Ohio Water Resources Council

Science.gov Websites

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

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...

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...

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...

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...

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...

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...

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...

Clean Water Act (CWA) Action Plan Implementation Priorities: Changes to Improve Water Quality, Increase Compliance and Expand Transparency

EPA Pesticide Factsheets

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

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 !

24 CFR 91.220 - Action plan.

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...

24 CFR 91.220 - Action plan.

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...

School Bus Fleet Safety: Planning and Development.

ERIC Educational Resources Information Center

Bieber, Robert M.

1984-01-01

To ensure worker safety, fleet safety managers need professional staffs, good access to top management, and sufficient authority to discharge their duties. Safety programs should include careful driver hiring; training, including orientation, testing, and practice; comprehensive accident reporting; and cooperative compliance programs with…

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

Discharge planning: a collaboration between provider and payer case managers using Medicare's Conditions of Participation.

PubMed

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.

Post discharge issues identified by a call-back program: identifying improvement opportunities.

PubMed

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.

Psychiatric Discharge Process

PubMed Central

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

Meta-analysis of the effectiveness of nursing discharge planning interventions for older inpatients discharged home.

PubMed

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.

Discharge Planning in Acute Care Hospitals in Israel: Services Planned and Levels of Implementation and Adequacy

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…

CMS keeps raising the stakes on quality improvement.

PubMed

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.

Discharge planning for acute coronary syndrome patients in a tertiary hospital: a best practice implementation project.

PubMed

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.

Improving the quality of vascular surgical discharge planning in a hub centre

PubMed Central

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

Improving the quality of vascular surgical discharge planning in a hub centre.

PubMed

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.

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…

Trend analyses of sediment data for the DEC project

USGS Publications Warehouse

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.

Social Work Discharge Planning in Acute Care Hospitals in Israel: Clients' Evaluation of the Discharge Planning Process and Adequacy

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…

Discharge Planning in Chronic Conditions

PubMed Central

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

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)

A Multidisciplinary Initiative to Increase Inpatient Discharges Before Noon.

PubMed

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.

Medical rehabilitation of leprosy patients discharged home in abia and ebonyi States of Nigeria.

PubMed

Enwereji, Ezinne Ezinna; Ahuizi, Eke Reginald; Iheanocho, Okereke Chukwunenye; Enwereji, Kelechi Okechukwu

2011-11-01

To examine the extent to which medical coverage is available to discharged leprosy patients in communities. Evidence has shown that after care services, follow-up visits and national disease prevention programs are important components of medical rehabilitation to leprosy patients discharged home after treatment. Denying them accessibility to these services could expose them to multiple disabilities as well as several disease conditions including HIV/AIDS. These adverse health conditions could be averted if health workers extend healthcare services to discharged leprosy patients. This study was conducted to examine the extent to which discharged leprosy patients have access to healthcare services in the communities. All 33 leprosy patients who were fully treated with multi-drug therapy (MDT) and discharged home in the two leprosy settlements in Abia and Ebonyi States of Nigeria were included in this study. The list of discharged leprosy patients studied and their addresses were provided by the leprosy settlements where they were treated. Also, snowball-sampling method was used to identify some of the leprosy patients whose addresses were difficult to locate in the communities. Instruments for data collection were questionnaire, interview guide and checklist. These were administered because respondents were essentially those with no formal education. Analysis of data was done quantitatively and qualitatively. Findings showed that 20 (60.6%) of discharged patients did not receive health programs like HIV/AIDS prevention or family planning. Also, follow-up visits and after-care services were poor. About 14 (42.4%) of the patients live in dirty and overcrowded houses. On the whole, discharged patients were poorly medically rehabilitated (mean score: 4.7±1.1 out of total score of 7). Denying discharged leprosy patients opportunity of accessing health care services could increase prevalence of infectious diseases including HIV/AIDS among them. There is need to extend national prevention programs, follow-up visits, after-care services and free treatment to discharged patients in the communities.

Medical Rehabilitation of Leprosy Patients Discharged Home in Abia and Ebonyi States of Nigeria

PubMed Central

Enwereji, Ezinne Ezinna; Ahuizi, Eke Reginald; Iheanocho, Okereke Chukwunenye; Enwereji, Kelechi Okechukwu

2011-01-01

Objectives To examine the extent to which medical coverage is available to discharged leprosy patients in communities. Evidence has shown that after care services, follow-up visits and national disease prevention programs are important components of medical rehabilitation to leprosy patients discharged home after treatment. Denying them accessibility to these services could expose them to multiple disabilities as well as several disease conditions including HIV/AIDS. These adverse health conditions could be averted if health workers extend healthcare services to discharged leprosy patients. This study was conducted to examine the extent to which discharged leprosy patients have access to healthcare services in the communities. Methods All 33 leprosy patients who were fully treated with multi-drug therapy (MDT) and discharged home in the two leprosy settlements in Abia and Ebonyi States of Nigeria were included in this study. The list of discharged leprosy patients studied and their addresses were provided by the leprosy settlements where they were treated. Also, snowball-sampling method was used to identify some of the leprosy patients whose addresses were difficult to locate in the communities. Instruments for data collection were questionnaire, interview guide and checklist. These were administered because respondents were essentially those with no formal education. Analysis of data was done quantitatively and qualitatively. Results Findings showed that 20 (60.6%) of discharged patients did not receive health programs like HIV/AIDS prevention or family planning. Also, follow-up visits and after-care services were poor. About 14 (42.4%) of the patients live in dirty and overcrowded houses. On the whole, discharged patients were poorly medically rehabilitated (mean score: 4.7±1.1 out of total score of 7). Conclusion Denying discharged leprosy patients opportunity of accessing health care services could increase prevalence of infectious diseases including HIV/AIDS among them. There is need to extend national prevention programs, follow-up visits, after-care services and free treatment to discharged patients in the communities. PMID:22253946

Physiotherapists' Perceptions of and Experiences with the Discharge Planning Process in Acute-Care General Internal Medicine Units in Ontario

PubMed Central

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

Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia.

PubMed

Katzenellenbogen, Judith M; Miller, Laura J; Somerford, Peter; McEvoy, Suzanne; Bessarab, Dawn

2015-09-01

The aim of the present study was to provide descriptive planning data for a hospital-based Aboriginal Health Liaison Officer (AHLO) program, specifically quantifying episodes of care and outcomes within 28 days after discharge. A follow-up study of Aboriginal in-patient hospital episodes was undertaken using person-based linked administrative data from four South Metropolitan hospitals in Perth, Western Australia (2006-11). Outcomes included 28-day deaths, emergency department (ED) presentations and in-patient re-admissions. There were 8041 eligible index admissions among 5113 individuals, with episode volumes increasing by 31% over the study period. Among patients 25 years and older, the highest ranking comorbidities included injury (47%), drug and alcohol disorders (41%), heart disease (40%), infection (40%), mental illness (31%) and diabetes (31%). Most events (96%) ended in a regular discharge. Within 28 days, 24% of events resulted in ED presentations and 20% resulted in hospital readmissions. Emergency readmissions (13%) were twice as likely as booked re-admissions (7%). Stratified analyses showed poorer outcomes for older people, and for emergency and tertiary hospital admissions. Future planning must address the greater service volumes anticipated. The high prevalence of comorbidities requires intensive case management to address case complexity. These data will inform the refinement of the AHLO program to improve in-patient experiences and outcomes.

Parental Understanding of Hospital Course and Discharge Plan.

PubMed

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.

Leaving the hospital - your discharge plan

MedlinePlus

... 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 ...

An inexact chance-constrained programming model for water quality management in Binhai New Area of Tianjin, China.

PubMed

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.

How IHI Promotes Learning Systems and Knowledge Management

DTIC Science & Technology

2011-01-26

promote social gatherings for individuals with similar age, etc. Early discharge planning 1.Flu/ Influenza -H1N1 Programs 2.Silver Sneakers Shared...Spread Aim: Prevent Ventilator Associated Pneumonia  Spread What: Ventilator Bundle  Target Goals: Zero Cases of VAP  Spread to Whom: All ICUs in

76 FR 66286 - Notice of Final 2010 Effluent Guidelines Program Plan

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-26

... Coalbed Methane Extraction (CBM) industry and will develop pretreatments requirements for discharges of...) industry. EPA is also issuing the detailed study report for the Coalbed Methane Extraction and the... Methane Point Source Category: Detailed Study Report, EPA-820-R-10-022, DCN 09999; Draft Guidance Document...

From Hospital to School: How a Transition Liaison Can Help.

ERIC Educational Resources Information Center

Stuart, Judy L.; Goodsitt, Jodi L.

1996-01-01

The role of the transition liaison professional, who is knowledgeable in medical terminology, hospital procedures, and educational/community services for helping children with chronic illnesses, is explained. Discussion covers effects of recent laws, the need for a formal discharge program and planning model, and the many functions of the…

Geriatric hip fracture management: keys to providing a successful program.

PubMed

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.

CMS proposes prioritizing patient preferences, linking patients to follow-up care in discharge planning process.

PubMed

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.

Water-quality assessment of south-central Texas: Occurrence and distribution of volatile organic compounds in surface water and ground water, 1983-94, and implications for future monitoring

USGS Publications Warehouse

Ging, P.B.; Judd, L.J.; Wynn, K.H.

1997-01-01

The study area of the South-Central Texas study unit of the National Water-Quality Assessment Program comprises the Edwards aquifer in the San Antonio region and its catchment area. The first phase of the assessment includes evaluation of existing water-quality data for surface water and ground water, including volatile organic compounds, to determine the scope of planned monitoring. Most analyses of volatile organic compounds in surface water are from the National Pollutant Discharge Elimination System sites in San Antonio, Texas. Nine volatile organic compounds were detected at the six sites. The three compounds with the most detections at National Pollutant Discharge Elimination System sites are 1,2,4-trimethylbenzene, toluene, and xylene. Analysis of volatile organic compounds in ground water was limited to Edwards aquifer wells. Twenty-eight volatile organic compounds were detected in samples from 89 wells. The five most commonly detected compounds in samples from wells, in descending order, are tetrachloroethene, trichloroethene, bromoform, chloroform, and dibromochloromethane. Detections of volatile organic compounds in surface water and ground water within the South-Central Texas study area are limited to site-specific sources associated with development; therefore, planned monitoring for possible detections of volatile organic compounds as part of the National Water-Quality Assessment Program will emphasize areas of expanding population and development. Monitoring of volatile organic compounds is planned at National Pollutant Discharge Elimination System sites, at basic fixed surface-water sites, and in the ground-water study-unit surveys.

Discharge planning in mental health care: an integrative review of the literature.

PubMed

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.

Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis.

PubMed

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.

Framework and components for effective discharge planning system: a delphi methodology

PubMed Central

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

ALS liquid hydrogen turbopump: Advanced Development Program

NASA Technical Reports Server (NTRS)

Shimp, Nancy R.; Claffy, George J.

1989-01-01

The point of departure (POD) turbopump concept was reviewed and finalized. The basis for the POD was the configuration presented in the Aerojet proposal. After reviewing this proposal concept, several modifications were made. These modifications include the following: (1) the dual pump discharge arrangement was changed to a single discharge; (2) commonality of the turbine inlet manifold with the advanced launch system (ALS) liquid oxygen (LOX) TPA was dropped for this program; (3) the turbine housing flange arrangement was improved by relocating it away from the first stage nozzles; (4) a ten percent margin (five percent diameter increase) was built into the impeller design to ensure meeting the required discharge pressure without the need for increasing speed; (5) a ten percent turbine power margin was imposed which is to be obtained by increasing turbine inlet pressure if required; and (6) the backup concept, as an alternative to the use of cast impellers, now incorporates forged/machined shrouded impellers, rather than the unshrouded type originally planned.

[From the asylums to the community: the reform process of National Colony "Dr. Manuel A. Montes de Oca"].

PubMed

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.

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...

Early exercise-based rehabilitation improves health-related quality of life and functional capacity after acute myocardial infarction: a randomized controlled trial.

PubMed

Peixoto, Thatiana C A; Begot, Isis; Bolzan, Douglas W; Machado, Lais; Reis, Michel S; Papa, Valeria; Carvalho, Antonio C C; Arena, Ross; Gomes, Walter J; Guizilini, Solange

2015-03-01

The purpose of this study was to evaluate the influence of an early cardiac rehabilitation (CR) program on health-related quality of life (HRQL) and functional capacity in patients who recently experienced an acute myocardial infarction (AMI). This program was initiated in the inpatient setting and was followed by an unsupervised outpatient intervention. After the same inpatient care plan, low-risk patients who experienced an AMI were randomized into 2 groups: (1) a control group (CG) (n = 43) entailing usual care and (2) an intervention group (IG) (n = 45) entailing outpatient (unsupervised) CR primarily centered on a progressive walking program. Initially, all patients underwent a supervised exercise program with early mobilization beginning 12 hours after an AMI. On hospital discharge, all patients were classified according to cardiovascular risk. Quality of life was evaluated by the MacNew Heart Disease HRQL questionnaire 30 days after discharge. Functional capacity was determined by a 6-minute walk test (6MWT) distance on the day of inpatient discharge as well as 30 days afterward. The HRQL global score was higher in the IG compared with the CG 30 days after discharge (P < 0.001); physical and emotional domain scores were both significantly higher in the IG (P < 0.001). Furthermore, the IG showed a greater 6MWT distance compared with the CG (P < 0.001). A CR program based on early progressive exercises, initiated by supervised inpatient training and followed by an unsupervised outpatient program, improved HRQL and functional capacity in patients at low cardiovascular risk who recently experienced an AMI. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Spill Prevention and Countermeasures Plan

DTIC Science & Technology

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

Water-resources investigations in Wisconsin: Programs and activities of the U.S. Geological Survey, 1991-92

USGS Publications Warehouse

Maertz, D.E.

1992-01-01

OBJECTIVE: The objectives of this study are to provide continuous discharge records for selected rivers at specific sites to supply the needs for: regulation, analytical studies, definition of statistical properties, trends analysis, determination of the occurrence, and distribution of water in streams for planning. The project is also designed to determine lake levels and to provide discharge for floods, low-flow conditions, and for water-quality investigations. Requests for streamflow data and information relating to streamflow in Wisconsin are answered. Basic data are published annually in "Water Resources Data Wisconsin."

Evaluating the Impact of Dental Care on Housing Intervention Program Outcomes Among Homeless Veterans

PubMed Central

Nunez, Elizabeth; Gibson, Gretchen; Jones, Judith A.; Schinka, John A.

2013-01-01

Objectives. In this retrospective longitudinal cohort study, we examined the impact of dental care on outcomes among homeless veterans discharged from a Department of Veterans Affairs (VA) transitional housing intervention program. Methods. Our sample consisted of 9870 veterans who were admitted into a VA homeless intervention program during 2008 and 2009, 4482 of whom received dental care during treatment and 5388 of whom did not. Primary outcomes of interest were program completion, employment or stable financial status on discharge, and transition to permanent housing. We calculated descriptive statistics and compared the 2 study groups with respect to demographic characteristics, medical and psychiatric history (including alcohol and substance use), work and financial support, and treatment outcomes. Results. Veterans who received dental care were 30% more likely than those who did not to complete the program, 14% more likely to be employed or financially stable, and 15% more likely to have obtained residential housing. Conclusions. Provision of dental care has a substantial positive impact on outcomes among homeless veterans participating in housing intervention programs. This suggests that homeless programs need to weigh the benefits and cost of dental care in program planning and implementation. PMID:23678921

Shortened lengths of stay: ensuring continuity of care for mothers and babies.

PubMed

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.

Evaluating hospital discharge planning: a randomized clinical trial.

PubMed

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.

Improving Hospital Discharge Planning for Elderly Patients

PubMed Central

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

Motivational aftercare planning to better care: Applying the principles of advanced directives and motivational interviewing to discharge planning for people with mental illness.

PubMed

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.

The impact of discharge plan upon re-admission, satisfaction with nursing care and the ability to self-care for coronary artery bypass graft surgery patients.

PubMed

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.

Aggregation of Minnesota water-use data and transfer of data to the National Water-Use Data System; Procedures and programs

USGS Publications Warehouse

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.

Discharge planning for heart failure patients in a tertiary hospital in Shanghai: a best practice implementation project.

PubMed

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.

Effectiveness of Needs-oriented Hospital Discharge Planning for Caregivers of Patients With Schizophrenia.

PubMed

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.

Illuminating hospital discharge planning: staff nurse decision making.

PubMed

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.

Joint Planning Of Energy Storage and Transmission Considering Wind-Storage Combined System and Demand Side Response

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.

The coach program - a "joint" approach to patient education and support.

PubMed

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.

Slope-Area Computation Program Graphical User Interface 1.0—A Preprocessing and Postprocessing Tool for Estimating Peak Flood Discharge Using the Slope-Area Method

USGS Publications Warehouse

Bradley, D. Nathan

2012-01-01

The slope-area method is a technique for estimating the peak discharge of a flood after the water has receded (Dalrymple and Benson, 1967). This type of discharge estimate is called an “indirect measurement” because it relies on evidence left behind by the flood, such as high-water marks (HWMs) on trees or buildings. These indicators of flood stage are combined with measurements of the cross-sectional geometry of the stream, estimates of channel roughness, and a mathematical model that balances the total energy of the flow between cross sections. This is in contrast to a “direct” measurement of discharge during the flood where cross-sectional area is measured and a current meter or acoustic equipment is used to measure the water velocity. When a direct discharge measurement cannot be made at a gage during high flows because of logistics or safety reasons, an indirect measurement of a peak discharge is useful for defining the high-flow section of the stage-discharge relation (rating curve) at the stream gage, resulting in more accurate computation of high flows. The Slope-Area Computation program (SAC; Fulford, 1994) is an implementation of the slope-area method that computes a peak-discharge estimate from inputs of water-surface slope (from surveyed HWMs), channel geometry, and estimated channel roughness. SAC is a command line program written in Fortran that reads input data from a formatted text file and prints results to another formatted text file. Preparing the input file can be time-consuming and prone to errors. This document describes the SAC graphical user interface (GUI), a crossplatform “wrapper” application that prepares the SAC input file, executes the program, and helps the user interpret the output. The SAC GUI is an update and enhancement of the slope-area method (SAM; Hortness, 2004; Berenbrock, 1996), an earlier spreadsheet tool used to aid field personnel in the completion of a slope-area measurement. The SAC GUI reads survey data, develops a plan-view plot, water-surface profile, cross-section plots, and develops the SAC input file. The SAC GUI also develops HEC-2 files that can be imported into HEC–RAS.

Multiple perceptions of discharge planning in one urban hospital.

PubMed

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.

Challenges in Patient Discharge Planning in the Health System of Iran: A Qualitative Study

PubMed Central

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

Design and Hospital-Wide Implementation of a Standardized Discharge Summary in an Electronic Health Record

PubMed Central

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

Incarcerated Veterans Outreach Program.

PubMed

Schaffer, Bradley J

2016-01-01

The objective of this study is to identify and facilitate re-entry services for military veterans in the Criminal Justice System through the Incarcerated Veteran Outreach Program. Veterans are explored as a subgroup of the general inmate jail populations in southern Ohio based upon veteran's status, military discharges, service-related injuries, treatment needs, pre-release planning, and re-entry services. Veterans reported having psycho-social problems, diverse levels of criminality, criminogenic needs, and significant episodes of homelessness. A sample of 399 incarcerated veterans in state prison, county jails, and community corrections setting were identified and completed the psycho-social pre-release assessment. Their average age was 44.6; they were more likely to be White males, divorced, most honorably discharged, and were represented in the following eras: 34% Vietnam, 35% post-Vietnam, 26% Persian Gulf War, and 5% Operation Iraqi Freedom/Operation Enduring Freedom. The findings encourage the development of a re-entry outreach model and strategies to prevent episodes of criminal recidivism.

Thinking about the patient's wishes: practical wisdom of discharge planning nurses in assisting surrogate decision-making.

PubMed

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.

Discharge planning for a patient with a new ostomy: best practice for clinicians.

PubMed

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.

Integrating Smartphone Technology at the Time of Discharge from a Child and Adolescent Inpatient Psychiatry Unit

PubMed Central

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

Tubal ligation - discharge

MedlinePlus

... 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 ...

Water-quality, bed-sediment, and discharge data for the Mississippi River-Gulf Outlet and adjacent waterways, southeastern Louisiana, August 2008 through December 2009

USGS Publications Warehouse

Swarzenski, Christopher M.; Mize, Scott V.; Lovelace, John K.

2012-01-01

The Mississippi River-Gulf Outlet navigation channel (MRGO) was constructed in the early 1960s to provide a safer and shorter route between the Gulf of Mexico and the Port of New Orleans for deep-draft, ocean-going vessels and to promote the economic development of the Port of New Orleans. In 2006, the U.S. Army Corps of Engineers developed a plan to de-authorize the MRGO. The plan called for a rock barrier to be constructed across the MRGO near Bayou La Loutre. In 2008, the U.S. Geological Survey, in cooperation with the Louisiana Coastal Area Science and Technology Program began a study to document the impacts of the rock barrier on water-quality and flow before, during, and after its construction. Water-quality, bed-sediment, and discharge data were collected in the MRGO and adjacent water bodies from August 2008 through December 2009.

Patient participation in discharge planning conference

PubMed Central

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

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...

A randomized trial testing the superiority of a post-discharge care management model for stroke survivors

PubMed Central

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

Outcomes for family carers of a nurse-delivered hospital discharge intervention for older people (the Further Enabling Care at Home Program): Single blind randomised controlled trial.

PubMed

Toye, Christine; Parsons, Richard; Slatyer, Susan; Aoun, Samar M; Moorin, Rachael; Osseiran-Moisson, Rebecca; Hill, Keith D

2016-12-01

Hospital discharge of older people receiving care at home offers a salient opportunity to identify and address their family caregivers' self-identified support needs. This study tested the hypothesis that the extent to which family caregivers of older people discharged home from hospital felt prepared to provide care at home would be positively influenced by their inclusion in the new Further Enabling Care at Home program. This single-blind randomised controlled trial compared outcomes from usual care alone with those from usual care plus the new program. The program, delivered by a specially trained nurse over the telephone, included: support to facilitate understanding of the patient's discharge letter; caregiver support needs assessment; caregiver prioritisation of urgent needs; and collaborative guidance, from the nurse, regarding accessing supports. Dyads were recruited from the medical assessment unit of a Western Australian metropolitan public hospital. Each dyad comprised a patient aged 70 years or older plus an English speaking family caregiver. The primary outcome was the caregiver's self-reported preparedness to provide care for the patient. Data collection time points were designated as: Time 1, within four days of discharge; Time 2, 15-21days after discharge; Time 3, six weeks after discharge. Other measures included caregivers' ratings of: their health, patients' symptoms and independence, caregiver strain, family well-being, caregiver stress, and positive appraisals of caregiving. Data were collected by telephone. Complete data sets were obtained from 62 intervention group caregivers and 79 controls. Groups were equivalent at baseline. Needs prioritised most often by caregivers were: to know whom to contact and what to expect in the future and to access practical help at home. Support guidance included how to: access help, information, and resources; develop crisis plans; obtain referrals and services; and organise legal requirements. Compared to controls, preparedness to care improved in the intervention group from Time 1 to Time 2 (effect size=0.52; p=0.006) and from Time 1 to Time 3 (effect size=0.43; p=0.019). These improvements corresponded to a change of approximately 2 points on the Preparedness for Caregiving instrument. Small but significant positive impacts were also observed in other outcomes, including caregiver strain. These unequivocal findings provide a basis for considering the Furthering Enabling Care at Home program's implementation in this and other similar settings. Further testing is required to determine the generalisability of results. Copyright © 2016 Elsevier Ltd. All rights reserved.

Implementing the NPDES program: An update on the WET ...

EPA Pesticide Factsheets

The U.S. EPA has utilized the Clean Water Act - National Pollutant Discharge Elimination System permitting program to protect waters of the U.S for over 40 years. NPDES permit effluent limitations serve as the primary mechanism for controlling discharges of pollutants to receiving waters. When developing effluent limitations for an NPDES permit, a permit writer must consider limits based on both the technology available to control the pollutants (i.e., technology-based effluent limits) and limits that are protective of the water quality standards of the receiving water (i.e., water quality-based effluent limits). WET testing is one of the water quality-based effluent limitation mechanisms available to permit writers that is useful in determining how the additive, synergistic and compounding effects of toxic effluents effect streams. This presentation will provide an overview of the current EPA NPDES permit program direction for increasing the efficacy of NPDES permits program administered by the U.S. EPA and States. The training implementation plan is expected to provide permit writers with a clearer understanding of WET requirements as established via the U.S. EPA WET test manuals, NPDES permitting regulatory authorities, and the WET science which has been long established. not applicable

The Electric Vehicle Alternative.

DTIC Science & Technology

1981-06-01

7 qc, LIST OF TABLES Table Page 2-1 AIR TRAINING COMMAND EV DEMONSTRATION PROGRAM 30 3-1 COMPUTATION FOR DERIVATION OF THE COMBINED RELIABILITY...batteries wear out quickly be- cause the zinc they use gets dissapated in their charging/discharging cycle. GM plans to have such problems solved by 1985...with how the G & W battery controls the release of poi- sonous chlorine gas in the case of an accident.. Unlike the lead-acid battery, the zinc

AE activity during transient beta drops in high poloidal beta discharges

NASA Astrophysics Data System (ADS)

Huang, J.; Gong, X. Z.; Ren, Q. L.; Ding, S. Y.; Qian, J. P.; Pan, C. K.; Li, G. Q.; Heidbrink, W. W.; Garofalo, A. M.; McClenaghan, J.

2016-10-01

Enhanced AE activity has been observed during transient beta drops in high poloidal beta DIII-D discharges with internal transport barriers (ITBs). These drops in beta are believed to be caused by n=1 external kink modes. In some discharges, beta recovers within 200 ms but, in others, beta stays suppressed. A typical discharge has βP 3, qmin 3, and q95 12. The drop in beta affects both fast ions and thermal particles, and a drop is also observed in the density and rotation. The enhanced AE activity follows the instability that causes the beta drop, is largest at the lowest beta, and subsides as beta recovers. MHD stability analysis is planned. A database study of the plasma conditions associated with the collapse will be also presented. Supported in part by the US Department of Energy under DE-FC02-04ER54698, DE-AC05-06OR23100, and by the National Natural Science Foundation of China 11575249, and the National Magnetic Confinement Fusion Program of China No. 2015GB110005.

Preventing readmissions through comprehensive discharge planning.

PubMed

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.

[Redesigning the hospital discharge process].

PubMed

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.

A scoping review of patient discharge from intensive care: opportunities and tools to improve care.

PubMed

Stelfox, Henry T; Lane, Dan; Boyd, Jamie M; Taylor, Simon; Perrier, Laure; Straus, Sharon; Zygun, David; Zuege, Danny J

2015-02-01

We conducted a scoping review to systematically review the literature reporting patient discharge from ICUs, identify facilitators and barriers to high-quality care, and describe tools developed to improve care. We searched Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials. Data were extracted on the article type, study details for research articles, patient population, phase of care during discharge, and dimensions of health-care quality. From 8,154 unique publications we included 224 articles. Of these, 131 articles (58%) were original research, predominantly case series (23%) and cohort (16%) studies; 12% were narrative reviews; and 11% were guidelines/policies. Common themes included patient and family needs/experiences (29% of articles) and the importance of complete and accurate information (26%). Facilitators of high-quality care included provider-patient communication (30%), provider-provider communication (25%), and the use of guidelines/policies (29%). Patient and family anxiety (21%) and limited availability of ICU and ward resources (26%) were reported barriers to high-quality care. A total of 47 tools to facilitate patient discharge from the ICU were identified and focused on patient evaluation for discharge (29%), discharge planning and teaching (47%), and optimized discharge summaries (23%). Common themes, facilitators and barriers related to patient and family needs/experiences, communication, and the use of guidelines/policies to standardize patient discharge from ICU transcend the literature. Candidate tools to improve care are available; comparative evaluation is needed prior to broad implementation and could be tested through local quality-improvement programs.

Effectiveness of emergency response planning for sudden cardiac arrest in United States high schools with automated external defibrillators.

PubMed

Drezner, Jonathan A; Rao, Ashwin L; Heistand, Justin; Bloomingdale, Megan K; Harmon, Kimberly G

2009-08-11

US high schools are increasingly adopting automated external defibrillators (AEDs) for use in campus settings. We analyzed the effectiveness of emergency response planning for sudden cardiac arrest (SCA) in a large cohort of US high schools that had onsite AED programs. A cohort of US high schools with at least 1 onsite AED was identified from the National Registry for AED Use in Sports. A school representative completed a comprehensive survey on emergency planning and provided details of any SCA incident occurring within 6 months of survey completion. Surveys were completed between December 2006 and July 2007. In total, 1710 high schools with an onsite AED program were studied. Although 83% (1428 of 1710) of schools have an established emergency response plan for SCA, only 40% practice and review the plan at least annually with potential school responders. A case of SCA was reported by 36 of 1710 schools (2.1%). The 36 SCA victims included 14 high school student athletes (mean age, 16 years; range, 14 to 17 years) and 22 older nonstudents (mean age, 57 years; range, 42 to 71 years) such as employees and spectators. No cases were reported in student nonathletes. Of the 36 SCA cases, 35 (97%) were witnessed, 34 (94%) received bystander cardiopulmonary resuscitation, and 30 (83%) received an AED shock. Twenty-three SCA victims (64%) survived to hospital discharge, including 9 of the 14 student athletes and 14 of the 22 older nonstudents. School-based AED programs provide a high survival rate for both student athletes and older nonstudents who suffer SCA on school grounds. High schools are strongly encouraged to implement onsite AED programs as part of a comprehensive emergency response plan to SCA.

Hospital Discharge Planning: A Guide for Families and Caregivers

MedlinePlus

... 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 ...

Results of Boron, Surfactant, and Cyanide Investigation, Beale AFB, California

DTIC Science & Technology

1991-07-01

ensure that their discharge does not produce instream toxicity. The Discharger shall carry-out the biotoxicity monitoring program in accordance with...Discharger shall implement the approved biotoxicity monitoring program. d. The Discharger shall submit the results of the biotoxicity monitoring program to

Proportion and Patterns of Hospice Discharges in Medicare Advantage Compared to Medicare Fee-for-Service.

PubMed

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.

Nationwide summary of US Geological Survey regional regression equations for estimating magnitude and frequency of floods for ungaged sites, 1993

USGS Publications Warehouse

Jennings, M.E.; Thomas, W.O.; Riggs, H.C.

1994-01-01

For many years, the U.S. Geological Survey (USGS) has been involved in the development of regional regression equations for estimating flood magnitude and frequency at ungaged sites. These regression equations are used to transfer flood characteristics from gaged to ungaged sites through the use of watershed and climatic characteristics as explanatory or predictor variables. Generally these equations have been developed on a statewide or metropolitan area basis as part of cooperative study programs with specific State Departments of Transportation or specific cities. The USGS, in cooperation with the Federal Highway Administration and the Federal Emergency Management Agency, has compiled all the current (as of September 1993) statewide and metropolitan area regression equations into a micro-computer program titled the National Flood Frequency Program.This program includes regression equations for estimating flood-peak discharges and techniques for estimating a typical flood hydrograph for a given recurrence interval peak discharge for unregulated rural and urban watersheds. These techniques should be useful to engineers and hydrologists for planning and design applications. This report summarizes the statewide regression equations for rural watersheds in each State, summarizes the applicable metropolitan area or statewide regression equations for urban watersheds, describes the National Flood Frequency Program for making these computations, and provides much of the reference information on the extrapolation variables needed to run the program.

Postabortion Care: 20 Years of Strong Evidence on Emergency Treatment, Family Planning, and Other Programming Components

PubMed Central

Huber, Douglas; Curtis, Carolyn; Irani, Laili; Pappa, Sara; Arrington, Lauren

2016-01-01

ABSTRACT Worldwide 75 million women need postabortion care (PAC) services each year following safe or unsafe induced abortions and miscarriages. We reviewed more than 550 studies on PAC published between 1994 and 2013 in the peer-reviewed and gray literature, covering emergency treatment, postabortion family planning, organization of services, and related topics that impact practices and health outcomes, particularly in the Global South. In this article, we present findings from studies with strong evidence that have major implications for programs and practice. For example, vacuum aspiration reduced morbidity, costs, and time in comparison to sharp curettage. Misoprostol 400 mcg sublingually or 600 mcg orally achieved 89% to 99% complete evacuation rates within 2 weeks in multiple studies and was comparable in effectiveness, safety, and acceptability to manual vacuum aspiration. Misoprostol was safely introduced in several PAC programs through mid-level providers, extending services to secondary hospitals and primary health centers. In multiple studies, postabortion family planning uptake before discharge increased by 30–70 percentage points within 1–3 years of strengthening postabortion family planning services; in some cases, increases up to 60 percentage points in 4 months were achieved. Immediate postabortion contraceptive acceptance increased on average from 32% before the interventions to 69% post-intervention. Several studies found that women receiving immediate postabortion intrauterine devices and implants had fewer unintended pregnancies and repeat abortions than those who were offered delayed insertions. Postabortion family planning is endorsed by the professional organizations of obstetricians/gynecologists, midwives, and nurses as a standard of practice; major donors agree, and governments should be encouraged to provide universal access to postabortion family planning. Important program recommendations include offering all postabortion women family planning counseling and services before leaving the facility, especially because fertility returns rapidly (within 2 to 3 weeks); postabortion family planning services can be quickly replicated to multiple sites with high acceptance rates. Voluntary family planning uptake by method should always be monitored to document program and provider performance. In addition, vacuum aspiration and misoprostol should replace sharp curettage to treat incomplete abortion for women who meet eligibility criteria. PMID:27571343

An Audit of Nursing Documentation at Three Public Hospitals in Jamaica.

PubMed

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.

Early Discharge and Home Care After Unplanned Cesarean Birth: Nursing Care Time

PubMed Central

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

Early Discharge Planning and Improved Care Transitions: Pre-Admission Assessment for Readmission Risk in an Elective Orthopedic and Cardiovascular Surgical Population

PubMed Central

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

School reintegration.

PubMed

Blakeney, P

1995-01-01

School reintegration programs have been developed to enhance a positive sense of self-worth in a child who has been burned. The premise of these programs is that cognitive and affective education about children with burns will diminish the anxiety of the patient with burns, the patient's family, faculty and staff of the school, and the students. Five principles guide school reentry programs: (1) preparation begins as soon as possible; (2) planning includes the patient and family; (3) each program is individualized; (4) each patient is encouraged to return to school quickly after hospital discharge; and (5) burn team professionals remain available for consultation to the school. Reintegration programs can vary in format depending on patient and/or family need and capability of the burn team, thus allowing flexibility in assisting every child with burns make the transition from hospital patient to normal living.

When can I go home? A prospective case control study to improve communication with patients regarding their diagnosis, treatment plan and likely discharge date.

PubMed

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.

Geriatric Hip Fracture Care: Fixing a Fragmented System.

PubMed

Anderson, Mary E; Mcdevitt, Kelly; Cumbler, Ethan; Bennett, Heather; Robison, Zachary; Gomez, Bryan; Stoneback, Jason W

2017-01-01

Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners. To describe a stepwise approach to systems redesign for this patient population. We designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning. Hospital length of stay. We identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved. Our comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system.

A case-mix in-service education program.

PubMed

Arons, R R

1985-01-01

The new case-mix in-service education program at the Presbyterian Hospital in the City of New York is a fine example of physicians and administration working together to achieve success under the new prospective pricing system. The hospital's office of Case-Mix Studies has developed an accurate computer-based information system with historical, clinical, and demographic data for patients discharged from the hospital over the past five years. Reports regarding the cases, diagnoses, finances, and characteristics are shared in meetings with the hospital administration and directors of sixteen clinical departments, their staff, attending physicians, and house officers in training. The informative case-mix reports provide revealing sociodemographic summaries and have proven to be an invaluable tool for planning, marketing, and program evaluation.

NPDES (National Pollution Discharge & Elimination System) Minor Dischargers

EPA Pesticide Factsheets

As authorized by the Clean Water Act, the National Pollutant Discharge Elimination System (NPDES) permit program controls water pollution by regulating point sources that discharge pollutants into waters of the United States. The NPDES permit program regulates direct discharges from municipal and industrial wastewater treatment facilities that discharge directly into surface waters. The NPDES permit program is part of the Permit Compliance System (PCS) which issues, records, tracks, and regulates point source discharge facilities. Individual homes that are connected to a municipal system, use a septic system, or do not have a surface discharge do not need an NPDES permit. Facilities in PCS are identified as either major or minor. Within the major/minor classification, facilities are grouped into municipals or non-municipals. In many cases, non-municipals are industrial facilities. This data layer contains Minor dischargers. Major municipal dischargers include all facilities with design flows of greater than one million gallons per day; minor dischargers are less that one million gallons per day. Essentially, a minor discharger does not meet the discharge criteria for a major. Since its introduction in 1972, the NPDES permit program is responsible for significant improvements to our Nation's water quality.

Improving discharge planning communication between hospitals and patients.

PubMed

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.

77 FR 58830 - State Program Requirements; Application To Administer Partial National Pollutant Discharge...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-24

... Pollutant Discharge Elimination System (AgPDES) program pursuant to Section 402(b) of the Clean Water Act... Discharge Elimination System (NPDES) permit program under Section 402(n)(3) of the Act for all discharges of... through Friday, excluding legal holidays, at EPA Region 6, 1445 Ross Ave., Dallas, Texas 75202. A copy of...

Physical Therapists Make Accurate and Appropriate Discharge Recommendations for Patients Who Are Acutely Ill

PubMed Central

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

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...

[Integration of the nursing process in the electronic health record in an university hospital].

PubMed

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.

Fluid Management Plan for Corrective Action Unit 447: Project Shoal Area, Subsurface, Nevada, Rev. No.: 1

DOE Office of Scientific and Technical Information (OSTI.GOV)

Findlay, Rick

The U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO) initiated the Offsites Project to characterize the risk posed to human health and the environment as a result of testing at formerly used nuclear sites in Alaska, Colorado, Mississippi, Nevada, and New Mexico. The scope of this Fluid Management Plan (FMP) is to support the subsurface investigation at the Project Shoal Area (PSA) Corrective Action Unit (CAU) 447, Shoal - Subsurface, Nevada, in accordance with the ''Federal Facility Agreement and Consent Order'' (FFACO) (1996). Corrective Action Unit 447 is located in the Sand Spring Range, southmore » of Highway 50, about 39 miles southeast of Fallon, Nevada. (Figure 1-1). This FMP will be used at the PSA in lieu of an individual discharge permit for each well or a general water pollution control permit for management of all fluids produced during the drilling, construction, development, testing, experimentation, and/or sampling of wells conducted by the Offsites Project. The FMP provides guidance for the management of fluids generated during investigation activities and provides the standards by which fluids may be discharged on site. Although the Nevada Division of Environmental Protection (NDEP), Bureau of Federal Facilities (BoFF) is not a signatory to this FMP, it is involved in the negotiation of the contents of this plan and approves the conditions contained within. The major elements of this FMP include: (1) establishment of a well-site operations strategy; (2) site design/layout; (3) monitoring of contamination indicators (monitoring program); (4) sump characterization (sump sampling program); (5) fluid management decision criteria and fluid disposition; and (6) reporting requirements.« less

Fluid Management Plan for Corrective Action Unit 447: Project Shoal Area, Subsurface, Nevada, Rev. No.: 1 with ROTC 1 and Errata Sheet

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tim Echelard

The U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO) initiated the Offsites Project to characterize the risk posed to human health and the environment as a result of testing at formerly used nuclear sites in Alaska, Colorado, Mississippi, Nevada, and New Mexico. The scope of this Fluid Management Plan (FMP) is to support the subsurface investigation at the Project Shoal Area (PSA) Corrective Action Unit (CAU) 447, Shoal-Subsurface, Nevada, in accordance with the ''Federal Facility Agreement and Consent Order'' (FFACO) (1996). Corrective Action Unit 447 is located in the Sand Spring Range, south of Highwaymore » 50, about 39 miles southeast of Fallon, Nevada. (Figure 1-1). This FMP will be used at the PSA in lieu of an individual discharge permit for each well or a general water pollution control permit for management of all fluids produced during the drilling, construction, development, testing, experimentation, and/or sampling of wells conducted by the Offsites Project. The FMP provides guidance for the management of fluids generated during investigation activities and provides the standards by which fluids may be discharged on site. Although the Nevada Division of Environmental Protection (NDEP), Bureau of Federal Facilities (BoFF) is not a signatory to this FMP, it is involved in the negotiation of the contents of this plan and approves the conditions contained within. The major elements of this FMP include: (1) establishment of a well-site operations strategy; (2) site design/layout; (3) monitoring of contamination indicators (monitoring program); (4) sump characterization (sump sampling program); (5) fluid management decision criteria and fluid disposition; and (6) reporting requirements.« less

S. 986: A Bill to require Federal review and approval of oil discharge contingency plans, and for other purposes. Introduced in the Senate of the United States, One Hundred First Congress, First Session, May 12, 1989

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

Improving discharge care: the potential of a new organisational intervention to improve discharge after hospitalisation for acute stroke, a controlled before-after pilot study.

PubMed

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.

Project RED Impacts Patient Experience.

PubMed

Cancino, Ramon S; Manasseh, Chris; Kwong, Lana; Mitchell, Suzanne E; Martin, Jessica; Jack, Brian W

2017-12-01

Hospitalized patients are frequently unprepared to care for themselves after discharge often leading to unplanned hospital readmission. One strategy to reduce readmission rates is improving the quality of patient education and preparation before hospital discharge. The ReEngineered Discharge (RED) is a standardized hospital-based program designed to provide patients and caregivers the information they need to continue care at home. We sought to study the impact of the RED intervention on posthospitalization adult patient experience scores in an urban academic safety-net hospital. We conducted a descriptive study of a pilot program that compared posthospitalization survey responses to the Press Ganey survey item "Instructions were given about how to care for yourself at home." We compared the survey results for 3 groups of adult patients: those receiving the RED program, those receiving a standard discharge on the same hospital unit, and those receiving a standard discharge on other hospital units. A greater percentage of adult patients who received the RED discharge program rated the quality of their discharge as "very good" as compared to those receiving a standard discharge on the same hospital unit and those receiving a standard discharge on other hospital units (61%, 35%, and 41%, respectively, P = .0001). Delivery of a standardized hospital discharge program resulted in a larger proportion of top-box "very good" responses on a Press Ganey posthospitalization survey. Future research should examine whether hospital-based transition programs can sustain improvement in patient experience measures and whether these improvements can be observed in other patient populations.

A hospital discharge summary quality improvement program featuring individual and team-based feedback and academic detailing.

PubMed

Axon, Robert N; Penney, Fletcher T; Kyle, Thomas R; Zapka, Jane; Marsden, Justin; Zhao, Yumin; Mauldin, Patrick D; Moran, William P

2014-06-01

Discharge summaries are an important component of hospital care transitions typically completed by interns in teaching hospitals. However, these documents are often not completed in a timely fashion or do not include pertinent details of hospitalization. This report outlines the development and impact of a curriculum intervention to improve the quality of discharge summaries by interns and residents in Internal Medicine. A previous study demonstrated that a discharge summary curriculum featuring individualized feedback was associated with improved summary quality, but few subsequent studies have described implementation of similar curricula. No information exists on the utility of other strategies such as team-based feedback or academic detailing. Study participants were 96 Internal Medicine intern and resident physicians at an academic medical center-based training program. A comprehensive evidence-based discharge summary quality improvement program was developed and implemented that featured a discharge summary template to facilitate summary preparation, individual feedback, team-based feedback, academic detailing and an objective discharge summary evaluation instrument. The discharge summary evaluation instrument had moderate interrater reliability (κ = 0.72). Discharge summary scores improved from mean score of 70% to 82% (P = 0.05). Interns and residents participating in this program also reported increased confidence in producing and critiquing summaries. A comprehensive discharge summary curriculum can be feasibly implemented within the context of a residency program. Team-based feedback and academic detailing may serve to reinforce individual feedback and extend program reach.

Improving Chronic Disease Self-Management by Older Home Health Patients through Community Health Coaching

PubMed Central

Willoughby, Deborah; Aybar-Damali, Begum; Grady, Carmelita; Oran, Rebecca; Knudson, Alana

2018-01-01

The purpose of the study was to pilot test a model to reduce hospital readmissions and emergency department use of rural, older adults with chronic diseases discharged from home health services (HHS) through the use of volunteers. The study’s priority population consistently experiences poorer health outcomes than their urban counterparts due in part to lower socioeconomic status, reduced access to health services, and incidence of chronic diseases. When they are hospitalized for complications due to poorly managed chronic diseases, they are frequently readmitted for the same conditions. This pilot study examines the use of volunteer community members who were trained as Health Coaches to mentor discharged HHS patients in following the self-care plan developed by their HHS RN; improving chronic disease self-management behaviors; reducing risk of falls, pneumonia, and flu; and accessing community resources. Program participants increased their ability to monitor and track their chronic health conditions, make positive lifestyle changes, and reduce incidents of falls, pneumonia and flu. Although differences in the ED and hospital admission rates after discharge from HHS between the treatment and comparison group (matched for gender, age, and chronic condition) were not statistically significant, the treatment group’s rate was less than the comparison group thus suggesting a promising impact of the HC program (90 day: 263 comparison vs. 129 treatment; p = 0.65; 180 day 666.67 vs. 290.32; p = 0.19). The community health coach model offers a potential approach for improving the ability of discharged older home health patients to manage chronic conditions and ultimately reduce emergent care. PMID:29614803

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.

A Reengineered Hospital Discharge Program to Decrease Rehospitalization

PubMed Central

Jack, Brian W.; Chetty, Veerappa K.; Anthony, David; Greenwald, Jeffrey L.; Sanchez, Gail M.; Johnson, Anna E.; Forsythe, Shaula R.; O'Donnell, Julie K.; Paasche-Orlow, Michael K.; Manasseh, Christopher; Martin, Stephen; Culpepper, Larry

2009-01-01

Background: Emergency department visits and rehospitalization are common after hospital discharge. Objective: To test the effects of an intervention designed to minimize hospital utilization after discharge. Design: Randomized trial using block randomization of 6 and 8. Randomly arranged index cards were placed in opaque envelopes labeled consecutively with study numbers, and participants were assigned a study group by revealing the index card. Setting: General medical service at an urban, academic, safety-net hospital. Patients: 749 English-speaking hospitalized adults (mean age, 49.9 years). Intervention: A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment. Measurements: Primary outcomes were emergency department visits and hospitalizations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers′ follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment. Results: Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care (n = 368) (0.314 vs. 0.451 visit per person per month; incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]; P = 0.009). The intervention was most effective among participants with hospital utilization in the 6 months before index admission (P = 0.014). Adverse events were not assessed; these data were collected but are still being analyzed. Limitation: This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome assessment sometimes relied on participant report. Conclusion: A package of discharge services reduced hospital utilization within 30 days of discharge. PMID:19189907

[Does the nutritional care plan and report upon discharge under the health care system substitute the nutrition support team summary at patient discharge?].

PubMed

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.

Geriatric Hip Fracture Care: Fixing a Fragmented System

PubMed Central

Anderson, Mary E; McDevitt, Kelly; Cumbler, Ethan; Bennett, Heather; Robison, Zachary; Gomez, Bryan; Stoneback, Jason W

2017-01-01

Context Fragmentation in geriatric hip fracture care is a growing concern because of the aging population. Patients with hip fractures at our institution historically were admitted to multiple different services and units, leading to unnecessary variation in inpatient care. Such inconsistency contributed to delays in surgery, discharge, and functional recovery; hospital-acquired complications; failure to adhere to best practices in osteoporosis management; and poor coordination with outpatient practitioners. Objective To describe a stepwise approach to systems redesign for this patient population. Design We designed and implemented a comprehensive geriatric hip fracture program for patients aged 65 years and older at our academic Medical Center in October 2014. Key interventions included admission of all ward-status patients to the Orthopedics Service with hospitalist comanagement; geographic placement on the Orthopedics Unit; and standardized, evidence-based electronic order sets bundling geriatric best practices and a streamlined workflow for discharge planning. Main Outcome Measures Hospital length of stay. Results We identified 271 admissions among 267 patients between January 1, 2012, and March 31, 2016; of those, 154 were before and 117 were after program implementation. Mean hospital length of stay significantly improved from 6.4 to 5.5 days (p = 0.004). The 30-day all-cause readmission rate and discharge disposition remained stable. The percentage of patients receiving osteoporosis evaluation and treatment increased significantly. The rate of completed 30-day outpatient follow-up also improved. Conclusion Our comprehensive geriatric hip fracture program achieved and sustained gains in the quality and efficiency of care by improving fragmentation in the health care system. PMID:28488991

Twenty-five years of ecological recovery of East Fork Poplar Creek: review of environmental problems and remedial actions.

PubMed

Loar, James M; Stewart, Arthur J; Smith, John G

2011-06-01

In May 1985, a National Pollutant Discharge Elimination System permit was issued for the Department of Energy's Y-12 National Security Complex (Y-12 Complex) in Oak Ridge, Tennessee, USA, allowing discharge of effluents to East Fork Poplar Creek (EFPC). The effluents ranged from large volumes of chlorinated once-through cooling water and cooling tower blow-down to smaller discharges of treated and untreated process wastewaters, which contained a mixture of heavy metals, organics, and nutrients, especially nitrates. As a condition of the permit, a Biological Monitoring and Abatement Program (BMAP) was developed to meet two major objectives: demonstrate that the established effluent limitations were protecting the classified uses of EFPC, and document the ecological effects resulting from implementing a Water Pollution Control Program at the Y-12 Complex. The second objective is the primary focus of the other papers in this special series. This paper provides a history of pollution and the remedial actions that were implemented; describes the geographic setting of the study area; and characterizes the physicochemical attributes of the sampling sites, including changes in stream flow and temperature that occurred during implementation of the BMAP. Most of the actions taken under the Water Pollution Control Program were completed between 1986 and 1998, with as many as four years elapsing between some of the most significant actions. The Water Pollution Control Program included constructing nine new wastewater treatment facilities and implementation of several other pollution-reducing measures, such as a best management practices plan; area-source pollution control management; and various spill-prevention projects. Many of the major actions had readily discernable effects on the chemical and physical conditions of EFPC. As controls on effluents entering the stream were implemented, pollutant concentrations generally declined and, at least initially, the volume of water discharged from the Y-12 Complex declined. This reduction in discharge was of ecological concern and led to implementation of a flow management program for EFPC. Implementing flow management, in turn, led to substantial changes in chemical and physical conditions of the stream: stream discharge nearly doubled and stream temperatures decreased, becoming more similar to those in reference streams. While water quality clearly improved, meeting water quality standards alone does not guarantee protection of a waterbody's biological integrity. Results from studies on the ecological changes stemming from pollution-reduction actions, such as those presented in this series, also are needed to understand how best to restore or protect biological integrity and enhance ecological recovery in stream ecosystems. With a better knowledge of the ecological consequences of their decisions, environmental managers can better evaluate alternative actions and more accurately predict their effects.

Twenty-Five Years of Ecological Recovery of East Fork Poplar Creek: Review of Environmental Problems and Remedial Actions

NASA Astrophysics Data System (ADS)

Loar, James M.; Stewart, Arthur J.; Smith, John G.

2011-06-01

In May 1985, a National Pollutant Discharge Elimination System permit was issued for the Department of Energy's Y-12 National Security Complex (Y-12 Complex) in Oak Ridge, Tennessee, USA, allowing discharge of effluents to East Fork Poplar Creek (EFPC). The effluents ranged from large volumes of chlorinated once-through cooling water and cooling tower blow-down to smaller discharges of treated and untreated process wastewaters, which contained a mixture of heavy metals, organics, and nutrients, especially nitrates. As a condition of the permit, a Biological Monitoring and Abatement Program (BMAP) was developed to meet two major objectives: demonstrate that the established effluent limitations were protecting the classified uses of EFPC, and document the ecological effects resulting from implementing a Water Pollution Control Program at the Y-12 Complex. The second objective is the primary focus of the other papers in this special series. This paper provides a history of pollution and the remedial actions that were implemented; describes the geographic setting of the study area; and characterizes the physicochemical attributes of the sampling sites, including changes in stream flow and temperature that occurred during implementation of the BMAP. Most of the actions taken under the Water Pollution Control Program were completed between 1986 and 1998, with as many as four years elapsing between some of the most significant actions. The Water Pollution Control Program included constructing nine new wastewater treatment facilities and implementation of several other pollution-reducing measures, such as a best management practices plan; area-source pollution control management; and various spill-prevention projects. Many of the major actions had readily discernable effects on the chemical and physical conditions of EFPC. As controls on effluents entering the stream were implemented, pollutant concentrations generally declined and, at least initially, the volume of water discharged from the Y-12 Complex declined. This reduction in discharge was of ecological concern and led to implementation of a flow management program for EFPC. Implementing flow management, in turn, led to substantial changes in chemical and physical conditions of the stream: stream discharge nearly doubled and stream temperatures decreased, becoming more similar to those in reference streams. While water quality clearly improved, meeting water quality standards alone does not guarantee protection of a waterbody's biological integrity. Results from studies on the ecological changes stemming from pollution-reduction actions, such as those presented in this series, also are needed to understand how best to restore or protect biological integrity and enhance ecological recovery in stream ecosystems. With a better knowledge of the ecological consequences of their decisions, environmental managers can better evaluate alternative actions and more accurately predict their effects.

"Giving us hope": Parent and neonatal staff views and expectations of a planned family-centred discharge process (Train-to-Home).

PubMed

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.

40 CFR 109.5 - Development and implementation criteria for State, local and regional oil removal contingency plans.

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...

Effect of Implementing a Discharge Plan on Functional Abilities of Geriatric Patients with Hip Fractures

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…

40 CFR 122.28 - General permits (applicable to State NPDES programs, see § 123.25).

Code of Federal Regulations, 2010 CFR

2010-07-01

... operations; (B) Discharge the same types of wastes or engage in the same types of sludge use or disposal... AGENCY (CONTINUED) WATER PROGRAMS EPA ADMINISTERED PERMIT PROGRAMS: THE NATIONAL POLLUTANT DISCHARGE... or subcategories of discharges or sludge use or disposal practices or facilities described in the...

Comparing clinical and demographic characteristics of people with mental illness in hospital- and community-based residential rehabilitation units in Queensland.

PubMed

Meehan, Tom; Stedman, Terry; Parker, Stephen; Curtis, Bretine; Jones, Donna

2017-05-01

Objective The aim of the present study was to examine care pathways and characteristics of mental health consumers participating in both hospital- and community-based residential rehabilitation programs. Methods An audit of consumers (n=240) in all publicly funded residential rehabilitation units in Queensland was performed on the same day in 2013. Data collection focused on demographic characteristics, clinical information and measures of consumer functioning. Results Significant differences emerged for consumers in community- and hospital-based services with regard to age, length of stay, functioning, Mental Health Act status, guardianship status, family contact and risk of violence. Consumers in hospital-based programs have more severe and complex problems. Conclusions Consumers in residential rehabilitation units have high levels of disability, poor physical health and high levels of vulnerability. Nonetheless, it is likely that a sizeable proportion of consumers occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options to move patients on were available. What is known about the topic? A small subgroup of people with severe and complex mental health problems is likely to require time in a residential rehabilitation program. This group is characterised by failure to respond to treatment, severe negative symptoms and some degree of cognitive impairment. What does this paper add? Patients currently occupying residential rehabilitation beds in Queensland have high levels of disability, poor physical health and high levels of vulnerability. Patients in hospital-based programs are more severely disabled than those in community-based programs. What are the implications for practitioners? It is likely that a sizeable proportion of patients occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options were available. Future planning initiatives need to focus on developing a greater array of community support options to facilitate the discharge of people from residential services.

Effectiveness of home- and community-based rehabilitation in a large cohort of patients disabled by cerebrovascular accident: evidence of a dose-response relationship.

PubMed

Altman, Irwin M; Swick, Shannon; Malec, James F

2013-09-01

To (1) assess the effectiveness of home- and community-based rehabilitation (HCBR) in a large cohort of individuals with disabilities secondary to cerebrovascular accident (CVA); and (2) evaluate the responsiveness to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4) to changes resulting from HCBR in this patient group. Retrospective analysis of program evaluation data for treatment completers and noncompleters. HCBR conducted in 7 geographically distinct U.S. cities. Individuals with CVA (n=738) who completed the prescribed course of rehabilitation (completed course of treatment [CCT]) compared with 150 individuals who were precipitously discharged (PD) before program completion. HCBR delivered by certified professional staff on an individualized basis. Mayo-Portland Adaptability Inventory (MPAI-4) completed by professional consensus on admission and at discharge. With the use of analysis of covariance, MPAI-4 total scores at discharge for CCT participants were compared with those of PD participants, with admission MPAI-4, age, length of stay, and time since event as covariates. CCT participants showed greater improvement than PD participants (F=99.48, P<.001) with a moderate effect size (partial η(2)=.10). Group differences and effect sizes were similar for the 3 index scores: Ability (F=75.96, P<.001; partial η(2)=.08), Adjustment (F=99.67, P<.001; partial η(2)=.10), and Participation (F=69.15, P<.001; partial η(2)=.07). Individuals in the CCT group who received the entire planned course of HCBR showed greater improvement on all MPAI-4 indexes than those in the PD group who were discharged before completing the prescribed program. This dose-response relationship provides evidence of a causal relationship between treatment and outcome. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Culvert analysis program for indirect measurement of discharge

USGS Publications Warehouse

Fulford, Janice M.; ,

1993-01-01

A program based on the U.S. Geological Survey (USGS) methods for indirectly computing peak discharges through culverts allows users to employ input data formats used by the water surface profile program (WSPRO). The program can be used to compute discharge rating surfaces or curves that describe the behavior of flow through a particular culvert or to compute discharges from measurements of upstream of the gradually varied flow equations and has been adapted slightly to provide solutions that minimize the need for the user to determine between different flow regimes. The program source is written in Fortran 77 and has been run on mini-computers and personal computers. The program does not use or require graphics capability, a color monitor, or a mouse.

Distinct Facets of Impulsivity Exhibit Differential Associations with Substance Use Disorder Treatment Processes: A Cross-Sectional and Prospective Investigation Among Military Veterans

PubMed Central

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

Medicare payment system for hospital inpatients: diagnosis-related groups.

PubMed

Baker, Judith J

2002-01-01

Diagnosis-Related Groups (DRGs) are categories of patient conditions that demonstrate similar levels of hospital resources required to treat the conditions. Each inpatient that is discharged from an acute care hospital can be classified into one of the 506 DRGs currently utilized by the Medicare program. The Medicare DRG prospective payment methodology has been in use for almost two decades and is used by hospital managers for planning and decisionmaking. The viability of DRGs for future prospective payment depends on the ability to keep up with the times through updates of the current methodology.

Using 'reverse triage' to create hospital surge capacity: Royal Darwin Hospital's response to the Ashmore Reef disaster.

PubMed

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.

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

Experience with a pharmacy technician medication history program.

PubMed

Cooper, Julie B; Lilliston, Michelle; Brooks, DeAnne; Swords, Bruce

2014-09-15

The implementation and outcomes of a pharmacy technician medication history program are described. An interprofessional medication reconciliation team, led by a clinical pharmacist and a clinical nurse specialist, was charged with implementing a new electronic medication reconciliation system to improve compliance with medication reconciliation at discharge and capture compliance-linked reimbursement. The team recommended that the pharmacy department be allocated new pharmacy technician full-time-equivalent positions to assume ownership of the medication history process. Concurrent with the implementation of this program, a medication history standard was developed to define rules for documentation of what a patient reports he or she is actually taking. The standard requires a structured interview with the patient or caregiver and validation with outside sources as indicated to determine which medications to document in the medication history. The standard is based on four medication administration category rules: scheduled, as-needed, short-term, and discontinued medications. The medication history standard forms the core of the medication history technician training and accountability program. Pharmacy technicians are supervised by pharmacists, using a defined accountability plan based on a set of medical staff approved rules for what medications comprise a best possible medication history. Medication history accuracy and completeness rates have been consistently over 90% and rates of provider compliance with medication reconciliation rose from under 20% to 100% since program implementation. A defined medication history based on a medication history standard served as an effective foundation for a pharmacy technician medication history program, which helped improve provider compliance with discharge medication reconciliation. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

FIM motor scores for classifying community discharge after inpatient rehabilitation for hip fracture.

PubMed

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.

Assertive outreach in Slovenia; identification of target group and goals of treatment in a new program.

PubMed

Furlan, Mirjana

2009-09-01

A team from the Rehabilitation unit of Ljubljana psychiatric clinic attended a course on community care in London in October and November 2005. Because we decided that the methods presented to us could be of great use in Slovenia where the Health system is lacking such services we decided to implement them after our return. Immediately after we returned we started to carry out our plan. We designated our target group which were patients who poorly participated in treatment or had multiple and severe difficulties functioning and retaining their progress after discharge. Our goals were to improve patient participation in treatment before and after discharge, less and shorter hospitalizations and better integration of patients into society. Initial results are very positive, which leaves me much hope for further implementation of assertive outreach and community care in Slovenia.

Radiological monitoring plan for the Oak Ridge Y-12 Plant: Surface Water

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1997-10-01

The Y-12 Plant conducts a surface water monitoring program in response to DOE Orders and state of Tennessee requirements under the National Pollutant Discharge Elimination System (NPDES). The anticipated codification of DOE Order 5400.5 for radiation protection of the public and the environment (10 CFR Part 834) will require an environmental radiation protection plan (ERPP). The NPDES permit issued by the state of Tennessee requires a radiological monitoring plan (RMP) for Y-12 Plant surface waters. In a May 4, 1995 memo, the state of Tennessee, Division of Water Pollution Control, stated their desired needs and goals regarding the content ofmore » RMPs, associated documentation, and data resulting from the RMPs required under the NPDES permitting system (L. Bunting, General Discussion, Radiological Monitoring Plans, Tennessee Division of Water Pollution Control, May 4,1995). Appendix A provides an overview of how the Y-12 Plant will begin to address these needs and goals. It provides a more complete, documented basis for the current Y-12 Plant surface water monitoring program and is intended to supplement documentation provided in the Annual Site Environmental Reports (ASERs), NPDES reports, Groundwater Quality Assessment Reports, and studies conducted under the Y-12 Plant Environmental Restoration (ER) Program. The purpose of this update to the Y-12 Plant RMP is to satisfy the requirements of the current NPDES permit, DOE Order 5400.5, and 10 CFR Part 834, as current proposed, by defining the radiological monitoring plan for surface water for the Y-12 Plant. This plan includes initial storm water monitoring and data analysis. Related activities such as sanitary sewer and sediment monitoring are also summarized. The plan discusses monitoring goals necessary to determine background concentrations of radionuclides, to quantify releases, determine trends, satisfy regulatory requirements, support consequence assessments, and meet requirements that releases be ``as low as reasonably achievable`` (ALARA).« less

Nursing assistance at the hospital discharge after cardiac surgery: integrative review

PubMed Central

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

Determination of the plasma impedance of a glow discharge in carbon dioxide

NASA Astrophysics Data System (ADS)

Kiselev, A. S.; Smirnov, E. A.

2017-07-01

In this work an expression for the dynamic resistance of a glow discharge flowing in long tubes is obtained and analyzed. The expression describes the physical processes occurring in the positive column of a glow discharge. The frequency dependences of the active and reactive components as well as the dynamic resistance module for the discharge conditions corresponding to CO2-lasers have been calculated. Based on the simulation results developed a computer program in the C# programming language for modeling the dynamic resistance discharge of glow discharge lasers.

Pediatric cardiac surgery Parent Education Discharge Instruction (PEDI) program: a pilot study.

PubMed

Staveski, Sandra L; Zhelva, Bistra; Paul, Reena; Conway, Rosalind; Carlson, Anna; Soma, Gouthami; Kools, Susan; Franck, Linda S

2015-01-01

In developing countries, more children with complex cardiac defects now receive treatment for their condition. For successful long-term outcomes, children also need skilled care at home after discharge. The Parent Education Discharge Instruction (PEDI) program was developed to educate nurses on the importance of discharge teaching and to provide them with a structured process for conducting parent teaching for home care of children after cardiac surgery. The aim of this pilot study was to generate preliminary data on the feasibility and acceptability of the nurse-led structured discharge program on an Indian pediatric cardiac surgery unit. A pre-/post-design was used. Questionnaires were used to evaluate role acceptability, nurse and parent knowledge of discharge content, and utility of training materials with 40 nurses and 20 parents. Retrospective audits of 50 patient medical records (25 pre and 25 post) were performed to evaluate discharge teaching documentation. Nurses' discharge knowledge increased from a mean of 81% to 96% (P = .001) after participation in the training. Nurses and parents reported high levels of satisfaction with the education materials (3.75-4 on a 4.00-point scale). Evidence of discharge teaching documentation in patient medical records improved from 48% (12 of 25 medical records) to 96% (24 of 25 medical records) six months after the implementation of the PEDI program. The structured nurse-led parent discharge teaching program demonstrated feasibility, acceptability, utility, and sustainability in the cardiac unit. Future studies are needed to examine nurse, parent, child, and organizational outcomes related to this expanded nursing role in resource-constrained environments. © The Author(s) 2014.

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...

Does participation in standardized aerobic fitness training during inpatient stroke rehabilitation promote engagement in aerobic exercise after discharge? A cohort study.

PubMed

Brown, Christiane; Fraser, Julia E; Inness, Elizabeth L; Wong, Jennifer S; Middleton, Laura E; Poon, Vivien; McIlroy, William E; Mansfield, Avril

2014-01-01

To determine whether attending an aerobic fitness program during inpatient stroke rehabilitation is associated with increased participation in physical activity after discharge. This was a prospective cohort study. Patients who received inpatient stroke rehabilitation and were discharged into the community (n = 61; mean age, 65 years) were recruited. Thirty-five participants attended a standardized aerobic fitness program during inpatient rehabilitation, whereas 26 did not. The Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) and adherence to the American College of Sports Medicine (ACSM) guidelines were assessed up to 6 months after discharge. Participants in the fitness group had PASIPD scores and adherence to ACSM guidelines similar to those of participants in the nonfitness group up to 6 months after discharge. There was no significant correlation between volume of exercise performed during the inpatient program and amount of physical activity after discharge. Participation in an inpatient fitness program did not increase participation in physical activity after discharge in individuals with stroke. A new model of care that encourages patients to pursue physical activity after discharge and reduces the potential barriers to participation should be developed.

Gender differences in discharge dispositions of emergency department visits involving drug misuse and abuse-2004-2011.

PubMed

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.

Discharging patients earlier in the day: a concept worth evaluating.

PubMed

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.

Outpatient Management of Neonatal Abstinence Syndrome: A Quality Improvement Project.

PubMed

Chau, Kim T; Nguyen, Jacqueline; Miladinovic, Branko; Lilly, Carol M; Ashmeade, Terri L; Balakrishnan, Maya

2016-11-01

An increasing number of infants are diagnosed with neonatal abstinence syndrome (NAS). The study's primary objectives were to describe an academic medical center's level IV neonatal ICU's (NICU's) comprehensive outpatient NAS management effort, measure guideline compliance, and assess its safety. Secondary objectives were to describe the duration and cumulative methadone exposure, and to improve parent and provider knowledge of NAS. The study included 22 infants having a gestational age of 35-41 weeks, diagnosed with NAS, and discharged for outpatient methadone management. Discharges spanned 10 months and included 3 improvement periods. The outpatient program includes comprehensive discharge planning, a focused electronic health record (EHR) template, management guidelines, and parent and provider education. Providers complied with using the outpatient management guideline and EHR template, and assessed weight, NAS symptoms, and methadone dose during appointments. Two infants required NAS-related hospital readmission in the study period. From improvement period 1 to period 3 there was no difference in total outpatient days on methadone (58, 53, 74 days, respectively) or cumulative methadone dose (2.7, 2.6, 3.1mg/kg, respectively). A downward trend pattern in cumulative methadone exposure was noted in improvement period 2. Pre- and postimplementation surveys revealed that after implementation, parents had better understanding of NAS before delivery (71% vs. 100%, p = 0.009), while providers had increased comfort with outpatient management (24% vs. 67%, p < 0.001) and educating parents (48% vs. 82%, p = 0.001). This preliminary study suggests that outpatient NAS management can be safe when a comprehensive management program is implemented and can result in provider compliance with the program. Copyright 2016 The Joint Commission.

A tailored multicomponent program to reduce discomfort in critically ill patients: a cluster-randomized controlled trial.

PubMed

Kalfon, Pierre; Baumstarck, Karine; Estagnasie, Philippe; Geantot, Marie-Agnès; Berric, Audrey; Simon, Georges; Floccard, Bernard; Signouret, Thomas; Boucekine, Mohamed; Fromentin, Mélanie; Nyunga, Martine; Sossou, Achille; Venot, Marion; Robert, René; Follin, Arnaud; Audibert, Juliette; Renault, Anne; Garrouste-Orgeas, Maïté; Collange, Olivier; Levrat, Quentin; Villard, Isabelle; Thevenin, Didier; Pottecher, Julien; Patrigeon, René-Gilles; Revel, Nathalie; Vigne, Coralie; Azoulay, Elie; Mimoz, Olivier; Auquier, Pascal

2017-12-01

Critically ill patients are exposed to stressful conditions and experience several discomforts. The primary objective was to assess whether a tailored multicomponent program is effective for reducing self-perceived discomfort. In a cluster-randomized two-arm parallel trial, 34 French adult intensive care units (ICUs) without planned interventions to reduce discomfort were randomized, 17 to the arm including a 6-month period of program implementation followed by a 6-month period without the program (experimental group), and 17 to the arm with an inversed sequence (control group). The tailored multicomponent program consisted of assessment of ICU-related self-perceived discomforts, immediate and monthly feedback to healthcare teams, and site-specific tailored interventions. The primary outcome was the overall discomfort score derived from the 16-item IPREA questionnaire (0, minimal, 100, maximal overall discomfort) and the secondary outcomes were the discomfort scores of each IPREA item. IPREA was administered on the day of ICU discharge with a considered timeframe from the ICU admission until ICU discharge. During a 1-month assessment period, 398 and 360 patients were included in the experimental group and the control group, respectively. The difference (experimental minus control) of the overall discomfort score between groups was - 7.00 (95% CI - 9.89 to - 4.11, p < 0.001). After adjustment (age, gender, ICU duration, mechanical ventilation duration, and type of admission), the program effect was still positive for the overall discomfort score (difference - 6.35, SE 1.23, p < 0.001) and for 12 out of 16 items. This tailored multicomponent program decreased self-perceived discomfort in adult critically ill patients. Clinicaltrials.gov Identifier NCT02442934.

Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement

PubMed Central

Whitcomb, Winthrop F.; Lagu, Tara; Krushell, Robert J.; Lehman, Andrew P.; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S.; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K.

2015-01-01

Background Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Methods Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. Results The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls— patients treated before bundle implementation—45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p = .24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p = .43), and lower median posthospital payments ($704 versus $1,121, p = .002), and were more likely to receive guideline-consistent care (99% versus 95%, p = .05). Discussion The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams. PMID:26289235

Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement.

PubMed

Whitcomb, Winthrop F; Lagu, Tara; Krushell, Robert J; Lehman, Andrew P; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K

2015-09-01

Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls-patients treated before bundle implementation-45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p=.24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p=.43), and lower median posthospital payments ($704 versus $1,121, p=.002), and were more likely to receive guideline-consistent care (99% versus 95%, p=.05). The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams.

76 FR 29747 - State Program Requirements; Proposal To Approve Maine's Base National Pollutant Discharge...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-23

...'s Base National Pollutant Discharge Elimination System (NPDES) Permitting Program AGENCY... of Maine's Base NPDES Permitting Program in these territories as part of the administrative record to... Maine's base program as EPA approved it in 2001. Thus, the state's program would not include regulation...

78 FR 20503 - Energy Conservation Program: Availability of the Interim Technical Support Document for High...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-05

... Conservation Program: Availability of the Interim Technical Support Document for High-Intensity Discharge Lamps... high-intensity discharge (HID) lamps energy conservation standards in the Federal Register. This... interim analysis for high- intensity discharge lamps energy conservation standards. The notice provided...

Planning primary health-care services for South Australian young offenders: a preliminary study.

PubMed

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.

Older veterans and emergency department discharge information.

PubMed

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.

Rehabilitation and transition after lung transplantation in children.

PubMed

Burton, J H; Marshall, J M; Munro, P; Moule, W; Snell, G I; Westall, G P

2009-01-01

We describe the key components of an outpatient pediatric recovery and rehabilitation program set up within the adult lung transplant service at the Alfred Hospital, Melbourne. Following discharge, pediatric lung transplant recipients and their families participated in an intensive 3-month outpatient rehabilitation program. Weekly sessions included education regarding transplant issues, physiotherapy, and occupational therapy sessions. The overall aim of the program was to comprehensively address physical rehabilitation and psychosocial and educational needs. Sessions tailored to meet the individual needs of the child were presented at an appropriate cognitive level. Education sessions for both the children and parents focused on medications, identification of infection and rejection, nutrition, physiotherapy/rehabilitation, occupational roles and stress management, donor issues, psychosocial readjustment, and transition issues. Physiotherapy included a progressive aerobic and strength training program, postural reeducation, and core stability. We incorporate Age-appropriate play activities: running, dancing, jumping, ball skills, and so on. Occupational therapy sessions addressed the primary roles of patient, students, and player. Transitions such as returning to school, friends, and the community were explored. Issues discussed included adjustment to new health status, strategies to manage side effects of medications, and altered body image issues. Weekly multidisciplinary team meetings were used to discuss and plan the rehabilitation progress. School liaison and visits occurred prior to school commencement with follow-up offered to review the ongoing transition process. Both patients and parents have reported a high level of satisfaction with the rehabilitation program. We plan to formally evaluate the program in the future.

Computer programs for describing the recession of ground-water discharge and for estimating mean ground-water recharge and discharge from streamflow records-update

USGS Publications Warehouse

Rutledge, A.T.

1998-01-01

The computer programs included in this report can be used to develop a mathematical expression for recession of ground-water discharge and estimate mean ground-water recharge and discharge. The programs are intended for analysis of the daily streamflow record of a basin where one can reasonably assume that all, or nearly all, ground water discharges to the stream except for that which is lost to riparian evapotranspiration, and where regulation and diversion of flow can be considered to be negligible. The program RECESS determines the master reces-sion curve of streamflow recession during times when all flow can be considered to be ground-water discharge and when the profile of the ground-water-head distribution is nearly stable. The method uses a repetitive interactive procedure for selecting several periods of continuous recession, and it allows for nonlinearity in the relation between time and the logarithm of flow. The program RORA uses the recession-curve displacement method to estimate the recharge for each peak in the streamflow record. The method is based on the change in the total potential ground-water discharge that is caused by an event. Program RORA is applied to a long period of record to obtain an estimate of the mean rate of ground-water recharge. The program PART uses streamflow partitioning to estimate a daily record of base flow under the streamflow record. The method designates base flow to be equal to streamflow on days that fit a requirement of antecedent recession, linearly interpolates base flow for other days, and is applied to a long period of record to obtain an estimate of the mean rate of ground-water discharge. The results of programs RORA and PART correlate well with each other and compare reasonably with results of the corresponding manual method.

[Morbidity among mothers and infants after ambulatory deliveries].

PubMed

Kierkegaard, O

1991-07-29

Postpartum early discharge programs are reviewed. Few programs were mandatory and both primi- and multiparae were included. Discharge varied from two to 72 hours after delivery. Nearly all programs had prenatal preparation and all patients had postpartum follow-up at home. Approximately one per cent of the infants were readmitted mostly on account of hyperbilirubinemia and infections, and half as many mothers were readmitted mostly for hemorrhage and endometritis. Infants discharged very early were readmitted more frequently than others. There were no statistical significant difference in mortality or morbidity between mothers or infants in early discharge groups and control groups.

Fatigue and pain limit independent mobility and physiotherapy after hip fracture surgery.

PubMed

Münter, Kristine H; Clemmesen, Christopher G; Foss, Nicolai B; Palm, Henrik; Kristensen, Morten T

2018-07-01

The patient's ability to complete their planned physiotherapy session after hip fracture surgery has been proposed as an independent predictor for achieving basic mobility independency upon hospital discharge. However, knowledge of factors limiting mobility is sparse. We therefore examined patient reported factors limiting ability to complete planned physiotherapy sessions as well as limitations for not achieving independency in basic mobility early after hip fracture surgery. A total of 204 consecutive patients with a hip fracture (mean (SD) age of 80 (9.9) years, 47 patients were admitted from a nursing home) were treated in accordance with a multimodal program. The Cumulated Ambulation Score was used to evaluate the patient's independency in three basic mobility activities: getting in and out of bed, sit-to-stand-to-sit from a chair and indoor walking. Pre-defined limitations; pain, motor blockade, dizziness, fatigue, nausea, acute cognitive dysfunction and "other limitations", for not achieving a full Cumulated Ambulation Score or inability to complete planned physiotherapy sessions were noted by the physiotherapist on each of the three first postoperative days. This period was chosen, because of its importance on how well the patients had regained their pre-fracture functional level. Fatigue and hip fracture-related pain were the most frequent reasons for patients not achieving an independent basic mobility level (> 85%) or not fully completing their planned physiotherapy (> 42%) on all three days. At hospital discharge (median day 10), only 54% of the patients had regained their pre-fracture basic mobility level. Based on the patient's perception, fatigue and pain are the most frequent limitations in not achieving independent basic mobility and not completing physiotherapy after hip fracture surgery. This raises questions whether multimodal peri-operative programs can be further optimized to enhance the early recovery of these frail patients. Implications for rehabilitation Early postoperative mobilization is essential for patients undergoing hip fracture surgery to regain the pre-fracture functional level, in not only the short but also in the long term. The most frequent reasons for not achieving an independent Cumulated Ambulation Score or completing physiotherapy, early after hip fracture surgery, are fatigue, pain, and the habitual cognitive status of patients. Knowledge concerning postoperative fatigue is important for rehabilitation professionals and should contribute as an essential factor when planning physiotherapy.

The utility of the functional independence measure (FIM) in discharge planning for burn patients.

PubMed

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.

Effects of an Enhanced Discharge Planning Intervention for Hospitalized Older Adults: A Randomized Trial

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…

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…

[The effectiveness of continuing care models in patients with chronic diseases: a systematic review].

PubMed

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.

A quality improvement project using a problem based post take ward round proforma based on the SOAP acronym to improve documentation in acute surgical receiving.

PubMed

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.

Perspectives of Post-Acute Transition of Care for Cardiac Surgery Patients

PubMed Central

Stoicea, Nicoleta; You, Tian; Eiterman, Andrew; Hartwell, Clifton; Davila, Victor; Marjoribanks, Stephen; Florescu, Cristina; Bergese, Sergio Daniel; Rogers, Barbara

2017-01-01

Post-acute care (PAC) facilities improve patient recovery, as measured by activities of daily living, rehabilitation, hospital readmission, and survival rates. Seamless transitions between discharge and PAC settings continue to be challenges that hamper patient outcomes, specifically problems with effective communication and coordination between hospitals and PAC facilities at patient discharge, patient adherence and access to cardiac rehabilitation (CR) services, caregiver burden, and the financial impact of care. The objective of this review is to examine existing models of cardiac transitional care, identify major challenges and social factors that affect PAC, and analyze the impact of current transitional care efforts and strategies implemented to improve health outcomes in this patient population. We intend to discuss successful methods to address the following aspects: hospital-PAC linkages, improved discharge planning, caregiver burden, and CR access and utilization through patient-centered programs. Regular home visits by healthcare providers result in decreased hospital readmission rates for patients utilizing home healthcare while improved hospital-PAC linkages reduced hospital readmissions by 25%. We conclude that widespread adoption of improvements in transitional care will play a key role in patient recovery and decrease hospital readmission, morbidity, and mortality. PMID:29230400

Perspectives of Post-Acute Transition of Care for Cardiac Surgery Patients.

PubMed

Stoicea, Nicoleta; You, Tian; Eiterman, Andrew; Hartwell, Clifton; Davila, Victor; Marjoribanks, Stephen; Florescu, Cristina; Bergese, Sergio Daniel; Rogers, Barbara

2017-01-01

Post-acute care (PAC) facilities improve patient recovery, as measured by activities of daily living, rehabilitation, hospital readmission, and survival rates. Seamless transitions between discharge and PAC settings continue to be challenges that hamper patient outcomes, specifically problems with effective communication and coordination between hospitals and PAC facilities at patient discharge, patient adherence and access to cardiac rehabilitation (CR) services, caregiver burden, and the financial impact of care. The objective of this review is to examine existing models of cardiac transitional care, identify major challenges and social factors that affect PAC, and analyze the impact of current transitional care efforts and strategies implemented to improve health outcomes in this patient population. We intend to discuss successful methods to address the following aspects: hospital-PAC linkages, improved discharge planning, caregiver burden, and CR access and utilization through patient-centered programs. Regular home visits by healthcare providers result in decreased hospital readmission rates for patients utilizing home healthcare while improved hospital-PAC linkages reduced hospital readmissions by 25%. We conclude that widespread adoption of improvements in transitional care will play a key role in patient recovery and decrease hospital readmission, morbidity, and mortality.

The National Flood Frequency Program, version 3 : a computer program for estimating magnitude and frequency of floods for ungaged sites

USGS Publications Warehouse

Ries, Kernell G.; Crouse, Michele Y.

2002-01-01

For many years, the U.S. Geological Survey (USGS) has been developing regional regression equations for estimating flood magnitude and frequency at ungaged sites. These regression equations are used to transfer flood characteristics from gaged to ungaged sites through the use of watershed and climatic characteristics as explanatory or predictor variables. Generally, these equations have been developed on a Statewide or metropolitan-area basis as part of cooperative study programs with specific State Departments of Transportation. In 1994, the USGS released a computer program titled the National Flood Frequency Program (NFF), which compiled all the USGS available regression equations for estimating the magnitude and frequency of floods in the United States and Puerto Rico. NFF was developed in cooperation with the Federal Highway Administration and the Federal Emergency Management Agency. Since the initial release of NFF, the USGS has produced new equations for many areas of the Nation. A new version of NFF has been developed that incorporates these new equations and provides additional functionality and ease of use. NFF version 3 provides regression-equation estimates of flood-peak discharges for unregulated rural and urban watersheds, flood-frequency plots, and plots of typical flood hydrographs for selected recurrence intervals. The Program also provides weighting techniques to improve estimates of flood-peak discharges for gaging stations and ungaged sites. The information provided by NFF should be useful to engineers and hydrologists for planning and design applications. This report describes the flood-regionalization techniques used in NFF and provides guidance on the applicability and limitations of the techniques. The NFF software and the documentation for the regression equations included in NFF are available at http://water.usgs.gov/software/nff.html.

Reporting of Sepsis Cases for Performance Measurement Versus for Reimbursement in New York State.

PubMed

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.

Colombia's discharge fee program: incentives for polluters or regulators?

PubMed

Blackman, Allen

2009-01-01

Colombia's discharge fee system for water effluents is often held up as a model of a well-functioning, economic incentive pollution control program in a developing country. Yet few objective evaluations of the program have appeared. Based on a variety of primary and secondary data, this paper finds that in its first 5 years, the program was beset by a number of serious problems including limited implementation in many regions, widespread noncompliance by municipal sewerage authorities, and a confused relationship between discharge fees and emissions standards. Nevertheless, in some watersheds, pollution loads dropped significantly after the program was introduced. While proponents claim the incentives that discharge fees created for polluters to cut emissions in a cost-effective manner were responsible, this paper argues that the incentives they created for regulatory authorities to improve permitting, monitoring, and enforcement were at least as important.

Decreasing Psychiatric Admission Wait Time in the Emergency Department by Facilitating Psychiatric Discharges.

PubMed

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.

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.

Plans for a sensitivity analysis of bridge-scour computations

USGS Publications Warehouse

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.

Healthcare Managers' Experiences of Leading the Implementation of Video Conferencing in Discharge Planning Sessions: An Interview Study.

PubMed

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.

NPDES Stormwater Program

EPA Pesticide Factsheets

The National Pollutant Discharge Elimination System (NPDES) stormwater program regulates some stormwater discharges from three potential sources: municipal separate storm sewer systems (MS4s), construction activities, and industrial activities.

Families’ Priorities Regarding Hospital-to-Home Transitions for Children With Medical Complexity

PubMed Central

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

32 CFR 724.112 - Clemency discharge.

Code of Federal Regulations, 2010 CFR

2010-07-01

... BOARD Definitions § 724.112 Clemency discharge. (a) The clemency discharge was created by the President... the mainstream of American society in accordance with that program. (b) The clemency discharge is a...

The implementation of a comprehensive discharge bundle to improve the discharge process: a quasi-experimental study.

PubMed

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.

40 CFR 112.9 - Spill Prevention, Control, and Countermeasure Plan Requirements for onshore oil production...

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...

40 CFR 112.9 - Spill Prevention, Control, and Countermeasure Plan Requirements for onshore oil production...

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...

40 CFR 112.9 - Spill Prevention, Control, and Countermeasure Plan Requirements for onshore oil production...

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...

40 CFR 112.9 - Spill Prevention, Control, and Countermeasure Plan Requirements for onshore oil production...

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...

40 CFR 112.9 - Spill Prevention, Control, and Countermeasure Plan Requirements for onshore oil production...

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...

40 CFR 112.8 - Spill Prevention, Control, and Countermeasure Plan requirements for onshore facilities (excluding...

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...

30 CFR 250.217 - What solid and liquid wastes and discharges information and cooling water intake information must...

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...

Evaluation of a monitoring program for assessing the effects of management practices on the quantity and quality of drainwater from the Panoche Water District, western San Joaquin Valley, California

USGS Publications Warehouse

Leighton, David A.; Fio, John L.

1995-01-01

An evaluation was made of an existing monitoring program in the Panoche Water District for 1986-93. The Panoche Water District is an agricultural area located in the western San Joaquin Valley of California. Because irrigation drainage from this area has high concentrations of dissolved solids and selenium, management strategies have been developed to improve the quality of drainwater discharge. The purpose of the Panoche Water District's monitoring program is to assess the effects of water- and land-use practices on local ground water and drain flow from the district. Drainflow from the district consists of the discharge from 50 separate on-farm underground tile-drainage systems. The Panoche Water District maintains information on water deliveries, planned and actual crop types, and planned and actual acreages planted each year. In addition, the water district monitors ground-water and drainage-system discharges using a variety of data-collection methods. A total of 62 observation well sites are used to monitor ground-water level and quality. A total of 42 sites were monitored for drainflow quantity, and drain flow quality samples were collected from the outlets of each of the 50 drainage systems. However, these data were collected inconsistently and (or) intermittently during the period studied. All data obtained from the water district were compiled and stored in a geographic information system database. Water delivered for irrigation by the Panoche Water District is a mix of imported water and local ground water pumped directly into delivery canals. Although delivered water is a mix, information on the proportion of water from the two sources is not reported. Also, individual growers pump directly to their crops unknown quantities of ground water, the total of which could be greater than 60 percent of total applications during years when water district deliveries are greatly reduced (for example, the years during and following a drought). To evaluate the effects of irrigation on ground-water and drainflow quality, data on the combined chemical characteristics and the volume of water applied to crops are needed as part of the district's monitoring program. For example, without these data, this study could estimate only the effects of irrigation on ground-water recharge for 1986 (60.4 106 m3/y), 1987 (74.2 106 m3/y), and 1988 (56.0 106 m3/y) in the Panoche Water District water years when the amount of ground water pumped by individual growers was probably small. Water-level data show a significant decline of the water table in the upslope, undrained parts of the study area, and little or no significant change in the down slope, drained parts of the study area. Pumping from productions wells, most of which are located in the upslope part of the study area, may have contributed to the decline of the water table in the upslope area. The quantities of drainflow, dissolved solids, and selenium discharged from the study area decreased during the study period. However, drainflow, dissolved solids, and selenium discharged from individual on-farm drainage systems did not decrease. These data also illustrate the need for consistent and regular monitoring of the factors that affect drainage in the western San Joaquin Valley.

The 1965 Mississippi River flood in Iowa

USGS Publications Warehouse

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.

Implementation of a Nutrition Program Reduced Post-Discharge Growth Restriction in Thai Very Low Birth Weight Preterm Infants.

PubMed

Japakasetr, Suchada; Sirikulchayanonta, Chutima; Suthutvoravut, Umaporn; Chindavijak, Busba; Kagawa, Masaharu; Nokdee, Somjai

2016-12-17

Very low birth weight (VLBW) preterm infants are vulnerable to growth restriction after discharge due to cumulative protein and energy deficits during their hospital stay and early post-discharge period. The current study evaluated the effectiveness of the preterm infant, post-discharge nutrition (PIN) program to reduce post-discharge growth restriction in Thai VLBW preterm infants. A prospective, non-randomized interventional cohort study was undertaken to assess the growth of 22 VLBW preterm infants who received the PIN program and compared them with 22 VLBW preterm infants who received conventional nutrition services. Infant's growth was recorded monthly until the infants reached six months' corrected age (6-moCA). Intervention infants had significantly greater body weights ( p = 0.013) and head circumferences ( p = 0.009). Also, a greater proportion of the intervention group recovered their weight to the standard weight at 4-moCA ( p = 0.027) and at 6-moCA ( p = 0.007) and their head circumference to the standard head circumference at 6-moCA ( p = 0.004) compared to their historical comparison counterparts. Enlistment in the PIN program thus resulted in significantly reduced post-discharge growth restriction in VLBW preterm infants. Further research on longer term effects of the program on infant's growth and development is warranted.

AiRCare: A naturalistic evaluation of the effectiveness of a protracted telephone-based recovery assistance program on continuing care outcomes.

PubMed

Proctor, Steven L; Wainwright, Jaclyn L; Herschman, Philip L; Kopak, Albert M

2017-02-01

Substance use disorder treatments are increasingly being contextualized within a disease management framework. Within this context, there is an identified need to maintain patients in treatment for longer periods of time in order to help them learn how to manage their disease. One way to meet this need is through telephone-based interventions that engage patients, and include more active outreach attempts and involvement of the patient's family. This study sought to evaluate the effectiveness of three formats of an intensive 12-month post-discharge telephone-based case management approach (AiRCare) on adherence to continuing care plans and substance use outcomes. Data were abstracted from electronic medical records for 379 patients (59.9% male) discharged from a residential treatment program located in the southwestern U.S. from 2013 to 2015. Patients were categorized into one of three groups and received telephone contacts based on their self-selection upon admission to residential treatment (i.e., patient only, family only, and both patient and family). Outcome variables included re-engagement and re-admission rates, quality of life, abstinence rates at 6 and 12 months, and compliance with continuing care plans. Favorable short- and long-term outcomes were found for the majority of patients, irrespective of case management group. There appeared to be some value in the addition of family contacts to patient contacts with respect to reducing risk for 12-month re-admission to residential care. These positive but preliminary indications of the effectiveness of AiRCare require replication in a well-powered, randomized controlled trial. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical utility of the AlphaFIM® instrument in stroke rehabilitation.

PubMed

Lo, Alexander; Tahair, Nicola; Sharp, Shelley; Bayley, Mark T

2012-02-01

The AlphaFIM instrument is an assessment tool designed to facilitate discharge planning of stroke patients from acute care, by extrapolating overall functional status from performance in six key Functional Independence Measure (FIM) instrument items. To determine whether acute care AlphaFIM rating is correlated to stroke rehabilitation outcomes. In this prospective observational study, data were analyzed from 891 patients referred for inpatient stroke rehabilitation through an Internet-based referral system. Simple linear and stepwise regression models determined correlations between rehabilitation-ready AlphaFIM rating and rehabilitation outcomes (admission and discharge FIM ratings, FIM gain, FIM efficiency, and length of stay). Covariates including demographic data, stroke characteristics, medical history, cognitive deficits, and activity tolerance were included in the stepwise regressions. The AlphaFIM instrument was significant in predicting admission and discharge FIM ratings at rehabilitation (adjusted R² 0.40 and 0.28, respectively; P < 0.0001) and was weakly correlated with FIM gain and length of stay (adjusted R² 0.04 and 0.09, respectively; P < 0.0001), but not FIM efficiency. AlphaFIM rating was inversely related to FIM gain. Age, bowel incontinence, left hemiparesis, and previous infarcts were negative predictors of discharge FIM rating on stepwise regression. Intact executive function and physical activity tolerance of 30 to 60 mins were predictors of FIM gain. The AlphaFIM instrument is a valuable tool for triaging stroke patients from acute care to rehabilitation and predicts functional status at discharge from rehabilitation. Patients with low AlphaFIM ratings have the potential to make significant functional gains and should not be denied admission to inpatient rehabilitation programs.

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

Correlates of improvement in substance abuse among dually diagnosed veterans with post-traumatic stress disorder in specialized intensive VA treatment.

PubMed

Coker, Kendell L; Stefanovics, Elina; Rosenheck, Robert

2016-01-01

Substantial rates of substance use comorbidity have been observed among veterans with Post-Traumatic Stress Disorder (PTSD), highlighting the need to identify patient and program characteristics associated with improved outcomes for substance abuse. Data were drawn from 12,270 dually diagnosed veterans who sought treatment from specialized intensive Veterans Health Administration PTSD programs between 1993 and 2011. The magnitude of the improvement in Addiction Severity Index (ASI) alcohol and drug use composite scores from baseline was moderate, with effect sizes (ES) of -.269 and -.287, respectively. Multivariate analyses revealed that treatment in longer-term programs, being prescribed psychiatric medication, and planned participation in reunions were all associated with slightly improved outcomes. Reductions in substance use measures were associated with robust improvements in PTSD symptoms and violent behavior. These findings suggest not only synergistic treatment effects linking improvement in PTSD symptoms with substance use disorders among dually diagnosed veterans with PTSD, but also to reductions in violent behavior. Furthermore, the findings indicate that proper discharge planning in addition to intensity and duration of treatment for dually diagnosed veterans with severe PTSD may result in better outcomes. Further dissemination of evidence-based substance abuse treatment may benefit this population. (c) 2016 APA, all rights reserved).

Promoting Optimal Physical Exercise for Life: An Exercise and Self-Management Program to Encourage Participation in Physical Activity after Discharge from Stroke Rehabilitation—A Feasibility Study

PubMed Central

Mansfield, Avril; Knorr, Svetlana; Poon, Vivien; Inness, Elizabeth L.; Middleton, Laura; Biasin, Louis; Brunton, Karen; Howe, Jo-Anne; Brooks, Dina

2016-01-01

People with stroke do not achieve adequate levels of physical exercise following discharge from rehabilitation. We developed a group exercise and self-management program (PROPEL), delivered during stroke rehabilitation, to promote uptake of physical activity after discharge. This study aimed to establish the feasibility of a larger study to evaluate the effect of this program on participation in self-directed physical activity. Participants with subacute stroke were recruited at discharge from one of three rehabilitation hospitals; one hospital offered the PROPEL program whereas the other two did not (comparison group; COMP). A high proportion (11/16) of eligible PROPEL program participants consented to the study. Fifteen COMP participants were also recruited. Compliance with wearing an accelerometer for 6 weeks continuously and completing physical activity questionnaires was high (>80%), whereas only 34% of daily heart rate data were available. Individuals who completed the PROPEL program seemed to have higher outcome expectations for exercise, fewer barriers to physical activity, and higher participation in physical activity than COMP participants (Hedge's g ≥ 0.5). The PROPEL program delivered during stroke rehabilitation shows promise for reducing barriers to exercise and increasing participation in physical activity after discharge. This study supports feasibility of a larger randomized trial to evaluate this program. PMID:27313948

Focus on patient safety all day, every day.

PubMed

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.

Community discharge of patients with schizophrenia: a Japanese experience.

PubMed

Noda, Fumitaka; Clark, Campbell; Terada, Hisako; Hayashi, Naoki; Maeda, Keiko; Sato, Mikiko; Ito, Keiko; Kitanaka, Junko; Asai, Takeshi; Nishimura, Takashi; Kushigami, Kenji; Okada, Kazushi; Taniguchi, Yosuke; Mantani, Tomoyuki

2004-01-01

In Japan, admission to a psychiatric facility for people with schizophrenia is usually for life. We developed a rehabilitation program aimed at discharging these patients into the Tokyo community. This paper describes the results for the 224 patients. Using an inpatient ward at the Tokyo Musashino Hospital, patients were enrolled in the program and subsequently discharged into the community with an assigned worker. The results indicate for the majority (79%) re-integration into the community was successful. The success of this program in a metropolitan city like Tokyo argues for the efficacy of such programs.

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...

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...

Effectiveness of a discharge education program in reducing the severity of postpartum depression: a randomized controlled evaluation study.

PubMed

Ho, Shiao-Ming; Heh, Shu-Shya; Jevitt, Cecilia M; Huang, Lian-Hua; Fu, Yu-Ying; Wang, Li-Lin

2009-10-01

The effectiveness of a hospital discharge education program including information on postnatal depression was evaluated to reduce psychological morbidity after childbirth. A randomized controlled trial (RCT) was conducted in a regional hospital in Taipei. Two hundred first-time mothers agreed to take part and were randomly allocated to an intervention group (n=100) or control group (n=100). The intervention group received discharge education on postnatal depression provided by postpartum ward nurses. The control group received general postpartum education. The main outcome measure was the Edinburgh Postnatal Depression Scale (EPDS) administered by postal questionnaire at six weeks and three months after delivery. Women who received discharge education intervention on postnatal depression were less likely to have high depression scores when compared to the control group at three months postpartum. A discharge educational intervention including postnatal depression information given to women during the postpartum stay benefits psychological well-being. A postpartum discharge education program including information on postnatal depression should be integrated into postpartum discharge care in general practice. 2009 Elsevier Ireland Ltd.

Process evaluation of discharge planning implementation in healthcare using normalization process theory.

PubMed

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.

Safety and feasibility of endovascular aortic aneurysm repair as day surgery.

PubMed

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.

The Preventable Admissions Care Team (PACT): A Social Work-Led Model of Transitional Care.

PubMed

Basso Lipani, Maria; Holster, Kathleen; Bussey, Sarah

2015-10-01

In 2010, the Preventable Admissions Care Team (PACT), a social work-led transitional care model, was developed at Mount Sinai to reduce 30-day readmissions among high-risk patients. PACT begins with a comprehensive bedside assessment to identify the psychosocial drivers of readmission. In partnership with the patient and family, a patient-centered action plan is developed and carried out through phone calls, accompaniments, navigations and home visits, as needed, in the first 30 days following discharge. 620 patients were enrolled during the pilot from September 2010-August 2012. Outcomes demonstrated a 43% reduction in inpatient utilization and a 54% reduction in emergency department visits among enrollees. In addition, 93% of patients had a follow-up appointment within 7-10 days of discharge and 90% of patients attended the appointment. The success of PACT has led to additional funding from the Centers for Medicare and Medicaid Services under the Community-based Care Transitions Program and several managed care companies seeking population health management interventions for high risk members.

Measurement of Electron Density and Ion Collision Frequency with Dual Assisted Grounded Electrode DBD in Atmospheric Pressure Helium Plasma Jet

NASA Astrophysics Data System (ADS)

Zhou, Qiujiao; Qi, Bing; Huang, Jianjun; Pan, Lizhu; Liu, Ying

2016-04-01

The properties of a helium atmospheric-pressure plasma jet (APPJ) are diagnosed with a dual assisted grounded electrode dielectric barrier discharge device. In the glow discharge, we captured the current waveforms at the positions of the three grounded rings. From the current waveforms, the time delay between the adjacent positions of the rings is employed to calculate the plasma bullet velocity of the helium APPJ. Moreover, the electron density is deduced from a model combining with the time delay and current intensity, which is about 1011 cm-3. In addition, The ion-neutral particles collision frequency in the radial direction is calculated from the current phase difference between two rings, which is on the order of 107 Hz. The results are helpful for understanding the basic properties of APPJs. supported by National Natural Science Foundation of China (No. 11105093), the Technological Project of Shenzhen, China (No. JC201005280485A), and the Planned S&T Program of Shenzhen, China (No. JC201105170703A)

The business of palliative medicine--part 4: Potential impact of an acute-care palliative medicine inpatient unit in a tertiary care cancer center.

PubMed

Walsh, Declan

2004-01-01

In this study, a hematology/oncology computerized discharge database was qualitatively and quantitatively reviewed using an empirical methodology. The goal was to identify potential patients for admission to a planned acute-care, palliative medicine inpatient unit. Patients were identified by the International Classifications of Disease (ICD-9) codes. A large heterogenous population, comprising up to 40 percent of annual discharges from the Hematology/Oncology service, was identified. If management decided to add an acute-care, palliative medicine unit to the hospital, these are the patients who would benefit. The study predicted a significant change in patient profile, acuity, complexity, and resource utilization in current palliative care services. This study technique predicted the actual clinical load of the acute-care unit when it opened and was very helpful in program development. Our model predicted that 695 patients would be admitted to the acute-care palliative medicine unit in the first year of operation; 655 patients were actually admitted during this time.

A Quality Improvement Collaborative to Improve the Discharge Process for Hospitalized Children.

PubMed

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.

Impact of discharge planning decision support on time to readmission among older adult medical patients.

PubMed

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.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harmon, K.M.; Lakey, L.T.; Leigh, I.W.

Worldwide activities related to nuclear fuel cycle and radioactive waste management programs are summarized. Several trends have developed in waste management strategy: All countries having to dispose of reprocessing wastes plan on conversion of the high-level waste (HLW) stream to a borosilicate glass and eventual emplacement of the glass logs, suitably packaged, in a deep geologic repository. Countries that must deal with plutonium-contaminated waste emphasize pluonium recovery, volume reduction and fixation in cement or bitumen in their treatment plans and expect to use deep geologic repositories for final disposal. Commercially available, classical engineering processing are being used worldwide to treatmore » and immobilize low- and intermediate-level wastes (LLW, ILW); disposal to surface structures, shallow-land burial and deep-underground repositories, such as played-out mines, is being done widely with no obvious technical problems. Many countries have established extensive programs to prepare for construction and operation of geologic repositories. Geologic media being studied fall into three main classes: argillites (clay or shale); crystalline rock (granite, basalt, gneiss or gabbro); and evaporates (salt formations). Most nations plan to allow 30 years or longer between discharge of fuel from the reactor and emplacement of HLW or spent fuel is a repository to permit thermal and radioactive decay. Most repository designs are based on the mined-gallery concept, placing waste or spent fuel packages into shallow holes in the floor of the gallery. Many countries have established extensive and costly programs of site evaluation, repository development and safety assessment. Two other waste management problems are the subject of major R and D programs in several countries: stabilization of uranium mill tailing piles; and immobilization or disposal of contaminated nuclear facilities, namely reactors, fuel cycle plants and R and D laboratories.« less

Value drivers: an approach for estimating health and disease management program savings.

PubMed

Phillips, V L; Becker, Edmund R; Howard, David H

2013-12-01

Health and disease management (HDM) programs have faced challenges in documenting savings related to their implementation. The objective of this eliminate study was to describe OptumHealth's (Optum) methods for estimating anticipated savings from HDM programs using Value Drivers. Optum's general methodology was reviewed, along with details of 5 high-use Value Drivers. The results showed that the Value Driver approach offers an innovative method for estimating savings associated with HDM programs. The authors demonstrated how real-time savings can be estimated for 5 Value Drivers commonly used in HDM programs: (1) use of beta-blockers in treatment of heart disease, (2) discharge planning for high-risk patients, (3) decision support related to chronic low back pain, (4) obesity management, and (5) securing transportation for primary care. The validity of savings estimates is dependent on the type of evidence used to gauge the intervention effect, generating changes in utilization and, ultimately, costs. The savings estimates derived from the Value Driver method are generally reasonable to conservative and provide a valuable framework for estimating financial impacts from evidence-based interventions.

User participation is a family matter: A multiple case study of the experiences of older, hospitalised people and their relatives.

PubMed

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.

Fifty-year flood-inundation maps for Choluteca, Honduras

USGS Publications Warehouse

Kresch, David L.; Mastin, Mark C.; Olsen, T.D.

2002-01-01

After the devastating floods caused by Hurricane Mitch in 1998, maps of the areas and depths of 50-year-flood inundation at 15 municipalities in Honduras were prepared as a tool for agencies involved in reconstruction and planning. This report, which is one in a series of 15, presents maps of areas in the municipality of Choluteca that would be inundated by 50-year floods on Rio Choluteca and Rio Iztoca. Geographic Information System (GIS) coverages of the flood inundation are available on a computer in the municipality of Choluteca as part of the Municipal GIS project and on the Internet at the Flood Hazard Mapping Web page (http://mitchnts1.cr.usgs.gov/projects/floodhazard.html). These coverages allow users to view the flood inundation in much more detail than is possible using the maps in this report. Water-surface elevations for 50-year-floods on Rio Choluteca and Rio Iztoca at Choluteca were estimated using HEC-RAS, a one-dimensional, steady-flow, step-backwater computer program. The channel and floodplain cross sections used in HEC-RAS were developed from an airborne light-detection-and-ranging (LIDAR) topographic survey of the area. The estimated 50-year-flood discharge for Rio Choluteca at Choluteca is 4,620 cubic meters per second, which is the drainage-area-adjusted weighted-average of two independently estimated 50-year-flood discharges for the gaging station Rio Choluteca en Puente Choluteca. One discharge, 4,913 cubic meters per second, was estimated from a frequency analysis of the 17 years of peak discharge record for the gage, and the other, 2,650 cubic meters per second, was estimated from a regression equation that relates the 50-year-flood discharge to drainage area and mean annual precipitation. The weighted-average of the two discharges at the gage is 4,530 cubic meters per second. The 50-year-flood discharge for the study area reach of Rio Choluteca was estimated by multiplying the weighted discharge at the gage by the ratio of the drainage areas upstream from the two locations. The 50-year-flood discharge for Rio Iztoca, which was estimated from the regression equation, is 430 cubic meters per second.

Fifty-year flood-inundation maps for Comayagua, Hondura

USGS Publications Warehouse

Kresch, David L.; Mastin, Mark C.; Olsen, T.D.

2002-01-01

After the devastating floods caused by Hurricane Mitch in 1998, maps of the areas and depths of the 50-year-flood inundation at 15 municipalities in Honduras were prepared as a tool for agencies involved in reconstruction and planning. This report, which is one in a series of 15, presents maps of areas in the municipality of Comayagua that would be inundated by 50-year floods on Rio Humuya and Rio Majada. Geographic Information System (GIS) coverages of the flood inundation are available on a computer in the municipality of Comayagua as part of the Municipal GIS project and on the Internet at the Flood Hazard Mapping Web page (http://mitchnts1.cr.usgs.gov/projects/floodhazard.html). These coverages allow users to view the flood inundation in much more detail than is possible using the maps in this report. Water-surface elevations for 50-year-floods on Rio Humuya and Rio Majada at Comayagua were estimated using HEC-RAS, a one-dimensional, steady-flow, step-backwater computer program. The channel and floodplain cross sections used in HEC-RAS were developed from an airborne light-detection-and-ranging (LIDAR) topographic survey of the area. The 50-year-flood discharge for Rio Humuya at Comayagua, 1,400 cubic meters per second, was estimated using a regression equation that relates the 50-year-flood discharge to drainage area and mean annual precipitation. The reasonableness of the regression discharge was evaluated by comparing it with drainage-area-adjusted 50-year-flood discharges estimated for three long-term Rio Humuya stream-gaging stations. The drainage-area-adjusted 50-year-flood discharges estimated from the gage records ranged from 946 to 1,365 cubic meters per second. Because the regression equation discharge agrees closely with the high end of the range of discharges estimated from the gaging-station records, it was used for the hydraulic modeling to ensure that the resulting 50-year-flood water-surface elevations would not be underestimated. The 50-year-flood discharge for Rio Majada at Comayagua (230 cubic meters per second) was estimated using the regression equation because there are no long-term gaging-stations on this river from which to estimate the discharge.

Analytical and Experimental Study to Improve Computer Models for Mixing and Dilution of Soluble Hazardous Chemicals.

DTIC Science & Technology

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

Identification of water quality management policy of watershed system with multiple uncertain interactions using a multi-level-factorial risk-inference-based possibilistic-probabilistic programming approach.

PubMed

Liu, Jing; Li, Yongping; Huang, Guohe; Fu, Haiyan; Zhang, Junlong; Cheng, Guanhui

2017-06-01

In this study, a multi-level-factorial risk-inference-based possibilistic-probabilistic programming (MRPP) method is proposed for supporting water quality management under multiple uncertainties. The MRPP method can handle uncertainties expressed as fuzzy-random-boundary intervals, probability distributions, and interval numbers, and analyze the effects of uncertainties as well as their interactions on modeling outputs. It is applied to plan water quality management in the Xiangxihe watershed. Results reveal that a lower probability of satisfying the objective function (θ) as well as a higher probability of violating environmental constraints (q i ) would correspond to a higher system benefit with an increased risk of violating system feasibility. Chemical plants are the major contributors to biological oxygen demand (BOD) and total phosphorus (TP) discharges; total nitrogen (TN) would be mainly discharged by crop farming. It is also discovered that optimistic decision makers should pay more attention to the interactions between chemical plant and water supply, while decision makers who possess a risk-averse attitude would focus on the interactive effect of q i and benefit of water supply. The findings can help enhance the model's applicability and identify a suitable water quality management policy for environmental sustainability according to the practical situations.

Rainfall, runoff, and water-quality data for the urban storm-water program in the Albuquerque, New Mexico, metropolitan area, water year 2004

USGS Publications Warehouse

Kelly, Todd; Romero, Orlando; Jimenez, Mike

2006-01-01

Urbanization has dramatically increased precipitation runoff to the system of drainage channels and natural stream channels in the Albuquerque, New Mexico, metropolitan area. Rainfall and runoff data are important for planning and designing future storm-water conveyance channels in newly developing areas. Storm-water quality also is monitored in accordance with the National Pollutant Discharge Elimination System mandated by the U.S. Environmental Protection Agency. The Albuquerque Metropolitan Arroyo Flood Control Authority, the City of Albuquerque, and the U.S. Geological Survey began a cooperative program to collect hydrologic data to assist in assessing the quality and quantity of surface-water resources in the Albuquerque area. This report presents water-quality, streamflow, and rainfall data collected from October 1, 2003, to September 30, 2004 (water year 2004). Also provided is a station analysis for each of the 18 streamflow-gaging sites and 39 rainfall-gaging sites, which includes a description of monitoring equipment, problems associated with data collection during the year, and other information used to compute streamflow discharges or rainfall records. A hydrographic comparison shows the effects that the largest drainage channel in the metropolitan area, the North Floodway Channel, has on total flow in the Rio Grande.

SAM 2.1—A computer program for plotting and formatting surveying data for estimating peak discharges by the slope-area method

USGS Publications Warehouse

Hortness, J.E.

2004-01-01

The U.S. Geological Survey (USGS) measures discharge in streams using several methods. However, measurement of peak discharges is often impossible or impractical due to difficult access, inherent danger of making measurements during flood events, and timing often associated with flood events. Thus, many peak discharge values often are calculated after the fact by use of indirect methods. The most common indirect method for estimating peak dis- charges in streams is the slope-area method. This, like other indirect methods, requires measuring the flood profile through detailed surveys. Processing the survey data for efficient entry into computer streamflow models can be time demanding; SAM 2.1 is a program designed to expedite that process. The SAM 2.1 computer program is designed to be run in the field on a portable computer. The program processes digital surveying data obtained from an electronic surveying instrument during slope- area measurements. After all measurements have been completed, the program generates files to be input into the SAC (Slope-Area Computation program; Fulford, 1994) or HEC-RAS (Hydrologic Engineering Center-River Analysis System; Brunner, 2001) computer streamflow models so that an estimate of the peak discharge can be calculated.

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...

Aircraft measurements of electrified clouds at Kennedy Space Center

NASA Technical Reports Server (NTRS)

Jones, J. J.; Winn, W. P.; Hunyady, S. J.; Moore, C. B.; Bullock, J. W.

1990-01-01

The space-vehicle launch commit criteria for weather and atmospheric electrical conditions in us at Cape Canaveral Air Force Station and Kennedy Space Center (KSC) have been made restrictive because of the past difficulties that have arisen when space vehicles have triggered lightning discharge after their launch during cloudy weather. With the present ground-base instrumentation and our limited knowledge of cloud electrification process over this region of Florida, it has not been possible to provide a quantitative index of safe launching conditions. During the fall of 1988, a Schweizer 845 airplane equipped to measure electric field and other meteorological parameters flew over KSC in a program to study clouds defined in the existing launch restriction criteria. All aspects of this program are addressed including planning, method, and results. A case study on the November 4, 1988 flight is also presented.

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...

33 CFR 155.1050 - Response plan development and evaluation criteria for vessels carrying groups I through IV...

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...

33 CFR 155.1050 - Response plan development and evaluation criteria for vessels carrying groups I through IV...

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...

33 CFR 155.1050 - Response plan development and evaluation criteria for vessels carrying groups I through IV...

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...

Postoperative rehabilitation for chronic subdural hematoma in the elderly. An observational study focusing on balance, ambulation and discharge destination.

PubMed

Carlisi, Ettore; Feltroni, Lucia; Tinelli, Carmine; Verlotta, Mariarosaria; Gaetani, Paolo; Dalla Toffola, Elena

2017-02-01

Chronic subdural hematoma (CSDH) can have a negative impact on autonomy of the elderly. Ambulatory and functional status may remain limited despite successful surgical evacuation. To evaluate the outcome of a postoperative assisted rehabilitation program. Single-institution short-term observational study. Inpatient (Neurosurgery Unit of a University Hospital). Thirty-five patients, aged 65 or older, who underwent burr-hole drainage for chronic subdural hematoma. Postoperatively all participants underwent a rehabilitation program, described in details, aimed at recovering standing position and gait as soon as possible. The program involved daily 30-minute individual sessions assisted by a physiotherapist, until discharge from hospital. The Markwalder's Grading Scale was used to assess the neurological status preoperatively and at discharge. The Trunk Control Test, the Standing Balance by Bohannon Scale and the Modified Rankin Scale were used to evaluate balance and general function (primary outcome) in the immediate postoperative and at discharge. We also recorded the rate of pre-CSDH walking patients who maintained ambulation at discharge and the discharge destination (secondary outcome). Total scores of Markwalder's Grading Scale, Trunk Control Test, Standing Balance by Bohannon Scale and Modified Rankin Scale improved (P<0.05), indicating a global favorable outcome, especially for balance. Excluding the patients who were dependent pre-CSDH, the others maintained gait function in 74.2% of cases. Only 45.7% of the patients were discharged home, the others being divided between inpatient medical settings and rehabilitation. The rehabilitation program was well tolerated by the patients. Our study showed a clear improvement in trunk control and standing balance and an overall favorable outcome for neurological and ambulatory status at discharge. Despite an assisted postoperative rehabilitation program, the residual impairment in general function was the main factor that prevents us to discharge more elderly patients home rather than to assisted settings. The results of this descriptive study suggest that an assisted rehabilitation program may be helpful in improving short-term postoperative balance and ambulatory status (more than functional status), but further studies, with a randomized controlled design, are certainly justified to understand the efficacy of rehabilitation in this context.

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...

Outcomes for a transitional living program serving LGBTQ youth in New York City.

PubMed

Nolan, Theresa C

2006-01-01

Providing stable housing for runaway and homeless youth is a major function of a transitional living program. This article introduces the focus of one program working with LGBTQ youth in New York City and discusses some issues to consider when working with this population. The article also presents data associated with young people's lives after discharge. In any discussion of outcomes, both reason for discharge and length of stay play important roles in whether or not an exit is safe. Regardless of these two elements, the places youth move to when leaving programs are crucial to their safety and well-being. The exit can be safe even when a young person is discharged early from a program. This article presents types of exits, as well as status of employment and school enrollment at exit. Some youth and staff-identified lessons gained in the program also are discussed in detail. Types of aftercare services sought by discharged youth are specified. This article also describes any differences in outcomes for youth with and without foster care experience.

[Measurement of antimicrobial consumption using DDD per 100 bed-days versus DDD per 100 discharges after the implementation of an antimicrobial stewardship program].

PubMed

Collado, Roberto; Losa, Juan Emilio; Álvaro, Elena Alba; Toro, Piedad; Moreno, Leonor; Pérez, Montserrat

2015-12-01

Monitoring antimicrobial consumption in hospitals is a necessary measure. The indicators commonly employed do not clearly reflect the antibiotic selection pressure. The objective of this study is to evaluate two different methods that analyze antimicrobial consumption based on DDD, per stay and per discharge, before and after the implementation an antimicrobial stewardship program. Comparative pre-post study of antimicrobial consumption with the implementation of an antimicrobial stewardship program using DDD per 100 bed-days and DDD per 100 discharges as indicators. Hospital bed days remained stable and discharges increased slightly along the period of study Antibiotic consumption in DDD per 100 bed-days decreased by 2.5% versus 3.8% when expressed as DDD per 100 discharges. Antifungal consumption decreased by more than 50%. When average hospital stay decreases, reductions in the consumption of antimicrobials with an antimicrobial stewardship program system occur at the expense of reducing the number of patients receiving treatment, while increases occur due to longer durations of treatment.

42 CFR 412.4 - Discharges and transfers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES General Provisions § 412.4 Discharges... hospital inpatient is considered discharged from a hospital paid under the prospective payment system when... the initial discharge) to another hospital that is— (1) Paid under the prospective payment system...

42 CFR 412.4 - Discharges and transfers.

Code of Federal Regulations, 2011 CFR

2011-10-01

... PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES General Provisions § 412.4 Discharges... hospital inpatient is considered discharged from a hospital paid under the prospective payment system when... the initial discharge) to another hospital that is— (1) Paid under the prospective payment system...

42 CFR 412.4 - Discharges and transfers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES General Provisions § 412.4 Discharges... hospital inpatient is considered discharged from a hospital paid under the prospective payment system when... the initial discharge) to another hospital that is— (1) Paid under the prospective payment system...

42 CFR 412.4 - Discharges and transfers.

Code of Federal Regulations, 2013 CFR

2013-10-01

... PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES General Provisions § 412.4 Discharges... hospital inpatient is considered discharged from a hospital paid under the prospective payment system when... the initial discharge) to another hospital that is— (1) Paid under the prospective payment system...

42 CFR 412.4 - Discharges and transfers.

Code of Federal Regulations, 2012 CFR

2012-10-01

... PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES General Provisions § 412.4 Discharges... hospital inpatient is considered discharged from a hospital paid under the prospective payment system when... the initial discharge) to another hospital that is— (1) Paid under the prospective payment system...

U.S. Geological Survey water-resources programs in New Mexico, FY 2015

USGS Publications Warehouse

Mau, David P.

2015-01-01

The U.S. Geological Survey (USGS) has collected hydrologic information in New Mexico since 1889, beginning with the first USGS streamflow-gaging station in the Nation, located on the Rio Grande near Embudo, New Mexico. Water-resources information provided by the USGS is used by many government agencies for issuing flood warnings to protect lives and reduce property damage,managing water rights and interstate water use, protecting water quality and regulating pollution discharges, designing highways and bridges, planning, designing, and operating reservoirs and watersupply facilities, monitoring the availability of groundwater resources and forecasting aquifer response to human and environmental stressors, and prioritizing areas where emergency erosion mitigation or other protective measures may be necessary after a wildfire. For more than 100 years, the Cooperative Water Program has been a highly successful cost-sharing partnership between the USGS and water-resources agencies at the State, local, and tribal levels. It would be difficult to effectively accomplish the mission of the USGS without the contributions of the Cooperative Water Program.

Region 9 NPDES Outfalls 2012

EPA Pesticide Factsheets

Point geospatial dataset representing locations of NPDES outfalls/dischargers for facilities which generally represent the site of the discharge. NPDES (National Pollution Discharge Elimination System) is an EPA permit program that regulates direct discharges from treated waste water that is discharged into waters of the US. Facilities are issued NPDES permits regulating their discharge as required by the Clean Water Act. A facility may have one or more dischargers. The location represents the discharge point of a discrete conveyance such as a pipe or man made ditch.

Fifty-year flood-inundation maps for Juticalpa, Honduras

USGS Publications Warehouse

Kresch, David L.; Mastin, M.C.; Olsen, T.D.

2002-01-01

After the devastating floods caused by Hurricane Mitch in 1998, maps of the areas and depths of 50-year-flood inundation at 15 municipalities in Honduras were prepared as a tool for agencies involved in reconstruction and planning. This report, which is one in a series of 15, presents maps of areas in the municipality of Juticalpa that would be inundated by a 50-year flood of Rio Juticalpa. Geographic Information System (GIS) coverages of the flood inundation are available on a computer in the municipality of Juticalpa as part of the Municipal GIS project and on the Internet at the Flood Hazard Mapping Web page (http://mitchnts1.cr.usgs.gov/projects/floodhazard.html). These coverages allow users to view the flood inundation in much more detail than is possible using the maps in this report. Water-surface elevations for a 50-year-flood on Rio Juticalpa at Juticalpa were estimated using HEC-RAS, a one-dimensional, steady-flow, step-backwater computer program. The channel and floodplain cross sections used in HEC-RAS were developed from an airborne light-detection-and-ranging (LIDAR) topographic survey of the area. The estimated 50-year-flood discharge for Rio Juticalpa at Juticalpa, 1,360 cubic meters per second, was computed as the drainage-area-adjusted weighted average of two independently estimated 50-year-flood discharges for the gaging station Rio Juticalpa en El Torito, located about 2 kilometers upstream from Juticalpa. One discharge, 1,551 cubic meters per second, was estimated from a frequency analysis of the 33 years of peak-discharge record for the gage, and the other, 486 cubic meters per second, was estimated from a regression equation that relates the 50-year-flood discharge to drainage area and mean annual precipitation. The weighted-average of the two discharges at the gage is 1,310 cubic meters per second. The 50-year flood discharge for the study area reach of Rio Juticalpa was estimated by multiplying the weighted discharge at the gage by the ratio of the drainage areas upstream from the two locations.

Computer program for the computation of total sediment discharge by the modified Einstein procedure

USGS Publications Warehouse

Stevens, H.H.

1985-01-01

Two versions of a computer program to compute total sediment discharge by the modified Einstein procedure are presented. The FORTRAN 77 language version is for use on the PRIME computer, and the BASIC language version is for use on most microcomputers. The program contains built-in limitations and input-output options that closely follow the original modified Einstein procedure. Program documentation and listings of both versions of the program are included. (USGS)

Enablers and barriers in delivery of a cancer exercise program: the Canadian experience

PubMed Central

Mina, D. Santa; Petrella, A.; Currie, K.L.; Bietola, K.; Alibhai, S.M.H.; Trachtenberg, J.; Ritvo, P.; Matthew, A.G.

2015-01-01

Background Exercise is an important therapy to improve well-being after a cancer diagnosis. Accordingly, cancer-exercise programs have been developed to enhance clinical care; however, few programs exist in Canada. Expansion of cancer-exercise programming depends on an understanding of the process of program implementation, as well as enablers and barriers to program success. Gaining knowledge from current professionals in cancer-exercise programs could serve to facilitate the necessary understanding. Methods Key personnel from Canadian cancer-exercise programs (n = 14) participated in semistructured interviews about program development and delivery. Results Content analysis revealed 13 categories and 15 subcategories, which were grouped by three organizing domains: Program Implementation, Program Enablers, and Program Barriers. ■ Program Implementation (5 categories, 8 subcategories) included Program Initiation (clinical care extension, research project expansion, program champion), Funding, Participant Intake (avenues of awareness, health and safety assessment), Active Programming (monitoring patient exercise progress, health care practitioner involvement, program composition), and Discharge and Follow-up Plan.■ Program Enablers (4 categories, 4 subcategories) included Patient Participation (personalized care, supportive network, personal control, awareness of benefits), Partnerships, Advocacy and Support, and Program Characteristics.■ Program Barriers (4 categories, 3 subcategories) included Lack of Funding, Lack of Physician Support, Deterrents to Participation (fear and shame, program location, competing interests), and Disease Progression and Treatment. Conclusions Interview results provided insight into the development and delivery of cancer-exercise programs in Canada and could be used to guide future program development and expansion in Canada. PMID:26715869

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...

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...

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...

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...

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...

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...

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...

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...

Scale Dependence in the Species-Discharge Relationship for Fishes of the Southeastern U.S.A.

EPA Science Inventory

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 ...

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...

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...

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...

The effectiveness of telehealth care on caregiver burden, mastery of stress, and family function among family caregivers of heart failure patients: a quasi-experimental study.

PubMed

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.

E-learning to improve the drug prescribing in the hospitalized elderly patients: the ELICADHE feasibility pilot study.

PubMed

Franchi, C; Mari, D; Tettamanti, M; Pasina, L; Djade, C D; Mannucci, P M; Onder, G; Bernabei, R; Gussoni, G; Bonassi, S; Nobili, A

2014-08-01

E-learning is an efficient and cost-effective educational method. This study aimed at evaluating the feasibility of an educational e-learning intervention, focused on teaching geriatric pharmacology and notions of comprehensive geriatric assessment, to improve drug prescribing to hospitalized elderly patients. Eight geriatric and internal medicine wards were randomized to intervention (e-learning educational program) or control. Clinicians of the two groups had to complete a specific per group e-learning program in 30 days. Then, ten patients (aged ≥75 years) had to be consecutively enrolled collecting clinical data at hospital admission, discharge, and 3 months later. The quality of prescription was evaluated comparing the prevalence of potentially inappropriate medications through Beer's criteria and of potential drug-drug interactions through a specific computerized database. The study feasibility was confirmed by the high percentage (90 %) of clinicians who completed the e-learning program, the recruitment, and follow-up of all planned patients. The intervention was well accepted by all participating clinicians who judged positively (a mean score of >3 points on a scale of 5 points: 0 = useless; 5 = most useful) the specific contents, the methodology applied, the clinical relevance and utility of e-learning contents and tools for the evaluation of the appropriateness of drug prescribing. The pilot study met all the requested goals. The main study is currently ongoing and is planned to finish on July 2015.

A predictive score to identify hospitalized patients' risk of discharge to a post-acute care facility

PubMed Central

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

34 CFR 685.214 - Closed school discharge.

Code of Federal Regulations, 2014 CFR

2014-07-01

... closure date is the date that the school ceases to provide educational instruction in all programs, as... 34 Education 4 2014-07-01 2014-07-01 false Closed school discharge. 685.214 Section 685.214... Provisions § 685.214 Closed school discharge. (a) General. (1) The Secretary discharges the borrower's (and...

Impact of comprehensive insurance parity on follow-up care after psychiatric inpatient treatment in Oregon.

PubMed

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.

Continuing education in physical rehabilitation and health issues of agricultural workers.

PubMed

Wilhite, Carla S; Jaco, Linda

2014-01-01

Limited attention has been devoted to the cultural and practice competencies needed by occupational therapy and physical therapy professionals who provide services to farming families impacted by chronic health or disability issues. Agricultural occupational safety and health should represent a continuum of services responsive to individuals, families, and agricultural communities across a life span and range of health status changes. Physical rehabilitation professionals have a key role in impacting an agricultural producer's sense of self-efficacy and capacities for returning to agricultural living and work. However, demonstration of competency is essential in providing person-centered rehabilitation services of assessment, evaluation, treatment planning, interventions, referrals, and discharge issues. The paper highlights methods utilized by a state AgrAbility program and a former National AgrAbility Project to develop a model of continuing education programming for occupational and physical therapists that evaluate and treat agricultural workers after acute injury or exacerbation of chronic health conditions.

Environmental Research Guidance Committee annual report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1982-01-01

Section 3-303 of the Natural Resources Article of the Annotated Code of Maryland (1973 Volume) provides for a Power Plant Environmental Research Program to be administered by the Secretary of Natural Resources in cooperation with the Secretaries of Health and Mental Hygiene, Agriculture, State Planning, Economic and Community Development, and Electric Company representatives. In order to carry out this provision of the law, the Power Plant Siting Program requested the Scientific Council of the Maryland Academy of Sciences to establish an Environmental Research Guidance Committee (ERGC) in June, 1973. The ERGC is divided into 4 subcommittees designated Biological Effects (impactmore » of power plants on aquatic and terrestrial ecosystems), Aquatic and Terrestrial (transport and chemical interactions of materials discharged into aquatic and terrestrial environments), Atmospheric (transport and chemical interactions of atmospheric emissions and their impacts on the environment), and Socioeconomic (effects of power plants on the social and economic structure of the State).« less

Culvert Analysis Program Graphical User Interface 1.0--A preprocessing and postprocessing tool for estimating flow through culvert

USGS Publications Warehouse

Bradley, D. Nathan

2013-01-01

The peak discharge of a flood can be estimated from the elevation of high-water marks near the inlet and outlet of a culvert after the flood has occurred. This type of discharge estimate is called an “indirect measurement” because it relies on evidence left behind by the flood, such as high-water marks on trees or buildings. When combined with the cross-sectional geometry of the channel upstream from the culvert and the culvert size, shape, roughness, and orientation, the high-water marks define a water-surface profile that can be used to estimate the peak discharge by using the methods described by Bodhaine (1968). This type of measurement is in contrast to a “direct” measurement of discharge made during the flood where cross-sectional area is measured and a current meter or acoustic equipment is used to measure the water velocity. When a direct discharge measurement cannot be made at a streamgage during high flows because of logistics or safety reasons, an indirect measurement of a peak discharge is useful for defining the high-flow section of the stage-discharge relation (rating curve) at the streamgage, resulting in more accurate computation of high flows. The Culvert Analysis Program (CAP) (Fulford, 1998) is a command-line program written in Fortran for computing peak discharges and culvert rating surfaces or curves. CAP reads input data from a formatted text file and prints results to another formatted text file. Preparing and correctly formatting the input file may be time-consuming and prone to errors. This document describes the CAP graphical user interface (GUI)—a modern, cross-platform, menu-driven application that prepares the CAP input file, executes the program, and helps the user interpret the output

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.

Current discharge management of acute coronary syndromes: baseline results from a national quality improvement initiative.

PubMed

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.

Theoretical technique for predicting the cumulative impact of iron and manganese oxidation in streams receiving discharge from coal mines

USGS Publications Warehouse

Bobay, Keith E.

1986-01-01

Two U.S. Geological Survey computer programs are modified and linked to predict the cumulative impact of iron and manganese oxidation in coal-mine discharge water on the dissolved chemical quality of a receiving stream. The coupled programs calculate the changes in dissolved iron, dissolved manganese, and dissolved oxygen concentrations; alkalinity; and, pH of surface water downstream from the point of discharge. First, the one-dimensional, stead-state stream, water quality program uses a dissolved oxygen model to calculate the changes in concentration of elements as a function of the chemical reaction rates and time-of-travel. Second, a program (PHREEQE) combining pH, reduction-oxidation potential, and equilibrium equations uses an aqueous-ion association model to determine the saturation indices and to calculate pH; it then mixes the discharge with a receiving stream. The kinetic processes of the first program dominate the system, whereas the equilibrium thermodynamics of the second define the limits of the reactions. A comprehensive test of the technique was not possible because a complete set of data was unavailable. However, the cumulative impact of representative discharges from several coal mines on stream quality in a small watershed in southwestern Indiana was simulated to illustrate the operation of the technique and to determine its sensitivity to changes in physical, chemical, and kinetic parameters. Mine discharges averaged 2 cu ft/sec, with a pH of 6.0, and concentrations of 7.0 mg/L dissolved iron, 4.0 mg/L dissolved manganese, and 8.08 mg/L dissolved oxygen. The receiving stream discharge was 2 cu ft/sec, with a pH of 7.0, and concentrations of 0.1 mg/L dissolved iron, 0.1 mg/L dissolved manganese, and 8.70 mg/L dissolved oxygen. Results of the simulations indicated the following cumulative impact on the receiving stream from five discharges as compared with the effect from one discharge: 0.30 unit decrease in pH, 1.82 mg/L increase in dissolved iron, 1.50 mg/L increase in dissolved manganese, and 0.24 mg/L decrease in dissolved oxygen concentration.

Review of wastewater problems and wastewater-management planning in the San Francisco Bay region, California

USGS Publications Warehouse

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.

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...

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...

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...

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...

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.

46 CFR 25.50-1 - Criteria.

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...

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...

National Contingency Plan Subpart J

EPA Pesticide Factsheets

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.

The inpatient evaluation and treatment of a self-professed budding serial killer.

PubMed

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.

San Francisco Bay Area Baseline Trash Loading Summary Results for all counties

EPA Pesticide Factsheets

The San Francisco Bay Area stormwater permit sets trash control guidelines for discharges through the storm drain system. The permit covers Alameda, Contra Costa, Santa Clara, and San Mateo counties and the cities of Vallejo, Fairfield, and Suisun City. By February 2012 the permittees must provide a baseline trash load estimate, a list of trash hotspots targeted for annual cleanup, and an implementation plan for best management practices to meet trash reduction milestones over the next decade. A trash reduction crediting program will be used to account for best management practice effectiveness. The permit establishes goals for trash reduction beginning in 2014 and reaching a zero level by 2022.

42 CFR 484.18 - Condition of participation: Acceptance of patients, plan of care, and medical supervision.

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...

Perceived Relapse Risk and Desire for Medication Assisted Treatment among Persons Seeking Inpatient Opiate Detoxification

PubMed Central

Bailey, Genie L; Herman, Debra S.; Stein, Michael D.

2016-01-01

Most patients with opioid addiction do not receive medication at the time of discharge from brief inpatient detoxification programs despite the high risk of relapse and the availability of three FDA-approved medications. We surveyed 164 inpatient opioid detoxification patients to assess desire for pharmacotherapy following detoxification program discharge. Participants were predominantly male (71.3%) and 80% had detoxed in the past. Reporting on their most recent previous inpatient detoxification, 27% had relapsed the day they were discharged, 65% within a month of discharge, and 90% within a year of discharge. 63% reported they wanted medication-assisted treatment (MAT) after discharge from the current admission. The odds of desiring a treatment medication increased by a factor of 1.02 for every 1% increase in perceived relapse risk (p < .01). These data suggest patient preference discussions including relapse risk could increase post-detox abstinence. PMID:23786852

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.

40 CFR 122.29 - New sources and new dischargers.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false New sources and new dischargers. 122... Application and Special NPDES Program Requirements § 122.29 New sources and new dischargers. (a) Definitions. (1) New source and new discharger are defined in § 122.2. [See Note 2.] (2) Source means any building...

Basic Outline Plan For Blacklist Operations to Occupy Japan Proper and Korea After Surrender or Collapse

DTIC Science & Technology

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

Instream biological assessment of NPDES point source discharges at the Savannah River Site, 1997-1998

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.

Implementing the NPDES program: An update on the WET requirements

EPA Science Inventory

The U.S. EPA has utilized the Clean Water Act - National Pollutant Discharge Elimination System permitting program to protect waters of the U.S for over 40 years. NPDES permit effluent limitations serve as the primary mechanism for controlling discharges of pollutants to receivin...

Communication at the interface between hospitals and primary care - a general practice audit of hospital discharge summaries.

PubMed

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.

Affect of Early Skin-to-Skin Mother-Infant Contact in the Maintenance of Exclusive Breastfeeding: Experience in a Health Department in Spain.

PubMed

Vila-Candel, Rafael; Duke, Kiri; Soriano-Vidal, F Javier; Castro-Sánchez, Enrique

2018-05-01

Breastfeeding has been shown to result in extensive physical and psychological benefits for both the mother and the newborn. However, the rate and duration of exclusive breastfeeding (EBF) remains low worldwide. Mother-infant skin-to-skin contact (SSC) immediately after birth has demonstrated results that support the argument for breastfeeding continuation. Research aim: This study aimed to investigate the prevalence of EBF 3 months postpartum and the effect of early SSC in maintaining optimal EBF practices for mothers and their healthy newborns. We conducted an observational, retrospective study in Spain from 2013 to 2015. Pregnant women were interviewed immediately postpartum and again at 3 months postpartum regarding variables associated with breastfeeding initiation and continuation. There were 1,071 women recruited. Early SSC was performed in 92% of vaginal births but only 57% of urgent cesarean births. Of women breastfeeding at discharge, 69.5% performed SSC with their newborn. We found that 68.6% of women were exclusively breastfeeding by discharge and 46.7% by 3 months postpartum. Type of feeding at discharge, country of origin, and parity were found to be associated with each other ( p = .003, p = .001, respectively). Early SSC was also significantly associated with type of feeding at discharge, 1 month, 2 months, and 3 months postpartum ( p < .001). Hypogalactia (19.8%) was the most frequently reported factor for breastfeeding discontinuation. Breastfeeding promotion interventions are likely to improve breastfeeding rates at 3 months postpartum. Social and economic factors should be taken into account when such programs are planned to be implemented.

45 CFR 1386.19 - Definitions.

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...

Microcumpter computation of water quality discharges

USGS Publications Warehouse

Helsel, Dennis R.

1983-01-01

A fully prompted program (SEDQ) has been developed to calculate daily and instantaneous water quality (QW) discharges. It is written in a version of BASIC, and requires inputs of gage heights, discharge rating curve, shifts, and water quality concentration information. Concentration plots may be modified interactively using the display screen. Semi-logarithmic plots of concentration and water quality discharge are output to the display screen, and optionally to plotters. A summary table of data is also output. SEDQ could be a model program for micro and minicomputer systems likely to be in use within the Water Resources Division, USGS, in the near future. The daily discharge-weighted mean concentration is one output from SEDQ. It is defined in this report, differentiated from the currently used mean concentration, and designated the ' equivalent concentration. ' (USGS)

Annual peak discharges from small drainage areas in Montana for stations discontinued before 1978

USGS Publications Warehouse

Omang, R.J.; Hull, J.A.; Parrett, Charles

1979-01-01

Annual peak stage and discharge data have been tabulated for crest-stage gage sites in Montana. The crest-stage program was begun in July 1955 to investigate the magnitude and frequency of floods from samll drainage areas. The program has expanded from 45 crest-stage gaging stations initially to 172 stations maintained in 1978. From 1955 to 1978, 156 stations have been discontinued. This report is a tabulation of the stage and discharge data for the discontinued stations. (Woodard-USGS)

Region 9 NPDES Facilities - Waste Water Treatment Plants

EPA Pesticide Factsheets

Point geospatial dataset representing locations of NPDES Waste Water Treatment Plant Facilities. NPDES (National Pollution Discharge Elimination System) is an EPA permit program that regulates direct discharges from facilities that discharge treated waste water into waters of the US. Facilities are issued NPDES permits regulating their discharge as required by the Clean Water Act. A facility may have one or more outfalls (dischargers). The location represents the facility or operating plant.

Does family-centred neonatal discharge planning reduce healthcare usage? A before and after study in South West England.

PubMed

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/

Biophysiologic and Social Stress Relationships with Breast Milk Feeding Pre and Post Discharge from the Neonatal Intensive Care Unit

PubMed Central

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

Don't let go of the rope: reducing readmissions by recognizing hospitals' fiduciary duties to their discharged patients.

PubMed

Hafemeister, Thomas L; Hinckley Porter, Joshua

2013-01-01

In the early years of the twenty-first century, it was widely speculated that massive, multi-purpose hospitals were becoming the "dinosaurs" of health care, to be largely replaced by community-based clinics providing specialty services on an outpatient basis. Hospitals, however, have roared back to life, in part by reworking their business model. There has been a wave of consolidations and acquisitions (including acquisitions of community-based clinics), with deals valued at $7.9 billion in 2011, the most in a decade, and the number of deals increasing another 18% in 2012. The costs of hospital care are enormous, with 31.5% ($851 billion) of the total health expenditures in the United States in 2011 devoted to these services. Hospitals are (1) placing growing emphasis on increasing revenue and decreasing costs; (2) engaging in pervasive marketing campaigns encouraging patients to view hospitals as an all-purpose care provider; (3) geographically targeting the expansion of their services to "capture" well-insured patients, while placing greater pressure on patients to pay for the services delivered; (4) increasing their size, wealth, and clout, with two-thirds of hospitals undertaking renovations or additional construction and smaller hospitals being squeezed out, and (5) expanding their use of hospital-employed physicians, rather than relying on community-based physicians with hospital privileges, and exercising greater control over medical staff. Hospitals have become so pivotal in the U.S. healthcare system that the Patient Protection and Affordable Care Act of 2010 (PPACA) frequently targeted them as a vehicle to enhance patient safety and control escalating health care costs. One such provision--the Hospital Readmissions Reduction Program, which goes into effect in fiscal year 2013--will reduce payments ordinarily made to hospitals if they have an "excess readmission" rate. It is estimated that adverse events following a hospital discharge impact as many as 19% of all discharged patients. When hospitals and similar health care facilities fail to adequately manage the discharge of their patients, devastating medical emergencies and sizeable healthcare costs can result. The urgency to better manage these discharges is compounded by the fact that the average length of hospital stays continues to shorten, potentially increasing the number of discharged patients who are at considerable risk of relapse. Also exacerbating the problem is a lack of clarity regarding who, if anyone, is responsible for these patients following discharge. Confusion over who bears responsibility for discharge-related preparation and community outreach, concerns about compensation, a lack of clear institutional policies, and the absence of legal mandates that patients be properly prepared for and monitored after discharge all contribute to the potential abandonment of patients at a crucial juncture. Although the PPACA establishes financial incentives for hospitals and similar facilities to combat the long-standing problem of high readmission rates, it does not provide a remedy for patients who have suffered avoidable harm after being discharged without adequate preparation or post-discharge assistance. This omission is particularly problematic as existing legal remedies, including medical malpractice suits, have provided little recourse for patients who have suffered injury that could have been prevented through the implementation of reasonable discharge-related policies. To protect the many patients who are highly vulnerable to complications following discharge and to provide them redress when needed services are not provided, hospitals' obligations to these patients should be recognized for what they are: a fiduciary duty to provide adequate discharge preparation and post-discharge services. The recognition of this duty is driven by changes in the nature of hospital care that enhance the perception that hospitals have become a "big business" that should "carry their own freight." Properly interpreted, this duty requires facilities to implement an appropriate discharge plan and provide post-discharge services for a period of time commensurate with a patient's continuing health risks. Notably, this is not the same as a generalized duty to provide all patients with continuing post-discharge treatment. It is a more limited obligation to offer necessary clarification and direction to patients upon discharge, and to institute a reasonable post-discharge monitoring program for patients with continuing health risks.

75 FR 3709 - Notice of Intent To Conduct Restoration Planning (Pursuant to 15 CFR 990.44)-Discharge of Oil...

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...

Impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft surgery: A quasi-experimental study in Iran.

PubMed

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.

Delayed transfer from hospital to community settings: the older person's perspective.

PubMed

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.

Impact of an Educational Program to Reduce Healthcare Resources in Community-Acquired Pneumonia: The EDUCAP Randomized Controlled Trial

PubMed Central

Simonetti, Antonella; Jiménez-Martínez, Emilio; Molero, Lorena; González-Samartino, Maribel; Castillo, Elena; Juvé-Udina, María-Eulalia; Alcocer, María-Jesús; Hernández, Carme; Buera, María-Pilar; Roel, Asunción; Abad, Emilia; Zabalegui, Adelaida; Ricart, Pilar; Gonzalez, Anna; Isla, Pilar; Dorca, Jordi; Garcia-Vidal, Carolina

2015-01-01

Background Additional healthcare visits and rehospitalizations after discharge are frequent among patients with community-acquired pneumonia (CAP) and have a major impact on healthcare costs. We aimed to determine whether the implementation of an individualized educational program for hospitalized patients with CAP would decrease subsequent healthcare visits and readmissions within 30 days of hospital discharge. Methods A multicenter, randomized trial was conducted from January 1, 2011 to October 31, 2014 at three hospitals in Spain. We randomly allocated immunocompetent adults patients hospitalized for CAP to receive either an individualized educational program or conventional information before discharge. The educational program included recommendations regarding fluid intake, adherence to drug therapy and preventive vaccines, knowledge and management of the disease, progressive adaptive physical activity, and counseling for alcohol and smoking cessation. The primary trial endpoint was a composite of the frequency of additional healthcare visits and rehospitalizations within 30 days of hospital discharge. Intention-to-treat analysis was performed. Results We assigned 102 patients to receive the individualized educational program and 105 to receive conventional information. The frequency of the composite primary end point was 23.5% following the individualized program and 42.9% following the conventional information (difference, -19.4%; 95% confidence interval, -6.5% to -31.2%; P = 0.003). Conclusions The implementation of an individualized educational program for hospitalized patients with CAP was effective in reducing subsequent healthcare visits and rehospitalizations within 30 days of discharge. Such a strategy may help optimize available healthcare resources and identify post-acute care needs in patients with CAP. Trial Registration Controlled-Trials.com ISRCTN39531840 PMID:26460907

[Effectiveness of an early discharge program after normal childbirth].

PubMed

Teulón González, M; Martínez Pillado, M; Cuadrado Martín, M M; Rivero Martín, M J; Cerezuela Requena, J F

To implement a program of early hospital discharge after an uncomplicated birth, in order to improve the effectiveness, as well as ensuring clinical safety and patient acceptability. Descriptive study of the effectiveness of an early discharge program after uncomplicated delivery between February 2012 and September 2013. The populations are post-partum women and newborns admitted to the University Hospital of Fuenlabrada, with a duration of less than 24h after uncomplicated delivery that met the defined inclusion criteria. Satisfaction was assessed using a Likert scale. The effectiveness of the program was monitored by safety indicators, productivity, adaptation, and continuity of care. A total of 20% of cases capable of early discharge from Fuenlabrada University Hospital completed the program. Almost all (94%) were normal deliveries. The 188 cases included were from 911 patients with uncomplicated childbirth, accounting for 6.5% of the 2,857 total births. The mean stay of patients included showed a decrease of 50% (2.4 to 1.2 days). All patients received continuity of care after hospital discharge. The review consultation was reprogrammed for 4.8% of cases, with 2% of patients re-admitted within 96h. with no serious problems. Four newborns (2%) required attention in the emergency department (mother or newborn) before 96h. The assessment of patient satisfaction achieved a score of 4.5 out of 5. The program achieved a decrease in the average stay by 50%, favouring the autonomy of midwives. This acceptance level is in line with similar interventions. The deployment of the program may be useful for other changes in care processes. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

Experiences of nurse case managers within a central discharge planning role of collaboration between physicians, patients and other healthcare professionals: A sociocultural qualitative study.

PubMed

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.

Results of chopper-controlled discharge life cycling studies on lead acid batteries

NASA Technical Reports Server (NTRS)

Ewashinka, J. G.; Sidik, S. M.

1982-01-01

A group of 108 state of the art nominally 6 volt lead acid batteries were tested in a program of one charge/discharge cycle per day for over two years or to ultimate battery failure. The primary objective was to determine battery cycle life as a function of depth of discharge (25 to 75 percent), chopper frequency (100 to 1000 Hz), duty cycle (25 to 87.5 percent), and average discharge current (20 to 260 A). The secondary objective was to determine the types of battery failure modes, if any, were due to the above parameters. The four parameters above were incorporated in a statistically designed test program.

Expanding The INSPIRED COPD Outreach Program™ to the emergency department: a feasibility assessment

PubMed Central

Gillis, Darcy; Demmons, Jillian; Rocker, Graeme

2017-01-01

Background The Halifax-based INSPIRED COPD Outreach Program™ is a facility-to-community home-based novel clinical initiative that through improved care transitions, self-management, and engagement in advance care planning has demonstrated a significant (60%–80%) reduction in health care utilization with substantial cost aversion. By assessing the feasibility of expanding INSPIRED into the emergency department (ED) we anticipated extending reach and potential for positive impact of INSPIRED to those with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) who avoid hospital admission. Methods Patients were eligible for the INSPIRED-ED study if >40 years of age, diagnosed with AECOPD and discharged from the ED, willing to be referred, community dwelling with at least one of: previous use of the ED services, admission to Intermediate Care Unit/Intensive Care Unit, or admission to hospital with AECOPD in the past year. We set feasibility objectives for referral rates, completion of action plans, advance care planning participation, and reduction in ED visit frequency. Results Referral rates were 0.5/week. Among eligible patients (n=174) 33 (19%) were referred of whom 15 (M=4, F=11) enrolled in INSPIRED-ED. Mean (SD) age was 68 (7) years, post-bronchdilator FEV1 44.2 (15.5) % predicted, and Medical Research Council (MRC) dyspnea score 3.8 (0.41). We met feasibility objectives for action plan and advance care planning completion. Frequency of subsequent ED visits fell by 54%. Mean (SD) Care Transition Measure (CTM-3) improved from 8.6 (2.0) to 11.3 (1.3), P=0.0004, and of 14 patients responding 12 (86%) found the program very helpful. An additional 34 patients were enrolled to our regular program from those referred but ineligible for INSPIRED-ED (n=27) or unwilling to participate (n=7). Conclusions INSPIRED-ED outcomes were generally positive, however referral and enrollment rates were lower than anticipated. Despite the potential of early self-management education, the ED may not be the ideal recruitment setting for home-based programs. Our findings underline the importance of conducting preliminary work to ascertain best settings for implementing new self-management education initiatives. PMID:28615932

Expanding The INSPIRED COPD Outreach Program™ to the emergency department: a feasibility assessment.

PubMed

Gillis, Darcy; Demmons, Jillian; Rocker, Graeme

2017-01-01

The Halifax-based INSPIRED COPD Outreach Program™ is a facility-to-community home-based novel clinical initiative that through improved care transitions, self-management, and engagement in advance care planning has demonstrated a significant (60%-80%) reduction in health care utilization with substantial cost aversion. By assessing the feasibility of expanding INSPIRED into the emergency department (ED) we anticipated extending reach and potential for positive impact of INSPIRED to those with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) who avoid hospital admission. Patients were eligible for the INSPIRED-ED study if >40 years of age, diagnosed with AECOPD and discharged from the ED, willing to be referred, community dwelling with at least one of: previous use of the ED services, admission to Intermediate Care Unit/Intensive Care Unit, or admission to hospital with AECOPD in the past year. We set feasibility objectives for referral rates, completion of action plans, advance care planning participation, and reduction in ED visit frequency. Referral rates were 0.5/week. Among eligible patients (n=174) 33 (19%) were referred of whom 15 (M=4, F=11) enrolled in INSPIRED-ED. Mean (SD) age was 68 (7) years, post-bronchdilator FEV 1 44.2 (15.5) % predicted, and Medical Research Council (MRC) dyspnea score 3.8 (0.41). We met feasibility objectives for action plan and advance care planning completion. Frequency of subsequent ED visits fell by 54%. Mean (SD) Care Transition Measure (CTM-3) improved from 8.6 (2.0) to 11.3 (1.3), P =0.0004, and of 14 patients responding 12 (86%) found the program very helpful. An additional 34 patients were enrolled to our regular program from those referred but ineligible for INSPIRED-ED (n=27) or unwilling to participate (n=7). INSPIRED-ED outcomes were generally positive, however referral and enrollment rates were lower than anticipated. Despite the potential of early self-management education, the ED may not be the ideal recruitment setting for home-based programs. Our findings underline the importance of conducting preliminary work to ascertain best settings for implementing new self-management education initiatives.

Comparing Budget-based and Tracer-based Residence Times in Butte Basin, California

NASA Astrophysics Data System (ADS)

Moran, J. E.; Visser, A.; Esser, B.; Buck, C.

2017-12-01

The California Sustainable Groundwater Management Act of 2014 (SGMA) calls for basin-scale Groundwater Sustainability Plans (GSPs) that include a water budget covering a 50 year planning horizon. A nine layer, Integrated Water Flow Model (IWFM) developed for Butte Basin, California, allows examination of water budgets within 36 sub-regions having varying land and water use, to inform SGMA efforts. Detailed land use, soil type, groundwater pumping, and surface water delivery data were applied in the finite element IWFM calibration. In a sustainable system, the volume of storage does not change over a defined time period, and the residence time can be calculated from the water storage volume divided by the flux (recharge or discharge rate). Groundwater ages based on environmental tracer data reflect the mean residence time of groundwater, or its inverse, the turnover rate. Comparisons between budget-based residence times determined from storage and flux, and residence times determined from isotopic tracers of groundwater age, can provide insight into data quality, model reliability, and system sustainability. Budget-based groundwater residence times were calculated from IWFM model output by assuming constant storage and dividing by either averaged annual net recharge or discharge. Calculated residence times range between approximately 100 and 1000 years, with shorter times in subregions where pumping dominates discharge. Independently, 174 wells within the model boundaries were analyzed for tritium-helium groundwater age as part of the California Groundwater Ambient Monitoring and Assessment program. Age distributions from isotopic tracers were compared to model-derived groundwater residence times from groundwater budgets within the subregions of Butte Basin. Mean, apparent, tracer-based residence times are mostly between 20 and 40 years, but 25% of the long-screened wells that were sampled do not have detectable tritium, indicating residence times of more than about 60 years and broad age distributions. A key factor in making meaningful comparisons is to examine budget-based and tracer-based results over transmissive vertical sections, where pumping increases turnover time.

40 CFR Appendix E to Part 300 - Oil Spill Response

Code of Federal Regulations, 2013 CFR

2013-07-01

... and Health Administration RSPA—Research and Special Programs Administration USCG—United States Coast... major discharge regardless of the following quantitative measures: (a) Minor discharge means a discharge... protection of response teams and necessary research, development, demonstration, and evaluation to improve...

40 CFR Appendix E to Part 300 - Oil Spill Response

Code of Federal Regulations, 2011 CFR

2011-07-01

... and Health Administration RSPA—Research and Special Programs Administration USCG—United States Coast... major discharge regardless of the following quantitative measures: (a) Minor discharge means a discharge... protection of response teams and necessary research, development, demonstration, and evaluation to improve...

40 CFR Appendix E to Part 300 - Oil Spill Response

Code of Federal Regulations, 2012 CFR

2012-07-01

... and Health Administration RSPA—Research and Special Programs Administration USCG—United States Coast... major discharge regardless of the following quantitative measures: (a) Minor discharge means a discharge... protection of response teams and necessary research, development, demonstration, and evaluation to improve...

40 CFR 125.120 - Scope and purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

....120 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Ocean Discharge Criteria § 125.120 Scope... Elimination System (NPDES) permits for the discharge of pollutants from a point source into the territorial...

40 CFR 125.120 - Scope and purpose.

Code of Federal Regulations, 2011 CFR

2011-07-01

....120 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Ocean Discharge Criteria § 125.120 Scope... Elimination System (NPDES) permits for the discharge of pollutants from a point source into the territorial...

Region 9 NPDES Facilities 2012- Waste Water Treatment Plants

EPA Pesticide Factsheets

Point geospatial dataset representing locations of NPDES Waste Water Treatment Plant Facilities. NPDES (National Pollution Discharge Elimination System) is an EPA permit program that regulates direct discharges from facilities that discharge treated waste water into waters of the US. Facilities are issued NPDES permits regulating their discharge as required by the Clean Water Act. A facility may have one or more outfalls (dischargers). The location represents the facility or operating plant.

A retrospective observational study of functional outcomes, length of stay, and discharge disposition after an inpatient stroke rehabilitation program in Saudi Arabia.

PubMed

Bindawas, Saad M; Mawajdeh, Hussam; Vennu, Vishal; Alhaidary, Hisham

2016-08-01

Functional outcomes, length of stay (LOS), and discharge disposition have become frequent outcome measures among stroke patients after rehabilitation programs. To examine the trends of changes in functional outcomes, LOS, and discharge disposition in stroke patients discharged from an inpatient rehabilitation facility.All patients (n = 432) were admitted to a tertiary inpatient rehabilitation hospital in Riyadh, Saudi Arabia with stroke diagnoses from November 2008 to December 2014. The functional independence measure (FIM) instrument used to assess the patient's functional status. The LOS was measured as the number of days the patients spent in the hospital from the day of admission to the day of discharge. The FIM efficiency was used to measure the patient's rehabilitation progress. All of the variables of the prospectively collected data were retrospectively analyzed.There were significant changes by years in the total FIM ranging from 23 to 29 (P < 0.001) and subscores: FIM motor ranging from 20 to 26 (P < 0.001); FIM cognitive ranging from 1.8 to 3 (P < 0.001). The mean LOS remained constant, from 52 days in 2011 to 40 days in 2013. The FIM efficiency was stable between years and ranged from 0.52 to 0.72. The rates of discharge (to home) were significantly unstable and ranged from 100% in 2010 and 2011 to 92% in 2013.Our results suggest that functional outcomes in patients with stroke have improved after an inpatient stroke rehabilitation program between 2008 and 2014 even with a constant LOS. Discharge disposition has remained unstable over this period. To improve the efficiency of the stroke rehabilitation program in Saudi Arabia, there is a need to decrease the LOS and emphasize a comprehensive interdisciplinary approach.

Considerations for use of the RORA program to estimate ground-water recharge from streamflow records

USGS Publications Warehouse

Rutledge, A.T.

2000-01-01

The RORA program can be used to estimate ground-water recharge in a basin from analysis of a streamflow record. The program can be appropriate for use if the ground-water flow system is characterized by diffuse areal recharge to the water table and discharge to a stream. The use of the program requires an estimate of a recession index, which is the time required for ground-water discharge to recede by one log cycle after recession becomes linear or near-linear on the semilog hydrograph. Although considerable uncertainty is inherent in the recession index, the results of the RORA program may not be sensitive to this variable. Testing shows that the program can yield consistent estimates under conditions that include leakage to or from deeper aquifers and ground-water evapotranspiration. These tests indicate that RORA estimates the net recharge, which is recharge to the water table minus leakage to a deeper aquifer, or recharge minus ground-water evapotranspiration. Before the program begins making calculations it designates days that fit a requirement of antecedent recession, and these days are used in calculations. The program user might increase the antecedent-recession requirement above its default value to reduce the influence of errors that are caused by direct-surface runoff, but other errors can result from the reduction in the number of peaks detected. To obtain an understanding of flow systems, results from the RORA program might be used in conjunction with other methods such as analysis of ground-water levels, estimates of ground-water discharge from other forms of hydrograph separation, and low-flow variables. Relations among variables may be complex for a variety of reasons; for example, there may not be a unique relation between ground-water level and ground-water discharge, ground-water recharge and discharge are not synchronous, and low-flow variables can be related to other factors such as the recession index.

Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review

PubMed Central

2013-01-01

Background Old adults admitted to the hospital are at severe risk of functional loss during hospitalization. Early in-hospital physical rehabilitation programs appear to prevent functional loss in geriatric patients. The first aim of this review was to investigate the effect of early physical rehabilitation programs on physical functioning among geriatric patients acutely admitted to the hospital. The second aim was to evaluate the feasibility of early physical rehabilitation programs. Methods Two searches, one for physical functioning and one for feasibility, were conducted in PubMed, CINAHL, and EMBASE. Additional studies were identified through reference and citation tracking. To be included articles had to report on in-hospital early physical rehabilitation of patients aged 65 years and older with an outcome measure of physical functioning. Studies were excluded when the treatment was performed on specialized units other than geriatric units. Randomized controlled trials were included to examine the effect of early physical rehabilitation on physical functioning, length of stay and discharge destination. To investigate feasibility also non randomized controlled trials were added. Results Fifteen articles, reporting on 13 studies, described the effect on physical functioning. The early physical rehabilitation programs were classified in multidisciplinary programs with an exercise component and usual care with an exercise component. Multidisciplinary programs focussed more on facilitating discharge home and independent ADL, whereas exercise programs aimed at improving functional outcomes. At time of discharge patients who had participated in a multidisciplinary program or exercise program improved more on physical functional tests and were less likely to be discharged to a nursing home compared to patients receiving only usual care. In addition, multidisciplinary programs reduced the length of hospital stay significantly. Follow-up interventions improved physical functioning after discharge. The feasibility search yielded four articles. The feasibility results showed that early physical rehabilitation for acutely hospitalized old adults was safe. Adherence rates differed between studies and the recruitment of patients was sometimes challenging. Conclusions Early physical rehabilitation care for acutely hospitalized old adults leads to functional benefits and can be safely executed. Further research is needed to specifically quantify the physical component in early physical rehabilitation programs. PMID:24112948

Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic review.

PubMed

Kosse, Nienke M; Dutmer, Alisa L; Dasenbrock, Lena; Bauer, Jürgen M; Lamoth, Claudine J C

2013-10-10

Old adults admitted to the hospital are at severe risk of functional loss during hospitalization. Early in-hospital physical rehabilitation programs appear to prevent functional loss in geriatric patients. The first aim of this review was to investigate the effect of early physical rehabilitation programs on physical functioning among geriatric patients acutely admitted to the hospital. The second aim was to evaluate the feasibility of early physical rehabilitation programs. Two searches, one for physical functioning and one for feasibility, were conducted in PubMed, CINAHL, and EMBASE. Additional studies were identified through reference and citation tracking. To be included articles had to report on in-hospital early physical rehabilitation of patients aged 65 years and older with an outcome measure of physical functioning. Studies were excluded when the treatment was performed on specialized units other than geriatric units. Randomized controlled trials were included to examine the effect of early physical rehabilitation on physical functioning, length of stay and discharge destination. To investigate feasibility also non randomized controlled trials were added. Fifteen articles, reporting on 13 studies, described the effect on physical functioning. The early physical rehabilitation programs were classified in multidisciplinary programs with an exercise component and usual care with an exercise component. Multidisciplinary programs focussed more on facilitating discharge home and independent ADL, whereas exercise programs aimed at improving functional outcomes. At time of discharge patients who had participated in a multidisciplinary program or exercise program improved more on physical functional tests and were less likely to be discharged to a nursing home compared to patients receiving only usual care. In addition, multidisciplinary programs reduced the length of hospital stay significantly. Follow-up interventions improved physical functioning after discharge. The feasibility search yielded four articles. The feasibility results showed that early physical rehabilitation for acutely hospitalized old adults was safe. Adherence rates differed between studies and the recruitment of patients was sometimes challenging. Early physical rehabilitation care for acutely hospitalized old adults leads to functional benefits and can be safely executed. Further research is needed to specifically quantify the physical component in early physical rehabilitation programs.

Transitions of Care Between Acute and Chronic Heart Failure: Critical Steps in the Design of a Multidisciplinary Care Model for the Prevention of Rehospitalization.

PubMed

Comín-Colet, Josep; Enjuanes, Cristina; Lupón, Josep; Cainzos-Achirica, Miguel; Badosa, Neus; Verdú, José María

2016-10-01

Despite advances in the treatment of heart failure, mortality, the number of readmissions, and their associated health care costs are very high. Heart failure care models inspired by the chronic care model, also known as heart failure programs or heart failure units, have shown clinical benefits in high-risk patients. However, while traditional heart failure units have focused on patients detected in the outpatient phase, the increasing pressure from hospital admissions is shifting the focus of interest toward multidisciplinary programs that concentrate on transitions of care, particularly between the acute phase and the postdischarge phase. These new integrated care models for heart failure revolve around interventions at the time of transitions of care. They are multidisciplinary and patient-centered, designed to ensure continuity of care, and have been demonstrated to reduce potentially avoidable hospital admissions. Key components of these models are early intervention during the inpatient phase, discharge planning, early postdischarge review and structured follow-up, advanced transition planning, and the involvement of physicians and nurses specialized in heart failure. It is hoped that such models will be progressively implemented across the country. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

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...

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...

A Lean Six Sigma quality improvement project to increase discharge paperwork completeness for admission to a comprehensive integrated inpatient rehabilitation program.

PubMed

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.

Social Work Admission Assessment Tool for Identifying Patients in Need of Comprehensive Social Work Evaluation

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…

Fifty-year flood-inundation maps for Nacaome, Honduras

USGS Publications Warehouse

Kresch, David L.; Mastin, M.C.; Olsen, T.D.

2002-01-01

After the devastating floods caused by Hurricane Mitch in 1998, maps of the areas and depths of 50-year-flood inundation at 15 municipalities in Honduras were prepared as a tool for agencies involved in reconstruction and planning. This report, which is one in a series of 15, presents maps of areas in the municipality of Nacaome that would be inundated by 50-year floods on Rio Nacaome, Rio Grande, and Rio Guacirope. Geographic Information System (GIS) coverages of the flood inundation are available on a computer in the municipality of Nacaome as part of the Municipal GIS project and on the Internet at the Flood Hazard Mapping Web page (http://mitchnts1.cr.usgs.gov/projects/floodhazard.html). These coverages allow users to view the flood inundation in much more detail than is possible using the maps in this report. Water-surface elevations for 50-year-floods on Rio Nacaome, Rio Grande, and Rio Guacirope at Nacaome were computed using HEC-RAS, a one-dimensional, steady-flow, step-backwater computer program. The channel and floodplain cross sections used in HEC-RAS were developed from an airborne light-detection-and-ranging (LIDAR) topographic survey of the area and ground surveys at two bridges. The estimated 50-year-flood discharge for Rio Nacaome at Nacaome, 5,040 cubic meters per second, was computed as the drainage-area-adjusted weighted average of two independently estimated 50-year-flood discharges for the gaging station Rio Nacaome en Las Mercedes, located about 13 kilometers upstream from Nacaome. One of the discharges, 4,549 cubic meters per second, was estimated from a frequency analysis of the 16 years of peak-discharge record for the gage, and the other, 1,922 cubic meters per second, was estimated from a regression equation that relates the 50-year-flood discharge to drainage area and mean annual precipitation. The weighted-average of the two discharges is 3,770 cubic meters per second. The 50-year-flood discharges for Rio Grande, 3,890 cubic meters per second, and Rio Guacirope, 1,080 cubic meters per second, were also computed by adjusting the weighted-average 50-year-flood discharge for the Rio Nacaome en Las Mercedes gaging station for the difference in drainage areas between the gage and these river reaches.

2015 Site Environmental Report Fernald Preserve

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hertel, Bill; Hooten, Gwen

The Fernald Preserve 2015 Site Environmental Report provides stakeholders with the results from the Fernald, Ohio, Site’s environmental monitoring programs for 2015; a summary of the U.S. Department of Energy’s (DOE’s) activities conducted onsite; and a summary of the Fernald Preserve’s compliance with the various environmental regulations, compliance agreements, and DOE policies that govern site activities. This report has been prepared in accordance with the “Integrated Environmental Monitoring Plan,” which is Attachment D of the Comprehensive Legacy Management and Institutional Controls Plan (LMICP) (DOE 2016). Remediation of the Fernald Preserve has been successfully completed with the exception of the groundwater.more » During 2015, activities at the Fernald Preserve included: environmental monitoring activities related to direct radiation, groundwater, and surface water; ecological restoration monitoring and maintenance as well as inspections, care, and monitoring of the site and the OSDF to ensure that provisions of the LMICP are fully implemented; OSDF leak detection monitoring and collection, monitoring, and treatment of leachate from the OSDF; extraction, monitoring, and treatment of contaminated groundwater from the Great Miami Aquifer (Operable Unit 5); ongoing operation of the Fernald Preserve Visitors Center, associated outreach, and educational activities; and monitoring as specified in the site’s National Pollutant Discharge Elimination System (NPDES) permit. Environmental monitoring programs were developed to ensure that the remedy remains protective of the environment. The requirements of these programs are described in detail in the LMICP and reported in this Site Environmental Report.« less

Outcomes from a patient-centered residential treatment plan for tobacco dependence.

PubMed

Hodgkin, John E; Sachs, David P L; Swan, Gary E; Jack, Lisa M; Titus, Betsy L; Waldron, Susan J S; Sachs, Bonnie L; Brigham, Janet

2013-09-01

St. Helena Hospital launched the first US residential stop-smoking program, The St. Helena Center for a Smoke-Free Life, in 1969. This observational report describes the center's treatment outcome rate for using a patient-centered approach to the use of tobacco dependence medications and behavioral treatment for patients who participated in the program from January 1, 2005 through December 31, 2007. A total of 284 patients used long-acting (nicotine patch, bupropion, and varenicline) and/or short-acting medications (nicotine nasal spray, nicotine gum, nicotine lozenge, and nicotine oral inhaler) alone or in combination during treatment and after discharge. Seven patients chose to use no medications. Patients using nicotine patch received a mean ± SD dose of 33.3±15.7 mg of nicotine in 16 hours (range, 5-90 mg). The 12-month 7-day point prevalence smoking abstinence rate after participation in the intensive, 1-week, residential program was 57.0%. Recommendations are discussed for future research and for implementing aspects of the St. Helena program in other treatment settings. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

40 CFR 469.13 - Monitoring.

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...

40 CFR 469.13 - Monitoring.

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...

40 CFR 469.13 - Monitoring.

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...

38 CFR 52.80 - Enrollment, transfer and discharge rights.

Code of Federal Regulations, 2013 CFR

2013-07-01

... hospitalizations, outpatient clinic visits; or emergency evaluation unit visits, in the past 12 months. (v) Diagnosis of clinical depression. (vi) Recent discharge from nursing home or hospital. (vii) Significant... management must permit each participant to remain in the program, and not transfer or discharge the...

TRI and DMR Comparison Dashboard | ECHO | US EPA

EPA Pesticide Factsheets

The dashboard provides a comparison of wastewater discharge data reported on Discharge Monitoring Reports (DMRs) under the Clean Water Act (CWA) National Pollutant Discharge Elimination System (NPDES) permit program and water releases reported under the Toxics Release Inventory (TRI) at a national, regional, or state level.

Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department.

PubMed

Weiner, Scott G; Griggs, Christopher A; Mitchell, Patricia M; Langlois, Breanne K; Friedman, Franklin D; Moore, Rebecca L; Lin, Shuo Cheng; Nelson, Kerrie P; Feldman, James A

2013-10-01

We compare emergency provider impression of drug-seeking behavior with objective criteria from a state prescription drug monitoring program, assess change in opioid pain reliever prescribing after prescription drug monitoring program review, and examine clinical factors associated with suspected drug-seeking behavior. This was a prospective observational study of emergency providers assessing a convenience sample of patients aged 18 to 64 years who presented to either of 2 academic medical centers with chief complaint of back pain, dental pain, or headache. Drug-seeking behavior was objectively defined as present when a patient had greater than or equal to 4 opioid prescriptions by greater than or equal to 4 providers in the 12 months before emergency department evaluation. Emergency providers completed data forms recording their impression of the likelihood of drug-seeking behavior, patient characteristics, and plan for prescribing pre- and post-prescription drug monitoring program review. Descriptive statistics were generated. We calculated agreement between emergency provider impression of drug-seeking behavior and prescription drug monitoring program definition, and sensitivity, specificity, and positive predictive value of emergency provider impression, using prescription drug monitoring program criteria as the criterion standard. A multivariate logistic regression analysis was conducted to determine clinical factors associated with drug-seeking behavior. Thirty-eight emergency providers with prescription drug monitoring program access participated. There were 544 patient visits entered into the study from June 2011 to January 2013. There was fair agreement between emergency provider impression of drug-seeking behavior and prescription drug monitoring program (κ=0.30). Emergency providers had sensitivity 63.2% (95% confidence interval [CI] 54.8% to 71.7%), specificity 72.7% (95% CI 68.4% to 77.0%), and positive predictive value 41.2% (95% CI 34.4% to 48.2%) for identifying drug-seeking behavior. After exposure to prescription drug monitoring program data, emergency providers changed plans to prescribe opioids at discharge in 9.5% of cases (95% CI 7.3% to 12.2%), with 6.5% of patients (n=35) receiving opioids not previously planned and 3.0% (n=16) no longer receiving opioids. Predictors for drug-seeking behavior by prescription drug monitoring program criteria were patient requests opioid medications by name (odds ratio [OR] 1.91; 95% CI 1.13 to 3.23), multiple visits for same complaint (OR 2.5; 95% CI 1.49 to 4.18), suspicious history (OR 1.88; 95% CI 1.1 to 3.19), symptoms out of proportion to examination (OR 1.83; 95% CI 1.1 to 3.03), and hospital site (OR 3.1; 95% CI 1.76 to 5.44). Emergency providers had fair agreement with objective criteria from the prescription drug monitoring program in suspecting drug-seeking behavior. Program review changed management plans in a small number of cases. Multiple clinical factors were predictive of drug-seeking behavior. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Voyager spacecraft electrostatic discharge testing

NASA Technical Reports Server (NTRS)

Whittlesey, A.; Inouye, G.

1980-01-01

The program of environmental testing undergone by the Voyager spacecraft in order to simulate the transient voltage effects of electrostatic discharges expected in the energetic plasma environment of Jupiter is reported. The testing consists of studies of the electrostatic discharge characteristics of spacecraft dielectrics in a vacuum-chamber-electron beam facility, brief piece part sensitivity tests on such items as a MOSFET multiplexer and the grounding of the thermal blanket, and assembly tests of the magnetometer boom and the science boom. In addition, testing of a complete spacecraft was performed using two arc sources to simulate long and short duration discharge sources for successive spacecraft shielding and grounding improvements. Due to the testing program, both Voyager 1 and Voyager 2 experienced tolerable electrostatic discharge-caused transient anomalies in science and engineering subsystems, however, a closer duplication of the spacecraft environment is necessary to predict and design actual spacecraft responses more accurately.

40 CFR 110.3 - Discharge of oil in such quantities as “may be harmful” pursuant to section 311(b)(4) of the Act.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Discharge of oil in such quantities as... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DISCHARGE OF OIL § 110.3 Discharge of... may be harmful to the public health or welfare or the environment of the United States include...

40 CFR 110.3 - Discharge of oil in such quantities as “may be harmful” pursuant to section 311(b)(4) of the Act.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Discharge of oil in such quantities as... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DISCHARGE OF OIL § 110.3 Discharge of... may be harmful to the public health or welfare or the environment of the United States include...

40 CFR 110.3 - Discharge of oil in such quantities as “may be harmful” pursuant to section 311(b)(4) of the Act.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Discharge of oil in such quantities as... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DISCHARGE OF OIL § 110.3 Discharge of... may be harmful to the public health or welfare or the environment of the United States include...

[Shortened hospital stay for elective cesarean section after initiation of a fast-track program and midwifery home-care].

PubMed

Gunnarsdottir, Johanna; Bjornsdottir, Thorbjörg Edda; Halldorsson, Thorhallur Ingi; Halldorsdottir, Gudrun; Geirsson, Reynir Tomas

2011-07-01

To audit whether hospital stay shortened without increasing readmissions after implementation of fast-track methodology for elective cesarean section and characterize what influences length of stay. A fast-track program was initiated in November 2008, with a one year clinical audit and satisfaction survey. Discharge criteria were predefined and midwife home visits included if discharge was within 48 hours. Hospital stay by parity for women with elective section for singleton pregnancy between 1.11. 2008 - 31.10. 2009 (n=213, fast-track 182) was compared to 2003 (n=199) and 2007 (n=183). Readmissions and outpatient visits 2007 and 2008-9 were counted. Reasons for longer stay were recorded in fast-track, and body mass index. Median hospital stay decreased significantly from 81 to 52 hours between 2007 and 2008-9. Readmissions were four in each period and outpatient visit rates similar. In 2008-9, 66% of all women were discharged within 48 hours. Women in the fast-track program were satisfied with early discharge. Hospital stay for parous women was shorter in 2007 compared to 2003, but unchanged for nulliparas. Parity had a minimal influence on length of stay in 2008-9, although nulliparous women ≤ 25 years were more likely to stay >48 hours. Body mass index did not correlate with length of stay. Pain was rarely the reason for a longer stay in the fast-track program and 90% were satisfied with pain-medication after discharge. Most healthy women can be discharged early after singleton birth by elective cesarean, without increasing readmissions.

Ni-MH storage test and cycle life test

NASA Technical Reports Server (NTRS)

Dell, R. Dan; Klein, Glenn C.; Schmidt, David F.

1994-01-01

Gates Aerospace Batteries is conducting two long term test programs to fully characterize the NiMH cell technology for aerospace applications. The first program analyzes the effects of long term storage upon cell performance. The second program analyzes cycle life testing and preliminary production lot testing. This paper summarizes these approaches to testing the NiMH couple and culminates with initial storage and testing recommendations. Long term storage presents challenges to deter the adverse condition of capacity fade in NiMH cells. Elevated but stabilized pressures and elevated but stabilized end-of-charge voltages also appear to be a characteristic phenomenon of long term storage modes. However, the performance degradation is dependent upon specific characteristics of the metal-hydride alloy. To date, there is no objective evidence with which to recommend the proper method for storage and handling of NiMH cells upon shipment. This is particularly critical due to limited data points that indicate open circuit storage at room temperature for 60 to 90 days will result in irrecoverable capacity loss. Accordingly a test plan was developed to determine what method of mid-term to long-term storage will prevent irrecoverable capacity loss. The explicit assumption is that trickle charging at some rate above the self-discharge rate will prevent the irreversible chemical changes to the negative electrode that result in the irrecoverable capacity loss. Another premise is that lower storage temperatures, typically 0 C for aerospace customers, will impede any negative chemical reactions. Three different trickle charge rates are expected to yield a fairly flat response with respect to recoverable capacity versus baseline cells in two different modes of open circuit. Specific attributes monitored include: end-of-charge voltage, end-of-charge pressure, mid-point discharge voltage, capacity, and end-of-discharge pressure. Cycle life testing and preliminary production lot testing continue to dominate the overall technology development effort at GAB. The cell life test program reflects continuing improvements in baseline cell designs. Performance improvements include lower and more stable charge voltages and pressures. The continuing review of production lot testing assures conformance to the design criteria and expectations. This is especially critical during this period of transferring technology from research and development status to production.

Moving from hospital into a care home--the nurse's role in supporting older people.

PubMed

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.

Understanding and enhancing the value of hospital discharge data.

PubMed

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.

Effectiveness of the Neonatal Discharge Program for Very Low-Birth-Weight Infants on Parental Efficacy and Psychological Distress.

PubMed

Shandra Bos, Lakshmi; Shorey, Shefaly; Kulantaipian, Tamill Salvee; Sng, Jane S P; Tam, Wilson W S; Koh, Serena S L

2018-05-17

This pilot study aimed to (i) evaluate the effectiveness of a neonatal discharge program, (ii) identify relationships between parent and infant factors and parental efficacy and psychological distress, and (iii) identify ways to improve the neonatal discharge program. A quasiexperimental 1-group pretest/posttest design was used. Through consecutive sampling, 42 participants were recruited. Data were collected using self-report questionnaires. Self-administering instruments gathered data on parental efficacy and psychological distress as well as feedback and recommendations on the intervention. A significant increase in parental efficacy and a reduction in psychological distress were observed from pre- to postdischarge intervention. Significant relationships were found between parental efficacy and infants' gestational age, birth weight, gender, and participants' level of education, and a significant relationship was found between psychological distress and number of children from previous pregnancies. Moreover, an Internet-based program, in addition to the face-to-face teaching, was identified as a preferred option to aid in information retention. It is important to evaluate and enhance the neonatal discharge program to suit the parents of today while providing them with informational and emotional support. Future studies should explore parental coping and the long-term effects of their infant's birth and the intervention.

APPARATUS FOR PRODUCING AND MANIPULATING PLASMAS

DOEpatents

Colgate, S.A.; Ferguson, J.P.; Furth, H.P.; Wright, R.E.

1960-07-26

An electrical pinch discharge apparatus is described for producing and manipulating high-temperature plasmas. The apparatus may be of either the linear or toroidal pinch discharge type. Arrangements are provided whereby stabilizing fields may be trapped in the plasma external to the main pinch discharge path and the boundary condition of the stabilizing field programed so as to stabilize the discharge or to promote instabilities in the discharge as desired. The produced plasmas may be employed for various purposes, and fusion neutrons have been produced with the apparatus.

38 CFR 52.80 - Enrollment, transfer and discharge rights.

Code of Federal Regulations, 2010 CFR

2010-07-01

... (CONTINUED) PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES Standards § 52.80 Enrollment, transfer and discharge rights. (a) Participants in the adult day health care program must meet the...) Diagnosis of clinical depression. (vi) Recent discharge from nursing home or hospital. (vii) Significant...

77 FR 18963 - Energy Conservation Program: Public Meeting and Availability of the Framework Document for High...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-29

... the Framework Document for High-Intensity Discharge Lamps AGENCY: Office of Energy Efficiency and... availability of framework document for high-intensity discharge (HID) lamps, initiating the rulemaking and data... Availability of Framework Document Regarding Energy Conservation Standards for High-Intensity Discharge (HID...

40 CFR 125.67 - Increase in effluent volume or amount of pollutants discharged.

Code of Federal Regulations, 2011 CFR

2011-07-01

... AGENCY (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Criteria for Modifying the Secondary Treatment Requirements Under Section 301(h) of the Clean Water Act § 125.67 Increase in effluent volume or amount of pollutants discharged. (a) No modified...

40 CFR 125.67 - Increase in effluent volume or amount of pollutants discharged.

Code of Federal Regulations, 2010 CFR

2010-07-01

... AGENCY (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Criteria for Modifying the Secondary Treatment Requirements Under Section 301(h) of the Clean Water Act § 125.67 Increase in effluent volume or amount of pollutants discharged. (a) No modified...

The who, what, why, and how-to guide for gastrostomy tube placement in infants.

PubMed

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.

40 CFR 469.13 - Monitoring.

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...

Variation in Use of Pediatric Cardiology Subspecialty Care: A Total Population Study in California, 1983 to 2011.

PubMed

Chamberlain, Lisa J; Fernandes, Susan M; Saynina, Olga; Grady, Stafford; Sanders, Lee; Staves, Kelly; Wise, Paul H

2015-07-07

American Academy of Pediatrics guidelines emphasize regionalized systems of care for pediatric chronic illness. There remains a paucity of information on the status of regionalized systems of care for pediatric congenital heart disease (CHD). This study evaluated variations in use of pediatric cardiology specialty care centers (PCSCC) for pediatric patients with CHD in California between 1983 and 2011. We performed a retrospective, total population analysis of pediatric CHD patients using the California Office of Statewide Health Planning and Development unmasked database. PCSCCs were identified by California's Title V program. There were 164,310 discharges meeting inclusion criterion. Discharges from PCSCCs grew from 58% to 88% between 1983 and 2011. Regionalized care was highest for surgical (96%) versus nonsurgical (71%) admissions. Admissions with a public payer increased from 42% (1983) to 61% (2011). Total bed days nearly doubled, and median length of stay increased from 2 to 3 days (nonspecialty care) and from 4 to 5 days (specialty care). There was a decrease in the pediatric CHD in-hospital death rate from 5.1 to 2.3 per 100,000 between 1983 and 2011, and a shift toward a larger percent of deaths occurring in the newborn period. California's inpatient regionalized specialty care of pediatric CHD has increased substantially since 1983, especially for surgical CHD discharges. The death rate has decreased, the number of bed days has increased, and a large proportion of these discharges now have public payers. Health care reform efforts must consider these shifts while protecting advances in regionalization of pediatric CHD care. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Biophysiologic and social stress relationships with breast milk feeding pre- and post-discharge from the neonatal intensive care unit.

PubMed

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.

Determinants of health after hospital discharge: rationale and design of the Vanderbilt Inpatient Cohort Study (VICS)

PubMed Central

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

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.

Failure of the public health testing program for ballast water treatment systems.

PubMed

Cohen, Andrew N; Dobbs, Fred C

2015-02-15

Since 2004, an international testing program has certified 53 shipboard treatment systems as meeting ballast water discharge standards, including limits on certain microbes to prevent the spread of human pathogens. We determined how frequently certification tests failed a minimum requirement for a meaningful evaluation, that the concentration of microbes in the untreated (control) discharge must exceed the regulatory limit for treated discharges. In 95% of cases where the result was accepted as evidence that the treatment system reduced microbes to below the regulatory limit, the discharge met the limit even without treatment. This shows that the certification program for ballast water treatment systems is dysfunctional in protecting human health. In nearly all cases, the treatment systems would have equally well "passed" these tests even if they had never been turned on. Protocols must require minimum concentrations of targeted microbes in test waters, reflecting the upper range of concentrations in waters where ships operate. Copyright © 2014 Elsevier Ltd. All rights reserved.

Managing mobility outcomes in vulnerable seniors ( MMOVeS): a randomized controlled pilot study.

PubMed

Figueiredo, Sabrina; Morais, Jose A; Mayo, Nancy

2017-12-01

To estimate feasibility and potential for efficacy of an individualized, exercise-focused, self-management program (i.e. Managing Mobility Outcomes In Vulnerable Seniors ( MMOVeS)), in comparison to exercise information in improving mobility after six months among seniors recently discharged from hospital. Randomized pilot study. Two McGill University-teaching hospitals. Community dwelling seniors, aged 70 years and older, recently discharged from either participating hospitals. The physiotherapy-facilitated intervention consisted of (1) evaluation of mobility capacity, (2) setting short- and long-term goals, (3) delineation of an exercise treatment plan, (4) an educational booklet to enhance mobility self-management skills, and (5) six monthly telephone calls. Control group received a booklet with information on exercises targeting mobility limitations in seniors. Mobility, pain, and health status were assessed at baseline and at six months using multiple indicators drawn from Disabilities of the Arm, Shoulder, and Hand (DASH) Score, Lower Extremity Functional Scale (LEFS) and Short-Form (SF)-36. In all, 26 people were randomized to the intervention (mean age: 81 ± 8; 39% women), and 23 were randomized to the control (mean age: 79 ± 7; 33% women). The odds ratio for the mobility outcomes combined was 3.08 and the 95% confidence interval excluded 1 (1.65-5.77). The odds ratio for pain and health perception favored the MMOVeS group, but the 95% confidence interval included the null value. This feasibility study highlights the potential for efficacy of an individualized, exercise-focused, self-management program in comparison to exercise information in improving mobility outcome for seniors. Furthermore, a home-program combining self-management skills and exercise taught with minimal supervision prove to be feasible. Finally, data from this study can be used to estimate sample size for a confirmatory trial.

40 CFR 112.4 - Amendment of Spill Prevention, Control, and Countermeasure Plan by Regional Administrator.

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...

40 CFR 112.4 - Amendment of Spill Prevention, Control, and Countermeasure Plan by Regional Administrator.

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...

40 CFR 112.4 - Amendment of Spill Prevention, Control, and Countermeasure Plan by Regional Administrator.

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...

40 CFR 112.4 - Amendment of Spill Prevention, Control, and Countermeasure Plan by Regional Administrator.

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...

33 CFR 157.02 - Incorporation by reference: Where can I get a copy of the publications mentioned in this part?

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...

33 CFR 157.02 - Incorporation by reference: Where can I get a copy of the publications mentioned in this part?

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...

33 CFR 157.02 - Incorporation by reference: Where can I get a copy of the publications mentioned in this part?

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...

33 CFR 157.02 - Incorporation by reference: Where can I get a copy of the publications mentioned in this part?

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...

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...

Leveraging The Affordable Care Act To Enroll Justice-Involved Populations In Medicaid: State And Local Efforts

PubMed Central

Bandara, Sachini N.; Huskamp, Haiden A.; Riedel, Lauren E.; McGinty, Emma E.; Webster, Daniel; Toone, Robert E.; Barry, Colleen L.

2016-01-01

The Affordable Care Act provides an unprecedented opportunity to enroll criminal justice–involved populations in health insurance, particularly Medicaid. As a result, many state and county corrections departments have launched programs that incorporate Medicaid enrollment in discharge planning. Our study characterizes the national landscape of programs enrolling criminal justice–involved populations in Medicaid as of January 2015. We provide an overview of sixty-four programs operating in jails, prisons, or community probation and parole systems that enroll individuals during detention, incarceration, and the release process. We describe the variation among the programs in terms of settings, personnel, timing of eligibility screening, and target populations. Seventy-seven percent of the programs are located in jails, and 56 percent use personnel from public health or social service agencies. We describe four practices that have facilitated the Medicaid enrollment process: suspending instead of terminating Medicaid benefits upon incarceration, presuming that an individual is eligible for Medicaid before the process is completed, allowing enrollment during incarceration, and accepting alternative forms of identification for enrollment. The criminal justice system is a complex one that requires a variety of approaches to enroll individuals in Medicaid. Future research should examine how these approaches influence health and criminal justice outcomes. PMID:26643624

Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma.

PubMed

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.

Sobriety as an admission criterion for transitional housing: a multi-site comparison of programs with a sobriety requirement to programs with no sobriety requirement.

PubMed

Tsai, Jack; Rosenheck, Robert A; Kasprow, Wesley J; McGuire, James F

2012-10-01

This study examined whether homeless clients enrolled in transitional housing programs that required sobriety (SR) as an admission criterion have outcomes comparable to clients enrolled in programs that did not require sobriety (NSR) as an admission criterion. A total of 1062 military veterans in 40 transitional housing programs funded by the United States Department of Veterans Affairs were grouped based on whether they were in SR or NSR programs and followed over a one-year period after program discharge. Participants in SR and NSR programs were compared on their ratings of the social climate of the program, and housing and psychosocial outcomes. Participants in SR programs reported more days housed and better psychosocial outcomes than participants in NSR programs, although the differences were small and there were no differences in ratings of their social climate. Both participants in SR and NSR programs showed improvements on most outcomes after discharge from transitional housing. There were no significant differences in outcomes between participants actively abusing substances at program entry compared to those who were not. Requiring sobriety as an admission criterion in transitional housing made only a small difference in housing outcomes post-discharge. Further study is needed to determine whether requiring sobriety at admission in transitional housing is necessary for successful client outcomes. Published by Elsevier Ireland Ltd.

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, or hidden, if they cannot be quantified from catchment data and must be estimated, e.g., from the literature. It is vital to consider the hidden 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 the visible 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.

Treatment of obsessive-compulsive disorder complicated by comorbid eating disorders.

PubMed

Simpson, H Blair; Wetterneck, Chad T; Cahill, Shawn P; Steinglass, Joanna E; Franklin, Martin E; Leonard, Rachel C; Weltzin, Theodore E; Riemann, Bradley C

2013-01-01

Eating disorders and obsessive-compulsive disorder (OCD) commonly co-occur, but there is little data for how to treat these complex cases. To address this gap, we examined the naturalistic outcome of 56 patients with both disorders, who received a multimodal treatment program designed to address both problems simultaneously. A residential treatment program developed a cognitive-behavioral approach for patients with both OCD and an eating disorder by integrating exposure and response prevention (ERP) treatment for OCD with ERP strategies targeting eating pathology. Patients also received a supervised eating plan, medication management, and social support. At admission and discharge, patients completed validated measures of OCD severity (the Yale-Brown Obsessive-Compulsive Scale--Self Report [Y-BOCS-SR]), eating disorder severity (the Eating Disorders Examination-Questionnaire), and depressive severity (the Beck Depression Inventory II [BDI-II]). Body mass index (BMI) was also measured. Paired-sample t-tests examined change on these measures. Between 2006 and 2011, 56 individuals completed all study measures at admission and discharge. Mean length of stay was 57 days (SD = 27). Most (89%) were on psychiatric medications. Significant decreases were observed in OCD severity, eating disorder severity, and depression. Those with bulimia nervosa showed more improvement than those with anorexia nervosa. BMI significantly increased, primarily among those underweight at admission. Simultaneous treatment of OCD and eating disorders using a multimodal approach that emphasizes ERP techniques for both OCD and eating disorders can be an effective treatment strategy for these complex cases.

Optimization of planting pattern plan in Logung irrigation area using linear program

NASA Astrophysics Data System (ADS)

Wardoyo, Wasis; Setyono

2018-03-01

Logung irrigation area is located in Kudus Regency, Central Java Province, Indonesia. Irrigation area with 2810 Ha of extent is getting water supply from Logung dam. Yet, the utilization of water at Logung dam is not optimal and the distribution of water is still not evenly distributed. Therefore, this study will discuss about the optimization of irrigation water utilization based on the beginning of plant season. This optimization begins with the analysis of hydrology, climatology and river discharge in order to determine the irrigation water needs. After determining irrigation water needs, six alternatives of planting patterns with the different early planting periods, i.e. 1st November, 2nd November, 3rd November, 1st December, 2nd December, and 3rd December with the planting pattern of rice-secondary crop-sugarcane is introduced. It is continued by the analysis of water distribution conducted using linear program assisted by POM-Quantity method for Windows 3 with the reliable discharge limit and the available land area. Output of this calculation are to determine the land area that can be planted based on the type of plant and growing season, and to obtaine the profits of harvest yields. Based on the optimum area of each plant species with 6 alternatives, the most optimum area was obtained at the early planting periods on 3rd December with the production profit of Rp 113.397.338.854,- with the planting pattern of rice / beans / sugarcane-rice / beans / sugarcane-beans / sugarcane.

Comprehensive care improves health outcomes among elderly Taiwanese patients with hip fracture.

PubMed

Shyu, Yea-Ing L; Liang, Jersey; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Yang, Ching-Tzu; Chou, Shih-Wei; Chen, Ching-Yen

2013-02-01

Few studies have investigated the effects of care models that combine interdisciplinary care with nutrition consultation, depression management, and fall prevention in older persons with hip fracture. The purpose of this study was to compare the effects of a comprehensive care program with those of interdisciplinary care and usual care for elderly patients with hip fracture. A randomized experimental trial was used to explore outcomes for 299 elderly patients with hip fracture receiving three treatment care models: interdisciplinary care (n = 101), comprehensive care (n = 99), and usual care (n = 99). Interdisciplinary care included geriatric consultation, continuous rehabilitation, and discharge planning with post-hospital services. Comprehensive care consisted of interdisciplinary care plus nutrition consultation, depression management, and fall prevention. Usual care included only in-hospital rehabilitation without geriatric consultation, in-home rehabilitation, and home environmental assessment. Participants in the comprehensive care group had better self-care ability (odds ratio, OR = 3.19, p < .01) and less risk of depression (OR = 0.48, p < .01) than those who received usual care. The comprehensive care group had less risk of depression (OR = 0.51, p < .05) and of malnutrition (OR = 0.48, p < .05) than the interdisciplinary care group during the first year following discharge. Older persons with hip fracture benefitted more from the comprehensive care program than from interdisciplinary care and usual care. Older persons with hip fracture benefitted more from comprehensive care including interdisciplinary care and nutrition consultation, depression management, and fall prevention than simply interdisciplinary care.

Accelerated aging test results for aerospace wire insulation constructions

NASA Technical Reports Server (NTRS)

Dunbar, William G.

1995-01-01

Several wire insulation constructions were evaluated with and without continuous glow discharges at low pressure and high temperature to determine the aging characteristics of acceptable wire insulation constructions. It was known at the beginning of the test program that insulation aging takes several years when operated at normal ambient temperature and pressure of 20 C and 760 torr. Likewise, it was known that the accelerated aging process decreases insulation life by approximately 50% for each 10 C temperature rise. Therefore, the first phases of the program, not reported in these test results, were to select wire insulation constructions that could operate at high temperature and low pressure for over 10,000 hours with negligible shrinkage and little materials' deterioration.The final phase of the program was to determine accelerated aging characteristics. When an insulation construction is subjected to partial discharges the insulation is locally heated by the bombardment of the discharges, the insulation is also subjected to ozone and other deteriorating gas particles that may significantly increase the aging process. Several insulation systems using either a single material or combinations of teflon, kapton, and glass insulation constructions were tested. All constructions were rated to be partial discharge and/or corona-free at 240 volts, 400 Hz and 260 C (500 F) for 50, 000 hours at altitudes equivalent to the Paschen law. Minimum partial discharge aging tests were preceded by screening tests lasting 20 hours at 260 C. The aging process was accelerated by subjecting the test articles to temperatures up to 370 C (700 F) with and without partial discharges. After one month operation with continuous glow discharges surrounding the test articles, most insulation systems were either destroyed or became brittle, cracked, and unsafe for use. Time with space radiation as with partial discharges is accumulative.

Accelerated aging test results for aerospace wire insulation constructions

NASA Astrophysics Data System (ADS)

Dunbar, William G.

1995-11-01

Several wire insulation constructions were evaluated with and without continuous glow discharges at low pressure and high temperature to determine the aging characteristics of acceptable wire insulation constructions. It was known at the beginning of the test program that insulation aging takes several years when operated at normal ambient temperature and pressure of 20 C and 760 torr. Likewise, it was known that the accelerated aging process decreases insulation life by approximately 50% for each 10 C temperature rise. Therefore, the first phases of the program, not reported in these test results, were to select wire insulation constructions that could operate at high temperature and low pressure for over 10,000 hours with negligible shrinkage and little materials' deterioration.The final phase of the program was to determine accelerated aging characteristics. When an insulation construction is subjected to partial discharges the insulation is locally heated by the bombardment of the discharges, the insulation is also subjected to ozone and other deteriorating gas particles that may significantly increase the aging process. Several insulation systems using either a single material or combinations of teflon, kapton, and glass insulation constructions were tested. All constructions were rated to be partial discharge and/or corona-free at 240 volts, 400 Hz and 260 C (500 F) for 50, 000 hours at altitudes equivalent to the Paschen law. Minimum partial discharge aging tests were preceded by screening tests lasting 20 hours at 260 C. The aging process was accelerated by subjecting the test articles to temperatures up to 370 C (700 F) with and without partial discharges. After one month operation with continuous glow discharges surrounding the test articles, most insulation systems were either destroyed or became brittle, cracked, and unsafe for use. Time with space radiation as with partial discharges is accumulative.

40 CFR 110.5 - Discharges of oil not determined “as may be harmful” pursuant to Section 311(b)(3) of the Act.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Discharges of oil not determined âas may be harmfulâ pursuant to Section 311(b)(3) of the Act. 110.5 Section 110.5 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DISCHARGE OF OIL § 110.5 Discharges of...

40 CFR 110.3 - Discharge of oil in such quantities as “may be harmful” pursuant to section 311(b)(4) of the Act.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 23 2013-07-01 2013-07-01 false Discharge of oil in such quantities as... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DISCHARGE OF OIL § 110.3 Discharge of oil in such quantities as “may be harmful” pursuant to section 311(b)(4) of the Act. For purposes of...

40 CFR 110.3 - Discharge of oil in such quantities as “may be harmful” pursuant to section 311(b)(4) of the Act.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 22 2014-07-01 2013-07-01 true Discharge of oil in such quantities as... Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS DISCHARGE OF OIL § 110.3 Discharge of oil in such quantities as “may be harmful” pursuant to section 311(b)(4) of the Act. For purposes of...

EPA NetDMR CROMERR System Checklist

EPA Pesticide Factsheets

The Network Disharge Monitoring Report (NetDMR) electronic reporting system is used for the receipt of discharge monitoring reports (DMRs) under the National Pollutant Discharge Elimination System (NPDES) program,

Using the Electronic Medical Record to Enhance Physician-Nurse Communication Regarding Patients' Discharge Status.

PubMed

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.

77 FR 23481 - State Program Requirements; Approval of Maine's Base National Pollutant Discharge Elimination...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... existing point source dischargers covered by the NPDES program. Appeal and Decision in Maine v. Johnson... Appeals for the First Circuit issued its opinion in Maine v. Johnson. 498 F.3d 37. The court held that EPA... Island treatment works (EPA NPDES Permit No. ME 0101311 and MEPDES License No. 2672) and the...

40 CFR 123.35 - As the NPDES Permitting Authority for regulated small MS4s, what is my role?

Code of Federal Regulations, 2013 CFR

2013-07-01

... MS4 storm water program.) (b) You must develop a process, as well as criteria, to designate small MS4s... under the NPDES storm water discharge control program. This process must include the authority to... storm water discharge results in or has the potential to result in exceedances of water quality...

40 CFR 123.35 - As the NPDES Permitting Authority for regulated small MS4s, what is my role?

Code of Federal Regulations, 2012 CFR

2012-07-01

... MS4 storm water program.) (b) You must develop a process, as well as criteria, to designate small MS4s... under the NPDES storm water discharge control program. This process must include the authority to... storm water discharge results in or has the potential to result in exceedances of water quality...

40 CFR 123.35 - As the NPDES Permitting Authority for regulated small MS4s, what is my role?

Code of Federal Regulations, 2014 CFR

2014-07-01

... MS4 storm water program.) (b) You must develop a process, as well as criteria, to designate small MS4s... under the NPDES storm water discharge control program. This process must include the authority to... storm water discharge results in or has the potential to result in exceedances of water quality...

Same-Day Discharge after Laparoscopic Roux-en-Y Gastric Bypass: An Analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program Database.

PubMed

Inaba, Colette S; Koh, Christina Y; Sujatha-Bhaskar, Sarath; Zhang, Lishi; Nguyen, Ninh T

2018-05-01

Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been performed with successful discharge on postoperative day 1 (POD1). There are limited studies on same-day discharge after LRYGB. The objective of this study was to examine the frequency and outcomes of same-day discharge after LRYGB. The 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database was analyzed for adult patients who underwent elective LRYGB cases with same-day vs POD1 discharge. Open and revisional cases were excluded. Multivariate analysis was performed to compare risk-adjusted 30-day mortality, overall morbidity, readmission, and reoperation. There were 354 (0.9%) patients who were discharged on the same day as surgery after LRYGB. After exclusion criteria, 319 patients with same-day discharge and 9,402 patients with POD1 discharge were examined. For same-day vs POD1 discharge groups, mean ages were 45.0 and 44.5 years, respectively, and mean BMIs were 47.3 kg/m 2 and 45.9 kg/m 2 , respectively. The unadjusted mortality rate was significantly higher for same-day compared with POD1 discharge (0.94% vs. 0.05%, respectively; p = 0.0017). Compared with POD1 discharge, same-day discharge had higher overall morbidity (3.76% vs 1.54%; adjusted odds ratio [AOR] 2.41; p = 0.0216), but no statistically significant differences for readmissions (3.45% vs. 3.66%; AOR 0.85; p = 0.9999) or reoperations (1.88% vs. 0.89%; AOR 2.33; p = 0.2428). Same-day discharge after LRYGB is associated with increased morbidity and mortality compared with POD1 discharge. The practice of same-day discharge after LRYGB should be considered experimental until further studies confirm which patient characteristics will ensure safe same-day discharge. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

A Patient-Centered Transitional Care Case Management Program: Taking Case Management to the Streets and Beyond.

PubMed

Lovelace, Derenda; Hancock, Diane; Hughes, Sabrina S; Wyche, Phyllis R; Jenkins, Claire; Logan, Cindy

In 2011, the Hunter Holmes McGuire Veterans Administration Medical Center (VAMC) in Richmond, VA, had a cumulative readmission rate and emergency department (ED) revisits for discharged Veterans of 1 in 5. In 2012, a transitional care program (TCP) was implemented to improve care coordination and outcomes among Veterans, with an emphasis on geriatric patients with chronic disease. This TCP was created with an interdisciplinary approach using intensive case management interventions, with a goal of reducing Veteran ED and hospital revisits by 30%. To examine the impact of the McGuire VAMC TCP on Veteran ED and hospital utilization and costs. Veterans being discharged to home following an inpatient admission, ED visit, and/or short rehab stay. The primary means of identifying patients for the program is through daily screening of the previous 24-hour admission and ED report, which the inpatient nurse practitioner performs. She completes an extensive review of each Veteran's electronic medical record to determine the number of ED visits and inpatient admissions at the VAMC and in the community. Initial criteria for consideration in the program included the following: more than two hospital admissions and/or ED visits in the past 90 days or at high risk for readmission based on a Care Assessment Need score of greater than 95. Two hundred Veterans participated in the program in fiscal year (FY) 2013, with 146 participating in FY 2014. A retrospective chart review of Veterans participating in the TCP in FYs 2013 and 2014 was conducted, with a focus on number of admissions and ED visits 90 days prior to admission to the TCP and 90 days following TCP admission. Average admission and ED costs for this VA were calculated to determine cost savings from pre- to post-90 days of admission and ED visits. Veterans who obtained TCP services in FYs 2013 and 2014 experienced a 67% decrease in hospital admissions and a 61% decrease in ED visits in the 90 days following participation in this program compared with the 90 days prior to participation. This produced an estimated net savings of $3,823,673 in medical center costs. In addition, registered nurse case managers (RN CMs) noted improved patient compliance and satisfaction with care and the licensed clinical social worker noted reduced caregiver burden. The results of this program demonstrate how using an interdisciplinary approach to develop patient-centered transition plans of care through intensive case management interventions improves resource utilization with substantial financial savings. This program represents a feasible option for other VAMCs as well as civilian hospitals seeking to provide cost-effective transitional care to patients upon discharge and prevent untimely readmissions. With an RN CM at the hub of patient care, this program successfully demonstrates the value of smooth care transitions.

Research on numerical method for multiple pollution source discharge and optimal reduction program

NASA Astrophysics Data System (ADS)

Li, Mingchang; Dai, Mingxin; Zhou, Bin; Zou, Bin

2018-03-01

In this paper, the optimal method for reduction program is proposed by the nonlinear optimal algorithms named that genetic algorithm. The four main rivers in Jiangsu province, China are selected for reducing the environmental pollution in nearshore district. Dissolved inorganic nitrogen (DIN) is studied as the only pollutant. The environmental status and standard in the nearshore district is used to reduce the discharge of multiple river pollutant. The research results of reduction program are the basis of marine environmental management.

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...

A Decision Framework to Protect Coral Reefs in Guánica Bay, Puerto Rico

EPA Science Inventory

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...

Applying WEPP technologies to western alkaline surface coal mines

Treesearch

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....

Agricultural conservation planning framework: 1. Developing multi-practice watershed planning scenarios and assessing nutrient reduction potential

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...

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.

Comparison and alignment of an academic medical center's strategic goals with ASHP initiatives.

PubMed

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.

Modeling for regional ecosystem sustainable development under uncertainty--A case study of Dongying, China.

PubMed

Zhang, K; Li, Y P; Huang, G H; You, L; Jin, S W

2015-11-15

In this study, a superiority-inferiority two-stage stochastic programming (STSP) method is developed for planning regional ecosystem sustainable development. STSP can tackle uncertainties expressed as fuzzy sets and probability distributions; it can be used to analyze various policy scenarios that are associated with different levels of economic penalties when the promised targets are violated. STSP is applied to a real case of planning regional ecosystem sustainable development in the City of Dongying, where ecosystem services valuation approaches are incorporated within the optimization process. Regional ecosystem can provide direct and indirect services and intangible benefits to local economy. Land trading mechanism is introduced for planning the regional ecosystem's sustainable development, where wetlands are buyers who would protect regional ecosystem components and self-organization and maintain its integrity. Results of regional ecosystem activities, land use patterns, and land trading schemes have been obtained. Results reveal that, although large-scale reclamation projects can bring benefits to the local economy development, they can also bring with negative effects to the coastal ecosystem; among all industry activities oil field is the major contributor with a large number of pollutant discharges into local ecosystem. Results also show that uncertainty has an important role in successfully launching such a land trading program and trading scheme can provide more effective manner to sustain the regional ecosystem. The findings can help decision makers to realize the sustainable development of ecological resources in the process of rapid industrialization, as well as the integration of economic and ecological benefits. Copyright © 2015 Elsevier B.V. All rights reserved.

Hydrologic data and description of a hydrologic monitoring plan for the Borax Lake area, Oregon

USGS Publications Warehouse

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.

A Prospective Cohort Study of Outpatient Interdisciplinary Rehabilitation of Chronic Headache Patients.

PubMed

Krause, Steven J; Stillman, Mark J; Tepper, Deborah E; Zajac, Deborah

2017-03-01

To evaluate the efficacy of an intensive outpatient program designed to improve functioning and reduce psychological impairment in chronic headache patients. Chronic headaches, occurring 15 or more days per month, for three or more months, may arise from multiple International Classification of Headache Disorders diagnoses: Chronic Migraine, Chronic Tension Type Headache, New Daily Persistent Headache, Chronic Post Traumatic Headaches, and Medication Overuse Headache. Several interdisciplinary programs that treat patients with chronic headaches have reported decreases in headache frequency. This study sought to evaluate the effect of a 3 week interdisciplinary treatment program for patients with chronic headache disorders on headache severity, functional status, and psychological impairment. Subjects were 379 patients admitted to an outpatient chronic headache treatment program. Assessments of headache severity, psychological status, and functional impairment were completed by 371 (97.8%) of these at the time of admission. At discharge, 340 subjects (89.7%) provided assessment data, and 152 (40.1%) provided data at 1-year follow-up. Subjects' mean ratings on a 0-10 scale for their headache pain in the prior week declined, and these improvements were maintained at follow-up. (Estimated marginal means on a 0-10 scale for Average pain: admission 6.1, discharge 3.5, follow-up 3.3; for Least pain: admission 3.2; discharge 1.5; follow-up 1.3; for Worst pain: admission 8.2; discharge 6.4; follow-up 5.7), and similar results were found for current pain (admission 4.7; discharge 2.8; follow-up 2.4): Measures of functional impairment also improved following treatment, and these gains were maintained at 12 month follow up (Estimated marginal mean Headache Impact Test-6 score: admission 66.1, discharge 55.4, follow-up 51.9; Estimated marginal mean Pain Disability Index score: admission 36.2, discharge 14.1, follow-up 11.6). As measured by the Depression, Anxiety and Stress Scale, anxiety and reactivity to stress decreased following treatment, and remained improved at follow-up (Estimated marginal mean score for Anxiety: admission 8.7, discharge 5.2, follow-up 4.4; Estimated marginal mean score for stress: admission 14.9, discharge 7.2, follow-up 7.6). Depression decreased with treatment, but while 1-year follow-up depression scores remained significantly lower than at admission, they were also significantly higher than at discharge (Estimated marginal means: admission 13.3, discharge 4.1, follow-up 6.6). The study supports the efficacy of the treatment model. Limitations of the study and suggestions for future research are also discussed. © 2017 American Headache Society.

Casemix and rehabilitation: evaluation of an early discharge scheme.

PubMed

Brandis, S

2000-01-01

This paper presents a case study of an early discharge scheme funded by casemix incentives and discusses limitations of a casemix model of funding whereby hospital inpatient care is funded separately from care in other settings. The POSITIVE Rehabilitation program received 151 patients discharged early from hospital in a twelve-month period. Program evaluation demonstrates a 40.9% drop in the average length of stay of rehabilitation patients and a 42.6% drop in average length of stay for patients with stroke. Other benefits of the program include a high level of patient satisfaction, improved carer support and increased continuity of care. The challenge under the Australian interpretation of a casemix model of funding is ensuring the viability of services that extend across acute hospital, non-acute care, and community and home settings.

40 CFR 125.64 - Effect of the discharge on other point and nonpoint sources.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Effect of the discharge on other point... (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Criteria for Modifying the Secondary Treatment Requirements Under Section 301(h) of the Clean Water Act...

40 CFR 125.64 - Effect of the discharge on other point and nonpoint sources.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Effect of the discharge on other point... (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Criteria for Modifying the Secondary Treatment Requirements Under Section 301(h) of the Clean Water Act...

40 CFR 125.64 - Effect of the discharge on other point and nonpoint sources.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 22 2014-07-01 2013-07-01 true Effect of the discharge on other point... (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Criteria for Modifying the Secondary Treatment Requirements Under Section 301(h) of the Clean Water Act...

40 CFR 125.64 - Effect of the discharge on other point and nonpoint sources.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Effect of the discharge on other point... (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Criteria for Modifying the Secondary Treatment Requirements Under Section 301(h) of the Clean Water Act...

40 CFR 125.64 - Effect of the discharge on other point and nonpoint sources.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 23 2013-07-01 2013-07-01 false Effect of the discharge on other point... (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Criteria for Modifying the Secondary Treatment Requirements Under Section 301(h) of the Clean Water Act...

The effect of diagnosis-specific computerized discharge instructions on 72-hour return visits to the pediatric emergency department.

PubMed

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.

Ocean outfall plume characterization using an Autonomous Underwater Vehicle.

PubMed

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.

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

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

Rehabilitation Practitioners' Prioritized Care Processes in Hip Fracture Post-Acute Care

PubMed Central

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

Predischarge education improves adherence to a healthy lifestyle among Jordanian patients with acute coronary syndrome.

PubMed

Eshah, Nidal F

2013-09-01

Risk factor reduction and modification of patient lifestyle have become the focus of secondary prevention and cardiac rehabilitation programs. Considering the scarcity of resources in developing countries, nurses can potentially provide great benefit to acute coronary syndrome patients by utilizing hospital time to teach the patients how to lower their risk for recurrence and adopt healthier lifestyles after discharge. The purpose of this study was to identify the effectiveness of a predischarge education on acute coronary syndrome patients' lifestyles. Quasi-experimental pretest-post-test design was used. The patients assigned to the experimental group were offered predischarge education that stimulates lifestyle modification and adoption of a healthier lifestyle. The experimental group scored significantly higher than the control group in three lifestyle components - health responsibilities, nutrition, and interpersonal relations. In conclusion, predischarge education helps motivate acute coronary syndrome patients to adhere to a healthy lifestyle postdischarge. Therefore, nurses must be educated and prepared to be qualified health educators, and health education should continue as one of the most important daily nursing practices, thus it is invested in the preparation of acute coronary patients' discharge plan. © 2012 Wiley Publishing Asia Pty Ltd.

NASA's Hall Thruster Program

NASA Technical Reports Server (NTRS)

Jankovsky, Robert S.; Jacobson, David T.; Rawlin, Vincent K.; Mason, Lee S.; Mantenieks, Maris A.; Manzella, David H.; Hofer, Richard R.; Peterson, Peter Y.

2001-01-01

NASA's Hall thruster program has base research and focused development efforts in support of the Advanced Space Transportation Program, Space-Based Program, and various other programs. The objective of the base research is to gain an improved understanding of the physical processes and engineering constraints of Hall thrusters to enable development of advanced Hall thruster designs. Specific technical questions that are current priorities of the base effort are: (1) How does thruster life vary with operating point? (2) How can thruster lifetime and wear rate be most efficiently evaluated? (3) What are the practical limitations for discharge voltage as it pertains to high specific impulse operation (high discharge voltage) and high thrust operation (low discharge voltage)? (4) What are the practical limits for extending Hall thrusters to very high input powers? and (5) What can be done during thruster design to reduce cost and integration concerns? The objective of the focused development effort is to develop a 50 kW-class Hall propulsion system, with a milestone of a 50 kW engineering model thruster/system by the end of program year 2006. Specific program wear 2001 efforts, along with the corporate and academic participation, are described.

Three dimensional thermal pollution models. Volume 3: Free surface models. [waste heat discharge from power plants and effects on ecosystems

NASA Technical Reports Server (NTRS)

Lee, S. S.; Sengupta, S.

1978-01-01

Two sets of programs, named Nasum 2 and Nasum 3 are presented in detail. Nasum 2 is a far field formulation and is used without including the plant thermal discharge. Nasum 3 uses horizontal stretching to provide higher resolution at thermal discharge joints; and includes far field influences such as varying tides and ambient currents far from point of discharge.

Development of Predictive Models of Injury for the Lower Extremity, Lumbar, and Thoracic Spine after discharge from Physical Rehabilitation

DTIC Science & Technology

2017-10-01

discharge from Physical Rehabilitation PRINCIPAL INVESTIGATOR: MAJ Daniel Rhon CONTRACTING ORGANIZATION: The Geneva Foundation Tacoma, WA 98402...and Thoracic Spine after discharge from Physical Rehabilitation 5b. GRANT NUMBER W81XWH-14-2-0141 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S...The objective and overall hypothesis is that service member performance on a battery of physical performance tests performed upon discharge from

Transitions to Care in the Community for Prison Releasees with HIV: a Qualitative Study of Facilitators and Challenges in Two States.

PubMed

Hammett, Theodore M; Donahue, Sara; LeRoy, Lisa; Montague, Brian T; Rosen, David L; Solomon, Liza; Costa, Michael; Wohl, David; Rich, Josiah D

2015-08-01

One in seven people living with HIV in the USA passes through a prison or jail each year, and almost all will return to the community. Discharge planning and transitional programs are critical but challenging elements in ensuring continuity of care, maintaining treatment outcomes achieved in prison, and preventing further viral transmission. This paper describes facilitators and challenges of in-prison care, transitional interventions, and access to and continuity of care in the community in Rhode Island and North Carolina based on qualitative data gathered as part of the mixed-methods Link Into Care Study of prisoners and releasees with HIV. We conducted 65 interviews with correctional and community-based providers and administrators and analyzed the transcripts using NVivo 10 to identify major themes. Facilitators of effective transitional systems in both states included the following: health providers affiliated with academic institutions or other entities independent of the corrections department; organizational philosophy emphasizing a patient-centered, personal, and holistic approach; strong leadership with effective "champions"; a team approach with coordination, collaboration and integration throughout the system, mutual respect and learning between corrections and health providers, staff dedicated to transitional services, and effective communication and information sharing among providers; comprehensive transitional activities and services including HIV, mental health and substance use services in prisons, timely and comprehensive discharge planning with specific linkages/appointments, supplies of medications on release, access to benefits and entitlements, case management and proactive follow-up on missed appointments; and releasees' commitment to transitional plans. These elements were generally present in both study states but their absence, which also sometimes occurred, represent ongoing challenges to success. The qualitative findings on the facilitators and challenges of the transitional systems were similar in the two states despite differences in context, demographics of target population, and system organization. Recommendations for improved transitional systems follow from the analysis of the facilitators and challenges.

Barriers to discharge from inpatient rehabilitation: a teamwork approach.

PubMed

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.

Does activity limitation predict discharge destination for postacute care patients?

PubMed

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.

30 CFR 250.217 - What solid and liquid wastes and discharges information and cooling water intake information must...

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...

Acute hospital dementia care: results from a national audit.

PubMed

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.

Association of E-Cigarette Use With Smoking Cessation Among Smokers Who Plan to Quit After a Hospitalization: A Prospective Study.

PubMed

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.

Hydrologic data and description of a hydrologic monitoring plan for Medicine Lake Volcano, California

USGS Publications Warehouse

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.

Facilitating the Timely Discharge of Well Newborns by Using Quality Improvement Methods.

PubMed

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.

An effectiveness and cost-benefit analysis of a hospital-based discharge transition program for elderly Medicare recipients.

PubMed

Saleh, Shadi S; Freire, Chris; Morris-Dickinson, Gwendolyn; Shannon, Trip

2012-06-01

To investigate the business case of postdischarge care transition (PDCT) among Medicare beneficiaries by conducting a cost-benefit analysis. Randomized controlled trial. A general hospital in upstate New York State. Elderly Medicare beneficiaries being treated from October 2008 through December 2009 were randomly selected to receive services as part of a comprehensive PDCT program (intervention--173 patients) or regular discharge process (control--160 patients) and followed for 12 months. The intervention comprised five activities: development of a patient-centered health record, a structured discharge preparation checklist of critical activities, delivery of patient self-activation and management sessions, follow-up appointments, and coordination of data flow. Cost-benefit ratio of the PDCT program; self-management skills and abilities. The 1-year readmission analysis revealed that control participants were more likely to be readmitted than intervention participants (58.2% vs 48.2%; P = .08); with most of that difference observed in the 91 to 365 days after discharge. Findings from the cost-benefit analysis revealed a cost-benefit ratio of 1.09, which indicates that, for every $1 spent on the program, a saving of $1.09 was realized. In addition, participating in a care transition program significantly enhanced self-management skills and abilities. Postdischarge care transition programs have a dual benefit of enhancing elderly adults' self-management skills and abilities and producing cost savings. This study builds a case for the inclusion of PDCT programs as a reimbursable service in benefit packages. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Trial of a "credit card" asthma self-management plan in a high-risk group of patients with asthma.

PubMed

D'Souza, W; Burgess, C; Ayson, M; Crane, J; Pearce, N; Beasley, R

1996-05-01

The "credit card" asthma self-management plan provides the adult asthmatic patient with simple guidelines for the self-management of asthma, which are based on the self-assessment of peak expiratory flow rate recordings and symptoms. The study was a trial of the clinical efficacy of the credit card plan in a high-risk group of asthmatic patients. In this "before-and-after" trial, patients discharged from the emergency department of Wellington Hospital, after treatment for severe asthma were invited to attend a series of hospital outpatient clinics at which the credit card plan was introduced. Questionnaires were used to compare markers of asthma morbidity, requirement for emergency medical care, and medication use during the 6-month period before and after intervention with the credit card plan. Of the 30 patients with asthma who attended the first outpatient clinic, 26 (17 women and 9 men) completed the program. In these 26 participants, there was a reduction in both morbidity and requirement for acute medical services: specifically, the proportion waking with asthma more than once a week decreased from 65% to 23% (p = 0.005) and the proportion visiting the emergency department for treatment of severe asthma decreased from 58% to 15% (p = 0.004). The patients attending the clinics commented favorably on the plan, in particular on its usefulness as an educational tool for monitoring and treating their asthma. Although the interpretation of this study is limited by the lack of a randomized control group, the findings are consistent with other evidence that the credit card asthma self-management plan can be an effective and acceptable system for improving asthma care in a high-risk group of adult patients with asthma.

Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital

PubMed Central

van der Knaap, Ronald; Bouhannouch, Fatiha; Borgsteede, Sander D.; Janssen, Marjo J. A.; Siegert, Carl E. H.; Egberts, Toine C. G.; van den Bemt, Patricia M. L. A.; van Wier, Marieke F.; Bosmans, Judith E.

2017-01-01

Background To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective. Methods A controlled clinical trial was performed at the Internal Medicine department of a general teaching hospital. All admitted patients using at least one prescription drug were included. The COACH program consisted of medication reconciliation, patient counselling at discharge, and communication to healthcare providers in primary care. The primary outcome was the proportion of patients with an unplanned rehospitalisation within three months after discharge. Also, the number of quality-adjusted life-years (QALYs) was assessed. Cost data were collected using cost diaries. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios between the groups was estimated by bootstrapping. Results In the COACH program, 168 patients were included and in usual care 151 patients. There was no significant difference in the proportion of patients with unplanned rehospitalisations (mean difference 0.17%, 95% CI -8.85;8.51), and in QALYs (mean difference -0.0085, 95% CI -0.0170;0.0001). Total costs for the COACH program were non-significantly lower than usual care (-€1160, 95% CI -3168;847). Cost-effectiveness planes showed that the program was not cost-effective compared with usual care for unplanned rehospitalisations and QALYs gained. Conclusion The COACH program was not cost-effective in comparison with usual care. Future studies should focus on high risk patients and include other outcomes (e.g. adverse drug events) as this may increase the chances of a cost-effective intervention. Dutch trial register NTR1519 PMID:28445474

Engaging stakeholders to design a comparative effectiveness trial in children with uncontrolled asthma

PubMed Central

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

Multimedia Exercise Training Program Improves Distance Walked, Heart Rate Recovery, and Self-efficacy in Cardiac Surgery Patients.

PubMed

Wang, Li-Wei; Ou, Shu-Hua; Tsai, Chien-Sung; Chang, Yue-Cune; Kao, Chi-Wen

2016-01-01

Patient education has been shown to be more effective when delivered using multimedia than written materials. However, the effects of using multimedia to assist patients in cardiac rehabilitation have not been investigated. The purpose of this study is to examine the effect of an inpatient multimedia exercise training program on distance walked in the 6-minute walking test (6MWT), heart rate recovery, and walking self-efficacy of patients who had undergone heart surgery. For this longitudinal quasi-experimental study, 60 consecutive patients were assigned to an experimental (n = 20; inpatient multimedia exercise training program) or control (n = 40; routine care) group. Data were collected at 3 times (before surgery, 1 to 2 days before hospital discharge, and 1 month after hospital discharge) and analyzed with the generalized estimating equation approach. Most subjects were men (66.7%), had a mean age of 61.32 ± 13.4 years and left ventricular ejection fraction of 56.96% ± 13.28%, and underwent coronary artery bypass graft surgery (n = 34, 56.7%). Subjects receiving the exercise training program showed significantly greater improvement than those in the control group in the 6MWT walking distance (P < .001), heart rate recovery (P = .04), and self-efficacy (P = .002) at hospital discharge. Furthermore, the intervention effects on 6MWT distance (P < .001) and self-efficacy (P < .001) were sustained at 1 month after hospital discharge. Our inpatient multimedia exercise training program safely improved distance walked in the 6MWT, heart rate recovery, and self-efficacy at hospital discharge in patients after heart surgery and maintained their improvement in 6MWT and self-efficacy 1 month later.

42 CFR § 512.600 - Waiver of direct supervision requirement for certain post-discharge home visits.

Code of Federal Regulations, 2010 CFR

2017-10-01

... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Waivers § 512.600 Waiver of direct supervision requirement for certain post...-discharge home visits. (c) Payment. Up to the maximum post-discharge home visits for a specific EPM episode...

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…

75 FR 20592 - Notice of Availability of Draft National Pollutant Discharge Elimination System (NPDES) General...

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...

29 CFR 2509.08-1 - Supplemental guidance relating to fiduciary responsibility in considering economically targeted...

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...

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...

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...

A sociological exploration of the tensions related to interprofessional collaboration in acute-care discharge planning.

PubMed

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.

Former foster youth's perspectives on independent living preparation six months after discharge.

PubMed

Jones, Loring P

2014-01-01

Research findings have developed a troubling narrative of youth leaving foster care. Congress attempted to address the post-discharge difficulties of foster youth by passing the Independent Living Initiative in 1986, which mandated that the states develop services that would prepare youth for life after foster care. However, it is unclear what effect these programs have on post-foster care trajectories. This largely qualitative study examined the perceptions of a sample of discharged foster six months after leaving care. Most youth felt prepared for life and foster care. They were also for the most part were satisfied with their independent living program, but had significant dissatisfactions with elements of the program. These satisfactions and dissatisfactions are reported along with suggestions for improvement. The policy and practice implications of these suggestions are considered.

Workflow technology: the new frontier. How to overcome the barriers and join the future.

PubMed

Shefter, Susan M

2006-01-01

Hospitals are catching up to the business world in the introduction of technology systems that support professional practice and workflow. The field of case management is highly complex and interrelates with diverse groups in diverse locations. The last few years have seen the introduction of Workflow Technology Tools, which can improve the quality and efficiency of discharge planning by the case manager. Despite the availability of these wonderful new programs, many case managers are hesitant to adopt the new technology and workflow. For a myriad of reasons, a computer-based workflow system can seem like a brick wall. This article discusses, from a practitioner's point of view, how professionals can gain confidence and skill to get around the brick wall and join the future.

28 CFR 70.25 - Revision of budget and program plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Revision of budget and program plans. 70... Revision of budget and program plans. (a) The budget plan is the financial expression of the project or... from budget and program plans, and request prior approvals for budget and program plan revisions, in...

45 CFR 2543.25 - Revision of budget and program plans.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 4 2010-10-01 2010-10-01 false Revision of budget and program plans. 2543.25... Revision of budget and program plans. (a) The budget plan is the financial expression of the project or... deviations from budget and program plans, and request prior approvals for budget and program plan revisions...

Incidence and predictors of 30-day readmission for patients discharged home after craniotomy for malignant supratentorial tumors in California (1995-2010).

PubMed

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.

Cost effectiveness of the U.S. Geological Survey's stream-gaging program in Wisconsin

USGS Publications Warehouse

Walker, J.F.; Osen, L.L.; Hughes, P.E.

1987-01-01

A minimum budget of $510,000 is required to operate the program; a budget less than this does not permit proper service and maintenance of the gaging stations. At this minimum budget, the theoretical average standard error of instantaneous discharge is 14.4%. The maximum budget analyzed was $650,000 and resulted in an average standard of error of instantaneous discharge of 7.2%. 

Annual peak discharges from small drainage areas in Montana through September 1978

USGS Publications Warehouse

Omang, R.J.; Parrett, C.; Hull, J.A.

1979-01-01

Annual peak stage and discharge data have been collected and tabulated for crest-stage gaging sites in Montana. The crest-stage program was begun in July 1955 to investigate the magnitude and frequency of floods from small drainage areas. The program has expanded from 45 crest-stage gaging stations initially to 173 stations maintained in 1978. Data are tabulated for the period of record. (Woodard-USGS)

(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.

Does Classification of Chronic Musculoskeletal Disorder Patients Into Psychosocial Subgroups Predict Differential Treatment Responsiveness and 1-Year Outcomes After a Functional Restoration Program?

PubMed

Asih, Sali; Mayer, Tom G; Williams, Mark; Choi, Yun Hee; Gatchel, Robert J

2015-12-01

The objectives of this study: (1) to assess whether Multidimensional Pain Inventory (MPI) profiles predicted differential responses to a functional restoration program (FRP) in chronic disabling occupational musculoskeletal disorder (CDOMD) patients; (2) to examine whether coping style improves following FRP; and (3) to determine whether discharge MPI profiles predict discharge psychosocial and 1-year socioeconomic outcomes. Consecutive CDOMD patients (N=716) were classified into Adaptive Coper (AC, n=209), Interpersonally Distressed (ID, n=154), Dysfunctional (DYS, n=310), and Anomalous (n=43) using the MPI, and reclassified at discharge. Profiles were compared on psychosocial measures and 1-year socioeconomic outcomes. An intent-to-treat sample analyzed the effect of drop-outs on treatment responsiveness. The MPI classification significantly predicted program completion (P=0.001), although the intent-to-treat analyses found no significant effects of drop-out on treatment responsiveness. There was a significant increase in the number of patients who became AC or Anomalous at FRP discharge and a decrease in those who were ID or DYS. Patients who changed or remained as DYS at FRP discharge reported the highest levels of pain, disability, and depression. No significant interaction effect was found between MPI group and time for pain intensity or disability. All groups improved on psychosocial measures at discharge. DYS patients had decreased work retention and a greater health care utilization at 1 year. An FRP was clinically effective for CDOMD patients regardless of initial MPI profiles. The FRP modified profiles, with patients changing from negative to positive profiles. Discharge DYS were more likely to have poor 1-year outcomes. Those classified as Anomalous had a good prognosis for functional recovery similar to ACs.

[Transferring palliative-care patients from hospital to community care: A qualitative study].

PubMed

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.

40 CFR 125.67 - Increase in effluent volume or amount of pollutants discharged.

Code of Federal Regulations, 2014 CFR

2014-07-01

... AGENCY (CONTINUED) WATER PROGRAMS CRITERIA AND STANDARDS FOR THE NATIONAL POLLUTANT DISCHARGE ELIMINATION... projections of effluent volume and mass loadings for any pollutants to which the modification applies in 5...

Effectiveness of a transitional home care program in reducing acute hospital utilization: a quasi-experimental study.

PubMed

Low, Lian Leng; Vasanwala, Farhad Fakhrudin; Ng, Lee Beng; Chen, Cynthia; Lee, Kheng Hock; Tan, Shu Yun

2015-03-14

Improving healthcare utilization is essential as health systems around the world grapple with the escalating demands for acute hospital resources. Evidence suggests that transitional care programs are effective to improve utilization of healthcare. However, the evidence for transitional care programs that enhance the home medical care model and provide multi-disciplinary patient-centered care is not well established. We evaluated if a transitional home care program operated by the Singapore General Hospital was effective in reducing acute hospital utilization. We performed a quasi-experimental study using a pre-post design to evaluate the effectiveness of a transitional home care program in reducing hospital admissions and emergency department attendances of medically complex patients enrolled into the program in a tertiary hospital in Singapore. Patients received a comprehensive needs assessment performed by the physician and a nurse case manager in the home setting, followed by an individualized care plan that included medical and nursing care, patient education and coordination of care with hospital specialists and community services. Primary study outcomes were emergency department attendances and hospital admissions to all hospitals. These were extracted from hospital administrative data and national health records. Wilcoxon Signed Ranks Test was used for assess differences in pre and post continuous data. Overall, 262 patients were enrolled into the program and 259 were analyzed. Patients had a 51.6% and 52.8% reduction in hospital admissions in the three-month and six-month post enrollment, respectively. Similarly, a 47.1% and 48.2% reduction was observed for emergency department attendances in the three and six months post enrollment, respectively. The average difference in per patient hospital bed days in the pre- and post-enrollment periods were 12.05 days and 20.03 days at the 3-month and 6-month periods, respectively. Patients enrolled in the transitional home care program had significantly lower acute hospital utilization through the reduction of emergency department attendances and hospital admissions. A comprehensive assessment of patients' medical and social needs in the home setting and formulation of an individualized care plan optimized post-discharge care for medically complex patients.

Predictors of formal home health care use in elderly patients after hospitalization.

PubMed

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.

[Study on Accurately Controlling Discharge Energy Method Used in External Defibrillator].

PubMed

Song, Biao; Wang, Jianfei; Jin, Lian; Wu, Xiaomei

2016-01-01

This paper introduces a new method which controls discharge energy accurately. It is achieved by calculating target voltage based on transthoracic impedance and accurately controlling charging voltage and discharge pulse width. A new defibrillator is designed and programmed using this method. The test results show that this method is valid and applicable to all kinds of external defibrillators.

Effects of the Discharge Parameters on the Efficiency and Stability of Ambient Metastable-Induced Desorption Ionization

NASA Astrophysics Data System (ADS)

Zhang, Xiaotian; Chen, Chilai; Liu, Youjiang; Wang, Hongwei; Zhang, Lehua; Kong, Deyi; Mario, Chavarria

2015-12-01

Ionization efficiency is an important factor for ion sources in mass spectrometry and ion mobility spectrometry. Using helium as the discharge gas, acetone as the sample, and high-field asymmetric ion mobility spectrometry (FAIMS) as the ion detection method, this work investigates in detail the effects of discharge parameters on the efficiency of ambient metastable-induced desorption ionization (AMDI) at atmospheric pressure. The results indicate that the discharge power and gas flow rate are both significantly correlated with the ionization efficiency. Specifically, an increase in the applied discharge power leads to a rapid increase in the ionization efficiency, which gradually reaches equilibrium due to ion saturation. Moreover, when the discharge voltage is fixed at 2.1 kV, a maximum efficiency can be achieved at the flow rate of 9.0 m/s. This study provides a foundation for the design and application of AMDI for on-line detection with mass spectrometry and ion mobility spectrometry. supported by National Natural Science Foundation of China (No. 61374016), the Changzhou Science and Technology Support Program, China (No. CE20120081) and the External Cooperation Program of Chinese Academy of Sciences (No. GJHZ1218)

U.S. Geological Survey cooperative water-resources programs in Chester County, Pennsylvania

USGS Publications Warehouse

Wood, Charles R.

1998-01-01

Since 1969, the U.S. Geological Survey (USGS) has had a cooperative water-resources investigation program with Chester County to measure and describe the water resources of the County. Generally, the USGS provides one-half of the program funding, and local cooperators are required to provide matching funds. Cooperation has been primarily with the Chester County Water Resources Authority (CCWRA), with participation from the Chester County Health Department and funding from the Chester County Board of Commissioners. Municipalities and the Red Clay Valley Association also have provided part of the funding for several projects. This report describes how the long-term partnership between the USGS and Chester County, Pa., provides the County with the information that it needs for sound water-resources management.The CCWRA was created in 1961, primarily for land acquisition and planning for flood-control and water-supply projects. With the backing of the Brandywine Valley Association, the CCWRA started its first cooperative project with the USGS in 1969. It was a study of the water-quality condition of Chester County streams with an emphasis on benthic macroinvertebrates and stream chemistry.The kinds of projects and data collection conducted by the USGS have changed with the needs of Chester County and the mission of the CCWRA. Chester County is experiencing rapid population growth (it had the tenth-highest rate of growth in the nation from 1980 to 1990). This growth places considerable stress on water resources and has caused the CCWRA to broaden its focus from flood control to water-supply planning, water quality, and ground-water and surface-water management. The results of USGS studies are used by the CCWRA and other County agencies, including the Planning Commission, Health Department, and Parks and Recreation Department, for conducting day-to-day activities and planning for future growth. The results also are used by the CCWRA to provide guidance and technical assistance to municipalities, water suppliers, industrial dischargers, watershed and conservancy associations and other civic organizations, state and Federal agencies, river basin commissions, and the private sector.The cooperative water-resources program, which is described in the following sections, benefits not only the citizens of Chester County but also serves the interests of the Federal Government. Innovative studies conducted in Chester County provide methods and interpretations that often can be used nationwide, and the headwaters of several interstate drainages lie within the County. Major program thrusts include collection of surface-water, ground-water, and water-quality data and interpretive studies. The use of this information also is described.

Recent developments - US spent fuel disposition

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

One of a US utility's major risk factors in continuing to operate a nuclear plant is managing discharged spent fuel. The US Department of Energy (DOE) signed contracts with utilities guaranteeing government acceptance of spent fuel by 1988. However, on December 17, 1992, DOE Secretary Watkins wrote to Sen. J. Bennett Johnston (D-LA), Chairman of the Senate Energy Committee, indicating a reassessment of DOE's programs, the results of which will be presented to Congress in January 1993. He indicated the Department may not be able to meet the 1988 date, because of difficulty in finding a site for the Monitoredmore » Retrievable Storage facility. Watkins indicated that DOE has investigated an interim solution and decided to expedite a program to certify a multi-purpose standardized cask system for spent fuel receipt, storage, transport, and disposal. To meet the expectations of US utilities, DOE is considering a plan to use federal sites for interim storage of the casks. Secretary Watkins recommended the waste program be taken off-budget and put in a revolving fund established to ensure that money already collected from utilities will be available to meet the schedule for completion of the repository.« less

Moral distress in rehabilitation professionals: results from a hospital ethics survey.

PubMed

Mukherjee, Debjani; Brashler, Rebecca; Savage, Teresa A; Kirschner, Kristi L

2009-05-01

Moral distress in the rehabilitation setting was examined in a follow-up survey. The survey had 3 goals: (1) to systematically and anonymously gather data about the ethical issues that employees struggle with in their daily work; (2) to raise the visibility of the hospital-based ethics program and resources available to employees; and (3) to prioritize and focus the direction of the program's educational seminars, quality improvement projects, and ethics consultation. Online survey of employees. Urban rehabilitation system of care. The survey was open to all employees; 207 completed the survey. N/A MAIN OUTCOME MEASUREMENTS: N/A CONCLUSIONS: Three broad categories of moral distress were identified: institutional ethics, professional practice, and clinical decision-making. Institutional ethics issues related to the health care environment, such as health care reimbursement pressures and corporate culture. Professional practice issues involved codes of behavior and concepts of professionalism, including patient confidentiality/privacy. Clinical decision-making included such practical dilemmas as conflicts around goal-setting, discharge planning, and assessment of decision-making capacity. An anonymous survey of staff members allowed the hospital ethics program to identify sources of moral distress and prioritize strategies to address them.

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...

Advance Identification (ADID)

EPA Pesticide Factsheets

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.

45 CFR 309.35 - What are the procedures for review of a Tribal IV-D program application, plan or plan amendment?

Code of Federal Regulations, 2010 CFR

2010-10-01

...-D program application, plan or plan amendment? 309.35 Section 309.35 Public Welfare Regulations... ENFORCEMENT (IV-D) PROGRAM Tribal IV-D Program Application Procedures § 309.35 What are the procedures for review of a Tribal IV-D program application, plan or plan amendment? (a) The Secretary will promptly...

Discharge in Long Air Gaps; Modelling and applications

NASA Astrophysics Data System (ADS)

Beroual, A.; Fofana, I.

2016-06-01

Discharge in Long Air Gaps: Modelling and applications presents self-consistent predictive dynamic models of positive and negative discharges in long air gaps. Equivalent models are also derived to predict lightning parameters based on the similarities between long air gap discharges and lightning flashes. Macroscopic air gap discharge parameters are calculated to solve electrical, empirical and physical equations, and comparisons between computed and experimental results for various test configurations are presented and discussed. This book is intended to provide a fresh perspective by contributing an innovative approach to this research domain, and universities with programs in high-voltage engineering will find this volume to be a working example of how to introduce the basics of electric discharge phenomena.

Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital.

PubMed

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.

Facilitating emergency hospital evacuation through uniform discharge criteria.

PubMed

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.

Physical functional outcome assessment of patients with major burns admitted to a UK Burn Intensive Care Unit.

PubMed

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.

Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke.

PubMed

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.

Influence of Clinical and Sociodemographic Characteristics on Early Intervention Enrollment after NICU Discharge

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),…

Spinal cord injury in the emergency context: review of program outcomes of a spinal cord injury rehabilitation program in Sri Lanka

PubMed Central

2014-01-01

Background The final months of the conflict in Sri Lanka in 2009 resulted in massive displacement of the civilian population and a high volume of orthopedic trauma including spinal cord injury. In response to this need, Médecins Sans Frontières implemented a multidisciplinary rehabilitation program. Methods Patients were admitted to the program if they had a spinal cord injury, a stable spine and absence of a high-grade pressure ulcer. All patients were assessed on admission with a standardized functional scale the Spinal Cord Independence Measure II (SCIM) and the American Spinal Injury Association Impairment Scale (ASIA). A multidisciplinary team provided nursing care, physiotherapy, bowel and bladder training, mental health care, and vocational rehabilitation. Patients were discharged from the program when medically stable and able to perform activities of daily living independently or with assistance of a caregiver. The primary outcome measures were discharge to the community, and change in SCIM score on discharge. Secondary outcome measures were measured at 6-12 weeks post-discharge, and included SCIM score and presence of complications (pressure ulcers, urinary tract infections and bowel problems). Results 89 patients were admitted. The majority of injuries were to the thoracic region or higher (89%). The injuries were classified as ASIA grade A in 37 (43%), grade B in 17(20%), grade C in 15 (17%) and grade D in 17(20%). 83.2% met the criteria for discharge, with a further 7.9% patients requiring transfer to hospital for surgical care of pressure ulcers. There was a significant change in SCIM score from 55 on admission to 71 on discharge (p < 0.01). 79.8% and 66.7% achieved a clinically significant and substantially significant SCIM score improvement, respectively. Amongst those with follow up data, there was a reduction in post spinal cord injury complications from those experienced either at or during admission. A further 79% of SCIM scores were stable or improved compared to the score on discharge. Conclusions Provision of effective rehabilitation for spinal cord injury is possible in complex humanitarian emergency situations. A multidisciplinary approach, including psychological support along with partnerships with local and international organizations with specialized expertise, was key to the program’s success. PMID:24650231

75 FR 78805 - Agency Information Collection (Application for Refund of Educational Contributions) Activity...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-16

... participant's discharge or disenrollment. Refunds may be made earlier in instances of hardship or other good reasons. Participants who stop their enrollment from the program after discharge or release from active...

Does an 8-week home-based exercise program affect physical capacity, quality of life, sick leave, and use of psychotropic drugs in patients with pulmonary embolism? Study protocol for a multicenter randomized clinical trial.

PubMed

Rolving, Nanna; Brocki, Barbara C; Mikkelsen, Hanne R; Ravn, Pernille; Bloch-Nielsen, Jannie Rhod; Frost, Lars

2017-05-30

The existing evidence base in pulmonary embolism (PE) is primarily focused on diagnostic methods, medical treatment, and prognosis. Only a few studies have investigated how everyday life is affected by PE, although many patients are negatively affected both physically and emotionally after hospital discharge. Currently, no documented rehabilitation options are available for these patients. We aim to examine whether an 8-week home-based exercise intervention can influence physical capacity, quality of life, sick leave, and use of psychotropic drugs in patients medically treated for PE. One hundred forty patients with incident first-time PE will be recruited in five hospitals. After inclusion, patients will be randomly allocated to either the control group, receiving usual care, or the intervention group, who will be exposed to an 8-week home-based exercise program in addition to usual care. The intervention includes an initial individual exercise planning session with a physiotherapist, leading to a recommended exercise program of a minimum of three weekly training sessions of 30-60 minutes' duration. The patients have regular telephone contact with the physiotherapist during the 8-week program. At the time of inclusion, after 2 months, and after 6 months, the patients' physical capacity is measured using the Incremental Shuttle Walk test. Furthermore the patients' quality of life, sick leave, and use of psychotropic drugs is measured using self-reported questionnaires. In both randomization arms, all follow-up measurements and visits will take place at the hospital from which the patient was discharged. Levels of eligibility, consent, adherence, and retention will be used as indicators of study feasibility. We expect that the home-based exercise program will improve the physical capacity and quality of life for the patients in the intervention group. The study will furthermore contribute significantly to the limited knowledge about the optimal rehabilitation of PE patients, and may thereby form the basis of future recommendations in this field. ClinicalTrials.gov, NCT02684721 . Registered on 20 January 2016.

A multicenter, randomized controlled trial of individualized occupational therapy for patients with schizophrenia in Japan

PubMed Central

Ohori, Manami; Inagaki, Yusuke; Shimooka, Yuko; Sugimura, Naoya; Ishihara, Ikuyo; Yoshida, Tomotaka

2018-01-01

The individualized occupational therapy (IOT) program is a psychosocial program that we developed to facilitate proactive participation in treatment and improve cognitive functioning and other outcomes for inpatients with acute schizophrenia. The program consists of motivational interviewing, self-monitoring, individualized visits, handicraft activities, individualized psychoeducation, and discharge planning. This multicenter, open-labeled, blinded-endpoint, randomized controlled trial evaluated the impact of adding IOT to a group OT (GOT) program as usual for outcomes in recently hospitalized patients with schizophrenia in Japanese psychiatric hospitals setting compared with GOT alone. Patients with schizophrenia were randomly assigned to the GOT+IOT group or the GOT alone group. Among 136 randomized patients, 129 were included in the intent-to-treat population: 66 in the GOT+IOT and 63 in the GOT alone groups. Outcomes were administered at baseline and discharge or 3 months following hospitalization including the Brief Assessment of Cognition in Schizophrenia Japanese version (BACS-J), the Schizophrenia Cognition Rating Scale Japanese version, the Social Functioning Scale Japanese version, the Global Assessment of Functioning scale, the Intrinsic Motivation Inventory Japanese version (IMI-J), the Morisky Medication Adherence Scale-8 (MMAS-8), the Positive and Negative Syndrome Scale (PANSS), and the Japanese version of Client Satisfaction Questionnaire-8 (CSQ-8J). Results of linear mixed effects models indicated that the IOT+GOT showed significant improvements in verbal memory (p <0.01), working memory (p = 0.02), verbal fluency (p < 0.01), attention (p < 0.01), and composite score (p < 0.01) on the BACS-J; interest/enjoyment (p < 0.01), value/usefulness (p < 0.01), perceived choice (p < 0.01), and IMI-J total (p < 0.01) on the IMI-J; MMAS-8 score (p < 0.01) compared with the GOT alone. Patients in the GOT+IOT demonstrated significant improvements on the CSQ-8J compared with the GOT alone (p < 0.01). The present findings provide support for the feasibility in implementing an IOT program and its effectiveness for improving cognitive impairment and other outcomes in patients with schizophrenia. PMID:29621261

A multicenter, randomized controlled trial of individualized occupational therapy for patients with schizophrenia in Japan.

PubMed

Shimada, Takeshi; Ohori, Manami; Inagaki, Yusuke; Shimooka, Yuko; Sugimura, Naoya; Ishihara, Ikuyo; Yoshida, Tomotaka; Kobayashi, Masayoshi

2018-01-01

The individualized occupational therapy (IOT) program is a psychosocial program that we developed to facilitate proactive participation in treatment and improve cognitive functioning and other outcomes for inpatients with acute schizophrenia. The program consists of motivational interviewing, self-monitoring, individualized visits, handicraft activities, individualized psychoeducation, and discharge planning. This multicenter, open-labeled, blinded-endpoint, randomized controlled trial evaluated the impact of adding IOT to a group OT (GOT) program as usual for outcomes in recently hospitalized patients with schizophrenia in Japanese psychiatric hospitals setting compared with GOT alone. Patients with schizophrenia were randomly assigned to the GOT+IOT group or the GOT alone group. Among 136 randomized patients, 129 were included in the intent-to-treat population: 66 in the GOT+IOT and 63 in the GOT alone groups. Outcomes were administered at baseline and discharge or 3 months following hospitalization including the Brief Assessment of Cognition in Schizophrenia Japanese version (BACS-J), the Schizophrenia Cognition Rating Scale Japanese version, the Social Functioning Scale Japanese version, the Global Assessment of Functioning scale, the Intrinsic Motivation Inventory Japanese version (IMI-J), the Morisky Medication Adherence Scale-8 (MMAS-8), the Positive and Negative Syndrome Scale (PANSS), and the Japanese version of Client Satisfaction Questionnaire-8 (CSQ-8J). Results of linear mixed effects models indicated that the IOT+GOT showed significant improvements in verbal memory (p <0.01), working memory (p = 0.02), verbal fluency (p < 0.01), attention (p < 0.01), and composite score (p < 0.01) on the BACS-J; interest/enjoyment (p < 0.01), value/usefulness (p < 0.01), perceived choice (p < 0.01), and IMI-J total (p < 0.01) on the IMI-J; MMAS-8 score (p < 0.01) compared with the GOT alone. Patients in the GOT+IOT demonstrated significant improvements on the CSQ-8J compared with the GOT alone (p < 0.01). The present findings provide support for the feasibility in implementing an IOT program and its effectiveness for improving cognitive impairment and other outcomes in patients with schizophrenia.

Program Planning in Health Professions Education

ERIC Educational Resources Information Center

Schmidt, Steven W.; Lawson, Luan

2018-01-01

In this chapter, the major concepts from program planning in adult education will be applied to health professions education (HPE). Curriculum planning and program planning will be differentiated, and program development and planning will be grounded in a systems thinking approach.

The Empirical Relationship between Mining Industry Development and Environmental Pollution in China.

PubMed

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.

Predicting the discharge status after liver transplantation at a single center: a new approach for a new era.

PubMed

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.

Mission simulator test data. [an overview of a real time mission simulation test program of a nickel cadmium battery

NASA Technical Reports Server (NTRS)

Hendee, E. A.

1980-01-01

A real time mission simulation test program of nickel cadmium cells, performed in conjunction with the Anik 1A2 satellite, is reviewed. Simulation of the temperature profiles, the electrical profiles, the depth of discharge, and the rate of charge and discharge is reported. The type of separator used in the cells and the transfer of electrolytes during overcharge are discussed.

Final Creech Air Force Base Capital Improvements Program Environmental Assessment

DTIC Science & Technology

2013-11-01

acts as a shell to softer, more vulnerable soils below. Lenses of caliche (sediment cemented together with sodium salts) and clay are also known to be...requirements. Contact Air Quality Program Manager YES Page 2 WATER QUALITY 99 CES/CEIEC, 652-2834 Any process that discharges to sanitary or industrial... Sanitary Wastewater Will the project result in the discharge of any sanitary wastewaters (e.g., wastewater from sinks, showers, toilets, etc)? A

Annual peak discharges from small drainage areas in Montana through September 1977

USGS Publications Warehouse

Omang, R.J.; Hull, J.A.

1978-01-01

Annual peak stage and stream-discharge data have been collected and tabulated for crest-stage gaging sites in Montana. The crest-stage program was begun in July 1955 to investigate the magnitude and frequency of floods from small drainage areas. The program has expanded from 45 crest-stage gaging stations initially to 191 stations in 1977. Data are tabulated for 336 sites throughout the period of record. (Woodard-USGS)

Annual peak discharges from small drainage areas in Montana through September 1980

USGS Publications Warehouse

Omang, R.J.; Parrett, Charles; Hull, J.A.

1955-01-01

Annual peak stage and discharge data have been collected and tabulated for crest-stage gaging sites in Montana. The crest-stage program was begun in July 1955 to investigate the magnitude and frequency of floods from small drainage areas. The program has expanded from 45 crest-stage gaging stations initially to 172 stations maintained in 1980. Data in the report are tabulated for the period of record. (USGS)

Annual peak discharges from small drainage areas in Montana through September 1979

USGS Publications Warehouse

Omang, R.J.; Parrett, C.; Hull, J.A.

1955-01-01

Annual peak stage and discharge data have been collected and tabulated for crest-stage gaging sites in Montana. The crest-stage program was begun in July 1955 to investigate the magnitude and frequency of floods from small drainage areas. The program has expanded from 45 crest-stage gaging stations initially to 173 stations maintained in 1979. Data in the report are tabulated for the period of record. (USGS)

Hydrology of the Jackson, Tennessee, area and delineation of areas contributing ground water to the Jackson well fields

USGS Publications Warehouse

Bailey, Z.C.

1993-01-01

A comprehensive hydrologic investigation of the Jackson area in Madison County, Tennessee, was conducted to provide information for the development of a wellhead-protection program for two municipal well fields. The136-square-mile study area is between the Middle Fork Forked Deer and South Fork Forked Deer Rivers and includes the city of Jackson. The formations that underlie and crop out in the study area, in descending order, are the Memphis Sand, Fort Pillow Sand, and Porters Creek Clay. The saturated thickness of the Memphis Sand ranges from 0 to 270 feet; the Fort Pillow Sand, from 0 to 180 feet. The Porters Creek Clay, which ranges from 130 to 320 feet thick, separates a deeper formation, the McNairy Sand, from the shallower units. Estimates by other investigators of hydraulic conductivity for the Memphis Sand range from 80 to 202 feet per day. Estimates of transmissivity of the Memphis Sand range from 2,700 to 33,000 feet squared per day. Estimates of hydraulic conductivity for the Fort Pillow Sand range from 68 to 167 feet per day, and estimates of transmissivity of that unit range from 6,700 to 10,050 feet squared per day. A finite-difference, ground-water flow model was calibrated to steady-state hydrologic conditions of April 1989, and was used to simulate hypothetical pumping plans for the North and South Well Fields. The aquifers were represented as three layers in the model to simulate the ground-water flow system. Layer 1 is the saturated part of the Memphis Sand; layer 2 is the upper half of the Fort Pillow Sand; and layer 3 is the lower half of the Fort Pillow Sand. The steady-state water budget of the simulated system showed that more than half of the inflow to the ground-water system is underflow from the model boundaries. Most of this inflow is discharged as seepage to the rivers and to pumping wells. Slightly less than half of the inflow is from areal recharge and recharge from streams. About 75 percent of the discharge from the system is into the streams, lakes, and out of the model area through a small quantity of ground-water underflow. The remaining 25 percent is discharge to pumping wells. The calibrated model was modified to simulate the effects on the ground-water system of three hypothetical pumping plans that increased pumping from the North Well Field to up to 20 million gallons per day, and from the South Well Field, to up to 15 million gallons per day. Maximum drawdown resulting from the 20 million-gallons-per-day rate of simulated pumping was 44.7 feet in a node containing a pumping well, and maximum drawdown over an extended area was about 38 feet. Up to 34 percent of ground-water seepage to streams in the calibrated model was intercepted by pumping in the simulations. A maximum of 9 percent more water was induced through model boundaries. A particle-tracking program, MODPATH, was used to delineate areas contributing water to the North and South Well Fields for the calibrated model and the three pumping simulations, and to estimate distances for different times-of-travel to the wells. The size of the area contributing water to the North Well Field, defined by the 5-year time-of-travel capture zone, is about 0.8 by 1.8 miles for the calibrated model and pumping plan 1. The size of the area for pumping plan 2 is 1.1 by 2.0 miles and, for pumping plan 3, 1.6 by 2.2 miles. The range of distance for l-year time-of-travel to individual wells is 200 to 800 feet for the calibrated model and plan 1, and 350 to 950 feet for plans 2 and 3. The size of the area contributing water to the South Well Field, defined by the 5-year time-of-travel capture zone, is about 0.8 by 1.4 miles for the calibrated model. The size of the area for pumping plans 1 and 3 is 1.6 by 2.2 miles and, for pumping plan 2, 1.1 by 1.7 miles. The range of distance for l-year time-of-travel to individual wells is 120 to 530 feet for the calibrated model, 670 to 1,300 feet for pumping plans 1 and 3, and 260 to 850 feet

40 CFR 122.46 - Duration of permits (applicable to State programs, see § 123.25).

Code of Federal Regulations, 2011 CFR

2011-07-01

... AGENCY (CONTINUED) WATER PROGRAMS EPA ADMINISTERED PERMIT PROGRAMS: THE NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM Permit Conditions § 122.46 Duration of permits (applicable to State programs, see § 123.25...

Considerations in developing an integrated pest management programme for control of sea lice on farmed salmon in Pacific Canada.

PubMed

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.

Documentation of a Regional Aquifer Simulation Model RAQSIM, and a description of support programs applied in the Twin Platte - Middle Republican Study Area, Nebraska

USGS Publications Warehouse

Cady, R.E.; Peckenpaugh, J.M.

1985-01-01

RAQSIM, a generalized flow model of a groundwater system using finite-element methods, is documented to explain how it works and to demonstrate that it gives valid results. Three support programs that are used to compute recharge and discharge data required as input to RAQSIM are described. RAQSIM was developed to solve transient, two-dimensional, regional groundwater flow problems with isotropic or anisotropic conductance. The model can also simulate radially-symmetric flow to a well and steady-state flow. The mathematical basis, program structure, data input and output procedures, organization of data sets, and program features and options of RAQSIM are discussed. An example , containing listings of data and results and illustrating RAQSIM 's capabilities, is discussed in detail. Two test problems also are discussed comparing RAQSIM 's results with analytical procedures. The first support program described, the PET Program, uses solar radiation and other climatic data in the Jensen-Haise method to compute potential evapotranspiration. The second support program, the Soil-Water Program, uses output from the PET Program, soil characteristics, and the ratio of potential to actual evapotranspiration for each crop to compute infiltration, storage, and removal of water from the soil zone. The third program, the Recharge-Discharge Program, uses output from the Soil-Water Program together with other data to compute recharge and discharge from the groundwater flow system. For each support program, a program listing and examples of the data and results for the Twin Platte-Middle Republican study are provided. In addition, a brief discussion on how each program operates and on procedures for running and modifying these programs are presented. (Author 's abstract)

Cost efficient environmental survey paths for detecting continuous tracer discharges

NASA Astrophysics Data System (ADS)

Alendal, G.

2017-07-01

Designing monitoring programs for detecting potential tracer discharges from unknown locations is challenging. The high variability of the environment may camouflage the anticipated anisotropic signal from a discharge, and there are a number of discharge scenarios. Monitoring operations may also be costly, constraining the number of measurements taken. By assuming that a discharge is active, and a prior belief on the most likely seep location, a method that uses Bayes' theorem combined with discharge footprint predictions is used to update the probability map. Measurement locations with highest reduction in the overall probability of a discharge to be active can be identified. The relative cost between reallocating and measurements can be taken into account. Three different strategies are suggested to enable cost efficient paths for autonomous vessels.

Quantifying opportunities for hospital cost control: medical device purchasing and patient discharge planning.

PubMed

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.

[The case manager--from words to deeds?].

PubMed

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.

Helping Seniors Plan for Posthospital Discharge Needs Before a Hospitalization Occurs: Results from the Randomized Control Trial of PlanYourLifespan.org.

PubMed

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

Characteristics of canine nasal discharge related to intranasal diseases: a  retrospective study of 105 cases.

PubMed

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.

Social implications of deinstitutionalization.

PubMed

Brown, P

1980-10-01

Attacks on custodialism offered the hope of more humane treatment approaches. Mental health planners thought that the costs of state hospital care could be reduced by discharging patients into the community. For state governments, this involved a shift of costs and responsibility to the federal government. This shift was accompanied by an increase in cost-effective planning at both state and federal levels. Cost-effective planning uses corporate-style standardization techniques to provide precise, measured types of treatment to certain categories of patients. Such planning is primarily oriented to balanced ledgers of the government budget, rather than meeting specific human needs. The shift in costs also increases profits in the private sector. This is most noticeable in the nursing and boarding home industry where entrepreneurs derive large returns from a newly custodialism mainly funded by government reimbursements. The institutional overuse of psychiatric drugs is continued in community programs. Cost-effective approaches also involve firing mental health staff and increasing the workload of those remaining. Community mental health centers and state hospital deinstitutionalization programs have largely failed to meet most of their promises such as noninstitutional treatment, more humane care, prevention, and rehabilitation. These failures have produced the beginning of a delegitimation of the new mental health approaches. This delegitimation is also used as part of more general attacks on social services so prevalent in this period of economic crisis. This reinforces the reliance on cost-effective plans which do not benefit clients. It also poses the danger of increasing the number of persons classified as psychological misfit among the marginal underclass. Even though this is an unintended effect, it can then be used to deflect onto these victims popular resentment against big business and the government. Further, the growth of such a misfit group, along with other types of social decay, may prompt an increase in the already growing forms of social control psychotechnology such as psychosurgery.

Interdisciplinary Team Collaboration during Discharge of Depressed Older Persons: A Norwegian Qualitative Implementation Study

PubMed Central

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

Corrective action investigation plan for Corrective Action Unit Number 423: Building 03-60 Underground Discharge Point, Tonopah Test Range, Nevada

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

Stormwater Pollution Prevention Plan for the TA-03-38 Metals Fabrication Shop, Los Alamos National Laboratory, Revision 3, January 2018

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

Stormwater Pollution Prevention Plan for the TA-60-01 Heavy Equipment Shop, Los Alamos National Laboratory, Revision 3, January 2018

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

Stormwater Pollution Prevention Plan for the TA-03-38 Carpenter's Shop, Los Alamos National Laboratory, Revision 3, January 2018

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

Stormwater Pollution Prevention Plan for the TA-03-22 Power and Steam Plant, Los Alamos National Laboratory, Revision 3, January 2018

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

Stormwater Pollution Prevention Plan - TA-60 Roads and Grounds Facility and Associated Sigma Mesa Staging Area

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

Transition Control with Dielectric Barrier Discharge Plasmas

DTIC Science & Technology

2010-10-01

AFRL-AFOSR-UK-TR-2011-0007 Transition Control with Dielectric Barrier Discharge Plasmas Cameron Tropea Technische...Discharge Plasmas 5a. CONTRACT NUMBER FA8655-08-1-3032 5b. GRANT NUMBER Grant 08-3032 5c. PROGRAM ELEMENT NUMBER 61102F 6. AUTHOR(S...is to control natural boundary-layer transition through the use of plasma actuators. Transition delay or even suppression has its merits not only in

Parts, Materials, and Processes Control Program for Expendable Launch Vehicles

DTIC Science & Technology

2015-07-31

burn-in, electrical tests (DWV, room and hot IR, partial discharge when in corona region); perform DPA with SEM/EDX analysis of dielectric...life test; x-ray and vicinal illumination inspection; electrical tests (DWV, room and hot IR, partial discharge when in corona region) Termination...defects; proper voltage derating. Partial discharge testing, corona inception testing up to 60% of rated voltage; CSAM screening; voltage burn

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...

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. ...

Report: State Enforcement of Clean Water Act Dischargers Can Be More Effective

EPA Pesticide Factsheets

Report #2001-P-00013, August 14, 2001. We believe that state enforcement programs could be much more effective in deterring noncompliance with discharge permits and, ultimately, improving the quality of the nation’s water.

Flow discharge prediction in compound channels using linear genetic programming

NASA Astrophysics Data System (ADS)

Azamathulla, H. Md.; Zahiri, A.

2012-08-01

SummaryFlow discharge determination in rivers is one of the key elements in mathematical modelling in the design of river engineering projects. Because of the inundation of floodplains and sudden changes in river geometry, flow resistance equations are not applicable for compound channels. Therefore, many approaches have been developed for modification of flow discharge computations. Most of these methods have satisfactory results only in laboratory flumes. Due to the ability to model complex phenomena, the artificial intelligence methods have recently been employed for wide applications in various fields of water engineering. Linear genetic programming (LGP), a branch of artificial intelligence methods, is able to optimise the model structure and its components and to derive an explicit equation based on the variables of the phenomena. In this paper, a precise dimensionless equation has been derived for prediction of flood discharge using LGP. The proposed model was developed using published data compiled for stage-discharge data sets for 394 laboratories, and field of 30 compound channels. The results indicate that the LGP model has a better performance than the existing models.

Low physical fitness is a strong predictor of health problems among young men: a follow-up study of 1411 male conscripts.

PubMed

Taanila, Henri; Hemminki, Antti J M; Suni, Jaana H; Pihlajamäki, Harri; Parkkari, Jari

2011-07-25

Military service in Finland is compulsory for male citizens and annually about 90% of 19-year-old men enter into the service. Approximately 15% of them are discharged due to medical reasons constituting a group of young men who are at risk of being marginalised in society. The purpose of the study was to evaluate predictive associations between medical discharge from the compulsory military service and various intrinsic risk factors, including socio-economic, health, health behavior, and physical fitness outcomes. We followed four successive cohorts of conscripts who formed a representative sample of Finnish young men (18-28 years old, median age 19 yrs) for 6 months. To exclude injuries and illnesses originating before the onset of service, conscripts discharged from the service at the medical screenings during the 2-week run-in period were excluded from the analyses. Data regarding medical discharge were charted from computerised patient records. Predictive associations between medical discharge and intrinsic risk factors were examined using multivariate Cox's proportional hazard models. Of 1411 participants, 9.4% (n = 133) were discharged prematurely for medical reasons, mainly musculoskeletal (44%, n = 59) and mental and behavioral (29%, n = 39) disorders. Low levels of physical fitness assessed with a 12-min running test (hazard ratio [HR] 3.3; 95% confidence interval [CI]: 1.7-6.4), poor school success (HR 4.6; 95% CI: 2.0-11.0), poor self-assessed health (HR 2.8; 95% CI: 1.6-5.2), and not belonging to a sports club (HR 4.9; 95% CI: 1.2-11.6) were most strongly associated with medical discharge in a graded manner. The present results highlight the need for an improved pre-enlistment examination and provide a new means of identifying young persons with a high risk for discharge. The majority of the observed risk factors are modifiable. Thus preventive measures and programs could be implemented. The findings suggest that increasing both aerobic and muscular fitness is a desirable goal in a pre-training program before entering military service. Attention to appropriate waist circumference and strategies addressing psychological well-being may strengthen the preventive program. Optimally the effectiveness of these programs should be tested in randomized controlled intervention studies.

Low physical fitness is a strong predictor of health problems among young men: a follow-up study of 1411 male conscripts

PubMed Central

2011-01-01

Background Military service in Finland is compulsory for male citizens and annually about 90% of 19-year-old men enter into the service. Approximately 15% of them are discharged due to medical reasons constituting a group of young men who are at risk of being marginalised in society. The purpose of the study was to evaluate predictive associations between medical discharge from the compulsory military service and various intrinsic risk factors, including socio-economic, health, health behavior, and physical fitness outcomes. Methods We followed four successive cohorts of conscripts who formed a representative sample of Finnish young men (18-28 years old, median age 19 yrs) for 6 months. To exclude injuries and illnesses originating before the onset of service, conscripts discharged from the service at the medical screenings during the 2-week run-in period were excluded from the analyses. Data regarding medical discharge were charted from computerised patient records. Predictive associations between medical discharge and intrinsic risk factors were examined using multivariate Cox's proportional hazard models. Results Of 1411 participants, 9.4% (n = 133) were discharged prematurely for medical reasons, mainly musculoskeletal (44%, n = 59) and mental and behavioral (29%, n = 39) disorders. Low levels of physical fitness assessed with a 12-min running test (hazard ratio [HR] 3.3; 95% confidence interval [CI]: 1.7-6.4), poor school success (HR 4.6; 95% CI: 2.0-11.0), poor self-assessed health (HR 2.8; 95% CI: 1.6-5.2), and not belonging to a sports club (HR 4.9; 95% CI: 1.2-11.6) were most strongly associated with medical discharge in a graded manner. The present results highlight the need for an improved pre-enlistment examination and provide a new means of identifying young persons with a high risk for discharge. Conclusions The majority of the observed risk factors are modifiable. Thus preventive measures and programs could be implemented. The findings suggest that increasing both aerobic and muscular fitness is a desirable goal in a pre-training program before entering military service. Attention to appropriate waist circumference and strategies addressing psychological well-being may strengthen the preventive program. Optimally the effectiveness of these programs should be tested in randomized controlled intervention studies. PMID:21787401

Heterogeneity of heart failure management programs in Australia.

PubMed

Driscoll, Andrea; Worrall-Carter, Linda; McLennan, Skye; Dawson, Anna; O'Reilly, Jan; Stewart, Simon

2006-03-01

Heart Failure Management Programs (HFMPs) have proven to be cost-effective in minimising recurrent hospitalisations, morbidity and mortality. However, variability between the programs exists which could translate into variable health outcomes. To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure. Thirty-nine post-discharge HFMPs were identified from a systematic search of the Australian health-care system in 2002. A comprehensive 19-item questionnaire specifically examining characteristics of HFMPs was sent to co-ordinators of identified programs in early 2003. All participants responded with six institutions (15%) indicating that their HFMP had ceased operations due to a lack of funding. The survey revealed an uneven distribution of the 33 active HFMPs operating throughout Australia. Overall, 4450 post-discharge HF patients (median: 74; IQR: 24-147) were managed via these programs, representing only 11% of the potential caseload for an Australia-wide network of HFMPs. Heterogeneity of these programs existed in respect to the model of care applied within the program (70% applied a home-based program and 18% a specialist HF clinic) and applied interventions (30% of programs had no discharge criteria and 45% of programs prevented nurses administering/titrating medications). Sustained funding was available to only 52% of the active HFMPs. Inequity of access to HFMPs in Australia is evident in relation to locality and high service demand, further complicated by inadequate funding. Heterogeneity between these programs is substantial. The development of national benchmarks for evidence-based HFMPs is required to address program variability and funding issues to realise their potential to improve health outcomes.

20 CFR 632.255 - Program planning.

Code of Federal Regulations, 2010 CFR

2010-04-01

... that may be characterized as planning and design but not program operation. (c) Expenses incurred in... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Program planning. 632.255 Section 632.255... EMPLOYMENT AND TRAINING PROGRAMS Summer Youth Employment and Training Programs § 632.255 Program planning. (a...

A computer program for simulating salinity loads in streams

USGS Publications Warehouse

Glover, Kent C.

1978-01-01

A FORTRAN IV program that simulates salinity loads in streams is described. Daily values of stream-discharge in cubic feet per second, or stream-discharge and specific conductance in micromhos, are used to estimate daily loads in tons by one of five available methods. The loads are then summarized by computing either total and mean monthly loads or various statistics for each calendar day. Results are output in tabular and, if requested, punch card format. Under selection of appropriate methods for estimating and summarizing daily loads is provided through the coding of program control cards. The program is designed to interface directly with data retrieved from the U.S. Geological Survey WATSTORE Daily Values File. (Woodard-USGS)

34 CFR 74.25 - Revision of budget and program plans.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false Revision of budget and program plans. 74.25 Section 74... Requirements Financial and Program Management § 74.25 Revision of budget and program plans. (a) The budget plan...) Recipients are required to report deviations from budget and program plans, and request prior approvals for...

Fifty-year flood-inundation maps for Catacamas, Honduras

USGS Publications Warehouse

Kresch, David L.; Mastin, Mark C.; Olsen, T.D.

2002-01-01

After the devastating floods caused by Hurricane Mitch in 1998, maps of the areas and depths of the 50-year-flood inundation at 15 municipalities in Honduras were prepared as a tool for agencies involved in reconstruction and planning. This report, which is one in a series of 15, presents maps of areas in the municipality of Catacamas that would be inundated by a 50-year-flood of Rio Catacamas. Geographic Information System (GIS) coverages of the flood inundation are available on a computer in the municipality of Catacamas as part of the Municipal GIS project and on the Internet at the Flood Hazard Mapping Web page (http://mitchnts1.cr.usgs.gov/projects/ floodhazard.html). These coverages allow users to view the flood inundation in much more detail than is possible using the maps in this report. Water-surface elevations for a 50-year-flood on Rio Catacamas at Catacamas were estimated using HEC-RAS, a one-dimensional, steady-flow, step-backwater computer program. The channel and floodplain cross sections used in HEC-RAS were developed from an airborne light-detection-and-ranging (LIDAR) topographic survey of the area. The 50-year-flood discharge for Rio Catacamas at Catacamas, 216 cubic meters per second, was estimated using a regression equation that relates the 50-year-flood discharge to drainage area and mean annual precipitation because there are no long-term stream-gaging stations on the river from which to estimate the discharge. The drainage area and mean annual precipitation estimated for Rio Catacamas at Catacamas are 45.4 square kilometers and 1,773 millimeters, respectively.

Fifty-year flood-inundation maps for Olanchito, Honduras

USGS Publications Warehouse

Kresch, David L.; Mastin, M.C.; Olsen, T.D.

2002-01-01

After the devastating floods caused by Hurricane Mitch in 1998, maps of the areas and depths of the 50-year-flood inundation at 15 municipalities in Honduras were prepared as a tool for agencies involved in reconstruction and planning. This report, which is one in a series of 15, presents maps of areas in the municipality of Olanchito that would be inundated by a 50-year-flood of Rio Uchapa. Geographic Information System (GIS) coverages of the flood inundation are available on a computer in the municipality of Olanchito as part of the Municipal GIS project and on the Internet at the Flood Hazard Mapping Web page (http://mitchnts1.cr.usgs.gov/projects/floodhazard.html). These coverages allow users to view the flood inundation in much more detail than is possible using the maps in this report. Water-surface elevations for a 50-year-flood discharge of 243 cubic meters per second on Rio Uchapa at Olanchito were estimated using HEC-RAS, a one-dimensional, steady-flow, step-backwater computer program. The channel and floodplain cross sections used in HEC-RAS were developed from an airborne light-detection-and-ranging (LIDAR) topographic survey of the area. There are no nearby long-term stream-gaging stations on Rio Uchapa; therefore, the 50-year-flood discharge for Rio Uchapa was estimated using a regression equation that relates the 50-year-flood discharge to drainage area and mean annual precipitation. The drainage area and mean annual precipitation estimated for Rio Uchapa at Olanchito are 97.1 square kilometers and 1,178 millimeters, respectively.

Fifty-year flood-inundation maps for La Ceiba, Honduras

USGS Publications Warehouse

Kresch, David L.; Mastin, M.C.; Olsen, T.D.

2002-01-01

After the devastating floods caused by Hurricane Mitch in 1998, maps of the areas and depths of the 50-year-flood inundation at 15 municipalities in Honduras were prepared as a tool for agencies involved in reconstruction and planning. This report, which is one in a series of 15, presents maps of areas in the municipality of La Ceiba that would be inundated by a 50-year-flood of Rio Cangrejal. Geographic Information System (GIS) coverages of the flood inundation are available on a computer in the municipality of La Ceiba as part of the Municipal GIS project and on the Internet at the Flood Hazard Mapping Web page (http://mitchnts1.cr.usgs.gov/projects/floodhazard.html). These coverages allow users to view the flood inundation in much more detail than is possible using the maps in this report. Water-surface elevations for a 50-year-flood discharge of 1,030 cubic meters per second on Rio Cangrejal at La Ceiba were computed using HEC-RAS, a one-dimensional, steady-flow, step-backwater computer program. The channel and floodplain cross sections used in HEC-RAS were developed from an airborne light-detection-and-ranging (LIDAR) topographic survey of the area. There are no nearby long-term stream-gaging stations on Rio Cangrejal; therefore, the 50-year-flood discharge for Rio Cangrejal at La Ceiba was estimated using a regression equation that relates the 50-year-flood discharge to drainage area and mean annual precipitation. The drainage area and mean annual precipitation estimated for Rio Cangrejal at La Ceiba are 498 square kilometers and 2,306 millimeters, respectively.

Predictive Validity of the Suicide Trigger Scale (STS-3) for Post-Discharge Suicide Attempt in High-Risk Psychiatric Inpatients

PubMed Central

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

Feasibility and cost-effectiveness of a multidisciplinary home-telehealth intervention programme to reduce falls among elderly discharged from hospital: study protocol for a randomized controlled trial.

PubMed

Giordano, Alessandro; Bonometti, Gian Pietro; Vanoglio, Fabio; Paneroni, Mara; Bernocchi, Palmira; Comini, Laura; Giordano, Amerigo

2016-12-07

Fall incidents are the third cause of chronic disablement in elderly according to the World Health Organization (WHO). Recent meta-analyses shows that a multifactorial falls risk assessment and management programmes are effective in all older population studied. However, the application of these programmes may not be the same in all National health care setting and, consequently, needs to be evaluated by cost-effectiveness studies before to plan this intervention in regular care. In Italy structured collaboration between hospital staff and primary care is generally lacking and the role of Information and Communication Technologies (ICT) in a fall prevention programme at home has never been explored. This will be a two-group randomised controlled trial aiming to evaluate the effects of a home-based intervention programme delivered by a multidisciplinary health team. The home tele-management programme, previously adopted in our Institute for chronic patients, will be proposed to elderly people affected by chronic diseases at high risk of falling at hospital discharge. The programme will involve the hospital staff and will be managed thanks to the collaboration between hospital and primary care setting. Patients will be followed for 6 months after hospital discharge. A nurse-tutor telephone support and tele-exercise will characterize the intervention programme. People in the control group will receive usual care. The main outcome measure of the study will be the percentage of patients sustaining a fall during the 6-months follow-up period. An economic evaluation will be performed from a societal perspective and will involve calculating cost-effectiveness and cost utility ratios. To date, no adequately powered studies have investigated the effect of the Information and Communication Technologies (ICT) in a home fall prevention program. We aim the program will be feasible in terms of intensity and characteristics, but particularly in terms of patient and provider compliance. The results of the economic evaluation could provide information about the cost-effectiveness of the intervention and the effects on quality of life. In case of shown effectiveness and cost effectiveness, the program could be implemented into health services settings. ClinicalTrials.gov ( NCT02487589 ).

Implications of arcing due to spacecraft charging on spacecraft EMI margins of immunity

NASA Technical Reports Server (NTRS)

Inouye, G. T.

1981-01-01

Arcing due to spacecraft charging on spacecraft EMI margins of immunity was determined. The configuration of the P78-2 spacecraft of the SCATHA program was analyzed. A brushfire arc discharge model was developed, and a technique for initiating discharges with a spark plug trigger was for data configuration. A set of best estimate arc discharge parameters was defined. The effects of spacecraft potentials in limiting the discharge current blowout component are included. Arc discharge source models were incorporated into a SEMCAP EMI coupling analysis code for the DSP spacecraft. It is shown that with no mission critical circuits will be affected.

[The painful hemiplegic shoulder: effects of exercises program according to Bobath].

PubMed

Gialanella, B; Benvenuti, P; Santoro, R

2004-01-01

To verify whether a shoulder exercises program according to Bobath reduced the shoulder pain in hemiplegic patients. We studied a total of 20 patients with pain shoulder. Ten patients are assigned to group R (submitted to rehabilitation) and ten to group R+E (submitted to rehabilitation and shoulder exercises program according to Bobath). Shoulder exercises program was self-performed by the patients after training in occupational rehabilitation unit. The assessment of patients was performed at admission to hospital, at discharge and three months after discharge. Shoulder pain (VAS), shoulder range of motion, disability (FIM), motor function (Fugl-Meyer scale) and spasticity (Ashworth scale) of paretic arm were evaluated in all patients. VAS was similar in both groups at admission and decreased in group R+E at discharge without reaching significant differences (p=0.253). On the contrary, VAS and Shoulder range of motion improved statistically in group R+E (p=0.0001, p<0.04 respectively) after three months. The others variables measured did not change. This study showed that a shoulder exercises program according to Bobath reduces shoulder pain of patients with hemiplegia if it is performed daily and for a long period of time.

Effect of Home Exercise Program Performance in Patients with Osteoarthritis of the Knee or the Spine on the Visual Analog Scale after Discharge from Physical Therapy

ERIC Educational Resources Information Center

Chen, Hamilton; Onishi, Kentaro

2012-01-01

The aim of our study was to assess the effect of the frequency of home exercise program (HEP) performance on pain [10-point visual analog scale (VAS)] in patients with osteoarthritis of the spine or knee after more than 6 months discharge from physical therapy (PT). We performed a retrospective chart review of 48 adult patients with a clinical…