1.20-1.93). Patients with a history of prior myocardial infarction were at an increased risk of readmission (OR 1.64, 95% CI 1.06-2.54) as were patients who developed hydrocephalus (OR 1.58, 95% CI 1.20-2.07) or venous complications during index surgical admission (OR 3.88, 95% CI 1.84-8.18). Using administrative data, this study demonstrates a baseline glioma surgery 30-day readmission rate of 13.2% in California for patients who are initially discharged home. This paper highlights the medical histories, perioperative complications, and patient demographic groups that are at an increased risk for readmission within 30 days of home discharge. An analysis of conditions present on readmission that were not present at the index surgical admission, such as infection and seizures, suggests that some readmissions may be preventable. Discharge planning strategies aimed at reducing readmission rates in neurosurgical practice should focus on patient groups at high risk for readmission and comprehensive discharge planning protocols should be implemented to specifically target the mitigation of potentially preventable conditions that are highly associated with readmission.
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40 CFR 63.1543 - Standards for process and process fugitive sources.
Code of Federal Regulations, 2010 CFR
2010-07-01
... lead metal produced) from the aggregation of emissions discharged from the air pollution control... CATEGORIES National Emission Standards for Hazardous Air Pollutants for Primary Lead Smelting § 63.1543... reconstructed primary lead smelter shall discharge or cause to be discharged into the atmosphere lead compounds...
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(Gas discharges and their applications)
DOE Office of Scientific and Technical Information (OSTI.GOV)
Christophorou, L. G.
1988-10-06
The traveler attended the IX International Conference on Gas Discharges and Their Applications held in Venice, Italy, September 19--23, 1988. He was a member of the International Organizing Committee of the conference, chaired a scientific session, presented a paper, and participated in scientific discussions and the planning of the next conference. Also, he exchanged research information and ideas on electron, ion, and laser interactions in fluid media with many participants.
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[Transferring palliative-care patients from hospital to community care: A qualitative study].
Correa-Casado, Matías; Granero-Molina, José; Hernández-Padilla, José Manuel; Fernández-Sola, Cayetano
To know the experience of case-manager nurses with regard to transferring palliative-care patients from the hospital to their homes. Qualitative phenomenological study carried out in 2014-2015. Poniente and Almería health districts, which referral hospitals are Poniente Hospital and Torrecárdenas Hospital, respectively. A purposive sample comprised of 12 case-manager nurses was recruited from the aforementioned setting. Theoretical data saturation was achieved after performing 7 in-depth individual interviews and 1 focus group. Data analysis was performed following Colaizzi's method. Three themes emerged: (1) 'Case-management nursing as a quality, patient-centred service' (2) 'Failures of the information systems', with the subthemes "patients" insufficient and inadequate previous information" and "ineffective between-levels communication channels for advanced nursing"; (3) 'Deficiencies in discharge planning', with the subthemes "deficient management of resources on admission", "uncertainty about discharge" and "insufficient human resources to coordinate the transfer". Case-manager nurses consider themselves a good-quality service. However, they think there are issues with coordination, information and discharge planning of palliative patients from hospital. It would be useful to review the communication pathways of both care and discharge reports, so that resources needed by palliative patients are effectively managed at the point of being transferred home. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.
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Managing seafood processing wastewater on the Oregon coast: A time of transition
DOE Office of Scientific and Technical Information (OSTI.GOV)
Anderson, M.D.; Miner, J.R.
1997-12-01
Seafood processors along the Oregon coast practice a wastewater management plan that is unique within the state. Most of these operations discharge wastewater under a General Permit issued by the Oregon Department of Environmental Quality (DEQ) that requires only that they screen the wastewater to remove particles that will not pass through a 40 mesh screen. The General Permit was issued in February of 1992 and was scheduled to expire at the end of December, 1996. It has been extended until a replacement is adopted. Alternatives are currently under consideration by the DEQ. A second issue is the increasing competitionmore » for water within the coastal communities that are experiencing a growing tourist industry and a static water supply. Tourism and seafood processing both have their peak water demands during the summer months when fresh water supplies are most limited. Disposal of solid wastes has been simplified for many of the processors along the Lower Columbia River by a Fisheries Enhancement Program which allows processors to grind the solid waste then to discharge it into the stream under appropriate tidal conditions. There is no data which indicates water quality damage from this practice nor is there clear evidence of enhanced fishery productivity.« less
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Predictors of formal home health care use in elderly patients after hospitalization.
Solomon, D H; Wagner, D R; Marenberg, M E; Acampora, D; Cooney, L M; Inouye, S K
1993-09-01
To prospectively study the incidence of and risk factors for home health care (HHC) use in a cohort of elderly medical and surgical patients discharged from acute care. Although HHC is commonly received by patients in this group, its predictors have not been well studied. Prospective cohort study. Medical and surgical wards at a university teaching hospital, followed by 23 Medicare-certified HHC agencies in the study catchment area. 226 medical and surgical patients aged 70 years and older immediately after discharge from acute care. HHC initiated within 14 days after hospital discharge, measured by direct review of HHC agency records. The incidence of HHC initiated within 2 weeks post-discharge was 75/226 (34%). The median duration of service was 30 days (range 3-483) with a median of 3 visits per week. Four independent predictors of HHC were identified through multivariate analysis: educational level < or = 12 years (relative risk (RR) 3.3; 95% confidence interval (CI) 1.6 to 6.6); less accessible social support (RR, 1.7; CI 0.9 to 3.1); impairment in at least one instrumental activity of daily living (RR, 1.9; CI, 1.0, 3.4); and prior HHC use (RR, 2.1; CI, 1.2 to 3.6). Risk strata were created by adding one point for each risk factor present: with 0-1 risk factors, 8% used HHC; with two risk factors, 28%; with three risk factors, 45%, with four risk factors, 76%. This trend was statistically significant (P < 0.001). HHC use is common among elderly patients after discharge from acute care. A simple predictive model based on four risk factors can be used on admission to predict HHC use. This model may be useful for discharge planning and health care utilization planning for the elderly population.
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NASA Astrophysics Data System (ADS)
Wortmann, Michel
2014-05-01
The Tarim River is the principle water source of the Xinjiang Uyghur Autonomous Region, NW China and the country's largest endorheic river, terminating in the Taklamakan desert. The vast majority of discharge is generated in the glaciated mountain ranges to the north (Tian Shan), south (Kunlun Shan/Tibetan Plateau) and west (Pamir Mountains) of the Taklamakan desert. The main water user is the intensive irrigation agriculture for mostly cotton and fruit production in linear river oases of the middle and lower reaches as well as a population of 10 Mil. people. Over the past 40 years, an increase in river discharge was reported, assumed to be caused by enhanced glacier melt due to a warming climate. Rapid population growth and economic development have led to a significant expansion of area under irrigation, resulting in water shortages for downstream users and the floodplain vegetation. Water resource planning and management of the Tarim require integrated assessment tools to examine changes under future climate change, land use and irrigation scenarios. The development of such tools, however, is challenged by sparse climate and discharge data as well as available data on water abstractions and diversions. The semi-distributed, process-based hydrological model SWIM (Soil and Water Integrated Model) was implemented for the headwater and middle reaches that generate over 90% of discharge, including the Aksu, Hotan and Yarkant rivers. It includes the representation of snow and glacier melt as well as irrigation abstractions. Once calibrated and validated to river discharge, the model is used to analyse future climate scenarios provided by one physically-based and one statistical regional climate model (RCM). Preliminary results of the model calibration and validation indicate that SWIM is able simulate river discharge adequately, despite poor data conditions. Snow and glacier melt account for the largest share in river discharge. The modelling results will devise sustainable management options for given climate change scenarios with the aim to balance water availability and water use for the basin as a whole and specifically for the riparian ecology.
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Test stand for gas-discharge chamber of TEA CO2 lasers with pulse-periodical energy supply
NASA Astrophysics Data System (ADS)
Shorin, Vladimyr P.; Bystrov, N. D.; Zhuravlyov, O. A.; Nekrasov, V. V.
1997-05-01
Test stand for function optimization (incomposition of gas- dynamic circuit (GDC) of operating characteristics of full- size discharge chamber of flowing TEA carbon-dioxide lasers (power up to 100 kW) was created in Samara State Aerospace University (former Kuibyshev Aviation Institute). Test stand includes an inside-type GDC, low inductive generators of voltage pulses of preionization and main discharges, two-flow rate system of gas supply and noise immunity diagnostic system. Module construction of units of GDC, power supplies of preionization and main discharges allows to change configuration of stand's systems for providing given properties of gas flow and its energy supply. This test stand can also be used in servicing of laser system. The diagnostic system of this stand allows us to analyze energy properties of discharge by means of oscillographic measurements of voltage and current with following processing of discharges' volt- ampere characteristics by means of a computer; rate of non- stationary gas-dynamic disturbances in discharge gap of discharge chamber was measured by means of pulse holographic system (UlG-1M) with data processing of schliren- and interferogram (density fluctuation sensitivity approximately 10-2) and sensor measurement system of gas-dynamic shock and acoustics process with resonance frequency exceeding 100 kHz. Research results of process of plasma plate wave and channel structures interaction with mediums, including actuation non-stationary gas-dynamic flows, cavitation erosion of preionization electrodes' dielectric substructure, ancillary heating of channels by main volumetric discharge are presented as well.
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Applying a foil queue micro-electrode in micro-EDM to fabricate a 3D micro-structure
NASA Astrophysics Data System (ADS)
Xu, Bin; Guo, Kang; Wu, Xiao-yu; Lei, Jian-guo; Liang, Xiong; Guo, Deng-ji; Ma, Jiang; Cheng, Rong
2018-05-01
Applying a 3D micro-electrode in a micro electrical discharge machining (micro-EDM) can fabricate a 3D micro-structure with an up and down reciprocating method. However, this processing method has some shortcomings, such as a low success rate and a complex process for fabrication of 3D micro-electrodes. By focusing on these shortcomings, this paper proposed a novel 3D micro-EDM process based on the foil queue micro-electrode. Firstly, a 3D micro-electrode was discretized into several foil micro-electrodes and these foil micro-electrodes constituted a foil queue micro-electrode. Then, based on the planned process path, foil micro-electrodes were applied in micro-EDM sequentially and the micro-EDM results of each foil micro-electrode were able to superimpose the 3D micro-structure. However, the step effect will occur on the 3D micro-structure surface, which has an adverse effect on the 3D micro-structure. To tackle this problem, this paper proposes to reduce this adverse effect by rounded corner wear at the end of the foil micro-electrode and studies the impact of machining parameters on rounded corner wear and the step effect on the micro-structure surface. Finally, using a wire cutting voltage of 80 V, a current of 0.5 A and a pulse width modulation ratio of 1:4, the foil queue micro-electrode was fabricated by wire electrical discharge machining. Also, using a pulse width of 100 ns, a pulse interval of 200 ns, a voltage of 100 V and workpiece material of 304# stainless steel, the foil queue micro-electrode was applied in micro-EDM for processing of a 3D micro-structure with hemispherical features, which verified the feasibility of this process.
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38 CFR 52.110 - Participant assessment.
Code of Federal Regulations, 2010 CFR
2010-07-01
... participant and family/caregiver; and (v) Discharge or transition plan, including specific criteria for... participant, and the participant's family or the participant's legal representative; and (iv) Periodically...
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Action planning and predictive coding when speaking
Wang, Jun; Mathalon, Daniel H.; Roach, Brian J.; Reilly, James; Keedy, Sarah; Sweeney, John A.; Ford, Judith M.
2014-01-01
Across the animal kingdom, sensations resulting from an animal's own actions are processed differently from sensations resulting from external sources, with self-generated sensations being suppressed. A forward model has been proposed to explain this process across sensorimotor domains. During vocalization, reduced processing of one's own speech is believed to result from a comparison of speech sounds to corollary discharges of intended speech production generated from efference copies of commands to speak. Until now, anatomical and functional evidence validating this model in humans has been indirect. Using EEG with anatomical MRI to facilitate source localization, we demonstrate that inferior frontal gyrus activity during the 300ms before speaking was associated with suppressed processing of speech sounds in auditory cortex around 100ms after speech onset (N1). These findings indicate that an efference copy from speech areas in prefrontal cortex is transmitted to auditory cortex, where it is used to suppress processing of anticipated speech sounds. About 100ms after N1, a subsequent auditory cortical component (P2) was not suppressed during talking. The combined N1 and P2 effects suggest that although sensory processing is suppressed as reflected in N1, perceptual gaps are filled as reflected in the lack of P2 suppression, explaining the discrepancy between sensory suppression and preserved sensory experiences. These findings, coupled with the coherence between relevant brain regions before and during speech, provide new mechanistic understanding of the complex interactions between action planning and sensory processing that provide for differentiated tagging and monitoring of one's own speech, processes disrupted in neuropsychiatric disorders. PMID:24423729
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Pages, K P; Russo, J E; Wingerson, D K; Ries, R K; Roy-Byrne, P P; Cowley, D S
1998-09-01
The study examined predictors of discharge against medical advice (AMA) and outcomes of psychiatric patients with AMA discharges, as measured by poorer symptom ratings at discharge and higher rates of rehospitalization. A total of 195 patients discharged AMA from general hospital psychiatric units were compared retrospectively with 2,230 regularly discharged patients. AMA status was defined as signing out against medical advice, being absent without leave, or being administratively discharged. All patients received standardized assessments within 24 hours of admission and at discharge. Demographic characteristics, psychiatric history, DSA-IV psychiatric and substance use diagnoses, and scores on an expanded 32-item version of the Psychiatric Symptom Assessment Scale were compared. The groups did not differ in primary psychiatric diagnoses. Patients discharged AMA were significantly less likely to be Caucasian or to be functionally impaired due to physical illness. They were more likely to live alone, have a substance use diagnosis, use more psychoactive substances, and have more previous hospitalizations. Patients discharged AMA had significantly shorter lengths of stay, higher rehospitalization rates, and more severe symptoms at discharge, even when length of stay was taken into account. The differences between the groups in male gender and young age were better accounted for by a greater likelihood of substance abuse in these groups. The results suggest a profile of patients who may be discharged AMA. Such patients have worse outcomes and are more likely to be high utilizers of inpatient resources. Aggressive identification of patients likely to be discharged AMA and early discharge planning for appropriate outpatient treatment are recommended.
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ERIC Educational Resources Information Center
Litt, Jonathan S.; Perrin, James M.
2014-01-01
This study aims to characterize participation of neonatal intensive care unit (NICU) graduates in early intervention (EI). We used data from the National Early Intervention Longitudinal Study. We fit models of days from referral to Individualized Family Service Plan creation (plan time), days from referral to initiation of services (service time),…
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77 FR 7960 - Unified Agenda of Federal Regulatory and Deregulatory Actions
Federal Register 2010, 2011, 2012, 2013, 2014
2012-02-13
... Identifier No. 373 Secure Handling of 1601-AA52 Ammonium Nitrate Program (Reg Plan Seq No. 53). 374 Homeland...) Proposed Rule Stage 373. Secure Handling of Ammonium Nitrate Program Regulatory Plan: This entry is Seq. No... performance standards to 33 CFR part 151, subparts C and D, for discharges of ballast water. It supports the...
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Going home from hospital -- an appreciative inquiry study.
Reed, Jan; Pearson, Pauline; Douglas, Barbara; Swinburne, Stella; Wilding, Helen
2002-01-01
This paper reports on a project that involved a number of agencies and groups, including older people, working together to examine and develop practice in an area of shared concern -- going home from hospital. The project was stimulated by a 'whole-system event', and was based on appreciative inquiry (AI) methodology, which has roots in both action research and organisational development. In AI, the research is directed towards appreciating what it is about the social world that is positive, and exploring this. The study was planned around three workshops to streamline data collection and analysis. Group members were also required to carry out some activities between workshops. Invitations were sent out to groups and individuals previously identified as involved or interested in the discharge process across one health district (n = 71). Workshop one discussed the planned research schedule, and introduced the basic concepts of AI. This workshop also took participants through the interview process. Each participant was asked to undertake two interviews. Thirty-five individual interviews and one focus group were completed. At workshop two, interview data were analysed by the group using the nominal group technique. Subsequent group discussion produced 'provocative propositions'. At the third workshop, provocative propositions were developed into action plans. This paper gives an overview of the study, and explores some of the issues involved when working with service users and providers as co-researchers.
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NASA Astrophysics Data System (ADS)
Vitelaru, Catalin; Aijaz, Asim; Constantina Parau, Anca; Kiss, Adrian Emil; Sobetkii, Arcadie; Kubart, Tomas
2018-04-01
Pressure and target voltage driven discharge runaway from low to high discharge current density regimes in high power impulse magnetron sputtering of carbon is investigated. The main purpose is to provide a meaningful insight of the discharge dynamics, with the ultimate goal to establish a correlation between discharge properties and process parameters to control the film growth. This is achieved by examining a wide range of pressures (2–20 mTorr) and target voltages (700–850 V) and measuring ion saturation current density at the substrate position. We show that the minimum plasma impedance is an important parameter identifying the discharge transition as well as establishing a stable operating condition. Using the formalism of generalized recycling model, we introduce a new parameter, ‘recycling ratio’, to quantify the process gas recycling for specific process conditions. The model takes into account the ion flux to the target, the amount of gas available, and the amount of gas required for sustaining the discharge. We show that this parameter describes the relation between the gas recycling and the discharge current density. As a test case, we discuss the pressure and voltage driven transitions by changing the gas composition when adding Ne into the discharge. We propose that standard Ar HiPIMS discharges operated with significant gas recycling do not require Ne to increase the carbon ionization.
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Time-resolved processes in a pulsed electrical discharge in argon bubbles in water
NASA Astrophysics Data System (ADS)
Gershman, S.; Belkind, A.
2010-12-01
A phenomenological picture of a pulsed electrical discharge in gas bubbles in water is produced by combining electrical, spectroscopic, and imaging characterization methods. The discharge is generated by applying 1 μ s pulses of 5 to 20 kV between a needle and a disk electrode submerged in water. An Ar gas bubble surrounds the tip of the needle electrode. Imaging, electrical characteristics, and time-resolved optical emission spectroscopic data suggest a fast streamer propagation mechanism and the formation of a plasma channel in the bubble. Comparing the electrical and imaging data for consecutive pulses applied to the bubble at a frequency of 1 Hz indicates that each discharge proceeds as an entirely new process with no memory of the previous discharge aside from the presence of long-lived chemical species, such as ozone and oxygen. Imaging and electrical data show the presence of two discharge events during each applied voltage pulse, a forward discharge near the beginning of the applied pulse depositing charge on the surface of the bubble and a reverse discharge removing the accumulated charge from the water/gas interface when the applied voltage is turned off. The pd value of ~ 300-500 torr cm, the 1 μs long pulse duration, low repetition rate, and unidirectional character of the applied voltage pulses make the discharge process here unique compared to the traditional corona or dielectric barrier discharges.
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The Empirical Relationship between Mining Industry Development and Environmental Pollution in China.
Li, Gerui; Lei, Yalin; Ge, Jianping; Wu, Sanmang
2017-03-02
This study uses a vector autoregression (VAR) model to analyze changes in pollutants among different mining industries and related policy in China from 2001 to 2014. The results show that: (1) because the pertinence of standards for mining waste water and waste gas emissions are not strong and because the maximum permissible discharge pollutant concentrations in these standards are too high, ammonia nitrogen and industrial sulfur dioxide discharges increased in most mining industries; (2) chemical oxygen demand was taken as an indicator of sewage treatment in environmental protection plans; hence, the chemical oxygen demand discharge decreased in all mining industries; (3) tax reduction policies, which are only implemented in coal mining and washing and extraction of petroleum and natural gas, decreased the industrial solid waste discharge in these two mining industries.
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Kelly, Dympna M; Bennett, Renee; Brown, Nancy; McCoy, Judy; Boerner, Derek; Yu, Changhong; Eghtesad, Bijan; Barsoum, Wael; Fung, John J; Kattan, Michael W
2012-07-01
The aim of this study was to develop a tool for preoperatively predicting the need of a patient to attend an extended care facility after orthotopic liver transplantation (OLT). A multidisciplinary group, which included 2 transplant surgeons, 2 transplant nurses, 1 nurse manager, 2 physical therapists, 1 case manager, 1 home health care professional, 1 rehabilitation physician, and 1 statistician, met to identify preoperative factors relevant to discharge planning. The parameters that were examined as potential predictors of the discharge status were as follows: age, sex, language, Karnofsky score, OLT alone (versus a combined procedure), creatinine, bilirubin, international normalized ratio (INR), albumin, body mass index (BMI), Child-Turcotte-Pugh score, chemical Model for End-Stage Liver Disease score, renal dialysis, location before transplantation, comorbidities (encephalopathy, ascites, hydrothorax, and hepatopulmonary syndrome), diabetes mellitus (DM), cardiac ejection fraction and right ventricular systolic pressure, sex and availability of the primary caregiver, donor risk index, and donor characteristics. Between January 2004 and April 2010, 730 of 777 patients (94%) underwent only liver transplantation, and 47 patients (6%) underwent combined procedures. Five hundred nineteen patients (67%) were discharged home, 215 (28%) were discharged to a facility, and 43 (6%) died early after OLT. A multivariate logistic regression analysis identified the following parameters as significantly influencing the discharge status: a low Karnofsky score, an older age, female sex, an INR of 2.0, a creatinine level of 2.0 mg/dL, DM, a high bilirubin level, a low albumin level, a low or high BMI, and renal dialysis before OLT. The nomogram was prospectively validated with a population of 126 OLT recipients with a concordance index of 0.813. In conclusion, a new approach to improving the efficiency of hospital care is essential. We believe that this tool will aid in reducing lengths of stay and improving the experience of patients by facilitating early discharge planning. Copyright © 2012 American Association for the Study of Liver Diseases.
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NASA Astrophysics Data System (ADS)
Jardine, P. M.; Mehlhorn, T. L.
2006-05-01
The following research investigated the effectiveness of an aggressive, large scale remedial action that is occurring to subsurface waste trenches containing radioactive and organic waste at the Oak Ridge National Laboratory. The site is being remediated as one of the top cleanup prioritization for the Oak Ridge Accelerated Remediation endeavor. Site landlords, Bechtel Jacobs Co., LLC (BJC) are installing a minimal RCRA cap with the primary objective of controlling the infiltration of storm water into the hundreds of unconfined waste trenches containing radioactive and organic waste. The site now offers a unique scientific opportunity to track the kinetic evolution of post-cap processes influencing contaminant migration and immobilization, because we have many years of pre-cap coupled processes information and knowledge. Since the cap is certain to disrupt the near steady-state contaminant discharge profiles that have existed for many years from the site, we have been quantifying the influence of post-cap hydrological, geochemical, and microbial processes on contaminant discharge as a function of scale and time in an effort to assess local-scale cap influences versus regional scale groundwater flow influences on contaminant discharge. We have been allowed to maintain numerous groundwater monitoring wells at a field site and these have a rich historical data set with regard to hydrology, geochemistry, microbiology, and contaminant flux. Our objectives are to investigate cap induced changes in (1) groundwater and surface hydrology and contaminant flux, (2) geochemistry and contaminant speciation, and (3) microbial community structure and organic contaminant degradation and inorganic contaminant immobilization. Our approach monitors coupled processes during base-flow and during storm events in both the groundwater and surface water discharge from the site and the surrounding watershed. Pre- and post-cap data will than be modeled with a multiprocess, multicomponent, transport model which is linked to pre- and post-cap surface water hydrograph analysis from the site and the surrounding watershed. Our goal is to provide an improved fundamental understanding of the long-term fate and transport of contaminants and an improved ability to predict system response to remedial actions. The experimental and numerical results from this investigation will provide knowledge and information in previously unexplored areas of cap performance with regard to coupled hydrology, geochemistry, microbiology, and contaminant flux in humid regimes. The products will support DOE's mission of long-term stewardship of contaminated environments and be transferable to other site where similar remediation exists or is planned.
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NASA Astrophysics Data System (ADS)
Huang, Y.; Liu, B. Z.; Wang, K. Y.; Ai, X.
2017-12-01
In response to the new requirements of the operation mode of wind-storage combined system and demand side response for transmission network planning, this paper presents a joint planning of energy storage and transmission considering wind-storage combined system and demand side response. Firstly, the charge-discharge strategy of energy storage system equipped at the outlet of wind farm and demand side response strategy are analysed to achieve the best comprehensive benefits through the coordination of the two. Secondly, in the general transmission network planning model with wind power, both energy storage cost and demand side response cost are added to the objective function. Not only energy storage operation constraints and but also demand side response constraints are introduced into the constraint condition. Based on the classical formulation of TEP, a new formulation is developed considering the simultaneous addition of the charge-discharge strategy of energy storage system equipped at the outlet of the wind farm and demand side response strategy, which belongs to a typical mixed integer linear programming model that can be solved by mature optimization software. The case study based on the Garver-6 bus system shows that the validity of the proposed model is verified by comparison with general transmission network planning model. Furthermore, the results demonstrate that the joint planning model can gain more economic benefits through setting up different cases.
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Brooks, K M
2009-01-01
In the development of integrated pest management (IPM) plans for the control of sea lice there are some components that are common to many areas. However, effective plans must be tailored to regionally varying environmental and biological factors affecting the severity of sea lice infections. This paper describes factors that would be involved in the development of an IPM plan for sea lice in the Broughton Archipelago, British Columbia. Temperature, salinity and currents affect the production, dispersion and competence of larvae of sea lice, Lepeophtheirus salmonis (Krøyer), as they develop to the infective copepodid stage. This information can be coupled with oceanographic conditions in the Broughton Archipelago and emerging computer models to define zones of infection where infections of new hosts are most likely. Salinity and temperature depend, in part, on river discharge in estuarine systems. River discharge depends on precipitation, snow pack and ambient temperatures, which can be monitored to help forecast the intensity of sea lice infections associated with both farmed and wild hosts. One of the goals of IPM planning is to reduce reliance on pesticides to avoid development of resistance in targeted parasites and to minimize environmental residues. Recommendations for developing an IPM plan specific to the Broughton Archipelago are provided along with a discussion of the additional information needed to refine IPM plans in this and other areas.
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Robinson, James C; Brown, Timothy T
2014-09-01
To quantify the potential reduction in hospital costs from adoption of best local practices in supply chain management and discharge planning. We performed multivariate statistical analyses of the association between total variable cost per procedure and medical device price and length of stay, controlling for patient and hospital characteristics. Ten hospitals in 1 major metropolitan area supplied patient-level administrative data on 9778 patients undergoing joint replacement, spine fusion, or cardiac rhythm management (CRM) procedures in 2008 and 2010. The impact on each hospital of matching lowest local market device prices and lowest patient length of stay (LOS) was calculated using multivariate regression analysis controlling for patient demographics, diagnoses, comorbidities, and implications. Average variable costs ranged from $11,315 for joint replacement to $16,087 for CRM and $18,413 for spine fusion. Implantable medical devices accounted for a large share of each procedure's variable costs: 44% for joint replacement, 39% for spine fusion, and 59% for CRM. Device prices and patient length-of-stay exhibited wide variation across hospitals. Total potential hospital cost savings from achieving best local practices in device prices and patient length of stay are 14.5% for joint replacement, 18.8% for spine fusion;,and 29.1% for CRM. Hospitals have opportunities for cost reduction from adoption of best local practices in supply chain management and discharge planning.
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[The case manager--from words to deeds?].
Lindegaard, Birthe Rosenkrantz; Qvist, Peter
2010-04-19
Allocation of a case manager is now mandatory for both in- and outpatients in Denmark. Case manager allocation is reported quarterly to the regions and results are generally satisfying. Knowledge about fulfillment of the case manager role is, however, sparse. This study aims to examine the degree of fulfillment of the case manager role for a sample of inpatients. Two medical and two surgical wards participated. Patients were interviewed in relation to discharge while staff assigned as case managers completed a survey. Both patients and case managers answered questions regarding the defined roles as case managers: Planning/coordination, continuous information and discharge planning. 107 of 125 eligible patients were interviewed. Only 25 declared themselves informed about the allocation of a case manager. The patients' assessment of the service provided by the staff in relation to case manager tasks was generally good, but the services were seldom provided by the named case manager. 22% of patients did not experience continuous information, while only 13% did not experience a generally coherent stay in hospital. 110 case managers completed the survey. Less than half felt themselves well informed about the case manager role. Only a few case managers feel that they succeed in fulfilling the role, particularly regarding the participation in discharge planning. There seems to be a need for a targeted effort to improve the conditions for case managers in Danish hospitals in order to meet the intentions of this initiative.
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Lindquist, Lee A; Ramirez-Zohfeld, Vanessa; Sunkara, Priya D; Forcucci, Chris; Campbell, Dianne S; Mitzen, Phyllis; Ciolino, Jody D; Kricke, Gayle; Seltzer, Anne; Ramirez, Ana V; Cameron, Kenzie A
2017-11-01
Investigate the effect of PlanYourLifespan.org (PYL) on knowledge of posthospital discharge options. Multisite randomized controlled trial. Nonhospitalized adults, aged =65 years, living in urban, suburban, and rural areas of Texas, Illinois, and Indiana. PYL is a national, publicly available tool that provides education on posthospital therapy choices and local home-based resources. Participants completed an in-person baseline survey, followed by exposure to intervention or attention control (AC) websites, then 1-month and 3-month telephone surveys. The primary knowledge outcome was measured with 6 items (possible 0-6 points) pertaining to hospital discharge needs. Among 385 participants randomized, mean age was 71.9 years (standard deviation 5.6) and 79.5% of participants were female. At 1 month, the intervention group had a 0.6 point change (standard deviation = 1.6) versus the AC group who had a -0.1 point change in knowledge score. Linear mixed modeling results suggest sex, health literacy level, level of education, income, and history of high blood pressure/kidney disease were significant predictors of knowledge over time. Controlling for these variables, treatment effect remained significant (P < 0.0001). Seniors who used PYL demonstrated an increased understanding of posthospitalization and home services compared to the control group. © 2017 Society of Hospital Medicine
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Plickert, H D; Tichy, A; Hirt, R A
2014-03-01
To compare characteristics of nasal discharge caused by different intranasal aetiologies in dogs. Medical records of 105 dogs with nasal discharge due to intranasal disease were retrospectively reviewed with special focus on composition, severity, duration and localisation of discharge. On the basis of diagnostic findings, cases were classified into different disease groups and characteristics of discharge were compared between groups. Cases were classified as having non-specific rhinitis (n=42), nasal neoplasia (n=23), foreign bodies (n=21), nasal mycosis (n=7) and miscellaneous disorders (n=13). Dogs with foreign bodies or nasal mycosis were significantly younger. Mucous components of discharge occurred more often in non-specific rhinitis and nasal neoplasia, although haemorrhagic components predominated in nasal neoplasia when discharge lasted ê14 days. Pure or mixed haemorrhagic discharge was significantly more common with nasal neoplasia, foreign bodies and nasal mycosis. Purulent components were associated with longer duration of discharge and predominantly seen in non-specific rhinitis and foreign bodies. Dogs with foreign bodies were presented earlier and sneezing was more frequent. Nasal stridor was significantly more often observed in dogs with nasal neoplasia. Characteristics of nasal discharge and associated clinical signs might aid in planning the diagnostic approach, but a combination of diagnostic techniques is still required to confirm a diagnosis. © 2014 British Small Animal Veterinary Association.
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Holm, Anne Lise; Severinsson, Elisabeth
2013-01-01
In order to deliver effective care, it is necessary to organise interdisciplinary activities for older persons who suffer from depressive disorders. This paper evaluated the interdisciplinary team members' perceptions of cooperation in the discharge planning of depressed older persons based on the Chronic Care Model (CCM). A qualitative implementation design was used, data were collected by means of multistage focus groups, and a thematic analysis was performed. Three themes emerged: lack of effective team leadership in the community, the need to change the delivery system, and enhancing self-management support for depressed older persons as well as the participation of their families. It was concluded that nurse managers must find ways of supporting the depressed older persons by better structuring the care, increasing cooperation with organisational leadership, and creating an environment characterised by trust and mutual respect. Distrust can have serious implications for discharge planning collaboration. The development of a common vision of transparency in the organization is important as is a policy of change among leadership and in clinical practice. PMID:23766896
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DOE Office of Scientific and Technical Information (OSTI.GOV)
NONE
1997-10-27
This Corrective Action Investigation Plan (CAIP) contains the environmental sample collection objectives and the criteria for conducting site investigation activities at Corrective Action Unit (CAU) Number 423, the Building 03-60 Underground Discharge Point (UDP), which is located in Area 3 at the Tonopah Test Range (TTR). The TTR, part of the Nellis Air Force Range, is approximately 225 kilometers (140 miles) northwest of Las Vegas, Nevada. CAU Number 423 is comprised of only one Corrective Action Site (CAS) which includes the Building 03-60 UDP and an associated discharge line extending from Building 03-60 to a point approximately 73 meters (240more » feet) northwest. The UDP was used between approximately 1965 and 1990 to dispose of waste fluids from the Building 03-60 automotive maintenance shop. It is likely that soils surrounding the UDP have been impacted by oil, grease, cleaning supplies and solvents as well as waste motor oil and other automotive fluids released from the UDP.« less
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Burgin, Jillian Elizabeth
This Storm Water Pollution Prevention Plan (SWPPP) was developed in accordance with the provisions of the Clean Water Act (33 U.S.C. §§1251 et seq., as amended), and the Multi-Sector General Permit for Storm Water Discharges Associated with Industrial Activity (U.S. EPA, June 2015) issued by the U.S. Environmental Protection Agency (EPA) for the National Pollutant Discharge Elimination System (NPDES) and using the industry specific permit requirements for Sector AA-Fabricated Metal Products as a guide. This SWPPP applies to discharges of stormwater from the operational areas of the TA-03-38 Metals Fabrication Shop at Los Alamos National Laboratory. Los Alamos National Laboratorymore » (also referred to as LANL or the “Laboratory”) is owned by the Department of Energy (DOE), and is operated by Los Alamos National Security, LLC (LANS). Throughout this document, the term “facility” refers to the TA-03-38 Metals Fabrication Shop and associated areas. The current permit expires at midnight on June 4, 2020.« less
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Burgin, Jillian Elizabeth
This Storm Water Pollution Prevention Plan (SWPPP) was developed in accordance with the provisions of the Clean Water Act (33 U.S.C. §§1251 et seq., as amended), and the Multi-Sector General Permit for Storm Water Discharges Associated with Industrial Activity (U.S. EPA, June 2015) issued by the U.S. Environmental Protection Agency (EPA) for the National Pollutant Discharge Elimination System (NPDES) and using the industry specific permit requirements for Sector P-Land Transportation and Warehousing as a guide. This SWPPP applies to discharges of stormwater from the operational areas of the TA-60-01 Heavy Equipment Shop at Los Alamos National Laboratory. Los Alamos Nationalmore » Laboratory (also referred to as LANL or the “Laboratory”) is owned by the Department of Energy (DOE), and is operated by Los Alamos National Security, LLC (LANS). Throughout this document, the term “facility” refers to the TA-60-01 Heavy Equipment Shop and associated areas. The current permit expires at midnight on June 4, 2020.« less
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Burgin, Jillian Elizabeth
This Storm Water Pollution Prevention Plan (SWPPP) was developed in accordance with the provisions of the Clean Water Act (33 U.S.C. §§1251 et seq., as amended), and the Multi-Sector General Permit for Storm Water Discharges Associated with Industrial Activity (U.S. EPA, June 2015) issued by the U.S. Environmental Protection Agency (EPA) for the National Pollutant Discharge Elimination System (NPDES) and using the industry specific permit requirements for Sector A–Timber Products, Subsector A4 (Wood Products Facilities not elsewhere classified) as a guide. This SWPPP applies to discharges of stormwater from the operational areas of the TA-03-38 Carpenter’s Shop at Los Alamosmore » National Laboratory. Los Alamos National Laboratory (also referred to as LANL or the “Laboratory”) is owned by the Department of Energy (DOE), and is operated by Los Alamos National Security, LLC (LANS). Throughout this document, the term “facility” refers to the TA-03-38 Carpenter’s Shop and associated areas. The current permit expires at midnight on June 4, 2020.« less
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Burgin, Jillian Elizabeth
This Storm Water Pollution Prevention Plan (SWPPP) was developed in accordance with the provisions of the Clean Water Act (33 U.S.C. §§1251 et seq., as amended), and the Multi-Sector General Permit for Storm Water Discharges Associated with Industrial Activity (U.S. EPA, June 2015) issued by the U.S. Environmental Protection Agency (EPA) for the National Pollutant Discharge Elimination System (NPDES) and using the industry specific permit requirements for Sector O-Steam Electric Generating Facilities as a guide. This SWPPP applies to discharges of stormwater from the operational areas of the TA-03-22 Power and Steam Plant at Los Alamos National Laboratory. Los Alamosmore » National Laboratory (also referred to as LANL or the “Laboratory”) is owned by the Department of Energy (DOE), and is operated by Los Alamos National Security, LLC (LANS). Throughout this document, the term “facility” refers to the TA-03-22 Power and Steam Plant and associated areas. The current permit expires at midnight on June 4, 2020.« less
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Sandoval, Leonard Frank
This Storm Water Pollution Prevention Plan (SWPPP) was developed in accordance with the provisions of the Clean Water Act (33 U.S.C. §§1251 et seq., as amended), and the Multi-Sector General Permit for Storm Water Discharges Associated with Industrial Activity (U.S. EPA, June 2015) issued by the U.S. Environmental Protection Agency (EPA) for the National Pollutant Discharge Elimination System (NPDES) and using the industry specific permit requirements for Sector P-Land Transportation and Warehousing as a guide. This SWPPP applies to discharges of stormwater from the operational areas of the TA-60 Roads and Grounds and Associated Sigma Mesa Staging Area at Losmore » Alamos National Laboratory. Los Alamos National Laboratory (also referred to as LANL or the “Laboratory”) is owned by the Department of Energy (DOE), and is operated by Los Alamos National Security, LLC (LANS). Throughout this document, the term “facility” refers to the TA-60 Roads and Grounds and Associated Sigma Mesa Staging Area. The current permit expires at midnight on June 4, 2020.« less
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33 CFR 332.4 - Planning and documentation.
Code of Federal Regulations, 2010 CFR
2010-07-01
....g., typical channel cross-sections), watershed size, design discharge, and riparian area plantings... achieved to ensure the long-term sustainability of the resource, including long-term financing mechanisms...
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Plasma-chemical processes accompanying discharge in air excited by a microwave beam
NASA Astrophysics Data System (ADS)
Askar'ian, G. A.; Batanov, G. M.; Gritsinin, S. I.; Kossyi, I. A.; Kostinskii, A. Iu.
1990-11-01
Experimental results are presented on plasma-chemical processes of nitrogen oxidation and ozone production accompanying microwave discharge in dry air and in nitrogen-oxygen mixtures. The degree of nitrogen oxidation and the energy expenditure toward the formation of oxides as a function of discharge conditions are established. The experimental results can be explained by assuming oxidation reactions of electron-excited metastable nitrogen molecules by oxygen atoms. Low ozone concentrations in the discharge indicate a significant energy input into the gas.
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Geriatric hip fracture management: keys to providing a successful program.
Basu, N; Natour, M; Mounasamy, V; Kates, S L
2016-10-01
Hip fractures are a common event in older adults and are associated with significant morbidity, mortality and costs. This review examines the necessary elements required to implement a successful geriatric fracture program and identifies some of the barriers faced when implementing a successful program. The Geriatric Fracture Center (GFC) is a treatment model that standardizes the approach to the geriatric fracture patient. It is based on five principles: surgical fracture management; early operative intervention; medical co-management with geriatricians; patient-centered, standard order sets to employ best practices; and early discharge planning with a focus on early functional rehabilitation. Implementing a geriatric fracture program begins with an assessment of the hospital's data on hip fractures and standard care metrics such as length of stay, complications, time to surgery, readmission rates and costs. Business planning is essential along with the medical planning process. To successfully develop and implement such a program, strong physician leadership is necessary to articulate both a short- and long-term plan for implementation. Good communication is essential-those organizing a geriatric fracture program must be able to implement standardized plans of care working with all members of the healthcare team and must also be able to foster relationships both within the hospital and with other institutions in the community. Finally, a program of continual quality improvement must be undertaken to ensure that performance outcomes are improving patient care.
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Abrahamson, Kathleen; Myers, Jaclyn; Nazir, Arif
2017-06-01
The objective of this study was to evaluate the feasibility and impact of implementing a person-centered medical care model for post-acute care residents within a skilled nursing facility (SNF). A mixed-method (qualitative and quantitative) pilot evaluation. An 89-bed SNF located within a large midwestern city. Forty SNF post-acute patients admitted to the facility during a 6-month period were enrolled in the pilot evaluation. The patients were 75% women, 57% African American, and had an average age of 73. To meet inclusion criteria, patients must have been admitted to the facility for rehabilitation with a plan for community discharge, and be cognitively able to consent as indicated by a cognitive screening tool or assent to participation with family member consent. The person-centered medical care model included (1) biweekly interdisciplinary care plan meetings, scheduled at a time of patients' preference and held in the patient's room; (2) patient selection of health-related goals that guide team discussions; (3) use of lay-language that facilitated patient understanding; (4) team accountability to the patient for patient care preferences; and (5) monthly care-team meetings to exchange feedback regarding the team's performance and the model. Evaluation data included admission and discharge Patient Activation Measure surveys; admission and discharge Care of Chronic Conditions surveys; admission and biweekly modified Castle Satisfaction Surveys; admission and discharge Patient and Caregiver Engagement surveys; and semistructured interviews with a sample of staff, family members, and patients. A significant (P < .01) improvement was noted between admission and discharge on both the Care for Chronic Conditions and the Patient Activation Measure surveys. Patient satisfaction surveys trended toward higher ratings over time on most questions, with significant improvement in 2 questions addressing satisfaction with their medical provider. Interviews revealed a perception that the model encouraged an environment of respect and honesty in patient communications, and an overall positive experience. The challenges of scheduling and time were noted by respondents. Implementation of person-centered medical care within an SNF was feasible, yet required changing care processes to better address individual goals and facilitate communication among patients, providers, and SNF staff. Overall pilot results indicated that patients and staff members viewed the person-centered care experience positively. Further research is needed to examine long-term effects of the model on resident outcomes. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
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Quality improvement through implementation of discharge order reconciliation.
Lu, Yun; Clifford, Pamela; Bjorneby, Andreas; Thompson, Bruce; VanNorman, Samuel; Won, Katie; Larsen, Kevin
2013-05-01
A coordinated multidisciplinary process to reduce medication errors related to patient discharges to skilled-nursing facilities (SNFs) is described. After determining that medication errors were a frequent cause of readmission among patients discharged to SNFs, a medical center launched a two-phase quality-improvement project focused on cardiac and medical patients. Phase one of the project entailed a three-month failure modes and effects analysis of existing procedures discharge, followed by the development and pilot testing of a multidisciplinary, closed-loop workflow process involving staff and resident physicians, clinical nurse coordinators, and clinical pharmacists. During pilot testing of the new workflow process, the rate of discharge medication errors involving SNF patients was tracked, and data on medication-related readmissions in a designated intervention group (n = 87) and a control group of patients (n = 1893) discharged to SNFs via standard procedures during a nine-month period were collected, with the data stratified using severity of illness (SOI) classification. Analysis of the collected data indicated a cumulative 30-day medication-related readmission rate for study group patients in the minor, moderate, and major SOI categories of 5.4% (4 of 74 patients), compared with a rate of 9.5% (169 of 1780 patients) in the control group. In phase 2 of the project, the revised SNF discharge medication reconciliation procedure was implemented throughout the hospital; since hospitalwide implementation of the new workflow, the readmission rate for SNF patients has been maintained at about 6.7%. Implementing a standardized discharge order reconciliation process that includes pharmacists led to decreased readmission rates and improved care for patients discharged to SNFs.
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Yaseen, Zimri S.; Kopeykina, Irina; Gutkovich, Zinoviy; Bassirnia, Anahita; Cohen, Lisa J.; Galynker, Igor I.
2014-01-01
Background The greatly increased risk of suicide after psychiatric hospitalization is a critical problem, yet we are unable to identify individuals who would attempt suicide upon discharge. The Suicide Trigger Scale v.3 (STS-3), was designed to measure the construct of an affective ‘suicide trigger state’ hypothesized to precede a suicide attempt (SA). This study aims to test the predictive validity of the STS-3 for post-discharge SA on a high-risk psychiatric-inpatient sample. Methods The STS-3, and a psychological test battery measuring suicidality, mood, impulsivity, trauma history, and attachment style were administered to 161 adult psychiatric patients hospitalized following suicidal ideation (SI) or SA. Receiver Operator Characteristic and logistic regression analyses were used to assess prediction of SA in the 6-month period following discharge from hospitalization. Results STS-3 scores for the patients who made post-discharge SA followed a bimodal distribution skewed to high and low scores, thus a distance from median transform was applied to the scores. The transformed score was a significant predictor of post-discharge SA (AUC 0.731), and a subset of six STS-3 scale items was identified that produced improved prediction of post-discharge SA (AUC 0.814). Scores on C-SSRS and BSS were not predictive. Patients with ultra-high (90th percentile) STS-3 scores differed significantly from ultra-low (10th percentile) scorers on measures of affective intensity, depression, impulsiveness, abuse history, and attachment security. Conclusion STS-3 transformed scores at admission to the psychiatric hospital predict suicide attempts following discharge among the high-risk group of suicidal inpatients. Patients with high transformed scores appear to comprise two clinically distinct groups; an impulsive, affectively intense, fearfully attached group with high raw STS-3 scores and a low-impulsivity, low affect and low trauma-reporting group with low raw STS-3 scores. These groups may correspond to low-plan and planned suicide attempts, respectively, but this remains to be established by future research. PMID:24466229
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The Safe Yield and Climatic Variability: Implications for Groundwater Management.
Loáiciga, Hugo A
2017-05-01
Methods for calculating the safe yield are evaluated in this paper using a high-quality and long historical data set of groundwater recharge, discharge, extraction, and precipitation in a karst aquifer. Consideration is given to the role that climatic variability has on the determination of a climatically representative period with which to evaluate the safe yield. The methods employed to estimate the safe yield are consistent with its definition as a long-term average extraction rate that avoids adverse impacts on groundwater. The safe yield is a useful baseline for groundwater planning; yet, it is herein shown that it is not an operational rule that works well under all climatic conditions. This paper shows that due to the nature of dynamic groundwater processes it may be most appropriate to use an adaptive groundwater management strategy that links groundwater extraction rates to groundwater discharge rates, thus achieving a safe yield that represents an estimated long-term sustainable yield. An example of the calculation of the safe yield of the Edwards Aquifer (Texas) demonstrates that it is about one-half of the average annual recharge. © 2016, National Ground Water Association.
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NASA Astrophysics Data System (ADS)
Khan, A. A.; Mohiuddin, A. K. M.; Latif, M. A. A.
2018-01-01
This paper discusses the effect of aluminium oxide (Al203) addition to dielectric fluid during electrical discharge machining (EDM). Aluminium oxide was added to the dielectric used in the EDM process to improve its performance when machining the stainless steel AISI 304, while copper was used as the electrode. Effect of the concentration of Al203 (0.3 mg/L) in dielectric fluid was compared with EDM without any addition of Al203. Surface quality of stainless steel and the material removal rate were investigated. Design of the experiment (DOE) was used for the experimental plan. Statistical analysis was done using ANOVA and then appropriate model was designated. The experimental results show that with dispersing of aluminium oxide in dielectric fluid surface roughness was improved while the material removal rate (MRR) was increased to some extent. These indicate the improvement of EDM performance using aluminium oxide in dielectric fluid. It was also found that with increase in pulse on time both MRR and surface roughness increase sharply.
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Investigation of the Neutral Gas Pressure Effect on the Metal Resistive Bolometer
NASA Astrophysics Data System (ADS)
Zhang, D.; Giannone, L.; Grulke, O.; Piechotka, M.; Windisch, T.; Stark, A.; Klinger, T.
2008-03-01
The bolometer system planned for W7-X consists mainly of metal (Au) resistive detector arrays. All the detectors are exposed to neutral gas environment. The thin bolometer foil used for detecting the radiated power loss may be sensitive to the neutral gas pressure due to the strain gauge effect. Recently, a prototype of this kind of bolometer camera consisting of 12 channels has been installed on the cylindrical plasma device VINETA in order to investigate the influences of the neutral gas pressure on the bolometer signals. Experiments are carried out for Ar-discharges under different gas pressure conditions. It is found that the pressure effect of the neutral gas can make considerable contributions, thus inducing non-negligible errors of the results in most of the investigated cases. Using the VINETA plasmas (Ar, Te<10 eV, ne<10-19 m-3) as examples, the paper demonstrates and discusses how to minimize the neutral gas effects, especially in the data analysis process. The radiated power and the radiation intensity profile obtained in helicon discharges are presented.
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NASA Astrophysics Data System (ADS)
Fairley, J. P., Jr.; Oyarzún L, R.; Villegas, G.
2015-12-01
Early theories of fluid migration in unsaturated fractured rock hypothesized that matrix suction would dominate flow up to the point of matrix saturation. However, experiments in underground laboratories such as the ESF (Yucca Mountain, NV) have demonstrated that liquid water can migrate significant distances through fractures in an unsaturated porous medium, suggesting limited interaction between fractures and unsaturated matrix blocks and potentially rapid transmission of recharge to the sat- urated zone. Determining the conditions under which this rapid recharge may take place is an important factor in understanding deep percolation processes in arid areas with thick unsaturated zones. As part of an on-going, Fondecyt-funded project (award 11150587) to study mountain block hydrological processes in arid regions, we are plan- ning a series of in-situ fracture flow injection tests in the Cerro Brillador/Mina Escuela, an underground laboratory and teaching facility belonging to the Universidad la Serena, Chile. Planning for the tests is based on an analytical model and curve-matching method, originally developed to evaluate data from injection tests at Yucca Mountain (Fairley, J.P., 2010, WRR 46:W08542), that uses a known rate of liquid injection to a fracture (for example, from a packed-off section of borehole) and the observed rate of seepage discharging from the fracture to estimate effective fracture aperture, matrix sorptivity, fracture/matrix flow partitioning, and the wetted fracture/matrix interac- tion area between the injection and recovery points. We briefly review the analytical approach and its application to test planning and analysis, and describe the proposed tests and their goals.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Brandenberger, Jill M.; Metallo, David; Johnston, Robert K.
2012-09-01
This interim report summarizes the stormwater monitoring conducted for non-dry dock outfalls in both the confined industrial area and the residential areas of Naval Base Kitsap within the Puget Sound Naval Shipyard (referred to as the Shipyard). This includes the collection, analyses, and descriptive statistics for stormwater sampling conducted from November 2010 through April 2011. Seven stormwater basins within the Shipyard were sampled during at least three storm events to characterize non-dry dock stormwater discharges at selected stormwater drains located within the facility. This serves as the Phase I component of the project and Phase II is planned for themore » 2011-2012 storm season. These data will assist the Navy, USEPA, Ecology and other stakeholders in understanding the nature and condition of stormwater discharges from the Shipyard and inform the permitting process for new outfall discharges. The data from Phase I was compiled with current stormwater data available from the Shipyard, Sinclair/Dyes Inlet watershed, and Puget Sound in order to support technical investigations for the Draft NPDES permit. The permit would require storm event sampling at selected stormwater drains located within the Shipyard. However, the data must be considered on multiple scales to truly understand potential impairments to beneficial uses within Sinclair and Dyes Inlets.« less
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[Automatic adjustment control system for DC glow discharge plasma source].
Wan, Zhen-zhen; Wang, Yong-qing; Li, Xiao-jia; Wang, Hai-zhou; Shi, Ning
2011-03-01
There are three important parameters in the DC glow discharge process, the discharge current, discharge voltage and argon pressure in discharge source. These parameters influence each other during glow discharge process. This paper presents an automatic control system for DC glow discharge plasma source. This system collects and controls discharge voltage automatically by adjusting discharge source pressure while the discharge current is constant in the glow discharge process. The design concept, circuit principle and control program of this automatic control system are described. The accuracy is improved by this automatic control system with the method of reducing the complex operations and manual control errors. This system enhances the control accuracy of glow discharge voltage, and reduces the time to reach discharge voltage stability. The glow discharge voltage stability test results with automatic control system are provided as well, the accuracy with automatic control system is better than 1% FS which is improved from 4% FS by manual control. Time to reach discharge voltage stability has been shortened to within 30 s by automatic control from more than 90 s by manual control. Standard samples like middle-low alloy steel and tin bronze have been tested by this automatic control system. The concentration analysis precision has been significantly improved. The RSDs of all the test result are better than 3.5%. In middle-low alloy steel standard sample, the RSD range of concentration test result of Ti, Co and Mn elements is reduced from 3.0%-4.3% by manual control to 1.7%-2.4% by automatic control, and that for S and Mo is also reduced from 5.2%-5.9% to 3.3%-3.5%. In tin bronze standard sample, the RSD range of Sn, Zn and Al elements is reduced from 2.6%-4.4% to 1.0%-2.4%, and that for Si, Ni and Fe is reduced from 6.6%-13.9% to 2.6%-3.5%. The test data is also shown in this paper.
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Neufeld, Nathan J; Hoyer, Erik H; Cabahug, Philippines; González-Fernández, Marlís; Mehta, Megha; Walker, N Colbey; Powers, Richard L; Mayer, R Samuel
2013-01-01
Lean Six Sigma (LSS) process analysis can be used to increase completeness of discharge summary reports used as a critical communication tool when a patient transitions between levels of care. The authors used the LSS methodology as an intervention to improve systems process. Over the course of the project, 8 required elements were analyzed in the discharge paperwork. The authors analyzed the discharge paperwork of patients (42 patients preintervention and 143 patients postintervention) of a comprehensive integrated inpatient rehabilitation program (CIIRP). Prior to this LSS project, 61.8% of required discharge elements were present. The intervention improved the completeness to 94.2% of the required elements. The percentage of charts that were 100% complete increased from 11.9% to 67.8%. LSS is a well-established process improvement methodology that can be used to make significant improvements in complex health care workflow issues. Specifically, the completeness of discharge documentation required for transition of care to CIIRP can be improved.
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Comparison and alignment of an academic medical center's strategic goals with ASHP initiatives.
Engels, Melanie J; Chaffee, Bruce W; Clark, John S
2015-12-01
An academic medical center's strategic goals were compared and aligned with the 2015 ASHP Health-System Pharmacy Initiative and the Pharmacy Practice Model Initiative (PPMI). The department's pharmacy practice model steering committee identified potential solutions to narrow prioritized gaps using a modified nominal group technique and a multivoting dot technique. Five priority solutions were identified and assigned to work groups to develop business plans, which included admission medication history and reconciliation for high-risk patients and those with complex medication regimens, pharmacist provision of discharge counseling to high-risk patients and those with complex medication regimens, improved measurement and reporting of the impact of PPMI programs on patient outcomes, implementation of a departmentwide formalized peer review and evaluation process, and the greeting of every patient at some time during his or her visit by a pharmacy team member. Stakeholders evaluated the business plans based on feasibility, financial return on investment, and anticipated safety enhancements. The solution that received the highest priority ranking and was subsequently implemented was "improved measurement and reporting of the impact of PPMI programs on patient outcomes." A defined process was followed for identifying gaps among current practices at an academic medical center and the 2015 ASHP Health-System Pharmacy Initiative and the PPMI. A key priority to better document the impact of pharmacists on patient care was identified for our department by using a nominal group technique brainstorming process and a multivoting dot technique and creating standardized business plans for five potential priority projects. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.
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NASA Astrophysics Data System (ADS)
Shoyama, Taiji; Yoshioka, Yoshio
To improve the NO removal performance in silent discharge process, we investigated the influence of the physical parameters such as current density, channel radius and pulse duration of the one micro discharge under the constant reduced electric field strength. And influence of the micro discharges occurrence locations were also discussed. In order to analyze the NO removal process, we assumed that the pulse micro discharges occur repeatedly at the same location in static gas and that the chemical reactions induced by micro discharge forms many radicals, which react with pollutants and by-products. The conclusions we obtained are that lower current density, smaller discharge radius and shorter discharge duration improve NO removal efficiency. These results also mean that the lower discharge energy of the one micro discharge and the larger number of parallel micro discharges increase the NO removal performance. Therefore, to make the area of one micro discharge small is a desirable way to improve the NO removal performance. So we think that the glow like discharge might be more effective than the streamer like discharge mode. Next, using the two-dimensional model, which considered the influence of gas flow, we obtained a conclusion that the repeated micro discharges at different positions are very effective to increase the De-NOx performance. The reason is that the reaction of NO2+O→NO+O2 and ozone dissociation reactions are suppressed by the movement of the location of micro discharges.
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Szymanski, Benjamin R.; Karlin, Bradley E.; Katz, Ira R.
2013-01-01
Objectives. We assessed suicide rates up to 6 months following discharge from US Department of Veterans Affairs (VA) nursing homes. Methods. In VA Minimum Data Set (MDS) records, we identified 281 066 live discharges from the 137 VA nursing homes during fiscal years 2002 to 2008. We used MDS and administrative data to assess resident age, gender, behaviors, pain, and indications of psychoses, bipolar disorder, dementia, and depression. We identified vital status and suicide mortality within 6 months of discharge through National Death Index searches. Results. Suicide rates within 6 months of discharge were 88.0 per 100 000 person-years for men and 89.4 overall. Standardized mortality ratios relative to age- and gender-matched individuals in the VA patient population were 2.3 for men (95% confidence interval [CI] = 1.9, 2.8) and 2.4 overall (95% CI = 2.0, 2.9). In multivariable proportional hazards regression analyses, resident characteristics, diagnoses, behaviors, and pain were not significantly associated with suicide risk. Conclusions. Suicide risk was elevated following nursing home discharge. This underscores the importance of ongoing VA efforts to enhance discharge planning and timely postdischarge follow-up. PMID:24134359
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Medlock, Stephanie; Eslami, Saeid; Askari, Marjan; van Lieshout, Erik Jan; Dongelmans, Dave A; Abu-Hanna, Ameen
2011-11-01
The discharge letter is the primary means of communication at patient discharge, yet discharge letters are often not completed on time. A multifaceted intervention was performed to improve communication in patient hand-off from the intensive care unit (ICU) to the wards by improving the timeliness of discharge letters. A management directive was operationalised by a working group of ICU staff in a longitudinal before-after study. The intervention consisted of (a) changing policy to require a letter for use as a transfer note at the time of ICU discharge, (b) changing the assignment of responsibility to an automatic process, (c) leveraging positive peer pressure by making the list of patients in need of letters visible to colleagues and (d) provision of decision support, through automatic copying of important content from the patient record to the letter and email reminders if letters were not written on time. Statistical process control charts were used to monitor the longitudinal effect of the intervention. The intervention resulted in a 77.9% absolute improvement in the proportion of patients with a complete transfer note at the time of discharge, and an 85.2% absolute improvement in the number of discharge letters written. Statistical process control shows that the effect was sustained over time. A multifaceted intervention can be highly effective for improving discharge communication from the ICU.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Prevosto, L., E-mail: prevosto@waycom.com.ar; Mancinelli, B.; Chamorro, J. C.
2015-02-15
Low-frequency (100 Hz), intermediate-current (50 to 200 mA) glow discharges were experimentally investigated in atmospheric pressure air between blunt copper electrodes. Voltage–current characteristics and images of the discharge for different inter-electrode distances are reported. A cathode-fall voltage close to 360 V and a current density at the cathode surface of about 11 A/cm{sup 2}, both independent of the discharge current, were found. The visible emissive structure of the discharge resembles to that of a typical low-pressure glow, thus suggesting a glow-like electric field distribution in the discharge. A kinetic model for the discharge ionization processes is also presented with the aim of identifying themore » main physical processes ruling the discharge behavior. The numerical results indicate the presence of a non-equilibrium plasma with rather high gas temperature (above 4000 K) leading to the production of components such as NO, O, and N which are usually absent in low-current glows. Hence, the ionization by electron-impact is replaced by associative ionization, which is independent of the reduced electric field. This leads to a negative current-voltage characteristic curve, in spite of the glow-like features of the discharge. On the other hand, several estimations show that the discharge seems to be stabilized by heat conduction; being thermally stable due to its reduced size. All the quoted results indicate that although this discharge regime might be considered to be close to an arc, it is still a glow discharge as demonstrated by its overall properties, supported also by the presence of thermal non-equilibrium.« less
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29 CFR 1952.270 - Description of the plan.
Code of Federal Regulations, 2010 CFR
2010-07-01
..., within the Department of Labor and Industry, will then have the responsibility of inspecting workplaces... discharge or discrimination in terms or conditions of employments; notice to employees or their...
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Woods, Jeff
2010-01-01
Discharge and salinity were measured along the southwest and the southeast coast of Florida in Everglades National Park (ENP) within several rivers and creeks from 1996 through 2008. Data were collected using hydro-acoustic instruments and continuous water-quality monitors at fixed monitoring stations. Water flowed through ENP within two distinct drainage basins; specifically, Shark Slough and Taylor Slough. Discharge to the southwest coast through Shark Slough was substantially larger than discharge to the southeast coast through Taylor Slough. Correlation analysis between coastal flows and regulated flows at water-management structures upstream from ENP suggests rainfall has a larger impact on discharge through Shark Slough than releases from the S-12 water management structures. In contrast, flow releases from water management structures upstream from Taylor Slough appear to be more closely related to discharge along the southeast coast. Salinity varied within a wide range (0 to 50 parts per thousand) along both coastlines. Periods of hypersalinity were greater along the southeast coast due to shallow compartmentalized basins within Florida Bay, which restrict circulation.
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NASA Astrophysics Data System (ADS)
Fan, Tingting; Yuan, Ping; Wang, Xuejuan; Cen, Jianyong; Chang, Xuan; Zhao, Yanyan
2017-09-01
The spectra of two negative cloud-to-ground lightning discharge processes with multi-return strokes are obtained by a slit-less high-speed spectrograph, which the temporal resolution is 110 μs. Combined with the synchronous electrical observation data and theoretical calculation, the physical characteristics during return strokes process are analysed. A positive correlation between discharge current and intensity of ionic lines in the spectra is verified, and based on this feature, the current evolution characteristics during four return strokes are investigated. The results show that the time from peak current to the half-peak value estimated by multi point-fitting is about 101 μs-139 μs. The Joule heat in per unit length of four return strokes channel is in the order of 105J/m-106 J/m. The radius of arc discharge channel is positively related to the discharge current, and the more intense the current is, the greater the radius of channel is. Furthermore, the evolution for radius of arc core channel in the process of return stroke is consistent with the change trend of discharge current after the peak value. Compared with the decay of the current, the temperature decreases more slowly.
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Land use change impacts on discharge analysis using SWAT model at Ciherang Pondok DAM catchment area
NASA Astrophysics Data System (ADS)
Utamahadi, M. A.; Pandjaitan, N. H.; Rau, M. I.
2018-05-01
The prompt increase of population influenced the requirement for new regions to fulfill people’s primary needs. Its increased land use change and caused many impacts on the environment, including watersheds as well. Ciherang Pondok DAM catchment area is part of Cisadane watershed and was selected as the research area. This research aimed to analyse the water supply and water discharge change caused by the Urban Planning (RTRW) in 2020. The analysis was conducted using soil and water assessment tools (SWAT) model. Stages of this research were catchment area delineation, HRU identification, calibration and validation of models, and prediction of discharge and water demand. The result showed that RTRW of 2020 increased the maximum discharge of 1.6 m3/s and decreased the minimum discharge of 0.01 m3/s, hence the maximum and minimum discharge ratio increased 0.26% from 2016. Output discharge in 2020 at Ciherang Pondok Dam Catchment Area was classified as well, with discharge of 6.72 – 126.2 m3/s, and could fulfil water demand. For the best result, it is better to use climate data from weather stations inside the study area and it is required an improvement in data archiving system.
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Increasing the utility of the Functional Assessment for Burns Score: Not just for major burns.
Smailes, Sarah T; Engelsman, Kayleen; Rodgers, Louise; Upson, Clara
2016-02-01
The Functional Assessment for Burns (FAB) score is established as an objective measure of physical function that predicts discharge outcome in adult patients with major burn. However, its validity in patients with minor and moderate burn is unknown. This is a multi-centre evaluation of the predictive validity of the FAB score for discharge outcome in adult inpatients with minor and moderate burns. FAB assessments were undertaken within 48 h of admission to (FAB 1), and within 48 h of discharge (FAB 2) from burn wards in 115 patients. Median age was 45 years and median burn size 4%. There were significant improvements in the patients' FAB scores (p<0.0001), 98 patients were discharged home (no social care) and 17 patients discharged to further inpatient rehabilitation or home with social care. FAB 1 score (≤ 14) is strongly associated with discharge to inpatient rehabilitation or home with social care (p=0.0001) and as such can be used to facilitate early discharge planning. FAB 2 (≤ 30) independently predicts discharge outcome to inpatient rehabilitation or home with social care (p<0.0001), increasing its utility to patients with minor and moderate burns. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.
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Neutral particle dynamics in a high-power RF source
DOE Office of Scientific and Technical Information (OSTI.GOV)
Todorov, D., E-mail: dimitar-tdrv@phys.uni-sofia.bg; Paunska, Ts.; Shivarova, A.
2015-04-08
Previous studies on the spatial discharge structure in the SPIDER source of negative hydrogen/deuterium ions carried out at low applied power are extended towards description of the discharge maintenance under the conditions of the actual rf power deposition of 100 kW planned for a single driver of the source. In addition to the expected higher electron density, the results show strong increase of the electron temperature and of the temperatures of the neutral species (hydrogen atoms and molecules). In the discussions, not only the spatial distribution of the plasma parameters but also that of the fluxes in the discharge (particlemore » and energy fluxes) is involved. The obtained results come in confirmation of basic concepts for low-pressure discharge maintenance: (i) mutually related electron density and temperature as a display of the generalized Schottky condition, (ii) discharge behavior governed by the fluxes, i.e. strong nonlocality in the discharge, and (iii) a non-ambipolarity in the discharge regime, which originates from shifted maxima of the electron density and temperature and shows evidence in a vortex electron flux and in a dc current in a rf discharge, the latter resulting from a shift in the positions of the maxima of the electron density and plasma potential.« less
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Deployment of lean six sigma in care coordination: an improved discharge process.
Breslin, Susan Ellen; Hamilton, Karen Marie; Paynter, Jacquelyn
2014-01-01
This article presents a quality improvement project to reduce readmissions in the Medicare population related to heart failure, acute myocardial infarction, and pneumonia. The article describes a systematic approach to the discharge process aimed at improving transitions of care from hospital to post-acute care, utilizing Lean Six Sigma methodology. Inpatient acute care hospital. A coordinated discharge process, which includes postdischarge follow-up, can reduce avoidable readmissions. Implications for The quality improvement project demonstrated the significant role case management plays in preventing costly readmissions and improving outcomes for patients through better transitions of care from the hospital to the community. By utilizing Lean Six Sigma methodology, hospitals can focus on eliminating waste in their current processes and build more sustainable improvements to deliver a safe, quality, discharge process for their patients. Case managers are leading this effort to improve care transitions and assure a smoother transition into the community postdischarge..
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Plasma Diagnostics For The Investigation of Silane Based Glow Discharge Deposition Processes
NASA Astrophysics Data System (ADS)
Mataras, Dimitrios
2001-10-01
In this work is presented the study of microcrystalline silicon PECVD process through highly diluted silane in hydrogen discharges. The investigation is performed by applying different non intrusive plasma diagnostics (electrical, optical, mass spectrometric and laser interferometric measurements). Each of these measurements is related to different plasma sub-processes (gas physics, plasma chemistry and plasma surface interaction) and compose a complete set, proper for the investigation of the effect of external discharge parameters on the deposition processes. In the specific case these plasma diagnostics are applied for prospecting the optimal experimental conditions from the ic-Si:H deposition rate point of view. Namely, the main characteristics of the effect of frequency, discharge geometry, power consumption and total gas pressure on the deposition process are presented successively. Special attention is given to the study of the frequency effect (13.56 MHz 50 MHz) indicating that the correct way to compare results of different driving frequency discharges is by maintaining constant the total power dissipation in the discharge. The important role of frequency in the achievement of high deposition rates and on the optimization of all other parameters is underlined. Finally, the proper combination of experimental conditions that result from the optimal choice of each of the above-mentioned discharge parameters and lead to high microcrystalline silicon deposition rates (7.5 Å/sec) is presented. The increase of silane dissociation rate towards neutral radicals (frequency effect), the contribution of highly sticking to the surface radicals (discharge geometry optimum) and the controlled production of higher radicals through secondary gas phase reactions (total gas pressure), are presented as prerequisites for the achievement of high deposition rates.
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Base Realignment and Closure (BRAC) Cleanup Plan, Ford Ord, Monterey, California
1994-03-25
2,036.39 1 10 Maria Antonia Field 563.19 1 11 Stephen Joseph Field 1,018.02 1 April 1944 Key: I = Undocumented o45.sj Fort Ord, California - 25 March 1994...geophysical anomalies Further investigation of canal containoc .etroleum hydrocarbons discharge area which depending on and vanous organic compounds...detected at various areas. Concentration below TPH cleanup standard. Canal discharge area soil contained Pb, Sb, and Cr at concentration of concern. For
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Why does Japan use the probability method to set design flood?
NASA Astrophysics Data System (ADS)
Nakamura, S.; Oki, T.
2015-12-01
Design flood is hypothetical flood to make flood prevention plan. In Japan, a probability method based on precipitation data is used to define the scale of design flood: Tone River, the biggest river in Japan, is 1 in 200 years, Shinano River is 1 in 150 years, and so on. It is one of important socio-hydrological issue how to set reasonable and acceptable design flood in a changing world. The method to set design flood vary among countries. Although the probability method is also used in Netherland, but the base data is water level or discharge data and the probability is 1 in 1250 years (in fresh water section). On the other side, USA and China apply the maximum flood method which set the design flood based on the historical or probable maximum flood. This cases can leads a question: "what is the reason why the method vary among countries?" or "why does Japan use the probability method?" The purpose of this study is to clarify the historical process which the probability method was developed in Japan based on the literature. In the late 19the century, the concept of "discharge" and modern river engineering were imported by Dutch engineers, and modern flood prevention plans were developed in Japan. In these plans, the design floods were set based on the historical maximum method. Although the historical maximum method had been used until World War 2, however, the method was changed to the probability method after the war because of limitations of historical maximum method under the specific socio-economic situations: (1) the budget limitation due to the war and the GHQ occupation, (2) the historical floods: Makurazaki typhoon in 1945, Kathleen typhoon in 1947, Ione typhoon in 1948, and so on, attacked Japan and broke the record of historical maximum discharge in main rivers and the flood disasters made the flood prevention projects difficult to complete. Then, Japanese hydrologists imported the hydrological probability statistics from the West to take account of socio-economic situation in design flood, and they applied to Japanese rivers in 1958. The probability method was applied Japan to adapt the specific socio-economic and natural situation during the confusion after the war.
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NASA Astrophysics Data System (ADS)
Rautio, Anne B.; Korkka-Niemi, Kirsti I.; Salonen, Veli-Pekka
2018-02-01
Mining development sites occasionally host complicated aquifer systems with notable connections to natural surface water (SW) bodies. A low-altitude thermal infrared (TIR) imaging survey was conducted to identify hydraulic connections between aquifers and rivers and to map spatial surface temperature patterns along the subarctic rivers in the proximity of the Hannukainen mining development area, northern Finland. In addition to TIR data, stable isotopic compositions ( δ 18O, δD) and dissolved silica concentrations were used as tracers to verify the observed groundwater (GW) discharge into the river system. Based on the TIR survey, notable GW discharge into the main river channel and its tributaries (61 km altogether) was observed and over 500 GW discharge sites were located. On the basis of the survey, the longitudinal temperature patterns of the studied rivers were found to be highly variable. Hydrological and hydrogeological information is crucial in planning and siting essential mining operations, such as tailing areas, in order to prevent any undesirable environmental impacts. The observed notable GW discharge was taken into consideration in the planning of the Hannukainen mining development area. The results of this study support the use of TIR imagery in GW-SW interaction and environmental studies in extensive and remote areas with special concerns for water-related issues but lacking the baseline research.
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The Empirical Relationship between Mining Industry Development and Environmental Pollution in China
Li, Gerui; Lei, Yalin; Ge, Jianping; Wu, Sanmang
2017-01-01
This study uses a vector autoregression (VAR) model to analyze changes in pollutants among different mining industries and related policy in China from 2001 to 2014. The results show that: (1) because the pertinence of standards for mining waste water and waste gas emissions are not strong and because the maximum permissible discharge pollutant concentrations in these standards are too high, ammonia nitrogen and industrial sulfur dioxide discharges increased in most mining industries; (2) chemical oxygen demand was taken as an indicator of sewage treatment in environmental protection plans; hence, the chemical oxygen demand discharge decreased in all mining industries; (3) tax reduction policies, which are only implemented in coal mining and washing and extraction of petroleum and natural gas, decreased the industrial solid waste discharge in these two mining industries. PMID:28257126
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Microelectrode-assisted low-voltage atmospheric pressure glow discharge in air
NASA Astrophysics Data System (ADS)
Liu, Wenzheng; Zhao, Shuai; Niu, Jiangqi; Chai, Maolin
2017-09-01
During the process of discharge, appropriately changing the paths corresponding to electric field lines and the field strength distribution along these paths, as well as increasing the number of initial electrons, can effectively enhance the uniformity of discharge and inhibit the formation of filamentary discharge. A method is proposed that uses a microelectrode to initiate the macroscopic discharge phenomenon. An asymmetric structure was designed comprising a single electrode of carbon fiber; this electrode structure is of helical-contact type. Benefitting from the special electric field distribution and the microdischarge process, a three-dimensional atmospheric pressure glow discharge was achieved in air, characterized by low discharge voltage, low energy consumption, good diffusion performance, and less ozone generation. The plasma studied is uniform and stable with good diffusion characteristics and low levels of contaminants and hence has potential applications in the field of air purification.
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Investigation of operating parameters on CO2 splitting by dielectric barrier discharge plasma
NASA Astrophysics Data System (ADS)
Pan, CHEN; Jun, SHEN; Tangchun, RAN; Tao, YANG; Yongxiang, YIN
2017-12-01
Experiments of CO2 splitting by dielectric barrier discharge (DBD) plasma were carried out, and the influence of CO2 flow rate, plasma power, discharge voltage, discharge frequency on CO2 conversion and process energy efficiency were investigated. It was shown that the absolute quantity of CO2 decomposed was only proportional to the amount of conductive electrons across the discharge gap, and the electron amount was proportional to the discharge power; the energy efficiency of CO2 conversion was almost a constant at a lower level, which was limited by CO2 inherent discharge character that determined a constant gap electric field strength. This was the main reason why CO2 conversion rate decreased as the CO2 flow rate increase and process energy efficiency was decreased a little as applied frequency increased. Therefore, one can improve the CO2 conversion by less feed flow rate or larger discharge power in DBD plasma, but the energy efficiency is difficult to improve.
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Comparison between Trichel pulse in negative corona and self-pulsing in other configurations
NASA Astrophysics Data System (ADS)
Xia, Qing; Zhang, Yu; He, Feng; Qin, Yu; Jiang, Zhaorui; Ouyang, Jiting
2018-02-01
We present here a comparison study on self-pulsing phenomena in negative corona, hollow cathode discharges (HCD) and parallel-plate discharge in air. The voltage-current (V-I) curve, the waveforms of self-pulsed currents, and the time-resolved images of the pulsed discharge are measured under various operating conditions. It is experimentally evidenced that the Trichel pulse in a negative corona and the self-pulsing in HCD and/or parallel-plate discharge have similar features as well as spatial-temporal developing process. It is suggested that they should have a similar mechanism that the pulsing reflects the mode transition of discharge between the low-current Townsend and the high-current normal glow. The pulse rising corresponds to the breakdown and formation of temporal glow discharge in a background of low-current Townsend discharge, while the decay edge relates to the transition back to Townsend discharge. The pulse interval is the re-building process of the space charge layer of high density to ensure the glow breakdown.
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Dean, Shannon M; Gilmore-Bykovskyi, Andrea; Buchanan, Joel; Ehlenfeldt, Brad; Kind, Amy JH
2016-01-01
Background The hospital discharge summary is the primary method used to communicate a patient's plan of care to the next provider(s). Despite the existence of regulations and guidelines outlining the optimal content for the discharge summary and its importance in facilitating an effective transition to post-hospital care, incomplete discharge summaries remain a common problem that may contribute to poor post-hospital outcomes. Electronic health records (EHRs) are regularly used as a platform upon which standardization of content and format can be implemented. Objective We describe here the design and hospital-wide implementation of a standardized discharge summary using an EHR. Methods We employed the evidence-based Replicating Effective Programs implementation strategy to guide the development and implementation during this large-scale project. Results Within 18 months, 90% of all hospital discharge summaries were written using the standardized format. Hospital providers found the template helpful and easy to use, and recipient providers perceived an improvement in the quality of discharge summaries compared to those sent from our hospital previously. Conclusions Discharge summaries can be standardized and implemented hospital-wide with both author and recipient provider satisfaction, especially if evidence-based implementation strategies are employed. The use of EHR tools to guide clinicians in writing comprehensive discharge summaries holds promise in improving the existing deficits in communication at transitions of care. PMID:28334559
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Kim, Seung Ju; Han, Kyu-Tae; Lee, Hyo Jung; Kwon, Jeoung A; Park, Eun-Cheol
2016-12-01
Improving quality of care is a major healthcare goal; however, the relationship between limited resources and appropriate healthcare distribution has always been problematic. Planning for resource shortages is important for improving healthcare quality. The aim of our study was to evaluate the effects of manpower planning on improvements in quality of care by estimating the effects of medical staffing on readmission within 30 days after discharge. We conducted an observational study using 2011-14 National Health Claim data from 692 hospitals and 633 461 admissions. The database included information on uterine (including adnexa) procedures (195 270 cases) and cesarean deliveries (438 191 cases). The outcome variable was readmission within 30 days after discharge. A generalized estimating equation model was used to evaluate associations between readmission and medical staffing. The number of doctors and the proportion of registered nurses (RNs) were significantly associated with a lower risk of readmission within 30 days (proportion of RNs, Relative Risk (RR): 0.97, P values: 0.0025; number of doctors, RR: 0.96, P values: <0.0001). The number of nurses (RNs + licensed practical nurses) was not associated with readmission within 30 days (RR: 1.01, P values: <0.0001). Our results suggested that higher numbers of doctors and higher proportions of RNs were positively correlated with a lower risk of readmission within 30 days. Human resource planning to solve manpower shortages should carefully consider the qualitative aspects of clinical care and include long-term planning. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
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75 FR 39502 - Privacy Act of 1974; System of Records
Federal Register 2010, 2011, 2012, 2013, 2014
2010-07-09
..., eyeglasses, hearing aids, prosthetic devices, diet/special nourishment plans, blood donor records, charges... years; patient accountability (admission/discharge) 5 years; blood donor 5 years or when no longer...
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42 CFR 484.55 - Condition of participation: Comprehensive assessment of patients.
Code of Federal Regulations, 2012 CFR
2012-10-01
..., rehabilitative, social, and discharge planning needs. For Medicare beneficiaries, the HHA must verify the patient..., including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug...
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42 CFR 484.55 - Condition of participation: Comprehensive assessment of patients.
Code of Federal Regulations, 2013 CFR
2013-10-01
..., rehabilitative, social, and discharge planning needs. For Medicare beneficiaries, the HHA must verify the patient..., including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug...
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42 CFR 484.55 - Condition of participation: Comprehensive assessment of patients.
Code of Federal Regulations, 2010 CFR
2010-10-01
..., rehabilitative, social, and discharge planning needs. For Medicare beneficiaries, the HHA must verify the patient..., including ineffective drug therapy, significant side effects, significant drug interactions, duplicate drug...
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40 Code of Federal Regulations (CFR) 300.900 - 920
Data requirements for this subpart J of the National Contingency Plan Product Schedule. Products include dispersants, bioremediation agents, or any other chemical authorized to remove or control oil discharges.
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Heart valve surgery - discharge
... weeks, or when you can easily climb 2 flights of stairs or walk a half-mile (800 ... vomiting or diarrhea You become pregnant or are planning to become pregnant Alternative Names Aortic valve replacement - ...
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Tooth, Leigh; McKenna, Kryss; Goh, Kong; Varghese, Paul
2005-07-01
Although implemented in 1998, no research has examined how well the Australian National Subacute and Nonacute Patient (AN-SNAP) Casemix Classification predicts length of stay (LOS), discharge destination, and functional improvement in public hospital stroke rehabilitation units in Australia. 406 consecutive admissions to 3 stroke rehabilitation units in Queensland, Australia were studied. Sociodemographic, clinical, and functional data were collected. General linear modeling and logistic regression were used to assess the ability of AN-SNAP to predict outcomes. AN-SNAP significantly predicted each outcome. There were clear relationships between the outcomes of longer LOS, poorer functional improvement and discharge into care, and the AN-SNAP classes that reflected poorer functional ability and older age. Other predictors included living situation, acute LOS, comorbidity, and stroke type. AN-SNAP is a consistent predictor of LOS, functional change and discharge destination, and has utility in assisting clinicians to set rehabilitation goals and plan discharge.
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Maingi, R.; Osborne, T. H.; Bell, M. G.; ...
2014-11-04
In this paper, the effects of a pre-discharge lithium evaporation variation on highly shaped discharges in the National Spherical Torus Experiment (NSTX) are documented. Lithium wall conditioning (‘dose’) was routinely applied onto graphite plasma facing components between discharges in NSTX, partly to reduce recycling. Reduced D α emission from the lower and upper divertor and center stack was observed, as well as reduced midplane neutral pressure; the magnitude of reduction increased with the pre-discharge lithium dose. Improved energy confinement, both raw τ E and H-factor normalized to scalings, with increasing lithium dose was also observed. At the highest doses, wemore » also observed elimination of edge-localized modes. The midplane edge plasma profiles were dramatically altered, comparable to lithium dose scans at lower shaping, where the strike point was farther from the lithium deposition centroid. As a result, this indicates that the benefits of lithium conditioning should apply to the highly shaped plasmas planned in NSTX-U.« less
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O'Donnell, Martin J; Fang, Jiming; D'Uva, Cami; Saposnik, Gustavo; Gould, Linda; McGrath, Emer; Kapral, Moira K
2012-11-12
We sought to develop and validate a simple clinical prediction rule for death and severe disability after acute ischemic stroke that can be used by general clinicians at the time of hospital admission. We analyzed data from a registry of 9847 patients (4943 in the derivation cohort and 4904 in the validation cohort) hospitalized with acute ischemic stroke and included in the Registry of the Canadian Stroke Network (July 1, 2003, to March 31, 2008; 11 regional stroke centers in Ontario, Canada). Outcome measures were 30-day and 1-year mortality and a modified Rankin score of 5 to 6 at discharge. Overall 30-day mortality was 11.5% (derivation cohort) and 13.5% (validation cohort). In the final multivariate model, we included 9 clinical variables that could be categorized as preadmission comorbidities (5 points for preadmission dependence [1.5], cancer [1.5], congestive heart failure [1.0], and atrial fibrillation [1.0]), level of consciousness (5 points for reduced level of consciousness), age (10 points, 1 point/decade), and neurologic focal deficit (5 points for significant/total weakness of the leg [2], weakness of the arm [2], and aphasia or neglect [1]). Maximum score is 25. In the validation cohort, the PLAN score (derived from preadmission comorbidities, level of consciousness, age, and neurologic deficit) predicted 30-day mortality (C statistic, 0.87), death or severe dependence at discharge (0.88), and 1-year mortality (0.84). The PLAN score also predicted favorable outcome (modified Rankin score, 0-2) at discharge (C statistic, 0.80). The PLAN clinical prediction rule identifies patients who will have a poor outcome after hospitalization for acute ischemic stroke. The score comprises clinical data available at the time of admission and may be determined by nonspecialist clinicians. Additional studies to independently validate the PLAN rule in different populations and settings are required.
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eFisioTrack: a telerehabilitation environment based on motion recognition using accelerometry.
Ruiz-Fernandez, Daniel; Marín-Alonso, Oscar; Soriano-Paya, Antonio; García-Pérez, Joaquin D
2014-01-01
The growing demand for physical rehabilitation processes can result in the rising of costs and waiting lists, becoming a threat to healthcare services' sustainability. Telerehabilitation solutions can help in this issue by discharging patients from points of care while improving their adherence to treatment. Sensing devices are used to collect data so that the physiotherapists can monitor and evaluate the patients' activity in the scheduled sessions. This paper presents a software platform that aims to meet the needs of the rehabilitation experts and the patients along a physical rehabilitation plan, allowing its use in outpatient scenarios. It is meant to be low-cost and easy-to-use, improving patients and experts experience. We show the satisfactory results already obtained from its use, in terms of the accuracy evaluating the exercises, and the degree of users' acceptance. We conclude that this platform is suitable and technically feasible to carry out rehabilitation plans outside the point of care.
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40 CFR 63.543 - Standards for process sources.
Code of Federal Regulations, 2010 CFR
2010-07-01
.... (a) No owner or operator of a secondary lead smelter shall discharge or cause to be discharged into the atmosphere from any existing, new, or reconstructed blast, reverberatory, rotary, or electric... discharge or cause to be discharged into the atmosphere from any existing, new, or reconstructed blast...
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Institutional impediments to using alternative water sources in thermoelectric power plants.
DOE Office of Scientific and Technical Information (OSTI.GOV)
Elcock, D.
2011-08-03
This report was funded by the U.S. Department of Energy's (DOE's) National Energy Technology Laboratory (NETL) Existing Plants Research Program, which has an energy-water research effort that focuses on water use at power plants. This study complements the Existing Plants Research Program's overall research effort by evaluating water issues that could impact power plants. Obtaining adequate water supplies for cooling and other operations at a reasonable cost is a key factor in siting new and maintaining existing thermoelectric power plant operations. One way to reduce freshwater consumption is to use alternative water sources such as reclaimed (or recycled) water, minemore » pool water, and other nontraditional sources. The use of these alternative sources can pose institutional challenges that can cause schedule delays, increase costs, or even require plants to abandon their plans to use alternative sources. This report identifies and describes a variety of institutional challenges experienced by power plant owners and operators across the country, and for many of these challenges it identifies potential mitigating approaches. The information comes from publically available sources and from conversations with power plant owners/operators familiar with using alternative sources. Institutional challenges identified in this investigation include, but are not limited to, the following: (1) Institutional actions and decisions that are beyond the control of the power plant. Such actions can include changes in local administrative policies that can affect the use of reclaimed water, inaccurate growth projections regarding the amount of water that will be available when needed, and agency workloads and other priorities that can cause delays in the permitting and approval processes. (2) Developing, cultivating, and maintaining institutional relationships with the purveyor(s) of the alternative water source, typically a municipal wastewater treatment plant (WWTP), and with the local political organizations that can influence decisions regarding the use of the alternative source. Often a plan to use reclaimed water will work only if local politics and power plant goals converge. Even then, lengthy negotiations are often needed for the plans to come to fruition. (3) Regulatory requirements for planning and developing associated infrastructure such as pipelines, storage facilities, and back-up supplies that can require numerous approvals, permits, and public participation, all of which can create delays and increased costs. (4) Permitting requirements that may be difficult to meet, such as load-based discharge limits for wastewater or air emissions limitations for particulate matter (which will be in the mist of cooling towers that use reclaimed water high in dissolved solids). (5) Finding discharge options for cooling tower blowdown of reclaimed water that are acceptable to permitting authorities. Constituents in this wastewater can limit options for discharge. For example, discharge to rivers requires National Pollutant Discharge Elimination System (NPDES) permits whose limits may be difficult to meet, and underground injection can be limited because many potential injection sites have already been claimed for disposal of produced waters from oil and gas wells or waters associated with gas shale extraction. (6) Potential liabilities associated with using alternative sources. A power plant can be liable for damages associated with leaks from reclaimed water conveyance systems or storage areas, or with mine water that has been contaminated by unscrupulous drillers that is subsequently discharged by the power plant. (7) Community concerns that include, but are not limited to, increased saltwater drift on farmers fields; the possibility that the reclaimed water will contaminate local drinking water aquifers; determining the 'best' use of WWTP effluent; and potential health concerns associated with emissions from the cooling towers that use recycled water. (8) Interveners that raise public concerns about the potential for emissions of emerging pollutants of concern to cause health or environmental problems. Mitigating solutions range from proactive communications with the local communities (which can be implemented by the power plants) to technical solutions, such as developing means to reduce the concentrations of total dissolved solids (TDS) and other contaminants in cooling water to maintain plant efficiency and while meeting discharge limits. These kinds of solutions may be appropriate for DOE research and development (R&D) funding.« less
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Kraloua, B.; Hennad, A.
The aim of this paper is to determine electric and physical properties by 2D modelling of glow discharge low pressure in continuous regime maintained by term constant source. This electric discharge is confined in reactor plan-parallel geometry. This reactor is filled by Argon monatomic gas. Our continuum model the order two is composed the first three moments the Boltzmann's equations coupled with Poisson's equation by self consistent method. These transport equations are discretized by the finite volumes method. The equations system is resolved by a new technique, it is about the N-BEE explicit scheme using the time splitting method.
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Post discharge issues identified by a call-back program: identifying improvement opportunities.
Ojeda, Patricia I; Kara, Areeba
2017-12-01
The period following discharge from the hospital is one of heightened vulnerability. Discharge instructions serve as a guide during this transition. Yet, clinicians receive little feedback on the quality of this document that ties into the patients' experience. We reviewed the issues voiced by discharged patients via a call-back program and compared them to the discharge instructions they had received. At our institution, patients receive an automated call forty-eight hours following discharge inquiring about progress. If indicated by the response to the call, they are directed to a nurse who assists with problem solving. We reviewed the nursing documentation of these encounters for a period of nine months. The issues voiced were grouped into five categories: communication, medications, durable medical equipment/therapies, follow up and new or ongoing symptoms. The discharge instructions given to each patient were reviewed. We retrieved data on the number of discharges from each specialty from the hospital over the same period. A total of 592 patients voiced 685 issues. The numbers of patients discharged from medical or surgical services identified as having issues via the call-back line paralleled the proportions discharged from medical and surgical services from the hospital during the same period. Nearly a quarter of the issues discussed had been addressed in the discharge instructions. The most common category of issues was related to communication deficits including missing or incomplete information which made it difficult for the patient to enact or understand the plan of care. Medication prescription related issues were the next most common. Resource barriers and questions surrounding medications were often unaddressed. Post discharge issues affect patients discharged from all services equally. Data from call back programs may provide actionable targets for improvement, identify the inpatient team's 'blind spots' and be used to provide feedback to clinicians.
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Kantor, Molly A; Evans, Kambria H; Shieh, Lisa
2015-03-01
Achieving safe transitions of care at hospital discharge requires accurate and timely communication. Both the presence of and follow-up plan for diagnostic studies that are pending at hospital discharge are expected to be accurately conveyed during these transitions, but this remains a challenge. To determine the prevalence, characteristics, and communication of studies pending at hospital discharge before and after the implementation of an electronic medical record (EMR) tool that automatically generates a list of pending studies. Pre-post analysis. 260 consecutive patients discharged from inpatient general medicine services from July to August 2013. Development of an EMR-based tool that automatically generates a list of studies pending at discharge. The main outcomes were prevalence and characteristics of pending studies and communication of studies pending at hospital discharge. We also surveyed internal medicine house staff on their attitudes about communication of pending studies. Pre-intervention, 70% of patients had at least one pending study at discharge, but only 18% of these were communicated in the discharge summary. Most studies were microbiology cultures (68%), laboratory studies (16%), or microbiology serologies (10%). The majority of study results were ultimately normal (83%), but 9% were newly abnormal. Post-intervention, communication of studies pending increased to 43% (p < 0.001). Most patients are discharged from the hospital with pending studies, but in usual practice, the presence of these studies has rarely been communicated to outpatient providers in the discharge summary. Communication significantly increased with the implementation of an EMR-based tool that automatically generated a list of pending studies from the EMR and allowed users to import this list into the discharge summary. This is the first study to our knowledge to introduce an automated EMR-based tool to communicate pending studies.
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Integrated Stirling Convertor and Hall Thruster Test Conducted
NASA Technical Reports Server (NTRS)
Mason, Lee S.
2002-01-01
An important aspect of implementing Stirling Radioisotope Generators on future NASA missions is the integration of the generator and controller with potential spacecraft loads. Some recent studies have indicated that the combination of Stirling Radioisotope Generators and electric propulsion devices offer significant trip time and payload fraction benefits for deep space missions. A test was devised to begin to understand the interactions between Stirling generators and electric thrusters. An electrically heated RG- 350 (350-W output) Stirling convertor, designed and built by Stirling Technology Company of Kennewick, Washington, under a NASA Small Business Innovation Research agreement, was coupled to a 300-W SPT-50 Hall-effect thruster built for NASA by the Moscow Aviation Institute (RIAME). The RG-350 and the SPT-50 shown, were installed in adjacent vacuum chamber ports at NASA Glenn Research Center's Electric Propulsion Laboratory, Vacuum Facility 8. The Stirling electrical controller interfaced directly with the Hall thruster power-processing unit, both of which were located outside of the vacuum chamber. The power-processing unit accepted the 48 Vdc output from the Stirling controller and distributed the power to all the loads of the SPT-50, including the magnets, keeper, heater, and discharge. On February 28, 2001, the Glenn test team successfully operated the Hall-effect thruster with the Stirling convertor. This is the world's first known test of a dynamic power source with electric propulsion. The RG-350 successfully managed the transition from the purely resistive load bank within the Stirling controller to the highly capacitive power-processing unit load. At the time of the demonstration, the Stirling convertor was operating at a hot temperature of 530 C and a cold temperature of -6 C. The linear alternator was producing approximately 250 W at 109 Vac, while the power-processing unit was drawing 175 W at 48 Vdc. The majority of power was delivered to the Hall thruster discharge circuit operating at 115 Vdc and 0.9 A. Testing planned for late 2001 will examine the possibility of directly driving the Hall thruster discharge circuit using rectified and filtered output from the Stirling alternator.
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Brennan, Gerard P; Fritz, Julie M; Houck, L T C Kevin M; Hunter, Stephen J
2015-05-01
Research examining care process variables and their relationship to clinical outcomes after total knee arthroplasty has focused primarily on inpatient variables. Care process factors related to outpatient rehabilitation have not been adequately examined. We conducted a retrospective review of 321 patients evaluating outpatient care process variables including use of continuous passive motion, home health physical therapy, number of days from inpatient discharge to beginning outpatient physical therapy, and aspects of outpatient physical therapy (number of visits, length of stay) as possible predictors of pain and disability outcomes of outpatient physical therapy. Only the number of days between inpatient discharge and outpatient physical therapy predicted better outcomes, suggesting that this may be a target for improving outcomes after total knee arthroplasty for patients discharged directly home. Copyright © 2014 Elsevier Inc. All rights reserved.
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Impact of Diagnosis Related Groups of Hospital Social Service Departments.
ERIC Educational Resources Information Center
Patchner, Michael A.; Wattenberg, Shirley H.
1985-01-01
Surveyed 19 hospital social service administrators to examine the impact of Diagnosis Related Groups (DRGs). Results indicated increased recognition and increased scrutiny, and changes in discharge planning procedures. (JAC)
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Analyzing Conductivity Profiles in Stream Waters Influenced by Mine Water Discharges
NASA Astrophysics Data System (ADS)
Räsänen, Teemu; Hämäläinen, Emmy; Hämäläinen, Matias; Turunen, Kaisa; Pajula, Pasi; Backnäs, Soile
2015-04-01
Conductivity is useful as a general measure of stream water quality. Each stream inclines to have a quite constant range of conductivity that can be used as a baseline for comparing and detecting influence of contaminant sources. Conductivity in natural streams and rivers is affected primarily by the geology of the watershed. Thus discharges from ditches and streams affect not only the flow rate in the river but also the water quality and conductivity. In natural stream waters, the depth and the shape of the river channel change constantly, which changes also the water flow. Thus, an accurate measuring of conductivity or other water quality indicators is difficult. Reliable measurements are needed in order to have holistic view about amount of contaminants, sources of discharges and seasonal variation in mixing and dilution processes controlling the conductivity changes in river system. We tested the utility of CastAway-CTD measuring device (SonTek Inc) to indicate the influence of mine waters as well as mixing and dilution occurring in the recipient river affected by treated dewatering and process effluent water discharges from a Finnish gold mine. The CastAway-CTD measuring device is a small, rugged and designed for profiling of depths of up to 100m. Device measures temperature, salinity, conductivity and sound of speed using 5 Hz response time. It has also built-in GPS which produces location information. CTD casts are normally used to produce vertical conductivity profile for rather deep waters like seas or lakes. We did seasonal multiple Castaway-CTD measurements during 2013 and 2014 and produced scaled vertical and horizontal profiles of conductivity and water temperature at the river. CastAway-CTD measurement pinpoints how possible contaminants behave and locate in stream waters. The conductivity profiles measured by CastAway-CTD device show the variation in maximum conductivity values vertically in measuring locations and horizontally in measured cross-sections. The data from field measurements was combined with detailed water quality analysis and processed by data analysis with Matlab to produce more holistic information about the behavior, mixing and dilution of possible contaminants at the river. Moreover, the results can be used to improve water sampling procedures for more representative sampling and to plan continuous monitoring site locations and measuring device mounting places.
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Improving hospital discharge time: a successful implementation of Six Sigma methodology.
El-Eid, Ghada R; Kaddoum, Roland; Tamim, Hani; Hitti, Eveline A
2015-03-01
Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions. The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process. This is a quantitative pre and post-intervention study. Three hundred and eighty-six bed tertiary care hospital. A series of Six Sigma driven interventions over a 10-month period. The primary outcome was discharge time (time from discharge order to patient leaving the room). Secondary outcome measures included percent of patients whose discharge order was written before noon, percent of patients leaving the room by noon, hospital length of stay (LOS), and LOS of admitted ED patients. Discharge time decreased by 22.7% from 2.2 hours during the preintervention period to 1.7 hours post-intervention (P < 0.001). A greater proportion of patients left their room before noon in the postintervention period (P < 0.001), though there was no statistical difference in before noon discharge. Hospital LOS dropped from 3.4 to 3.1 days postintervention (P < 0.001). ED mean LOS of patients admitted to the hospital was significantly lower in the postintervention period (6.9 ± 7.8 vs 5.9 ± 7.7 hours; P < 0.001). Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific.
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Patient experiences of in-hospital preparations for follow-up care at home.
Keller, Gretchen; Merchant, Alefia; Common, Carol; Laizner, Andrea M
2017-06-01
To examine patient experiences of hospital-based discharge preparation for referral for follow-up home care services. To identify aspects of discharge preparation that will assist patients with their transition from hospital-based care to home-based follow-up care. To improve patients' transitions from hospital-based care to community-based home care, hospitals incorporate home care referral processes into discharge planning. This includes patient preparation for follow-up home care services. While there is evidence to support that such preparation needs to be more patient-centred to be effective, there is little knowledge of patient experiences of preparation that would guide improvements. Qualitative descriptive study. The study was carried out at a supra-regional hospital in Eastern Canada. Findings are based on thematic content analysis of 13 semi-structured interviews of patients requiring home care after hospitalisation on a medical or surgical unit. Most interviews were held within one week of discharge. Patient experiences were associated with patient attitudes and levels of engagement in preparation. Attitudes and levels of engagement were seen as related to one another. Those who 'didn't really think about it', had low engagement, while those with the attitude 'guide me', looked for partnership. Those who had an attitude of 'this is what I want', had a very high level of engagement. Previous experience with home care services influenced patients' level of trust in the health care system, and ultimately shaped their attitudes towards and levels of engagement in preparation. Patient preparation for follow-up home care can be improved by assessing their knowledge of and previous experiences with home care. Patients recognised as using a proactive approach may be highly vulnerable. © 2016 John Wiley & Sons Ltd.
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Jolin, Jonathan; van Aalst, Robertus; Volpp, Bryan; Taylor, Thomas; Cohen, Emily
2018-06-01
Pneumococcal infections are an important source of morbidity and mortality in older adults and persons with compromised immune systems. New recommendations from the Advisory Committee on Immunization Practices (ACIP) became available September 2014, which included recommendations for the use of the 13-valent pneumococcal conjugate vaccine (PCV13). A study was conducted to increase the PCV13 vaccination rates of hospitalized patients at the White River Junction Veterans Affairs Medical Center (White River Junction, Vermont) through the use of a resident-driven quality improvement (QI) project. From December 2014 through April 2016, 16 internal medicine inpatient residents addressed inpatient PCV13 vaccination rates by participating in the facility's QI curriculum. Eight Plan-Do-Study-Act cycles were used, including discharge template editing, electronic reminders, and the discovery of a vaccination administration documentation error in the record through data validation. The measure was the monthly percentage of patients who received PCV13 vaccination (vaccination completion rate) of those discharged from the hospital medicine service who were due for PCV13 vaccination. The percentage of veterans discharged with an up-to-date PCV13 vaccination on discharge increased from approximately 30% to 87% and was sustained. Despite being driven by many different residents, this project demonstrates that continuous improvement can be achieved through a structured and iterative process while providing active learning of core QI concepts to residents. It also displays a method in which new guidelines can be incorporated into practice in an effective manner. Finally, this project is an example of how resident-driven data validation can lead to further improvement. Published by Elsevier Inc.
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Harte, P.T.; Trowbridge, P.R.
2010-01-01
Concentrations of chloride in excess of State of New Hampshire water-quality standards (230 mg/l) have been measured in watersheds adjacent to an interstate highway (I-93) in southern New Hampshire. A proposed widening plan for I-93 has raised concerns over further increases in chloride. As part of this effort, road-salt-contaminated groundwater discharge was mapped with terrain electrical conductivity (EC) electromagnetic (EM) methods in the fall of 2006 to identify potential sources of chloride during base-flow conditions to a small stream, Policy Brook. Three different EM meters were used to measure different depths below the streambed (ranging from 0 to 3 m). Results from the three meters showed similar patterns and identified several reaches where high EC groundwater may have been discharging. Based on the delineation of high (up to 350 mmhos/m) apparent terrain EC, seven-streambed piezometers were installed to sample shallow groundwater. Locations with high specific conductance in shallow groundwater (up to 2630 mmhos/m) generally matched locations with high streambed (shallow subsurface) terrain EC. A regression equation was used to convert the terrain EC of the streambed to an equivalent chloride concentration in shallow groundwater unique for this site. Utilizing the regression equation and estimates of onedimensional Darcian flow through the streambed, a maximum potential groundwater chloride load was estimated at 188 Mg of chloride per year. Changes in chloride concentration in stream water during streamflow recessions showed a linear response that indicates the dominant process affecting chloride is advective flow of chloride-enriched groundwater discharge. Published in 2010 by John Wiley & Sons, Ltd.
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Early illness experiences related to unexpected heart surgery: A qualitative descriptive study.
Chang, Yu-Ling; Tsai, Yun-Fang
2017-09-01
Most studies on patients' experiences following emergency cardiac surgery focus on evaluation of patients after their discharge. Few studies have evaluated patients' experiences after being transferred from intensive care and before being discharged. This study aimed to describe patients' experiences in the early stages of recovery following emergency heart surgery. For this exploratory qualitative descriptive study, 13 patients were recruited from a medical centre in northern Taiwan. Participants had undergone emergency heart surgery and had resided in the cardiothoracic surgical ward for ≥6 days following transfer from the ICU; all expected to be discharged from the hospital within 3 days. Semi-structured, face-to-face interviews were conducted in private after the patients had been transferred to the cardiothoracic surgical wards. Audiotaped interviews were transcribed and analysed using content analysis. Data analysis identified four themes, which represented different recovery stages: sudden and serious symptoms, nightmares and vivid dreams, physical and emotional disturbances, and establishing a new life after emergency surgery. A fifth theme, support for a new lifestyle, occurred between the four stages. Participants experienced symptoms of physical and psychological stress during the early recovery stages following emergency heart surgery. A lack of understanding of the process of recovery increased these difficulties; participants wanted and needed multidisciplinary care and education. Emergency heart surgery does not allow healthcare professionals to inform patients of what to expect post-surgery. Our findings suggest that rather than waiting until discharge to offer disease information and treatment plans, multidisciplinary care should be initiated as soon as possible to facilitate recovery. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
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A modelling tool for capacity planning in acute and community stroke services.
Monks, Thomas; Worthington, David; Allen, Michael; Pitt, Martin; Stein, Ken; James, Martin A
2016-09-29
Mathematical capacity planning methods that can take account of variations in patient complexity, admission rates and delayed discharges have long been available, but their implementation in complex pathways such as stroke care remains limited. Instead simple average based estimates are commonplace. These methods often substantially underestimate capacity requirements. We analyse the capacity requirements for acute and community stroke services in a pathway with over 630 admissions per year. We sought to identify current capacity bottlenecks affecting patient flow, future capacity requirements in the presence of increased admissions, the impact of co-location and pooling of the acute and rehabilitation units and the impact of patient subgroups on capacity requirements. We contrast these results to the often used method of planning by average occupancy, often with arbitrary uplifts to cater for variability. We developed a discrete-event simulation model using aggregate parameter values derived from routine administrative data on over 2000 anonymised admission and discharge timestamps. The model mimicked the flow of stroke, high risk TIA and complex neurological patients from admission to an acute ward through to community rehab and early supported discharge, and predicted the probability of admission delays. An increase from 10 to 14 acute beds reduces the number of patients experiencing a delay to the acute stroke unit from 1 in every 7 to 1 in 50. Co-location of the acute and rehabilitation units and pooling eight beds out of a total bed stock of 26 reduce the number of delayed acute admissions to 1 in every 29 and the number of delayed rehabilitation admissions to 1 in every 20. Planning by average occupancy would resulted in delays for one in every five patients in the acute stroke unit. Planning by average occupancy fails to provide appropriate reserve capacity to manage the variations seen in stroke pathways to desired service levels. An appropriate uplift from the average cannot be based simply on occupancy figures. Our method draws on long available, intuitive, but underused mathematical techniques for capacity planning. Implementation via simulation at our study hospital provided valuable decision support for planners to assess future bed numbers and organisation of the acute and rehabilitation services.
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Noyes, Jane; Brenner, Maria; Fox, Patricia; Guerin, Ashleigh
2014-05-01
To report a novel review to develop a health systems model of successful transition of children with complex healthcare needs from hospital to home. Children with complex healthcare needs commonly experience an expensive, ineffectual and prolonged nurse-led discharge process. Children gain no benefit from prolonged hospitalization and are exposed to significant harm. Research to enable intervention development and process evaluation across the entire health system is lacking. Novel mixed-method integrative review informed by health systems theory. DATA CINAHL, PsychInfo, EMBASE, PubMed, citation searching, personal contact. REVIEW Informed by consultation with experts. English language studies, opinion/discussion papers reporting research, best practice and experiences of children, parents and healthcare professionals and purposively selected policies/guidelines from 2002-December 2012 were abstracted using Framework synthesis, followed by iterative theory development. Seven critical factors derived from thirty-four sources across five health system levels explained successful discharge (new programme theory). All seven factors are required in an integrated care pathway, with a dynamic communication loop to facilitate effective discharge (new programme logic). Current health system responses were frequently static and critical success factors were commonly absent, thereby explaining ineffectual discharge. The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models. © 2013 John Wiley & Sons Ltd.
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40 CFR 434.10 - Applicability.
Code of Federal Regulations, 2010 CFR
2010-07-01
... Provisions § 434.10 Applicability. This part applies to discharges from any coal mine at which the extraction of coal is taking place or is planned to be undertaken and to coal preparation plants and associated...
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40 CFR 434.10 - Applicability.
Code of Federal Regulations, 2011 CFR
2011-07-01
... Provisions § 434.10 Applicability. This part applies to discharges from any coal mine at which the extraction of coal is taking place or is planned to be undertaken and to coal preparation plants and associated...
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29 CFR 1952.340 - Description of the plan as initially approved.
Code of Federal Regulations, 2010 CFR
2010-07-01
... inspectors before or during the physical inspection of any workplace for the purpose of aiding such... of employees against discharge or discrimination; procedures for prompt restraint or elimination of...
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NASA Astrophysics Data System (ADS)
Huo, Chunqing; Lundin, Daniel; Raadu, Michael A.; Anders, André; Tomas Gudmundsson, Jon; Brenning, Nils
2014-04-01
The onset and development of self-sputtering (SS) in a high power impulse magnetron sputtering (HiPIMS) discharge have been studied using a plasma chemical model and a set of experimental data, taken with an aluminum target and argon gas. The model is tailored to duplicate the discharge in which the data are taken. The pulses are long enough to include both an initial transient and a following steady state. The model is used to unravel how the internal discharge physics evolves with pulse power and time, and how it is related to features in the discharge current-voltage-time characteristics such as current densities, maxima, kinks and slopes. The connection between the self-sputter process and the discharge characteristics is quantified and discussed in terms of three parameters: a critical target current density Jcrit based on the maximum refill rate of process (argon) gas above the target, an SS recycling factor ΠSS-recycle, and an approximation \\tilde{\\alpha} of the probabilities of ionization of species that come from the target (both sputtered metal and embedded argon atoms). For low power pulses, discharge voltages UD ⩽ 380 V with peak current densities below ≈ 0.2 A cm-2, the discharge is found to be dominated by process gas sputtering. In these pulses there is an initial current peak in time, associated with partial gas rarefaction, which is followed by a steady-state-like plateau in all parameters similar to direct current magnetron sputtering. In contrast, high power pulses, with UD ⩾ 500 V and peak current densities above JD ≈ 1.6 A cm-2, make a transition to a discharge mode where SS dominates. The transition is found not to be driven by process gas rarefaction which is only about 10% at this time. Maximum gas rarefaction is found later in time and always after the initial peak in the discharge current. With increasing voltage, and pulse power, the discharge can be described as following a route where the role of SS increases in four steps: process gas sputtering, gas-sustained SS, self-sustained SS and SS runaway. At the highest voltage, 1000 V, the discharge is very close to, but does not go into, the SS runaway mode. This absence of runaway is proposed to be connected to an unexpected finding: that twice ionized ions of the target species play almost no role in this discharge, not even at the highest powers. This reduces ionization by secondary-emitted energetic electrons almost to zero in the highest power range of the discharge.
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40 CFR 436.21 - Specialized definitions.
Code of Federal Regulations, 2012 CFR
2012-07-01
... natural deposits. (e) The term “process generated waste water” shall mean any waste water used in the... of the mine operator. However, if a mine is also used for treatment of process generated waste water, discharges of commingled water from the facilities shall be deemed discharges of process generated waste...
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Shortened lengths of stay: ensuring continuity of care for mothers and babies.
Welsh, C; Ludwig-Beymer, P
1998-01-01
Hospital discharge on the day after an uncomplicated vaginal delivery may be appropriate if clinical criteria are used for the selection of patients and post-discharge follow-up plans are in place. To ensure safety for these patients, Advocate Health Care developed a mother/baby philosophy statement, guidelines for maternal and infant discharge in less than 48 hours, and an algorithm to assure that appropriate follow-up care takes place after discharge. To evaluate the Mother/Baby Home Transition Program, home health follow up, readmission rates, and sentinel events were tracked. Most home health visits occurred within 48 hours. Infant readmission rates ranged from 1.1-2.6%, whereas maternal readmission rates ranged from 0-0.52%. Three sentinel events in 1996 and three in 1997 required readmissions to an ICU. Data continue to be monitored and shared monthly with clinical leaders.
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Bay, Esther; Strong, Carrie
2011-01-01
Research indicates that the assessment and discharge teaching practices for persons with traumatic brain injury are more focused on ruling out severe brain injury and informing the person about "red flags" warranting a return visit to the medical provider. Our primary purpose was to determine the extent to which discharge practices were aligned with the Centers for Disease Control and Prevention guidelines contained within the Acute Concussion Evaluation care plan. Responses from 87 nurses (25.0% response rate) to a tailored survey were analyzed to determine emergency department nurses' discharge teaching practices for adults who experienced a mild traumatic brain injury (MTBI). Results indicated that nurses in general were focused on injury-specific information and less often provided information about MTBI, symptom management, or strategies for preventing future brain damage. System improvements are justified to provide injured persons with a clearly defined diagnosis and instructions for follow-up and symptom management.
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Patel, Shilpa J; Longhurst, Christopher A; Lin, Anna; Garrett, Lyn; Gillette-Arroyo, Jenny; Mark, John D; Wood, Matthew S; Sharek, Paul J
2012-08-01
Asthma exacerbation is one of the most common causes for pediatric hospitalization. One of the three Joint Commission quality measures--which has proven the most challenging--addresses the provision of a home management plan of care (HMPC) for discharge of pediatric inpatients with a primary diagnosis of asthma. A user-friendly electronic medical record (EMR)-generated HMPC was developed and implemented at Lucile Packard Children's Hospital (LPCH) Palo Alto, California, an HPMC needed to be completed before entry of an inpatient discharge order. A cohort study using historical controls was conducted in 2010-2011. Patients were eligible to receive an HMPC if they were between the ages of 2 and 17 years old at discharge, had a length of stay < 120 days, were not enrolled in clinical trials, and had the primary discharge diagnosis of asthma. These patients were identified by the EMR if this diagnosis was listed in the diagnosis list or problem list or if the asthma admit/discharge order set was initiated. Compliance with the HMPC increased from 65.3% for the 39 months (April 1, 2007-June 30, 2010) before integration of the HMPC into EMR to 93.7% for the 18 months after integration (July 1, 2010, through December 31, 2011); p < .0001. Users of the EMR-integrated HMPC found it to be significantly easier to complete, less time-consuming, and less prone to potential errors or omission. Lessons learned at LPCH included the need for a continuous surveillance and improvement model, which resulted in several iterations of the HMPC; the importance of soliciting user input, which resulted in improvements in work flow; and consistent support from the quality management and information technology departments, which are crucial to eliminating barriers and facilitating improvement.
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Beck, A; Andersen, U T; Leedo, E; Jensen, L L; Martins, K; Quvang, M; Rask, K Ø; Vedelspang, A; Rønholt, F
2015-11-01
The objective was to test whether adding a dietician to a discharge Liaison-Team after discharge of geriatric patients improves nutritional status, muscle strength and patient relevant outcomes. Twelve-week randomized controlled trial. Geriatric patients (70 + years and at nutritional risk) at discharge. Participants were randomly allocated to receive discharge Liaison-Team vs. discharge Liaison-Team in cooperation with a dietician. The dietician performed a total of three home visits with the aim of developing and implementing an individual nutritional care plan. The first visit took place at the day of discharge together with the discharge Liaison-Team while the remaining visits took place approximately three and eight weeks after discharge and were performed by a dietician alone. Nutritional status (weight, and dietary intake), muscle strength (hand grip strength, chair-stand), functional status (mobility, and activities of daily living), quality of life, use of social services, re-/hospitalization and mortality. Seventy-one patients were included (34 in the intervention group), and 63 (89%) completed the second data collection after 12 weeks (31 in the intervention group). Odds ratios for hospitalization and mortality 6 months after discharge were 0.367 (0.129; 1.042) and 0.323 (0.060; 1.724). Nutritional status improved and some positive tendencies in favour of the intervention group were observed for patient relevant outcomes, i.e. activities of daily living, and quality of life. Almost 100% of the intervention group received three home visits by a dietician. Adding a dietician to the discharge Liaison-Team after discharge of geriatric patients can improve nutritional status and may reduce the number of times hospitalized within 6 months. A larger study is necessary to see a significant effect on other patient relevant outcomes. © The Author(s) 2014.
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Dutta, Sayon; Long, William J; Brown, David F M; Reisner, Andrew T
2013-08-01
As use of radiology studies increases, there is a concurrent increase in incidental findings (eg, lung nodules) for which the radiologist issues recommendations for additional imaging for follow-up. Busy emergency physicians may be challenged to carefully communicate recommendations for additional imaging not relevant to the patient's primary evaluation. The emergence of electronic health records and natural language processing algorithms may help address this quality gap. We seek to describe recommendations for additional imaging from our institution and develop and validate an automated natural language processing algorithm to reliably identify recommendations for additional imaging. We developed a natural language processing algorithm to detect recommendations for additional imaging, using 3 iterative cycles of training and validation. The third cycle used 3,235 radiology reports (1,600 for algorithm training and 1,635 for validation) of discharged emergency department (ED) patients from which we determined the incidence of discharge-relevant recommendations for additional imaging and the frequency of appropriate discharge documentation. The test characteristics of the 3 natural language processing algorithm iterations were compared, using blinded chart review as the criterion standard. Discharge-relevant recommendations for additional imaging were found in 4.5% (95% confidence interval [CI] 3.5% to 5.5%) of ED radiology reports, but 51% (95% CI 43% to 59%) of discharge instructions failed to note those findings. The final natural language processing algorithm had 89% (95% CI 82% to 94%) sensitivity and 98% (95% CI 97% to 98%) specificity for detecting recommendations for additional imaging. For discharge-relevant recommendations for additional imaging, sensitivity improved to 97% (95% CI 89% to 100%). Recommendations for additional imaging are common, and failure to document relevant recommendations for additional imaging in ED discharge instructions occurs frequently. The natural language processing algorithm's performance improved with each iteration and offers a promising error-prevention tool. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.
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Wang, F; Zhang, H L
2018-03-20
Objective: To explore influence of the WeChat platform on the compliance of continuous treatment of scar in adult burn patients. Methods: A total of 124 adult burn patients, conforming to the study criteria, admitted in the Department of Burns of our hospital from January 2015 to January 2016 were divided into WeChat group ( n =63) and control group ( n =61) according to the random number table. Patients in control group only received regular discharging rehabilitation guide, while patients in WeChat group received regular discharging rehabilitation guide and joined WeChat platform after being discharged from hospital. Through pushing rehabilitation plan and rehabilitation related knowledge, organizing support discussion of burn patients, answering the patients' questions, members of WeChat platform intervention group conducted continuous treatment for 6 months on patients of WeChat group. The compliance of functional exercise of patients in two groups in one week before discharge and 3 and 6 months after discharge was evaluated by using the self-made functional exercise compliance log sheet. The compliance of using anti-scar drug and appliance of patients in two groups in 3 and 6 months after discharge was evaluated by using self-made anti-scar drug and appliance usage log sheets. Data were processed with chi-square test, independent sample t test, non-parametric rank sum test of independent sample, and Wilcoxon rank sum test. Results: (1) The compliance ratio of functional exercise of patients in WeChat group (95.24%, 60/63) was close to 93.44% (57/61) in control group in one week before discharge ( χ (2)=0.188, P >0.05). The compliance ratios of functional exercise of patients in WeChat group were respectively 93.65% (59/63) and 87.30% (55/63) in 3 and 6 months after discharge, which were higher than 68.85% (42/61) and 65.57% (40/61) in control group ( χ (2)=12.615, 8.166, P <0.01). (2) The compliance of using anti-scar drug of patients in WeChat group was significantly better than that in control group in 3 and 6 months after discharge ( Z =-4.150, -4.563, P <0.01). (3) The compliance of using anti-scar appliance of patients in WeChat group in 3 and 6 months after discharge was obviously better than that in control group ( Z =-4.242, -4.301, P <0.01). Conclusions: By using WeChat platform to provide guide for scar rehabilitation continuous treatment, adult burn patients have better compliance to functional exercise and usage of anti-scar drug and appliance.
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Consistent and efficient processing of ADCP streamflow measurements
Mueller, David S.; Constantinescu, George; Garcia, Marcelo H.; Hanes, Dan
2016-01-01
The use of Acoustic Doppler Current Profilers (ADCPs) from a moving boat is a commonly used method for measuring streamflow. Currently, the algorithms used to compute the average depth, compute edge discharge, identify invalid data, and estimate velocity and discharge for invalid data vary among manufacturers. These differences could result in different discharges being computed from identical data. Consistent computational algorithm, automated filtering, and quality assessment of ADCP streamflow measurements that are independent of the ADCP manufacturer are being developed in a software program that can process ADCP moving-boat discharge measurements independent of the ADCP used to collect the data.
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Introduction of Nano-seconds Pulsed Discharge Plasma and its Applications
NASA Astrophysics Data System (ADS)
Namihira, Takao; Wang, Douyan; Matsumoto, Takao; Okada, Sho; Akiyama, Hidenori
During the decades, the developments of high power semiconductor switch, magnetic core and etc have allowed us to manufacture the pulsed power source having higher energy transfer efficiency. As the results, the pulsed discharge has been recognized as one of the promised non-thermal plasma to practical use. In this paper, a generation process, electron energy, impedance and a temperature of the pulsed discharge plasma would be explained. In addition, a nano-seconds pulsed discharge plasma would be introduced as the non-thermal plasma processing giving us the highest energy efficiency and be demonstrated it.
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Jordan, Alexander T; Hsieh, Jeffery S; Lee, Daniel T
2013-01-01
A method to separate inkjet ink from water was developed using a liquid phase, electric discharge process. The liquid phase, electric discharge process with filtration or sedimentation was shown to remove 97% of inkjet ink from solutions containing between 0.1-0.8 g/L and was consistent over a range of treatment conditions. Additionally, particle size analysis of treated allyl alcohol and treated propanol confirmed the electric discharge treatment has a polymerization mechanism, and small molecule analysis of treated methanol using gas chromatography and mass spectroscopy confirmed the mechanism was free radical initiated polymerization.
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Non-linear macro evolution of a dc driven micro atmospheric glow discharge
DOE Office of Scientific and Technical Information (OSTI.GOV)
Xu, S. F.; Zhong, X. X., E-mail: xxzhong@sjtu.edu.cn
2015-10-15
We studied the macro evolution of the micro atmospheric glow discharge generated between a micro argon jet into ambient air and static water. The micro discharge behaves similarly to a complex ecosystem. Non-linear behaviors are found for the micro discharge when the water acts as a cathode, different from the discharge when water behaves as an anode. Groups of snapshots of the micro discharge formed at different discharge currents are captured by an intensified charge-coupled device with controlled exposure time, and each group consisted of 256 images taken in succession. Edge detection methods are used to identify the water surfacemore » and then the total brightness is defined by adding up the signal counts over the area of the micro discharge. Motions of the water surface at different discharge currents show that the water surface lowers increasingly rapidly when the water acts as a cathode. In contrast, the water surface lowers at a constant speed when the water behaves as an anode. The light curves are similar to logistic growth curves, suggesting that a self-inhibition process occurs in the micro discharge. Meanwhile, the total brightness increases linearly during the same time when the water acts as an anode. Discharge-water interactions cause the micro discharge to evolve. The charged particle bomb process is probably responsible for the different behaviors of the micro discharges when the water acts as cathode and anode.« less
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Yue, Wencong; Cai, Yanpeng; Xu, Linyu; Yang, Zhifeng; Yin, Xin'An; Su, Meirong
2017-07-11
To improve the capabilities of conventional methodologies in facilitating industrial water allocation under uncertain conditions, an integrated approach was developed through the combination of operational research, uncertainty analysis, and violation risk analysis methods. The developed approach can (a) address complexities of industrial water resources management (IWRM) systems, (b) facilitate reflections of multiple uncertainties and risks of the system and incorporate them into a general optimization framework, and (c) manage robust actions for industrial productions in consideration of water supply capacity and wastewater discharging control. The developed method was then demonstrated in a water-stressed city (i.e., the City of Dalian), northeastern China. Three scenarios were proposed according to the city's industrial plans. The results indicated that in the planning year of 2020 (a) the production of civilian-used steel ships and machine-made paper & paperboard would reduce significantly, (b) violation risk of chemical oxygen demand (COD) discharge under scenario 1 would be the most prominent, compared with those under scenarios 2 and 3, (c) the maximal total economic benefit under scenario 2 would be higher than the benefit under scenario 3, and (d) the production of rolling contact bearing, rail vehicles, and commercial vehicles would be promoted.
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Note: Triggering behavior of a vacuum arc plasma source
DOE Office of Scientific and Technical Information (OSTI.GOV)
Lan, C. H., E-mail: lanchaohui@163.com; Long, J. D.; Zheng, L.
2016-08-15
Axial symmetry of discharge is very important for application of vacuum arc plasma. It is discovered that the triggering method is a significant factor that would influence the symmetry of arc discharge at the final stable stage. Using high-speed multiframe photography, the transition processes from cathode-trigger discharge to cathode-anode discharge were observed. It is shown that the performances of the two triggering methods investigated are quite different. Arc discharge triggered by independent electric source can be stabilized at the center of anode grid, but it is difficult to achieve such good symmetry through resistance triggering. It is also found thatmore » the triggering process is highly correlated to the behavior of emitted electrons.« less
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Improving transition of care for veterans after total joint replacement.
Green, Uthona R; Dearmon, Valorie; Taggart, Helen
2015-01-01
Patients transitioning from hospital to home are at risk for readmission to the hospital. Readmissions are costly and occur too often. Standardized discharge education processes have shown to decrease readmissions. The purpose of this quality improvement project was to utilize evidence-based practice changes to decrease 30-day all-cause readmissions after total joint replacement. Review of literature revealed that improved discharge education can decrease unnecessary readmissions after discharge. A quality improvement project was developed including standardized total joint replacement discharge education, teach-back education methodology, and improved postdischarge telephone follow-up. The quality improvement project was initiated and outcomes were evaluated. Improving coordination of the discharge process, enhanced education for patients/caregivers, and postdischarge follow-up decreased total joint replacement readmissions.
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Implementing Same Day Discharge Following Percutaneous Coronary Intervention: A Process Evaluation.
Chen, Yingyan; Lin, Frances; Marshall, Andrea
2018-06-14
The safety and effectiveness of same day discharge (SDD) following percutaneous coronary intervention are well demonstrated; however, the uptake of this model of care is low. The aim was to examine the effectiveness of implementing SDD using a process evaluation methodology. This study was undertaken in a cardiac services department of a tertiary teaching hospital in southeast Queensland, Australia. It was anticipated before the implementation that 120 patients could be discharged the same day in a 6 months' time period. Patient selection process and guideline adherence were assessed along with patients' and relatives' satisfaction. During implementation, 22 patients were discharged home the same day. It was found that staff did not follow the guideline consistently, with an overall adherence of 77.3%. The uptake of SDD was low in this implementation. The study is important as it provides direction for future improvement both in the criteria and the implementation process.
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Ramsay, Pam; Huby, Guro; Merriweather, Judith; Salisbury, Lisa; Rattray, Janice; Griffith, David; Walsh, Timothy
2016-01-01
Objectives To explore and compare patient/carer experiences of rehabilitation in the intervention and usual care arms of the RECOVER trial (ISRCTN09412438); a randomised controlled trial of a complex intervention of post-intensive care unit (ICU) acute hospital-based rehabilitation following critical illness. Design Mixed methods process evaluation including comparison of patients' and carers' experience of usual care versus the complex intervention. We integrated and compared quantitative data from a patient experience questionnaire (PEQ) with qualitative data from focus groups with patients and carers. Setting Two university-affiliated hospitals in Scotland. Participants 240 patients discharged from ICU who required ≥48 hours of mechanical ventilation were randomised into the trial (120 per trial arm). Exclusion criteria comprised: primary neurologic diagnosis, palliative care, current/planned home ventilation and age <18 years. 182 patients completed the PEQ at 3 months postrandomisation. 22 participants (14 patients and 8 carers) took part in focus groups (2 per trial group) at >3 months postrandomisation. Interventions A complex intervention of post-ICU acute hospital rehabilitation, comprising enhanced physiotherapy, nutritional care and information provision, case-managed by dedicated rehabilitation assistants (RAs) working within existing ward-based clinical teams, delivered between ICU discharge and hospital discharge. Comparator was usual care. Outcome measures A novel PEQ capturing patient-reported aspects of quality care. Results The PEQ revealed statistically significant between-group differences across 4 key intervention components: physiotherapy (p=0.039), nutritional care (p=0.038), case management (p=0.045) and information provision (p<0.001), suggesting greater patient satisfaction in the intervention group. Focus group data strongly supported and helped explain these findings. Specifically, case management by dedicated RAs facilitated greater access to physiotherapy, nutritional care and information that cut across disciplinary boundaries and staffing constraints. Patients highly valued its individualisation according to their needs, abilities and preferences. Conclusions Case management by dedicated RAs improves patients' experiences of post-ICU hospital-based rehabilitation and increases perceived quality of care. Trial registration number ISRCTN09412438. PMID:27481624
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Nandy, T; Dhodapkar, R S; Pophali, G R; Kaul, S N; Devotta, S
2005-09-01
Environmental concerns associated with textile processing had placed the textile sector in a Southern State of India under serious threat of survival. The textile industries were closed under the orders of the Statutory Board for reason of inadequate compliance to environmental discharge norms of the State for the protection of the drinking water source of the State capital. In compliance with the direction of the Board for zero effluent discharge, advanced treatment process have been implemented for recovery of boiler feed quality water with recourse to effluent recycling/reuse. The paper describes to a case study on the adequacy assessment of the full scale effluent treatment plant comprising chemical, biological and filtration processes in a small scale textile industry. In addition, implementation of measures for discernable improvement in the performance of the existing units through effective operation & maintenance, and application of membrane separation processes leading to zero effluent discharge is also highlighted.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
None
This Corrective Action Investigation Plan (CAIP) contains the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Sites Office's (NNSA/NSO's) approach to collect the data necessary to evaluate corrective action alternatives appropriate for the closure of Corrective Action Unit (CAU) 516, Septic Systems and Discharge Points, Nevada Test Site (NTS), Nevada, under the Federal Facility Agreement and Consent Order. CAU 516 consists of six Corrective Action Sites: 03-59-01, Building 3C-36 Septic System; 03-59-02, Building 3C-45 Septic System; 06-51-01, Sump Piping, 06-51-02, Clay Pipe and Debris; 06-51-03, Clean Out Box and Piping; and 22-19-04, Vehicle Decontamination Area. Located in Areasmore » 3, 6, and 22 of the NTS, CAU 516 is being investigated because disposed waste may be present without appropriate controls, and hazardous and/or radioactive constituents may be present or migrating at concentrations and locations that could potentially pose a threat to human health and the environment. Existing information and process knowledge on the expected nature and extent of contamination of CAU 516 are insufficient to select preferred corrective action alternatives; therefore, additional information will be obtained by conducting a corrective action investigation. The results of this field investigation will support a defensible evaluation of corrective action alternatives in the corrective action decision document. Record of Technical Change No. 1 is dated 3/2004.« less
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Helder, Onno K; Verweij, Jos C M; van Staa, AnneLoes
2012-05-01
To explore parents' and nurses' experiences with the transition of infants from the neonatal intensive care unit to a special care nursery. Qualitative explorative study in two phases. Level IIID neonatal intensive care unit in a university hospital and special care nurseries (level II) in five community hospitals in the Netherlands. Twenty-one pairs of parents and 18 critical care nurses. Semistructured interviews were used. Thematic analysis and comparison of themes across participants were performed. Trust was a central theme for parents. Three subthemes, related to the chronological stages of transition, were identified: gaining trust; betrayal of trust; and rebuilding confidence. Trust was associated with five other themes: professional attitude; information management; coordination of transfer; different environments; and parent participation. Although nurses at an early stage repeatedly mentioned a possible transition to community hospitals, the actual announcement took many parents by surprise. Parents felt excluded during the actual transfer and most questioned its necessity. In the special care nursery, parents found it difficult to adjust to new routines and to gain trust in new caregivers, but eventually their worries dissolved. In contrast to neonatal intensive care unit nurses, special care nursery nurses quite understood the impact of transition on parents. Both parents and nurses considered present transitional arrangements to be inadequate. Nurses should provide more effective discharge planning and transitional care. A positive labeling of the transition as a first step to home discharge for the newborn seems appropriate. Parents need to be better-informed and should be involved in the planning process.
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Time-Series Approaches for Forecasting the Number of Hospital Daily Discharged Inpatients.
Ting Zhu; Li Luo; Xinli Zhang; Yingkang Shi; Wenwu Shen
2017-03-01
For hospitals where decisions regarding acceptable rates of elective admissions are made in advance based on expected available bed capacity and emergency requests, accurate predictions of inpatient bed capacity are especially useful for capacity reservation purposes. As given, the remaining unoccupied beds at the end of each day, bed capacity of the next day can be obtained by examining the forecasts of the number of discharged patients during the next day. The features of fluctuations in daily discharges like trend, seasonal cycles, special-day effects, and autocorrelation complicate decision optimizing, while time-series models can capture these features well. This research compares three models: a model combining seasonal regression and ARIMA, a multiplicative seasonal ARIMA (MSARIMA) model, and a combinatorial model based on MSARIMA and weighted Markov Chain models in generating forecasts of daily discharges. The models are applied to three years of discharge data of an entire hospital. Several performance measures like the direction of the symmetry value, normalized mean squared error, and mean absolute percentage error are utilized to capture the under- and overprediction in model selection. The findings indicate that daily discharges can be forecast by using the proposed models. A number of important practical implications are discussed, such as the use of accurate forecasts in discharge planning, admission scheduling, and capacity reservation.
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Hospital to Home: Plan for a Smooth Transition
... can cause falls, such as area rugs and electric cords (a good idea in any event) ■ Create ... on many aspects of transitions, including medication management, discharge checklists, hospice and palliative care, and many others. ...
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A Statewide Quality Improvement Collaborative to Increase Breastfeeding Rates in Tennessee.
Ware, Julie L; Schetzina, Karen E; Morad, Anna; Barker, Brenda; Scott, Theresa A; Grubb, Peter H
2018-05-01
Tennessee has low breastfeeding rates and has identified opportunities for improvement to enhance maternity practices to support breastfeeding mothers. We sought a 10% relative increase in the aggregate Joint Commission measure of breastfeeding exclusivity at discharge (TJC PC-05) by focusing on high-reliability (≥90%) implementation of processes that promote breastfeeding in the delivery setting. A statewide, multidisciplinary development team reviewed evidence from the WHO-UNICEF "Ten Steps to Successful Breastfeeding" to create a consensus toolkit of process indicators aligned with the Ten Steps. Hospitals submitted monthly TJC PC-05 data for 6 months while studying local implementation of the Ten Steps to identify improvement opportunities, and for an additional 11 months while conducting tests of change to improve Ten Steps implementation using Plan-Do-Study-Act cycles, local process audits, and control charts. Data were aggregated at the state level and presented at 12 monthly webinars, 3 regional learning sessions, and 1 statewide meeting where teams shared their local data and implementation experiences. Thirteen hospitals accounting for 47% of live births in Tennessee submitted data on 31,183 mother-infant dyads from August 1, 2012, to December 31, 2013. Aggregate monthly mean PC-05 demonstrated "special cause" improvement increasing from 37.1% to 41.2%, an 11.1% relative increase. Five hospitals reported implementation of ≥5 of the Ten Steps and two hospitals reported ≥90% reliability on ≥5 of the Ten Steps using locally designed process audits. Using large-scale improvement methodology, a successful statewide collaborative led to >10% relative increase in breastfeeding exclusivity at discharge in participating Tennessee hospitals. Further opportunities for improvement in implementing breastfeeding supportive practices were identified.
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1988-02-05
for understanding the microscopic processes of electrical discharges and for designing gaseous discharge switches. High power gaseous discharge switches...half-maximum) energy resolution. The electron gun and ion extraction were of the same design of Srivastava at the Jet Propulsion Laboratory. Ions...photons. - The observed current switching can be applied to the design of discharge switches. Elec- tron transport parameters are needed for the
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Peltonen, Laura-Maria; McCallum, Louise; Siirala, Eriikka; Haataja, Marjaana; Lundgrén-Laine, Heljä; Salanterä, Sanna; Lin, Frances
2015-01-01
The literature shows that delayed admission to the intensive care unit (ICU) and discharge delays from the ICU are associated with increased adverse events and higher costs. Identifying factors related to delays will provide information to practice improvements, which contribute to better patient outcomes. The aim of this integrative review was to explore the incidence of patients' admission and discharge delays in critical care and to identify organisational factors associated with these delays. Seven studies were included. The major findings are as follows: (1) explanatory research about discharge delays is scarce and one study on admission delays was found, (2) delays are a common problem mostly due to organisational factors, occurring in 38% of admissions and 22–67% of discharges, and (3) redesigning care processes by improving information management and coordination between units and interdisciplinary teams could reduce discharge delays. In conclusion, patient outcomes can be improved through efficient and safe care processes. More exploratory research is needed to identify factors that contribute to admission and discharge delays to provide evidence for clinical practice improvements. Shortening delays requires an interdisciplinary and multifaceted approach to the whole patient flow process. Conclusions should be made with caution due to the limited number of articles included in this review. PMID:26558286
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NASA Astrophysics Data System (ADS)
Tweed, Sarah O.; Leblanc, Marc; Webb, John A.; Lubczynski, Maciek W.
2007-02-01
Identifying groundwater recharge and discharge areas across catchments is critical for implementing effective strategies for salinity mitigation, surface-water and groundwater resource management, and ecosystem protection. In this study, a synergistic approach has been developed, which applies a combination of remote sensing and geographic information system (GIS) techniques to map groundwater recharge and discharge areas. This approach is applied to an unconfined basalt aquifer, in a salinity and drought prone region of southeastern Australia. The basalt aquifer covers ~11,500 km2 in an agriculturally intensive region. A review of local hydrogeological processes allowed a series of surface and subsurface indicators of groundwater recharge and discharge areas to be established. Various remote sensing and GIS techniques were then used to map these surface indicators including: terrain analysis, monitoring of vegetation activity, and mapping of infiltration capacity. All regions where groundwater is not discharging to the surface were considered potential recharge areas. This approach, applied systematically across a catchment, provides a framework for mapping recharge and discharge areas. A key component in assigning surface and subsurface indicators is the relevance to the dominant recharge and discharge processes occurring and the use of appropriate remote sensing and GIS techniques with the capacity to identify these processes.
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NASA Astrophysics Data System (ADS)
Kuznetsov, D. L.; Filatov, I. E.; Uvarin, V. V.
2018-01-01
Effect of electronegative additives (oxygen O2, sulfur dioxide SO2, carbon disulfide CS2, and carbon tetrachloride CCl4) on physical properties and chemical activity of plasma formed by pulsed corona discharge and by non-self-sustained discharge supported by pulsed electron beam in atmospheric pressure gas mixtures was investigated. It is shown that a decrease in discharge current depends on a sort of the additive and on its concentration. The reason is the difference in rate constants of electron attachment processes for the above molecules. In experiments on volatile organic compounds (VOCs) conversion in air by streamer corona it is obtained that an addition of CCl4 both decreases the discharge current amplitude and increases the VOCs conversion degree. An installation for investigation of electron attachment processes and for study of toxic impurities conversion in plasma formed by non-self-sustained discharge initiated by pulsed nanosecond electron beam is created.
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NASA Technical Reports Server (NTRS)
Hollyday, E. F. (Principal Investigator)
1975-01-01
The author has identified the following significant results. Streamflow characteristics in the Delmarva Peninsula derived from the records of daily discharge of 20 gaged basins are representative of the full range in flow conditions and include all of those commonly used for design or planning purposes. They include annual flood peaks with recurrence intervals of 2, 5, 10, 25, and 50 years, mean annual discharge, standard deviation of the mean annual discharge, mean monthly discharges, standard deviation of the mean monthly discharges, low-flow characteristics, flood volume characteristics, and the discharge equalled or exceeded 50 percent of the time. Streamflow and basin characteristics were related by a technique of multiple regression using a digital computer. A control group of equations was computed using basin characteristics derived from maps and climatological records. An experimental group of equations was computed using basin characteristics derived from LANDSAT imagery as well as from maps and climatological records. Based on a reduction in standard error of estimate equal to or greater than 10 percent, the equations for 12 stream flow characteristics were substantially improved by adding to the analyses basin characteristics derived from LANDSAT imagery.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Tie, W., E-mail: twh.110.666@163.com, E-mail: 84470220@qq.com; Xi'an Jiaotong University, Xi'an 710049; Liu, S.
The temporal and spatial evolution of a plasma jet generated by a spark discharge was observed. The electron temperature and density were obtained under different time and gas pressures by optical emission spectroscopy. Moreover, the discharge process of the plasma-jet triggered gas switch was recorded and analyzed at the lowest working coefficient. The results showed that the plasma jet moved forward in a bullet mode, and the advancing velocity increased with the decrease of pressure, and decreased with time growing. At initial time, the maximum velocity of a plasma jet could reach 3.68 × 10{sup 6 }cm/s. The electron temperature decreased from 2.0 eVmore » to 1.3 eV, and the electron density increased from 3.1 × 10{sup 15}/cm{sup 3} to 6.3 × 10{sup 15}/cm{sup 3} at the initial moment as the gas pressure increases from 0.1 MPa to 0.32 MPa. For a two-gap gas switch, the discharge performances were more depended on the second discharge spark gap (gap 2). Because plasma jet promoted the discharge in Gap 2, the gas switch operating in mode II had better triggered discharge characteristics. In the discharge process, the plasma-jet triggering had the effect of non-penetrating inducing, which not only provided initial electrons for reducing statistical lag but also enhanced the local electric field. The discharge was initiated and accelerated from electron avalanche to streamer. Therefore, a fast discharge was occurred in the gas switch.« less
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Electron heating and the Electrical Asymmetry Effect in capacitively coupled RF discharges
NASA Astrophysics Data System (ADS)
Schulze, Julian
2011-10-01
For applications of capacitive radio frequency discharges, the control of particle distribution functions at the substrate surface is essential. Their spatio-temporal shape is the result of complex heating mechanisms of the respective species. Enhanced process control, therefore, requires a detailed understanding of the heating dynamics. There are two known modes of discharge operation: α- and γ-mode. In α-mode, most ionization is caused by electron beams generated by the expanding sheaths and field reversals during sheath collapse, while in γ-mode secondary electrons dominate the ionisation. In strongly electronegative discharges, a third heating mode is observed. Due to the low electron density in the discharge center the bulk conductivity is reduced and a high electric field is generated to drive the RF current through the discharge center. In this field, electrons are accelerated and cause significant ionisation in the bulk. This bulk heating mode is observed experimentally and by PIC simulations in CF4 discharges. The electron dynamics and mode transitions as a function of driving voltage and pressure are discussed. Based on a detailed understanding of the heating dynamics, the concept of separate control of the ion mean energy and flux in classical dual-frequency discharges is demonstrated to fail under process relevant conditions. To overcome these limitations of process control, the Electrical Asymmetry Effect (EAE) is proposed in discharges driven at multiple consecutive harmonics with adjustable phase shifts between the driving frequencies. Its concept and a recipe to optimize the driving voltage waveform are introduced. The functionality of the EAE in different gases and first applications to large area solar cell manufacturing are discussed. Finally, limitations caused by the bulk heating in strongly electronegative discharges are outlined.
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40 CFR 436.21 - Specialized definitions.
Code of Federal Regulations, 2011 CFR
2011-07-01
.... However, if a mine is also used for treatment of process generated waste water, discharges of commingled water from the facilities shall be deemed discharges of process generated waste water. (c) The term “10... treatment of such waste water. ...
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Stark, J.R.; Hult, M.F.
1985-01-01
Simulation of a proposed gradient-control plan, in which lateral homogeneity and isotropy of individual hydro geologic units was assumed, indicates that the actions would be effective in limiting expansion of the contaminated volume in the Prairie du Chien-Jordan aquifer. The plan includes the control of withdrawal from five wells. The simulations also show, however, that modelcalculated potentiometric surfaces are sensitive to changes in withdrawal rates at wells not intended to be under the control of the plan. Management of discharge from these wells also will be important to overall effectiveness of the remedial-action plan.
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NASA Astrophysics Data System (ADS)
Juniati, A. T.; Sutjiningsih, D.; Soeryantono, H.; Kusratmoko, E.
2018-01-01
The water availability (WA) of a region is one of important consideration in both the formulation of spatial plans and the evaluation of the effectiveness of actual land use in providing sustainable water resources. Information on land-water needs vis-a-vis their availability in a region determines the state of the surplus or deficit to inform effective land use utilization. How to calculate water availability have been described in the Guideline in Determining the Carrying Capacity of the Environment in Regional Spatial Planning. However, the method of determining the supply and demand of water on these guidelines is debatable since the determination of WA in this guideline used a rational method. The rational method is developed the basis for storm drain design practice and it is essentially a peak discharge method peak discharge calculation method. This paper review the literature in methods of water availability estimation which is described descriptively, and present arguments to claim that water balance method is a more fundamental and appropriate tool in water availability estimation. A better water availability estimation method would serve to improve the practice in preparing formulations of Regional Spatial Plan (RSP) as well as evaluating land use capacity in providing sustainable water resources.
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Management, characteristics and outcomes of patients with acute coronary syndrome in Sri Lanka.
Galappatthy, Priyadarshani; Bataduwaarachchi, Vipula R; Ranasinghe, Priyanga; Galappatthy, Gamini K S; Wijayabandara, Maheshi; Warapitiya, Dinuka S; Sivapathasundaram, Mythily; Wickramarathna, Thilini; Senarath, Upul; Sridharan, Sathasivam; Wijeyaratne, Chandrika N; Ekanayaka, Ruvan
2018-02-16
Ischaemic heart disease is the leading cause of in-hospital mortality in Sri Lanka. Acute Coronary Syndrome Sri Lanka Audit Project (ACSSLAP) is the first national clinical-audit project that evaluated patient characteristics, clinical outcomes and care provided by state-sector hospitals. ACSSLAP prospectively evaluated acute care, in-hospital care and discharge plans provided by all state-sector hospitals managing patients with ACS. Data were collected from 30 consecutive patients from each hospital during 2-4 weeks window. Local and international recommendations were used as audit standards. Data from 87/98 (88.7%) hospitals recruited 2177 patients, with 2116 confirmed as having ACS. Mean age was 61.4±11.8 years (range 20-95) and 58.7% (n=1242) were males. There were 813 (38.4%) patients with unstable angina, 695 (32.8%) with non-ST-elevation myocardial infarction (NSTEMI) and 608 (28.7%) with ST-elevation myocardial infarction (STEMI). Both STEMI (69.9%) and NSTEMI (61.4%) were more in males (P<0.001). Aspirin, clopidogrel and statins were given to over 90% in acute setting and on discharge. In STEMI, 407 (66.9%) were reperfused; 384 (63.2%) were given fibrinolytics and only 23 (3.8%) underwent primary percutaneous coronary intervention (PCI). Only 42.3 % had thrombolysis in <30 min and 62.5% had PCI in <90 min. On discharge, beta-blockers and ACE inhibitors/angiotensin II receptor blockers were given to only 50.7% and 69.2%, respectively and only 17.6% had coronary interventions planned. In patients with ACS, aspirin, clopidogrel and statin use met audit standards in acute setting and on discharge. Vast majority of patients with STEMI underwent fibrinolyisis than PCI, due to limited resources. Primary PCI, planned coronary interventions and timely thrombolysis need improvement in Sri Lanka. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
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Hydrogeological controls on spatial patterns of groundwater discharge in peatlands
NASA Astrophysics Data System (ADS)
Hare, Danielle K.; Boutt, David F.; Clement, William P.; Hatch, Christine E.; Davenport, Glorianna; Hackman, Alex
2017-11-01
Peatland environments provide important ecosystem services including water and carbon storage, nutrient processing and retention, and wildlife habitat. However, these systems and the services they provide have been degraded through historical anthropogenic agricultural conversion and dewatering practices. Effective wetland restoration requires incorporating site hydrology and understanding groundwater discharge spatial patterns. Groundwater discharge maintains wetland ecosystems by providing relatively stable hydrologic conditions, nutrient inputs, and thermal buffering important for ecological structure and function; however, a comprehensive site-specific evaluation is rarely feasible for such resource-constrained projects. An improved process-based understanding of groundwater discharge in peatlands may help guide ecological restoration design without the need for invasive methodologies and detailed site-specific investigation. Here we examine a kettle-hole peatland in southeast Massachusetts historically modified for commercial cranberry farming. During the time of our investigation, a large process-based ecological restoration project was in the assessment and design phases. To gain insight into the drivers of site hydrology, we evaluated the spatial patterning of groundwater discharge and the subsurface structure of the peatland complex using heat-tracing methods and ground-penetrating radar. Our results illustrate that two groundwater discharge processes contribute to the peatland hydrologic system: diffuse lower-flux marginal matrix seepage and discrete higher-flux preferential-flow-path seepage. Both types of groundwater discharge develop through interactions with subsurface peatland basin structure, often where the basin slope is at a high angle to the regional groundwater gradient. These field observations indicate strong correlation between subsurface structures and surficial groundwater discharge. Understanding these general patterns may allow resource managers to more efficiently predict and locate groundwater seepage, confirm these using remote sensing technologies, and incorporate this information into restoration design for these critical ecosystems.
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Following up patients with depression after hospital discharge: a mixed methods approach
2011-01-01
Background A medication information intervention was delivered to patients with a major depressive episode prior to psychiatric hospital discharge. Methods The objective of this study was to explore how patients evolved after hospital discharge and to identify factors influencing this evolution. Using a quasi-experimental longitudinal design, the quantitative analysis measured clinical (using the Hospital Anxiety and Depression Scale, the somatic dimension of the Symptom Checklist 90 and recording the number of readmissions) and humanistic (using the Quality of Life Enjoyment and Satisfaction Questionnaire) outcomes of patients via telephone contacts up to one year following discharge. The qualitative analysis was based on the researcher diary, consisting of reports on the telephone outcome assessment of patients with major depression (n = 99). All reports were analyzed using the thematic framework approach. Results The change in the participants' health status was as diverse as it was at hospital discharge. Participants reported on remissions; changes in mood; relapses; and re-admissions (one third of patients). Quantitative data on group level showed low anxiety, depression and somatic scores over time. Three groups of contributing factors were identified: process, individual and environmental factors. Process factors included self caring process, medical care after discharge, resumption of work and managing daily life. Individual factors were symptom control, medication and personality. Environmental factors were material and social environment. Each of them could ameliorate, deteriorate or be neutral to the patient's health state. A mix of factors was observed in individual patients. Conclusions After hospital discharge, participants with a major depressive episode evolved in many different ways. Process, individual and environmental factors may influence the participant's health status following hospital discharge. Each of the factors could be positive, neutral or negative for the patient. PMID:22074732
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Burgin, Jillian Elizabeth
This Storm Water Pollution Prevention Plan (SWPPP) was developed in accordance with the provisions of the Clean Water Act (33 U.S.C. §§1251 et seq., as amended), and the Multi-Sector General Permit for Storm Water Discharges Associated with Industrial Activity (U.S. EPA, June 2015) issued by the U.S. Environmental Protection Agency (EPA) for the National Pollutant Discharge Elimination System (NPDES) and using the industry specific permit requirements for Sector P-Land Transportation and Warehousing as a guide. The applicable stormwater discharge permit is EPA General Permit Registration Number NMR053915 (Los Alamos National Security (LANS) (U.S. EPA, June 2015). Contents of the Junemore » 4, 2015 Multi-sector General Permit can be viewed at: https://www.epa.gov/sites/production/files/2015- 10/documents/msgp2015_finalpermit.pdf This SWPPP applies to discharges of stormwater from the operational areas of the TA-60-02 Salvage and Warehouse facility at Los Alamos National Laboratory. Los Alamos National Laboratory (also referred to as LANL or the “Laboratory”) is owned by the Department of Energy (DOE), and is operated by Los Alamos National Security, LLC (LANS). Throughout this document, the term “facility” refers to the TA-60-02 Salvage/ Warehouse and associated areas. The current permit expires at midnight on June 4, 2020. A copy of the facility NOI and LANS Delegation of Authority Letter are located in Appendix C of this SWPPP.« less
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40 CFR 421.15 - Standards of performance for new sources.
Code of Federal Regulations, 2010 CFR
2010-07-01
... subpart: There shall be no discharge of process waste water pollutants to navigable waters. (b) During any calendar month there may be discharged from the overflow of a process waste water impoundment either a volume of process waste water equal to the difference between the precipitation for that month that falls...
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Code of Federal Regulations, 2010 CFR
2010-07-01
... effluent limitations representing the application of BPT: There shall be no discharge of process waste water pollutants to navigable waters. (b) Process waste pollutants in the overflow may be discharged to... waste water from a facility designed, constructed and operated to contain all process generated waste...
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Code of Federal Regulations, 2012 CFR
2012-07-01
... operation using HF flotation, discharges of process waste water pollutants from facilities that recycle waste water, for use in the processing shall not exceed the following limitations: Effluent... paragraphs (a) (1) and (3) of this section, there shall be no discharge of process generated waste water...
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Code of Federal Regulations, 2014 CFR
2014-07-01
... operation using HF flotation, discharges of process waste water pollutants from facilities that recycle waste water, for use in the processing shall not exceed the following limitations: Effluent... paragraphs (a) (1) and (3) of this section, there shall be no discharge of process generated waste water...
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Code of Federal Regulations, 2010 CFR
2010-07-01
... this paragraph, which may be discharged from the carbon black lamp process by a point source subject to... Lamp Process Subcategory § 458.43 Effluent limitations guidelines representing the degree of effluent... achievable: There shall be no discharge of process waste water pollutants to navigable waters. ...
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Hall, David W.
2006-01-01
The U.S. Geological Survey, in cooperation with the Southeastern Wisconsin Regional Planning Commission (SEWRPC), collected discharge and water-quality data at nine sites in previously monitored areas of the upper Milwaukee River, Cedar Creek, and Root River Basins, in Wisconsin from May 1 through November 15, 2004. The data were collected for calibration of hydrological models that will be used to simulate how various management strategies will affect the water quality of streams. The data also will support SEWRPC and Milwaukee Metropolitan Sewerage District (MMSD) managers in development of the SEWRPC Regional Water Quality Management Plan and the MMSD 2020 Facilities Plan. These management plans will provide a scientific basis for future management decisions regarding development and maintenance of public and private waste-disposal systems. In May 2004, parts of the study area received over 13 inches of precipitation (3.06 inches is normal). In June 2004, most of the study area received between 7 and 11 inches of rainfall (3.56 inches is normal). This excessive rainfall caused flooding throughout the study area and resultant high discharges were measured at all nine monitoring sites. For example, the mean daily discharge recorded at the Cedar Creek site on May 27, 2004, was 2,120 cubic feet per second. This discharge ranked ninth of the largest 10 mean daily discharges in the 75-year record, and was the highest discharge recorded since March 30, 1960. Discharge records from continuous monitoring on the Root River Canal near Franklin since October 1, 1963, indicated that the discharge recorded on May 23, 2004, ranked second highest on record, and was the highest discharge recorded since March 4, 1974. Water-quality samples were taken during two base-flow events and six storm events at each of the nine sites. Analysis of water-quality data indicated that most concentrations of dissolved oxygen, biological oxygen demand, fecal coliform bacteria, chloride, suspended solids, nitrate plus nitrite nitrogen, ammonia nitrogen, Kjeldahl nitrogen, total phosphorus, dissolved orthophosphorus, total copper, particulate mercury, dissolved mercury, particulate methylmercury, dissolved methylmercury, and total zinc were below U.S. Environmental Protection Agency (USEPA) and State of Wisconsin water-quality standards at all sites, with the exception of dissolved oxygen at the Kewaskum, Farmington, Root River Canal, Root River Racine, and Root River Mouth sites. Each of these sites had from several days to several weeks of daily average dissolved oxygen concentrations below the 5 milligrams per liter State of Wisconsin standard for aquatic life. The lowest dissolved oxygen concentrations were measured at the heavily urbanized Root River Mouth site in downtown Racine, Wisconsin, where elevated concentrations of ammonia may have contributed to oxygen consumption during oxidation of ammonia to nitrate. Additionally, the maximum concentrations of copper in several Root River samples exceeded draft USEPA Ambient Water-Quality Criteria (U.S. Environmental Protection Agency, 2003) for acute toxicity to several species of aquatic organisms. Substantial water-quality changes were not correlated with hydrologic changes at any of the nine sites. Base-flow water-quality was generally indistinguishable from that sampled during storm events. The sparsely developed upper Milwaukee River and Cedar Creek Basins had relatively low ranges of contamination for all laboratory-reported parameters. For all nine sites, the highest reported concentrations of chloride (216 mg/L), total phosphorus (0.627 mg/L), ortho-phosphorus (0.136 mg/L), nitrate plus nitrate (9.32 mg/L), and copper (38 ?g/L) were reported for samples collected at the Root River Canal site. The highest concentrations of fecal coliforms (3,600 colonies per 100 mL) and Escherichia coli (2,300 colonies per 100 mL) were reported in samples collected at Kewaskum. The highest concentrations of s
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Impact of HMO ownership on management processes and utilization outcomes.
Ahern, M; Molinari, C
2001-05-01
To examine the effects of health maintenance organization (HMO) ownership characteristics on selected utilization outcomes and management processes affecting utilization. We used 1995 HMO data from the American Association of Health Plans. Using regression analysis, we examined the relation between HMO utilization (hospital discharges, days, and average length of stay; cardiac catheterization procedures; and average cost of outpatient prescriptions) and the structural characteristics of HMOs: ownership type (insurance company, hospital, physician, independent, and national managed care company), HMO size, for-profit status, model type, geographic region, and payer mix. HMO ownership type is significantly associated with medical management processes, including risk sharing by providers, risk sharing by consumers, and other management strategies. Relative to hospital-owned HMOs, insurance company-owned HMOs have fewer hospital discharges, fewer hospital days, and longer lengths of stay. National managed care organization-owned HMOs have fewer cardiac catheterizations and lower average outpatient prescription costs. Independently owned HMOs have more cardiac catheterizations. For-profit HMOs have lower prescription costs. Relative to hospital-owned HMOs, insurance company-owned HMOs are more likely to use hospital risk sharing and provider capitation and less likely to use out-of-pocket payments for hospital use and a closed formulary. National managed care organization-owned HMOs are less likely to use provider capitation, out-of-pocket payments for hospital use, catastrophic case management, and hospital risk sharing. Physician-hospital-owned HMOs are less likely to use catastrophic case management. For-profit HMOs are more likely to use hospital risk sharing and catastrophic case management. HMO ownership type affects utilization outcomes and management strategies.
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A green preparation method of battery grade α-PbO based on Pb-O2 fuel cell
NASA Astrophysics Data System (ADS)
Wang, Pingyuan; Pan, Junqing; Gong, Shumin; Sun, Yanzhi
2017-08-01
In order to solve the problem of high pollution and high energy consumption of the current lead oxide (PbO) preparation processes, a new clean and energy saving preparation method for high purity α-PbO via discharge of a Pb-O2 fuel cell is reported. The fuel cell with metallic lead anode, oxygen cathode, and 30% NaOH electrolyte can provide a discharge voltage of 0.66-0.38 V corresponding to discharge current range of 5-50 mA cm-2. PbO is precipitated from the NaHPbO2-containing electrolyte through a cooling crystallization process after discharge process, and the XRD patterns indicate the structure is pure α-PbO. The mother liquid after crystallization can be recycled for the next batch. The obtained PbO mixed with 60% Shimadzu PbO is superior to the pure Shimadzu PbO in discharge capacity and cycle ability.
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Discharge prediction in the Upper Senegal River using remote sensing data
NASA Astrophysics Data System (ADS)
Ceccarini, Iacopo; Raso, Luciano; Steele-Dunne, Susan; Hrachowitz, Markus; Nijzink, Remko; Bodian, Ansoumana; Claps, Pierluigi
2017-04-01
The Upper Senegal River, West Africa, is a poorly gauged basin. Nevertheless, discharge predictions are required in this river for the optimal operation of the downstream Manantali reservoir, flood forecasting, development plans for the entire basin and studies for adaptation to climate change. Despite the need for reliable discharge predictions, currently available rainfall-runoff models for this basin provide only poor performances, particularly during extreme regimes, both low-flow and high-flow. In this research we develop a rainfall-runoff model that combines remote-sensing input data and a-priori knowledge on catchment physical characteristics. This semi-distributed model, is based on conceptual numerical descriptions of hydrological processes at the catchment scale. Because of the lack of reliable input data from ground observations, we use the Tropical Rainfall Measuring Mission (TRMM) remote-sensing data for precipitation and the Global Land Evaporation Amsterdam Model (GLEAM) for the terrestrial potential evaporation. The model parameters are selected by a combination of calibration, by match of observed output and considering a large set of hydrological signatures, as well as a-priori knowledge on the catchment. The Generalized Likelihood Uncertainty Estimation (GLUE) method was used to choose the most likely range in which the parameter sets belong. Analysis of different experiments enhances our understanding on the added value of distributed remote-sensing data and a-priori information in rainfall-runoff modelling. Results of this research will be used for decision making at different scales, contributing to a rational use of water resources in this river.
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NASA Astrophysics Data System (ADS)
Tomita, Yasumasa; Kimura, Noritaka; Izumi, Yusuke; Arai, Juichi; Kohno, Yoshiumi; Kobayashi, Kenkichiro
2017-06-01
4LiF-NiMn2O4 composites are synthesized by the mechanical milling of LiF and NiMn2O4 in a molar ratio of 4: 1 for 36-192 h. The synthesized composites are investigated by XRD, charge-discharge measurements, and XPS. A broad XRD peak of 4LiF-NiMn2O4 was observed and those of LiF and NiMn2O4 disappear after the milling of 144 h and more. The discharge capacity of the 4LiF-NiMn2O4 composites changes with the milling time, with the composite prepared by milling for 144 h exhibiting a discharge capacity of 256 mA h g-1 at 0.1 C for voltages of 2.0-4.8 V. With a cut-off voltage of 4.8 V or more, decomposition of the electrolyte proceeds along with the charge process, so the charge-discharge current efficiency deteriorates and the discharge voltage decreases. In the charge-discharge measurement without the capacity limit, although the charge-discharge efficiency was low due to the decomposition of the electrolyte, the high discharge capacity of 310 mA h g-1 was obtained. The XPS data suggests that the Ni2+ ion and Mn3+ ion are oxidized to Ni3+ and Mn4+ ion in charge process up to 4.8 V and are reduced to Ni2+ ion and Mn3+ ion during the discharge process.
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Gotlib Conn, Lesley; Zwaiman, Ashley; DasGupta, Tracey; Hales, Brigette; Watamaniuk, Aaron; Nathens, Avery B
2018-01-01
Challenges delivering quality care are especially salient during hospital discharge and care transitions. Severely injured patients discharged from a trauma centre will go either home, to rehabilitation or another acute care hospital with complex management needs. This purpose of this study was to explore the experiences of trauma patients and families treated in a regional academic trauma centre to better understand and improve their discharge and care transition experiences. A qualitative study using inductive thematic analysis was conducted between March and October 2016. Telephone interviews were conducted with trauma patients and/or a family member after discharge from the trauma centre. Data collection and analysis were completed inductively and iteratively consistent with a qualitative approach. Twenty-four interviews included 19 patients and 7 family members. Participants' experiences drew attention to discharge and transfer processes that either (1) Fostered quality discharge or (2) Impeded quality discharge. Fostering quality discharge was ward staff preparation efforts; establishing effective care continuity; and, adequate emotional support. Impeding discharge quality was perceived pressure to leave the hospital; imposed transfer decisions; and, sub-optimal communication and coordination around discharge. Patient-provider communication was viewed to be driven by system, rather than patient need. Inter-facility information gaps raised concern about receiving facilities' ability to care for injured patients. The quality of trauma patient discharge and transition experiences is undermined by system- and ward-level processes that compete, rather than align, in producing high quality patient-centred discharge. Local improvement solutions focused on modifiable factors within the trauma centre include patient-oriented discharge education and patient navigation; however, these approaches alone may be insufficient to enhance patient experiences. Trauma patients encounter complex barriers to quality discharge that likely require a comprehensive, multimodal intervention. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Neural correlates of learning and trajectory planning in the posterior parietal cortex
Torres, Elizabeth B.; Quian Quiroga, Rodrigo; Cui, He; Buneo, Christopher A.
2013-01-01
The posterior parietal cortex (PPC) is thought to play an important role in the planning of visually-guided reaching movements. However, the relative roles of the various subdivisions of the PPC in this function are still poorly understood. For example, studies of dorsal area 5 point to a representation of reaches in both extrinsic (endpoint) and intrinsic (joint or muscle) coordinates, as evidenced by partial changes in preferred directions and positional discharge with changes in arm posture. In contrast, recent findings suggest that the adjacent medial intraparietal area (MIP) is involved in more abstract representations, e.g., encoding reach target in visual coordinates. Such a representation is suitable for planning reach trajectories involving shortest distance paths to targets straight ahead. However, it is currently unclear how MIP contributes to the planning of other types of trajectories, including those with various degrees of curvature. Such curved trajectories recruit different joint excursions and might help us address whether their representation in the PPC is purely in extrinsic coordinates or in intrinsic ones as well. Here we investigated the role of the PPC in these processes during an obstacle avoidance task for which the animals had not been explicitly trained. We found that PPC planning activity was predictive of both the spatial and temporal aspects of upcoming trajectories. The same PPC neurons predicted the upcoming trajectory in both endpoint and joint coordinates. The predictive power of these neurons remained stable and accurate despite concomitant motor learning across task conditions. These findings suggest the role of the PPC can be extended from specifying abstract movement goals to expressing these plans as corresponding trajectories in both endpoint and joint coordinates. Thus, the PPC appears to contribute to reach planning and approach-avoidance arm motions at multiple levels of representation. PMID:23730275
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Computational study of arc discharges: Spark plug and railplug ignitors
NASA Astrophysics Data System (ADS)
Ekici, Ozgur
A theoretical study of electrical arc discharges that focuses on the discharge processes in spark plug and railplug ignitors is presented. The aim of the study is to gain a better understanding of the dynamics of electrical discharges, more specifically the transfer of electrical energy into the gas and the effect of this energy transfer on the flow physics. Different levels of computational models are presented to investigate the types of arc discharges seen in spark plugs and railplugs (i.e., stationary and moving arc discharges). Better understanding of discharge physics is important for a number of applications. For example, improved fuel economy under the constraint of stricter emissions standards and improved plug durability are important objectives of current internal combustion engine designs. These goals can be achieved by improving the existing systems (spark plug) and introducing more sophisticated ignition systems (railplug). In spite of the fact spark plug and railplug ignitors are the focus of this work, the methods presented in this work can be extended to study the discharges found in other applications such as plasma torches, laser sparks, and circuit breakers. The system of equations describing the physical processes in an air plasma is solved using computational fluid dynamics codes to simulate thermal and flow fields. The evolution of the shock front, temperature, pressure, density, and flow of a plasma kernel were investigated for both stationary and moving arcs. Arc propagation between the electrodes under the effects of gas dynamics and electromagnetic processes was studied for moving arcs. The air plasma is regarded as a continuum, single substance material in local thermal equilibrium. Thermophysical properties of high temperature air are used to take into consideration the important processes such as dissociation and ionization. The different mechanisms and the relative importance of several assumptions in gas discharges and thermal plasma modeling were investigated. Considering the complex nature of the studied problem, the computational models aid in analyzing the analytical theory and serve as relatively inexpensive tools when compared to experiments in design process.
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Teno, Joan M; Christian, Thomas J; Gozalo, Pedro; Plotzke, Michael
2018-03-01
When Medicare Advantage (MA) patients elect hospice, all covered services are reimbursed under the Medicare fee-for-service (FFS) program. This financial arrangement may incentivize MA plans to refer persons to hospice near end of life when costs of care typically rise. To characterize hospice discharge patterns for MA versus FFS patients and examine whether patterns differ by MA concentration across hospital referral regions (HRRs). The rate and pattern of live discharges and length of stay (LOS) between FFS and MA patients were examined. A multivariate mixed-effects model examined whether hospice patients in MA versus FFS had differential patterns of discharges. In addition, we tested whether concentrations of MA hospice patients in a patient's HRR were associated with different patterns of discharges. In fiscal year 2014, there were 1,199,533 hospice discharges with 331,142 MA patients having a slightly higher live discharge rate (15.8%) compared to 868,391 FFS hospice discharges (15.4%). After controlling for patient characteristics, the adjusted odds ratio (AOR) was 1.01 (95% CI 0.99-1.02). MA patients were less likely to have early live discharges (AOR 0.87 95% CI 0.84-0.91) and burdensome transitions (AOR 0.61 95% CI 0.58-0.64) but did not differ in live discharges post 210 days. Among hospice deaths, MA hospice patients were less likely to have a three-day or less LOS (AOR 0.95 95% 0.94-0.96) and a LOS exceeding 180 days (AOR 0.97 95% 0.96-0.99). The concentration of MA patients in a HRR had minimal impact. MA hospice patients' discharge patterns raised less concerns than FFS.
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Nguyen, Vu Q C; PrvuBettger, Janet; Guerrier, Tami; Hirsch, Mark A; Thomas, J George; Pugh, Terrence M; Rhoads, Charles F
2015-07-01
To examine sociodemographic and clinical characteristics independently associated with discharge home compared with discharge to a skilled nursing facility (SNF) after acute inpatient rehabilitation. Retrospective cohort study. Three tertiary accredited acute care rehabilitation facilities. Adult patients with stroke (N=2085). Not applicable. Not applicable. Of 2085 patients with stroke treated at 3 centers over a 4-year period, 78.2% (n=1631) were discharged home and 21.8% (n=454) discharged to an SNF. Findings from a multivariable logistic regression analysis indicated that patients were less likely to be discharged home if they were older (odds ratio [OR], .98; 95% confidence interval [CI], .96-.99), separated or divorced (compared with married; OR, .61; 95% CI, .48-.79), or with Medicare health insurance (compared with private insurance; OR, .69; 95% CI, .55-.88), or had dysphagia (OR, .83; 95% CI, .71-.98) or cognitive deficits (OR, .79; 95% CI, .77-.81). The odds of being discharged home were higher for those admitted with a higher motor FIM score (OR, 1.10; 95% CI, 1.09-1.11). The following were not associated with discharge disposition: sex, race, prestroke vocational status, availability of secondary health insurance, number of days from stroke onset to rehabilitation facility admission, stroke type, impairment group, cognitive FIM on admission, other stroke deficits (aphasia, ataxia, neglect, or speech disturbance), stroke complications of hyponatremia or urinary tract infection, or comorbid conditions. One in 5 patients with stroke were discharged to an SNF after inpatient rehabilitation. On admission, several sociodemographic and clinical characteristics were identified that could be considered as important factors in early discussions for discharge planning. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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NASA Astrophysics Data System (ADS)
Kim, Duk-jae; Shim, Yeun-keun; Park, Jeongwon; Kim, Hyung-jun; Han, Jeon-geon
2016-04-01
Nonthermal atmospheric-pressure plasma discharge is designed with low-temperature cofired ceramic (LTCC) electrodes to achieve dielectric barrier surface discharge (DBSD). The environmental requirement (below 0.05 ppm) of the amount of byproducts (ozone and NO x ) produced during the process was met by optimizing the electrode design to produce a high dielectric barrier discharge for low-voltage (∼700 V) operation and minimizing the distance between electrodes to improve the plasma discharging efficiency. The concentrations of volatile organic compounds (VOCs) within interior cabins of commercial vehicles were significantly reduced after 1-h treatment to improve air quality cost-effectively. This atmospheric-pressure plasma process was demonstrated for the sterilization of Escherichia coli to prevent food poisoning during the preservation of food in refrigerators.
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Hart, J A; Wallace, D
1998-10-19
Casemix funding has markedly increased surgeons' awareness of the economies of the activities they undertake. Surgery has become a major focus at all large public hospitals, because of its high earning potential, and this pressure to maximise funding could influence surgical practice. Casemix funding's emphasis on length of hospital stay has encouraged forward planning for earlier discharge after surgical procedures. Patients are now assessed in pre-admission clinics, educated about their condition and their hospital stay, and a plan formulated for their discharge and rehabilitation. Funding for major surgical procedures of long duration in patients with complex conditions should reflect the higher level of resource utilisation. Tertiary referral centres, because of their commitment to training and research and their more severely ill patient population, are less cost-effective and require funding to ensure their viability. The improved information that casemix generates should be used to evaluate outcomes and improve patient care; efficiency must not take precedence over quality of care and compassion.
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Psychiatric treatment in prison: a missed opportunity?
Smith, S S; Baxter, V J; Humphreys, M S
2003-04-01
National Health Service Executive guidelines require psychiatric services to maintain links with prisoners previously subject to the Care Programme Approach (CPA) and to participate in discharge planning. We are unaware of previous studies assessing the involvement of general psychiatric services with patients in prison or prisoners' perceptions of their needs. Consecutive referrals to a prison psychiatric liaison service over a three-month period were screened for previous psychiatric contact. Half of those interviewed reported previous psychiatric contact. Two-thirds were in contact with services at the time of detention. One-third believed services knew of their imprisonment. Ninety-three per cent believed they would require psychiatric support after release. Few patients received input from general psychiatric services during imprisonment despite a high level of perceived need. Improved liaison would help facilitate both care in prison and discharge planning in the spirit of CPA and the government directive.