The HEART Pathway randomized trial: identifying emergency department patients with acute chest pain for early discharge.

PubMed

Mahler, Simon A; Riley, Robert F; Hiestand, Brian C; Russell, Gregory B; Hoekstra, James W; Lefebvre, Cedric W; Nicks, Bret A; Cline, David M; Askew, Kim L; Elliott, Stephanie B; Herrington, David M; Burke, Gregory L; Miller, Chadwick D

2015-03-01

The HEART Pathway is a decision aid designed to identify emergency department patients with acute chest pain for early discharge. No randomized trials have compared the HEART Pathway with usual care. Adult emergency department patients with symptoms related to acute coronary syndrome without ST-elevation on ECG (n=282) were randomized to the HEART Pathway or usual care. In the HEART Pathway arm, emergency department providers used the HEART score, a validated decision aid, and troponin measures at 0 and 3 hours to identify patients for early discharge. Usual care was based on American College of Cardiology/American Heart Association guidelines. The primary outcome, objective cardiac testing (stress testing or angiography), and secondary outcomes, index length of stay, early discharge, and major adverse cardiac events (death, myocardial infarction, or coronary revascularization), were assessed at 30 days by phone interview and record review. Participants had a mean age of 53 years, 16% had previous myocardial infarction, and 6% (95% confidence interval, 3.6%-9.5%) had major adverse cardiac events within 30 days of randomization. Compared with usual care, use of the HEART Pathway decreased objective cardiac testing at 30 days by 12.1% (68.8% versus 56.7%; P=0.048) and length of stay by 12 hours (9.9 versus 21.9 hours; P=0.013) and increased early discharges by 21.3% (39.7% versus 18.4%; P<0.001). No patients identified for early discharge had major adverse cardiac events within 30 days. The HEART Pathway reduces objective cardiac testing during 30 days, shortens length of stay, and increases early discharges. These important efficiency gains occurred without any patients identified for early discharge suffering MACE at 30 days. URL: http://www.clinicaltrials.gov. Unique Identifier: NCT01665521. © 2015 American Heart Association, Inc.

Early trends in N-terminal pro-brain natriuretic peptide values after left ventricular assist device implantation for chronic heart failure.

PubMed

Hasin, Tal; Kushwaha, Sudhir S; Lesnick, Timothy G; Kremers, Walter; Boilson, Barry A; Schirger, John A; Clavell, Alfredo L; Rodeheffer, Richard J; Frantz, Robert P; Edwards, Brooks S; Pereira, Naveen L; Stulak, John M; Joyce, Lyle; Daly, Richard; Park, Soon J; Jaffe, Allan S

2014-10-15

Left ventricular assist devices (LVADs) acutely decrease left ventricular wall stress. Thus, early postoperative levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) should decrease. This study investigated postoperative changes in NT-proBNP levels, the parameters related to changes, and the possible association with complications by performing a retrospective analysis of changes in daily NT-proBNP (pg/ml) levels from admission to discharge both before and after LVAD implantation in a tertiary referral center. For 72 patients implanted with HeartMate II LVADs, baseline NT-proBNP levels were elevated at 3,943 ng/ml (interquartile range 1,956 to 12,964). Preoperative stabilization led to marked decreases in NT-proBNP. Levels peaked 3 days after surgery and subsequently decreased. Patients with complicated postoperative courses had higher early postoperative elevations. By discharge, NT-proBNP decreased markedly but was still 2.83 (1.60 to 5.76) times the age-based upper limit of normal. The 26% reduction in NT-proBNP between admission and discharge was due mostly to the preoperative reductions and not those induced by the LVAD itself. The decrease was not associated with decreases in LV volume. In conclusion, preoperative treatment reduces NT-proBNP values. The magnitude of early postoperative changes is related to the clinical course. Levels at discharge remain markedly elevated and similar to values after preoperative stabilization despite presumptive acute LV unloading. Copyright © 2014 Elsevier Inc. All rights reserved.

Early discharge after total thyroidectomy: a retrospective feasibility study.

PubMed

Tartaglia, F; Giuliani, A; Sorrenti, S; Tromba, L; Carbotta, S; Maturo, A; Carbotta, G; De Anna, L; Merola, R; Livadoti, G; Pelle, F; Ulisse, S

2016-01-01

The continued hospitalization after total thyroidectomy is often due to the onset of hypocalcemic complications more than 24 hours after surgery. So it would be important to predict which patients will not develop the hypocalcemic complication to discharge them early. This was the aim of our study. Our retrospective study was conducted on 327 consecutive thyroidectomized patients, operated on for benign and malignant diseases. We evaluated the values of preoperative serum calcium levels (Cal0) and of the first postoperative day (Cal1) and two new variables were calculated (dCal and dCaln). The same thing was made on a subgroup of 111 patients in whom also parathiroyd hormone (PTH) values were detected. Statistical analysis was performed with the goal of determining if we could establish a safe criterion for discharge at 24 hours after surgery and if there is a correlation between suitability for discharge and diagnosis. As to discharge, the predictive power of the discriminant function applied was significant both on the total of patients and in the subgroup of 111 patients, but it was clinically unacceptable because it would expose us to a 21% to 27% error rate. It is not possible to identify a threshold, below which to consider patients surely dischargeable. The diagnosis does not appear correlated with the suitability for discharge. On the basis of serum calcium and PTH levels in the first postoperative day, it is impossible to predict which patients can be discharged 24 hours after surgery without incurring in hypocalcemic complications.

Hysterectomy - vaginal - discharge

MedlinePlus

Vaginal hysterectomy - discharge; Laparoscopically assisted vaginal hysterectomy - discharge; LAVH - discharge ... you were in the hospital, you had a vaginal hysterectomy. Your surgeon made a cut in your ...

Clinical and economic consequences of early discharge of patients following supratentorial stereotactic brain biopsy.

PubMed

Kaakaji, W; Barnett, G H; Bernhard, D; Warbel, A; Valaitis, K; Stamp, S

2001-06-01

The goal of this study was to determine the clinical and economic consequences of early discharge (< 8 hours) of patients following stereotactic brain biopsy (SBB). The records of all patients who underwent percutaneous SBB at The Cleveland Clinic Foundation, a tertiary care teaching hospital, during 1994 and 1995 (Group A) were retrospectively reviewed to collect data on the nature and timing of perioperative (< 48 hours) clinical and radiological complications. Biopsies were performed using image-guided stereotaxy either with or without a frame. Based on the results, guidelines for early discharge of patients following SBB were implemented. Information on the nature and timing of perioperative complications was also collected prospectively in all patients who underwent percutaneous SBB from January 1996 through July 1998 (Group B). Hospital financial records for patients who underwent SBB in 1997 and 1998 were also reviewed and assessed for net revenue stratified by discharge status: early discharge (< 8 hours), extended outpatient observation (> or = 8 and < 24 hours). and inpatient hospitalization (> or = 24 hours). In Group A, 130 biopsies were performed. There were five serious complications (3.8%), of which four were transient, and there was one death (0.8%). The death and any sustained deficit occurred in patients in whom a clot had been demonstrated on postoperative CT scans. All complications were detected within 6 hours after surgery. Intraoperative bleeding occurred in 12 patients (9.2%), but was associated with only 40% of cases in which hemorrhage appeared on postoperative CT scans. Guidelines for early discharge (< 8 hours) following SBB were developed and stipulated the absence of the following: 1) intraoperative hemorrhage; 2) new postoperative deficit; and 3) clot on a postoperative CT scan. In Group B, 139 biopsies were performed. There were three serious complications (2.2%), one of which was sustained due to a clot that had been demonstrated on

The Australian Defence Force Post‑discharge GP Health Assessment.

PubMed

Reed, Richard L; Masters, Stacey; Roeger, Leigh S

2016-03-01

All former serving members of the Australian Defence Force (ADF) can receive a comprehensive health assessment from their general practitioners (GPs). The aim of this article is to describe the ADF Post-discharge GP Health Assessment and introduce a tool that assists GPs in performing the assessment. The ADF Post-discharge GP Health Assessment is intended to promote the early detection and intervention of potential mental or physical health concerns in the veteran population and facilitate the establishment of ongoing care with a GP.

Robot-Assisted Training Early After Cardiac Surgery.

PubMed

Schoenrath, Felix; Markendorf, Susanne; Brauchlin, Andreas E; Seifert, Burkhardt; Wilhelm, Markus J; Czerny, Martin; Riener, Robert; Falk, Volkmar; Schmied, Christian M

2015-07-01

To assess feasibility and safety of a robot-assisted gait therapy with the Lokomat® system in patients early after open heart surgery. Within days after open heart surgery 10 patients were subjected to postoperative Lokomat® training (Intervention group, IG) whereas 20 patients served as controls undergoing standard postoperative physiotherapy (Control group, CG). All patients underwent six-minute walk test and evaluation of the muscular strength of the lower limbs by measuring quadriceps peak force. The primary safety end-point was freedom from any device-related wound healing disturbance. Patients underwent clinical follow-up after one month. Both training methods resulted in an improvement of walking distance (IG [median, interquartile range, p-value]: +119 m, 70-201 m, p = 0.005; CG: 105 m, 57-152.5m, p < 0.001) and quadriceps peak force (IG left: +5 N, 3.8 7 N, p = 0.005; IG right: +3.5 N, 1.5-8.8 N, p = 0.011; CG left: +5.5 N, 4-9 N, p < 0.001; CG right: +6 N, 4.3-9.8 N, p < 0.001) in all participants. Results with robot-assisted training were comparable to early postoperative standard in hospital training (median changes in walking distance in percent, p = 0.81; median changes in quadriceps peak force in percent, left: p = 0.97, right p = 0.61). No deep sternal wound infection or any adverse event occurred in the robot-assisted training group. Robot-assisted gait therapy with the Lokomat® system is feasible and safe in patients early after median sternotomy. Results with robot-assisted training were comparable to standard in hospital training. An adapted and combined aerobic and resistance training intervention with augmented feedback may result in benefits in walking distance and lower limb muscle strength (ClinicalTrials.gov number, NCT 02146196). © 2015 Wiley Periodicals, Inc.

"Dad - a practical guy in the shadow": Fathers' experiences of their paternal role as a father during early discharge after birth and readmission of their newborns.

PubMed

Feenstra, Maria Monberg; Nilsson, Ingrid; Danbjørg, Dorthe Boe

2018-03-01

The aim is to explore how new fathers experience early discharge after birth and readmission of their newborn in relation to their role and involvement as a father. Fathers of today are active participants during pregnancy, birth and in the care of the newborn. Still studies demonstrate that health care professionals are unsuccessful at involving fathers in ante- and postnatal care. How fathers experience their paternal role in the early postnatal period may affect the well-being of the new family. A qualitative study inspired by the hermeneutic approach. Data was collected through telephone interviews. The study was conducted in the Region of Southern Denmark in a University Hospital setting. Convenience sampling was applied. Eight fathers were included from November 2015 till February 2016 and six were interviewed. The data analysis revealed three categories: Early discharge - ups and downs, Readmission -waiting but being in good hands, and Practical guy in the shadow. Our study points at fathers being comfortable with being discharged early, but experienced insecurity when at home. The fathers experienced to be categorized by health care professionals as the practical guy, who had to assist the mother. Yet fathers saw themselves as equal to the mothers. Fathers also saw themselves in the shadow of the mother and showed greater considerations for the mother's feelings than their own. Fathers can be insecure in their paternal role when being met as just the practical guy. Copyright © 2017 Elsevier B.V. All rights reserved.

The effect of early postnatal discharge from hospital for women and infants: a systematic review protocol.

PubMed

Jones, Eleanor; Taylor, Beck; MacArthur, Christine; Pritchett, Ruth; Cummins, Carole

2016-02-08

The length of postnatal hospital stay has declined over the last 40 years. There is little evidence to support a policy of early discharge following birth, and there is some concern about whether early discharge of mothers and babies is safe. The Cochrane review on the effects of early discharge from hospital only included randomised controlled trials (RCTs) which are problematic in this area, and a systematic review including other study designs is required. The aim of this broader systematic review is to determine possible effects of a policy of early postnatal discharge on important maternal and infant health-related outcomes. A systematic search of published literature will be conducted for randomised controlled trials, non-randomised controlled trials (NRCTs), controlled before-after studies (CBA), and interrupted time series studies (ITS) that report on the effect of a policy of early postnatal discharge from hospital. Databases including Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and Science Citation Index will be searched for relevant material. Reference lists of articles will also be searched in addition to searches to identify grey literature. Screening of identified articles and data extraction will be conducted in duplicate and independently. Methodological quality of the included studies will be assessed using the Effective Practice and Organisation of Care (EPOC) criteria for risk of bias tool. Discrepancies will be resolved by consensus or by consulting a third author. Meta-analysis using a random effects model will be used to combine data. Where significant heterogeneity is present, data will be combined in a narrative synthesis. The findings will be reported according to the preferred reporting items for systematic reviews (PRISMA) statement. Information on the effects of early postnatal discharge from hospital will be important for policy makers and clinicians providing maternity care. This review will also identify any gaps in the current

Home care after early discharge: impact on healthy mothers and newborns.

PubMed

Askelsdottir, Björk; Lam-de Jonge, Willemien; Edman, Gunnar; Wiklund, Ingela

2013-08-01

to compare early discharge with home care versus standard postpartum care in terms of mothers' sense of security; contact between mother, newborn and partner; emotions towards breast feeding; and breast-feeding duration at one and three months after birth. retrospective case-control study. a labour ward unit in Stockholm, Sweden handling both normal and complicated births. 96 women with single, uncomplicated pregnancies and births, and their healthy newborns. early discharge at 12-24 hours post partum with 2-3 home visits during the first week after birth. The intervention group consisted of women who had a normal vaginal birth (n=45). This group was compared with healthy controls who received standard postnatal care at the hospital (n=51). mothers' sense of security was measured using the Parents' Postnatal Sense of Security Scale. Contact between mother, child and father, and emotions towards breast feeding were measured using the Alliance Scale, and breast-feeding rates at one and three months post partum were recorded. women in the intervention group reported a greater sense of security in the first postnatal week but had more negative emotions towards breast feeding compared with the control group. At three months post partum, 74% of the newborns in the intervention group were fully breast fed versus 93% in the control group (p=0.021). Contact between the mother, newborn and partner did not differ between the groups. early discharge with home care is a feasible option for healthy women and newborns, but randomised controlled studies are needed to investigate the effects of home care on breast-feeding rates. Copyright © 2012 Elsevier Ltd. All rights reserved.

A feasibility pilot using a mobile personal health assistant (PHA) app to assist stroke patient and caregiver communication after hospital discharge.

PubMed

Siegel, Jason; Edwards, Emily; Mooney, Lesia; Smith, Christina; Peel, J Brent; Dole, Adam; Maler, Paul; Freeman, W David

2016-01-01

Recent advancements have lowered national acute stroke mortality, yet posthospital care and readmission rates remain challenges. A personal health assistant (PHA) may help manage the spectrum of posthospital care. We hypothesized that a PHA application (app) would be associated with high poststroke patient care satisfaction and might prevent hospital readmission. This is a case series of acute stroke patients admitted to a single, tertiary care, comprehensive stroke center (Mayo Clinic, Jacksonville, Florida) who were offered a personal health assistance through a smart phone app. Patients were screened based on having a cerebrovascular event and the ability to use a necessary device. All patients received the standard poststroke discharge protocol, the PHA app, and the 30-day Likert scale survey. We screened 21 patients and enrolled 3 (14%) before premature financial closure. Two of the 3 patients rated the app highly, and the third patient had not started using it. Of the ineligible patients, 4 had no device, 3 declined enrollment, and 2 were not able to use the device. One of the 2 patients who used the PHA app was readmitted for new stroke symptoms. Both patients who used the app were very satisfied with the PHA and their posthospital care coordination. This study had an enrollment rate of about 14% due to various factors, including limited access or utilization of necessary technology. Though limited by final patient sample size and early termination from funding, this study provides useful information about developing future mobile health apps for acute stroke patients.

Health problems related to early discharge of Turkish women.

PubMed

Gözüm, Sebahat; Kiliç, Dilek

2005-12-01

to determine women's problems when discharged early from hospital after normal vaginal birth among a simple convenience sample of mothers in one part of Turkey. a descriptive interview study. primary health-care unit in Erzurum, Turkey. 112 mothers who came to the primary health-care unit for vaccination of their 2-month old babies between May and June 2000. Data were collected by structured face-to-face interviews. A symptom checklist was used to determine health problems. length of hospital stay after delivery was a mean of 7.1+/-7.0 hrs, and 66.1% (n=74) of mothers did not receive appropriate education about potential postpartum health problems. The findings indicated that the morbidity rate of mothers in the postpartum period was high. Among the most prevalent problems experienced by mothers were fatigue (86.6%; n=97), insomnia (80.4%; n=90), breast problems [engorged breast, tenderness and pain] 71.4%; n=80) and constipation 61.7%; n=69). Vaginal infection was reported by 16 mothers (14.3%; n=16). The prevalence of the use of medical services resulting from postnatal health problems in the postpartum period was 42.0% (n=47). About half of the mothers (51.8%; n=58) were not visited by midwives during the first postpartum week after discharge from hospital because both the maternity hospital and mother had not reported any health problems to the midwife. RECOMMENDATIONS FOR PRACTICE: mothers can experience many problems in the postpartum period. It is not possible to predict which mother will experience risks, such as an infection or mastitis. Therefore, women discharged from hospital in the first 24 hrs after birth should be educated about the problems that may arise during the postpartum period. They should also be given professional care and help in their own home by midwives working in the primary-care unit. Mothers should be told to notify their midwives about delivery and discharge in order to receive early follow-up in their homes. We suggest promoting

Early Discharge in Low-Risk Patients Hospitalized for Acute Coronary Syndromes: Feasibility, Safety and Reasons for Prolonged Length of Stay.

PubMed

Laurencet, Marie-Eva; Girardin, François; Rigamonti, Fabio; Bevand, Anne; Meyer, Philippe; Carballo, David; Roffi, Marco; Noble, Stéphane; Mach, François; Gencer, Baris

2016-01-01

Length of hospital stay (LHS) is an indicator of clinical effectiveness. Early hospital discharge (≤72 hours) is recommended in patients with acute coronary syndromes (ACS) at low risk of complications, but reasons for prolonged LHS poorly reported. We collected data of ACS patients hospitalized at the Geneva University Hospitals from 1st July 2013 to 30th June 2015 and used the Zwolle index score to identify patients at low risk (≤ 3 points). We assessed the proportion of eligible patients who were successfully discharged within 72 hours and the reasons for prolonged LHS. Outcomes were defined as adherence to recommended therapies, major adverse events at 30 days and patients' satisfaction using a Likert-scale patient-reported questionnaire. Among 370 patients with ACS, 255 (68.9%) were at low-risk of complications but only 128 (50.2%)were eligible for early discharge, because of other clinical reasons for prolonged LHS (e.g. staged coronary revascularization, cardiac monitoring) in 127 patients (49.8%). Of the latter, only 45 (35.2%) benefitted from an early discharge. Reasons for delay in discharge in the remaining 83 patients (51.2%) were mainly due to delays in additional investigations, titration of medical therapy, admission or discharge during weekends. In the early discharge group, at 30 days, only one patient (2.2%) had an adverse event (minor bleeding), 97% of patients were satisfied by the medical care. Early discharge was successfully achieved in one third of eligible ACS patients at low risk of complications and appeared sufficiently safe while being overall appreciated by the patients.

Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds.

PubMed

Collins, Carmel T; Makrides, Maria; McPhee, Andrew J

2015-07-08

Early discharge of stable preterm infants still requiring gavage feeds offers the benefits of uniting families sooner and reducing healthcare and family costs compared with discharge home when on full sucking feeds. Potential disadvantages of early discharge include increased care burden for the family and risk of complications related to gavage feeding. To determine the effects of a policy of early discharge of stable preterm infants with home support of gavage feeding compared with a policy of discharge of such infants when they have reached full sucking feeds.We planned subgroup analyses to determine whether safety and efficacy outcomes are altered by the type of support received (outpatient visits vs home support) or by the maturity of the infants discharged (gestational age ≤ 28 weeks at birth or birth weight ≤ 1000 grams). We used the standard search strategy of the Cochrane Neonatal Review Group, together with searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to March 2015), EMBASE (1980 to March 2015) and MEDLINE (1950 to March 2015). We found no new trials. We included all randomised and quasi-randomised trials among infants born at < 37 weeks and requiring no intravenous nutrition at the point of discharge. Trials were required to compare early discharge home with gavage feeds and healthcare support versus later discharge home when full sucking feeds were attained. Two review authors independently assessed trial quality and extracted data. We conducted study authors for additional information. We performed data analysis in accordance with the standards of the Cochrane Neonatal Review Group. We included in the review data from one quasi-randomised trial with 88 infants from 75 families. Infants in the early discharge programme with home gavage feeding had a mean hospital stay that was 9.3 days shorter (mean difference (MD) -9.3, 95

Prediction of rhythmic and periodic EEG patterns and seizures on continuous EEG with early epileptiform discharges.

PubMed

Koren, J; Herta, J; Draschtak, S; Pötzl, G; Pirker, S; Fürbass, F; Hartmann, M; Kluge, T; Baumgartner, C

2015-08-01

Continuous EEG (cEEG) is necessary to document nonconvulsive seizures (NCS), nonconvulsive status epilepticus (NCSE), as well as rhythmic and periodic EEG patterns of 'ictal-interictal uncertainty' (RPPIIU) including periodic discharges, rhythmic delta activity, and spike-and-wave complexes in neurological intensive care patients. However, cEEG is associated with significant recording and analysis efforts. Therefore, predictors from short-term routine EEG with a reasonably high yield are urgently needed in order to select patients for evaluation with cEEG. The aim of this study was to assess the prognostic significance of early epileptiform discharges (i.e., within the first 30 min of EEG recording) on the following: (1) incidence of ictal EEG patterns and RPPIIU on subsequent cEEG, (2) occurrence of acute convulsive seizures during the ICU stay, and (3) functional outcome after 6 months of follow-up. We conducted a separate analysis of the first 30 min and the remaining segments of prospective cEEG recordings according to the ACNS Standardized Critical Care EEG Terminology as well as NCS criteria and review of clinical data of 32 neurological critical care patients. In 17 patients with epileptiform discharges within the first 30 min of EEG (group 1), electrographic seizures were observed in 23.5% (n = 4), rhythmic or periodic EEG patterns of 'ictal-interictal uncertainty' in 64.7% (n = 11), and neither electrographic seizures nor RPPIIU in 11.8% (n = 2). In 15 patients with no epileptiform discharges in the first 30 min of EEG (group 2), no electrographic seizures were recorded on subsequent cEEG, RPPIIU were seen in 26.7% (n = 4), and neither electrographic seizures nor RPPIIU in 73.3% (n = 11). The incidence of EEG patterns on cEEG was significantly different between the two groups (p = 0.008). Patients with early epileptiform discharges developed acute seizures more frequently than patients without early epileptiform discharges (p = 0.009). Finally, functional

Robotic-assisted fertility-sparing surgery for early ovarian cancer.

PubMed

Finger, Tamara Natasha; Nezhat, Farr Reza

2014-01-01

To show the feasibility and safety of robotic-assisted laparoscopic fertility-sparing surgery for earlystage ovarian cancer in women of reproductive age. The first patient was a 29-year-old para 0 woman with well-differentiated endometrioid adenocarcinoma of the ovary and complex endometrial hyperplasia with marked atypia. The second patient was a 31-year-old para 0 woman with an immature grade 1 teratoma. Both patients underwent robotic-assisted laparoscopic surgical staging. In the first patient, there were no intra- or postoperative complications. Operative time was 5 hours 43 minutes and estimated blood loss was 100 mL. She was discharged home on postoperative day 1. She received 3 cycles of carboplatin and paclitaxel, as well as medroxyprogesterone acetate for the duration of chemotherapy. She conceived twice spontaneously since surgery and had two successful deliveries. She currently has no evidence of disease. In the second patient, there were no intra- or postoperative complications. Operative time was 2 hours 52 minutes and estimated blood loss was 200 mL. She was discharged home on postoperative day 1. She declined adjuvant chemotherapy with bleomycin, etoposide, and cisplatin. She conceived spontaneously 4 months later and had a normal vaginal delivery. She currently has no evidence of disease. Because fertility-sparing surgery is now accepted as a viable option in young women with earlystage ovarian cancer, less invasive techniques are being used. With the advent of robotic-assisted surgery and its advantages over conventional laparoscopy, we show that it is a safe and feasible approach in select patients. This is the first reported series on robotic fertility-sparing surgery, but more research is needed.

Interference of postoperative pain on women's daily life after early discharge from cardiac surgery.

PubMed

Leegaard, Marit; Rustøen, Tone; Fagermoen, May Solveig

2010-06-01

Women report more postoperative pain and problems performing domestic activities than men in the first month of recovery after cardiac surgery. The purpose of this article is to describe how women rate and describe pain interference with daily life after early discharge from cardiac surgery. A qualitative study was conducted in 2004-2005 with ten women recruited from a large Norwegian university hospital before discharge from their first elective cardiac surgery. Various aspects of the women's postoperative experiences were collected with qualitative interviews in the women's homes 8-14 days after discharge: a self-developed pain diary measuring pain intensity, types and amount of pain medication taken every day after returning home from hospital; and the Brief Pain Inventory-Short Form immediately before the interview. Qualitative content analysis was used to identify recurring themes from the interviews. Data from the questionnaires provided more nuances to the experiences of pain, pain management, and interference of postoperative pain. Postoperative pain interfered most with sleep, general activity, and the ability to perform housework during the first 2 weeks after discharge. Despite being advised at the hospital to take pain medication regularly, few women consumed the maximum amount of analgesics. Early hospital discharge after open cardiac surgery implies increased patient participation in pain management. Women undergoing this surgery need more information in hospital on why postoperative pain management beyond simple pain relief is important. (c) 2010 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Early discharge of patients with pulmonary embolism in daily clinical practice: A prospective observational study comparing clinical gestalt and clinical rules.

PubMed

Vanni, Simone; Becattini, Cecilia; Nazerian, Peiman; Bova, Carlo; Stefanone, Valerio Teodoro; Cimini, Ludovica Anna; Viviani, Gabriele; Caviglioli, Cosimo; Sanna, Michela; Pepe, Giuseppe; Grifoni, Stefano

2018-05-08

To estimate the efficiency and safety of clinicians' gestalt in the identification of patients with pulmonary embolism (PE) candidates for early discharge and to compare the efficiency and safety of clinical gestalt with that of the Pulmonary Embolism Severity Index (PESI), the simplified PESI (sPESI) and the Hestia criteria (HC). Consecutive adult patients presenting to the emergency department of four Italian hospitals with confirmed diagnosis of PE were included. Data for PESI, sPESI and HC assessment were prospectively collected. Patients were managed according to the clinical gestalt of the attending physician, independent of the results of PESI, sPESI and HC. Efficiency was defined as the prevalence of candidates to early discharge. The primary safety measure was the incidence of a composite of venous thromboembolic recurrence, major haemorrhage or all-cause mortality within 30 days. Out of 547 included patients, 178 (32.5%) were judged to be at low risk and discharged within 48 h from presentation. HC identified a higher proportion (41.7%) whereas both PESI (24.1%) and sPESI (18.3%) identified a lower proportion of candidates for early discharge when compared to clinical gestalt (P < 0.01 for all). The incidence of the safety outcome was 2.8% in early-discharged patients according to clinical gestalt and 2.3%, 3.0% and 2.6% in candidates to early discharge according to PESI, sPESI and HC, without differences between strategies. In our cohort, clinical gestalt identified one-third of PE patients for early discharge. Among different strategies HC showed the highest efficiency sharing similar safety with the other strategies. Copyright © 2018 Elsevier Ltd. All rights reserved.

The National Early Childhood Technical Assistance Center Model for Long-Term Systems Change

ERIC Educational Resources Information Center

Kahn, Lynne; Hurth, Joicey; Kasprzak, Christina M.; Diefendorf, Martha J.; Goode, Susan E.; Ringwalt, Sharon S.

2009-01-01

The National Early Childhood Technical Assistance Center was charged by the U.S. Department of Education's Office of Special Education Programs from October 2001 through September 2006 to develop, implement, and evaluate an approach to technical assistance (TA) that would result in sustainable systems change in state early intervention and…

Admissions for early parenting difficulties among women with infants conceived by assisted reproductive technologies: a prospective cohort study.

PubMed

Fisher, Jane R W; Rowe, Heather; Hammarberg, Karin

2012-06-01

To describe rate of and risks for residential early parenting service (REPS) admissions in women with infants conceived with assisted reproductive technology (ART). A prospective study of women who conceived with ART. Self-report telephone interview and questionnaire data were collected in two pregnancy and three postpartum waves. Melbourne IVF and Royal Women's Hospital Reproductive Services, Victoria, Australia. A consecutive cohort of women with ART pregnancies. None. REPS admission up to 18 months postpartum. Of 239 eligible women. 183 (77%) were recruited, six experienced pregnancy loss, and 153/177 (86%) were retained. In total, 17% (26/153) of participants were admitted to a REPS, 3.37 times more than the population admission rate of 5.05%. Admission risk was increased by primiparity, inadequate breastfeeding advice, low caregiving confidence when discharged from maternity hospital, lower early postpartum mood, unsettled infant behavior, and insufficient help from others. Compared with spontaneous conception, women who conceived with ART are at elevated risk of early parenting difficulties. Early interventions to address breastfeeding difficulties, management of unsettled infant behavior, social isolation, and postpartum anxiety are indicated. Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Early primary care follow-up after ED and hospital discharge - does it affect readmissions?

PubMed

Sinha, Sanjai; Seirup, Joanna; Carmel, Amanda

2017-04-01

After hospitalization, timely discharge follow-up has been linked to reduced readmissions in the heart failure population, but data from general inpatients has been mixed. The objective of this study was to determine if there was an association between completed follow-up appointments within 14 days of hospital discharge and 30-day readmission amongst primary care patients at an urban academic medical center. Index discharges included both inpatient and emergency room settings. A secondary objective was to identify patient factors associated with completed follow-up appointments within 14 days. We conducted a retrospective review of primary care patients at an urban academic medical center who were discharged from either the emergency department (ED) or inpatient services at the Weill Cornell Medical Center/New York Presbyterian Hospital from 1 January 2014-31 December 2014. Cox proportional hazard models were used to identify the relationship between follow-up in primary care within 14 days and readmission within 30 days. Logistic regression was used to evaluate the association of patient factors with 14-day follow-up. Among 9,662 inpatient and ED discharges, multivariable analysis (adjusting for age, gender, race/ethnicity, insurance, number of diagnoses on problem list, length of stay, and discharge service) showed that follow-up with primary care within 14 days was not associated with a lower hazard of readmission within 30 days (HR = 0.78; 95% CI 0.56-1.09). A higher number of diagnoses on the problem list was associated with greater odds of follow-up for both inpatient and emergency department discharges (inpatient: HR = 1.03, 95% CI 1.02-1.04; ED: HR = 1.02, 95% CI 1.00-1.04). For inpatient discharges, each additional day in length of stay was associated with 3% lower odds of follow-up (HR = 0.97, 95% CI 0.96-0.99). Early follow-up within 14 days after discharge from general inpatient services was associated with a trend toward lower hazard of

Studies on laser-assisted Penning ionization by the optogalvanic effect in Ne/Eu hollow cathode discharge.

PubMed

Saini, V K; Kumar, P; Dixit, S K; Nakhe, S V

2015-02-01

Laser-assisted Penning ionization (LAPI) is detected in a Ne/Eu hollow cathode (HC) discharge lamp using the pulsed optogalvanic (OG) method. In the Ne/Eu discharge, doubly ionized europium excited energy levels Eu[4f(7)(P(7/2,5/2)6)] lie within the thermal limit (∼kT) from the laser-excited neon's energy level [2p(5)(P3/202)3p or 2p(8) (in Paschen notation)] lying at 149,848  cm(-1). Therefore, Penning ionization (PI) of europium atoms likely to occur into its highly excited ionic states is investigated. To probe the PI of europium, the temporal profiles of its counterpart neon OG signal are studied as a function of discharge current for the transitions (1s(4)→2p(8)) and (1s(2)→2p(2)), corresponding to 650.65 and 659.89 nm wavelengths, respectively. It is observed that PI of europium alters the overall discharge characteristics significantly and, hence, modifies the temporal profile of the OG signals accordingly. The quasi-resonant ionizing energy transfer collisions between laser-excited Ne 2p(8) atoms and electronically excited europium P(9/2)10 atoms are used to explain the LAPI mechanism. Such LAPI studies carried out in HC discharge could be useful for the discharge of a metal-vapor laser with appropriate Penning mixtures.

Symptomatic hypoglycemia causing brain injury in a term breast fed newborn following early discharge.

PubMed

Marwah, Ashish; Gathwala, Geeta

2011-12-01

Cerebral metabolism and functioning depends upon an adequate blood glucose supply which provides for majority of the brain's energy requirement. Studies from the past have shown that neonatal hypoglycemia is associated with acute and long term neurological sequelae. Early discharge without adequately established breast feeding may lead to feeding problems, post discharge hypoglycemia and its associated neurological complications. The authors describe one such case of an exclusively breast fed term newborn who presented on day 3 with symptomatic hypoglycemia and associated neurological injury.

Interaction between pulsed discharge and radio frequency discharge burst at atmospheric pressure

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

Zhang, Jie; College of Science, Donghua University, Shanghai 201620; Guo, Ying

The atmospheric pressure glow discharges (APGD) with dual excitations in terms of pulsed voltage and pulse-modulation radio frequency (rf) power are studied experimentally between two parallel plates electrodes. Pulse-modulation applied in rf APGD temporally separates the discharge into repetitive discharge bursts, between which the high voltage pulses are introduced to ignite sub-microsecond pulsed discharge. The discharge characteristics and spatio-temporal evolution are investigated by means of current voltage characteristics and time resolved imaging, which suggests that the introduced pulsed discharge assists the ignition of rf discharge burst and reduces the maintain voltage of rf discharge burst. Furtherly, the time instant ofmore » pulsed discharge between rf discharge bursts is manipulated to study the ignition dynamics of rf discharge burst.« less

Robot-assisted laparoscopic radical prostatectomy with early retrograde release of the neurovascular bundle and endopelvic fascia sparing

PubMed Central

de Albuquerque, George Augusto Monteiro Lins; Guglielmetti, Giuliano Betoni; Cordeiro, Maurício Dener; Nahas, William Carlos; Coelho, Rafael Ferreira

2017-01-01

ABSTRACT Introduction Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP. Materials and Methods A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy. Results The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent. Conclusion This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves. PMID:27802002

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.

Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care

PubMed Central

Richards, Suzanne H; Coast, Joanna; Gunnell, David J; Peters, Tim J; Pounsford, John; Darlow, Mary-Anne

1998-01-01

Objective: To compare effectiveness and acceptability of early discharge to a hospital at home scheme with that of routine discharge from acute hospital. Design: Pragmatic randomised controlled trial. Setting: Acute hospital wards and community in north of Bristol, with a catchment population of about 224 000 people. Subjects: 241 hospitalised but medically stable elderly patients who fulfilled criteria for early discharge to hospital at home scheme and who consented to participate. Interventions: Patients’ received hospital at home care or routine hospital care. Main outcome measures: Patients’ quality of life, satisfaction, and physical functioning assessed at 4 weeks and 3 months after randomisation to treatment; length of stay in hospital and in hospital at home scheme after randomisation; mortality at 3 months. Results: There were no significant differences in patient mortality, quality of life, and physical functioning between the two arms of the trial at 4 weeks or 3 months. Only one of 11 measures of patient satisfaction was significantly different: hospital at home patients perceived higher levels of involvement in decisions. Length of stay for those receiving routine hospital care was 62% (95% confidence interval 51% to 75%) of length of stay in hospital at home scheme. Conclusions: The early discharge hospital at home scheme was similar to routine hospital discharge in terms of effectiveness and acceptability. Increased length of stay associated with the scheme must be interpreted with caution because of different organisational characteristics of the services. Key messages Pressure on hospital beds, the increasing age of the population, and high costs associated with acute hospital care have fuelled the search for alternatives to inpatient hospital care There were no significant differences between early discharge to hospital at home scheme and routine hospital care in terms of patient quality of life, physical functioning, and most measures of

Development of an assisting detection system for early infarct diagnosis

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

Sim, K. S.; Nia, M. E.; Ee, C. S.

2015-04-24

In this paper, a detection assisting system for early infarct detection is developed. This new developed method is used to assist the medical practitioners to diagnose infarct from computed tomography images of brain. Using this assisting system, the infarct could be diagnosed at earlier stages. The non-contrast computed tomography (NCCT) brain images are the data set used for this system. Detection module extracts the pixel data from NCCT brain images, and produces the colourized version of images. The proposed method showed great potential in detecting infarct, and helps medical practitioners to make earlier and better diagnoses.

Direct current dielectric barrier assistant discharge to get homogeneous plasma in capacitive coupled discharge

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

Du, Yinchang, E-mail: ycdu@mail.ustc.edu.cn; Max-Planck Institute for Extraterrestrial Physics, D-85748 Garching; Li, Yangfang

In this paper, we propose a method to get more homogeneous plasma in the geometrically asymmetric capacitive coupled plasma (CCP) discharge. The dielectric barrier discharge (DBD) is used for the auxiliary discharge system to improve the homogeneity of the geometrically asymmetric CCP discharge. The single Langmuir probe measurement shows that the DBD can increase the electron density in the low density volume, where the DBD electrodes are mounted, when the pressure is higher than 5 Pa. By this manner, we are able to improve the homogeneity of the plasma production and increase the overall density in the target volume. At last,more » the finite element simulation results show that the DC bias, applied to the DBD electrodes, can increase the homogeneity of the electron density in the CCP discharge. The simulation results show a good agreement with the experiment results.« less

Do Early Intervention Programmes Improve Cognitive and Motor Outcomes for Preterm Infants after Discharge? A Systematic Review

ERIC Educational Resources Information Center

Orton, Jane; Spittle, Alicia; Doyle, Lex; Anderson, Peter; Boyd, Roslyn

2009-01-01

Aim: The aim of this study was to review the effects of early developmental intervention after discharge from hospital on motor and cognitive development in preterm infants. Method: Randomized controlled trials (RCTs) or quasi-RCTs of early developmental intervention programmes for preterm infants in which motor or cognitive outcomes were reported…

Patients' expectations of coming home with Very Early Supported Discharge and home rehabilitation after stroke - an interview study.

PubMed

Nordin, Åsa; Sunnerhagen, Katharina S; Axelsson, Åsa B

2015-11-16

An Early Supported Discharge (ESD) and rehabilitation from a coordinated team in the home environment is recommended in several high-income countries for patients with mild to moderate symptoms after stroke. Returning home from the hospital takes place very early in Sweden today (12 days post stroke), thus the term Very Early Supported Discharge (VESD) is used in the current study. The aim of this study was to describe patients' expectations of coming home very early after stroke with support and rehabilitations at home. This is an interview study nested within a randomized controlled trial; Gothenburg Very Early Supported Discharge (GOTVED), comparing VESD containing a home rehabilitation intervention from a coordinated team to conventional care after stroke. Ten participants (median age 69) with mild to moderate stroke symptoms (NHISS 0 to 8 points) were recruited from the intervention group in GOTVED. Interviews were conducted 0-5 days before discharge and the material was analyzed with qualitative content analysis. Four main categories containing 11 subcategories were found. The VESD team was expected to provide "Support towards independency", by helping the participants to manage and feel safe at home as well as to regain earlier abilities. The very early discharge gave rise to expectations of coming home to "A new and unknown situation", causing worries not to manage at home and to leave the safe environment at the ward. A fear to suffer a recurrent stroke when being out of reach of immediate professional help was also pronounced. In contrast to these feelings of insecurity and fear, "Returning to one's own setting" described the participants longing home, where they would become autonomous and capable people again. They expected this to facilitate recovery and rehabilitation. "A new everyday life" waited for the participants at home and this was expected to be challenging. Different strategies to deal with these challenges were described. The participants

Reducing Readmissions among Heart Failure Patients Discharged to Home Health Care: Effectiveness of Early and Intensive Nursing Services and Early Physician Follow-Up.

PubMed

Murtaugh, Christopher M; Deb, Partha; Zhu, Carolyn; Peng, Timothy R; Barrón, Yolanda; Shah, Shivani; Moore, Stanley M; Bowles, Kathryn H; Kalman, Jill; Feldman, Penny H; Siu, Albert L

2017-08-01

To compare the effectiveness of two "treatments"-early, intensive home health nursing and physician follow-up within a week-versus less intense and later postacute care in reducing readmissions among heart failure (HF) patients discharged to home health care. National Medicare administrative, claims, and patient assessment data. Patients with a full week of potential exposure to the treatments were followed for 30 days to determine exposure status, 30-day all-cause hospital readmission, other health care use, and mortality. An extension of instrumental variables methods for nonlinear statistical models corrects for nonrandom selection of patients into treatment categories. Our instruments are the index hospital's rate of early aftercare for non-HF patients and hospital discharge day of the week. All hospitalizations for a HF principal diagnosis with discharge to home health care between July 2009 and June 2010 were identified from source files. Neither treatment by itself has a statistically significant effect on hospital readmission. In combination, however, they reduce the probability of readmission by roughly 8 percentage points (p < .001; confidence interval = -12.3, -4.1). Results are robust to changes in implementation of the nonlinear IV estimator, sample, outcome measure, and length of follow-up. Our results call for closer coordination between home health and medical providers in the clinical management of HF patients immediately after hospital discharge. © Health Research and Educational Trust.

[Early implementation of home care and 30 day readmissions in >65 years Veneto region patients discharged for heart failure and with disability].

PubMed

Gennaro, Nicola; Maggi, Stefania; Pellizzari, Michele; Carlucci, Francesco; Pilotto, Alberto; Saugo, Mario

2014-01-01

Early implementation of home care and 30 day readmissions in >65 years Veneto region patients discharged for heart failure and with disability. The effectiveness of Home care (HC) on preventing rehospitalizations in patients discharged for heart failure (HF) are uncertain. The aim of the study was to measure the impact of HC on early rehospitalizations of patients discharged for HF and with disabilities. Cohort retrospective study on >65 years patients, discharged at home and with a Barthel index <50. Variables considered were: previous hospitalizations for ischaemic cardiopathy ad/or chronic obstructive pulmonary disease, number of hospital admissions in the previous year, length of index hospitalization; outcomes considered were: hospital readmissions and days of hospitalizations 30 days from hospital discharge in patients with or without a home care visit within two days from hospital discharge. Of the 5.094 patients (60%>85 years), 14.8% received a HC visit within 2 days from discharge (43.7% from a nurse); 18.3% of patients (933) were readmitted within one month. In multivariate analyses an HC access within 2 days did not reduce the risk for readmission (although with better results in younger males but not in older women). An early HC visit reduced the days of hospital stay in males of all ages (65-74 years IRR 0.53 CI 95% 0.37-0.75; 75-84 years IRR 0.71 CI95% 0.60-0.83; 85+ years IRR 0.79 CI 95% 0.67-0.93) while in >75 years females there was a significant increase. An early HC visit (within two days from discharge) may have positive effects on males, but not in older women, possibly for the coexistence of socio-economic factors.

40 CFR 35.2112 - Marine discharge waiver applicants.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Marine discharge waiver applicants. 35.2112 Section 35.2112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2112 Marine discharge...

40 CFR 35.2112 - Marine discharge waiver applicants.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Marine discharge waiver applicants. 35.2112 Section 35.2112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2112 Marine discharge...

40 CFR 35.2112 - Marine discharge waiver applicants.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Marine discharge waiver applicants. 35.2112 Section 35.2112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2112 Marine discharge...

40 CFR 35.2112 - Marine discharge waiver applicants.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Marine discharge waiver applicants. 35.2112 Section 35.2112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2112 Marine discharge...

40 CFR 35.2112 - Marine discharge waiver applicants.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Marine discharge waiver applicants. 35.2112 Section 35.2112 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works § 35.2112 Marine discharge...

Length of stay for childbirth in Trentino (North-East of Italy): the impact of maternal characteristics and organizational features of the maternity unit on the probability of early discharge of healthy, term infants.

PubMed

Pertile, Riccardo; Pavanello, Lucia; Soffiati, Massimo; Manica, Laura; Piffer, Silvano

2018-01-01

Early discharge (ED) of healthy term infants has become a common practice due to current social and economic needs. The primary objective of the present study was to evaluate trends in early discharge of healthy term neonates (≥ 37 gestational weeks) by delivery method (cesarean and vaginal) in maternity units in the Province of Trento. The secondary objective was to identify the socio-demographic characteristics (including the area of residence and distance from the designated hospital) and clinical characteristics of mothers whose infants were discharged early. This retrospective study reviewed records of live births from 2006 to 2016, for a total of 45, 314 healthy term infants. The trend for ED grew significantly during the period 2006-2016, for both cesarean and vaginal deliveries. The multiple logistic regression analysis shows how the determinants of ED are maternal age, birth order, citizenship of mother, maternal smoking, maternal employment status, and the number of births at the hospital on the day of birth. The post-partum length of stay should be adjusted based on the characteristics and needs of the mother-infant dyad, identifying the criteria for safe discharge. In Trento, various procedures and programs are becoming more uniform today with the intention to provide family assistance service. What is Known: • Admission for childbirth is one of the primary causes of hospitalization in industrialized countries. • The length of stay for childbirth has been steadily declining in recent decades, with the aim of reducing costs while also demedicalizing pregnancy. What is New: • A higher rate of early discharge (ED) was recorded for neonates of women having foreign citizenship, < 30 years, pluriparous, smoked during pregnancy, housewife, and, if emplyed, entrepreneurs, self-employed professionals or managers. • ED was more common when the new mother gave birth on a day in which there was a higher number of births at the hospital, indicating

Microwave Discharges

NASA Astrophysics Data System (ADS)

Marec, J.; Bloyet, E.; Chaker, M.; Leprince, P.; Nghiem, P.

Microwave discharges first appeared as unwanted and disturbing effects. However, beginning about the end of World War II, Professors Allis and Brown at the Massachusetts Institute of Technology started to investigate the physics of these discharges. During the next few years, many experimental and theoretical studies were undertaken. However, in the early 60's and for about 15 years, there were few studies of such discharges because of the theoretical difficulties encountered. Effectively, the impossibility of modeling microwave discharges prevented a good understanding of their behavior, and their future use did not appear promising. Recently there has been new interest in these discharges. The plasmas produced by microwave discharges find applications in areas such as: 1) spectroscopy (because of their low contamination), and 2) plasma chemistry. Another advantage of these discharges as compared to d.c. discharges is their ease of operation.

Effect of bed exercises and gum chewing on abdominal sounds, flatulence and early discharge in the early period after caesarean section.

PubMed

Çevik, Semra Akköz; Başer, Mürüvvet

2016-05-01

The purpose of this study was to determine the effects of bed exercises and gum chewing on abdominal sounds, flatulence and early discharge on women who have given birth at the Cengiz Gökçek Gynecology and Obstetrics Hospital surgery services in Gaziantep city centre. Caesarean operation is the most significant surgical intervention that affects central nervous system and decelerates bowel movements in the postoperative period. Conducted studies show that practices such as gum chewing ensure that bowel functions start in a short time through early feeding and mobilisation and shorten the duration of hospital stay. A randomised controlled experimental was used. A total of 120 women participated in the study in three groups of 40 for gum, exercise and control groups. Gum was given to the groups in the gum section two hours after the ceasarean, the women chewed gum for the first eight hours until flatulence for 15 minutes every two hours. However, the women in the exercise group started moving two hours after the caesarean for the first eight hours until flatulence for five minutes every two hours. The control group consisted of women under routine treatment and care of the hospital. All women were hourly evaluated in terms of abdominal sounds, flatulence and defaecation. It was determined that following caesarean, bowel functions started in three groups at the same time, there was no significant difference between three groups. It was determined that the gum group, exercise group and the control group were discharged earlier, there was no significant difference between three groups The study results show that spinal anaesthesia have positive effects on discharge time after caesarean section operation. This study provides useful information to clinician and researchers when determining practices such as postoperative standing up in early period, gum chewing and early liquid intake related to postoperative bowel functions after abdominal operations. © 2016 John

The impact of early discharge laws on the health of newborns.

PubMed

Evans, William N; Garthwaite, Craig; Wei, Heng

2008-07-01

Using an interrupted time series design and a census of births in California over a 6-year period, we show that state and federal laws passed in the late 1990s designed to increase the length of postpartum hospital stays reduced considerably the fraction of newborns that were discharged early. The law had little impact on re-admission rates for privately insured, vaginally delivered newborns, but reduced re-admission rates for privately insured c-section-delivered and Medicaid-insured vaginally delivered newborns by statistically significant amounts. Our calculations suggest the program was not cost saving.

Laser-assisted guiding of electric discharges around objects

PubMed Central

Clerici, Matteo; Hu, Yi; Lassonde, Philippe; Milián, Carles; Couairon, Arnaud; Christodoulides, Demetrios N.; Chen, Zhigang; Razzari, Luca; Vidal, François; Légaré, François; Faccio, Daniele; Morandotti, Roberto

2015-01-01

Electric breakdown in air occurs for electric fields exceeding 34 kV/cm and results in a large current surge that propagates along unpredictable trajectories. Guiding such currents across specific paths in a controllable manner could allow protection against lightning strikes and high-voltage capacitor discharges. Such capabilities can be used for delivering charge to specific targets, for electronic jamming, or for applications associated with electric welding and machining. We show that judiciously shaped laser radiation can be effectively used to manipulate the discharge along a complex path and to produce electric discharges that unfold along a predefined trajectory. Remarkably, such laser-induced arcing can even circumvent an object that completely occludes the line of sight. PMID:26601188

Intervention among new parents followed up by an interview study exploring their experiences of telemedicine after early postnatal discharge.

PubMed

Danbjørg, D B; Wagner, L; Kristensen, B R; Clemensen, J

2015-06-01

a move towards earlier postnatal discharge raises the challenge of finding new ways to support families when they are discharged early after childbirth. to explore how postnatal parents experienced the use of telemedicine following early discharge from hospital (i.e. 24 hours after childbirth) by investigating if they consider that their postnatal needs are met, and whether or not they experience a sense of security and parental self-efficacy. intervention followed by a qualitative interview study. The intervention took place on a postnatal ward with approximately 1000 births a year. An app including chat, a knowledgebase and automated messages was trialled between postnatal parents at home and the hospital. Parents had access to the app for seven days after discharge. 42 new mothers were recruited from the postnatal ward in accordance with the inclusion criteria (i.e. discharged within 24 hours of childbirth). Both parents were invited for interview. 42 sets of parents participated in the trial, and 28 sets agreed to be interviewed. Interviews (n=28) were conducted with 27 mothers and 11 fathers. Parents were interviewed together in 10 cases, 17 mothers were interviewed alone, and one father was interviewed alone. The data analysis was inspired by systematic text condensation based on Giorgi׳s descriptive phenomenological method. parents were confident in use of the app, and did not experience any barriers in contacting the nurses via asynchronous communication. Parents received timely information and guidance by communicating online, and felt that their follow-up support needs were met. parents viewed the app as a lifeline, and saw it as a means of informing and guiding them following early discharge from hospital after childbirth. As such, this app shows potential for enhancing self-efficacy and postnatal sense of security. Copyright © 2015 Elsevier Ltd. All rights reserved.

Microelectrode-assisted low-voltage atmospheric pressure glow discharge in air

NASA Astrophysics Data System (ADS)

Liu, Wenzheng; Zhao, Shuai; Niu, Jiangqi; Chai, Maolin

2017-09-01

During the process of discharge, appropriately changing the paths corresponding to electric field lines and the field strength distribution along these paths, as well as increasing the number of initial electrons, can effectively enhance the uniformity of discharge and inhibit the formation of filamentary discharge. A method is proposed that uses a microelectrode to initiate the macroscopic discharge phenomenon. An asymmetric structure was designed comprising a single electrode of carbon fiber; this electrode structure is of helical-contact type. Benefitting from the special electric field distribution and the microdischarge process, a three-dimensional atmospheric pressure glow discharge was achieved in air, characterized by low discharge voltage, low energy consumption, good diffusion performance, and less ozone generation. The plasma studied is uniform and stable with good diffusion characteristics and low levels of contaminants and hence has potential applications in the field of air purification.

An accelerated diagnostic protocol for the early, safe discharge of low-risk chest pain patients.

PubMed

Altherwi, Tawfeeq; Grad, Willis B

2015-07-01

Can an accelerated 2-hour diagnostic protocol using the cardiac troponin I (cTnI) measurement as the only biomarker be implemented to allow an earlier and safe discharge of low-risk chest pain patients? Than M, Cullen L, Aldous S, et al. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol 2012;59(23):2091-8. To determine whether an accelerated diagnostic protocol (ADP) for possible cardiac chest pain could identify low-risk patients suitable for early discharge using cTnI as the sole biomarker.

The Use of Personal Data Assistants in Early Childhood Assessment

ERIC Educational Resources Information Center

Ledoux, Michael W.; Yoder, Noreen N.; Hanes, Barbara

2010-01-01

Four early childhood education teachers, two veteran and two newer teachers, were asked to pilot the use of handheld Personal Data Assistants loaded with Childchart assessment software. The participants were observed in their use of the electronic devices for monitoring student performance and interviewed regarding the use of the devices and their…

[Microwave assisted UV electrodeless discharge lamp photochemical degradation of 4-chlorophenol in aquatic solutions].

PubMed

Ai, Zhi-hui; Jiang, Jun-qing; Yang, Peng; Zhou, Tao; Lu, Xiao-hua

2004-07-01

A microwave assisted UV electrodeless discharge lamp system (MW/UV) was used for photo-degradation of 4CP simulated wastewater. In order to evaluate the degradation efficiency of 4CP, UV spectrophotometry and ion chromatography were used for determination of 4CP and Cl- respectively. The degradation rate in MW/UV system was higher than that in the UV system within 120min, which were 52.40% and 21.56% respectively. The degradation efficiency was improved by increasing pH value of the solution, aerating O2 gas, enhancing light intensity, or adding H2O2 oxidant. The degradation of 4CP under MW/UV accords with the first order kinetics equation.

Core guidelines for the discharge home of the child on long term assisted ventilation in the United Kingdom

PubMed Central

Jardine, E.; Wallis, C.

1998-01-01

Paediatric home ventilation is a feasible option and can be successful in a wide range of conditions and ages. Advances in ventilator technology and an ethos of optimism for home care has increased the possibilities for discharging chronically ventilated children from intensive care units and acute medical beds. With careful planning the process can succeed, but difficulties often thwart the responsible team, especially when attempting discharge for the first time. These core guidelines aim to assist a smooth, swift and successful transfer. They were developed by a working party of interested professionals spanning a wide range of health care disciplines and represent a synthesis of views accumulated from the experiences of individual teams throughout the UK. Three case scenarios provide further illustrative detail and guidance.

 PMID:10319058

Discharge destination following lower limb fracture: development of a prediction model to assist with decision making.

PubMed

Kimmel, Lara A; Holland, Anne E; Edwards, Elton R; Cameron, Peter A; De Steiger, Richard; Page, Richard S; Gabbe, Belinda

2012-06-01

Accurate prediction of the likelihood of discharge to inpatient rehabilitation following lower limb fracture made on admission to hospital may assist patient discharge planning and decrease the burden on the hospital system caused by delays in decision making. To develop a prognostic model for discharge to inpatient rehabilitation. Isolated lower extremity fracture cases (excluding fractured neck of femur), captured by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), were extracted for analysis. A training data set was created for model development and validation data set for evaluation. A multivariable logistic regression model was developed based on patient and injury characteristics. Models were assessed using measures of discrimination (C-statistic) and calibration (Hosmer-Lemeshow (H-L) statistic). A total of 1429 patients met the inclusion criteria and were randomly split into training and test data sets. Increasing age, more proximal fracture type, compensation or private fund source for the admission, metropolitan location of residence, not working prior to injury and having a self-reported pre-injury disability were included in the final prediction model. The C-statistic for the model was 0.92 (95% confidence interval (CI) 0.88, 0.95) with an H-L statistic of χ(2)=11.62, p=0.17. For the test data set, the C-statistic was 0.86 (95% CI 0.83, 0.90) with an H-L statistic of χ(2)=37.98, p<0.001. A model to predict discharge to inpatient rehabilitation following lower limb fracture was developed with excellent discrimination although the calibration was reduced in the test data set. This model requires prospective testing but could form an integral part of decision making in regards to discharge disposition to facilitate timely and accurate referral to rehabilitation and optimise resource allocation. Copyright © 2011 Elsevier Ltd. All rights reserved.

Degradation of atrazine by microwave-assisted electrodeless discharge mercury lamp in aqueous solution.

PubMed

Ta, Na; Hong, Jun; Liu, Tingfeng; Sun, Cheng

2006-11-02

The present study investigates the degradation of atrazine (2-chloro-4-(ethyl amino)-6-isopropyl amino-s-triazine) in aqueous solution by a developed new method, namely by means of a microwave-assisted electrodeless discharge mercury lamp (MW-EDML). An experimental design was conducted to assess the influence of various parameters: pH value, initial concentration, amount of EDML, initial volume and coexisted solvent. Atrazine was degraded completely by EDML in a relatively short time (i.e. t(1/2)=1.2 min for 10 mg/l). Additionally, the identification of main degradation products during atrazine degradation process was conducted by gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS). This study proposes the degradation mechanism including four possible pathways for atrazine degradation according to the degradation products.

Robotic-Assisted Thoracic Surgery for Early-Stage Lung Cancer: A Review.

PubMed

Brooks, Paula

2015-07-01

This review evaluates the benefits and disadvantages associated with the use of robotic-assisted technology in performing lobectomies in patients with early-stage lung cancer. The author conducted a literature search of Ovid®, MEDLINE®, PubMed®, and CINAHL® for articles published from 2005 to 2013. Search criteria included key terms such as robot, robotic, robotic-assisted lobectomy, and lung cancer. Of 922 articles, the author included a total of 12 research-based published studies in the analysis and incorporated the findings into an evidence table. Results showed that robotic-assisted lobectomies are feasible safe procedures for patients with stage 1A or 1B lung cancer; however, there is a steep learning curve and long-term randomized studies evaluating robotic-assisted lobectomy and conventional posterolateral thoracotomy or video-assisted thoracic lobectomy are needed. For patient safety, perioperative nurses should be aware of the length of time and experience required to perform these procedures, the costs, techniques, benefits, and disadvantages. Copyright © 2015 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Changes in the physical activity of acute stroke survivors between inpatient and community living with early supported discharge: an observational cohort study.

PubMed

Kerr, A; Rowe, P; Esson, D; Barber, M

2016-12-01

To describe and compare patterns of physical activity among stroke survivors during their hospital stay and community living with early supported discharge. Observational cohort study of physical activity before and after early supported discharge. UK National Health Service stroke units and participants' homes. Forty-one stroke survivors with a mean age of 69 (standard deviation 11) years, and a median Modified Rivermead Mobility Index of 33.5 [interquartile range (IQR) 25.8 to 35.3]. The primary outcome measures were time spent in sitting/standing/walking and number of steps taken, as recorded by a physical activity monitor. There were statistical differences (P<0.001) for all categories of physical activity. After early supported discharge to the community, participants took more than twice the number of steps {median 474 (IQR 189 to 773) vs. 1193 (IQR 512 to 2856), median difference 636 [95% confidence interval (CI) 262 to 931]} and spent more than double the time in standing [median 51 (IQR 22 to 128) minutes vs. 100 (IQR 51 to 178) minutes, median difference 28 (95% CI 11 to 68)] compared with their hospital stay. Community living with early supported discharge promoted higher levels of physical activity in medically stable stroke survivors. The near-doubling of activity may serve as a guideline for what is achievable during stroke rehabilitation. Number UKCRN 15472. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Impact of pharmacists assisting with prescribing and undertaking medication review on oxycodone prescribing and supply for patients discharged from surgical wards.

PubMed

Tran, T; Taylor, S E; Hardidge, A; Findakly, D; Aminian, P; Elliott, R A

2017-10-01

Overprescribing of oxycodone is a contributor to the epidemic of prescription opioid misuse and deaths. Practice models to optimize oxycodone prescribing and supply need to be evaluated. We explored the impact of pharmacist-assisted discharge prescribing and medication review on oxycodone prescribing and supply for patients discharged from surgical wards. A retrospective audit was conducted on two surgical inpatient wards following a 16-week prospective pre- and post-intervention study. During the pre-intervention period, discharge prescriptions were prepared by hospital doctors and then reviewed by a ward pharmacist (WP) before being dispensed. Post-intervention, prescriptions were prepared by a project pharmacist in consultation with hospital doctors and then reviewed by a WP and dispensed. Proportion of patients who were prescribed, and proportion supplied, oxycodone on discharge; Median amount (milligrams) of oxycodone prescribed and supplied, for patients who were prescribed and supplied at least one oxycodone-containing preparation, respectively. A total of 320 and 341 patients were evaluated pre- and post-intervention, respectively. Pre-intervention, 75.6% of patients were prescribed oxycodone; after WP review, 60.3% were supplied oxycodone (P<.01); the median amount both prescribed and supplied was 100 milligrams/patient. Post-intervention, 68.6% of patients were prescribed oxycodone; after WP review, 57.8% were supplied oxycodone (P<.01); median amount prescribed and supplied was 50 milligrams/patient (difference in amount prescribed and supplied: 50 milligrams, P<.01). WP review of doctor-prepared prescriptions reduced the proportion of patients who were supplied oxycodone but not the amount supplied/patient. Having a pharmacist assist with prescribing reduced the amount of oxycodone supplied. © 2017 John Wiley & Sons Ltd.

Feasibility of early discharge after implantable cardioverter-defibrillator procedures.

PubMed

Choudhuri, Indrajit; Desai, Dipan; Walburg, Jon; August, Phyllis; Keller, Seth I; Suri, Ranjit

2012-10-01

Registry data demonstrate considerably low complication rates after implantable cardioverter-defibrillator (ICD) procedures for primary prevention of sudden death. Yet standard of care includes postimplant overnight in-hospital observation that may levy substantial unnecessary financial burden on health care systems. In appropriate patients, discharge soon after implant could translate into significant cost savings, if such practice does not result in complications. We applied a simple clinical algorithm to assess feasibility of discharge on the same day of ICD implantation in patients at low risk for procedural complications. We prospectively randomized primary prevention ICD candidates at low risk for complications (not pacing-dependent or requiring bridging heparin anticoagulation) to next-day discharge with overnight in-hospital observation, or same-day discharge with remote monitoring for 24 hours after ICD implant. Implants were performed via cephalic vein access, and randomization occurred after 4-hours clinical observation and device interrogation. All patients were followed for a minimum of 6 weeks to assess acute procedural complications. 71 patients comprised the study cohort (mean age 62, 79% male) after 3 were excluded. The most common indication for ICD implant was ischemic cardiomyopathy with ejection fraction ≤35%. Device data obtained through 24-hour remote monitoring was comparable to 4-hour postimplant parameters in same-day discharge patients. No acute complications occurred in same-day discharge patients; 1 next-day discharge patient developed pneumothorax. ICD implantation with same-day discharge is reasonable in patients at low risk for complications. Remote monitoring can be useful in indicating lead-parameter stability during the immediate postoperative period. © 2012 Wiley Periodicals, Inc.

Pre-discharge home assessment visits in assisting patients' return to community living: A systematic review and meta-analysis.

PubMed

Lockwood, Kylee J; Taylor, Nicholas F; Harding, Katherine E

2015-04-01

To determine the effectiveness of pre-discharge home assessment visits by occupational therapists in assisting hospitalized patients from a range of settings to return to community living. Electronic databases MEDLINE, CINAHL, Embase, PsychINFO, Cochrane Central Register of Controlled Trials and OTseeker were searched until February 2014. Quantitative and qualitative studies were included if they evaluated pre-discharge home assessment visits by an occupational therapist. Of 1,778 potentially relevant articles, 14 studies met the inclusion criteria. After data extraction, study quality was assessed using check-lists. Pre-discharge home assessment visits reduced the risk of falling (risk ratio 0.68, 95% confidence interval (95% CI) 0.49-0.94) and increased participation levels (standardized mean difference 0.49; 95% CI 0.01-0.98) in geriatric and mixed rehabilitation settings. The risk of readmission to hospital was also reduced (risk ratio 0.47, 95% CI 0.33-0.66), but not for patients following stroke. There was no effect on activity or quality of life. Patients and carers perceived that home assessment visits were beneficial and were satisfied with the process. There is low-to-moderate quality evidence that pre-discharge home assessment visits reduce patients' risk of falling and increase participation. The risk of readmission to hospital is also reduced, but not for patients following stroke.

Operative technique and early experience for robotic-assisted laparoscopic nephroureterectomy (RALNU) using da Vinci Xi.

PubMed

Darwiche, Fadi; Swain, Sanjaya; Kallingal, George; Punnen, Sanoj; Manoharan, Murugesan; Parekh, Dipen J; Gonzalgo, Mark L

2015-01-01

Robotic-assisted laparoscopic nephroureterectomy (RALNU) has been previously utilized for management of upper tract urothelial carcinoma. The da Vinci Xi surgical system was released in April of 2014. We describe our operative technique and early experience for RALNU using the da Vinci Xi system highlighting unique features of this surgical platform. A total of 10 patients with a diagnosis of upper tract urothelial carcinoma underwent RALNU using the da Vinci Xi system between April and November of 2014. A novel, oblique "in line" robotic trocar configuration was utilized to access the upper abdomen (nephrectomy portion) and pelvis (bladder cuff excision) without undocking. The port hopping feature of da Vinci Xi was utilized to facilitate optimal, multi-quadrant visualization during RALNU. Robotic-assisted laparoscopic nephroureterectomy was successfully completed without open conversion in all 10 patients. Mean operative time was 184 min (range 140-300 min), mean estimated blood loss was 121 cc (range 60-300 cc), and mean hospital stay was 2.4 days. Final pathology demonstrated high grade urothelial carcinoma in all patients. Surgical margins were negative in all patients. No intra-operative complications were encountered. One patient developed a pulmonary embolus after being discharged. No patients required a blood transfusion. Mean patient follow-up was 130 days (range 15-210 days). The use of da Vinci Xi with a novel, oblique "in line" port configuration and camera port hopping technique allows for an efficient and reproducible method for RALNU without the need for repositioning the patient or the robot during surgery.

Pre- and post-discharge factors influencing early readmission to acute psychiatric wards: implications for quality-of-care indicators in psychiatry.

PubMed

Donisi, Valeria; Tedeschi, Federico; Salazzari, Damiano; Amaddeo, Francesco

2016-01-01

This study aims to describe the association between pre- and post-discharge factors and early readmission to acute psychiatric wards in a well-integrated community-based psychiatric service. The analysis consisted of all the hospital discharge records containing a psychiatric diagnosis in 2011 from four Italian acute inpatient wards. Socio-demographic, clinical, admission and aftercare variables were investigated as possible predictors of readmission at 7, 30 and 90 days after discharge and were analyzed, controlling for dependency among same-patient observations. Previous psychiatric history was the most important predictor of readmissions. The socio-demographic and clinical characteristics of patients did not clearly influence readmission. Length of stay (LoS) was significant for readmission at 7 days even after controlling for other predictors and for same-patient dependence, in particular, for patients with previous admissions. Results suggest a protective role of a LoS higher than 28 days. In general, having a contact in community services did not turn out as protective from early readmission. This paper contributes to increase the knowledge about factors that may predict the risk of early readmission. Implications for quality assessment in psychiatry emerged: readmission seems actionable by LoS and not by community follow-up. Copyright © 2016 Elsevier Inc. All rights reserved.

Readiness for hospital discharge: A concept analysis.

PubMed

Galvin, Eileen Catherine; Wills, Teresa; Coffey, Alice

2017-11-01

To report on an analysis on the concept of 'readiness for hospital discharge'. No uniform operational definition of 'readiness for hospital discharge' exists in the literature; therefore, a concept analysis is required to clarify the concept and identify an up-to-date understanding of readiness for hospital discharge. Clarity of the concept will identify all uses of the concept; provide conceptual clarity, an operational definition and direction for further research. Literature review and concept analysis. A review of literature was conducted in 2016. Databases searched were: Academic Search Complete, CINAHL Plus with Full Text, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycINFO, Social Sciences Full Text (H.W. Wilson) and SocINDEX with Full Text. No date limits were applied. Identification of the attributes, antecedents and consequences of readiness for hospital discharge led to an operational definition of the concept. The following attributes belonging to 'readiness for hospital discharge' were extracted from the literature: physical stability, adequate support, psychological ability, and adequate information and knowledge. This analysis contributes to the advancement of knowledge in the area of hospital discharge, by proposing an operational definition of readiness for hospital discharge, derived from the literature. A better understanding of the phenomenon will assist healthcare professionals to recognize, measure and implement interventions where necessary, to ensure patients are ready for hospital discharge and assist in the advancement of knowledge for all professionals involved in patient discharge from hospital. © 2017 John Wiley & Sons Ltd.

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

Evaluating Assistive Technology in Early Childhood Education: The Use of a Concurrent Time Series Probe Approach

ERIC Educational Resources Information Center

Parette, Howard P.; Blum, Craig; Boeckmann, Nichole M.

2009-01-01

As assistive technology applications are increasingly implemented in early childhood settings for children who are at risk or who have disabilities, it is critical that teachers utilize observational approaches to determine whether targeted assistive technology-supported interventions make a difference in children's learning. One structured…

Design of a Microwave Assisted Discharge Inductive Plasma Accelerator

NASA Technical Reports Server (NTRS)

Hallock, Ashley K.; Polzin, Kurt A.

2010-01-01

A new plasma accelerator concept that employs electrodeless plasma preionization and pulsed inductive acceleration is presented. Preionization is achieved through an electron cyclotron resonance discharge that produces a weakly-ionized plasma at the face of a conical theta pinch-shaped inductive coil. The presence of the preionized plasma allows for current sheet formation at lower discharge voltages than those found in other pulsed inductive accelerators. The location of an electron cyclotron resonance discharge can be controlled through the design of the applied magnetic field in the thruster. A finite-element model of the magnetic field was used as a design tool, allowing for the implementation of an arrangement of permanent magnets that yields a small volume of preionized propellant at the coil face. This allows for current sheet formation at the face of the inductive coil, minimizing the initial inductance of the pulse circuit and maximizing the potential efficiency of the new accelerator.

Mission Assessment of the Faraday Accelerator with Radio-frequency Assisted Discharge (FARAD)

NASA Technical Reports Server (NTRS)

Dankanich, John W.; Polzin, Kurt A.

2008-01-01

Pulsed inductive thrusters have typically been considered for future, high-power, missions requiring nuclear electric propulsion. These high-power systems, while promising equivalent or improved performance over state-of-the-art propulsion systems, presently have no planned missions for which they are well suited. The ability to efficiently operate an inductive thruster at lower energy and power levels may provide inductive thrusters near term applicability and mission pull. The Faraday Accelerator with Radio-frequency Assisted Discharge concept demonstrated potential for a high-efficiency, low-energy pulsed inductive thruster. The added benefits of energy recapture and/or pulse compression are shown to enhance the performance of the pulsed inductive propulsion system, yielding a system that con compete with and potentially outperform current state-of-the-art electric propulsion technologies. These enhancements lead to mission-level benefits associated with the use of a pulsed inductive thruster. Analyses of low-power near to mid-term missions and higher power far-term missions are undertaken to compare the performance of pulsed inductive thrusters with that delivered by state-of-the-art and development-level electric propulsion systems.

Current sheet Formation in a Conical Theta Pinch Faraday Accelerator with Radio-Frequency Assisted Discharge

NASA Technical Reports Server (NTRS)

Hallock, Ashley K.; Choueiri, Edgar Y.; Polzin, Kurt A.

2007-01-01

The inductive formation of current sheets in a conical theta pinch FARAD (Faraday Accelerator with Radio-frequency Assisted Discharge) thruster is investigated experimentally with time-integrated photography. The goal is to help in understanding the mechanisms and conditions controlling the strength and extent of the current sheet, which are two indices important for FARAD as a propulsion concept. The profiles of these two indices along the inside walls of the conical acceleration coil are assumed to be related to the profiles of the strength and extent of the luminosity pattern derived from photographs of the discharge. The variations of these profiles as a function of uniform back-fill neutral pressure (with no background magnetic field and all parameters held constant) provided the first clues on the nature and qualitative dependencies of current sheet formation. It was found that there is an optimal pressure for which both indices reach a maximum and that the rate of change in these indices with pressure differs on either side of this optimal pressure. This allowed the inference that current sheet formation follows a Townsend-like breakdown mechanism modified by the existence of a finite pressure-dependent radio-frequency-generated electron density background. The observation that the effective location of the luminosity pattern favors the exit-half of the conical coil is explained as the result of the tendency of the inductive discharge circuit to operate near its minimal self-inductance. Movement of the peak in the luminosity pattern towards the upstream side of the cone with increasing pressure is believed to result from the need of the circuit to compensate for the increase in background plasma resistivity due to increasing pressure.

[Feasibility and results of at-home follow-up after early postpartum discharge from maternity units in Bobo-Dioulasso, Burkina Faso].

PubMed

Ouattara, S; Some, D A; Toure, B; Ouattara, Z A; Dembele, A; Bambara, M; Dao, B

2014-01-01

to describe the feasibility and results of at-home follow-up of mothers and newborns discharged early from the maternity ward after normal childbirth. This prospective descriptive study took place during a one month period (April 1-30, 2011) in five maternity units in Bobo-Dioulasso, the second largest city in Burkina Faso. Mothers with normal vaginal deliveries and no complications at the sixth hour postpartum were included in the study with their newborns after informed oral consent. The discharge took place between 12 and 48 hours after delivery. The follow-up took place by telephone, home visits, and emergency hospital visits in cases of complications. A postnatal hospital visit was systematically planned for day 7. The study included 630 mothers and their babies. There were 1567 phone calls made: 27 women could not be reached by telephone after discharge, and 140 home visits took place, either at the mother's request or because of the failure to reach her by telephone. Complications were observed in 55 mothers and 135 babies. Postnatal follow-up at home is required for mothers and their newborns discharged early from the maternity ward after normal childbirth in view of the possibility of complications. This ensures continuity of care to improve survival of mothers and babies. As cell phones become more and more available, they may play an important role as a tool for such follow up.

76 FR 32967 - Proposed Extensions and Waivers: National Early Childhood Technical Assistance Center

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-07

... DEPARTMENT OF EDUCATION [CFDA No. 84.326H] Proposed Extensions and Waivers: National Early Childhood Technical Assistance Center AGENCY: Office of Special Education Programs, Office of Special Education and Rehabilitative Services, Department of Education. ACTION: Notice of proposed extension of...

Early hospital discharge of infants born to group B streptococci-positive mothers: a decision analysis.

PubMed

Berger, M B; Xu, X; Williams, J A; Van de Ven, C J M; Mozurkewich, E L

2012-03-01

To compare the cost-effectiveness of an additional 24-hour inpatient observation for asymptomatic term neonates born to group B streptococcus (GBS)-colonised mothers with adequate intrapartum antibiotic prophylaxis (IAP) after an initial 24-hour in-hospital observation. Cost-effectiveness analysis from a societal perspective. United States. Asymptomatic term neonates born to GBS-colonised mothers with IAP after an initial 24-hour in-hospital observation. Monte Carlo simulation for a decision tree model incorporating the following chance events: development of GBS sepsis during the second 24 hours of life, development of GBS sepsis between 48 hours and 7 days of life, prompt versus delayed treatment for sepsis, neonatal mortality and long-term health sequelae. Expected cost and quality-adjusted life years (QALYs), Incremental cost-effectiveness ratio (ICER). Delayed, versus early, hospital discharge results in similar mean expected QALYs, but substantially higher expected cost. The mean difference in QALY is 0.00016 (95% CI 0.00005-0.00040), whereas the mean difference in cost is $1170.96 (95% CI $750.13-1584.32). The ICER is estimated to be $9,771,520.87 per QALY (95% CI $2,573,139.89-24,407,017.82). The proportion of early-onset GBS that develops during the second 24 hours of life, the cost of 24 hours of inpatient observation, and the probability of long-term sequelae following prompt versus delayed treatment play important roles in determining the cost-effectiveness of delayed hospital discharge. Cost-effectiveness analysis suggests that with adequate IAP, discharging asymptomatic term neonates to home after 24 hours is the preferred approach compared with 48 hours inpatient observation. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

Modified PADSS (Post Anaesthetic Discharge Scoring System) for monitoring outpatients discharge.

PubMed

Palumbo, Piergaspare; Tellan, Guglielmo; Perotti, Bruno; Pacilè, Maria Antonietta; Vietri, Francesco; Illuminati, Giulio

2013-01-01

The decision to discharge a patient undergoing day surgery is a major step in the hospitalization pathway, because it must be achieved without compromising the quality of care, thus ensuring the same assistance and wellbeing as for a long-term stay. Therefore, the use of an objective assessment for the management of a fair and safe discharge is essential. The authors propose the Post Anaesthetic Discharge Scoring System (PADSS), which considers six criteria: vital signs, ambulation, nausea/vomiting, pain, bleeding and voiding. Each criterion is given a score ranging from 0 to 2. Only patients who achieve a score of 9 or more are considered ready for discharge. Furthermore, PADSS has been modified to ensure a higher level of safety, thus the "vital signs" criteria must never score lower than 2, and none of the other five criteria must ever be equal to 0, even if the total score reaches 9. The effectiveness of PADSS was analyzed on 2432 patients, by recording the incidence of postoperative complications and the readmission to hospital. So far PADDS has proved to be an efficient system that guarantees safe discharge.

Medication-related factors affecting discharge to home.

PubMed

Hashimoto, Masako; Matsuzaki, Yu; Kawahara, Kumiko; Matsuda, Hiroshi; Nishimura, Genichi; Hatae, Takashi; Kimura, Yoshiaki; Arai, Kunizo

2014-01-01

To assess the reasons for barriers to home discharge by determining whether they were predicted by medication, clinical variables, and patient characteristics, the retrospective cohort study of 282 patients discharged from Kanazawa Red Cross Hospital in Kanazawa, Japan from January 2011 to December 2012 was performed. The percentage of patients discharged was 67.4%. By multivariate logistic analysis, significant differences in home discharge destination were determined by six factors: the duration of hospitalization before discharge (odds ratio (OR) 0.993; 95% 95% confidence interval (CI) 0.988-0.999), the presence of excretion assistance (OR 0.115; 95% CI 0.043-0.308), individual payment of medical expense (OR 0.344; 95% CI 0.146-0.811), the degree of independent living for the demented elderly (OR4.570; 95% CI 1.969-10.604), presence of the primary caregiver (OR 8.638; 95% CI 3.121-23.906), and admission to a hospital from home (OR 5.483; 95% CI 2.589-11.613). This study suggests that necessity of excretion assistance, long duration of hospitalization, and high individual payment of medical expense were barriers to home discharge. In contrast, three factors i.e., admission to a hospital form home, low degree of independent living for the demented elderly, and presence of the primary caregiver, favored home discharge. The relation between a patient's status (cognitive status and incontinence) and a caregiver has an important effect on the home discharge. However, medication characteristics appeared to have little effect on recuperation destination.

Early discharge after high-dose melphalan and peripheral blood stem cell reinfusion in patients with hematological and non-hematological disease.

PubMed

Anastasia, Antonella; Giglio, Fabio; Mazza, Rita; Sarina, Barbara; Todisco, Elisabetta; Bramanti, Stefania; Castagna, Luca

2009-01-01

The purpose of this study was to analyse our experience of early discharge 2 days after high-dose melphalan (HDM) (Day-1) followed by peripheral blood stem cell re-infusion (Day-0) and re-admission on Day +5 in patients with hematological diseases or solid tumors. From 2000 to November 2005, seven patients received tandem Melphalan 200 mg/m(2) HDM with peripheral blood stem cells transplantation (PBSC-T), 130 a single HDM, for a total of 144 procedures. In 123 of them, patients were discharged on Day +1 for re-admission on Day +5 or earlier in the event of complications. Antibiotic prophylaxis was not used. Patients were hospitalised in positive-pressure reverse isolation room during the neutropenic period. Of the 123 procedures eligible for our mixed inpatient-outpatient management regimen, six (5%) required early re-admission for complications. Full engraftment was achieved in all cases. Median time to neutrophil count >0.5 x 10(9)/microL and >1 x 10(9)/microL were 12 and 14 days, respectively. Median time to platelet recovery (>20 x 10(9)/microL) was 13 days. Severe extra-hematological toxicities occurred in 78 (63%) patients: all had oral mucositis and five had associated diarrhoea. During hospitalisation, 94/123 (76%) experienced febrile neutropenia, 20/94 (21%) had documented infection and 74/94 (79%) were considered fever of unknown origin. Median fever duration was 1 day (range 0-11). Median duration of antibiotic treatment was 6 days (range 3-26). Median time to discharge (from Day 0) was 16 days (range 11-57). There was no mortality by on Day +100. Our experience of early discharge after HDM and PBSC-T with re-admission on Day +5 is safe and feasible with acceptable frequency of hematological and extra-hematological toxicities. The regimen allows reduced hospital stay and hence cost savings.

The practice of terminal discharge.

PubMed

Radha Krishna, Lalit Kumar; Murugam, Vengadasalam; Quah, Daniel Song Chiek

2017-01-01

'Terminal discharges' are carried out in Singapore for patients who wish to die at home. However, if due diligence is not exercised, parallels may be drawn with euthanasia. We present a theoretical discussion beginning with the definition of terminal discharges and the reasons why they are carried out in Singapore. By considering the intention behind terminal discharges and utilising a multidisciplinary team to deliberate on the clinical, social and ethical intricacies with a patient- and context-specific approach, euthanasia is avoided. It is hoped that this will provide a platform for professionals in palliative medicine to negotiate challenging issues when arranging a terminal discharge, so as to avoid the pitfall of committing euthanasia in a country such as Singapore where euthanasia is illegal. It is hoped that a set of guidelines for terminal discharges may someday be realised to assist professionals in Singapore and around the world.

Impact of metabolic syndrome on early recovery of continence after robot-assisted radical prostatectomy.

PubMed

Nishikawa, Masatomo; Watanabe, Hiromitsu; Kurahashi, Toshifumi

2017-09-01

To evaluate the impact of metabolic syndrome on the early recovery of urinary continence after robot-assisted radical prostatectomy. The present study included a total of 302 consecutive Japanese patients with clinically localized prostate cancer who underwent robot-assisted radical prostatectomy. In this study, postoperative urinary continence was defined as no leak or the use of a security pad. The continence status was assessed by interviews before and 1 and 3 months after robot-assisted radical prostatectomy. Metabolic syndrome was defined as follows: body mass index ≥25 kg/m 2 and two or more of the following: hypertension, diabetes mellitus and dyslipidemia. The effect of the presence of metabolic syndrome on the continence status of these patients was retrospectively examined. A total of 116 (38.4%) and 203 (67.2%) of the 302 patients were continent at 1 and 3 months after robot-assisted radical prostatectomy, respectively. A total of 31 (10.3%) patients were judged to have metabolic syndrome. Despite the operative time being longer in patients with metabolic syndrome, no significant differences were observed in the remaining preoperative, intraoperative or postoperative variables between patients with or without metabolic syndrome. On multivariate logistic regression analysis, metabolic syndrome and the duration of hospitalization were significantly correlated with the 1-month continence status. Similarly, metabolic syndrome and estimated blood loss during surgery were independent predictors of continence rates at 3 months after robot-assisted radical prostatectomy. These findings suggest that the presence of metabolic syndrome could have a significant impact on the early recovery of urinary continence after robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

[Practices of nursing staff in the process of preterm baby hospital discharge].

PubMed

Schmidt, Kayna Trombini; Terassi, Mariélli; Marcon, Sonia Silva; Higarashi, Ieda Harumi

2013-12-01

The objective of this study was to identify the strategies used by the nursing team in the neonatal unity care of a school-hospital during the preparation of the family for the premature baby discharge. It is a descriptive study with qualitative approach. The data was collected between March and June 2011, by means of observation and semi-structured interviews. From the discourse analysis two categories appeared: Orientations and professional strategies in preparing the family for the premature baby hospital discharge and Difficulties and potentialities in the neonatal attention space. The main strategy mentioned was the family early insertion in the caring process and the stressed difficulty was the parents' absence during the child's hospital staying. The potentialities and limitations pointed out in this study revealed that the assistance process is dynamic, asking for constant correction and adequacies to effectively and wholly care for the premature baby and its family.

Hospital at home for chronic obstructive pulmonary disease: an integrated hospital and community based generic intermediate care service for prevention and early discharge.

PubMed

Davison, A G; Monaghan, M; Brown, D; Eraut, C D; O'Brien, A; Paul, K; Townsend, J; Elston, C; Ward, L; Steeples, S; Cubitt, L

2006-01-01

Recent randomized controlled studies have reported success for hospital at home for prevention and early discharge of chronic obstructive pulmonary disease (COPD) patients using hospital based respiratory nurse specialists. This observational study reports results using an integrated hospital and community based generic intermediate care service. The length of care, readmission within 60 days and death within 60 days in the early discharge (9.37 days, 21.1%, 7%) and the prevention of admission (five to six days, 34.1%, 3.8%) are similar to previous studies. We suggest that this generic community model of service may allow hospital at home services for COPD to be introduced in more areas.

Microwave discharge electrodeless lamps (MDEL). V. Microwave-assisted photolytic disinfection of Bacillus subtilis in simulated electroplating wash wastewaters.

PubMed

Horikoshi, Satoshi; Tsuchida, Akihiro; Abe, Masahiko; Ohba, Naoki; Uchida, Masayoshi; Serpone, Nick

2010-01-01

This short article examines the microwave-assisted photolytic disinfection of aqueous solutions contaminated by Bacillus subtilis microorganisms using UV and vacuum-UV radiation emitted from a microwave discharge electrodeless lamp (MDEL), a device containing a Hg/Ar gas-fill that was proposed recently for use in Advanced Oxidation Processes (AOPs). Results of the disinfection are compared with those obtained from UV radiation emitted by a low-pressure electrode Hg lamp and by an excimer lamp. Also examined is the disinfection of B. subtilis aqueous media that contained Au3+ or Ni2+ ions, species often found in the treatment of electroplating wash wastewaters.

Design of a Microwave Assisted Discharge Inductive Plasma Accelerator

NASA Technical Reports Server (NTRS)

Hallock, Ashley K.; Polzin, Kurt A.

2010-01-01

The design and construction of a thruster that employs electrodeless plasma preionization and pulsed inductive acceleration is described. Preionization is achieved through an electron cyclotron resonance discharge that produces a weakly-ionized plasma at the face of a conical theta pinch-shaped inductive coil. The presence of the preionized plasma allows for current sheet formation at lower discharge voltages than those employed in other pulsed inductive accelerators that do not employ preionization. The location of the electron cyclotron resonance discharge is controlled through the design of the applied magnetic field in the thruster. Finite element analysis shows that there is an arrangement of permanent magnets that yields a small volume of resonant magnetic field at the coil face. Preionization in the resonant zone leads to current sheet formation at the coil face, which minimizes the initial inductance of the pulse circuit and maximizes the potential electrical efficiency of the accelerator. A magnet assembly was constructed around an inductive coil to provide structural support to the selected arrangement of neodymium magnets. Measured values of the resulting magnetic field compare favorably with the finite element model.

Predicting Time to Hospital Discharge for Extremely Preterm Infants

PubMed Central

Hintz, Susan R.; Bann, Carla M.; Ambalavanan, Namasivayam; Cotten, C. Michael; Das, Abhik; Higgins, Rosemary D.

2010-01-01

As extremely preterm infant mortality rates have decreased, concerns regarding resource utilization have intensified. Accurate models to predict time to hospital discharge could aid in resource planning, family counseling, and perhaps stimulate quality improvement initiatives. Objectives For infants <27 weeks estimated gestational age (EGA), to develop, validate and compare several models to predict time to hospital discharge based on time-dependent covariates, and based on the presence of 5 key risk factors as predictors. Patients and Methods This was a retrospective analysis of infants <27 weeks EGA, born 7/2002-12/2005 and surviving to discharge from a NICHD Neonatal Research Network site. Time to discharge was modeled as continuous (postmenstrual age at discharge, PMAD), and categorical variables (“Early” and “Late” discharge). Three linear and logistic regression models with time-dependent covariate inclusion were developed (perinatal factors only, perinatal+early neonatal factors, perinatal+early+later factors). Models for Early and Late discharge using the cumulative presence of 5 key risk factors as predictors were also evaluated. Predictive capabilities were compared using coefficient of determination (R2) for linear models, and AUC of ROC curve for logistic models. Results Data from 2254 infants were included. Prediction of PMAD was poor, with only 38% of variation explained by linear models. However, models incorporating later clinical characteristics were more accurate in predicting “Early” or “Late” discharge (full models: AUC 0.76-0.83 vs. perinatal factor models: AUC 0.56-0.69). In simplified key risk factors models, predicted probabilities for Early and Late discharge compared favorably with observed rates. Furthermore, the AUC (0.75-0.77) were similar to those of models including the full factor set. Conclusions Prediction of Early or Late discharge is poor if only perinatal factors are considered, but improves substantially with

Algorithm for early discharge after total thyroidectomy using PTH to predict hypocalcemia: prospective study.

PubMed

Schlottmann, F; Arbulú, A L Campos; Sadava, E E; Mendez, P; Pereyra, L; Fernández Vila, J M; Mezzadri, N A

2015-10-01

Hypocalcemia is the most common complication after total thyroidectomy. The aim of this study was to determine whether postoperative parathyroid hormone (PTH) levels predict hypocalcemia in order to design an algorithm for early discharge. We present a prospective study including patients who underwent total thyroidectomy. Hypocalcemia was defined as serum ionized calcium < 1.09 mmol/L or clinical evidence of hypocalcemia. PTH measurement was performed preoperatively and at 1, 3, and 6 h postoperatively. The percent decline of preoperative values was calculated for each time point. One hundred and six patients were included. Thirty-six (33.9%) patients presented hypocalcemia. A 50% decline in PTH levels at 3 h postoperatively showed the highest sensitivity and specificity to predict hypocalcemia (91 and 73%, respectively). No patients with a decrease <35% developed hypocalcemia (100% sensitivity), and all patients with a decrease >80% had hypocalcemia (100% specificity). PTH determination at 3 h postoperatively is a reliable predictor of hypocalcemia. According to the proposed algorithm, patients with less than 80% drop in PTH levels can be safely discharged the day of the surgery.

Factors associated with exclusive breastfeeding at hospital discharge in rural Western Australia.

PubMed

Cox, Kylee; Giglia, Roslyn; Zhao, Yun; Binns, Colin W

2014-11-01

Breastfeeding is accepted as the best way of feeding infants, and health authorities recommend exclusive breastfeeding to around 6 months of age, but despite the evidence of its benefits, few mothers meet this goal. Infants who are exclusively breastfed in the early postpartum period are more likely to continue breastfeeding at 6 and 12 months, reinforcing the role that Baby-Friendly hospital practices play in supporting exclusive breastfeeding. This study aimed to determine the rate of breastfeeding initiation and identify the factors associated with exclusive breastfeeding at discharge from hospital for rural mothers. The prospective cohort study recruited 489 women from hospitals in regional Western Australia following the birth of their infant. Breastfeeding exclusivity at discharge was assessed based on mothers' self-reported infant feeding behavior during her hospital stay. The self-administered baseline questionnaire was completed by 427 mothers. Breastfeeding was initiated by 97.7% of the mothers in this cohort, with 82.7% exclusively breastfeeding at hospital discharge. The odds of exclusive breastfeeding at discharge were more than 4 times higher for women whose infants did not require admission to the special care nursery (adjusted odds ratio [aOR] = 4.43; 95% confidence interval [CI], 1.98-9.99). Demand feeding (aOR = 3.33; 95% CI, 1.59-6.95) and 24-hour rooming-in (aOR = 2.31; 95% CI, 1.15-4.62) were also significant positive factors. The findings suggest that hospital practices are strong predictors of exclusive breastfeeding. Greater emphasis on Baby-Friendly hospital practices in the early postpartum period may help the establishment of exclusive breastfeeding, assisting rural mothers to reach established international breastfeeding recommendations. © The Author(s) 2014.

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.

Experimental Investigation – Magnetic Assisted Electro Discharge Machining

NASA Astrophysics Data System (ADS)

Kesava Reddy, Chirra; Manzoor Hussain, M.; Satyanarayana, S.; Krishna, M. V. S. Murali

2018-04-01

Emerging technology needs advanced machined parts with high strength and temperature resistance, high fatigue life at low production cost with good surface quality to fit into various industrial applications. Electro discharge machine is one of the extensively used machines to manufacture advanced machined parts which cannot be machined by other traditional machine with high precision and accuracy. Machining of DIN 17350-1.2080 (High Carbon High Chromium steel), using electro discharge machining has been discussed in this paper. In the present investigation an effort is made to use permanent magnet at various positions near the spark zone to improve surface quality of the machined surface. Taguchi methodology is used to obtain optimal choice for each machining parameter such as peak current, pulse duration, gap voltage and Servo reference voltage etc. Process parameters have significant influence on machining characteristics and surface finish. Improvement in surface finish is observed when process parameters are set at optimum condition under the influence of magnetic field at various positions.

TOPICAL REVIEW: Plasma assisted ignition and combustion

NASA Astrophysics Data System (ADS)

Starikovskaia, S. M.

2006-08-01

In recent decades particular interest in applications of nonequilibrium plasma for the problems of plasma-assisted ignition and plasma-assisted combustion has been observed. A great amount of experimental data has been accumulated during this period which provided the grounds for using low temperature plasma of nonequilibrium gas discharges for a number of applications at conditions of high speed flows and also at conditions similar to automotive engines. The paper is aimed at reviewing the data obtained and discusses their treatment. Basic possibilities of low temperature plasma to ignite gas mixtures are evaluated and historical references highlighting pioneering works in the area are presented. The first part of the review discusses plasmas applied to plasma-assisted ignition and combustion. The paper pays special attention to experimental and theoretical analysis of some plasma parameters, such as reduced electric field, electron density and energy branching for different gas discharges. Streamers, pulsed nanosecond discharges, dielectric barrier discharges, radio frequency discharges and atmospheric pressure glow discharges are considered. The second part depicts applications of discharges to reduce the ignition delay time of combustible mixtures, to ignite transonic and supersonic flows, to intensify ignition and to sustain combustion of lean mixtures. The results obtained by different authors are cited, and ways of numerical modelling are discussed. Finally, the paper draws some conclusions on the main achievements and prospects of future investigations in the field.

Radiation doses to critical groups since the early 1950s due to discharges of liquid radioactive waste from Sellafield.

PubMed

Hunt, G J

1997-04-01

First, some of the early work is reviewed on exposure pathways in connection with proposed and early liquid radioactive waste discharges from Sellafield. The main historical features of these discharges, affected by relevant plant operations, are then briefly described. The important radiological exposure pathways resulting from the discharges and people's consumption and occupancy habits are considered. To place the changing scenario onto a consistent basis using present-day methodology, a reconstruction of exposures has been carried out using environmental monitoring data and models. The three major pathways are examined of Porphyra/laverbread consumption in South Wales, fish and shellfish consumption near Sellafield, and external exposure over local and more distant sediments. The results show that over the period 1952 to about 1970 the laverbread pathway was probably critical, taking a cautious approach. Effective dose rates fluctuated at around 1 mSv y(-1) from about 1956 to 1971. From about 1970 to 1985, the fish and shellfish pathway was likely to have been critical, with effective dose rates peaking at about 2 mSv y(-1) in 1975-1976. External exposure was likely to have been of lesser importance than the other two pathways until about 1985, when with the retention of previously-released radiocesium on sediments it has become dominant. This phenomenon applies particularly further afield where radiocesium concentrations have been slower to decline; in the Ribble estuary, houseboat dwellers have been the critical group from about 1985. Effective doses have been at about 0.3 mSv y(-1) and declining; they are due to the effects of radiocesium discharges in earlier years. Dose rates have remained within contemporary ICRP dose limits.

[Per os early nutrition for colorectal pathology susceptible of laparoscopy-assisted surgery].

PubMed

Fernández de Bustos, A; Creus Costas, G; Pujol Gebelli, J; Virgili Casas, N; Pita Mercé, A M

2006-01-01

Current less invasive surgical techniques, the use of new analgesic and anesthetic drugs, and early mobilization ("multimodal surgical strategies") reduce the occurrence of post-surgery paralytic ileus and vomiting, making possible early nutrition by the digestive route. With these premises, a nutrition protocol was designed for its implementation in colorectal pathology susceptible of laparoscopy-assisted surgery. to assess the efficacy of this protocol that comprises 3 phases. Phase I: home preparation with 7 days duration; low-residues and insoluble fiber diet, supplemented with 400 mL of hyperproteic polymeric formula with no lactose or fiber, bowel cleansing 2 days prior to surgery and hydration with water, sugared infusions, and vegetable broth. Phase II: immediate post-surgical period with watery diet for 3 days with polymeric diet with no fiber. Phase III: semi-solid diet with no residues, nutritional formula and progressive reintroduction of food intake in four stages of varying duration according to surgery and digestive tolerance. prospective study performed at our hospital with patients from our influence area, from February 2003 to May 2004, including 25 patients, 19 men and 6 women, with mean age of 63.3 years (range = 33-79) and mean body mass index of 26.25 kg/m2 (range = 20.84-31.3), all of them suffering from colorectal pathology susceptible of laparoscopy-assisted surgery, and to which the study protocol was applied. Fourteen left hemicolectomies, 5 right hemicolectomies, 4 low anterior resections with protective colostomy, and subtotal colectomies and lateral ileostomy were done. Final diagnoses were: 3 diverticular diseases; 3 adenomas; 7 rectosigmoidal neoplasms; and 12 large bowel neoplasms in other locations. The pathology study confirmed: pT3N0 (n = 7), pT3N1 (n = 3), pT3N2 (n = 1), and pT3N1M1 (n = 1), pT1N0 (n = 4), pT1N1 (n = 2), pTis (n = 1). Twelve patients were started on adjuvant therapy of which 3 had received an initial treatment

Punctuated Sediment Discharge during Early Pliocene Birth of the Colorado River: Evidence from Regional Stratigraphy, Sedimentology, and Paleontology

NASA Astrophysics Data System (ADS)

Dorsey, Rebecca J.; O'Connell, Brennan; McDougall, Kristin; Homan, Mindy B.

2018-01-01

The Colorado River in the southwestern U.S. provides an excellent natural laboratory for studying the origins of a continent-scale river system, because deposits that formed prior to and during river initiation are well exposed in the lower river valley and nearby basinal sink. This paper presents a synthesis of regional stratigraphy, sedimentology, and micropaleontology from the southern Bouse Formation and similar-age deposits in the western Salton Trough, which we use to interpret processes that controlled the birth and early evolution of the Colorado River. The southern Bouse Formation is divided into three laterally persistent members: basal carbonate, siliciclastic, and upper bioclastic members. Basal carbonate accumulated in a tide-dominated marine embayment during a rise of relative sea level between 6.3 and 5.4 Ma, prior to arrival of the Colorado River. The transition to green claystone records initial rapid influx of river water and its distal clay wash load into the subtidal marine embayment at 5.4-5.3 Ma. This was followed by rapid southward progradation of the Colorado River delta, establishment of the earliest through-flowing river, and deposition of river-derived turbidites in the western Salton Trough (Wind Caves paleocanyon) between 5.3 and 5.1 Ma. Early delta progradation was followed by regional shut-down of river sand output between 5.1 and 4.8 Ma that resulted in deposition of marine clay in the Salton Trough, retreat of the delta, and re-flooding of the lower river valley by shallow marine water that deposited the Bouse upper bioclastic member. Resumption of sediment discharge at 4.8 Ma drove massive progradation of fluvial-deltaic deposits back down the river valley into the northern Gulf and Salton Trough. These results provide evidence for a discontinuous, start-stop-start history of sand output during initiation of the Colorado River that is not predicted by existing models for this system. The underlying controls on punctuated sediment

Validating a simple discharge planning tool following hospital admission for an isolated lower limb fracture.

PubMed

Kimmel, Lara A; Holland, Anne E; Simpson, Pam M; Edwards, Elton R; Gabbe, Belinda J

2014-07-01

Early, accurate prediction of discharge destination from the acute hospital assists individual patients and the wider hospital system. The Trauma Rehabilitation and Prediction Tool (TRaPT), developed using registry data, determines probability of inpatient rehabilitation discharge for patients with isolated lower limb fractures. The aims of this study were: (1) to prospectively validatate the TRaPT, (2) to assess whether its performance could be improved by adding additional demographic data, and (3) to simplify it for use as a bedside tool. This was a cohort, measurement-focused study. Patients with isolated lower limb fractures (N=114) who were admitted to a major trauma center in Melbourne, Australia, were included. The participants' TRaPT scores were calculated from admission data. Performance of the TRaPT score alone, and in combination with frailty, weight-bearing status, and home supports, was assessed using measures of discrimination and calibration. A simplified TRaPT was developed by rounding the coefficients of variables in the original model and grouping age into 8 categories. Simplified TRaPT performance measures, including specificity, sensitivity, and positive and negative predictive values, were evaluated. Prospective validation of the TRaPT showed excellent discrimination (C-statistic=0.90 [95% confidence interval=0.82, 0.97]), a sensitivity of 80%, and specificity of 94%. All participants able to weight bear were discharged directly home. Simplified TRaPT scores had a sensitivity of 80% and a specificity of 88%. Generalizability may be limited given the compensation system that exists in Australia, but the methods used will assist in designing a similar tool in any population. The TRaPT accurately predicted discharge destination for 80% of patients and may form a useful aid for discharge decision making, with the simplified version facilitating its use as a bedside tool. © 2014 American Physical Therapy Association.

Early supported discharge services for stroke patients: a meta-analysis of individual patients' data.

PubMed

Langhorne, Peter; Taylor, Gillian; Murray, Gordon; Dennis, Martin; Anderson, Craig; Bautz-Holter, Erik; Dey, Paola; Indredavik, Bent; Mayo, Nancy; Power, Michael; Rodgers, Helen; Ronning, Ole Morten; Rudd, Anthony; Suwanwela, Nijasri; Widen-Holmqvist, Lotta; Wolfe, Charles

Stroke patients conventionally undergo a substantial part of their rehabilitation in hospital. Services have been developed that offer patients early discharge from hospital with rehabilitation at home (early supported discharge [ESD]). We have assessed the effects and costs of such services. We did a meta-analysis of data from individual patients who took part in randomised trials that recruited patients with stroke in hospital to receive either conventional care or any ESD service intervention that provided rehabilitation and support in a community setting with the aim of shortening the duration of hospital care. The primary outcome was death or dependency at the end of scheduled follow-up. Outcome data were available for 11 trials (1597 patients). ESD services were mostly provided by specialist multidisciplinary teams to a selected group (median 41%) of stroke patients admitted to hospital. There was a reduced risk of death or dependency equivalent to six (95% CI one to ten) fewer adverse outcomes for every 100 patients receiving an ESD service (p=0.02). The hospital stay was 8 days shorter for patients assigned ESD services than for those assigned conventional care (p<0.0001). There were also significant improvements in scores on the extended activities of daily living scale and in the odds of living at home and reporting satisfaction with services. The greatest benefits were seen in the trials evaluating a coordinated multidisciplinary ESD team and in stroke patients with mild to moderate disability. Appropriately resourced ESD services provided for a selected group of stroke patients can reduce long-term dependency and admission to institutional care as well as shortening hospital stays.

Schlieren Imaging and Pulsed Detonation Engine Testing of Ignition by a Nanosecond Repetitively Pulsed Discharge

DTIC Science & Technology

2016-05-16

in ethylene–air and aviation gasoline (avgas)–air mixtures. Testing of NRP discharges in the glow and corona regimes in PDE engines has been...in further detail in Refs. [17,21–23]. NRP discharges in the pin-to-pin configuration have been shown to operate in three regimes: corona , glow, and...assisted combustion Plasma assisted ignition Aircraft propulsionA nanosecond repetitively pulsed (NRP) discharge in the spark regime has been investigated

Thunderstorm activity in early Earth: same estimations from point of view a role of electric discharges in formation of prebiotic conditions

NASA Astrophysics Data System (ADS)

Serozhkin, Yu.

2008-09-01

Introduction The structure and the physical parameters of an early Earth atmosphere [1], most likely, played a determining role in formation of conditions for origin of life. The estimation of thunderstorm activity in atmosphere of the early Earth is important for understanding of the real role of electrical discharges during formation of biochemical compounds. The terrestrial lightning a long time are considered as one of components determining a physical state and chemical structure of an atmosphere. Liebig in 1827 has considered a capability of nitrogen fixation at discharges of lightning [2]. Recent investigations (Lamarque et al. 1996) have achieved that production rate of NOx due to lightning at 3·106 ton/year [3]. The efficiency of electric discharges as energy source for synthesis of low molecular weight organic compounds is explained by the several factors. To them concern effect of optical radiation, high temperature, shock waves and that is especially important, pulse character of these effects. The impulse impact is essentially reduced the probability of destruction of the formed compounds. However, for some reasons is not clear the real role of electric discharges in synthesis of biochemical compounds. The discharges used in experiments on synthesis of organic substances, do not remind the discharges observable in a nature. One more aspect of a problem about a role of electric discharges in forming pre-biotic conditions on the Earth is connected with the thunderstorm activity in a modern atmosphere. This activity is connected with the presence in an atmosphere of ice crystals and existing gradient of temperature. To tell something about a degree of thunderstorm activity during the early Earth, i.e. that period, when formed pre-biotic conditions were is very difficult. Astrobiological potential of various discharges First of all the diversity of electric discharges in terrestrial atmosphere (usual lightning, lightning at eruption of volcanoes

Phrenic and intercostal nerves with rhythmic discharge can promote early nerve regeneration after brachial plexus repair in rats.

PubMed

Rui, Jing; Xu, Ya-Li; Zhao, Xin; Li, Ji-Feng; Gu, Yu-Dong; Lao, Jie

2018-05-01

distal to the coaptation site of the musculocutaneous nerve at 1 month after surgery was significantly higher in phrenic and intercostal nerve groups than in thoracodorsal nerve and negative control groups. These results indicate that endogenous autonomic discharge from phrenic and intercostal nerves can promote nerve regeneration in early stages after brachial plexus injury.

Essential Elements of Early Post Discharge Care of Patients with Heart Failure.

PubMed

Soucier, Richard J; Miller, P Elliott; Ingrassia, Joseph J; Riello, Ralph; Desai, Nihar R; Ahmad, Tariq

2018-06-01

Heart failure is associated with an enormous burden on both patients and health care systems in the USA. Several national policy initiatives have focused on improving the quality of heart failure care, including reducing readmissions following hospitalization, which are common, costly, and, at least in part, preventable. The transition from inpatient to ambulatory care setting and the immediate post-hospitalization period present an opportunity to further optimize guideline concordant medical therapy, identify reversible issues related to worsening heart failure, and evaluate prognosis. It can also provide opportunities for medication reconciliation and optimization, consideration of device-based therapies, appropriate management of comorbidities, identification of individual barriers to care, and a discussion of goals of care based on prognosis. Recent studies suggest that attention to detail regarding patient comorbidities, barriers to care, optimization of both diuretic and neurohormonal therapies, and assessment of prognosis improve patient outcomes. Despite the fact that the transition period appears to be an optimal time to address these issues in a comprehensive manner, most patients are not referred to programs specializing in this approach post hospital discharge. The objective of this review is to provide an outline for early post discharge care that allows clinicians and other health care providers to care for these heart failure patients in a manner that is both firmly rooted in the guidelines and patient-centered. Data regarding which intervention is most likely to confer benefit to which subset of patients with this disease is lacking and warrants further study.

Structured scoring of supporting nursing tasks to enhance early discharge in geriatric rehabilitation: The BACK-HOME quasi-experimental study.

PubMed

Holstege, M S; Bakkers, E; van Balen, R; Gussekloo, J; Achterberg, W P; Caljouw, M A A

2016-12-01

In geriatric rehabilitation it is important to have timely discharge of patients, especially if they have low nursing support needs. However, no instruments are available to identify early discharge potential. To evaluate if weekly scoring of a nursing support scorecard in the evenings/nights and discussing the results in the multidisciplinary team meeting, leads to potential differences in discharge of geriatric rehabilitation patients. Quasi-experimental study with a reference cohort (n=200) and a Back-Home implementation cohort (n=283). Patients in geriatric rehabilitation in the four participating skilled nursing facilities in the Netherlands. Implementation of the nursing support scorecard during one year consisted of (1) weekly scoring of the scorecard to identify the supporting nursing tasks during the evenings/nights by trained nurses, and (2) discussion of the results in a multidisciplinary team meeting to establish if discharge home planning was feasible. Data on patients' characteristics and setting before admission were collected at admission; at discharge, the length of stay, discharge destination and barriers for discharge were collected by the nursing staff. Both cohorts were comparable with regard to median age, gender [reference cohort: 81 (IQR 75-88) years; 66% females vs. Back-Home cohort 82 (IQR 76-87) years; 71% females] and reasons for admission: stroke (23% vs. 23%), joint replacement (12% vs. 13%), traumatic injuries (31% vs. 34%), and other (35% vs. 30%). Overall, the median length of stay for the participants discharged home in the reference cohort was 56 (IQR 29-81) days compared to 46 (IQR 30-96) days in the Back-Home cohort (p=0.08). When no home adjustments were needed, participants were discharged home after 50 (IQR 29.5-97) days in the reference cohort, and after 42.5 (IQR 26-64.8) days in the Back-Home cohort (p=0.03). Reasons for discharge delay were environmental factors (36.7%) and patient-related factors, such as mental (21

Early Parental Abuse and Daily Assistance to Aging Parents With Disability: Associations With the Middle-Aged Adults' Daily Well-being.

PubMed

Liu, Yin; Kong, Jooyoung; Bangerter, Lauren R; Zarit, Steven H; Almeida, David M

2018-01-09

The current study examined the within-person association between providing daily assistance to aging parents with disability and adult children's daily mood in the context of early relationship with parents. We used data from 782 participants and 5,758 daily interviews from the Midlife in the United States (MIDUS) Refresher, with 248 people self-reported providing daily assistance ranging from 1 to 8 days out of the entire daily-interview period. Multilevel models were fit to examine the moderating effect of physical and emotional abuse from parents in early life on the associations between daily assistance to parents today and yesterday and daily mood. Additional analyses were conducted to examine whether the moderating effect of parental abuse remained when the assistance was provided for other family members and friends. Providing assistance today and yesterday to parents had immediate and lagged associations with higher negative affect when adult children experienced childhood emotional abuse from parents. No significant findings were found for daily positive affect. The moderating effect of parental abuse became nonsignificant when the assistance was provided to other family members or friends. Daily assistance to parents with disability needs to be examined in the context of the relationship history with parents. The impact of childhood abuse can linger long after the actual incident. Frequent early emotional abuse from parents was associated with greater distress when the middle-aged provided daily assistance to their aging parents. © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Focused breastfeeding counselling improves short- and long-term success in an early-discharge setting: A cluster-randomized study.

PubMed

Nilsson, Ingrid M S; Strandberg-Larsen, Katrine; Knight, Christopher H; Hansen, Anne Vinkel; Kronborg, Hanne

2017-10-01

Length of postnatal hospitalization has decreased and has been shown to be associated with infant nutritional problems and increase in readmissions. We aimed to evaluate if guidelines for breastfeeding counselling in an early discharge hospital setting had an effect on maternal breastfeeding self-efficacy, infant readmission and breastfeeding duration. A cluster randomized trial was conducted and assigned nine maternity settings in Denmark to intervention or usual care. Women were eligible if they expected a single infant, intended to breastfeed, were able to read Danish, and expected to be discharged within 50 hr postnatally. Between April 2013 and August 2014, 2,065 mothers were recruited at intervention and 1,476 at reference settings. Results show that the intervention did not affect maternal breastfeeding self-efficacy (primary outcome). However, less infants were readmitted 1 week postnatally in the intervention compared to the reference group (adjusted OR 0.55, 95% CI 0.37, -0.81), and 6 months following birth, more infants were exclusively breastfed in the intervention group (adjusted OR 1.36, 95% CI 1.02, -1.81). Moreover, mothers in the intervention compared to the reference group were breastfeeding more frequently (p < .001), and spend more hours skin to skin with their infants (p < .001). The infants were less often treated for jaundice (p = 0.003) and there was more paternal involvement (p = .037). In an early discharge hospital setting, a focused breastfeeding programme concentrating on increased skin to skin contact, frequent breastfeeding, good positioning of the mother infant dyad, and enhanced involvement of the father improved short-term and long-term breastfeeding success. © 2017 John Wiley & Sons Ltd.

Early hemi-diaphragmatic plication through a video assisted mini-thoracotomy in postcardiotomy phrenic nerve paresis

PubMed Central

Tsakiridis, Kosmas; Visouli, Aikaterini N.; Machairiotis, Nikolaos; Christofis, Christos; Stylianaki, Aikaterini; Katsikogiannis, Nikolaos; Mpakas, Andreas; Courcoutsakis, Nicolaos; Zarogoulidis, Konstantinos

2012-01-01

New symptom onset of respiratory distress without other cause, and new hemi-diaphragmatic elevation on chest radiography postcardiotomy, are usually adequate for the diagnosis of phrenic nerve paresis. The symptom severity varies (asymptomatic state to severe respiratory failure) depending on the degree of the lesion (paresis vs. paralysis), the laterality (unilateral or bilateral), the age, and the co-morbidity (respiratory, cardiac disease, morbid obesity, etc). Surgical treatment (hemi-diaphragmatic plication) is indicated only in the presence of symptoms. The established surgical treatment is plication of the affected hemidiaphragm which is generally considered safe and effective. Several techniques and approaches are employed for diaphragmatic plication (thoracotomy, video-assisted thoracoscopic surgery, video-assisted mini-thoracotomy, laparoscopic surgery). The timing of surgery depends on the severity and the progression of symptoms. In infants and young children with postcardiotomy phrenic nerve paresis the clinical status is usually severe (failure to wean from mechanical ventilation), and early plication is indicated. Adults with postcardiotomy phrenic nerve paresis usually suffer from chronic dyspnoea, and, in the absence of respiratory distress, conservative treatment is recommended for 6 months -2 years, since improvement is often observed. Nevertheless, earlier surgical treatment may be indicated in non-resolving respiratory failure. We present early (25th day postcardiotomy) right hemi-diaphragm plication, through a video assisted mini-thoracotomy in a high risk patient with postcardiotomy phrenic nerve paresis and respiratory distress. Early surgery with minimal surgical trauma, short operative time, minimal blood loss and postoperative pain, led to fast rehabilitation and avoidance of prolonged hospitalization complications. The relevant literature is discussed. PMID:23304442

Early intervention of negative pressure wound therapy using Vacuum-Assisted Closure in trauma patients: impact on hospital length of stay and cost.

PubMed

Kaplan, Mark; Daly, Darron; Stemkowski, Stephen

2009-03-01

The cost of treating complex traumatic wounds is substantial because of trauma severity, potential for infection, and delayed closure. Negative pressure wound therapy using reticulated open cell foam (NPWT/ROCF) as delivered by Vacuum-Assisted Closure* (KCI Licensing, Inc, San Antonio, Texas) is an established, viable option for treating traumatic wounds. The authors used retrospective data to study the clinical and cost-effective benefits of using NPWT/ROCF early on day 1 or day 2 of treatment for traumatic wounds as compared with using it late (on day 3 or later). Hospital data records from trauma wound patients treated with NPWT/ROCF were retrospectively analyzed. Data were subdivided into 2 groups based on start of treatment. The group of patients treated on day 1 or 2 of their hospital stay was referred to as the early group, and that composed of patients treated on day 3 or later as the late group. Clinical and cost-effective metrics were compared between the 2 groups. For the early group, 518 patient records were included; 1000 records were reviewed for the late group. Early-group patients had fewer hospital inpatient days (10.6 vs 20.6 days; P < .0001), fewer treatment days (5.1 vs 6.0 days; P = .0498), shorter intensive care unit (ICU) stays (5.3 vs 12.4 days; P < .0001), and higher ICU admission rates (51.5 vs 44.5%; P = .0091) than the late group. Compared with late-group patients, early-group patients had lower total and variable costs per patient discharge ($43,956 vs $32,175; P < .0001 and $22,891 vs $15,805; P < .0001, respectively). Acute-care trauma wound patients receiving early NPWT/ROCF demonstrated significant reductions in length of stay, treatment days, and ICU stay, which resulted in significant reduced patient treatment costs. These results indicate that early intervention with NPWT/ROCF has potential clinical and cost-effective benefits for the treatment of traumatic wounds.

Early-switch/early-discharge opportunities for hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections: proof of concept in the United Arab Emirates.

PubMed

El Houfi, Ashraf; Javed, Nadeem; Solem, Caitlyn T; Macahilig, Cynthia; Stephens, Jennifer M; Raghubir, Nirvana; Chambers, Richard; Li, Jim Z; Haider, Seema

2015-01-01

To describe real-world treatment patterns and health care resource use and to estimate opportunities for early-switch (ES) from intravenous (IV) to oral (PO) antibiotics and early-discharge (ED) for patients hospitalized in the United Arab Emirates (UAE) with methicillin-resistant Staphylococcus aureus (MRSA) complicated skin and soft tissue infections. This retrospective observational medical chart review study enrolled physicians from four UAE sites to collect data for 24 patients with documented MRSA complicated skin and soft tissue infections, hospitalized between July 2010 and June 2011, and discharged alive by July 2011. Data include clinical characteristics and outcomes, hospital length of stay (LOS), MRSA-targeted IV and PO antibiotic use, and ES and ED eligibility using literature-based and expert-validated criteria. Five included patients (20.8%) were switched from IV to PO antibiotics while being inpatients. Actual length of MRSA-active treatment was 10.8±7.0 days, with 9.8±6.6 days of IV therapy. Patients were hospitalized for a mean 13.9±9.3 days. The most frequent initial MRSA-active therapies used were vancomycin (37.5%), linezolid (16.7%), and clindamycin (16.7%). Eight patients were discharged with MRSA-active antibiotics, with linezolid prescribed most frequently (n=3; 37.5%). Fifteen patients (62.5%) met ES criteria and potentially could have discontinued IV therapy 8.3±6.0 days sooner, and eight (33.3%) met ED criteria and potentially could have been discharged 10.9±5.8 days earlier. While approximately one-fifth of patients were switched from IV to PO antibiotics in the UAE, there were clear opportunities for further optimization of health care resource use. Over half of UAE patients hospitalized for MRSA complicated skin and soft tissue infections could be eligible for ES, with one-third eligible for ED opportunities, resulting in substantial potential for reductions in IV days and bed days.

Improving Posthospital Discharge Telephone Reach Rates Through Prehospital Discharge Face-to-Face Meetings.

PubMed

Vergara, Franz H; Sheridan, Daniel J; Sullivan, Nancy J; Budhathoki, Chakra

The purpose of this study was to determine whether a face-to-face meeting with patients by a telephonic case manager prehospital discharge would result in increased telephone follow-up (TFU) reach rates posthospital discharge. Acute care adult medicine inpatient units. A quasiexperimental design was utilized. Two adult inpatient medicine units were selected as the intervention and comparison groups. The framework of the study is the transitions theory. A convenience sampling technique was used, whereby 88 eligible patients on the intervention unit received face-to-face meetings prehospital discharge whereas 123 patients on the comparison unit received standard care (no face-to-face meetings). Cross-tabulation and chi-square tests were employed to examine the association of face-to-face meeting intervention and TFU reach rates. Implementing brief (<10 min) face-to-face meetings by a telephonic case manager prehospital discharge resulted in a TFU reach rate of 87% on the intervention unit, whereas the comparison unit only had a 58% TFU reach rate (p < .001). Increasing reach rates by a telephonic case manager facilitates communication with more patients posthospital discharge. A brief prehospital discharge face-to-face meeting with patients assisted them to understand the reasons for a posthospital discharge telephone call, identified the best times to call using accurate telephone numbers, and taught patients how best to prepare for the call. In addition, by meeting patients face-to-face, the telephonic case manager was no longer an unknown person on the telephone asking them questions about their medical condition. These factors combined may have significantly helped to increase TFU reach rates.

Direct observation of laser guided corona discharges

PubMed Central

Wang, Tie-Jun; Wei, Yingxia; Liu, Yaoxiang; Chen, Na; Liu, Yonghong; Ju, Jingjing; Sun, Haiyi; Wang, Cheng; Lu, Haihe; Liu, Jiansheng; Chin, See Leang; Li, Ruxin; Xu, Zhizhan

2015-01-01

Laser based lightning control holds a promising way to solve the problem of the long standing disaster of lightning strikes. But it is a challenging project due to insufficient understanding of the interaction between laser plasma channel and high voltage electric filed. In this work, a direct observation of laser guided corona discharge is reported. Laser filament guided streamer and leader types of corona discharges were observed. An enhanced ionization took place in the leader (filament) through the interaction with the high voltage discharging field. The fluorescence lifetime of laser filament guided corona discharge was measured to be several microseconds, which is 3 orders of magnitude longer than the fluorescence lifetime of laser filaments. This work could be advantageous towards a better understanding of laser assisted leader development in the atmosphere. PMID:26679271

Constricted glow discharge plasma source

DOEpatents

Anders, Andre; Anders, Simone; Dickinson, Michael; Rubin, Michael; Newman, Nathan

2000-01-01

A constricted glow discharge chamber and method are disclosed. The polarity and geometry of the constricted glow discharge plasma source is set so that the contamination and energy of the ions discharged from the source are minimized. The several sources can be mounted in parallel and in series to provide a sustained ultra low source of ions in a plasma with contamination below practical detection limits. The source is suitable for applying films of nitrides such as gallium nitride and oxides such as tungsten oxide and for enriching other substances in material surfaces such as oxygen and water vapor, which are difficult process as plasma in any known devices and methods. The source can also be used to assist the deposition of films such as metal films by providing low-energy ions such as argon ions.

40 CFR 35.918-3 - Requirements for discharge of effluents.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Requirements for discharge of effluents. 35.918-3 Section 35.918-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act...

40 CFR 35.918-3 - Requirements for discharge of effluents.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Requirements for discharge of effluents. 35.918-3 Section 35.918-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act...

40 CFR 35.918-3 - Requirements for discharge of effluents.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Requirements for discharge of effluents. 35.918-3 Section 35.918-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act...

40 CFR 35.918-3 - Requirements for discharge of effluents.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Requirements for discharge of effluents. 35.918-3 Section 35.918-3 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GRANTS AND OTHER FEDERAL ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act...

Discharge information needs and symptom distress after abdominal aortic surgery.

PubMed

Galloway, S; Rebeyka, D; Saxe-Braithwaite, M; Bubela, N; McKibbon, A

1997-01-01

The purpose of this study was to describe the discharge information needs and symptom distress of people after abdominal aortic reconstructive surgery. Interviews (N = 51) were conducted prior to, and 4 weeks after, hospital discharge. People indicated that the most important information to help them manage their care after discharge related to the recognition, prevention and management of complications. Broken sleep and incisional pain were the most distressful of symptoms prior to hospital discharge, whereas fatigue and broken sleep were most distressful once home. These results may assist nurses to understand the discharge information needs and symptom distress of people recovering from aortic reconstructive surgery and the importance of discharge education to help people to manage their care once home.

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

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.

Discharge measurements at gaging stations

USGS Publications Warehouse

Turnipseed, D. Phil; Sauer, Vernon B.

2010-01-01

The techniques and standards for making discharge measurements at streamflow gaging stations are described in this publication. The vertical axis rotating-element current meter, principally the Price current meter, has been traditionally used for most measurements of discharge; however, advancements in acoustic technology have led to important developments in the use of acoustic Doppler current profilers, acoustic Doppler velocimeters, and other emerging technologies for the measurement of discharge. These new instruments, based on acoustic Doppler theory, have the advantage of no moving parts, and in the case of the acoustic Doppler current profiler, quickly and easily provide three-dimensional stream-velocity profile data through much of the vertical water column. For much of the discussion of acoustic Doppler current profiler moving-boat methodology, the reader is referred to U.S. Geological Survey Techniques and Methods 3-A22 (Mueller and Wagner, 2009). Personal digital assistants (PDAs), electronic field notebooks, and other personal computers provide fast and efficient data-collection methods that are more error-free than traditional hand methods. The use of portable weirs and flumes, floats, volumetric tanks, indirect methods, and tracers in measuring discharge are briefly described.

Early supported discharge following mild stroke: a qualitative study of patients' and their partners' experiences of rehabilitation at home.

PubMed

Lou, Stina; Carstensen, Kathrine; Møldrup, Marie; Shahla, Seham; Zakharia, Elias; Nielsen, Camilla Palmhøj

2017-06-01

Early supported discharge (ESD) allows mild-to-moderate stroke patients to return home as soon as possible and continue rehabilitation at their own pace in familiar surroundings. Thus, the main responsibility for continued rehabilitation is in the hands of patients and their partners, who must collaborate to adjust to poststroke everyday life. However, couples' joint experiences of stroke, early discharge and rehabilitation at home remain minimally investigated. To investigate how mild stroke patients' and their partners' experience and manage everyday life in a context of ESD. We conducted qualitative interviews with a purposive sample of 22 ESD patients and 18 partners. Interviews were conducted 3-6 weeks after stroke, and we used thematic analysis to analyse the data. The analysis identified three themes. First, 'Home as a healing place' involved the couples' experiences of a well-informed discharge from hospital. They trusted the health professionals' assessment that the patient was ready to go home. They described home as a comforting and calm place, where recovery could meaningfully take place. The second theme, 'Flow of everyday life', comprised the experiences of adapting to and continuing everyday life. Most of the interviewees had relatively minor physical and cognitive impairments, and the patients and their partners were hopeful for a full recovery in the foreseeable future. Finally, 'Professional safety net' involved the much appreciated stroke team. Although most of the participants only had one visit from the team, knowing that they were an accessible resource was very important to the couples. ESD was experienced as a meaningful and adequate rehabilitation service that allowed patients and partners to collaboratively reinvent and rebuild their flow of everyday life by jointly adjusting routines, activities and their relationship. © 2016 Nordic College of Caring Science.

Study of ultrasound-assisted radio-frequency plasma discharges in n-dodecane

NASA Astrophysics Data System (ADS)

Camerotto, Elisabeth; De Schepper, Peter; Nikiforov, Anton Y.; Brems, Steven; Shamiryan, Denis; Boullart, Werner; Leys, Christophe; De Gendt, Stefan

2012-10-01

This paper investigates the generation of a stable plasma phase in a liquid hydrocarbon (n-dodecane) by means of ultrasound (US) and radio-frequency (RF) or electromagnetic radiation. It is demonstrated for the first time that ultrasonic aided RF plasma discharges can be generated in a liquid. Plasma discharges are obtained for different gas mixtures at a pressure of 12 kPa and at low ignition powers (100 W for RF and 2.4 W cm-2 for US). Direct carbon deposition from the liquid precursor on Cu, Ni, SiO2 and Si substrates has been obtained and no apparent compositional or structural difference among the substrate materials was observed. Characterization of the deposited solid phase revealed an amorphous structure. In addition, structural changes in the liquid precursor after plasma treatment have been analysed. Optical emission spectroscopy (OES) allowed the estimation of several plasma characteristic temperatures. The plasma excitation temperature was estimated to be about 2.3-2.4 eV. The rotational and vibrational temperatures of the discharge in n-dodecane with Ar as a feed gas were 1400 K and 6500 K, respectively. In Ar/O2 plasma, an increased rotational (1630 K) and vibrational temperature (7200 K) were obtained.

Long recovery VLF perturbations associated with lightning discharges

NASA Astrophysics Data System (ADS)

Salut, M. M.; Abdullah, M.; Graf, K. L.; Cohen, M. B.; Cotts, B. R. T.; Kumar, Sushil

2012-08-01

Long D-region ionospheric recovery perturbations are a recently discovered and poorly understood subcategory of early VLF events, distinguished by exceptionally long ionospheric recovery times of up to 20 min (compared to more typical ˜1 min recovery times). Characteristics and occurrence rates of long ionospheric recovery events on the NWC transmitter signal recorded at Malaysia are presented. 48 long recovery events were observed. The location of the causative lightning discharge for each event is determined from GLD360 and WWLLN data, and each discharge is categorized as being over land or sea. Results provide strong evidence that long recovery events are attributed predominately to lightning discharges occurring over the sea, despite the fact that lightning activity in the region is more prevalent over land. Of the 48 long recovery events, 42 were attributed to lightning activity over water. Analysis of the causative lightning of long recovery events in comparison to all early VLF events reveals that these long recovery events are detectable for lighting discharges at larger distances from the signal path, indicating a different scattering pattern for long recovery events.

A direct comparison of decision rules for early discharge of suspected acute coronary syndromes in the era of high sensitivity troponin.

PubMed

Chew, Pei Gee; Frost, Fredrick; Mullen, Liam; Fisher, Michael; Zadeh, Heidar; Grainger, Ruth; Albouaini, Khaled; Dodd, James; Patel, Bilal; Velavan, Periaswamy; Kunadian, Babu; Rawat, Anju; Obafemi, Toba; Tong, Sarah; Jones, Julia; Khand, Aleem

2018-02-01

We tested the hypothesis that a single high sensitivity troponin at limits of detection (LOD HSTnT) (<5 ng/l) combined with a presentation non-ischaemic electrocardiogram is superior to low-risk Global Registry of Acute Coronary Events (GRACE) (<75), Thrombolysis in Myocardial Infarction (TIMI) (≤1) and History, ECG, Age, Risk factors and Troponin (HEART) score (≤3) as an aid to early, safe discharge for suspected acute coronary syndrome. In a prospective cohort study, risk scores were computed in consecutive patients with suspected acute coronary syndrome presenting to the Emergency Room of a large English hospital. Adjudication of myocardial infarction, as per third universal definition, involved a two-physician, blinded, independent review of all biomarker positive chest pain re-presentations to any national hospital. The primary and secondary outcome was a composite of type 1 myocardial infarction, unplanned coronary revascularisation and all cause death (MACE) at six weeks and one year. Of 3054 consecutive presentations with chest pain 1642 had suspected acute coronary syndrome (52% male, median age 59 years, 14% diabetic, 20% previous myocardial infarction). Median time from chest pain to presentation was 9.7 h. Re-presentations occurred in eight hospitals with 100% follow-up achieved. Two hundred and eleven (12.9%) and 279 (17%) were adjudicated to suffer MACE at six weeks and one year respectively. Only HEART ≤3 (negative predictive value MACE 99.4%, sensitivity 97.6%, %discharge 53.4) and LOD HSTnT strategy (negative predictive value MACE 99.8%, sensitivity 99.5%, %discharge 36.9) achieved pre-specified negative predictive value of >99% for MACE at six weeks. For type 1 myocardial infarction alone the negative predictive values at six weeks and one year were identical, for both HEART ≤3 and LOD HSTnT at 99.8% and 99.5% respectively. HEART ≤3 or LOD HSTnT strategy rules out short and medium term myocardial infarction with ≥99.5% certainty, and

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.

Technical Assistance and Changes in Nutrition and Physical Activity Practices in the National Early Care and Education Learning Collaboratives Project, 2015-2016.

PubMed

Chiappone, Alethea; Smith, Teresa M; Estabrooks, Paul A; Rasmussen, Cristy Geno; Blaser, Casey; Yaroch, Amy L

2018-04-26

The National Early Care and Education Learning Collaboratives Project (ECELC) aims to improve best practices in early care and education (ECE) programs in topic areas of the Nutrition and Physical Activity Self-Assessment in Child Care (NAP SACC). Technical assistance is a component of the ECELC, yet its effect on outcomes is unclear. Beyond dose and duration of technical assistance, limited research exists on characteristics of technical assistance that contribute to outcomes. The objective of this study was to identify and describe technical assistance characteristics and explore associations with NAP SACC outcomes. We collected data from 10 collaboratives comprising 84 ECE programs in 2 states in 2015-2016. The objective of technical assistance was to support programs in improving best practices. Technical assistance was provided to programs via on-site, telephone, or email and was tailored to program needs. We used a mixed-methods design to examine associations between technical assistance and NAP SACC outcomes. We used multiple regression analysis to assess quantitative data and qualitative comparative analysis to determine necessary and sufficient technical assistance conditions supporting NAP SACC outcomes. We also conducted a document review to describe technical assistance that referred conditions identified by the qualitative comparative analysis. Regression analyses detected an inverse relationship between changes in NAP SACC scores and hours of technical assistance. No clear pattern emerged in the qualitative comparative analysis, leaving no necessary and sufficient conditions. However, the qualitative comparative analysis identified feedback as a potentially important component of technical assistance, whereas resource sharing and frequent email were characteristics that seemed to reduce the likelihood of improved outcomes. Email and resource sharing were considered primarily general information rather than tailored technical assistance. Technical

Effects of post-discharge management on rates of early re-admission and death after hospitalisation for heart failure.

PubMed

Huynh, Quan; Negishi, Kazuaki; De Pasquale, Carmine; Hare, James; Leung, Dominic; Stanton, Tony; Marwick, Thomas H

2018-06-18

To investigate whether enrolment of patients in management programs after hospitalisation for heart failure (HF) reduces the likelihood of post-hospital adverse outcomes. Cohort study in which associations between adverse outcomes at 30 and 90 days for people hospitalised for HF and baseline clinical, socio-demographic and blood pathology factors, and with post-discharge management strategies, were assessed. Setting, participants: 906 patients with HF were prospectively enrolled in five Australian states at cardiology departments with expertise in treating people with HF. All-cause re-admissions and deaths at 30 and 90 days after discharge from the index admission. 58% of patients were men; the mean age was 72.5 years (SD, 13.9 years). By hospital, 30-day re-admission rates ranged from 17% to 33%, and 90-day rates from 40% to 55%; 30-day mortality rates were 0-13%, 90-day rates 4-24%. Factors associated with increased odds of re-admission or death at 30 or 90 days included living alone, cognitive impairment, depression, NYHA classification, left atrial volume index, and Charlson index score. Nurse-led disease management programs and reviews within 7 days were associated with reduced odds of re-admission (but not of death) at 30 and 90 days; exercise programs were associated with reduced odds at 90 days. Significant between-hospital differences in re-admission rates were reduced after adjustment for post-discharge management programs, and abolished by further adjustment for echocardiography findings. Between-hospital differences in mortality were largely explained by differences in echocardiographic findings. Differences in early re-admission rates after hospitalisation for HF are primarily explained by differences in post-discharge management.

Characteristics of sediment discharge in the subarctic Yukon River, Alaska

USGS Publications Warehouse

Chikita, K.A.; Kemnitz, R.; Kumai, R.

2002-01-01

The characteristics of sediment discharge in the Yukon River, Alaska were investigated by monitoring water discharge, water turbidity and water temperature. The river-transported sediment, 90 wt.% or more, consists of silt and clay (grain size ??? 62.5 ??m), which probably originated in the glacier-covered mountains mostly in the Alaska Range. For early June to late August 1999, we continuously measured water turbidity and temperature near the estuary and in the middle of Yukon River by using self-recording turbidimeters and temperature data loggers. The water turbidity (ppm) was converted to suspended sediment concentration (SSC; mg/l) of river water, using a relation between simultaneous turbidity and SSC at each of the two sites, and then, the suspended sediment discharge, approximately equal to water discharge times SSC, was numerically obtained every 1 or 2 h. It should be noted that the sediment discharge in the Yukon River is controlled by SSC rather than water discharge. As a result, a peak sediment discharge occurred in mid or late August by local sediment runoffs due to glacier-melt (or glacier-melt plus rainfall), while a peak water discharge was produced by snowmelt in late June or early July. Application of the "extended Shields diagram" indicates that almost all the river-transported sediments are under complete suspension. ?? 2002 Elsevier Science B.V. All rights reserved.

A comparison of resource utilization following chemotherapy for acute myeloid leukemia in children discharged versus children that remain hospitalized during neutropenia

PubMed Central

Getz, Kelly D; Miller, Tamara P; Seif, Alix E; Li, Yimei; Huang, Yuan-Shung; Bagatell, Rochelle; Fisher, Brian T; Aplenc, Richard

2015-01-01

Comparisons of early discharge and outpatient postchemotherapy supportive care in pediatric acute myeloid leukemia (AML) patients are limited. We used data from the Pediatric Health Information System on a cohort of children treated for newly diagnosed AML to compare course-specific mortality and resource utilization in patients who were discharged after chemotherapy to outpatient management during neutropenia relative to patients who remained hospitalized. Patients were categorized at each course as early or standard discharge. Discharges within 3 days after chemotherapy completion were considered “early”. Resource utilization was determined based on daily billing data and reported as days of use per 1000 hospital days. Inpatient mortality, occurrence of intensive care unit (ICU)-level care, and duration of hospitalization were compared using logistic, log-binomial and linear regression methods, respectively. Poisson regression with inpatient days as offset was used to compare resource use by discharge status. The study population included 996 patients contributing 2358 treatment courses. Fewer patients were discharged early following Induction I (7%) than subsequent courses (22–24%). Across courses, patients discharged early experienced high readmission rates (69–84%), yet 9–12 fewer inpatient days (all P < 0.001). Inpatient mortality was low across courses and did not differ significantly by discharge status. The overall risk for ICU-level care was 116% higher for early compared to standard discharge patients (adjusted risk ratio: 2.16, 95% confidence interval: 1.50, 3.11). Rates of antibiotic, vasopressor, and supplemental oxygen use were consistently elevated for early discharge patients. Despite similar inpatient mortality to standard discharge patients, early discharge patients may be at greater risk for life-threatening chemotherapy-related complications, including infections. PMID:26105201

Kinetic study on non-thermal volumetric plasma decay in the early afterglow of air discharge generated by a short pulse microwave or laser

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

Yang, Wei, E-mail: yangwei861212@126.com; Zhou, Qianhong; Dong, Zhiwei

This paper reports a kinetic study on non-thermal plasma decay in the early afterglow of air discharge generated by short pulse microwave or laser. A global self-consistent model is based on the particle balance of complex plasma chemistry, electron energy equation, and gas thermal balance equation. Electron-ion Coulomb collision is included in the steady state Boltzmann equation solver to accurately describe the electron mobility and other transport coefficients. The model is used to simulate the afterglow of microsecond to nanosecond pulse microwave discharge in N{sub 2}, O{sub 2}, and air, as well as femtosecond laser filament discharge in dry andmore » humid air. The simulated results for electron density decay are in quantitative agreement with the available measured ones. The evolution of plasma decay under an external electric field is also investigated, and the effect of gas heating is considered. The underlying mechanism of plasma density decay is unveiled through the above kinetic modeling.« less

Safe start at home: what parents of newborns need after early discharge from hospital - a focus group study.

PubMed

Kurth, Elisabeth; Krähenbühl, Katrin; Eicher, Manuela; Rodmann, Susanne; Fölmli, Luzia; Conzelmann, Cornelia; Zemp, Elisabeth

2016-03-08

The length of postpartum hospital stay is decreasing internationally. Earlier hospital discharge of mothers and newborns decreases postnatal care or transfers it to the outpatient setting. This study aimed to investigate the experiences of new parents and examine their views on care following early hospital discharge. Six focus group discussions with new parents (n = 24) were conducted. A stratified sampling scheme of German and Turkish-speaking groups was employed. A 'playful design' method was used to facilitate participants communication wherein they used blocks and figurines to visualize their perspectives on care models The visualized constructions of care models were photographed and discussions were audio-recorded and transcribed verbatim. Text and visual data was thematically analyzed by a multi-professional group and findings were validated by the focus group participants. Following discharge, mothers reported feeling physically strained during recuperating from birth and initiating breastfeeding. The combined requirements of infant and self-care needs resulted in a significant need for practical and medical support. Families reported challenges in accessing postnatal care services and lacking inter-professional coordination. The visualized models of ideal care comprised access to a package of postnatal care including monitoring, treating and caring for the health of the mother and newborn. This included home visits from qualified midwives, access to a 24-h helpline, and domestic support for household tasks. Participants suggested that improving inter-professional networks, implementing supervisors or a centralized coordinating center could help to remedy the current fragmented care. After hospital discharge, new parents need practical support, monitoring and care. Such support is important for the health and wellbeing of the mother and child. Integrated care services including professional home visits and a 24-hour help line may help meet the needs of

44 CFR 401.1 - Prohibited transportation and discharge.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Prohibited transportation and... TRANSPORTATION SHIPPING RESTRICTIONS (T-1) § 401.1 Prohibited transportation and discharge. No person shall..., employee or agent of the owner of the ship or aircraft who participates in the transportation. The consular...

44 CFR 401.1 - Prohibited transportation and discharge.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 44 Emergency Management and Assistance 1 2014-10-01 2014-10-01 false Prohibited transportation and... TRANSPORTATION SHIPPING RESTRICTIONS (T-1) § 401.1 Prohibited transportation and discharge. No person shall..., employee or agent of the owner of the ship or aircraft who participates in the transportation. The consular...

44 CFR 401.1 - Prohibited transportation and discharge.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 44 Emergency Management and Assistance 1 2012-10-01 2011-10-01 true Prohibited transportation and... TRANSPORTATION SHIPPING RESTRICTIONS (T-1) § 401.1 Prohibited transportation and discharge. No person shall..., employee or agent of the owner of the ship or aircraft who participates in the transportation. The consular...

44 CFR 401.1 - Prohibited transportation and discharge.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 44 Emergency Management and Assistance 1 2013-10-01 2013-10-01 false Prohibited transportation and... TRANSPORTATION SHIPPING RESTRICTIONS (T-1) § 401.1 Prohibited transportation and discharge. No person shall..., employee or agent of the owner of the ship or aircraft who participates in the transportation. The consular...

Effect of Inductive Coil Geometry on the Thrust Efficiency of a Microwave Assisted Discharge Inductive Plasma Accelerator

NASA Technical Reports Server (NTRS)

Hallock, Ashley; Polzin, Kurt; Emsellem, Gregory

2012-01-01

Pulsed inductive plasma thrusters [1-3] are spacecraft propulsion devices in which electrical energy is capacitively stored and then discharged through an inductive coil. The thruster is electrodeless, with a time-varying current in the coil interacting with a plasma covering the face of the coil to induce a plasma current. Propellant is accelerated and expelled at a high exhaust velocity (O(10-100 km/s)) by the Lorentz body force arising from the interaction of the magnetic field and the induced plasma current. While this class of thruster mitigates the life-limiting issues associated with electrode erosion, pulsed inductive plasma thrusters require high pulse energies to inductively ionize propellant. The Microwave Assisted Discharge Inductive Plasma Accelerator (MAD-IPA) [4, 5] is a pulsed inductive plasma thruster that addressees this issue by partially ionizing propellant inside a conical inductive coil via an electron cyclotron resonance (ECR) discharge. The ECR plasma is produced using microwaves and permanent magnets that are arranged to create a thin resonance region along the inner surface of the coil, restricting plasma formation, and in turn current sheet formation, to a region where the magnetic coupling between the plasma and the inductive coil is high. The use of a conical theta-pinch coil is under investigation. The conical geometry serves to provide neutral propellant containment and plasma plume focusing that is improved relative to the more common planar geometry of the Pulsed Inductive Thruster (PIT) [2, 3], however a conical coil imparts a direct radial acceleration of the current sheet that serves to rapidly decouple the propellant from the coil, limiting the direct axial electromagnetic acceleration in favor of an indirect acceleration mechanism that requires significant heating of the propellant within the volume bounded by the current sheet. In this paper, we describe thrust stand measurements performed to characterize the performance

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.

Pilot Study on Early Postoperative Discharge in Pituitary Adenoma Patients: Effect of Socioeconomic Factors and Benefit of Specialized Pituitary Centers.

PubMed

Sarkiss, Christopher A; Lee, James; Papin, Joseph A; Geer, Eliza B; Banik, Rudrani; Rucker, Janet C; Oudheusden, Barbara; Govindaraj, Satish; Shrivastava, Raj K

2015-08-01

Introduction Pituitary neoplasms are benign entities that require distinct diagnostic and treatment considerations. Recent advances in endoscopic transsphenoidal surgery have resulted in shorter lengths of stay (LOS). We implemented a postoperative day (POD) 1 discharge paradigm involving a multidisciplinary approach and detailed preoperative evaluation and review of both medical and socioeconomic factors. Methods The experience of a single neurosurgeon/ears, nose, throat (ENT) team was reviewed, generating a preliminary retrospective database of the first 30 patients who underwent resection of pituitary lesions under the POD 1 discharge paradigm. We assessed multiple axes from their preoperative, in-house, and postoperative care. Results There were 14 men and 16 women with an average age of 53.8 years (range: 27-76 years). There were 22 nonsecretory and 8 secretory tumors with average size of 2.80 cm (range: 1.3-5.0 cm). All 30 patients underwent preoperative ENT evaluation. Average LOS was 1.5 ± 0.7 days. A total of 18 of 30 patients were discharged on POD 1. The insurance status included 15 with public insurance such as emergency Medicaid and 15 with private insurance. Four patients had transient diabetes insipidus (DI); none had permanent DI. Overall, 28 of 30 patients received postoperative steroids. Factors that contributed to LOS > 1 day included public insurance status, two or more medical comorbidities, diabetes mellitus, transient panhypopituitarism, and DI. Conclusion The implementation of a POD 1 discharge plan for pituitary tumors is feasible and safe for elective patients. This implementation requires the establishment of a dedicated Pituitary Center model with experienced team members. The consistent limitation to early discharge was socioeconomic status. Efforts that incorporate the analysis of social disposition parameters with proper management of clinical sequelae are crucial to the maintenance of ideal LOS and optimal patient

Discharge Chamber Primary Electron Modeling Activities in Three-Dimensions

NASA Technical Reports Server (NTRS)

Steuber, Thomas J.

2004-01-01

Designing discharge chambers for ion thrusters involves many geometric configuration decisions. Various decisions will impact discharge chamber performance with respect to propellant utilization efficiency, ion production costs, and grid lifetime. These hardware design decisions can benefit from the assistance of computational modeling. Computational modeling for discharge chambers has been limited to two-dimensional codes that leveraged symmetry for interpretation into three-dimensional analysis. This paper presents model development activities towards a three-dimensional discharge chamber simulation to aid discharge chamber design decisions. Specifically, of the many geometric configuration decisions toward attainment of a worthy discharge chamber, this paper focuses on addressing magnetic circuit considerations with a three-dimensional discharge chamber simulation as a tool. With this tool, candidate discharge chamber magnetic circuit designs can be analyzed computationally to gain insight into factors that may influence discharge chamber performance such as: primary electron loss width in magnetic cusps, cathode tip position with respect to the low magnetic field volume, definition of a low magnetic field region, and maintenance of a low magnetic field region across the grid span. Corroborating experimental data will be obtained from mockup hardware tests. Initially, simulated candidate magnetic circuit designs will resemble previous successful thruster designs. To provide opportunity to improve beyond previous performance benchmarks, off-design modifications will be simulated and experimentally tested.

Infrasound reveals transition to oscillatory discharge regime during lava fountaining: Implication for early warning

NASA Astrophysics Data System (ADS)

Ulivieri, Giacomo; Ripepe, Maurizio; Marchetti, Emanuele

2013-06-01

present the analysis of ~4 million infrasonic signals which include 39 episodes of lava fountains recorded at 5.5 km from the active vents. We show that each eruptive episode is characterized by a distinctive trend in the amplitude, waveform, and frequency content of the acoustic signals, reflecting different explosive levels. Lava fountain starts with an ~93 min long violent phase of acoustic transients at ~1.25 Hz repeating every 2-5 s. Infrasound suddenly evolves into a persistent low-frequency quasi-monochromatic pressure oscillation at ~0.4 Hz. We interpret this shift as induced by the transition from the slug (discrete Strombolian) to churn flow (sustained lava fountain) regime that is reflecting an increase in the gas discharge rate. We calculate that infrasonic transition can occur at a gas superficial velocity of ≤76 m/s and it can be used to define infrasonic-based thresholds for an efficient early warning system.

Vancouver Transcatheter Aortic Valve Replacement Clinical Pathway: Minimalist Approach, Standardized Care, and Discharge Criteria to Reduce Length of Stay.

PubMed

Lauck, Sandra B; Wood, David A; Baumbusch, Jennifer; Kwon, Jae-Yung; Stub, Dion; Achtem, Leslie; Blanke, Philipp; Boone, Robert H; Cheung, Anson; Dvir, Danny; Gibson, Jennifer A; Lee, Bobby; Leipsic, Jonathan; Moss, Robert; Perlman, Gidon; Polderman, Jopie; Ramanathan, Krishnan; Ye, Jian; Webb, John G

2016-05-01

We describe the development, implementation, and evaluation of a standardized clinical pathway to facilitate safe discharge home at the earliest time after transfemoral transcatheter aortic valve replacement. Between May 2012 and October 2014, the Heart Team developed a clinical pathway suited to the unique requirements of transfemoral transcatheter aortic valve replacement in contemporary practice. The components included risk-stratified minimalist periprocedure approach, standardized postprocedure care with early mobilization and reconditioning, and criteria-driven discharge home. Our aim was to reduce variation in care, identify a subgroup of patients suitable for early discharge (≤48 hours), and decrease length of stay for all patients. We addressed barriers related to historical practices, complex multidisciplinary stakeholder engagement, and adoption of length of stay as a quality indicator. We retrospectively reviewed the experiences of 393 consecutive patients; 150 (38.2%) were discharged early. At baseline, early discharge patients had experienced less previous balloon aortic valvuloplasty, had higher left ventricular ejection fraction, better cognitive function, and were less frail than the standard discharge group (>48 hours). Early discharge was associated with the use of local anesthesia, implantation of balloon expandable device, avoidance of urinary catheter, and early removal of temporary pacemaker. Median length of stay was 1 day for early discharge and 3 days for other patients; 97.7% were discharged home. There were no differences in 30-day mortality (1.3%), disabling stroke (0.8%), or readmission (10.7%). The implementation of a transcatheter aortic valve replacement clinical pathway shifted the program's approach to combine standardized processes and individual risk stratification. The Vancouver transcatheter aortic valve replacement clinical pathway requires a rigorous assessment to determine its efficacy, safety, and reproducibility. �

Factors associated with discharge to home versus discharge to institutional care after inpatient stroke rehabilitation.

PubMed

Nguyen, Vu Q C; PrvuBettger, Janet; Guerrier, Tami; Hirsch, Mark A; Thomas, J George; Pugh, Terrence M; Rhoads, Charles F

2015-07-01

To examine sociodemographic and clinical characteristics independently associated with discharge home compared with discharge to a skilled nursing facility (SNF) after acute inpatient rehabilitation. Retrospective cohort study. Three tertiary accredited acute care rehabilitation facilities. Adult patients with stroke (N=2085). Not applicable. Not applicable. Of 2085 patients with stroke treated at 3 centers over a 4-year period, 78.2% (n=1631) were discharged home and 21.8% (n=454) discharged to an SNF. Findings from a multivariable logistic regression analysis indicated that patients were less likely to be discharged home if they were older (odds ratio [OR], .98; 95% confidence interval [CI], .96-.99), separated or divorced (compared with married; OR, .61; 95% CI, .48-.79), or with Medicare health insurance (compared with private insurance; OR, .69; 95% CI, .55-.88), or had dysphagia (OR, .83; 95% CI, .71-.98) or cognitive deficits (OR, .79; 95% CI, .77-.81). The odds of being discharged home were higher for those admitted with a higher motor FIM score (OR, 1.10; 95% CI, 1.09-1.11). The following were not associated with discharge disposition: sex, race, prestroke vocational status, availability of secondary health insurance, number of days from stroke onset to rehabilitation facility admission, stroke type, impairment group, cognitive FIM on admission, other stroke deficits (aphasia, ataxia, neglect, or speech disturbance), stroke complications of hyponatremia or urinary tract infection, or comorbid conditions. One in 5 patients with stroke were discharged to an SNF after inpatient rehabilitation. On admission, several sociodemographic and clinical characteristics were identified that could be considered as important factors in early discussions for discharge planning. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

38 CFR 21.7046 - Eligibility for supplemental educational assistance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... qualify the individual for basic educational assistance without a break in any such service. (2) After...) Continue on active duty without a break, (ii) Be discharged from service with an honorable discharge, (iii... attached to a unit of the Selected Reserve for any reason (also to be prescribed by the Secretary concerned...

Growth and body composition of human milk-fed premature infants provided with extra energy and nutrients early after hospital discharge: 1-year follow-up.

PubMed

Aimone, Ashley; Rovet, Joanne; Ward, Wendy; Jefferies, Ann; Campbell, Douglas M; Asztalos, Elizabeth; Feldman, Mark; Vaughan, Jennifer; Westall, Carol; Whyte, Hilary; O'Connor, Deborah L

2009-10-01

Human milk (HM) is the optimal source of nutrition for premature infants; however, it is unclear whether HM alone is sufficient to meet their elevated nutritional requirements early after hospital discharge. We previously reported that premature infants (750-1800 g birth weight) fed HM containing extra nutrients for 12 weeks after discharge had dietary intakes closer to recommended levels and grew more rapidly than those fed HM alone. The objectives of the present article are to examine the impact of this intervention on bone mineralization, body composition, and HM use up to 1 year. Data are also presented on general developmental level at 18-month corrected age (CA). At discharge, predominantly HM-fed infants were randomized to receive for 12 weeks either approximately half of their feedings containing a multinutrient fortifier (intervention, n=19) or all of their feedings as HM alone (control, n=20). Intervention infants remained longer (P<0.001) and had greater whole-body bone mineral content (P=0.02) until 12-month CA compared with controls. Intervention infants born less than or equal to 1250 g continued to have a larger mean head circumference throughout the first year of life (P<0.0001). Human milk feeding (mL.kg(-1).day(-1)) differed between groups at 6- (P=0.035), but not 12-month CA. No statistically significant differences were found between groups in the mental, motor, or behavior rating scale scores of the Bayley II at 18-month CA. Adding a multinutrient fortifier to HM provided to predominantly HM-fed premature infants early after discharge results in sustained differences in weight, length, and whole-body bone mineral content, and in smaller babies, head circumference for the first year of life.

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.

34 CFR 686.42 - Discharge of agreement to serve.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 3 2010-07-01 2010-07-01 false Discharge of agreement to serve. 686.42 Section 686.42 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION TEACHER EDUCATION ASSISTANCE FOR COLLEGE AND HIGHER EDUCATION (TEACH...

34 CFR 686.42 - Discharge of agreement to serve.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 4 2011-07-01 2011-07-01 false Discharge of agreement to serve. 686.42 Section 686.42 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION (CONTINUED) TEACHER EDUCATION ASSISTANCE FOR COLLEGE AND HIGHER EDUCATION...

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

Parents' preparedness for their infants' discharge following first-stage cardiac surgery: development of a parental early warning tool.

PubMed

Gaskin, Kerry L; Barron, David J; Daniels, Amanda

2016-10-01

Aim The aim of this study was to explore parental preparedness for discharge and their experiences of going home with their infant after the first-stage surgery for a functionally univentricular heart. Technological advances worldwide have improved outcomes for infants with a functionally univentricular heart over the last 3 decades; however, concern remains regarding mortality in the period between the first and second stages of surgery. The implementation of home monitoring programmes for this group of infants has improved this initial inter-stage survival; however, little is known about parents' experiences of going home, their preparedness for discharge, and parents' recognition of deterioration in their fragile infant. This study was conducted in 2011-2013; eight sets of parents were consulted in the research planning stage in September, 2011, and 22 parents with children aged 0-2 years responded to an online survey during November, 2012-March, 2013. Description of categorical data and deductive thematic analysis of the open-ended questions were undertaken. Not all parents were taught signs of deterioration or given written information specific to their baby. The following three themes emerged from the qualitative data: mixed emotions about going home, knowledge and preparedness, and support systems. Parents are not adequately prepared for discharge and are not well equipped to recognise deterioration in their child. There is a role for greater parental education through development of an early warning tool to address the gap in parents' understanding of signs of deterioration, enabling appropriate contact and earlier management by clinicians.

Technical Assistance and Changes in Nutrition and Physical Activity Practices in the National Early Care and Education Learning Collaboratives Project, 2015–2016

PubMed Central

Smith, Teresa M.; Estabrooks, Paul A.; Rasmussen, Cristy Geno; Blaser, Casey; Yaroch, Amy L

2018-01-01

Purpose and Objectives The National Early Care and Education Learning Collaboratives Project (ECELC) aims to improve best practices in early care and education (ECE) programs in topic areas of the Nutrition and Physical Activity Self-Assessment in Child Care (NAP SACC). Technical assistance is a component of the ECELC, yet its effect on outcomes is unclear. Beyond dose and duration of technical assistance, limited research exists on characteristics of technical assistance that contribute to outcomes. The objective of this study was to identify and describe technical assistance characteristics and explore associations with NAP SACC outcomes. Intervention Approach We collected data from 10 collaboratives comprising 84 ECE programs in 2 states in 2015–2016. The objective of technical assistance was to support programs in improving best practices. Technical assistance was provided to programs via on-site, telephone, or email and was tailored to program needs. Evaluation Methods We used a mixed-methods design to examine associations between technical assistance and NAP SACC outcomes. We used multiple regression analysis to assess quantitative data and qualitative comparative analysis to determine necessary and sufficient technical assistance conditions supporting NAP SACC outcomes. We also conducted a document review to describe technical assistance that referred conditions identified by the qualitative comparative analysis. Results Regression analyses detected an inverse relationship between changes in NAP SACC scores and hours of technical assistance. No clear pattern emerged in the qualitative comparative analysis, leaving no necessary and sufficient conditions. However, the qualitative comparative analysis identified feedback as a potentially important component of technical assistance, whereas resource sharing and frequent email were characteristics that seemed to reduce the likelihood of improved outcomes. Email and resource sharing were considered primarily

Simulation of spring discharge from a limestone aquifer in Iowa, USA

USGS Publications Warehouse

Zhang, Y.-K.; Bai, E.-W.; Libra, R.; Rowden, R.; Liu, H.

1996-01-01

A lumped-parameter model and least-squares method were used to simulate temporal variations of discharge from Big Spring, Iowa, USA, from 1983 to 1994. The simulated discharge rates poorly match the observed one when precipitation is taken as the sole input. The match is improved significantly when the processes of evapotranspiration and infiltration are considered. The best results are obtained when snowmelt is also included in the model. Potential evapotranspiration was estimated with Thornthwaite's formula, infiltration was calculated through a water-balance approach, and snowmelt was generated by a degree-day model. The results show that groundwater in the limestone aquifer is mainly recharged by snowmelt in early spring and by infiltration from rainfall in later spring and early summer. Simulated discharge was visually calibrated against measured discharge; the similarity between the two supports the validity of this approach. The model can be used to study the effects of climate change on groundwater resources and their quality.

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

Omission of Dysphagia Therapies in Hospital Discharge Communications

PubMed Central

Kind, Amy; Anderson, Paul; Hind, Jacqueline; Robbins, JoAnne; Smith, Maureen

2009-01-01

Background Despite the wide implementation of dysphagia therapies, it is unclear whether these therapies are successfully communicated beyond the inpatient setting. Objective To examine the rate of dysphagia recommendation omissions in hospital discharge summaries for high-risk sub-acute care (i.e., skilled nursing facility, rehabilitation, long-term care) populations. Design Retrospective cohort study Subjects All stroke and hip fracture patients billed for inpatient dysphagia evaluations by speech-language pathologists (SLPs) and discharged to sub-acute care in 2003-2005 from a single large academic medical center (N=187). Measurements Dysphagia recommendations from final SLP hospital notes and from hospital (physician) discharge summaries were abstracted, coded, and compared for each patient. Recommendation categories included: dietary (food and liquid), postural/compensatory techniques (e.g., chin-tuck), rehabilitation (e.g., exercise), meal pacing (e.g., small bites), medication delivery (e.g., crush pills), and provider/supervision (e.g., 1-to-1 assist). Results 45% of discharge summaries omitted all SLP dysphagia recommendations. 47%(88/186) of patients with SLP dietary recommendations, 82%(93/114) with postural, 100%(16/16) with rehabilitation, 90%(69/77) with meal pacing, 95%(21/22) with medication, and 79%(96/122) with provider/supervision recommendations had these recommendations completely omitted from their discharge summaries. Conclusions Discharge summaries omitted all categories of SLP recommendations at notably high rates. Improved post-hospital communication strategies are needed for discharges to sub-acute care. PMID:20098999

Remote monitoring of left ventricular assist device parameters after HeartAssist-5 implantation.

PubMed

Pektok, Erman; Demirozu, Zumrut Tuba; Arat, Nurcan; Yildiz, Omer; Oklu, Emine; Eker, Deniz; Ece, Ferah; Ciftci, Cavlan; Yazicioglu, Nuran; Bayindir, Osman; Kucukaksu, Deniz Suha

2013-09-01

Although several left ventricular assist devices (LVADs) have been used widely, remote monitoring of LVAD parameters has been available only recently. We present our remote monitoring experience with an axial-flow LVAD (HeartAssist-5, MicroMed Cardiovascular, Inc., Houston, TX, USA). Five consecutive patients who were implanted a HeartAssist-5 LVAD because of end-stage heart failure due to ischemic (n=4) or idiopathic (n=1) cardiomyopathy, and discharged from hospital between December 2011 and January 2013 were analyzed. The data (pump speed, pump flow, power consumption) obtained from clinical visits and remote monitoring were studied. During a median follow-up of 253 (range: 80-394) days, fine tuning of LVADs was performed at clinical visits. All patients are doing well and are in New York Heart Association Class-I/II. A total of 39 alarms were received from three patients. One patient was hospitalized for suspected thrombosis and was subjected to physical examinations as well as laboratory and echocardiographic evaluations; however, no evidence of thrombus washout or pump thrombus was found. The patient was treated conservatively. Remaining alarms were due to insufficient water intake and were resolved by increased water consumption at night and summer times, and fine tuning of pump speed. No alarms were received from the remaining two patients. We believe that remote monitoring is a useful technology for early detection and treatment of serious problems occurring out of hospital thereby improving patient care. Future developments may ease troubleshooting, provide more data from the patient and the pump, and eventually increase physician and patient satisfaction. Despite all potential clinical benefits, remote monitoring should be taken as a supplement to rather than a substitute for routine clinical visits for patient follow-up. © 2013 Wiley Periodicals, Inc. and International Center for Artificial Organs and Transplantation.

Exercise Capacity and Functional Performance in Heart Failure Patients Supported by a Left Ventricular Assist Device at Discharge From Inpatient Rehabilitation.

PubMed

Schmidt, Thomas; Bjarnason-Wehrens, Birna; Bartsch, Petra; Deniz, Ezin; Schmitto, Jan; Schulte-Eistrup, Sebastian; Willemsen, Detlev; Reiss, Nils

2018-01-01

Adequate physical and functional performance is an important prerequisite for renewed participation and integration in self-determined private and (where appropriate) professional lives following left ventricular assist device (LVAD) implantation. During cardiac rehabilitation (CR), individually adapted exercise programs aim to increase exercise capacity and functional performance. A retrospective analysis of cardiopulmonary exercise capacity and functional performance in LVAD patients at discharge from a cardiac rehabilitation program was conducted. The results from 68 LVAD patients (59 males, 9 females; 55.9 ± 11.7 years; 47 HVAD, 2 MVAD, 15 HeartMate II, 4 HeartMate 3, and 4 different implanting centers) were included in the analysis. Exercise capacity was assessed using a cardiopulmonary exercise test on a bicycle ergometer (ramp protocol; 10 W/min). The 6-min walk test was used to determine functional performance. At discharge from CR (53 ± 17 days after implantation), the mean peak work load achieved was 62.2 ± 19.3 W (38% of predicted values) or 0.79 ± 0.25 W/kg body weight. The mean cardiopulmonary exercise capacity (relative peak oxygen uptake) was 10.6 ± 5.3 mL/kg/min (37% of predicted values). The 6-min walk distance improved significantly during CR (325 ± 106 to 405 ± 77 m; P < 0.01). No adverse events were documented during CR. The results show that, even following LVAD implantation, cardiopulmonary exercise capacity remains considerably restricted. In contrast, functional performance, measured by the 6-min walk distance, reaches an acceptable level. Light everyday tasks seem to be realistically surmountable for patients, making discharge from inpatient rehabilitation possible. Long-term monitoring is required in order to evaluate the situation and how it develops further. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Robotic assisted excision of a left ventricular myxoma.

PubMed

Hassan, Mohammed; Smith, J Michael

2012-01-01

We present a rare case of left ventricular myxoma discovered incidentally in an asymptomatic 16-year old male. The patient underwent the appropriate work-up and a robotic-assisted excision of the mass. The patient had an uneventful recovery and was discharged home at postoperative day 3. To our knowledge, this is the first case of robotic-assisted left ventricular myxoma excision in the literature. Robotic-assisted surgery of left ventricular myxomas is a safe and feasible method of excision.

Fall Risk, Supports and Services, and Falls Following a Nursing Home Discharge.

PubMed

Noureldin, Marwa; Hass, Zachary; Abrahamson, Kathleen; Arling, Greg

2017-09-04

Falls are a major source of morbidity and mortality among older adults; however, little is known regarding fall occurrence during a nursing home (NH) to community transition. This study sought to examine whether the presence of supports and services impacts the relationship between fall-related risk factors and fall occurrence post NH discharge. Participants in the Minnesota Return to Community Initiative who were assisted in achieving a community discharge (N = 1459) comprised the study sample. The main outcome was fall occurrence within 30 days of discharge. Factor analyses were used to estimate latent models from variables of interest. A structural equation model (SEM) was estimated to determine the relationship between the emerging latent variables and falls. Fifteen percent of participants fell within 30 days of NH discharge. Factor analysis of fall-related risk factors produced three latent variables: fall concerns/history; activities of daily living impairments; and use of high-risk medications. A supports/services latent variable also emerged that included caregiver support frequency, medication management assistance, durable medical equipment use, discharge location, and receipt of home health or skilled nursing services. In the SEM model, high-risk medications use and fall concerns/history had direct positive effects on falling. Receiving supports/services did not affect falling directly; however, it reduced the effect of high-risk medication use on falling (p < .05). Within the context of a state-implemented transition program, findings highlight the importance of supports/services in mitigating against medication-related risk of falling post NH discharge. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

ZnO Nanowire-Based Corona Discharge Devices Operated Under Hundreds of Volts.

PubMed

Yang, Wenming; Zhu, Rong; Zong, Xianli

2016-12-01

Minimizing the voltage of corona discharges, especially when using nanomaterials, has been of great interest in the past decade or so. In this paper, we report a new corona discharge device by using ZnO nanowires operated in atmospheric air to realize continuous corona discharge excited by hundreds of volts. ZnO nanowires were synthesized on microelectrodes using electric-field-assisted wet chemical method, and a thin tungsten film was deposited on the microchip to enhance discharging performance. The testing results showed that the corona inception voltages were minimized greatly by using nanowires compared to conventional dischargers as a result of the local field enhancement of nanowires. The corona could be continuously generated and self-sustaining. It was proved that the law of corona inception voltage obeyed the conventional Peek's breakdown criterion. An optimal thickness of tungsten film coated over ZnO nanowires was figured out to obtain the lowest corona inception voltage. The ion concentration of the nanowire-based discharger attained 10(17)/m(3) orders of magnitude, which is practicable for most discharging applications.

Premenarchal, recurrent vaginal discharge associated with an incomplete obstructing longitudinal vaginal septum.

PubMed

Hansen, Keith A; DeWitt, Jason

2005-12-01

To describe an unusual, premenarchal presentation of an obstructive vaginal anomaly. Case Report. University Medical Center. Premenarchal subject Vaginogram, vaginal septum resection. Vaginal septum resection with resolution of vaginal discharge. This case demonstrates some of the typical features of uterus didelphys bicollis with incomplete obstructing hemivagina, but had a unique presentation with premenarchal, recurrent vaginal discharge. Typically, patients with an obstructing mullerian anomaly present after menarche with pelvic pain and a mass. The vaginogram assists in the preoperative definition of abnormal anatomy which allows the surgeon to develop the most appropriate surgical approach. Resection of this incompletely obstructing vaginal septum resulted in resolution of the recurrent vaginal discharge.

Robotic-assisted repair of iatrogenic ureteral ligation following robotic-assisted hysterectomy.

PubMed

Kalisvaart, Jonathan F; Finley, David S; Ornstein, David K

2008-01-01

Ureteral injuries, while rare, do occur during gynecologic procedures. The expansion of laparoscopic and robotic pelvic surgical procedures increases the risk of ureteral injury from these procedures and suggests a role for minimally invasive approaches to the delayed repair of ureteral injuries. We present, to our knowledge, the first case of delayed robotic-assisted ureteral deligation and ureterolysis following iatrogenic ureteral injury occurring during a robotic abdominal hysterectomy. We present a case report and review of the literature. A 57-year-old female underwent a seemingly uncomplicated robotic-assisted laparoscopic total abdominal hysterectomy and bilateral oophorectomy for symptomatic fibroids. On postoperative day 8, she presented with persistent right flank pain. Imaging studies revealed high-grade ureteral obstruction consistent with suture ligation of the right ureter. She underwent successful robotic-assisted ureteral deligation and ureterolysis. Her postoperative course was unremarkable, and she was discharged home on postoperative day 1 from the deligation. Robotic-assisted management of complications from urologic or gynecologic surgery is technically feasible. This can potentially preserve the advantages to the patient that are being seen from the initial less-invasive surgery.

Numerical study of nonequilibrium plasma assisted detonation initiation in detonation tube

NASA Astrophysics Data System (ADS)

Zhou, Siyin; Wang, Fang; Che, Xueke; Nie, Wansheng

2016-12-01

Nonequilibrium plasma has shown great merits in ignition and combustion nowadays, which should be especially useful for hypersonic propulsion. A coaxial electrodes configuration was established to investigate the effect of alternating current (AC) dielectric barrier discharge nonequilibrium plasma on the detonation initiation process in a hydrogen-oxygen mixture. A discharge simulation-combustion simulation loosely coupled method was used to simulate plasma assisted detonation initiation. First, the dielectric barrier discharge in the hydrogen-oxygen mixture driven by an AC voltage was simulated, which takes 17 kinds of particles (including positively charged particles, negatively charged particles, and neutral particles) and 47 reactions into account. The temporal and spatial characteristics of the discharge products were obtained. Then, the discharge products were incorporated into the combustion model of a detonation combustor as the initial conditions for the later detonation initiation simulation. Results showed that the number density distributions of plasma species are different in space and time, and develop highly nonuniformly from high voltage electrode to grounded electrode at certain times. All the active species reach their highest concentration at approximately 0.6T (T denotes a discharge cycle). Compared with the no plasma case, the differences of flowfield shape mainly appear in the early stage of the deflagration to detonation transition process. None of the sub-processes (including the very slow combustion, deflagration, over-driven detonation, detonation decay, and propagation of a self-sustained stable detonation wave) have been removed by the plasma. After the formation of a C-J detonation wave, the whole flowfield remains unchanged. With the help of plasma, the deflagration to detonation transition (DDT) time and distance are reduced by about 11.6% and 12.9%, respectively, which should be attributed to the active particles effect of

Exploring the experience of clients with tetraplegia utilizing assistive technology for computer access.

PubMed

Folan, Alyce; Barclay, Linda; Cooper, Cathy; Robinson, Merren

2015-01-01

Assistive technology for computer access can be used to facilitate people with a spinal cord injury to utilize mainstream computer applications, thereby enabling participation in a variety of meaningful occupations. The aim of this study was to gain an understanding of the experiences of clients with tetraplegia trialing assistive technologies for computer access during different stages in a public rehabilitation service. In order to explore the experiences of clients with tetraplegia trialing assistive technologies for computer use, qualitative methodology was selected. Data were collected from seven participants using semi-structured interviews, which were audio-taped, transcribed and analyzed thematically. Three main themes were identified. These were: getting back into life, assisting in adjusting to injury and learning new skills. The findings from this study demonstrated that people with tetraplegia can be assisted to return to previous life roles or engage in new roles, through developing skills in the use of assistive technology for computer access. Being able to use computers for meaningful activities contributed to the participants gaining an enhanced sense of self-efficacy, and thereby quality of life. Implications for Rehabilitation Findings from this pilot study indicate that people with tetraplegia can be assisted to return to previous life roles, and develop new roles that have meaning to them through the use of assistive technologies for computer use. Being able to use the internet to socialize, and complete daily tasks, contributed to the participants gaining a sense of control over their lives. Early introduction to assistive technology is important to ensure sufficient time for newly injured people to feel comfortable enough with the assistive technology to use the computers productively by the time of discharge. Further research into this important and expanding area is indicated.

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.

Large-area assembly of three-dimensional nanoparticle structures via ion assisted aerosol lithography with a multi-pin spark discharge generator.

PubMed

Ha, Kyungyeon; Choi, Hoseop; Jung, Kinam; Han, Kyuhee; Lee, Jong-Kwon; Ahn, KwangJun; Choi, Mansoo

2014-06-06

We present an approach utilizing ion assisted aerosol lithography (IAAL) with a newly designed multi-pin spark discharge generator (SDG) for fabricating large-area three-dimensional (3D) nanoparticle-structure (NPS) arrays. The design of the multi-pin SDG allows us to uniformly construct 3D NPSs on a large area of 50 mm × 50 mm in a parallel fashion at atmospheric pressure. The ion-induced focusing capability of IAAL significantly reduces the feature size of 3D NPSs compared to that of the original pre-patterns formed on a substrate. The spatial uniformity of 3D NPSs is above 95% using the present multi-pin SDG, which is far superior to that of the previous single-pin SDG with less than 32% uniformity. The effect of size distributions of nanoparticles generated via the multi-pin SDG on the 3D NPSs also has been studied. In addition, we measured spectral reflectance for the present 3D NPSs coated with Ag, demonstrating enhanced diffuse reflectance.

Large-area assembly of three-dimensional nanoparticle structures via ion assisted aerosol lithography with a multi-pin spark discharge generator

NASA Astrophysics Data System (ADS)

Ha, Kyungyeon; Choi, Hoseop; Jung, Kinam; Han, Kyuhee; Lee, Jong-Kwon; Ahn, KwangJun; Choi, Mansoo

2014-06-01

We present an approach utilizing ion assisted aerosol lithography (IAAL) with a newly designed multi-pin spark discharge generator (SDG) for fabricating large-area three-dimensional (3D) nanoparticle-structure (NPS) arrays. The design of the multi-pin SDG allows us to uniformly construct 3D NPSs on a large area of 50 mm × 50 mm in a parallel fashion at atmospheric pressure. The ion-induced focusing capability of IAAL significantly reduces the feature size of 3D NPSs compared to that of the original pre-patterns formed on a substrate. The spatial uniformity of 3D NPSs is above 95% using the present multi-pin SDG, which is far superior to that of the previous single-pin SDG with less than 32% uniformity. The effect of size distributions of nanoparticles generated via the multi-pin SDG on the 3D NPSs also has been studied. In addition, we measured spectral reflectance for the present 3D NPSs coated with Ag, demonstrating enhanced diffuse reflectance.

Early Right Ventricular Assist Device Use in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation: Incidence and Risk Factors From the Interagency Registry for Mechanically Assisted Circulatory Support.

PubMed

Kiernan, Michael S; Grandin, E Wilson; Brinkley, Marshall; Kapur, Navin K; Pham, Duc Thinh; Ruthazer, Robin; Rame, J Eduardo; Atluri, Pavan; Birati, Edo Y; Oliveira, Guilherme H; Pagani, Francis D; Kirklin, James K; Naftel, David; Kormos, Robert L; Teuteberg, Jeffrey J; DeNofrio, David

2017-10-01

To investigate preimplant risk factors associated with early right ventricular assist device (RVAD) use in patients undergoing continuous-flow left ventricular assist device (LVAD) surgery. Patients in the Interagency Registry for Mechanically Assisted Circulatory Support who underwent primary continuous-flow-LVAD surgery were examined for concurrent or subsequent RVAD implantation within 14 days of LVAD. Risk factors for RVAD implantation and the combined end point of RVAD or death within 14 days of LVAD were assessed with stepwise logistic regression. We compared survival between patients with and without RVAD using Kaplan-Meier method and Cox proportional hazards modeling. Of 9976 patients undergoing continuous-flow-LVAD implantation, 386 patients (3.9%) required an RVAD within 14 days of LVAD surgery. Preimplant characteristics associated with RVAD use included interagency registry for mechanically assisted circulatory support patient profiles 1 and 2, the need for preoperative extracorporeal membrane oxygenation or renal replacement therapy, severe preimplant tricuspid regurgitation, history of cardiac surgery, and concomitant procedures other than tricuspid valve repair at the time of LVAD. Hemodynamic determinants included elevated right atrial pressure, reduced pulmonary artery pulse pressure, and reduced stroke volume. The final model demonstrated good performance for both RVAD implant (area under the curve, 0.78) and the combined end point of RVAD or death within 14 days (area under the curve, 0.73). Compared with patients receiving an isolated LVAD, patients requiring RVAD had decreased 1- and 6-month survival: 78.1% versus 95.8% and 63.6% versus 87.9%, respectively ( P <0.0001 for both). The need for RVAD implantation after LVAD is associated with indices of global illness severity, markers of end-organ dysfunction, and profiles of hemodynamic instability. © 2017 American Heart Association, Inc.

Evaluating the learning curve for robot-assisted laparoscopic radical cystectomy.

PubMed

Pruthi, Raj S; Smith, Angela; Wallen, Eric M

2008-11-01

We seek to describe the learning curve of robot-assisted laparoscopic radical cystectomy by evaluating some of the surgical, oncologic, and clinical outcomes in our initial experience with 50 consecutive patients undergoing this novel procedure. Fifty consecutive patients (representing our initial experience with robot-assisted cystectomy) underwent radical cystectomy and urinary diversion from January 2006 to December 2007. Several different metrics were used to evaluate the learning curve of this procedure, including estimated blood loss (EBL), operative (OR) time, pathologic outcomes, and complication rate. We evaluated patients as a continuous variable, divided into five distinct time periods (quintiles), and stratified by first half and second half of robotic experience. EBL was not significantly lower until the third quintile (patients 21-30), after which further significant reductions were not observed. Mean OR time declined between each quintile for the first 30 patients (1-10 v 11-20 v 21-30). No significant declines occurred after the third quintile (21-30). When evaluated as a continuous variable, the statistical cut point at which no further significant reductions were observed was after patient 20 for OR time. No differences were observed with regard to time to flatus, bowel movement, or hospital discharge. Furthermore, complications were not different between the initial 25 patients and the most recent patients. There has been no case of a positive margin, and there was only one inadvertent bladder entry. Lymph node yield has also not significantly changed over time. This report helps to define the learning curve associated with robot-assisted laparoscopic radical cystectomy for bladder cancer. Despite the higher OR times and blood loss that is observed early in the learning curve, no such compromises are observed with regard to these oncologic parameters even early in the experience.

Discharges to prison from medium secure psychiatric units in England and Wales.

PubMed

Doyle, Michael; Coid, Jeremy; Archer-Power, Laura; Dewa, Lindsay; Hunter-Didrichsen, Alice; Stevenson, Rachel; Wainwright, Verity; Kallis, Costas; Ullrich, Simone; Shaw, Jenny

2014-09-01

Early findings from a national study of discharges from 32 National Health Service medium secure units revealed that nearly twice as many patients than expected were discharged back to prison. To compare the characteristics of those discharged back to prison with those discharged to the community, and consider the implications for ongoing care and risk. Prospective cohort follow-up design. All forensic patients discharged from 32 medium secure units across England and Wales over a 12-month period were identified. Those discharged to prison were compared with those who were discharged to the community. Nearly half of the individuals discharged to prison were diagnosed with a serious mental illness and over a third with schizophrenia. They were a higher risk, more likely to have a personality disorder, more symptomatic and less motivated than those discharged to the community. Findings suggest that alternative models of prison mental healthcare should be considered to reduce risks to the patient and the public. Royal College of Psychiatrists.

The Uncertainty of Mass Discharge Measurements Using Pumping Methods Under Simplified Conditions

EPA Science Inventory

Mass discharge measurements at contaminated sites have been used to assist with site management decisions, and can be divided into two broad categories: point-scale measurement techniques and pumping methods. Pumping methods can be sub-divided based on the pumping procedures use...

32 CFR 865.122 - Summary of statistics for Discharge Review Board.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Summary of statistics for Discharge Review Board. 865.122 Section 865.122 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE... Deputy Assistant Secretary of Defense (Military Personnel and Force Management) DASD(MP&FM), Office of...

32 CFR 865.122 - Summary of statistics for Discharge Review Board.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false Summary of statistics for Discharge Review Board. 865.122 Section 865.122 National Defense Department of Defense (Continued) DEPARTMENT OF THE AIR FORCE... Deputy Assistant Secretary of Defense (Military Personnel and Force Management) DASD(MP&FM), Office of...

The History of Water Discharge in the Margaritifer Sinus Region of Mars

NASA Technical Reports Server (NTRS)

Grant, J. A.; Parker, T.

2001-01-01

Uzboi-Holden-Ladon-Margaritifer Valles and Samara and Parana-Loire Valles discharge into Margaritifer Basin during late-Noachian/early-Hesperian caused ponding, infiltration, and storage. Early-to-mid Hesperian release formed Margaritifer Chaos and Ares Valles. Additional information is contained in the original extended abstract.

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.

Costs and Consequences of Early Hospital Discharge After Major Inpatient Surgery in Older Adults

PubMed Central

Regenbogen, Scott E.; Cain-Nielsen, Anne H.; Norton, Edward C.; Chen, Lena M.; Birkmeyer, John D.; Skinner, Jonathan S.

2017-01-01

IMPORTANCE As prospective payment transitions to bundled reimbursement, many US hospitals are implementing protocols to shorten hospitalization after major surgery. These efforts could have unintended consequences and increase overall surgical episode spending if they induce more frequent postdischarge care use or readmissions. OBJECTIVE To evaluate the association between early postoperative discharge practices and overall surgical episode spending and expenditures for postdischarge care use and readmissions. DESIGN, SETTING, AND PARTICIPANTS This investigation was a cross-sectional cohort study of Medicare beneficiaries undergoing colectomy (189 229 patients at 1876 hospitals), coronary artery bypass grafting (CABG) (218 940 patients at 1056 hospitals), or total hip replacement (THR) (231774 patients at 1831 hospitals) between January 1, 2009, and June 30, 2012. The dates of the analysis were September 1, 2015, to May 31, 2016. Associations between surgical episode payments and hospitals’ length of stay (LOS) mode were evaluated among a risk and postoperative complication-matched cohort of patients without major postoperative complications. To further control for potential differences between hospitals, a within-hospital comparison was also performed evaluating the change in hospitals’ mean surgical episode payments according to their change in LOS mode during the study period. EXPOSURE Undergoing surgery in a hospital with short vs long postoperative hospitalization practices, characterized according to LOS mode, a measure least sensitive to postoperative outliers. MAIN OUTCOMES AND MEASURES Risk-adjusted, price-standardized, 90-day overall surgical episode payments and their components, including index, outlier, readmission, physician services, and postdischarge care. RESULTS A total of 639 943 Medicare beneficiaries were included in the study. Total surgical episode payments for risk and postoperative complication-matched patients were significantly lower

Plasma ``anti-assistance'' and ``self-assistance'' to high power impulse magnetron sputtering

NASA Astrophysics Data System (ADS)

Anders, André; Yushkov, Georgy Yu.

2009-04-01

A plasma assistance system was investigated with the goal to operate high power impulse magnetron sputtering (HiPIMS) at lower pressure than usual, thereby to enhance the utilization of the ballistic atoms and ions with high kinetic energy in the film growth process. Gas plasma flow from a constricted plasma source was aimed at the magnetron target. Contrary to initial expectations, such plasma assistance turned out to be contraproductive because it led to the extinction of the magnetron discharge. The effect can be explained by gas rarefaction. A better method of reducing the necessary gas pressure is operation at relatively high pulse repetition rates where the afterglow plasma of one pulse assists in the development of the next pulse. Here we show that this method, known from medium-frequency (MF) pulsed sputtering, is also very important at the much lower pulse repetition rates of HiPIMS. A minimum in the possible operational pressure is found in the frequency region between HiPIMS and MF pulsed sputtering.

Experimental investigation on large-area dielectric barrier discharge in atmospheric nitrogen and air assisted by the ultraviolet lamp.

PubMed

Zhang, Yan; Gu, Biao; Wang, Wenchun; Wang, Dezhen; Peng, Xuwen

2009-04-01

In this paper, ultraviolet radiation produced by the ultraviolet lamp is employed to supply pre-ionization for the dielectric barrier discharge in N(2) or air at atmospheric pressure. The effect of the ultraviolet pre-ionization on improving the uniformity of the dielectric barrier discharge is investigated experimentally. The atmospheric pressure glow discharge of the large area (270 mm x 120 mm) is obtained successfully via the ultraviolet pre-ionization in atmospheric DBD in N(2) when the gas gap decrease to 3mm. Based on the emission spectra, the mechanism which ultraviolet pre-ionization improves the uniformity of the dielectric barrier discharge is discussed.

Predicting Readmission at Early Hospitalization Using Electronic Clinical Data: An Early Readmission Risk Score.

PubMed

Tabak, Ying P; Sun, Xiaowu; Nunez, Carlos M; Gupta, Vikas; Johannes, Richard S

2017-03-01

Identifying patients at high risk for readmission early during hospitalization may aid efforts in reducing readmissions. We sought to develop an early readmission risk predictive model using automated clinical data available at hospital admission. We developed an early readmission risk model using a derivation cohort and validated the model with a validation cohort. We used a published Acute Laboratory Risk of Mortality Score as an aggregated measure of clinical severity at admission and the number of hospital discharges in the previous 90 days as a measure of disease progression. We then evaluated the administrative data-enhanced model by adding principal and secondary diagnoses and other variables. We examined the c-statistic change when additional variables were added to the model. There were 1,195,640 adult discharges from 70 hospitals with 39.8% male and the median age of 63 years (first and third quartile: 43, 78). The 30-day readmission rate was 11.9% (n=142,211). The early readmission model yielded a graded relationship of readmission and the Acute Laboratory Risk of Mortality Score and the number of previous discharges within 90 days. The model c-statistic was 0.697 with good calibration. When administrative variables were added to the model, the c-statistic increased to 0.722. Automated clinical data can generate a readmission risk score early at hospitalization with fair discrimination. It may have applied value to aid early care transition. Adding administrative data increases predictive accuracy. The administrative data-enhanced model may be used for hospital comparison and outcome research.

Preventability of early vs. late readmissions in an academic medical center

PubMed Central

Graham, Kelly L.; Dike, Ogechi; Doctoroff, Lauren; Jupiter, Marisa; Vanka, Anita

2017-01-01

Background It is unclear if the 30-day unplanned hospital readmission rate is a plausible accountability metric. Objective Compare preventability of hospital readmissions, between an early period [0–7 days post-discharge] and a late period [8–30 days post-discharge]. Compare causes of readmission, and frequency of markers of clinical instability 24h prior to discharge between early and late readmissions. Design, setting, patients 120 patient readmissions in an academic medical center between 1/1/2009-12/31/2010 Measures Sum-score based on a standard algorithm that assesses preventability of each readmission based on blinded hospitalist review; average causation score for seven types of adverse events; rates of markers of clinical instability within 24h prior to discharge. Results Readmissions were significantly more preventable in the early compared to the late period [median preventability sum score 8.5 vs. 8.0, p = 0.03]. There were significantly more management errors as causative events for the readmission in the early compared to the late period [mean causation score [scale 1–6, 6 most causal] 2.0 vs. 1.5, p = 0.04], and these errors were significantly more preventable in the early compared to the late period [mean preventability score 1.9 vs 1.5, p = 0.03]. Patients readmitted in the early period were significantly more likely to have mental status changes documented 24h prior to hospital discharge than patients readmitted in the late period [12% vs. 0%, p = 0.01]. Conclusions Readmissions occurring in the early period were significantly more preventable. Early readmissions were associated with more management errors, and mental status changes 24h prior to discharge. Seven-day readmissions may be a better accountability measure. PMID:28622384

Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single-center study of early perioperative outcomes at a community hospital.

PubMed

Ahmad, Arif; Carleton, Jared D; Ahmad, Zoha F; Agarwala, Ashish

2016-09-01

The purpose of this study was to compare the operative and early perioperative outcomes of laparoscopic versus robotic-assisted Roux-en-Y gastric bypass procedures performed in a community hospital setting. The study was a chart review and analysis of the early perioperative outcomes of a total of 345 Roux-en-Y gastric bypass procedures performed by a single surgeon in a community hospital setting from January 2011 to October 2014. Of these, 173 procedures were performed laparoscopically and 172 were performed with robotic assistance utilizing the daVinci(®) surgical platform. Factors such as baseline patient characteristics, operative time, estimated blood loss (EBL), conversions to open procedure, complication rates, adverse events, length of stay (LOS), and return to the operating room for the two groups were retrospectively analyzed from a prospectively maintained database. Student's t test with unequal variances was used for statistical analysis, and a p value <0.05 was used for significance. There were no statistically significant differences in complication rates, EBL, or LOS between the two groups. There was a significant difference between the total operative times (135.30 ± 37.60 min for the laparoscopic procedure versus 154.84 ± 38.44 min for the robotic procedure, p < 0.05). There were no adverse intraoperative events, conversions to open procedures, leaks, strictures, returns to the operating room within 30 days, or mortalities in either group. Our study, which is the first of its kind to analyze the operative and early perioperative outcomes between laparoscopic and robotic-assisted Roux-en-Y gastric bypass procedures in the US community hospital setting, indicates that both are comparable in terms of safety, efficacy, and operative and early perioperative outcomes.

Stereotactic radiosurgery - discharge

MedlinePlus

Gamma knife - discharge; Cyberknife - discharge; Stereotactic radiotherapy - discharge; Fractionated stereotactic radiotherapy - discharge; Cyclotrons - discharge; Linear accelerator - discharge; Lineacs - discharge; Proton beam radiosurgery - discharge

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.

A Novel Use of a Metronome in Dispatcher-assisted Cardiopulmonary Resuscitation.

PubMed

Ateyyah, Khalid A; Cady, Charles E; Poltrock, James T; Pirrallo, Ronald G

2015-01-01

Abstract Early, high-quality cardiopulmonary resuscitation (CPR) is the key to increasing the likelihood of successful resuscitation in cardiac arrest. The use of dispatch-assisted (DA) CPR can increase the likelihood of bystander CPR. We describe a case in which a metronome was introduced to guide DA-CPR. The wife of a 52-year-old male activated 9-1-1 after her husband suffered a cardiac arrest. During her 9-1-1 call she received CPR instructions and heard a metronome over the phone while following the instructions. Return of spontaneous circulation of the patient occurred during paramedic on scene care. The patient was transported to hospital and discharged 6 days later with no neurological deficit. This case supports the use of a metronome by emergency medical dispatchers during the provision of DA-CPR to improve bystander CPR.

Large discharge-volume, silent discharge spark plug

DOEpatents

Kang, Michael

1995-01-01

A large discharge-volume spark plug for providing self-limiting microdischarges. The apparatus includes a generally spark plug-shaped arrangement of a pair of electrodes, where either of the two coaxial electrodes is substantially shielded by a dielectric barrier from a direct discharge from the other electrode, the unshielded electrode and the dielectric barrier forming an annular volume in which self-terminating microdischarges occur when alternating high voltage is applied to the center electrode. The large area over which the discharges occur, and the large number of possible discharges within the period of an engine cycle, make the present silent discharge plasma spark plug suitable for use as an ignition source for engines. In the situation, where a single discharge is effective in causing ignition of the combustible gases, a conventional single-polarity, single-pulse, spark plug voltage supply may be used.

Digital-model analysis of the effects of water-use alternatives on spring discharges Gooding and Jerome Counties, Idaho

USGS Publications Warehouse

Moreland, Joe A.

1976-01-01

Springs discharging from the Snake Plain aquifer contribute approximately 6,000 cubic feet per second (170 cubic metres per second) to flow in the Snake River between Milner and King Hill. Before irrigation began on the Snake River Plain north and east of the springs, total spring discharge was about 4,200 cubic feet per second (120 cubic meters per second). Increasing amounts of irrigated acreage from the early 1900's to the mid-1940's contributed more irrigation-return water to the aquifer resulting in increased discharge at the springs. Maximum discharge of about 6,800 cubic feet per second (190 cubic metres per second) occurred during the late 1940's and early 1950's. Increased use of pumped ground water for irrigation and changing irrigation practices have since resulted in a decline in spring discharge.

Rationale and design of TRANSITION: a randomized trial of pre‐discharge vs. post‐discharge initiation of sacubitril/valsartan

PubMed Central

Wachter, Rolf; Senni, Michele; Belohlavek, Jan; Noè, Adele; Carr, David; Butylin, Dmytro

2017-01-01

Abstract Aims The prognosis after hospitalization for acute decompensated heart failure (ADHF) remains poor, especially <30 days post‐discharge. Evidence‐based medications with prognostic impact administered at discharge improve survival and hospital readmission, but robust studies comparing pre‐discharge with post‐discharge initiation are rare. The PARADIGM‐HF trial established sacubitril/valsartan as a new evidence‐based therapy in patients with heart failure (HF) and reduced left ventricular ejection fraction (<40%) (rEF). In common with other landmark studies, it enrolled patients who were ambulatory at the time of inclusion. In addition, there is also still limited knowledge of initiation and up‐titration of sacubitril/valsartan in ACEi/ARB‐ naïve patients and in de novo HF with rEF patients. Methods and results TRANSITION is a multicentre, open‐label study in which ~1000 adults hospitalized for ADHF with rEF are randomized to start sacubitril/valsartan in a pre‐discharge arm (initiated ≥24 h after haemodynamic stabilization) or a post‐discharge arm (initiated within Days 1–14 after discharge). The protocol allows investigators to select the appropriate starting dose and dose adjustments according to clinical circumstances. Over a 10 week treatment period, the primary and secondary objectives assess the feasibility and safety of starting sacubitril/valsartan in‐hospital, early after haemodynamic stabilization. Exploratory objectives also include assessment of HF signs and symptoms, readmissions, N‐terminal pro‐B‐type natriuretic peptide and high‐sensitivity troponin T levels, and health resource utilization parameters. Conclusions TRANSITION will provide new evidence about initiating sacubitril/valsartan following hospitalization for ADHF, occurring either as de novo ADHF or as deterioration of chronic HF, and in patients with or without prior ACEI/ARB therapy. The results of TRANSITION will thus be highly relevant to

Feedback-controlled robotics-assisted treadmill exercise to assess and influence aerobic capacity early after stroke: a proof-of-concept study.

PubMed

Stoller, Oliver; Schindelholz, Matthias; Bichsel, Lukas; Schuster, Corina; de Bie, Rob A; de Bruin, Eling D; Hunt, Kenneth J

2014-07-01

The majority of post-stroke individuals suffer from low exercise capacity as a secondary reaction to immobility. The aim of this study was to prove the concept of feedback-controlled robotics-assisted treadmill exercise (RATE) to assess aerobic capacity and guide cardiovascular exercise in severely impaired individuals early after stroke. Subjects underwent constant load and incremental exercise testing using a human-in-the-loop feedback system within a robotics-assisted exoskeleton (Lokomat, Hocoma AG, CH). Inclusion criteria were: stroke onset ≤8 weeks, stable medical condition, non-ambulatory status, moderate motor control of the lower limbs and appropriate cognitive function. Outcome measures included oxygen uptake kinetics, peak oxygen uptake (VO2peak), gas exchange threshold (GET), peak heart rate (HRpeak), peak work rate (Ppeak) and accuracy of reaching target work rate (P-RMSE). Three subjects (18-42 d post-stroke) were included. Oxygen uptake kinetics during constant load ranged from 42.0 to 60.2 s. Incremental exercise testing showed: VO2peak range 19.7-28.8 ml/min/kg, GET range 11.6-12.7 ml/min/kg, and HRpeak range 115-161 bpm. Ppeak range was 55.2-110.9 W and P-RMSE range was 3.8-7.5 W. The concept of feedback-controlled RATE for assessment of aerobic capacity and guidance of cardiovascular exercise is feasible. Further research is warranted to validate the method on a larger scale. Aerobic capacity is seriously reduced in post-stroke individuals as a secondary reaction to immobility. Robotics-assisted walking devices may have substantial clinical relevance regarding assessment and improvement of aerobic capacity early after stroke. Feedback-controlled robotics-assisted treadmill exercise represents a new concept for cardiovascular assessment and intervention protocols for severely impaired individuals.

Technical Performance Scores are strongly associated with early mortality, postoperative adverse events, and intensive care unit length of stay-analysis of consecutive discharges for 2 years.

PubMed

Nathan, Meena; Karamichalis, John; Liu, Hua; Gauvreau, Kimberley; Colan, Steven; Saia, Matthew; Pigula, Frank; Fynn-Thompson, Francis; Emani, Sitaram; Baird, Christopher; Mayer, John E; del Nido, Pedro J

2014-01-01

Previous work in our institution has indicated that the Technical Performance Score (TPS) is highly associated with early outcomes in select subsets of procedures and age groups. We hypothesized that the TPS could predict early outcomes in a wide range of diagnoses and age groups. Consecutive patients discharged from January 2011 to March 2013 were prospectively evaluated. The TPS was assigned according to the discharge echocardiographic findings and the need for reinterventions in the anatomic area of interest. Case complexity was determined using Risk Adjustment for Congenital Heart Surgery (RACHS-1) categories. Early mortality and postoperative adverse events were recorded. Relationships between the TPS and outcomes were assessed after adjusting for the baseline patient characteristics. The median age of the 1926 patients was 1.8 years (range, 0 days to 68 years). Bypass was used in 1740 (90%); 322 (17%) were neonates, 520 (27%) infants, 873 (45%) children, 211 (11%) adults. TPS was class 1 (optimal) in 956 (50%), class 2 (adequate) in 584 (30%), and class 3 (inadequate) in 226 (12%); 160 patients (8%) could not be scored. A total of 51 early deaths (2.6%) and 111 adverse events (5.7%) occurred. On univariate analysis, age, RACHS-1 category, and TPS were significantly associated with mortality and the occurrence of adverse events. On multivariate modeling, class 3 (inadequate) TPS was strongly associated with mortality (odds ratio, 16.9; 95% confidence interval, 6.7-42.9; P < .001), adverse events (odds ratio, 6.9; 95% confidence interval, 4.1-11.6; P < .001), and postoperative intensive care unit length of stay (coefficient, 2.3; 95% confidence interval, 2.0-2.6; P < .001) after adjusting for other covariates. The TPS is strongly associated with early outcomes across a wide range of ages and disease complexity and can serve as important tool for self-assessment and quality improvement. Copyright © 2014 The American Association for Thoracic Surgery

Cardiovascular rehabilitation soon after stroke using feedback-controlled robotics-assisted treadmill exercise: study protocol of a randomised controlled pilot trial

PubMed Central

2013-01-01

Background After experiencing a stroke, most individuals also suffer from cardiac disease, are immobile and thus have low endurance for exercise. Aerobic capacity is seriously reduced in these individuals and does not reach reasonable levels after conventional rehabilitation programmes. Cardiovascular exercise is beneficial for improvement of aerobic capacity in mild to moderate stroke. However, less is known about its impact on aerobic capacity, motor recovery, and quality-of-life in severely impaired individuals. The aim of this pilot study is to explore the clinical efficacy and feasibility of cardiovascular exercise with regard to aerobic capacity, motor recovery, and quality-of-life using feedback-controlled robotics-assisted treadmill exercise in non-ambulatory individuals soon after experiencing a stroke. Methods/Design This will be a single-centred single blind, randomised control trial with a pre-post intervention design. Subjects will be recruited early after their first stroke (≤20 weeks) at a neurological rehabilitation clinic and will be randomly allocated to an inpatient cardiovascular exercise programme that uses feedback-controlled robotics-assisted treadmill exercise (experimental) or to conventional robotics-assisted treadmill exercise (control). Intervention duration depends on the duration of each subject’s inpatient rehabilitation period. Aerobic capacity, as the primary outcome measure, will be assessed using feedback-controlled robotics-assisted treadmill-based cardiopulmonary exercise testing. Secondary outcome measures will include gait speed, walking endurance, standing function, and quality-of-life. Outcome assessment will be conducted at baseline, after each 4-week intervention period, and before clinical discharge. Ethical approval has been obtained. Discussion Whether cardiovascular exercise in non-ambulatory individuals early after stroke has an impact on aerobic capacity, motor recovery, and quality-of-life is not yet known

Cardiovascular rehabilitation soon after stroke using feedback-controlled robotics-assisted treadmill exercise: study protocol of a randomised controlled pilot trial.

PubMed

Stoller, Oliver; de Bruin, Eling D; Schuster-Amft, Corina; Schindelholz, Matthias; de Bie, Rob A; Hunt, Kenneth J

2013-09-22

After experiencing a stroke, most individuals also suffer from cardiac disease, are immobile and thus have low endurance for exercise. Aerobic capacity is seriously reduced in these individuals and does not reach reasonable levels after conventional rehabilitation programmes. Cardiovascular exercise is beneficial for improvement of aerobic capacity in mild to moderate stroke. However, less is known about its impact on aerobic capacity, motor recovery, and quality-of-life in severely impaired individuals. The aim of this pilot study is to explore the clinical efficacy and feasibility of cardiovascular exercise with regard to aerobic capacity, motor recovery, and quality-of-life using feedback-controlled robotics-assisted treadmill exercise in non-ambulatory individuals soon after experiencing a stroke. This will be a single-centred single blind, randomised control trial with a pre-post intervention design. Subjects will be recruited early after their first stroke (≤20 weeks) at a neurological rehabilitation clinic and will be randomly allocated to an inpatient cardiovascular exercise programme that uses feedback-controlled robotics-assisted treadmill exercise (experimental) or to conventional robotics-assisted treadmill exercise (control). Intervention duration depends on the duration of each subject's inpatient rehabilitation period. Aerobic capacity, as the primary outcome measure, will be assessed using feedback-controlled robotics-assisted treadmill-based cardiopulmonary exercise testing. Secondary outcome measures will include gait speed, walking endurance, standing function, and quality-of-life. Outcome assessment will be conducted at baseline, after each 4-week intervention period, and before clinical discharge. Ethical approval has been obtained. Whether cardiovascular exercise in non-ambulatory individuals early after stroke has an impact on aerobic capacity, motor recovery, and quality-of-life is not yet known. Feedback-controlled robotics-assisted

Laparoscopic hand-assisted pancreaticoduodenectomy: initial UK experience.

PubMed

Ammori, B J

2004-04-01

By and large, the limited world experience with laparoscopic pancreaticoduodenectomy (PD) has been unfavorable, but the laparoscopic hand-assisted approach to PD has recently shown promising results. We report the first successful UK experience with laparoscopic hand-assisted PD (LHAPD). A 62-year-old man who presented with painless obstructive jaundice was found at endoscopy, to have an ampullary tumor. Preoperative biopsy specimens confirmed the diagnosis of an adenocarcinoma, and CT showed no evidence of either vascular involvement or metastatic disease. A staging laparoscopy showed no intraabdominal metastases, and an LHAPD was performed using a Gelport. The intraoperative course was uneventful. Two units of blood were transfused intraoperatively, but no postoperative blood transfusion was required. The operative time was 11 h (plus a 30-min break). The patients postoperative recovery was uneventful except for superficial pressure sores over the buttocks and elbows. The patient resumed oral fluid and dietary intake on the 1st and 3rd postoperative days, respectively, and was discharged from hospital on the 9th postoperative day. Histology demonstrated an ampullary adenocarcinoma with clear resection margins and involvement of two of the 13 lymph nodes examined. At 2-month follow-up, the patient remains well and is receiving adjuvant chemotherapy. LHAPD achieves good oncological clearance and can be performed safely in selected patients. The early promising results with this approach will undoubtedly encourage wider adoption of this procedure and are likely to widen the selection criteria.

Holding the baby: early mother-infant contact after childbirth and outcomes.

PubMed

Redshaw, Maggie; Hennegan, Julie; Kruske, Sue

2014-05-01

to describe the timing, type and duration of initial infant contact and associated demographic and clinical factors in addition to investigating the impact of early contact on breastfeeding and maternal health and well being after birth. data from a recent population survey of women birthing in Queensland, Australia were used to describe the nature of the first hold and associated demographic characteristics. Initial comparisons, with subsequent adjustment for type of birthing facility and mode of childbirth, were used to assess associations between timing, type and duration of initial contact and outcomes. Further analyses were conducted to investigate a dose-response relationship between duration of first contact and outcomes. women who had an unassisted vaginal birth held their infant sooner, and for longer than women who had an assisted vaginal birth or caesarean and were more satisfied with their early contact. Multivariate models showed a number of demographic and clinical interventions contributing to timing, duration and type of first contact with type of birthing facility (public/private), area of residence, and assisted birth as prominent factors. For women who had a vaginal birth; early, skin-to-skin, and longer duration of initial contact were associated with high rates of breastfeeding initiation and breastfeeding at discharge, but not breastfeeding at 13 weeks. Some aspects of early contact were associated with improved maternal well being. However, these associations were not found for women who had a caesarean birth. With longer durations of first contact, a dose-response effect was found for breastfeeding. results of the study provide a description of current practice in Queensland, Australia and factors impacting on early contact. For vaginal births, findings add to the evidence in support of early skin-to-skin contact for an extended period. It is suggested that all research in this area should consider the effects of early contact separately for

Investigation of flame structure in plasma-assisted turbulent premixed methane-air flame

NASA Astrophysics Data System (ADS)

Hualei, ZHANG; Liming, HE; Jinlu, YU; Wentao, QI; Gaocheng, CHEN

2018-02-01

The mechanism of plasma-assisted combustion at increasing discharge voltage is investigated in detail at two distinctive system schemes (pretreatment of reactants and direct in situ discharge). OH-planar laser-induced fluorescence (PLIF) technique is used to diagnose the turbulent structure methane-air flame, and the experimental apparatus consists of dump burner, plasma-generating system, gas supply system and OH-PLIF system. Results have shown that the effect of pretreatment of reactants on flame can be categorized into three regimes: regime I for voltage lower than 6.6 kV; regime II for voltage between 6.6 and 11.1 kV; and regime III for voltage between 11.1 and 12.5 kV. In regime I, aerodynamic effect and slower oxidation of higher hydrocarbons generated around the inner electrode tip plays a dominate role, while in regime III, the temperature rising effect will probably superimpose on the chemical effect and amplify it. For wire-cylinder dielectric barrier discharge reactor with spatially uneven electric field, the amount of radicals and hydrocarbons are decreased monotonically in radial direction which affects the flame shape. With regard to in situ plasma discharge in flames, the discharge pattern changes from streamer type to glow type. Compared with the case of reactants pretreatment, the flame propagates further in the upstream direction. In the discharge region, the OH intensity is highest for in situ plasma assisted combustion, indicating that the plasma energy is coupled into flame reaction zone.

Pediatric experience with the VentrAssist LVAD.

PubMed

Ruygrok, Peter N; Esmore, Don S; Alison, Peter M; Finucane, Kirsten A; McGuinness, Shay P; McGeorge, Alastair D; Negri, Justin; Jones, Kylie; Gibbs, Helen C

2008-08-01

The purpose of this study is to describe the first experience of implanting a new left ventricular assist device in pediatric patients with end-stage heart failure. In two recent prospective, international, multicenter clinical trials, three children (aged Assist (Ventracor Limited, Chatswood, Australia), a relatively small, novel, continuous flow, third-generation left ventricular assist device. Despite the patients' disease severity (each child was in extremis at the time of implantation), VentrAssist (Ventracor Limited) implantation enabled each patient to be discharged home from the hospital. All patients survived for more than 1 year. One patient was successfully transplanted and another was bridged to an adequate degree of recovery; unfortunately, the third patient died on postoperative day 375 while waiting for a suitable donor heart. Consistent with the complications associated with left ventricular assist devices in adults, the main complications in these pediatric patients were infection and thromboembolism. The VentrAssist may provide a major advancement in the management of larger children and adolescents with end-stage heart failure.

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.

Shoulder replacement - discharge

MedlinePlus

Total shoulder arthroplasty - discharge; Endoprosthetic shoulder replacement - discharge; Partial shoulder replacement - discharge; Partial shoulder arthroplasty - discharge; Replacement - shoulder - discharge; Arthroplasty - shoulder - ...

Microsecond-scale electric field pulses in cloud lightning discharges

NASA Technical Reports Server (NTRS)

Villanueva, Y.; Rakov, V. A.; Uman, M. A.; Brook, M.

1994-01-01

From wideband electric field records acquired using a 12-bit digitizing system with a 500-ns sampling interval, microsecond-scale pulses in different stages of cloud flashes in Florida and New Mexico are analyzed. Pulse occurrence statistics and waveshape characteristics are presented. The larger pulses tend to occur early in the flash, confirming the results of Bils et al. (1988) and in contrast with the three-stage representation of cloud-discharge electric fields suggested by Kitagawa and Brook (1960). Possible explanations for the discrepancy are discussed. The tendency for the larger pulses to occur early in the cloud flash suggests that they are related to the initial in-cloud channel formation processes and contradicts the common view found in the atmospheric radio-noise literature that the main sources of VLF/LF electromagnetic radiation in cloud flashes are the K processes which occur in the final, or J type, part of the cloud discharge.

Early impact of robot-assisted partial nephrectomy on renal function as assessed by renal scintigraphy.

PubMed

Luciani, Lorenzo G; Chiodini, Stefano; Donner, Davide; Cai, Tommaso; Vattovani, Valentino; Tiscione, Daniele; Giusti, Guido; Proietti, Silvia; Chierichetti, Franca; Malossini, Gianni

2016-06-01

To measure the early impact of robot-assisted partial nephrectomy (RAPN) on renal function as assessed by renal scan (Tc 99m-DTPA), addressing the issue of risk factors for ischemic damage to the kidney. All patients undergoing RAPN for cT1 renal masses between June 2013 and May 2014 were included in this prospective study. Renal function as expressed by glomerular filtration rate (GFR) was assessed by Technetium 99m-diethylenetriaminepentaacetic acid (Tc 99m-DTPA) renal scan preoperatively and postoperatively at 1 month in every patient. A multivariable analysis was used for the determination of independent factors predictive of GFR decrease of the operated kidney. Overall, 32 patients underwent RAPN in the time interval. Median tumor size, blood loss, and ischemia time were 4 cm, 200 mL, and 24 min, respectively. Two grade III complications occurred (postoperative bleeding in the renal fossa, urinoma). The GFR of the operated kidney decreased significantly from 51.7 ± 15.1 mL/min per 1.73 m(2) preoperatively to 40, 12 ± 12.4 mL/min per 1.73 m(2) 1 month postoperatively (p = 0.001) with a decrease of 22.4 %. On multivariable analysis, only tumor size (p = 0.05) was a predictor of GFR decrease of the operated kidney. Robotic-assisted partial nephrectomy had a detectable impact on early renal function in a series of relatively large tumors and prevailing intermediate nephrometric risk. A mean decrease of 22 % of GFR as assessed by renal scan in the operated kidney was found at 1 month postoperatively. In multivariable analysis, tumor size only was a significant predictor of renal function loss.

Characteristics of back corona discharge in a honeycomb catalyst and its application for treatment of volatile organic compounds.

PubMed

Feng, Fada; Zheng, Yanyan; Shen, Xinjun; Zheng, Qinzhen; Dai, Shaolong; Zhang, Xuming; Huang, Yifan; Liu, Zhen; Yan, Keping

2015-06-02

The main technical challenges for the treatment of volatile organic compounds (VOCs) with plasma-assisted catalysis in industrial applications are large volume plasma generation under atmospheric pressure, byproduct control, and aerosol collection. To solve these problems, a back corona discharge (BCD) configuration has been designed to evenly generate nonthermal plasma in a honeycomb catalyst. Voltage-current curves, discharge images, and emission spectra have been used to characterize the plasma. Grade particle collection results and flow field visualization in the discharge zones show not only that the particles can be collected efficiently, but also that the pressure drop of the catalyst layer is relatively low. A three-stage plasma-assisted catalysis system, comprising a dielectric barrier discharge (DBD) stage, BCD stage, and catalyst stage, was built to evaluate toluene treatment performance by BCD. The ozone analysis results indicate that BCD enhances the ozone decomposition by collecting aerosols and protecting the Ag-Mn-O catalyst downstream from aerosol contamination. The GC and FTIR results show that BCD contributes to toluene removal, especially when the specific energy input is low, and the total removal efficiency reaches almost 100%. Furthermore, this removal results in the emission of fewer byproducts.

Plasma Discharge Process in a Pulsed Diaphragm Discharge System

NASA Astrophysics Data System (ADS)

Duan, Jianjin; Hu, Jue; Zhang, Chao; Wen, Yuanbin; Meng, Yuedong; Zhang, Chengxu

2014-12-01

As one of the most important steps in wastewater treatment, limited study on plasma discharge process is a key challenge in the development of plasma applications. In this study, we focus on the plasma discharge process of a pulsed diaphragm discharge system. According to the analysis, the pulsed diaphragm discharge proceeds in seven stages: (1) Joule heating and heat exchange stage; (2) nucleated site formation; (3) plasma generation (initiation of the breakdown stage); (4) avalanche growth and plasma expansion; (5) plasma contraction; (6) termination of the plasma discharge; and (7) heat exchange stage. From this analysis, a critical voltage criterion for breakdown is obtained. We anticipate this finding will provide guidance for a better application of plasma discharges, especially diaphragm plasma discharges.

Robot-Assisted Versus Laparoscopy-Assisted Proximal Gastrectomy for Early Gastric Cancer in the Upper Location: Comparison of Oncological Outcomes, Surgical Stress, and Nutritional Status.

PubMed

Zhang, Kecheng; Huang, Xiaohui; Gao, Yunhe; Liang, Wenquan; Xi, Hongqing; Cui, Jianxin; Li, Jiyang; Zhu, Minghua; Liu, Guoxiao; Zhao, Huazhou; Hu, Chong; Liu, Yi; Qiao, Zhi; Wei, Bo; Chen, Lin

2018-01-01

An increasing amount of attention has been paid to minimally invasive function-preserving gastrectomy, with an increase in incidence of early gastric cancer in the upper stomach. This study aimed to compare oncological outcomes, surgical stress, and nutritional status between robot-assisted proximal gastrectomy (RAPG) and laparoscopy-assisted proximal gastrectomy (LAPG). Eighty-nine patients were enrolled in this retrospective study between November 2011 and December 2013. Among them, 27 patients underwent RAPG and 62 underwent LAPG. Perioperative parameters, surgical stress, nutritional status, disease-free survival, and overall survival were compared between the 2 groups. Sex, age, and comorbidity were similar in the RAPG and LAPG groups. There were also similar perioperative outcomes regarding operation time, complications, and length of hospital stay between the groups. The reflux esophagitis rates following RAPG and LAPG were 18.5% and 14.5%, respectively ( P = .842). However, patients in the RAPG group had less blood loss ( P = .024), more harvested lymph nodes ( P = .021), and higher costs than those in the LAPG group ( P < .001). With regard to surgical stress, no significant differences were observed in C-reactive protein concentrations and white blood cell count on postoperative days 1, 3, and 7 between the groups ( Ps > .05). There appeared to be higher hemoglobin levels at 6 months ( P = .053) and a higher body mass index at 12 months ( P = .056) postoperatively in patients in the RAPG group compared with those in the LAPG group, but this difference was not significant. Similar disease-free survival and overall survival rates were observed between the groups. RAPG could be an alternative to LAPG for patients with early gastric cancer in the upper stomach with comparable oncological safety and nutritional status. Further well-designed, prospective, large-scale studies are needed to validate these results.

Stroke rehabilitation services to accelerate hospital discharge and provide home-based care: an overview and cost analysis.

PubMed

Anderson, Craig; Ni Mhurchu, Cliona; Brown, Paul M; Carter, Kristie

2002-01-01

Limited information exists on the best way to organise stroke rehabilitation after hospital discharge and the relative costs of such services. To review the evidence of the cost effectiveness of services that accelerate hospital discharge and provide home-based rehabilitation for patients with acute stroke. A systematic review with economic analysis of published randomised clinical trials (available to March 2001) comparing early hospital discharge and domiciliary rehabilitation with usual care in patients with stroke was conducted. From included studies, data were extracted on study quality; major clinical outcomes including hospital stay, death, institutionalisation, disability, and readmission rates; and resource use associated with hospital stay, rehabilitation, and community services. The resources were priced using Australian dollars ($A) healthcare costs. The outcomes and costs of the new intervention were compared with standard care. Seven published trials involving 1277 patients (54% men; mean age 73 years) were identified. The pooled data showed that overall, a policy of early hospital discharge and domiciliary rehabilitation reduced total length of stay by 13 days [95% confidence interval (CI): -19 to -7 days]. There was no significant effect on mortality (odds ratio = 0.95; 95% CI: 0.65 to 1.38) or other clinical outcomes making a cost minimisation analysis for the economic analysis appropriate. The overall mean costs were approximately 15% lower for the early discharge intervention [$A16 016 ($US9941) versus $A18 350] ($US11 390)] compared with standard care. A policy of early hospital discharge and home-based rehabilitation for patients with stroke may reduce the use of hospital beds without compromising clinical outcomes. Our analysis shows this service to be a cost saving alternative to conventional in-hospital stroke rehabilitation for an important subgroup of patients with stroke-related disability.

Hospital readmission and parent perceptions of their child's hospital discharge

PubMed Central

Berry, Jay G.; Ziniel, Sonja I.; Freeman, Linda; Kaplan, William; Antonelli, Richard; Gay, James; Coleman, Eric A.; Porter, Stephanie; Goldmann, Don

2013-01-01

Objective To describe parent perceptions of their child's hospital discharge and assess the relationship between these perceptions and hospital readmission. Design A prospective study of parents surveyed with questions adapted from the care transitions measure, an adult survey that assesses components of discharge care. Participant answers, scored on a 5-point Likert scale, were compared between children who did and did not experience a readmission using a Fisher's exact test and logistic regression that accounted for patient characteristics associated with increased readmission risk, including complex chronic condition and assistance with medical technology. Setting A tertiary-care children's hospital. Participants: A total of 348 parents surveyed following their child's hospital discharge between March and October 2010. Intervention None. Main Outcome Measure Unplanned readmission within 30 days of discharge. Results There were 28 children (8.1%) who experienced a readmission. Children had a lower readmission rate (4.4 vs. 11.3%, P = 0.004) and lower adjusted readmission likelihood [odds ratio 0.2 (95% confidence interval 0.1, 0.6)] when their parents strongly agreed (n = 206) with the statement, ‘I felt that my child was healthy enough to leave the hospital’ from the index admission. Parent perceptions relating to care management responsibilities, medications, written discharge plan, warning signs and symptoms to watch for and primary care follow-up were not associated with readmission risk in multivariate analysis. Conclusions Parent perception of their child's health at discharge was associated with the risk of a subsequent, unplanned readmission. Addressing concerns with this perception prior to hospital discharge may help mitigate readmission risk in children. PMID:23962990

The characteristics and impact of a hospitalist-staffed post-discharge clinic.

PubMed

Doctoroff, Lauren; Nijhawan, Ank; McNally, Diane; Vanka, Anita; Yu, Roger; Mukamal, Kenneth J

2013-11-01

Limited primary care access and care discontinuities hamper care for patients following hospital discharge. As the proportion of inpatient care delivered by hospitalists continues to increase, hybrid models that incorporate hospitalists in post-discharge care may ameliorate this problem. We established a post-discharge clinic staffed by hospitalists in a large academic urban primary care practice in October 2009. We compared visits of recently hospitalized patients seen in the post-discharge clinic with post-discharge visits elsewhere in the practice, including patient demographics, health care utilization, and duration from discharge, using generalized estimating equations to account for repeated hospitalizations. Patients seen in the post-discharge clinic and elsewhere in the practice were generally similar, although patients seen in the post-discharge clinic were particularly likely to be black and receive primary care from residents. Relative to other patients seen following discharge, patients in the post-discharge clinic were seen 8.45 ± 0.43 days earlier (P <.001). Among all 10,845 discharges of Healthcare Associates patients between 2009 and 2011, patients were 40% more likely to be seen within a week of discharge when the post-discharge clinic was open than when it was closed (adjusted odds ratio 1.41; 95% confidence interval, 1.25-1.57). In this primary care practice, a hospitalist-staffed post-discharge clinic was associated with substantially shorter time to first post-hospitalization visit and with improvement in the overall likelihood of an early visit among all hospitalized patients. It was particularly used by black patients and those seen by residents, in whom access tends to be most fragmented, and may represent a novel approach to the problem of post-discharge care. Copyright © 2013 Elsevier Inc. All rights reserved.

Does the Computer-Assisted Remedial Mathematics Program at Kearny High School Lead to Improved Scores on the N.J. Early Warning Test?

ERIC Educational Resources Information Center

Schalago-Schirm, Cynthia

Eighth-grade students in New Jersey take the Early Warning Test (EWT), which involves reading, writing, and mathematics. Students with EWT scores below the state level of competency take a remedial mathematics course that provides students with computer-assisted instruction (2 days per week) as well as regular classroom instruction (3 days per…

[The prognostic value of variables from the quality assurance program and of the rehabilitation-discharge report of the LVA Baden-Württemberg for early retirement: results of a retrospective cohort-study].

PubMed

Küpper-Nybelen, J; Rothenbacher, D; Jacobi, E; Brenner, H

2003-12-01

Since 1997 the LVA Baden-Württemberg pension insurance agency has implemented an instrument to measure the outcome quality of in-patient rehabilitation. The objective of this study was to evaluate the prognostic value of various short-term rehabilitation success markers and of variables of the quality assurance program and the rehab-discharge report of the LVA Baden-Württemberg on early retirement by means of a retrospective cohort study. The analysis was based on routinely registered data of patients who underwent in-hospital rehabilitation in a hospital accredited by the LVA Baden-Württemberg between June 1997 and June 1999. Baseline data included information from medical discharge reports and from the quality assurance programme. Follow-up information with regard to disability was collected until July 2000. The prognostic value of the quality assurance programme and of 4 standardized documented items from the medical discharge report was estimated by proportional hazards regression. In this analysis 6,823 patients aged 30-59 years who underwent an in-patient rehab programme between June 1997 and July 1999 in 5 of 6 LVA rehab clinics were included. During follow-up (mean duration: 1.8 years) 908 (13.3%) patients retired because of health-related disability. The variables with the strongest prognostic values were the evaluation of the patient health status by the physician and the patients themselves and the capacity to work. The variables with the highest prognostic value were the evaluation on a 1-6 visual analogue scale; a better assessment by one mark of the health status by physician and patient himself, respectively, was associated with a 53% and 40% reduced risk of disability. Fitness for work at discharge was the most prognostic variable from the discharge report. Patients who were able to work had a 78% reduced risk of disability compared to patients unable to work. Also of prognostic relevance were a positive performance and the duration of the

Early removal of urethral catheter with suprapubic tube drainage versus urethral catheter drainage alone after robot-assisted laparoscopic radical prostatectomy.

PubMed

Prasad, Sandip M; Large, Michael C; Patel, Amit R; Famakinwa, Olufenwa; Galocy, R Matthew; Karrison, Theodore; Shalhav, Arieh L; Zagaja, Gregory P

2014-07-01

Retrospective single institution data suggest that postoperative pain after robot-assisted laparoscopic radical prostatectomy is decreased by early removal of the urethral catheter with suprapubic tube drainage. In a randomized patient population we determined whether suprapubic tube drainage with early urethral catheter removal would improve postoperative pain compared with urethral catheter drainage alone. Men with a body mass index of less than 40 kg/m(2) who had newly diagnosed prostate cancer and elected robot-assisted laparoscopic radical prostatectomy were included in analysis. Block randomization by surgeon was used and randomization assignment was done after completing the urethrovesical anastomosis. In patients assigned to suprapubic tube drainage the urethral catheter was removed on postoperative day 1 and all catheters were removed on postoperative day 7. Visual analog pain scale and satisfaction questionnaires were administered on postoperative days 0, 1 and 7. A total of 29 patients were randomized to the urethral catheter vs 29 to the suprapubic tube plus early urethral catheter removal at the time of interim futility analysis. Mean visual analog pain scale scores did not differ between the groups at any time point and a similar percent of patients cited the catheter as the greatest bother with nonsignificant differences in treatment related satisfaction. Complications during postoperative week 1 did not vary between the groups. Based on interim results the trial was terminated due to lack of effect. Patients randomized to suprapubic tube vs urethral catheter drainage for the week after prostatectomy had similar pain, catheter related bother and treatment related satisfaction in the perioperative period. We no longer routinely offer suprapubic tube drainage with early urethral catheter removal at our institution. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Signal enhancement in laser-induced breakdown spectroscopy using fast square-pulse discharges

NASA Astrophysics Data System (ADS)

Sobral, H.; Robledo-Martinez, A.

2016-10-01

A fast, high voltage square-shaped electrical pulse initiated by laser ablation was investigated as a means to enhance the analytical capabilities of laser Induced breakdown spectroscopy (LIBS). The electrical pulse is generated by the discharge of a charged coaxial cable into a matching impedance. The pulse duration and the stored charge are determined by the length of the cable. The ablation plasma was produced by hitting an aluminum target with a nanosecond 532-nm Nd:YAG laser beam under variable fluence 1.8-900 J cm- 2. An enhancement of up to one order of magnitude on the emission signal-to-noise ratio can be achieved with the spark discharge assisted laser ablation. Besides, this increment is larger for ionized species than for neutrals. LIBS signal is also increased with the discharge voltage with a tendency to saturate for high laser fluences. Electron density and temperature evolutions were determined from time delays of 100 ns after laser ablation plasma onset. Results suggest that the spark discharge mainly re-excites the laser produced plume.

Robot-assisted laparoscopic prostatectomy is not associated with early postoperative radiation therapy.

PubMed

Chino, Junzo; Schroeck, Florian R; Sun, Leon; Lee, W Robert; Albala, David M; Moul, Judd W; Koontz, Bridget F

2009-11-01

To compare open radical prostatectomy (RP) and robot-assisted laparoscopic prostatectomy (RALP), and to determine whether RALP is associated with a higher risk of features that determine recommendations for postoperative radiation therapy (RT). Patients undergoing RP from 2003 to 2007 were stratified into two groups: open RP and RALP. Preoperative (PSA level, T stage and Gleason score), pathological factors (T stage, Gleason score, extracapsular extension [ECE] and the status of surgical margins and seminal vesicle invasion [SVI]) and early treatment with RT or referral for RT within 6 months were compared between the groups. Multivariate analysis was used to control for selection bias in the RALP group. In all, 904 patients were identified; 368 underwent RALP and 536 underwent open RP (retropubic or perineal). Patients undergoing open RP had a higher pathological stage with ECE present in 24.8% vs 19.3% in RALP (P = 0.05) and SVI in 10.3% vs 3.8% (P < 0.001). In the RALP vs open RP group, there were positive surgical margins in 31.5% vs 31.9% (P = 0.9) and there were postoperative PSA levels of (3) 0.2 ng/mL in 5.7% vs 6.3% (P = 0.7), respectively. On multivariate analysis to control for selection bias, RALP was not associated with indication for RT (odds ratio (OR) 1.10, P = 0.55), or referral for RT (OR 1.04, P = 0.86). RALP was not associated with an increase in either indication or referral for early postoperative RT.

Rationale and design of TRANSITION: a randomized trial of pre-discharge vs. post-discharge initiation of sacubitril/valsartan.

PubMed

Pascual-Figal, Domingo; Wachter, Rolf; Senni, Michele; Belohlavek, Jan; Noè, Adele; Carr, David; Butylin, Dmytro

2018-04-01

The prognosis after hospitalization for acute decompensated heart failure (ADHF) remains poor, especially <30 days post-discharge. Evidence-based medications with prognostic impact administered at discharge improve survival and hospital readmission, but robust studies comparing pre-discharge with post-discharge initiation are rare. The PARADIGM-HF trial established sacubitril/valsartan as a new evidence-based therapy in patients with heart failure (HF) and reduced left ventricular ejection fraction (<40%) (rEF). In common with other landmark studies, it enrolled patients who were ambulatory at the time of inclusion. In addition, there is also still limited knowledge of initiation and up-titration of sacubitril/valsartan in ACEi/ARB- naïve patients and in de novo HF with rEF patients. TRANSITION is a multicentre, open-label study in which ~1000 adults hospitalized for ADHF with rEF are randomized to start sacubitril/valsartan in a pre-discharge arm (initiated ≥24 h after haemodynamic stabilization) or a post-discharge arm (initiated within Days 1-14 after discharge). The protocol allows investigators to select the appropriate starting dose and dose adjustments according to clinical circumstances. Over a 10 week treatment period, the primary and secondary objectives assess the feasibility and safety of starting sacubitril/valsartan in-hospital, early after haemodynamic stabilization. Exploratory objectives also include assessment of HF signs and symptoms, readmissions, N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T levels, and health resource utilization parameters. TRANSITION will provide new evidence about initiating sacubitril/valsartan following hospitalization for ADHF, occurring either as de novo ADHF or as deterioration of chronic HF, and in patients with or without prior ACEI/ARB therapy. The results of TRANSITION will thus be highly relevant to the management of patients hospitalized for ADHF with rEF. © 2017 The Authors

Suicidal behavior and assisted suicide in dementia.

PubMed

Draper, Brian M

2015-10-01

Concerns about suicide risk in people with dementia have been increasing in recent years along with a discourse about rational suicide and assisted suicide. A systematic narrative literature review of suicidal behavior and assisted suicide in persons with dementia. Most studies that have examined the spectrum of suicidal ideation, attempted suicide and suicide in dementia have methodological limitations but the overall suicide risk does not appear to be increased. When suicidal behavior does occur, common themes include the presence of psychiatric comorbidity, mainly depression; occurrence early in the dementia course with preserved insight and capacity; and an increased risk in younger people. The emerging discourse on rational and assisted suicide has been spurred by early and pre-symptomatic diagnosis and poses a number of ethical challenges for clinicians including the role of proxy decision-makers. Although dementia might not confer a significant overall risk for suicidal behavior, clinicians still need to consider the potential for suicide in vulnerable individuals particularly early in the dementia course.

Influence of the voltage waveform during nanocomposite layer deposition by aerosol-assisted atmospheric pressure Townsend discharge

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

Profili, J.; Département de Physique, Université de Montréal, Montréal, Québec H3C 3J7; Levasseur, O.

2016-08-07

This work examines the growth dynamics of TiO{sub 2}-SiO{sub 2} nanocomposite coatings in plane-to-plane Dielectric Barrier Discharges (DBDs) at atmospheric pressure operated in a Townsend regime using nebulized TiO{sub 2} colloidal suspension in hexamethyldisiloxane as the growth precursors. For low-frequency (LF) sinusoidal voltages applied to the DBD cell, with voltage amplitudes lower than the one required for discharge breakdown, Scanning Electron Microscopy of silicon substrates placed on the bottom DBD electrode reveals significant deposition of TiO{sub 2} nanoparticles (NPs) close to the discharge entrance. On the other hand, at higher frequencies (HF), the number of TiO{sub 2} NPs deposited stronglymore » decreases due to their “trapping” in the oscillating voltage and their transport along the gas flow lines. Based on these findings, a combined LF-HF voltage waveform is proposed and used to achieve significant and spatially uniform deposition of TiO{sub 2} NPs across the whole substrate surface. For higher voltage amplitudes, in the presence of hexamethyldisiloxane and nitrous oxide for plasma-enhanced chemical vapor deposition of inorganic layers, it is found that TiO{sub 2} NPs become fully embedded into a silica-like matrix. Similar Raman spectra are obtained for as-prepared TiO{sub 2} NPs and for nanocomposite TiO{sub 2}-SiO{sub 2} coating, suggesting that plasma exposure does not significantly alter the crystalline structure of the TiO{sub 2} NPs injected into the discharge.« less

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.

Cardiac catheterization - discharge

MedlinePlus

Catheterization - cardiac - discharge; Heart catheterization - discharge: Catheterization - cardiac; Heart catheterization; Angina - cardiac catheterization discharge; CAD - cardiac catheterization discharge; Coronary artery disease - cardiac catheterization ...

Early Conversion of External Fixation to Interlocked Nailing in Open Fractures of Both Bone Leg Assisted with Vacuum Closure (VAC) - Final Outcome

PubMed Central

Raj, Manish; Kumar, Sunil; Singh, Pulkesh; Kumar, Dinesh; Singh, Jasveer; Deep, Akash

2016-01-01

Introduction Management of compound grade III fractures of both bone leg includes external stabilization for long period, followed by various soft tissue coverage procedures. Primary interlocking of tibia had been also done with variable results. External fixation for long time without any bone loss often leads to infected nonunion, loss of reduction, pin tract infection and failure of fixation, primary interlocking in compound grade III fractures had shown high medullary infection rate. We managed all cases of compound grade III A/B fractures with primary external fixation, simultaneous wound management using vacuum assisted closure (VAC) followed by early conversion to interlocking within 2 weeks of fixator application. Aim To determine the effectiveness of vacuum assisted closure (VAC) for the early conversion of external fixator to definitive interlocking in open fractures of the both bone leg. Materials and Methods In current study we selected 84 cases of compound grade IIIA/B diaphyseal fractures of both bone leg during period of May 2010 to September 2013. We managed these cases by immediate debridement and application of external fixation followed by repeated debridement, application of vacuum assisted closure (VAC) and conversion to interlocking within two weeks. Results Out of 84 cases union was achieved in 80(95%) of cases with definitive tibial interlocking. Excellent to good result were obtained in 77(91.8%) of cases and fair to poor result seen in rest of 7(8.2%) of cases according to modified Ketenjian’s criteria. 5 out of these 7 poor result group cases were from Compound Grade III B group to start with. Deep infection rate in our series were 7% i.e. total 6 cases and 4 out of these were from compound Grade III B group to start with. Conclusion Vacuum assisted closure (VAC) give a good help for rapid closure of the wound and help in early conversion to definitive intramedullary nailing. Reamed nail could well be used in compound grade IIIA

Interactions between surface discharges induced by volume discharges in a dielectric barrier discharge system

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

Gao, Yenan; Dong, Lifang, E-mail: donglfhbu@163.com; Zhao, Longhu

2014-10-15

The interaction between micro-discharges involved in surface discharges (SDs) is studied in dielectric barrier discharge system. Instantaneous images taken by high speed cameras show that the SDs are induced by volume discharges (VDs). They cannot cross the midperpendicular of two neighbouring volume charges at low voltage while they stretch along it at high voltage, indicating that there is interaction between SDs. The differences of plasma parameters between SD and VD are studied by optical emission spectroscopy. The simulation of the electric fields of the wall charges accumulated by VD further confirms the existence of the interaction.

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

Unravelling relationships: Hospital occupancy levels, discharge timing and emergency department access block.

PubMed

Khanna, Sankalp; Boyle, Justin; Good, Norm; Lind, James

2012-10-01

To investigate the effect of hospital occupancy levels on inpatient and ED patient flow parameters, and to simulate the impact of shifting discharge timing on occupancy levels. Retrospective analysis of hospital inpatient data and ED data from 23 reporting public hospitals in Queensland, Australia, across 30 months. Relationships between outcome measures were explored through the aggregation of the historic data into 21 912 hourly intervals. Main outcome measures included admission and discharge rates, occupancy levels, length of stay for admitted and emergency patients, and the occurrence of access block. The impact of shifting discharge timing on occupancy levels was quantified using observed and simulated data. The study identified three stages of system performance decline, or choke points, as hospital occupancy increased. These choke points were found to be dependent on hospital size, and reflect a system change from 'business-as-usual' to 'crisis'. Effecting early discharge of patients was also found to significantly (P < 0.001) impact overcrowding levels and improve patient flow. Modern hospital systems have the ability to operate efficiently above an often-prescribed 85% occupancy level, with optimal levels varying across hospitals of different size. Operating over these optimal levels leads to performance deterioration defined around occupancy choke points. Understanding these choke points and designing strategies around alleviating these flow bottlenecks would improve capacity management, reduce access block and improve patient outcomes. Effecting early discharge also helps alleviate overcrowding and related stress on the system. © 2012 CSIRO. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Combination of cylindrical confinement and spark discharge for signal improvement using laser induced breakdown spectroscopy.

PubMed

Hou, Zongyu; Wang, Zhe; Liu, Jianmin; Ni, Weidou; Li, Zheng

2014-06-02

Spark discharge has been proved to be an effective way to enhance the LIBS signal while moderate cylindrical confinement is able to increase the signal repeatability with limited signal enhancement effects. In the present work, these two methods were combined together not only to improve the pulse-to-pulse signal repeatability but also to simultaneously and significantly enhance the signal as well as SNR. Plasma images showed that the confinement stabilized the morphology of the plasma, especially for the discharge assisted process, which explained the improvement of the signal repeatability.

Evaluation of Young Children for Early Intervention and Early Childhood Special Education.

ERIC Educational Resources Information Center

Allen, Diana

This technical assistance document provides guidelines for child assessment and eligibility determination for early intervention and early childhood special education programs in Oregon. An overview of the assessment process explains screening, eligibility evaluation, and assessment for the Individual Family Service Plan (IFSP). Legal requirements…

[Management of breast nipple discharge: Recommendations].

PubMed

Ouldamer, L; Kellal, I; Legendre, G; Ngô, C; Chopier, J; Body, G

2015-12-01

To investigate diagnostic value of imaging procedures and management strategies of the patients with nipple discharge (ND) to establish management recommendations. Bibliographical search in French and English languages by consultation of PubMed, Cochrane and Embase databases. Although, all ND require an systematic evaluation guided by clinical data, bloody ND could be a predictor of breast cancer risk among different colors of discharge particularly in patients of more than 50 years (LE2). The mammography and breast ultrasography are the imaging procedures to realize in first intention (grade C) but they turn out useful only when they detect radiological abnormalities (LE4). Galactography has only a localizing value of possible ductal abnormalities (when standard imaging procedures is not contributive) (LE4). Thus, in the diagnostic investigation of a suspicious ND, galactography it is not recommended in standard practice (grade C). The breast Magnetic Resonance Imaging (MRI) is recommended when breast standard imaging procedures are not contributive (grade C). The ND cytology is useful only if it is positive (i.e. reveal cancer cells). There is no proof on the diagnostic performance of the cytological analysis of the ND to allow a recommendation on its realization or not. In front of a suspicious ND, when breast-imaging procedures reveals an associated radiological lesion, an adapted percutaneous biopsy is recommended by percutaneous way (grade C). Vacuum-assisted breast biopsies is a diagnostic tool but can also be therapeutic allowing to avoid surgery in case of benign lesion but current literature data do not allow recommendations on the therapeutic aspect of vacuum-assisted breast biopsy (LE4). In the absence of associated radiological signal, and in case of reproducible bloody persistent ND, a pyramidectomy is recommended (grade C). Copyright © 2015 Elsevier Masson SAS. All rights reserved.

On production and asymmetric focusing of flat electron beams using rectangular capillary discharge plasmas

DOE PAGES

Bagdasarov, G. A.; Bobrova, N. A.; Boldarev, A. S.; ...

2017-12-27

A method for the asymmetric focusing of electron bunches, based on the active plasma lensing technique is proposed. Our method takes advantage of the strong inhomogeneous magnetic field generated inside the capillary discharge plasma to focus the ultrarelativistic electrons. The plasma and magnetic field parameters inside the capillary discharge are described theoretically and modeled with dissipative magnetohydrodynamic computer simulations enabling analysis of the capillaries of rectangle cross-sections. We could use large aspect ratio rectangular capillaries to transport electron beams with high emittance asymmetries, as well as assist in forming spatially flat electron bunches for final focusing before the interaction point.

On production and asymmetric focusing of flat electron beams using rectangular capillary discharge plasmas

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

Bagdasarov, G. A.; Bobrova, N. A.; Boldarev, A. S.

A method for the asymmetric focusing of electron bunches, based on the active plasma lensing technique is proposed. Our method takes advantage of the strong inhomogeneous magnetic field generated inside the capillary discharge plasma to focus the ultrarelativistic electrons. The plasma and magnetic field parameters inside the capillary discharge are described theoretically and modeled with dissipative magnetohydrodynamic computer simulations enabling analysis of the capillaries of rectangle cross-sections. We could use large aspect ratio rectangular capillaries to transport electron beams with high emittance asymmetries, as well as assist in forming spatially flat electron bunches for final focusing before the interaction point.

On production and asymmetric focusing of flat electron beams using rectangular capillary discharge plasmas

NASA Astrophysics Data System (ADS)

Bagdasarov, G. A.; Bobrova, N. A.; Boldarev, A. S.; Olkhovskaya, O. G.; Sasorov, P. V.; Gasilov, V. A.; Barber, S. K.; Bulanov, S. S.; Gonsalves, A. J.; Schroeder, C. B.; van Tilborg, J.; Esarey, E.; Leemans, W. P.; Levato, T.; Margarone, D.; Korn, G.; Kando, M.; Bulanov, S. V.

2017-12-01

A method for the asymmetric focusing of electron bunches, based on the active plasma lensing technique, is proposed. This method takes advantage of the strong inhomogeneous magnetic field generated inside the capillary discharge plasma to focus on the ultrarelativistic electrons. The plasma and magnetic field parameters inside the capillary discharge are described theoretically and modeled with dissipative magnetohydrodynamic computer simulations enabling analysis of the capillaries of rectangle cross-sections. Large aspect ratio rectangular capillaries might be used to transport electron beams with high emittance asymmetries, as well as assist in forming spatially flat electron bunches for final focusing before the interaction point.

Ventriculoperitoneal shunt - discharge

MedlinePlus

... ventriculoperitoneal - discharge; VP shunt - discharge; Shunt revision - discharge; Hydrocephalus shunt placement - discharge ... Your child has hydrocephalus and needed a shunt placed to drain excess fluid and relieve pressure in the brain. This buildup of brain ...

Partial discharge testing under direct voltage conditions

NASA Technical Reports Server (NTRS)

Bever, R. S.; Westrom, J. L.

1982-01-01

DC partial discharge (PD) (corona) testing is performed using a multichannel analyzer for pulse storing, and data is collected during increase of voltage and at quiescent voltage levels. Thus high voltage ceramic disk capacitors were evaluated by obtaining PD data interspersed during an accelerated life test. Increased PD activity was found early in samples that later failed catastrophically. By this technique, trends of insulation behavior are revealed sensitively and nondestructively in high voltage dc components.

Bone marrow transplant - discharge

MedlinePlus

Transplant - bone marrow - discharge; Stem cell transplant - discharge; Hematopoietic stem cell transplant - discharge; Reduced intensity; Non-myeloablative transplant - discharge; Mini transplant - discharge; Allogenic bone marrow transplant - discharge; ...

O2 and CO2 glow-discharge-assisted oxygen transport through Ag

NASA Astrophysics Data System (ADS)

Outlaw, R. A.

1990-08-01

The permeation of oxygen through Ag normally occurs by a sequence of steps which include the initial dissociative adsorption of molecular oxygen at the upstream surface, the dissolution of the atoms into the bulk, and the subsequent migration of the atoms between octahedral sites of the lattice until they arrive at the vacuum interface downstream. The dissociative adsorption step, however, proceeds slowly, as indicated by the low sticking coefficient of O2 on Ag(10-6-10-3). The application of a dc field in 0.5 Torr of O2 (E/n˜10-14 V cm2) on the upstream side of a Ag membrane generated gas phase atomic oxygen that substantially enhanced the transport. The transport flux was observed to increase from a value of 4.4×1013 cm-2 s-1 to a glow discharge value of 2.83×1014 cm-2 s-1 at a membrane temperature of 650 °C. This suggests that the dissociative adsorption step limits the supply of oxygen atoms to the upstream side of the membrane. When the upstream O2 was replaced by an equal pressure of CO2, only a small permeation signal was observed, but the application of the glow discharge substantially increased the transport flux from 3.25×1012 cm-2 s-1 to 1.74×1014 cm-2 s-1. This method of separating O2 from a CO2 environment may be a possible mechanism for providing a supply of oxygen for astronauts in a manned mission to Mars.

Gallbladder removal - laparoscopic - discharge

MedlinePlus

Cholecystectomy laparoscopic - discharge; Cholelithiasis - laparoscopic discharge; Biliary calculus - laparoscopic discharge; Gallstones - laparoscopic discharge; Cholecystitis - laparoscopic discharge

Parental language and dosing errors after discharge from the pediatric emergency department.

PubMed

Samuels-Kalow, Margaret E; Stack, Anne M; Porter, Stephen C

2013-09-01

Safe and effective care after discharge requires parental education in the pediatric emergency department (ED). Parent-provider communication may be more difficult with parents who have limited health literacy or English-language fluency. This study examined the relationship between language and discharge comprehension regarding medication dosing. We completed a prospective observational study of the ED discharge process using a convenience sample of English- and Spanish-speaking parents of children 2 to 24 months presenting to a single tertiary care pediatric ED with fever and/or respiratory illness. A bilingual research assistant interviewed parents to ascertain their primary language and health literacy and observed the discharge process. The primary outcome was parental demonstration of an incorrect dose of acetaminophen for the weight of his or her child. A total of 259 parent-child dyads were screened. There were 210 potential discharges, and 145 (69%) of 210 completed the postdischarge interview. Forty-six parents (32%) had an acetaminophen dosing error. Spanish-speaking parents were significantly more likely to have a dosing error (odds ratio, 3.7; 95% confidence interval, 1.6-8.1), even after adjustment for language of discharge, income, and parental health literacy (adjusted odds ratio, 6.7; 95% confidence interval, 1.4-31.7). Current ED discharge communication results in a significant disparity between English- and Spanish-speaking parents' comprehension of a crucial aspect of medication safety. These differences were not explained purely by interpretation, suggesting that interventions to improve comprehension must address factors beyond language alone.

Pediatric heart surgery - discharge

MedlinePlus

... of the aorta repair - discharge; Heart surgery for children - discharge; Atrial septal defect repair - discharge; Ventricular septal ... discharge; Acquired heart disease - discharge; Heart valve surgery - ... Heart surgery - pediatric - discharge; Heart transplant - pediatric - ...

Mortality and cardiovascular morbidity within 30 days of discharge following acute coronary syndrome in a contemporary European cohort of patients: How can early risk prediction be improved? The six-month GRACE risk score.

PubMed

Raposeiras-Roubín, Sergio; Abu-Assi, Emad; Cambeiro-González, Cristina; Álvarez-Álvarez, Belén; Pereira-López, Eva; Gestal-Romaní, Santiago; Pedreira-López, Milagros; Rigueiro-Veloso, Pedro; Virgós-Lamela, Alejandro; García-Acuña, José María; González-Juanatey, José Ramón

2015-06-01

Given the increasing focus on early mortality and readmission rates among patients with acute coronary syndrome (ACS), this study was designed to evaluate the accuracy of the GRACE risk score for identifying patients at high risk of 30-day post-discharge mortality and cardiovascular readmission. This was a retrospective study carried out in a single center with 4229 ACS patients discharged between 2004 and 2010. The study endpoint was the combination of 30-day post-discharge mortality and readmission due to reinfarction, heart failure or stroke. One hundred and fourteen patients had 30-day events: 0.7% mortality, 1% reinfarction, 1.3% heart failure, and 0.2% stroke. After multivariate analysis, the six-month GRACE risk score was associated with an increased risk of 30-day events (HR 1.03, 95% CI 1.02-1.04; p<0.001), demonstrating good discrimination (C-statistic: 0.79 ± 0.02) and optimal fit (Hosmer-Lemeshow p=0.83). The sensitivity and specificity were adequate (78.1% and 63.3%, respectively), and negative predictive value was excellent (99.1%). In separate analyses for each event of interest (all-cause mortality, reinfarction, heart failure and stroke), assessment of the six-month GRACE risk score also demonstrated good discrimination and fit, as well as adequate predictive values. The six-month GRACE risk score is a useful tool to predict 30-day post-discharge death and early cardiovascular readmission. Clinicians may find it simple to use with the online and mobile app score calculator and applicable to clinical daily practice. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Use of inpatient continuous passive motion versus no CPM in computer-assisted total knee arthroplasty.

PubMed

Alkire, Martha R; Swank, Michael L

2010-01-01

Continuous passive motion (CPM) has shown positive effects on tissue healing, edema, hemarthrosis, and joint function (L. Brosseau et al., 2004). CPM has also been shown to increase short-term early flexion and decrease length of stay (LOS) ( L. Brosseau et al., 2004; C. M. Chiarello, C. M. S. Gundersen, & T. O'Halloran, 2004). The benefits of CPM for the population of patients undergoing computer-assisted total knee arthroplasty (TKA) have not been examined. The primary objective of this study was to determine whether the use of CPM following computer-assisted TKA resulted in differences in range of motion, edema/drainage, functional ability, and pain. This was an experimental, prospective, randomized study of patients undergoing unilateral, computer-assisted TKA. The experimental group received CPM thrice daily and physical therapy (PT) twice daily during their hospitalization. The control group received PT twice daily and no CPM during the hospital stay. Both groups received PT after discharge. Measurement included Knee Society scores, Western Ontario McMaster Osteoarthritis Index values, range of motion, knee circumference, and HemoVac drainage. Data were collected at various intervals from preoperatively through 3 months. Although the control group was found to be higher functioning preoperatively, there was no statistically significant difference in flexion, edema or drainage, function, or pain between groups through the 3-month study period.

Vessel Sewage Discharges: No-Discharge Zones (NDZs)

EPA Pesticide Factsheets

States may petition the EPA to establish areas, called no discharge zones (NDZs), where vessel sewage discharges are prohibited. This page describes how NDZs are designated, the types of designations, who enforces them, and how to comply.

Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial.

PubMed

Bell, Susan P; Schnipper, Jeffrey L; Goggins, Kathryn; Bian, Aihua; Shintani, Ayumi; Roumie, Christianne L; Dalal, Anuj K; Jacobson, Terry A; Rask, Kimberly J; Vaccarino, Viola; Gandhi, Tejal K; Labonville, Stephanie A; Johnson, Daniel; Neal, Erin B; Kripalani, Sunil

2016-05-01

Reduction in 30-day readmission rates following hospitalization for acute coronary syndrome (ACS) and acute decompensated heart failure (ADHF) is a national goal. The aim of this study was to determine the effect of a tailored, pharmacist-delivered, health literacy intervention on unplanned health care utilization, including hospital readmission or emergency room (ER) visit, following discharge. Randomized, controlled trial with concealed allocation and blinded outcome assessors Two tertiary care academic medical centers Adults hospitalized with a diagnosis of ACS and/or ADHF. Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge The primary outcome was time to first unplanned health care event, defined as hospital readmission or an ER visit within 30 days of discharge. Pre-specified analyses were conducted to evaluate the effects of the intervention by academic site, health literacy status (inadequate versus adequate), and cognition (impaired versus not impaired). Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) are reported. A total of 851 participants enrolled in the study at Vanderbilt University Hospital (VUH) and Brigham and Women's Hospital (BWH). The primary analysis showed no statistically significant effect on time to first unplanned hospital readmission or ER visit among patients who received interventions compared to controls (aHR = 1.04, 95% CI 0.78-1.39). There was an interaction of treatment effect by site (p = 0.04 for interaction); VUH aHR = 0.77, 95% CI 0.51-1.15; BWH aHR = 1.44 (95% CI 0.95-2.12). The intervention reduced early unplanned health care utilization among patients with inadequate health literacy (aHR 0.41, 95% CI 0.17-1.00). There was no difference in treatment effect by patient cognition. A tailored, pharmacist-delivered health literacy-sensitive intervention did not reduce post-discharge

Electrical energy sources for organic synthesis on the early earth

NASA Technical Reports Server (NTRS)

Chyba, Christopher; Sagan, Carl

1991-01-01

It is pointed out that much of the contemporary origin-of-life research uses the original estimates of Miller and Urey (1959) for terrestrial energy dissipation by lightning and coronal discharges being equal to 2 x 10 to the 19th J/yr and 6 x 10 to the 19th J/yr, respectively. However, data from experiments that provide analogues to naturally-occurring lightning and coronal discharges indicate that lightning energy yields for organic synthesis (nmole/J) are about one order of magnitude higher than the coronal discharge yields. This suggests that, on early earth, organic production by lightning may have dominated that due to coronal emission. New values are recommended for lightning and coronal discharge dissipation rates on the early earth, 1 x 10 to the 18th J/yr and 5 x 10 to the 17th J/yr, respectively.

Effects of Dispatcher-assisted Cardiopulmonary Resuscitation on Survival Outcomes in Infants, Children, and Adolescents with Out-of-hospital Cardiac Arrests.

PubMed

Ro, Young Sun; Shin, Sang Do; Song, Kyoung Jun; Hong, Ki Jeong; Ahn, Ki Ok; Kim, Do Kyun; Kwak, Young Ho

2016-11-01

We studied the effect of a dispatcher-assisted cardiopulmonary resuscitation (CPR) program on paediatric out-of-hospital cardiac arrest (OHCA) outcomes by age groups. All emergency medical services (EMS)-treated paediatric OHCAs in Korea were enrolled between 2012 and 2014, excluding cases witnessed by EMS providers and those with unknown outcomes. The cases were divided into three groups: bystander CPR with dispatcher assistance, bystander CPR without dispatcher assistance, and no-bystander CPR. The endpoint was survival until discharge from hospital. Multivariable logistic regression analysis was performed. The final model with an interaction term was evaluated to compare the effects across age groups. A total of 1529 patients (32.8% bystander CPR with dispatcher assistance, 17.3% without dispatcher assistance, and 54.6% no-bystander CPR) were included. Both bystander CPR groups were more likely to have higher rate of survival to discharge (8.8% and 12.1%) compared to no-bystander CPR (3.9%). The adjusted OR (95% CI) for survival to discharge were 1.77 (1.04-3.00) in bystander CPR with dispatcher assistance and 2.86 (1.61-5.08) in without dispatcher assistance compared with no-bystander CPR. By age groups, the adjusted OR (95% CI) in bystander CPR with and without dispatcher assistance were 2.18 (1.07-4.42) and 2.27 (1.01-5.14) for the group aged 9-18 years; 2.32 (0.64-8.44) and 6.21 (1.83-21.01) for the group aged 1-8 years; 1.06 (0.41-2.77) and 2.00 (0.64-6.18) for the group aged 0-12 months, respectively. Bystander CPR, regardless of dispatcher assistance, was associated with improved survival outcomes after OHCA in the paediatric population. However, the associations between dispatcher-assisted bystander CPR and survival outcomes varied by age. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Optimising recovery after surgery: Predictors of early discharge and hospital readmission.

PubMed

Carter, Jonathan; Philp, Shannon; Wan, King M

2016-10-01

Fast track surgery (FTS) programs minimise the stress response after surgery and allow for enhanced recovery. To document the frequency and incidence of adverse events in patients enrolled on a FTS program and to investigate factors associated with shorter length of stay and readmission to hospital. A seven-year updated surgical audit of patients undergoing laparotomy for suspected or confirmed malignancy on a FTS program. Five hundred and fifty patients comprise the study group. Average age and body mass index (BMI) were 55 years and 28, respectively. Mean length of stay (LOS) was 3.4 days with 194 (35%) patients discharged on day 2. Six (1%) patients had confirmed venous thromboembolism (VTE), three of whom were diagnosed on pre-operative imaging. Overall, transfusion rate was 5%. Adverse events in decreasing frequency were hospital readmission (4%) and significant wound infection (3%). All other adverse events were uncommon with rates <0.5%. Factors associated with a discharge on or after day 3 include age, pathology, Eastern Cooperative Oncology Group performance status, incision type, operating time, blood transfusion and cyclo-oxygenase 2 inhibitors. Factors associated with hospital readmission include longer operating time, performance of lymph node sampling/dissection, longer LOS, development of wound infection, febrile morbidity, return to the operating room, unplanned intensive care unit admission and presence of other complications. Patients managed by a FTS protocol can expect enhanced outcomes when compared to historical controls. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

The Impacts of Workplace Advantage, Learning Intentions, and Technology Skills on the Use of Information Technology-Assisted Instruction by Early Childhood Pre-Service Teachers

ERIC Educational Resources Information Center

Chen, Ru-Si

2015-01-01

The practical value and usefulness of IT-assisted instruction for Taiwanese preschool children are popular topics in academic and practical settings. The purpose of this study was to survey early childhood pre-service teachers' attitudes regarding the workplace advantage of IT-related pedagogy and their learning intentions regarding IT-based…

Rehabilitation as "destination triage": a critical examination of discharge planning.

PubMed

Durocher, Evelyne; Gibson, Barbara E; Rappolt, Susan

2017-06-01

In this paper we examine how the intersection of various social and political influences shapes discharge planning and rehabilitation practices in ways that may not meet the espoused aims of rehabilitation programs or the preferences of older adults and their families. Taking a critical bioethics perspective, we used microethnographic case study methods to examine discharge-planning processes in a well-established older adult inpatient rehabilitation setting in Canada. The data included observations of discharge-planning family conferences and semi-structured interviews conducted with older adults facing discharge, their family members and rehabilitation professionals involved in discharge planning. From the time of admission, a contextual push to focus on discharge superseded program aims of providing interventions to increase older adults' functional capabilities. Professionals' primary commitment to safety limited consideration of discharge options and resulted in costly and potentially unnecessary recommendations for 24-hour care. The resulting "rehabilitation" stay was more akin to an extended process of "destination triage" biased towards the promotion of physical safety than optimizing functioning. The resulting reduction of rehabilitation into "destination triage" has significant social, financial and occupational implications for older adults and their families, and broader implications for healthcare services and overarching healthcare systems. Implications for Rehabilitation Current trends promoting consideration of discharge planning from the point of admission and prioritizing physical safety are shifting the focus of rehabilitation away from interventions to maximize recovery of function, which are the stated aims of rehabilitation. Such practices furthermore promote assessments to determine prognosis early in the rehabilitation stay when accurate prognosis is difficult, which can lead to overly conservative recommendations for discharge from

Design and Development of a Miniaturized Percutaneously Deployable Wireless Left Ventricular Assist Device: Early Prototypes and Feasibility Testing.

PubMed

Letzen, Brian; Park, Jiheum; Tuzun, Zeynep; Bonde, Pramod

The current left ventricular assist devices (LVADs) are limited by a highly invasive implantation procedure in a severely unstable group of advanced heart failure patients. Additionally, the current transcutaneous power drive line acts as a nidus for infection resulting in significant morbidity and mortality. In an effort to decrease this invasiveness and eliminate drive line complications, we have conceived a wireless miniaturized percutaneous LVAD, capable of being delivered endovascularly with a tether-free operation. The system obviates the need for a transcutaneous fluid purge line required in existing temporary devices by utilizing an incorporated magnetically coupled impeller for a complete seal. The objective of this article was to demonstrate early development and proof-of-concept feasibility testing to serve as the groundwork for future formalized device development. Five early prototypes were designed and constructed to iteratively minimize the pump size and improve fluid dynamic performance. Various magnetic coupling configurations were tested. Using SolidWorks and ANSYS software for modeling and simulation, several geometric parameters were varied. HQ curves were constructed from preliminary in vitro testing to characterize the pump performance. Bench top tests showed no-slip magnetic coupling of the impeller to the driveshaft up to the current limit of the motor. The pump power requirements were tested in vitro and were within the appropriate range for powering via a wireless energy transfer system. Our results demonstrate the proof-of-concept feasibility of a novel endovascular cardiac assist device with the potential to eventually offer patients an untethered, minimally invasive support.

Southampton Mealtime Assistance Study: design and methods.

PubMed

Roberts, Helen C; Pilgrim, Anna L; Elia, Marinos; Jackson, Alan A; Cooper, Cyrus; Sayer, Avan Aihie; Robinson, Sian M

2013-01-07

Malnutrition is common in older people in hospital and is associated with adverse clinical outcomes including increased mortality, morbidity and length of stay. This has raised concerns about the nutrition and diet of hospital in-patients. A number of factors may contribute to low dietary intakes in hospital, including acute illness and cognitive impairment among in-patients. The extent to which other factors influence intake such as a lack of help at mealtimes, for patients who require assistance with eating, is uncertain. This study aims to evaluate the effectiveness of using trained volunteer mealtime assistants to help patients on an acute medical ward for older people at mealtimes. The study design is quasi-experimental with a before (year one) and after (year two) comparison of patients on the intervention ward and parallel comparison with patients on a control ward in the same department. The intervention in the second year was the provision of trained volunteer mealtime assistance to patients in the intervention ward. There were three components of data collection that were repeated in both years on both wards. The first (primary) outcome was patients' dietary intake, collected as individual patient records and as ward-level balance data over 24 hour periods. The second was clinical outcome data assessed on admission and discharge from both wards, and 6 and 12 months after discharge. Finally qualitative data on the views and experience of patients, carers, staff and volunteers was collected through interviews and focus groups in both years to allow a mixed-method evaluation of the intervention. The study will describe the effect of provision of trained volunteer mealtime assistants on the dietary intake of older medical in-patients. The association between dietary intake and clinical outcomes including malnutrition risk, body composition, grip strength, length of hospital stay and mortality will also be determined. An important component of the study is the

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

Base flow recession from unsaturated-saturated porous media considering lateral unsaturated discharge and aquifer compressibility

NASA Astrophysics Data System (ADS)

Liang, Xiuyu; Zhan, Hongbin; Zhang, You-Kuan; Schilling, Keith

2017-09-01

Unsaturated flow is an important process in base flow recessions and its effect is rarely investigated. A mathematical model for a coupled unsaturated-saturated flow in a horizontally unconfined aquifer with time-dependent infiltrations is presented. The effects of the lateral discharge of the unsaturated zone and aquifer compressibility are specifically taken into consideration. Semianalytical solutions for hydraulic heads and discharges are derived using Laplace transform and Cosine transform. The solutions are compared with solutions of the linearized Boussinesq equation (LB solution) and the linearized Laplace equation (LL solution), respectively. A larger dimensionless constitutive exponent κD (a smaller retention capacity) of the unsaturated zone leads to a smaller discharge during the infiltration period and a larger discharge after the infiltration. The lateral discharge of the unsaturated zone is significant when κD≤1, and becomes negligible when κD≥100. The compressibility of the aquifer has a nonnegligible impact on the discharge at early times. For late times, the power index b of the recession curve -dQ/dt˜ aQb, is 1 and independent of κD, where Q is the base flow and a is a constant lumped aquifer parameter. For early times, b is approximately equal to 3 but it approaches infinity when t→0. The present solution is applied to synthetic and field cases. The present solution matched the synthetic data better than both the LL and LB solutions, with a minimum relative error of 16% for estimate of hydraulic conductivity. The present solution was applied to the observed streamflow discharge in Iowa, and the estimated values of the aquifer parameters were reasonable.

Development and current applications of assisted fertilization.

PubMed

Palermo, Gianpiero D; Neri, Queenie V; Monahan, Devin; Kocent, Justin; Rosenwaks, Zev

2012-02-01

Since the very early establishment of in vitro insemination, it became clear that one of the limiting steps is the achievement of fertilization. Among the different assisted fertilization methods, intracytoplasmic sperm injection emerged as the ultimate technique to allow fertilization with ejaculated, epididymal, and testicular spermatozoa. This work describes the early steps that brought forth the development of intracytoplasmic sperm injection and its role in assisted reproductive techniques. The current methods to select the preferential male gamete will be elucidated and the concerns related to the offspring of severe male factor couples will be discussed. Copyright © 2012. Published by Elsevier Inc.

13 CFR 305.11 - Contract awards; early construction start.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Contract awards; early construction start. 305.11 Section 305.11 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION... § 305.11 Contract awards; early construction start. EDA must determine that the award of all contracts...

13 CFR 305.11 - Contract awards; early construction start.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false Contract awards; early construction start. 305.11 Section 305.11 Business Credit and Assistance ECONOMIC DEVELOPMENT ADMINISTRATION... § 305.11 Contract awards; early construction start. EDA must determine that the award of all contracts...

Plasma Assisted Ignition and Combustion at Low Initial Gas Temperatures: Development of Kinetic Mechanism

DTIC Science & Technology

2016-10-05

describes physics of a nanosecond surface dielectric barrier discharge (SDBD) at ambient gas temperature and high pressures (1-6 bar) in air. Details about...the ignition by a nanosecond discharge. Chapter 7 presents the high pressure high temperature reactor built recently at Laboratory for Plasma Physics ...livelink.ebs.afrl.af.mil/livelink/llisapi.dll Laboratory for Physics of Plasma, Ecole Polytechnique Plasma Assisted Ignition and Combustion at Low Initial Gas

GAS DISCHARGE DEVICES

DOEpatents

Arrol, W.J.; Jefferson, S.

1957-08-27

The construction of gas discharge devices where the object is to provide a gas discharge device having a high dark current and stabilized striking voltage is described. The inventors have discovered that the introduction of tritium gas into a discharge device with a subsequent electrical discharge in the device will deposit tritium on the inside of the chamber. The tritium acts to emit beta rays amd is an effective and non-hazardous way of improving the abovementioned discharge tube characteristics

Snowmelt discharge characteristics Sierra Nevada, California

USGS Publications Warehouse

Peterson, David; Smith, Richard; Stewart, Iris; Knowles, Noah; Soulard, Chris; Hager, Stephen

2005-01-01

Alpine snow is an important water resource in California and the western U.S. Three major features of alpine snowmelt are the spring pulse (the first surge in snowmelt-driven river discharge in spring), maximum snowmelt discharge, and base flow (low river discharge supported by groundwater in fall). A long term data set of hydrologic measurements at 24 gage locations in 20 watersheds in the Sierra Nevada was investigated to relate patterns of snowmelt with stream discharge In wet years, the daily variations in snowmelt discharge at all the gage locations in the Sierra Nevada correlate strongly with the centrally located Merced River at Happy Isles, Yosemite National Park (i.e., in 1983, the mean of the 23 correlations was R= 0.93 + 0.09) ; in dry years, however, this correlation breaks down (i.e., in year 1977, R=0.72 + 0.24). A general trend towards earlier snowmelt was found and modeled using correlations with the timing of the spring pulse and the river discharge center of mass. For the 24 river and creek gage locations in this study, the spring pulse appeared to be a more sensitive measure of early snowmelt than the center of mass. The amplitude of maximum daily snowmelt discharge correlates strongly with initial snow water equivalent. Geologic factors, base rock permeability and soil-to-bedrock ratio, influence snowmelt flow pathways. Although both surface and ground water flows and water levels increase in wet years compared to dry years, the increase was greater for surface water in a watershed with relatively impermeable base rock than for surface water in a watershed with highly permeable base rock The relation was the opposite for base flow (ground water). The increase was greater for groundwater in a watershed with permeable rock compared to ground water in a watershed with impermeable rock. A similar, but weaker, surface/groundwater partitioning was observed in relatively impermeable granitic watersheds with differing soil-to-bedrock ratios. The

Which Reasons Do Doctors, Nurses, and Patients Have for Hospital Discharge? A Mixed-Methods Study

PubMed Central

Ubbink, Dirk T.; Tump, Evelien; Koenders, Josje A.; Kleiterp, Sieta; Goslings, J. Carel; Brölmann, Fleur E.

2014-01-01

Background The decision to discharge a patient from a hospital is a complex process governed by many medical and non-medical factors, while the actual reasons for discharge frequently remain ill-defined. Aim To define relevant discharge criteria as perceived by doctors, nurses and patients for the development of a standard hospital discharge policy, we collected actual reasons and most pivotal medical and organisational criteria for discharge among all stakeholders. Setting A tertiary referral university teaching hospital. Methods We conducted a mixed methods analysis, using patient questionnaires, interviews and a focus group with caregivers, and observations during the daily rounds of doctors, nurses and patients during their hospital stay. Fourteen wards of the Surgery, Paediatrics and Neurology departments contributed. Results We observed 426 patients during their hospital stay. Forty doctors and nurses were interviewed, and 7 senior nurses attended a focus group. The most commonly used discharge criteria were clinical factors, organisational discharge issues and patient-related factors. A total of 269 patients returned their questionnaires. About one third of the adult patients and nearly half of the children (or their parents) felt their personal situation and assistance needed at home was insufficiently taken into account before discharge. Patients were least satisfied with the information given about what they were allowed to do or should avoid after discharge and their involvement in the planning of their discharge. Thus, besides obvious medical reasons for discharge, several non-medical reasons were signalled by all stakeholders as important issues to be improved. Conclusions A set of discharge criteria could be defined that is useful for a more uniform hospital discharge policy that may help reduce unnecessary length of stay and improve patient satisfaction. PMID:24625666

The hollow cathode in the quasi-steady MPD discharge

NASA Technical Reports Server (NTRS)

Von Jaskowsky, W. F.; Jahn, R. G.; Clark, K. E.; Krishnan, M.

1973-01-01

A large hollow cathode has been operated in a quasi-steady MPD discharge over a range of current from 7 to 30 kA and argon mass flow from 0.04 to 6.0 g/sec. The 1.3-cm-i.d. cathode cavity attains steady emission characteristics in some tens of microseconds without the assistance of auxiliary heating, low work function inserts, or external keeper electrodes. Measured current and potential distributions within the cavity reveal that the current attaches in a zone 1 to 2 cm long with a surface current density greater than 1000 A/sq cm and a local axial electric field less than 10 V/cm. Electron densities within the cavity, estimated from spectroscopic records, are above 10 to the 17th power per cu cm, at least one order of magnitude greater than has been reported for either ion engine hollow cathodes or conventional solid cathodes in similar arc discharges.

Early Supported Discharge/Hospital At Home For Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Review and Meta-Analysis.

PubMed

Echevarria, Carlos; Brewin, Karen; Horobin, Hazel; Bryant, Andrew; Corbett, Sally; Steer, John; Bourke, Stephen C

2016-08-01

A systematic review and meta-analysis was performed to assess the safety, efficacy and cost of Early Supported Discharge (ESD) and Hospital at Home (HAH) compared to Usual Care (UC) for patients with acute exacerbation of COPD (AECOPD). The structure of ESD/HAH schemes was reviewed, and analyses performed assuming return to hospital during the acute period (prior to discharge from home treatment) was, and was not, considered a readmission. The pre-defined search strategy completed in November 2014 included electronic databases (Medline, Embase, Amed, BNI, Cinahl and HMIC), libraries, current trials registers, national organisations, key respiratory journals, key author contact and grey literature. Randomised controlled trials (RCTs) comparing ESD/HAH to UC in patients admitted with AECOPD, or attending the emergency department and triaged for admission, were included. Outcome measures were mortality, all-cause readmissions to 6 months and cost. Eight RCTs were identified; seven reported mortality and readmissions. The structure of ESD/HAH schemes, particularly selection criteria applied and level of support provided, varied considerably. Compared to UC, ESD/HAH showed a trend towards lower mortality (RRMH = 0.66; 95% CI 0.40-1.09, p = 0.10). If return to hospital during the acute period was not considered a readmission, ESD/HAH was associated with fewer readmissions (RRMH = 0.74, 95% CI: 0.60-0.90, p = 0.003), but if considered a readmission, the benefit was lost (RRMH = 0.84; 95% CI 0.69-1.01, p = 0.07). Costs were lower for ESD/HAH than UC. ESD/HAH is safe in selected patients with an AECOPD. Further research is required to define optimal criteria to guide patient selection and models of care.

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 ...

Teaching Assistants Talking

ERIC Educational Resources Information Center

McLachlan, Benita

2016-01-01

Local Authorities (LAs) in Britain traditionally employ Visual Impairment (VI) teams as integrative statutory Special Educational Needs and Inclusion (SENI) provision. Teaching Assistants (TAs) work alongside Qualified Teachers (QTs) in VI teams to support children and young people (CYP) with VI. The VI TA has a broad role in covering early years,…

Numerical modelling of the effect of dry air traces in a helium parallel plate dielectric barrier discharge

NASA Astrophysics Data System (ADS)

Lazarou, C.; Belmonte, T.; Chiper, A. S.; Georghiou, G. E.

2016-10-01

A validated numerical model developed for the study of helium barrier discharges in the presence of dry air impurities is presented in this paper. The model was used to numerically investigate the influence of air traces on the evolution of the helium dielectric barrier discharge (DBD). The level of dry air used as impurity was in the range from 0 to 1500 ppm, which corresponds to the most commonly encountered range in atmospheric pressure discharge experiments. The results presented in this study clearly show that the plasma chemistry and consequently the discharge evolution is highly affected by the concentration level of impurities in the mixture. In particular, it was observed that air traces assist the discharge ignition at low concentration levels (~55 ppm), while on the other hand, they increase the burning voltage at higher concentration levels (~1000 ppm). Furthermore, it was found that the discharge symmetry during the voltage cycle highly depends on the concentration of air. For the interpretation of the results, a detailed analysis of the processes that occur in the discharge gap is performed and the main reaction pathways of ion production are described. Thanks to this approach, useful insight into the physics behind the evolution of the discharge is obtained.

[Hospital at home: assessment of early discharge in terms of patients mortality and satisfaction].

PubMed

Damiani, G; Pinnarelli, L; Ricciardi, G

2006-01-01

New organizational models are essentials for European Hospitals because of restraining budget and ageing of population. Hospital at home is an alternative to inpatient care, effective both in clinical and economic ground. The aim of our study was to evaluate the impact of Hospital at Home in terms of decreased mortality and patient satisfaction. We carried out a meta-analysis of the literature about hospital at home interventions. We searched Medline (to December 2002), the Cochrane Controlled Trials Register (to October 2002) and other bibliographical databases, with a supplementary handsearching of literature. We used the following keywords: hospital at home, home hospitalization, mortality, patient satisfaction, cost, acute hospital care, conventional hospitalization. We included studies respecting the following criteria: analytical or experimental studies aimed at compare early discharge to hospital at home and continued care in an acute hospital. Review Manager 4.2 software was used to collect data and perform statistical analysis. We found 2420 articles searching for the chosen keywords. Twelve studies (2048 patients) were included for death outcome and six studies (1382 patients) were included for satisfaction outcome. The selected studies indicated a greater effect size of patient satisfaction in home patients than hospitalized ones (Odds Ratio: 1.58 95% CI: 1.25, 2.00) and showed no difference in terms of mortality (Risk Difference: -0.01 95% CI: -0.03, 0.02). Our results underline the effectiveness of this organizational model, as an alternative to continued care in an acute hospital. Further useful considerations could be drawn by economic evaluation studies carried out on field.

Study of Mechanical and Thermal Impact of a Plasma Focus Discharge on Diagnostic Elements of PFM-72M Installation

NASA Astrophysics Data System (ADS)

Bashutin, O. A.; Savelov, A. S.; Sidorov, P. P.

2017-12-01

Mechanical and thermal impact of the plasma focus discharge on structural elements of diagnostic windows of the PFM-72m discharge installation are calculated. The absence of critical impact at early discharge stages and during the first 300 ns after the "plasma focus" formation is shown. The possibility of shock impact on the surface of diagnostic windows at later times, which may result in their substantial deformation and destruction, is demonstrated.

Clinical characteristics of vaginal discharge in bacterial vaginosis diagnosed by Nugent's criteria.

PubMed

Hapsari, E D; Hayashi, M; Matsuo, H

2006-01-01

To determine which clinical signs have an important contribution in bacterial vaginosis (BV) diagnosed by Nugent's criteria. This was a cross-sectional study of 58 women undergoing vaginal examination at Hayashi women's clinic, Hyogo Prefecture. Characteristics of vaginal discharge (color, amount, odor, and pH level) and the number of clue cells were compared among normal, intermediate, and BV groups. BV was diagnosed by using Nugent's criteria. The incidence of BV in our study population was 25.9%. Compared to the non-BV group, women in the BV group were found more often to have yellowish color and a moderate amount of discharge (66.67% vs 33.33%, NS; 55.56% vs 44.44%, NS), odorous discharge (100% vs 0%, p < 0.05) and furthermore, pH level and the number of clue cells were significantly higher. Odor, pH level and the number of clue cells in the vaginal discharge were helpful clinical signs for early detection of BV diagnosed by Nugent's criteria.

Ultra-wide-field scanning laser ophthalmoscopy assists in the clinical detection and evaluation of asymptomatic early-stage familial exudative vitreoretinopathy.

PubMed

Lyu, Jiao; Zhang, Qi; Wang, Shi-Yuan; Chen, Yi-Ye; Xu, Yu; Zhao, Pei-Quan

2017-01-01

This study aims to investigate the ability of the ultra-wide-field scanning laser ophthalmoscope (UWF SLO) in clinically detecting and evaluating asymptomatic early-stage familial exudative vitreoretinopathy (FEVR). We retrospectively reviewed 163 eyes of 83 asymptomatic family members of 48 patients with FEVR. UWF SLO imaging (Optos® PLC, Scotland, UK) was performed on asymptomatic family members as a preliminary screening test for fundus anomalies, and the findings were compared with subsequent examinations using indirect fundus ophthalmoscopy in full mydriasis, fluorescein angiography (FA), fundus autoflourescence, and genetic sequencing. A total of 86 eyes of 43 asymptomatic family members were clinically diagnosed with early-stage FEVR, and 17 of the affected 43 family members were also genetically diagnosed. Compared with FA as a standard, the UWF SLO was highly effective in diagnosing FEVR with a sensitivity and specificity of 93.0 % and 97.5 %, respectively. The UWF SLO was able to diagnose early-stage FEVR in 93.0 % of eyes, and guided the selection of therapies in 46.5 % of the eyes studied. UWF SLO is a valuable imaging tool for detecting fundus anomalies related to early-stage FEVR, and this tool can assist in the clinical diagnosis and evaluation of early-stage FEVR in asymptomatic family members of patients with FEVR.

Investigation of ionized metal flux in enhanced high power impulse magnetron sputtering discharges

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

Stranak, Vitezslav, E-mail: stranak@prf.jcu.cz; Hubicka, Zdenek; Cada, Martin

2014-04-21

The metal ionized flux fraction and production of double charged metal ions Me{sup 2+} of different materials (Al, Cu, Fe, Ti) by High Power Impulse Magnetron Sputtering (HiPIMS) operated with and without a pre-ionization assistance is compared in the paper. The Electron Cyclotron Wave Resonance (ECWR) discharge was employed as the pre-ionization agent providing a seed of charge in the idle time of HiPIMS pulses. A modified grid-free biased quartz crystal microbalance was used to estimate the metal ionized flux fraction ξ. The energy-resolved mass spectrometry served as a complementary method to distinguish particular ion contributions to the total ionizedmore » flux onto the substrate. The ratio between densities of doubly Me{sup 2+} and singly Me{sup +} charged metal ions was determined. It is shown that ECWR assistance enhances Me{sup 2+} production with respect of absorbed rf-power. The ECWR discharge also increases the metal ionized flux fraction of about 30% especially in the region of lower pressures. Further, the suppression of the gas rarefaction effect due to enhanced secondary electron emission of Me{sup 2+} was observed.« less

Concussion - adults - discharge

MedlinePlus

Brain injury - concussion - discharge; Traumatic brain injury - concussion - discharge; Closed head injury - concussion - discharge ... Barth JT, Broshek DK, Freeman JR. Concussion and brain injury. In: Miller MD, Thompson SR, eds. DeLee ...

Socioeconomic Factors Are Associated With Readmission After Lobectomy for Early Stage Lung Cancer.

PubMed

Medbery, Rachel L; Gillespie, Theresa W; Liu, Yuan; Nickleach, Dana C; Lipscomb, Joseph; Sancheti, Manu S; Pickens, Allan; Force, Seth D; Fernandez, Felix G

2016-11-01

Data regarding risk factors for readmissions after surgical resection for lung cancer are limited and largely focus on postoperative outcomes, including complications and hospital length of stay. The current study aims to identify preoperative risk factors for postoperative readmission in early stage lung cancer patients. The National Cancer Data Base was queried for all early stage lung cancer patients with clinical stage T2N0M0 or less who underwent lobectomy in 2010 and 2011. Patients with unplanned readmission within 30 days of hospital discharge were identified. Univariate analysis was utilized to identify preoperative differences between readmitted and not readmitted cohorts; multivariable logistic regression was used to identify risk factors resulting in readmission. In all, 840 of 19,711 patients (4.3%) were readmitted postoperatively. Male patients were more likely to be readmitted than female patients (4.9% versus 3.8%, p < 0.001), as were patients who received surgery at a nonacademic rather than an academic facility (4.6% versus 3.6%; p = 0.001) and had underlying medical comorbidities (Charlson/Deyo score 1+ versus 0; 4.8% versus 3.7%; p < 0.001). Readmitted patients had a longer median hospital length of stay (6 days versus 5; p < 0.001) and were more likely to have undergone a minimally invasive approach (5.1% video-assisted thoracic surgery versus 3.9% open; p < 0.001). In addition to those variables, multivariable logistic regression analysis identified that median household income level, insurance status (government versus private), and geographic residence (metropolitan versus urban versus rural) had significant influence on readmission. The socioeconomic factors identified significantly influence hospital readmission and should be considered during preoperative and postoperative discharge planning for patients with early stage lung cancer. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

The transition mechanism from a symmetric single period discharge to a period-doubling discharge in atmospheric helium dielectric-barrier discharge

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

Zhang, Dingzong; Wang, Yanhui; Wang, Dezhen

2013-06-15

Period-doubling and chaos phenomenon have been frequently observed in atmospheric-pressure dielectric-barrier discharges. However, how a normal single period discharge bifurcates into period-doubling state is still unclear. In this paper, by changing the driving frequency, we study numerically the transition mechanisms from a normal single period discharge to a period-doubling state using a one-dimensional self-consistent fluid model. The results show that before a discharge bifurcates into a period-doubling state, it first deviates from its normal operation and transforms into an asymmetric single period discharge mode. Then the weaker discharge in this asymmetric discharge will be enhanced gradually with increasing of themore » frequency until it makes the subsequent discharge weaken and results in the discharge entering a period-doubling state. In the whole transition process, the spatial distribution of the charged particle density and the electric field plays a definitive role. The conclusions are further confirmed by changing the gap width and the amplitude of the applied voltage.« less

Early Discharge After Primary Percutaneous Coronary Intervention: The Added Value of N‐Terminal Pro–Brain Natriuretic Peptide to the Zwolle Risk Score

PubMed Central

Schellings, Dirk A. A. M.; Adiyaman, Ahmet; Giannitsis, Evangelos; Hamm, Christian; Suryapranata, Harry; ten Berg, Jurrien M.; Hoorntje, Jan C. A.; van‘t Hof, Arnoud W. J.

2014-01-01

Background The Zwolle Risk Score (ZRS) identifies ST‐elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) eligible for early discharge. We aimed to investigate whether baseline N‐terminal pro–brain natriuretic peptide (NT‐proBNP) is also able to identify these patients and could improve future risk strategies. Methods and Results PPCI patients included in the Ongoing Tirofiban in Myocardial Infarction Evaluation (On‐TIME) II study were candidates (N=861). We analyzed whether ZRS and baseline NT‐proBNP predicted 30‐day mortality and assessed the occurrence of major adverse cardiac events (MACEs) and major bleeding. Receiver operating characteristic curve analysis was used to assess discriminative accuracy for ZRS, NT‐pro‐BNP, and their combination. After multiple imputation, 845 patients were included. Both ZRS >3 (hazard ratio [HR]=9.42; P<0.001) and log NT‐pro‐BNP (HR=2.61; P<0.001) values were associated with 30‐day mortality. On multivariate analysis, both the ZRS (HR=1.41; 95% confidence interval [CI]=1.27 to 1.56; P<0.001) and log NT‐proBNP (HR=2.09; 95% CI=1.59 to 2.74; P<0.001) independently predicted death at 30 days. The area under the curve for 30‐day mortality for combined ZRS/NT‐proBNP was 0.94 (95% CI=0.90 to 0.99), with optimal predictive values of a ZRS ≥2 and a NT‐proBNP value of ≥200 pg/mL. Using these cut‐off values, 64% of the study population could be identified as very low risk with zero mortality at 30 days follow‐up and low occurrence of MACEs and major bleeding between 48 hours and 10 days (1.3% and 0.6%, respectively). Conclusion Baseline NT‐proBNP identifies a large group of low‐risk patients who may be eligible for early (48‐ to 72‐hour) discharge, whereas optimal predictive accuracy is reached by the combination of both baseline NT‐proBNP and ZRS. PMID:25389283

Reliability of reporting nosocomial infections in the discharge abstract and implications for receipt of revenues under prospective reimbursement.

PubMed Central

Massanari, R M; Wilkerson, K; Streed, S A; Hierholzer, W J

1987-01-01

Proper reporting of discharge diagnoses, including complications of medical care, is essential for maximum recovery of revenues under the prospective reimbursement system. To evaluate the effectiveness of abstracting techniques in identifying nosocomial infections at discharge, discharge abstracts of patients with nosocomial infections were reviewed during September through November of 1984. Patients with nosocomial infections were identified using modified Centers for Disease Control (CDC) definitions and trained surveillance technicians. Records which did not include the diagnosis of nosocomial infections in the discharge abstract were identified, and potential lost revenues were estimated. We identified 631 infections in 498 patients. On average, only 57 per cent of the infections were properly recorded and coded in the discharge abstract. Of the additional monies which might be anticipated by the health care institution to assist in the cost of care of adverse events, approximately one-third would have been lost due to errors in coding in the discharge abstract. Although these lost revenues are substantial, they constitute but a small proportion of the potential costs to the institution when patients acquire nosocomial infections. PMID:3105338

Punctuated sediment discharge during early Pliocene birth of the Colorado River: Evidence from regional stratigraphy, sedimentology, and paleontology

USGS Publications Warehouse

Dorsey, Rebecca J.; O’Connell, Brennan; McDougall-Reid, Kristin; Homan, Mindy B.

2018-01-01

The Colorado River in the southwestern U.S. provides an excellent natural laboratory for studying the origins of a continent-scale river system, because deposits that formed prior to and during river initiation are well exposed in the lower river valley and nearby basinal sink. This paper presents a synthesis of regional stratigraphy, sedimentology, and micropaleontology from the southern Bouse Formation and similar-age deposits in the western Salton Trough, which we use to interpret processes that controlled the birth and early evolution of the Colorado River. The southern Bouse Formation is divided into three laterally persistent members: basal carbonate, siliciclastic, and upper bioclastic members. Basal carbonate accumulated in a tide-dominated marine embayment during a rise of relative sea level between ~ 6.3 and 5.4 Ma, prior to arrival of the Colorado River. The transition to green claystone records initial rapid influx of river water and its distal clay wash load into the subtidal marine embayment at ~ 5.4–5.3 Ma. This was followed by rapid southward progradation of the Colorado River delta, establishment of the earliest through-flowing river, and deposition of river-derived turbidites in the western Salton Trough (Wind Caves paleocanyon) between ~ 5.3 and 5.1 Ma. Early delta progradation was followed by regional shut-down of river sand output between ~ 5.1 and 4.8 Ma that resulted in deposition of marine clay in the Salton Trough, retreat of the delta, and re-flooding of the lower river valley by shallow marine water that deposited the Bouse upper bioclastic member. Resumption of sediment discharge at ~ 4.8 Ma drove massive progradation of fluvial-deltaic deposits back down the river valley into the northern Gulf and Salton Trough.These results provide evidence for a discontinuous, start-stop-start history of sand output during initiation of the Colorado River that is not predicted by existing models for this system. The underlying controls on

Early Incorporation of an Evidence-Based Aquatic-Assisted Approach to Arthroscopic Rotator Cuff Repair Rehabilitation: Prospective Case Study.

PubMed

Burmaster, Chris; Eckenrode, Brian J; Stiebel, Matthew

2016-01-01

Both traditional and progressive rotator cuff repair rehabilitation protocols often delay active motion of the shoulder for 6 weeks or more. The early inclusion of a comprehensive aquatic-assisted exercise program presents a unique approach to postoperative management. The purpose of this case study is to describe a comprehensive evidence-based, aquatic-assisted rehabilitation program following arthroscopic rotator cuff repair. A 73-year-old woman with a nonretracted, medium-size, full-thickness tear (2.5 cm) of the supraspinatus tendon underwent arthroscopic rotator cuff repair and was referred for postoperative physical therapy. The rehabilitation program was initiated at 2 weeks postoperatively and consisted of concurrent land- and aquatic-based interventions over 6 weeks for a total of 18 physical therapy visits. Improvements were made in all 5 patient-reported outcome measures that were recorded weekly over the course of care. Improvements reached or exceeded minimal detectable change levels for the Shoulder Pain and Disability Index and the Penn Shoulder Score. Her numeric pain rating scale score at rest decreased from 4/10 at the initial evaluation to 2/10 at 8 weeks postoperatively and with activity decreased from 9/10 to 6/10. Shoulder strength and range of motion values also exhibited improvement over the course of care. No adverse events occurred during the case study. This case study illustrates the safe inclusion of low-stress aquatic exercises as an early adjunct to traditional land-based rotator cuff repair rehabilitation programs in small- to medium-size repairs. Further studies are needed to determine the long-term effectiveness of adding aquatic therapy to traditional postoperative programs. © 2016 American Physical Therapy Association.

Payment Rates for Personal Care Assistants and the Use of Long-Term Services and Supports among Those Dually Eligible for Medicare and Medicaid

PubMed Central

Ko, Michelle; Newcomer, Robert; Kang, Taewoon; Hulett, Denis; Chu, Philip; Bindman, Andrew B

2014-01-01

Objective To examine the association between payment rates for personal care assistants and use of long-term services and supports (LTSS) following hospital discharge among dual eligible Medicare and Medicaid beneficiaries. Data Sources State hospital discharge, Medicaid and Medicare claims, and assessment data on California Medicaid LTSS users from 2006 to 2008. Study Design Cross-sectional study. We used multinomial logistic regression to analyze county personal care assistant payment rates and postdischarge LTSS use, and estimate marginal probabilities of each outcome across the range of rates paid in California. Data Extraction Methods We identified dual eligible Medicare and Medicaid adult beneficiaries discharged from an acute care hospital with no hospitalizations or LTSS use in the preceding 12 months. Principal Findings Personal care assistant payment rates were modestly associated with home and community-based services (HCBS) use versus nursing facility entry following hospital discharge (RRR 1.2, 95 percent CI: 1.0–1.4). For a rate of $6.75 per hour, the probability of HCBS use was 5.6 percent (95 percent CI: 4.2–7.1); at $11.75 per hour, 18.0 percent (95 percent CI: 12.5–23.4). Payment rate was not associated with the probability of nursing facility entry. Conclusions Higher payment rates for personal care assistants may increase utilization of HCBS, but with limited substitution for nursing facility care. PMID:25327166

Payment rates for personal care assistants and the use of long-term services and supports among those dually eligible for Medicare and Medicaid.

PubMed

Ko, Michelle; Newcomer, Robert; Kang, Taewoon; Hulett, Denis; Chu, Philip; Bindman, Andrew B

2014-12-01

To examine the association between payment rates for personal care assistants and use of long-term services and supports (LTSS) following hospital discharge among dual eligible Medicare and Medicaid beneficiaries. State hospital discharge, Medicaid and Medicare claims, and assessment data on California Medicaid LTSS users from 2006 to 2008. Cross-sectional study. We used multinomial logistic regression to analyze county personal care assistant payment rates and postdischarge LTSS use, and estimate marginal probabilities of each outcome across the range of rates paid in California. We identified dual eligible Medicare and Medicaid adult beneficiaries discharged from an acute care hospital with no hospitalizations or LTSS use in the preceding 12 months. Personal care assistant payment rates were modestly associated with home and community-based services (HCBS) use versus nursing facility entry following hospital discharge (RRR 1.2, 95 percent CI: 1.0-1.4). For a rate of $6.75 per hour, the probability of HCBS use was 5.6 percent (95 percent CI: 4.2-7.1); at $11.75 per hour, 18.0 percent (95 percent CI: 12.5-23.4). Payment rate was not associated with the probability of nursing facility entry. Higher payment rates for personal care assistants may increase utilization of HCBS, but with limited substitution for nursing facility care. © Health Research and Educational Trust.

Angioplasty and stent - heart - discharge

MedlinePlus

Drug-eluting stents - discharge; PCI - discharge; Percutaneous coronary intervention - discharge; Balloon angioplasty - discharge; Coronary angioplasty - discharge; Coronary artery angioplasty - discharge; Cardiac ...

Single-incision video-assisted thoracoscopic surgery left-lower lobe anterior segmentectomy (S8)

PubMed Central

Lirio, Francisco; Sesma, Julio; Baschwitz, Benno; Bolufer, Sergio

2017-01-01

Unusual anatomical segmentectomies are technically demanding procedures that require a deep knowledge of intralobar anatomy and surgical skill. In the other hand, these procedures preserve more normal lung parenchyma for lesions located in specific anatomical segments, and are indicated for benign lesions, metastasis and also early stage adenocarcinomas without nodal involvement. A 32-year-old woman was diagnosed of a benign pneumocytoma in the anterior segment of the left-lower lobe (S8, LLL), so we performed a single-incision video-assisted thoracoscopic surgery (SI-VATS) anatomical S8 segmentectomy in 140 minutes under intercostal block. There were no intraoperative neither postoperative complications, the chest tube was removed at 24 hours and the patient discharged at 5th postoperative day with low pain on the visual analogue scale (VAS). Final pathologic exam reported a benign sclerosant pneumocytoma with free margins. The patient has recovered her normal activities at 3 months completely with radiological normal controls at 1 and 3 months. PMID:29078674

Single-incision video-assisted thoracoscopic surgery left-lower lobe anterior segmentectomy (S8).

PubMed

Galvez, Carlos; Lirio, Francisco; Sesma, Julio; Baschwitz, Benno; Bolufer, Sergio

2017-01-01

Unusual anatomical segmentectomies are technically demanding procedures that require a deep knowledge of intralobar anatomy and surgical skill. In the other hand, these procedures preserve more normal lung parenchyma for lesions located in specific anatomical segments, and are indicated for benign lesions, metastasis and also early stage adenocarcinomas without nodal involvement. A 32-year-old woman was diagnosed of a benign pneumocytoma in the anterior segment of the left-lower lobe (S8, LLL), so we performed a single-incision video-assisted thoracoscopic surgery (SI-VATS) anatomical S8 segmentectomy in 140 minutes under intercostal block. There were no intraoperative neither postoperative complications, the chest tube was removed at 24 hours and the patient discharged at 5 th postoperative day with low pain on the visual analogue scale (VAS). Final pathologic exam reported a benign sclerosant pneumocytoma with free margins. The patient has recovered her normal activities at 3 months completely with radiological normal controls at 1 and 3 months.

Refractive corneal surgery - discharge

MedlinePlus

Nearsightedness surgery - discharge; Refractive surgery - discharge; LASIK - discharge; PRK - discharge ... November 27, 2017. Garg S, McColgin AZ, Steinert RF. LASIK. In: Tasman W, Jaeger EA, eds. Duane's Ophthalmology . ...

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

On the Effectiveness of Robot-Assisted Language Learning

ERIC Educational Resources Information Center

Lee, Sungjin; Noh, Hyungjong; Lee, Jonghoon; Lee, Kyusong; Lee, Gary Geunbae; Sagong, Seongdae; Kim, Munsang

2011-01-01

This study introduces the educational assistant robots that we developed for foreign language learning and explores the effectiveness of robot-assisted language learning (RALL) which is in its early stages. To achieve this purpose, a course was designed in which students have meaningful interactions with intelligent robots in an immersive…

Robotic-Assisted Videothoracoscopic Surgery of the Lung.

PubMed

Velez-Cubian, Frank O; Ng, Emily P; Fontaine, Jacques P; Toloza, Eric M

2015-07-01

Despite initial concerns about the general safety of videothoracoscopic surgery, minimally invasive videothoracoscopic surgical procedures have advantages over traditional open thoracic surgery via thoracotomy. Robotic-assisted minimally invasive surgery has expanded to almost every surgical specialty, including thoracic surgery. Adding a robotic-assisted surgical system to a videothoracoscopic surgical procedure corrects several shortcomings of videothoracoscopic surgical cameras and instruments. We performed a literature search on robotic-assisted pulmonary resections and compared the published robotic series data with our experience at the H. Lee Moffitt Cancer Center & Research Institute. All perioperative outcomes, such as intraoperative data, postoperative complications, chest tube duration, hospital length of stay (LOS), and in-hospital mortality rates were noted. Our literature search found 23 series from multiple surgical centers. We divided the literature into 2 groups based on the year published (2005-2010 and 2011-2014). Operative times from earlier studies ranged from 150 to 240 minutes compared with 90 to 242 minutes for later studies. Conversion rates (to open lung resection) from the earlier studies ranged from 0% to 19% compared with 0% to 11% in the later studies. Mortality rates for the earlier studies ranged from 0% to 5% compared with 0% to 2% for the later studies. Since 2010, our group has performed more than 600 robotic-assisted thoracic surgical procedures, including more than 200 robotic-assisted pulmonary lobectomies, which we also divided into 2 groups. Our median skin-to-skin operative time improved from 179 minutes for our early group (n = 104) to 172 minutes for our later group (n = 104). The overall conversion rate was 9.6% and the emergent conversion rate (for bleeding) was 5% for our robotic-assisted lobectomies. The most common postoperative complications in our cohort were prolonged air leak (> 7 days; 16.8%) and atrial

Accelerated discharge within 72 hours of colorectal cancer resection using simple discharge criteria.

PubMed

Emmanuel, A; Chohda, E; Botfield, C; Ellul, J

2018-01-01

Introduction Short hospital stays and accelerated discharge within 72 hours following colorectal cancer resections have not been widely achieved. Series reporting on accelerated discharge involve heterogeneous patient populations and exclude important groups. Strict adherence to some discharge requirements may lead to delays in discharge. The aim of this study was to evaluate the safety and feasibility of accelerated discharge within 72 hours of all elective colorectal cancer resections using simple discharge criteria. Methods Elective colorectal cancer resections performed between August 2009 and December 2015 by a single surgeon were reviewed. Perioperative care was based on an enhanced recovery programme. A set of simplified discharge criteria were used. Outcomes including postoperative complications, readmissions and reoperations were compared between patients discharged within 72 hours and those with a longer postoperative stay. Results Overall, 256 colorectal cancer resections (90% laparoscopic) were performed. The mean patient age was 70.8 years. The median length of stay was 3 days. Fifty-eight per cent of all patients and sixty-three per cent of patients undergoing laparoscopic surgery were discharged within 72 hours. Accelerated discharge was not associated with adverse outcomes compared with delayed discharge. Patients discharged within 72 hours had significantly fewer postoperative complications, readmissions and reoperations. Open surgery and stoma formation were associated with discharge after 72 hours but not age, co-morbidities, neoadjuvant chemoradiation or surgical procedure. Conclusions Accelerated discharge within 72 hours of elective colorectal resection for cancer is safely achievable for the majority of patients without compromising short-term outcomes.

Biosurfactant assisted synthesis of Fe3O4@rhamnolipid@BiOBr and its behaviour in plasma discharge system

NASA Astrophysics Data System (ADS)

Wang, Li; Yu, Zebin; Hou, Yanping; Peng, Zhenbo; Zhang, Li; Meng, Zhengcheng; Li, Fengyuan; He, Jun; Huang, Junlin

2016-06-01

A novel Fe3O4@rhamnolipid@BiOBr (FRB) was synthesized via a modified precipitation method and applied in the plasma discharge system. Rhamnolipid was used as biosurfactant to modify Fe3O4 by interacting with Fe3O4 via its aliphatic chain. The results show that the prepared FRB magnetic photocatalyst exhibited excellent photocatalytic activity and Fenton reaction behavior in the plasma discharge system. Meanwhile, the addition of FRB could improve energy efficiency of defluorination by 21.29 mg kW-1 h-1.

Production of fullerenes and single-wall carbon nanotubes by high-temperature pulsed arc discharge

NASA Astrophysics Data System (ADS)

Sugai, Toshiki; Omote, Hideki; Bandow, Shunji; Tanaka, Nobuo; Shinohara, Hisanori

2000-04-01

Fullerenes and single-wall carbon nanotubes (SWNTs) have been produced for the first time by the high-temperature pulsed arc-discharge technique, which has developed in this laboratory. Fullerenes are identified quantitatively by high-performance liquid chromatography (HPLC), and scanning electron microscopy (SEM) and transmission electron microscopy (TEM) observations reveal a significant amount of production of bundles of SWNTs in soot. The pulse arc production of fullerenes and SWNTs favors the high-temperature (⩾1000 °C), long pulses (⩾1 ms) and a heavy rare gas such as Ar or Kr as a buffer gas. We have found that fullerenes and SWNTs have complementary relationships in their early stage of production. The details of the pulsed arc discharge have been obtained by observing the transition from the pulsed arc discharge to the steady arc discharge while increasing the pulse width.

Gastric bypass surgery - discharge

MedlinePlus

... bypass - discharge; Gastric bypass - Roux-en-Y - discharge; Obesity gastric bypass discharge; Weight loss - gastric bypass discharge ... al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised ...

Robotic-Assisted Laparoscopic Cervicovaginal Myomectomy.

PubMed

Javadian, Pouya; Juusela, Alexander; Nezhat, Farr

2018-03-28

To illustrate a robotic-assisted laparoscopic resection for cervicovaginal myomectomy. Step-wise instruction using video and case report (Canadian Task Force classification III). A tertiary referral center. A 39-year-old woman. Robotic-assisted laparoscopy resection of leiomyoma. A 39-year-old woman, gravida 0, body mass index of 23.0 kg/m 2 , with a known cervicovaginal myoma that in the past underwent uterine artery embolization, presented with recurrence of her severe abnormal vaginal bleeding. She was referred for surgical resection of the mass. Magnetic resonance imaging revealed a 5-cm posterior cervicovaginal leiomyoma. The patient wanted to preserve her reproductive organs. A total robotic procedure lasted 123 minutes, with an estimated blood loss of 100 mL. She was discharged uneventfully on the day 0 postoperatively. Pathology results showed a 37-g leiomyoma of the uterus. The patient presented at her 2-weeks postoperative visit with no more complaint of vaginal bleeding. Robot-assisted laparoscopic surgery is a feasible approach for cervicovaginal myoma with minimal complications. Copyright © 2018 American Association of Gynecologic Laparoscopists. Published by Elsevier Inc. All rights reserved.

Thyroid gland removal - discharge

MedlinePlus

... tingling in your face or lips Alternative Names Total thyroidectomy - discharge; Partial thyroidectomy - discharge; Thyroidectomy - discharge; Subtotal thyroidectomy - discharge References Lai SY, Mandel SJ, Weber RS. Management of thyroid neoplasms. In: Flint PW, Haughey BH, ...

Cirrhosis - discharge

MedlinePlus

Liver failure - discharge; Liver cirrhosis - discharge ... You have cirrhosis of the liver. Scar tissue forms and your liver gets smaller and harder. Most of the time, this damage cannot be undone. However, the ...

[The information about discharge medication: what do general practitioners need?].

PubMed

Adam, Henning; Niebling, Wilhelm-Bernhard; Schott, Gisela

2015-04-01

The information about the patient's discharge medication (DM) in the discharge letter guarantees the subsequent pharmacotherapy at the interface between tertiary to primary care. International data however shows that general practitioners (GPs) receive discharge letters with a delay and relevant information about DM is lacking. The aim of this study was to assess the point of view of German GPs concerning the information about DM, since no recent data about this topic is available. In a postal survey 516 GPs in the city of Berlin were contacted and asked about the transit of discharge letters and the information about DM. Results | 117 GPs answered the questionnaire (23 %). Most frequently, the patient himself handed over the information about DM to the GP on the day of his first visit in the practice after discharge. However, more than two third of GPs wished to receive the information before the patient's first consultation (73 %). Therefore, the majority preferred the electronic communication via fax (46 %) or email (9 %). Almost half of the GPs stated that discharge letters were lacking information about changes in medication and reasons for these changes. At the same time, nearly all GPs thought that these informational aspects were important. GPs wish an early and electronic transit of the DM with information concerning changes in medication and reasons. If these wishes were considered, a continuous and thus safer pharmacotherapy at the interface could be guaranteed. © Georg Thieme Verlag KG Stuttgart · New York.

GAS DISCHARGE DEVICES

DOEpatents

Jefferson, S.

1958-11-11

An apparatus utilized in introducing tritium gas into envelope of a gas discharge device for the purpose f maintaining the discharge path in ionized condition is described. ln addition to the cathode and anode, the ischarge device contains a zirconium or tantalum ilament arranged for external excitation and a metallic seed containing tritium, and also arranged to have a current passed through it. Initially, the zirconium or tantalum filament is vaporized to deposit its material adjacent the main discharge region. Then the tritium gas is released and, due to its affinity for the first released material, it deposits in the region of the main discharge where it is most effective in maintaining the discharge path in an ionized condition.

Nipple Discharge

MedlinePlus

... breast-feeding. It also may be associated with menstrual hormone changes and fibrocystic changes. The milky discharge ... that requires treatment. If you're still having menstrual periods and your nipple discharge doesn't resolve ...

Vaginal Discharge

MedlinePlus

... also be on the lookout for symptoms of yeast infections, bacterial vaginosis and trichomoniasis, 3 infections that ... cause changes in your vaginal discharge. Signs of yeast infections White, cottage cheese-like discharge Swelling and ...

Early hospital discharge versus continued hospitalization in febrile pediatric cancer patients with prolonged neutropenia: A randomized, prospective study.

PubMed

Ahmed, Nabil; El-Mahallawy, Hadir A; Ahmed, Ibrahim A; Nassif, Shimaa; El-Beshlawy, Aamal; El-Haddad, Alaa

2007-11-01

Hospitalization with single or multi-agent antibiotic therapy has been the standard of care for treatment of febrile neutropenia in cancer patients. We hypothesized that an empiric antibiotic regimen that is effective and that can be administered once-daily will allow for improved hospital utilization by early transition to outpatient care. Febrile pediatric cancer patients with anticipated prolonged neutropenia were randomized between a regimen of once-daily ceftriaxone plus amikacin (C + A) and imipenem monotherapy (control). Afebrile patients on C + A satisfying "Early Discharge Criteria" at 72 hr continued treatment as outpatients. We compared the outcome, adverse events, duration of hospitalization, and cost between both groups. A prospective randomized controlled clinical trial was conducted on 129 febrile episodes in pediatric cancer patients with prolonged neutropenia. No adverse events were seen in 32 children (84% of study arm) treated on an outpatient basis. We found a statistically significant difference between the duration of hospitalization of the C + A group [median 5 days] and control [median 9 days](P < 0.001), per episode antibiotic cost (P < 0.001) and total episode cost (P < 0.001). There was no statistically significant difference in the response to treatment at 72 hr or after necessary antimicrobial modifications. We conclude that pediatric febrile cancer patients initially considered at risk for sepsis due to prolonged neutropenia can be re-evaluated at 72 hr for outpatient therapy. The convenience, low incidence of adverse effects, and cost benefit of the once-daily regimen of C + A may be particularly useful to reduce the overall treatment costs and duration of hospitalization. (c) 2007 Wiley-Liss, Inc.

Modeling the distribution of illicit oily discharges detected by aerial surveillance in western Canadian marine waters.

PubMed

Serra-Sogas, Norma; O'Hara, Patrick D; Canessa, Rosaline

2014-10-15

Oily discharges from vessel operations have been documented in Canada's Pacific region by the National Aerial Surveillance Program (NASP) since the early 1990s. We explored a number of regression methods to explain the distribution and counts per grid cell of oily discharges detected from 1998 to 2007 using independent predictor variables, while trying to address the large number of zeros present in the data. Best-fit models indicate that discharges are generally concentrated close to shore typically in association with small harbours, and with major commercial and tourist centers. Oily discharges were also concentrated in Barkley Sound and at the entrance of Juan de Fuca Strait. The identification of important factors associated with discharge patterns, and predicting discharge rates in areas with surveillance effort can be used to inform future surveillance. Model output can also be used as inputs for risk models for existing conditions and as baseline for future scenarios. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

A Study into the Impact of the Reading Education Assistance Dogs Scheme on Reading Engagement and Motivation to Read among Early Years Foundation-Stage Children

ERIC Educational Resources Information Center

Noble, Olivia; Holt, Nicole

2018-01-01

This research explores the impact of the Reading Education Assistance Dogs (READ) scheme on reading engagement and motivation among Early Years Foundation-Stage children using a case study approach at a primary school in the English Midlands. There is a notable lack of UK-based research into the READ scheme, which offers a potential alternative…

Predictors of Post-discharge Mortality Among Patients Hospitalized for Acute Heart Failure

PubMed Central

Collins, Sean P; Greene, Stephen J; Pang, Peter S; Ambrosy, Andrew P; Antohi, Elena-Laura; Vaduganathan, Muthiah; Butler, Javed; Gheorghiade, Mihai

2017-01-01

Acute Heart Failure (AHF) is a “ multi-event disease” and hospitalisation is a critical event in the clinical course of HF. Despite relatively rapid relief of symptoms, hospitalisation for AHF is followed by an increased risk of death and re-hospitalisation. In AHF, risk stratification from clinically available data is increasingly important in evaluating long-term prognosis. From the perspective of patients, information on the risk of mortality and re-hospitalisation would be helpful in providing patients with insight into their disease. From the perspective of care providers, it may facilitate management decisions, such as who needs to be admitted and to what level of care (i.e. floor, step-down, ICU). Furthermore, risk-stratification may help identify patients who need to be evaluated for advanced HF therapies (i.e. left-ventricle assistance device or transplant or palliative care), and patients who need early a post-discharge follow-up plan. Finally, risk stratification will allow for more robust efforts to identify among risk markers the true targets for therapies that may direct treatment strategies to selected high-risk patients. Further clinical research will be needed to evaluate if appropriate risk stratification of patients could improve clinical outcome and resources allocation. PMID:29387465

Changes in inpatient payer-mix and hospitalizations following Medicaid expansion: Evidence from all-capture hospital discharge data.

PubMed

Freedman, Seth; Nikpay, Sayeh; Carroll, Aaron; Simon, Kosali

2017-01-01

The Affordable Care Act resulted in unprecedented reductions in the uninsured population through subsidized private insurance and an expansion of Medicaid. Early estimates from the beginning of 2014 showed that the Medicaid expansion decreased uninsured discharges and increased Medicaid discharges with no change in total discharges. To provide new estimates of the effect of the ACA on discharges for specific conditions. We compared outcomes between states that did and did not expand Medicaid using state-level all-capture discharge data from 2009-2014 for 42 states from the Healthcare Costs and Utilization Project's FastStats database; for a subset of states we used data through 2015. We stratified the analysis by baseline uninsured rates and used difference-in-differences and synthetic control methods to select comparison states with similar baseline characteristics that did not expand Medicaid. Our main outcomes were total and condition-specific hospital discharges per 1,000 population and the share of total discharges by payer. Conditions reported separately in FastStats included maternal, surgical, mental health, injury, and diabetes. The share of uninsured discharges fell in Medicaid expansion states with below (-4.39 percentage points (p.p.), -6.04 --2.73) or above (-7.66 p.p., -9.07 --6.24) median baseline uninsured rates. The share of Medicaid discharges increased in both small (6.42 p.p. 4.22-6.62) and large (10.5 p.p., 8.48-12.5) expansion states. Total and most condition-specific discharges per 1,000 residents did not change in Medicaid expansion states with high or low baseline uninsured rates relative to non-expansion states (0.418, p = 0.225), with one exception: diabetes. Discharges for that condition per 1,000 fell in states with high baseline uninsured rates relative to non-expansion states (-0.038 95% p = 0.027). Early changes in payer mix identified in the first two quarters of 2014 continued through the Medicaid expansion's first year and are

Fine-Water-Mist Multiple-Orientation-Discharge Fire Extinguisher

NASA Technical Reports Server (NTRS)

Butz, James R.; Turchi, Craig S.; Kimball, Amanda; McKinnon, Thomas; Riedel, Edward

2010-01-01

A fine-water-mist fire-suppression device has been designed so that it can be discharged uniformly in any orientation via a high-pressure gas propellant. Standard fire extinguishers used while slightly tilted or on their side will not discharge all of their contents. Thanks to the new design, this extinguisher can be used in multiple environments such as aboard low-gravity spacecraft, airplanes, and aboard vehicles that may become overturned prior to or during a fire emergency. Research in recent years has shown that fine water mist can be an effective alternative to Halons now banned from manufacture. Currently, NASA uses carbon dioxide for fire suppression on the International Space Station (ISS) and Halon chemical extinguishers on the space shuttle. While each of these agents is effective, they have drawbacks. The toxicity of carbon dioxide requires that the crew don breathing apparatus when the extinguishers are deployed on the ISS, and Halon use in future spacecraft has been eliminated because of international protocols on substances that destroy atmospheric ozone. A major advantage to the new system on occupied spacecraft is that the discharged system is locally rechargeable. Since the only fluids used are water and nitrogen, the system can be recharged from stores of both carried aboard the ISS or spacecraft. The only support requirement would be a pump to fill the water and a compressor to pressurize the nitrogen propellant gas. This system uses a gaseous agent to pressurize the storage container as well as to assist in the generation of the fine water mist. The portable fire extinguisher hardware works like a standard fire extinguisher with a single storage container for the agents (water and nitrogen), a control valve assembly for manual actuation, and a discharge nozzle. The design implemented in the proof-of-concept experiment successfully extinguished both open fires and fires in baffled enclosures.

A Descriptive Study of Mothers’ Experiences Feeding Their Preterm Infants After Discharge

PubMed Central

Reyna, Barbara A.; Pickler, Rita H.; Thompson, Alison

2013-01-01

Purpose The purpose of this study was to explore mothers’ perceptions of their experiences in feeding their preterm infants in the early weeks after hospital discharge. Subjects Twenty-seven mothers whose preterm infants were part of a larger study of feeding readiness participated. Design A qualitative, descriptive approach was used to explore mothers’ experiences in feeding their preterm infants after hospital discharge. Methods A convenience sample of mothers of preterm infants were interviewed 2 to 3 weeks after hospital discharge. Data were generated by semi-structured interview and analyzed by searching for thematic patterns in the data. Mothers were asked to describe their experiences feeding their infants, their perceptions of how their infants’ feeding ability had changed since discharge, and the meanings they gave to these changes. The interviews were audiotaped and transcribed. Agreement of themes between the investigators was achieved. Main Outcome Measures Three themes emerged from the interviews: interpreting infant behaviors, managing the feeding process, and realizing knowledge gaps. Principal Results Mothers struggle with infant feeding in the first few weeks after discharge and experience a period of transition before comfort develops. Conclusions Nursing interventions should include anticipatory guidance to mothers about feeding their infants after discharge and more concrete information regarding infant cues of hunger and satiation. Follow-up visits after discharge should include a review of the current feeding regimen, information regarding feeding progression, and reinforcement about changing infant behaviors as the preterm infant approaches 40 weeks postmenstrual age. PMID:17208164

38 CFR 21.9525 - Eligibility for increased and supplemental educational assistance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... addition to the years counted to qualify for educational assistance, without a break in such service, and— (i) Continues on active duty without a break; (ii) Is discharged from service with an honorable... the Selected Reserve that has a vacancy; or (C) For any other reason other than those stated in...

Prolonged Hospital Discharge for Children with Technology Dependency: A Source of Health Care Disparities.

PubMed

Sobotka, Sarah A; Agrawal, Rishi K; Msall, Michael E

2017-10-01

Children with ventilator assistance have been supported in living at home since 1981 when parental advocacy ushered in a change to Medicaid policy. As the population of children who use medical technology such as long-term ventilation increases, we must critically evaluate our systems for preparing families for home life. Discharge delays persist in the modern era because of fragmentation between hospital and home systems. These discharge delays result in children spending time in less developmentally rich environments, further exacerbating the health and development disparities of children with complex disabilities. In this article, we discuss the complication of hospital discharge and how it contributes to health and developmental disparities. We also describe a hospital-to-home transitional care model, which presents a home-like environment to provide developmental support while focusing on parental training, home nursing, and public-funding arrangements. [Pediatr Ann. 2017;46(10):e365-e370.]. Copyright 2017, SLACK Incorporated.

Southampton mealtime assistance study: design and methods

PubMed Central

2013-01-01

Background Malnutrition is common in older people in hospital and is associated with adverse clinical outcomes including increased mortality, morbidity and length of stay. This has raised concerns about the nutrition and diet of hospital in-patients. A number of factors may contribute to low dietary intakes in hospital, including acute illness and cognitive impairment among in-patients. The extent to which other factors influence intake such as a lack of help at mealtimes, for patients who require assistance with eating, is uncertain. This study aims to evaluate the effectiveness of using trained volunteer mealtime assistants to help patients on an acute medical ward for older people at mealtimes. Methods/design The study design is quasi-experimental with a before (year one) and after (year two) comparison of patients on the intervention ward and parallel comparison with patients on a control ward in the same department. The intervention in the second year was the provision of trained volunteer mealtime assistance to patients in the intervention ward. There were three components of data collection that were repeated in both years on both wards. The first (primary) outcome was patients’ dietary intake, collected as individual patient records and as ward-level balance data over 24 hour periods. The second was clinical outcome data assessed on admission and discharge from both wards, and 6 and 12 months after discharge. Finally qualitative data on the views and experience of patients, carers, staff and volunteers was collected through interviews and focus groups in both years to allow a mixed-method evaluation of the intervention. Discussion The study will describe the effect of provision of trained volunteer mealtime assistants on the dietary intake of older medical in-patients. The association between dietary intake and clinical outcomes including malnutrition risk, body composition, grip strength, length of hospital stay and mortality will also be determined. An

Co-axial discharges

DOEpatents

Luce, J. S.; Smith, L. P.

1960-11-22

An apparatus is described for producing coaxial arc discharges in an evacuated enclosure and within a strong, confining magnetic field. The arcs are maintained at a high potential difference. Electrons diffuse to the more positive arc from the negative arc, and positive ions diffuse from the more positive arc to the negative arc. Coaxial arc discharges have the advantuge that ions that return to strike the positive arc discharge will lose no energy since they do not strike a solid wall or electrode. These discharges are useful in confining an ionized plasma between the discharges and have the advantage of preventing impurities from the walls of the enclosure from entering the plasma area because of the arc barrier set up by the cylindrical outer arc. (auth)

Further insights into prepeak emission in pulsed radiofrequency glow discharge

NASA Astrophysics Data System (ADS)

Valledor, Rebeca; Vega, Paola; Pisonero, Jorge; Nelis, Thomas; Bordel, Nerea

2013-07-01

Side-on optical emission measurements, with spatial and temporal resolution, have been carried out on a modified Grimm type pulsed rf glow discharge, using a copper sample and argon as discharge gas. In particular, the early ignition phase of the pulsed discharge, prepeak, and the beginning of the plateau have been electrically characterized and spectroscopically evaluated along the plasma plume for several argon and copper emission lines. Different pulse repetition frequencies have been used while keeping a constant duty cycle of 25%, covering a range from the μs to the ms pulsed GD. In all the cases a spatially extended discharge has been observed during the first 10-20 μs of the pulse, when the dc bias voltage has not been fully established yet. During this early phase of the pulse, the species present in the chamber are excited following the amplitude of the voltage symmetrical oscillations, and argon and copper emission can be detected at all the distances evaluated along the plasma axis at delays as short as 4 μs. After the first 20 μs approximately, the discharge has contracted close to the sample surface, the dc bias voltage has been almost established and the sputtering process is taking place. Emission registered through side-on observation, at positions relatively far from the sample, decreases and then progressively increases to reach a plateau if the voltage pulse lasts long enough. Moreover, the further the detection position is from the sample surface, the later the increase of the copper and argon emission is observed. Therefore transport phenomena involving both argon and copper species are now evidently leading to an estimated average speed of 100 m/s. Additionally, end-on optical emission measurements have been carried out to evaluate the prepeak emission from the negative glow region close to the sample surface, and then to compare this emission with that occurring at farther positions (side-on detection experiments). The results have shown

Feasibility and safety of early lower limb robot-assisted training in sub-acute stroke patients: a pilot study.

PubMed

Gandolfi, Marialuisa; Geroin, Christian; Tomelleri, Christopher; Maddalena, Isacco; Kirilova Dimitrova, Eleonora; Picelli, Alessandro; Smania, Nicola; Waldner, Andreas

2017-12-01

So far, the development of robotic devices for the early lower limb mobilization in the sub-acute phase after stroke has received limited attention. To explore the feasibility of a newly robotic-stationary gait training in sub-acute stroke patients. To report the training effects on lower limb function and muscle activation. A pilot study. Rehabilitation ward. Two sub-acute stroke inpatients and ten age-matched healthy controls were enrolled. Healthy controls served as normative data. Patients underwent 10 robot-assisted training sessions (20 minutes, 5 days/week) in alternating stepping movements (500 repetitions/session) on a hospital bed in addition to conventional rehabilitation. Feasibility outcome measures were compliance, physiotherapist time, and responses to self-report questionnaires. Efficacy outcomes were bilateral lower limb muscle activation pattern as measured by surface electromyography (sEMG), Motricity Index (MI), Medical Research Council (MRC) grade, and Ashworth Scale (AS) scores before and after training. No adverse events occurred. No significant differences in sEMG activity between patients and healthy controls were observed. Post-training improvement in MI and MRC scores, but no significant changes in AS scores, were recorded. Post-treatment sEMG analysis of muscle activation patterns showed a significant delay in rectus femoris offset (P=0.02) and prolonged duration of biceps femoris (P=0.04) compared to pretreatment. The robot-assisted training with our device was feasible and safe. It induced physiological muscle activations pattern in both stroke patients and healthy controls. Full-scale studies are needed to explore its potential role in post-stroke recovery. This robotic device may enrich early rehabilitation in subacute stroke patients by inducing physiological muscle activation patterns. Future studies are warranted to evaluate its effects on promoting restorative mechanisms involved in lower limb recovery after stroke.

Robot assistant versus human or another robot assistant in patients undergoing laparoscopic cholecystectomy.

PubMed

Gurusamy, Kurinchi Selvan; Samraj, Kumarakrishnan; Fusai, Giuseppe; Davidson, Brian R

2012-09-12

The role of a robotic assistant in laparoscopic cholecystectomy is controversial. While some trials have shown distinct advantages of a robotic assistant over a human assistant others have not, and it is unclear which robotic assistant is best. The aims of this review are to assess the benefits and harms of a robot assistant versus human assistant or versus another robot assistant in laparoscopic cholecystectomy, and to assess whether the robot can substitute the human assistant. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded (until February 2012) for identifying the randomised clinical trials. Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing robot assistants versus human assistants in laparoscopic cholecystectomy were considered for the review. Randomised clinical trials comparing different types of robot assistants were also considered for the review. Two authors independently identified the trials for inclusion and independently extracted the data. We calculated the risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) using the fixed-effect and the random-effects models based on intention-to-treat analysis, when possible, using Review Manager 5. We included six trials with 560 patients. One trial involving 129 patients did not state the number of patients randomised to the two groups. In the remaining five trials 431 patients were randomised, 212 to the robot assistant group and 219 to the human assistant group. All the trials were at high risk of bias. Mortality and morbidity were reported in only one trial with 40 patients. There was no mortality or morbidity in either group. Mortality and morbidity were not reported in the remaining trials. Quality of life or the proportion of patients who were discharged as day-patient laparoscopic cholecystectomy patients were not reported in any

Chronic consequences of acute injuries: worse survival after discharge.

PubMed

Shafi, Shahid; Renfro, Lindsay A; Barnes, Sunni; Rayan, Nadine; Gentilello, Larry M; Fleming, Neil; Ballard, David

2012-09-01

The Trauma Quality Improvement Program uses inhospital mortality to measure quality of care, which assumes patients who survive injury are not likely to suffer higher mortality after discharge. We hypothesized that survival rates in trauma patients who survive to discharge remain stable afterward. Patients treated at an urban Level I trauma center (2006-2008) were linked with the Social Security Administration Death Master File. Survival rates were measured at 30, 90, and 180 days and 1 and 2 years from injury among two groups of trauma patients who survived to discharge: major trauma (Abbreviated Injury Scale score ≥ 3 injuries, n = 2,238) and minor trauma (Abbreviated Injury Scale score ≤ 2 injuries, n = 1,171). Control groups matched to each trauma group by age and sex were simulated from the US general population using annual survival probabilities from census data. Kaplan-Meier and log-rank analyses conditional upon survival to each time point were used to determine changes in risk of mortality after discharge. Cox proportional hazards models with left truncation at the time of discharge were used to determine independent predictors of mortality after discharge. The survival rate in trauma patients with major injuries was 92% at 30 days posttrauma and declined to 84% by 3 years (p > 0.05 compared with general population). Minor trauma patients experienced a survival rate similar to the general population. Age and injury severity were the only independent predictors of long-term mortality given survival to discharge. Log-rank tests conditional on survival to each time point showed that mortality risk in patients with major injuries remained significantly higher than the general population for up to 6 months after injury. The survival rate of trauma patients with major injuries remains significantly lower than survival for minor trauma patients and the general population for several months postdischarge. Surveillance for early identification and treatment of

Decadal predictability of river discharge with climate oscillations over the 20th and early 21st century

NASA Astrophysics Data System (ADS)

Wanders, Niko; Wada, Yoshihide

2015-12-01

Long-term hydrological forecasts are important to increase our resilience and preparedness to extreme hydrological events. The skill in these forecasts is still limited due to large uncertainties inherent in hydrological models and poor predictability of long-term meteorological conditions. Here we show that strong (lagged) correlations exist between four different major climate oscillation modes and modeled and observed discharge anomalies over a 100 year period. The strongest correlations are found between the El Niño-Southern Oscillation signal and river discharge anomalies all year round, while North Atlantic Oscillation and Antarctic Oscillation time series are strongly correlated with winter discharge anomalies. The correlation signal is significant for periods up to 5 years for some regions, indicating a high added value of this information for long-term hydrological forecasting. The results suggest that long-term hydrological forecasting could be significantly improved by including the climate oscillation signals and thus improve our preparedness for hydrological extremes in the near future.

CO-AXIAL DISCHARGES

DOEpatents

Luce, J.S.; Smith, L.P.

1960-11-22

A method and apparatus are given for producing coaxial arc discharges in an evacuated enclosure and within a strong, confining magnetic field. The arcs are maintained at a high potential difference. Electrons will diffuse to the more positive arc from the negative arc, and positive ions will diffuse from the more positive arc to the negative arc. Coaxial arc discharges have the advantage that ions which return to strike the positive arc discharge will lose no energy since they do not strike a solid wall or electrode. Those discharges are useful in confining an ionized plasma between the discharges, and have the advantage of preventing impurities from the walls of the enclosure from entering ihe plasma area because of the arc barrier set up bv the cylindrical outer arc.

Problems associated with estimating ground water discharge and recharge from stream-discharge records

USGS Publications Warehouse

Halford, K.J.; Mayer, G.C.

2000-01-01

Ground water discharge and recharge frequently have been estimated with hydrograph-separation techniques, but the critical assumptions of the techniques have not been investigated. The critical assumptions are that the hydraulic characteristics of the contributing aquifer (recession index) can be estimated from stream-discharge records; that periods of exclusively ground water discharge can be reliably identified; and that stream-discharge peaks approximate the magnitude and tinting of recharge events. The first assumption was tested by estimating the recession index from st earn-discharge hydrographs, ground water hydrographs, and hydraulic diffusivity estimates from aquifer tests in basins throughout the eastern United States and Montana. The recession index frequently could not be estimated reliably from stream-discharge records alone because many of the estimates of the recession index were greater than 1000 days. The ratio of stream discharge during baseflow periods was two to 36 times greater than the maximum expected range of ground water discharge at 12 of the 13 field sites. The identification of the ground water component of stream-discharge records was ambiguous because drainage from bank-storage, wetlands, surface water bodies, soils, and snowpacks frequently exceeded ground water discharge and also decreased exponentially during recession periods. The timing and magnitude of recharge events could not be ascertained from stream-discharge records at any of the sites investigated because recharge events were not directly correlated with stream peaks. When used alone, the recession-curve-displacement method and other hydrograph-separation techniques are poor tools for estimating ground water discharge or recharge because the major assumptions of the methods are commonly and grossly violated. Multiple, alternative methods of estimating ground water discharge and recharge should be used because of the uncertainty associated with any one technique.

Gait training assisted by multi-channel functional electrical stimulation early after stroke: study protocol for a randomized controlled trial.

PubMed

van Bloemendaal, Maijke; Bus, Sicco A; de Boer, Charlotte E; Nollet, Frans; Geurts, Alexander C H; Beelen, Anita

2016-10-01

Many stroke survivors suffer from paresis of lower limb muscles, resulting in compensatory gait patterns characterised by asymmetries in spatial and temporal parameters and reduced walking capacity. Functional electrical stimulation has been used to improve walking capacity, but evidence is mostly limited to the orthotic effects of peroneal functional electrical stimulation in the chronic phase after stroke. The aim of this study is to investigate the therapeutic effects of up to 10 weeks of multi-channel functional electrical stimulation (MFES)-assisted gait training on the restoration of spatiotemporal gait symmetry and walking capacity in subacute stroke patients. In a proof-of-principle study with a randomised controlled design, 40 adult patients with walking deficits who are admitted for inpatient rehabilitation within 31 days since the onset of stroke are randomised to either MFES-assisted gait training or conventional gait training. Gait training is delivered in 30-minute sessions each workday for up to 10 weeks. The step length symmetry ratio is the primary outcome. Blinded assessors conduct outcome assessments at baseline, every 2 weeks during the intervention period, immediately post intervention and at 3-month follow-up. This study aims to provide preliminary evidence for the feasibility and effectiveness of MFES-assisted gait rehabilitation early after stroke. Results will inform the design of a larger multi-centre trial. This trial is registered at the Netherlands Trial Register (number NTR4762 , registered 28 August 2014).

Effect of Early Rehabilitation during Intensive Care Unit Stay on Functional Status: Systematic Review and Meta-Analysis

PubMed Central

Castro-Avila, Ana Cristina; Serón, Pamela; Fan, Eddy; Gaete, Mónica; Mickan, Sharon

2015-01-01

Background and Aim Critically ill survivors may have functional impairments even five years after hospital discharge. To date there are four systematic reviews suggesting a beneficial impact for mobilisation in mechanically ventilated and intensive care unit (ICU) patients, however there is limited information about the influence of timing, frequency and duration of sessions. Earlier mobilisation during ICU stay may lead to greater benefits. This study aims to determine the effect of early rehabilitation for functional status in ICU/high-dependency unit (HDU) patients. Design Systematic review and meta-analysis. MEDLINE, EMBASE, CINALH, PEDro, Cochrane Library, AMED, ISI web of science, Scielo, LILACS and several clinical trial registries were searched for randomised and non-randomised clinical trials of rehabilitation compared to usual care in adult patients admitted to an ICU/HDU. Results were screened by two independent reviewers. Primary outcome was functional status. Secondary outcomes were walking ability, muscle strength, quality of life, and healthcare utilisation. Data extraction and methodological quality assessment using the PEDro scale was performed by primary reviewer and checked by two other reviewers. The authors of relevant studies were contacted to obtain missing data. Results 5733 records were screened. Seven articles were included in the narrative synthesis and six in the meta-analysis. Early rehabilitation had no significant effect on functional status, muscle strength, quality of life, or healthcare utilisation. However, early rehabilitation led to significantly more patients walking without assistance at hospital discharge (risk ratio 1.42; 95% CI 1.17-1.72). There was a non-significant effect favouring intervention for walking distance and incidence of ICU-acquired weakness. Conclusions Early rehabilitation during ICU stay was not associated with improvements in functional status, muscle strength, quality of life or healthcare utilisation

Extending lean operating limit and reducing emissions of methane spark-ignited engines using a microwave-assisted spark plug

DOE PAGES

Rapp, Vi H.; DeFilippo, Anthony; Saxena, Samveg; ...

2012-01-01

Amore » microwave-assisted spark plug was used to extend the lean operating limit (lean limit) and reduce emissions of an engine burning methane-air. In-cylinder pressure data were collected at normalized air-fuel ratios of λ = 1.46, λ = 1.51, λ = 1.57, λ = 1.68, and λ = 1.75. For each λ , microwave energy (power supplied to the magnetron per engine cycle) was varied from 0 mJ (spark discharge alone) to 1600 mJ. At lean conditions, the results showed adding microwave energy to a standard spark plug discharge increased the number of complete combustion cycles, improving engine stability as compared to spark-only operation. Addition of microwave energy also increased the indicated thermal efficiency by 4% at λ = 1.68. At λ = 1.75, the spark discharge alone was unable to consistently ignite the air-fuel mixture, resulting in frequent misfires. Although microwave energy produced more consistent ignition than spark discharge alone at λ = 1.75, 59% of the cycles only partially burned. Overall, the microwave-assisted spark plug increased engine performance under lean operating conditions (λ = 1.68) but did not affect operation at conditions closer to stoichiometric.« less

Optimization of discharge circuit of the TEA CO II laser with two discharge channels

NASA Astrophysics Data System (ADS)

Hu, Xiao Yong; Zhang, LiLi; Ren, DeMing; Qu, YanChen; Zhao, WeiJiang; Song, BaoAn

2007-01-01

In order to achieve the highest peak power of radiation pulse and highest output energy, the primary circuit parameters are investigated to optimize the discharge circuit performance of the laser. The structure and the discharge circuit of the laser are discussed at first. To realize synchronous discharge in two discharge channels, the conjunct electrode device for two pairs of discharge electrodes is designed. Finally, the results of the experiments on the primary circuit parameters are given. The discharge is most stable at a pressure of 5.33×10 4Pa when the pressure of gaseous mixture CO II:N II:He=1:1:3 is changed from 2.67×10 4 Pa to 6.67×10 4 Pa. The ratio of storage capacitance to peak capacitance is chosen to be about 1.5-7/3, because residual voltage is lower on this condition and residual voltage is adverse to discharge. When the inductance 330μH is used, the homogeneous glow discharge in a widest voltage range is obtained. The duration of when the stimuli voltage is increased in homogeneous glow discharge condition. The discharge circuit allows charge and discharge and the magnitude of residual voltage decrease the homogeneous glow discharge in a wide range of pressure of gaseous mixture when these circuit parameters are used. Thus it offers reference to the improvement of output characteristic of TEA CO II laser with two discharge channels.

Time to Send the Preemie Home? Additional Maturity at Discharge and Subsequent Health Care Costs and Outcomes

PubMed Central

Silber, Jeffrey H; Lorch, Scott A; Rosenbaum, Paul R; Medoff-Cooper, Barbara; Bakewell-Sachs, Susan; Millman, Andrea; Mi, Lanyu; Even-Shoshan, Orit; Escobar, Gabriel J

2009-01-01

Objective To determine whether longer stays of premature infants allowing for increased physical maturity result in subsequent postdischarge cost savings that help counterbalance increased inpatient costs. Data Sources One thousand four hundred and two premature infants born in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2002. Study Design/Methods Using multivariate matching with a time-dependent propensity score we matched 701 “Early” babies to 701 “Late” babies (developmentally similar at the time the earlier baby was sent home but who were discharged on average 3 days later) and assessed subsequent costs and clinical outcomes. Principal Findings Late babies accrued inpatient costs after the Early baby was already home, yet costs after discharge through 6 months were virtually identical across groups, as were clinical outcomes. Overall, after the Early baby went home, the Late–Early cost difference was $5,016 (p<.0001). A sensitivity analysis suggests our conclusions would not easily be altered by failure to match on some unmeasured covariate. Conclusions In a large integrated health care system, if a baby is ready for discharge (as defined by the typical criteria), staying longer increased inpatient costs but did not reduce postdischarge costs nor improve postdischarge clinical outcomes. PMID:19207592

Using the red/yellow/green discharge tool to improve the timeliness of hospital discharges.

PubMed

Mathews, Kusum S; Corso, Philip; Bacon, Sandra; Jenq, Grace Y

2014-06-01

As part of Yale-New Haven Hospital (Connecticut)'s Safe Patient Flow Initiative, the physician leadership developed the Red/Yellow/Green (RYG) Discharge Tool, an electronic medical record-based prompt to identify likelihood of patients' next-day discharge: green (very likely), yellow (possibly), and red (unlikely). The tool's purpose was to enhance communication with nursing/care coordination and trigger earlier discharge steps for patients identified as "green" or "yellow." Data on discharge assignments, discharge dates/ times, and team designation were collected for all adult medicine patients discharged in October-December 2009 (Study Period 1) and October-December 2011 (Study Period 2), between which the tool's placement changed from the sign-out note to the daily progress note. In Study Period 1, 75.9% of the patients had discharge assignments, compared with 90.8% in Period 2 (p < .001). The overall 11 A.M. discharge rate improved from 10.4% to 21.2% from 2007 to 2011. "Green" patients were more likely to be discharged before 11 A.M. than "yellow" or "red" patients (p < .001). Patients with RYG assignments discharged by 11 A.M. had a lower length of stay than those without assignments and did not have an associated increased risk of readmission. Discharge prediction accuracy worsened after the change in placement, decreasing from 75.1% to 59.1% for "green" patients (p < .001), and from 34.5% to 29.2% (p < .001) for "yellow" patients. In both periods, hospitalists were more accurate than house staff in discharge predictions, suggesting that education and/or experience may contribute to discharge assignment. The RYG Discharge Tool helped facilitate earlier discharges, but accuracy depends on placement in daily work flow and experience.

Using the Red/Yellow/Green Discharge Tool to Improve the Timeliness of Hospital Discharges

PubMed Central

Mathews, Kusum S.; Corso, Philip; Bacon, Sandra; Jenq, Grace Y.

2015-01-01

Background As part of Yale-New Haven Hospital (Connecticut)’s Safe Patient Flow Initiative, the physician leadership developed the Red/Yellow/Green (RYG) Discharge Tool, an electronic medical record–based prompt to identify likelihood of patients’ next-day discharge: green (very likely), yellow (possibly), and red (unlikely). The tool’s purpose was to enhance communication with nursing/care coordination and trigger earlier discharge steps for patients identified as “green” or “yellow”. Methods Data on discharge assignments, discharge dates/times, and team designation were collected for all adult medicine patients discharged from October – December 2009 (Study Period 1) and October – December 2011 (Study Period 2), between which the tool’s placement changed from the sign-out note to the daily progress note. Results In Study Period 1, 75.9% of the patients had discharge assignments, compared with 90.8% in Period 2 (p < .001). The overall 11 A.M. discharge rate improved from 10.4% to 21.2% from 2007 to 2011. “Green” patients were more likely to be discharged before 11 A.M. than “yellow” or “red” patients (p < .001). Patients with RYG assignments discharged by 11 A.M. had a lower length of stay than those without assignments and did not have an associated increased risk of readmission. Discharge prediction accuracy worsened after the change in placement, decreasing from 75.1% to 59.1% for “green” patients (p < .001), and from 34.5% to 29.2% (p < .001) for “yellow” patients. In both periods, hospitalists were more accurate than housestaff in discharge predictions, suggesting that education and/or experience may contribute to discharge assignment. Conclusions The RYG Discharge Tool helped facilitate earlier discharges, but accuracy depends on placement in daily work flow and experience. PMID:25016672

Magnetic dipole discharges. II. Cathode and anode spot discharges and probe diagnostics

NASA Astrophysics Data System (ADS)

Stenzel, R. L.; Urrutia, J. M.; Ionita, C.; Schrittwieser, R.

2013-08-01

The high current regime of a magnetron-type discharge has been investigated. The discharge uses a permanent magnet as a cold cathode which emits secondary electrons while the chamber wall or a grounded electrode serves as the anode. As the discharge voltage is increased, the magnet develops cathode spots, which are short duration arcs that provide copious electrons to increase the discharge current dramatically. Short (1 μs), high current (200 A) and high voltage (750 V) discharge pulses are produced in a relaxation instability between the plasma and a charging capacitor. Spots are also observed on a negatively biased plane Langmuir probe. The probe current pulses are as large as those on the magnet, implying that the high discharge current does not depend on the cathode surface area but on the properties of the spots. The fast current pulses produce large inductive voltages, which can reverse the electrical polarity of the magnet and temporarily operate it as an anode. The discharge current may also oscillate at the frequency determined by the charging capacitor and the discharge circuit inductance. Each half cycle of high-current current pulses exhibits a fast (≃10 ns) current rise when a spot is formed. It induces high frequency (10-100 MHz) transients and ringing oscillations in probes and current circuits. Most probes behave like unmatched antennas for the electromagnetic pulses of spot discharges. Examples are shown to distinguish the source of oscillations and some rf characteristics of Langmuir probes.

Anti-reflux surgery - children - discharge

MedlinePlus

Fundoplication - children - discharge; Nissen fundoplication - children - discharge; Belsey (Mark IV) fundoplication - children - discharge; Toupet fundoplication - children - discharge; Thal fundoplication - ...

Discharge dynamics of pin-to-plate dielectric barrier discharge at atmospheric pressure

NASA Astrophysics Data System (ADS)

Sun, Liqun; Huang, Xiaojiang; Zhang, Jie; Zhang, Jing; Shi, J. J.

2010-11-01

The discharge dynamics of pin-to-plate dielectric barrier discharge was studied in atmospheric helium at 20 kHz. The discharge was predominately ignited in positive half cycle of applied voltage with sinusoidal waveform. The temporal evolution of the discharge was investigated vertically along the discharge gap and radically on the dielectric surface by time resolved imaging. It is found that a discharge column with a diameter of 2 mm was ignited above the pin electrode and expanded toward a plate electrode. On the dielectric surface with space charge accumulation, plasma disk in terms of plasma ring was formed with radius up to 25 mm. The expansion velocity of plasma ring can reach a hypersonic speed of 3.0 km/s. The ionization wave due to electron diffusion is considered to be the mechanism for plasma ring formation and dynamics.

Integrated services and early intervention in the vocational rehabilitation of people with spinal cord injuries

PubMed Central

Bloom, Julia; Dorsett, Pat; McLennan, Vanette

2017-01-01

Introduction: The design was a narrative review. The objective of the study was to investigate the potential for early vocational rehabilitation (VR) interventions for people with spinal cord injury (SCI) in overcoming barriers in returning to work, and to pinpoint factors contributing to effectiveness in early VR intervention for this population. The setting was at Queensland, Australia. Materials and methods: Synthesis of the findings of a literature search of online databases ProQuest and CINAHL, using keywords relating to the employment situation and VR of people with SCI. Themes were identified and analysed in accordance with the research objectives. Results: Despite increasing government commitment to the workforce and social participation of people with disabilities, Australians living with SCI have significantly diminished employment outcomes compared with the general population. Current VR approaches usually do not commence until some months post discharge, potentially missing a window of opportunity to preserve pre-existing employment or assist in vocational decision making. The review found that there are opportunities for enhancing VR service provision following SCI, namely integrating the VR programme within the primary rehabilitation team thus facilitating early VR intervention. Discussion: Emerging evidence shows promising results for early intervention in VR; however, questions remain regarding ideal intervention approaches, and it is clear that further empirical investigation is required to support the use of early intervention models post SCI. The study was sponsored by Motor Accident Insurance Commission (MAIC). PMID:28382213

Prematurity and parental expectations: too early and now too much.

PubMed

Maypole, Jack; Trozzi, Maria; Augustyn, Marilyn

2011-05-01

Hami is a 3-year-old boy who is a former premature 25-week infant with a birth weight of 1 pound 9 ounces. He had a relatively smooth Neonatal Intensive Care Unit (NICU) course; he required intubation for 1 month and went home on room air. He had a left Grade I intraventricular hemorrhage that was resolved by 2 months of life. He had 7 blood transfusions for anemia over the first 3 months of life. A brainstem auditory evoked potential test was normal at hospital discharge, and he showed no evidence of retinopathy of prematurity. He never had seizure activity.He was discharged to home at 3 months where he did well and thrived on a high calorie formula. He walked at 17 months and spoke his first words at 2 years. He was enrolled in Early Intervention at the time of discharge from hospital; monthly home visits were increased to weekly visits by an early childhood educator at 12 months. When he was 12 months, he was enrolled in a family day care with 4 other children younger than 3 years. Hami's language development was slow; at 2.5 years of age, he was beginning to make 2 word combinations. Early intervention services were increased to include an additional hour of speech and language therapy as well as a play group.Hami's mother is 33 years old, and this is her first child. She worked as an accounting assistant, but she was able to be home with Hami for the first year of his life. She returned to full-time work on his first birthday. Hami's father is 35 years old and works for the national electrical grid as a manager. They are not married but have lived together for the last 5 years. Dad works evenings and cares for Hami from 4 to 6 pm after childcare; mom returns from work at 6 pm. Dad leaves for work at 7 pm and works till 2 am. Their relationship has been strained by the child care demands, their work schedules, and Hami's developmental progress.Hami's primary care pediatrician specializes in children with complex medical problems. The parents express concern at

Functional Assessment and Intervention by Nursing Assistants in Hospice and Palliative Care Inpatient Care Settings: A Quality Improvement Pilot Study.

PubMed

Mueller, Karen; Hamilton, Gillian; Rodden, Betheny; DeHeer, Hendrick D

2016-03-01

This study assessed the impact of a nursing assistant-led functional intervention in an urban hospice. Thirty-three patients participated. A physical therapist trained 4 nursing assistants to assess 4 basic functional activities at admission and discharge and to provide daily activity training to intervention group participants. Control group participants were assessed at admission and discharge and received the usual standard of care. Both groups improved. The intervention group participants demonstrated significant improvement in the Timed up and Go test as well as their self-reported ability to achieve goals on the Patient-Specific Functional Scale. Control group participants made significant improvements in the ability to move from supine to sit in bed. These findings suggest that nursing assistants can provide activity-based assessment and intervention leading to improved function among patients in hospice. © The Author(s) 2014.

Atmospheric-pressure diffuse dielectric barrier discharges in Ar/O2 gas mixture using 200 kHz/13.56 MHz dual frequency excitation

NASA Astrophysics Data System (ADS)

Liu, Y.; Starostin, S. A.; Peeters, F. J. J.; van de Sanden, M. C. M.; de Vries, H. W.

2018-03-01

Atmospheric-pressure diffuse dielectric barrier discharges (DBDs) were obtained in Ar/O2 gas mixture using dual-frequency (DF) excitation at 200 kHz low frequency (LF) and 13.56 MHz radio frequency (RF). The excitation dynamics and the plasma generation mechanism were studied by means of electrical characterization and phase resolved optical emission spectroscopy (PROES). The DF excitation results in a time-varying electric field which is determined by the total LF and RF gas voltage and the spatial ion distribution which only responds to the LF component. By tuning the amplitude ratio of the superimposed LF and RF signals, the effect of each frequency component on the DF discharge mechanism was analysed. The LF excitation results in a transient plasma with the formation of an electrode sheath and therefore a pronounced excitation near the substrate. The RF oscillation allows the electron trapping in the gas gap and helps to improve the plasma uniformity by contributing to the pre-ionization and by controlling the discharge development. The possibility of temporally modifying the electric field and thus the plasma generation mechanism in the DF discharge exhibits potential applications in plasma-assisted surface processing and plasma-assisted gas phase chemical conversion.

Length of stay, discharge destination, and functional improvement: utility of the Australian National Subacute and Nonacute Patient Casemix Classification.

PubMed

Tooth, Leigh; McKenna, Kryss; Goh, Kong; Varghese, Paul

2005-07-01

Although implemented in 1998, no research has examined how well the Australian National Subacute and Nonacute Patient (AN-SNAP) Casemix Classification predicts length of stay (LOS), discharge destination, and functional improvement in public hospital stroke rehabilitation units in Australia. 406 consecutive admissions to 3 stroke rehabilitation units in Queensland, Australia were studied. Sociodemographic, clinical, and functional data were collected. General linear modeling and logistic regression were used to assess the ability of AN-SNAP to predict outcomes. AN-SNAP significantly predicted each outcome. There were clear relationships between the outcomes of longer LOS, poorer functional improvement and discharge into care, and the AN-SNAP classes that reflected poorer functional ability and older age. Other predictors included living situation, acute LOS, comorbidity, and stroke type. AN-SNAP is a consistent predictor of LOS, functional change and discharge destination, and has utility in assisting clinicians to set rehabilitation goals and plan discharge.

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.

Modeling the Influence of Early Skin-to-Skin Contact on Exclusive Breastfeeding in a Sample of Hispanic Immigrant Women.

PubMed

Linares, Ana M; Wambach, Karen; Rayens, Mary K; Wiggins, Amanda; Coleman, Elizabeth; Dignan, Mark B

2017-10-01

Using data from a longitudinal study of breastfeeding in Hispanics, this study evaluated the influence of early skin-to-skin contact (SSC) on initiation and sustained exclusive breastfeeding (EBF) at 1 month postpartum. Two-thirds of the women in the sample participated in early SSC. At discharge, over half of the women were EBF; this proportion decreased to one-third at 1 month postpartum. Controlling for demographic and clinical variables in the model, participation in early SSC was associated with a greater than sevenfold increase in the odds of EBF at discharge (p = .005) but was not predictive of EBF at 1 month post-discharge (p = .7). Younger maternal age and increased prenatal infant feeding intention were associated with an increased likelihood of EBF across both timepoints. Promoting early SSC may help with initiation of EBF, while further breastfeeding support may be needed to maintain EBF following discharge for this vulnerable population.

[Effects of an early psychological intervention on parents of children with cleft lip/palate].

PubMed

Wang, Yangyang; Xin, Yanhua; Ma, Jian; Xin, Xiuhong; Shi, Bing; Huang, Yongqing

2013-08-01

To provide basis for effects of an early psychological intervention on parents of children with cleft lip/palate, and investigate the effects of an early psychological intervention to them. One self-administered questionnaire (SCL-90) was applied in 102 parents of children with cleft lip/palate, compared to 126 parents of healthy individuals on the day of admission. They were given the psychological intervention during hospitalization and 3 months after discharge. The questionnaire (SCL-90) was again applied to them on the day of discharge and 3 months after discharge. Using the questionnaire (SCL-90), the answer scores of somatization, obsessive-compulsive, depression and anxiety etc. were significantly higher than those of the control group (P < 0.05). There were no statistical differences during 3 subgroups in the case group (P > 0.05). There were no statistical differences on the day of admission and on the day of discharge (P > 0.05), but there were statistical difference on the day of admission and 3 months after discharge (P < 0.05). In this study, the psychosomatic states of parents of children with cleft lip/palate is poor. It's important and greatly significant that we conduct early psychological intervention to parents of children with cleft lip/palate and to the children's psychosomatic health.

Advances in the Remote Glow Discharge Experiment

NASA Astrophysics Data System (ADS)

Dominguez, Arturo; Zwicker, A.; Rusaits, L.; McNulty, M.; Sosa, Carl

2014-10-01

The Remote Glow Discharge Experiment (RGDX) is a DC discharge plasma with variable pressure, end-plate voltage and externally applied axial magnetic field. While the experiment is located at PPPL, a webcam displays the live video online. The parameters (voltage, magnetic field and pressure) can be controlled remotely in real-time by opening a URL which shows the streaming video, as well as a set of Labview controls. The RGDX is designed as an outreach tool that uses the attractive nature of a plasma in order to reach a wide audience and extend the presence of plasma physics and fusion around the world. In March 2014, the RGDX was made publically available and, as of early July, it has had approximately 3500 unique visits from 107 countries and almost all 50 US states. We present recent upgrades, including the ability to remotely control the distance between the electrodes. These changes give users the capability of measuring Paschen's Law remotely and provides a comprehensive introduction to plasma physics to those that do not have access to the necessary equipment.

Solo surgery--early results of robot-assisted three-dimensional laparoscopic hysterectomy.

PubMed

Tuschy, Benjamin; Berlit, Sebastian; Brade, Joachim; Sütterlin, Marc; Hornemann, Amadeus

2014-08-01

Report of our initial experience in laparoscopic hysterectomy by a solo surgeon using a robotic camera system with three-dimensional visualisation. This novel device (Einstein Vision®, B. Braun, Aesculap AG, Tuttlingen, Germany) (EV) was used for laparoscopic supracervical hysterectomy (LASH) performed by one surgeon. Demographic data, clinical and surgical parameters were evaluated. Our first 22 cases, performed between June and November 2012, were compared with a cohort of 22 age-matched controls who underwent two-dimensional LASH performed by the same surgeon with a second surgeon assisting. Compared to standard two-dimensional laparoscopic hysterectomy, there were no significant differences regarding duration of surgery, hospital stay, blood loss or incidence of complications. The number of trocars used was significantly higher in the control group (p <.0001). All hysterectomies in the treatment group were performed without assistance of a second physician. Robot-assisted solo surgery laparoscopic hysterectomy is a feasible and safe procedure. Duration of surgery, hospital stay, blood loss, and complication rates are comparable to a conventional laparoscopic hysterectomy.

Discharge dynamics of pin-to-plate dielectric barrier discharge at atmospheric pressure

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

Sun Liqun; Huang, Xiaojiang; Member of Magnetic Confinement Fusion Research Center, Ministry of Education of the People's Republic of China, Shanghai 201620

2010-11-15

The discharge dynamics of pin-to-plate dielectric barrier discharge was studied in atmospheric helium at 20 kHz. The discharge was predominately ignited in positive half cycle of applied voltage with sinusoidal waveform. The temporal evolution of the discharge was investigated vertically along the discharge gap and radically on the dielectric surface by time resolved imaging. It is found that a discharge column with a diameter of 2 mm was ignited above the pin electrode and expanded toward a plate electrode. On the dielectric surface with space charge accumulation, plasma disk in terms of plasma ring was formed with radius up tomore » 25 mm. The expansion velocity of plasma ring can reach a hypersonic speed of 3.0 km/s. The ionization wave due to electron diffusion is considered to be the mechanism for plasma ring formation and dynamics.« less

Tennis elbow surgery - discharge

MedlinePlus

Lateral epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... Soon after surgery, severe pain will decrease, but you may have mild soreness for 3 to 6 months.

The family living the child recovery process after hospital discharge.

PubMed

Pinto, Júlia Peres; Mandetta, Myriam Aparecida; Ribeiro, Circéa Amalia

2015-01-01

to understand the meaning attributed by the family to its experience in the recovery process of a child affected by an acute disease after discharge, and to develop a theoretical model of this experience. Symbolic interactionism was adopted as a theoretical reference, and grounded theory was adopted as a methodological reference. data were collected through interviews and participant observation with 11 families, totaling 15 interviews. A theoretical model consisting of two interactive phenomena was formulated from the analysis: Mobilizing to restore functional balance and Suffering from the possibility of a child's readmission. the family remains alert to identify early changes in the child's health, in an attempt to avoid rehospitalization. the effects of the disease and hospitalization continue to manifest in family functioning, causing suffering even after the child's discharge and recovery.

ACL reconstruction - discharge

MedlinePlus

Anterior cruciate ligament reconstruction - discharge; ACL reconstruction - discharge ... had surgery to reconstruct your anterior cruciate ligament (ACL). The surgeon drilled holes in the bones of ...

Modeling of Plasma Assisted Combustion

NASA Astrophysics Data System (ADS)

Akashi, Haruaki

2012-10-01

Recently, many experimental study of plasma-assisted combustion has been done. However, numerous complex reactions in combustion of hydrocarbons are preventing from theoritical study for clarifying inside the plasma-assisted combustion, and the effect of plasma-assist is still not understood. Shinohara and Sasaki [1,2] have reported that the shortening of flame length by irradiating microwave without increase of gas temperature. And they also reported that the same phenomena would occur when applying dielectric barrier discharges to the flame using simple hydrocarbon, methane. It is suggested that these phenomena may result by the electron heating. To clarify this phenomena, electron behavior under microwave and DBD was examined. For the first step of DBD plasma-assisted combustion simulation, electron Monte Carlo simulation in methane, oxygen and argon mixture gas(0.05:0.14:0.81) [2] has been done. Electron swarm parameters are sampled and electron energy distribution function (EEDF)s are also determined. In the combustion, gas temperature is higher(>1700K), so reduced electric field E/N becomes relatively high(>10V/cm/Torr). The electrons are accelerated to around 14 eV. This result agree with the optical emission from argon obtained by the experiment of reference [2]. Dissociation frequency of methane and oxygens are obtained in high. This might be one of the effect of plasma-assist. And it is suggested that the electrons should be high enough to dissociate methane, but plasma is not needed.[4pt] [1] K. Shinohara et al, J. Phys. D:Appl. Phys., 42, 182008 (1-7) (2009).[0pt] [2] K. Sasaki, 64th Annual Gaseous Electronic Conference, 56, 15 CT3.00001(2011).

Coaching and Quality Assistance in Quality Rating Improvement Systems: Approaches Used by TA Providers to Improve Quality in Early Care and Education Programs and Home-Based Settings

ERIC Educational Resources Information Center

Smith, Sheila; Robbins, Taylor; Schneider, Will; Kreader, J. Lee; Ong, Christine

2012-01-01

Quality Rating Improvement Systems (QRISs) commonly offer on-site technical assistance (TA) and coaching to help early care and education settings achieve quality improvements and a higher QRIS rating. In surveys of administrators overseeing statewide QRISs, almost all states reported the use of on-site TA and coaching in both center-based and…

Two-dimensional simulation of discharge channels in atmospheric-pressure single dielectric barrier discharges

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

Zhang, Jiao; Wang, Yanhui, E-mail: wangyh@dlut.edu.cn; Wang, Dezhen, E-mail: wangdez@dlut.edu.cn

A two-dimensional fluid model is developed to study the filaments (or discharge channels) in atmospheric-pressure discharge with one plate electrode covered by a dielectric layer. Under certain discharge parameters, one or more stable filaments with wide radii could be regularly arranged in the discharge space. Different from the short-lived randomly distributed microdischarges, this stable and thick filament can carry more current and have longer lifetime. Because only one electrode is covered by a dielectric layer in the simulation, the formed discharge channel extends outwards near the dielectric layer and shrinks inwards near the naked electrode, agreeing with the experimental results.more » In this paper, the evolution of channel is studied, and its behavior is like a streamer or an ionization wave, but the propagation distance is short. The discharge parameters such as voltage amplitude, electrode width, and N{sub 2} impurities content could significantly influence the number of discharge channel, which is discussed in the paper.« less

Extreme ultraviolet spectroscopy of low pressure helium microwave driven discharges

NASA Astrophysics Data System (ADS)

Espinho, Susana; Felizardo, Edgar; Tatarova, Elena; Alves, Luis Lemos

2016-09-01

Surface wave driven discharges are reliable plasma sources that can produce high levels of vacuum and extreme ultraviolet radiation (VUV and EUV). The richness of the emission spectrum makes this type of discharge a possible alternative source in EUV/VUV radiation assisted applications. However, due to challenging experimental requirements, publications concerning EUV radiation emitted by microwave plasmas are scarce and a deeper understanding of the main mechanisms governing the emission of radiation in this spectral range is required. To this end, the EUV radiation emitted by helium microwave driven plasmas operating at 2.45 GHz has been studied for low pressure conditions. Spectral lines from excited helium atoms and ions were detected via emission spectroscopy in the EUV/VUV regions. Novel data concerning the spectral lines observed in the 23 - 33 nm wavelength range and their intensity behaviour with variation of the discharge operational conditions are presented. The intensity of all the spectral emissions strongly increases with the microwave power delivered to the plasma up to 400 W. Furthermore, the intensity of all the ion spectral emissions in the EUV range decreases by nearly one order of magnitude as the pressure was raised from 0.2 to 0.5 mbar. Work funded by FCT - Fundacao para a Ciencia e a Tecnologia, under Project UID/FIS/50010/2013 and grant SFRH/BD/52412/2013 (PD-F APPLAuSE).

Effect of magnetic polarity on surface roughness during magnetic field assisted EDM of tool steel

NASA Astrophysics Data System (ADS)

Efendee, A. M.; Saifuldin, M.; Gebremariam, MA; Azhari, A.

2018-04-01

Electrical discharge machining (EDM) is one of the non-traditional machining techniques where the process offers wide range of parameters manipulation and machining applications. However, surface roughness, material removal rate, electrode wear and operation costs were among the topmost issue within this technique. Alteration of magnetic device around machining area offers exciting output to be investigated and the effects of magnetic polarity on EDM remain unacquainted. The aim of this research is to investigate the effect of magnetic polarity on surface roughness during magnetic field assisted electrical discharge machining (MFAEDM) on tool steel material (AISI 420 mod.) using graphite electrode. A Magnet with a force of 18 Tesla was applied to the EDM process at selected parameters. The sparks under magnetic field assisted EDM produced better surface finish than the normal conventional EDM process. At the presence of high magnetic field, the spark produced was squeezed and discharge craters generated on the machined surface was tiny and shallow. Correct magnetic polarity combination of MFAEDM process is highly useful to attain a high efficiency machining and improved quality of surface finish to meet the demand of modern industrial applications.

Comparison of laparoscopy-assisted hysterectomies with conventional hysterectomies.

PubMed

Abdollahi, Seddigheh F; Bahlouli, Abolfazl; Mostafa, Parvin G; Rasooli, Susan; Morteza, Ghojazadeh

2009-06-01

To compare operative and early postoperative outcomes of laparoscopic-assisted vaginal hysterectomy (LAVH) and laparoscopy assisted supracervical hysterectomy (LASH) with conventional hysterectomy by laparotomy or vaginally, including patients undergoing total or subtotal hysterectomy for benign gynecologic disease. Three different methods of hysterectomies: laparoscopic, vaginal, and abdominal, were compared at the Department of Obstetrics and Gynecology of Tabriz University of Medical Sciences, Tabriz, Iran, including all patients with indication of uterus removal for benign uterine disease from January 2005 to December 2007. The regional medical research ethics committee approved the study. A total of 288 hysterectomies were performed: 165 (57.3%) abdominal hysterectomy, 85 (29.5%) vaginal hysterectomy, and 38 (13.2%) laparoscopic-assisted hysterectomy. Laparoscopy assisted hysterectomy (LAVH, LASH) was associated with significantly lower early postoperative pain scores and complication rates, less blood loss, short hospital stay, and resulted in lower hospital charge with reusable devices statistically (p=0.03). Laparoscopy is preferred to abdominal hysterectomy by laparotomy and to vaginal hysterectomy. Though vaginal hysterectomy had less complications and rapid recovery and patient satisfaction as compared with abdominal, but it was limited for multiparous patients with some degree of pelvic organ prolapse.

Investigation on the Micro-Discharge Characteristics of Dielectric Barrier Discharge in a Needle-Plate Geometry

NASA Astrophysics Data System (ADS)

Li, Xuechen; Niu, Dongying; Jia, Pengying; Zhao, Na; Yuan, Ning

2011-04-01

In this study, a dielectric barrier discharge device with needle-plate electrodes was used to investigate the characteristics of the micro-discharge in argon at one atmospheric pressure by an optical method. The results show that there are two discharge modes in the dielectric barrier discharge, namely corona mode and filamentary mode. The corona discharge only occurs in the vicinity of the needle tip when the applied voltage is very low. However, the filamentary discharge mode can occur, and micro-discharge bridges the two electrodes when the applied voltage reaches a certain value. The extended area of micro-discharge on the dielectric plate becomes larger with the increase in applied voltage or decrease in gas pressure. The variance of the light emission waveforms is studied as a function of the applied voltage. Results show that very narrow discharge pulse only appears at the negative half cycle of the applied voltage in the corona discharge mode. However, broad hump (about several microseconds) can be discerned at both the negative half cycle and the positive half cycle for a high voltage in the filamentary mode. Furthermore, the inception voltage decreases and the width of the discharge hump increases with the increase in applied voltage. These experimental phenomena can be explained qualitatively by analyzing the discharge mechanism.

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

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

Surgical treatment of tricuspid valve insufficiency promotes early reverse remodeling in patients with axial-flow left ventricular assist devices.

PubMed

Maltais, Simon; Topilsky, Yan; Tchantchaleishvili, Vakhtang; McKellar, Stephen H; Durham, Lucian A; Joyce, Lyle D; Daly, Richard C; Park, Soon J

2012-06-01

The HeartMate II (Thoratec Corp, Pleasanton, Calif) continuous-flow left ventricular assist device has emerged as the standard of care for patients with advanced heart failure. The objective of this study was to assess the safety and early effectiveness of concomitant tricuspid valve procedures in patients undergoing implantation of a HeartMate II device. From February 2007 to April 2010, 83 patients underwent HeartMate II left ventricular assist device implantation. Of these, 37 patients had concomitant tricuspid valve procedures (32 repairs, 5 replacements) for severe tricuspid regurgitation. The effects of a tricuspid valve procedure on tricuspid regurgitation and right ventricular remodeling were assessed comparing echocardiographic findings at baseline and 30 days after left ventricular assist device implantation. Overall survival was also compared. Patients undergoing a concomitant tricuspid valve procedure had more tricuspid regurgitation (vena contracta, 5.6 ± 2.1 mm vs 2.9 ± 2.0 mm; P < .001), worse right ventricular dysfunction (right ventricular end-diastolic area, 33.6 ± 6.2 mm vs 31.6 ± 8.5 mm; P = .05), higher mean right atrial pressure (17.4 ± 7.1 mm Hg vs 14.9 ± 5.1 mm Hg; P = .03), and a higher Kormos score (2.6 ± 2.1 vs 1.2 ± 1.4; P = .0008) preoperatively. One month after surgery, tricuspid regurgitation was worse in patients who underwent left ventricular assist device implantation alone (+18.6%), whereas it improved significantly in patients undergoing a concomitant tricuspid valve procedure (-50.2%) (P = .005). A corresponding significant reduction in right ventricular end-diastolic area (33.6% ± 6.2% vs 30.1% ± 9.7%; P = .03) and a trend toward better right ventricular function (55.5% ± 79.7% vs 35.7% ± 60.5%; P = .28) were noted in patients undergoing a concomitant tricuspid valve procedure. Survival was comparable between the 2 groups. In patients with severe tricuspid regurgitation undergoing left ventricular assist device

Liquid-Phase Electrical Discharges: Fundamental Mechanisms and Applications

NASA Astrophysics Data System (ADS)

Franclemont, Joshua

The increased demand in alternative energy in recent decades has generated significant interest in cleaner fuel sources including hydrogen and syngas (hydrogen and carbon monoxide). Hydrogen and syngas are both primarily produced through the steam reforming of hydrocarbons, specifically natural gas. Although other processes are known, the cheapest source of these fuels is currently through the heating of natural gas in the presence of steam and a catalyst. However, due to the emissions associated with the steam reforming of natural gas and the lack of low cost, efficient, and reliable onboard hydrogen storage technologies for fuel cell powered vehicles, attention has been focused on plasma-assisted reforming of hydrocarbons. Plasma processes can be implemented onboard and are able to directly reform liquid hydrocarbons and alcohols without external heating or catalysts. In addition to hydrogen and syngas, the plasma-assisted reforming of hydrocarbons and alcohols offers other desirable products such as C2 gases (ethane, ethylene, and acetylene), methanol and ethanol. The primary goal of this study is to investigate the fundamental chemical reactions occurring during plasma-assisted reforming of liquid hydrocarbons and alcohols using streamer-like pulsed electrical discharges. Due to the relatively unexplored field of chemical reactions in liquid plasmas, the focus of this study is on elucidating chemical pathways responsible for the formation of hydrogen, syngas, and other products during the direct reforming of liquid methanol, glycerol, and pentane as model species.

Visual development of human milk-fed preterm infants provided with extra energy and nutrients after hospital discharge.

PubMed

O'Connor, Deborah L; Weishuhn, Karen; Rovet, Joanne; Mirabella, Giuseppe; Jefferies, Ann; Campbell, Douglas M; Asztalos, Elizabeth; Feldman, Mark; Whyte, Hilary; Westall, Carol

2012-05-01

Human milk (HM) is the optimal way to nourish preterm low birth weight (LBW) infants after hospital discharge. However, there are few data on which to assess whether HM alone is sufficient to address hospital-acquired nutrition deficits, and no adequately powered studies have examined this question using neurodevelopment as an outcome. The purpose of this work was to determine whether adding extra energy and nutrients to the feedings of predominantly HM-fed LBW infants early after discharge improves their visual development. Visual development was used in this study as a surrogate marker for neurodevelopment. At discharge, 39 predominantly HM-fed LBW infants (750-1800 g, 1288 ± 288 g) were randomized to receive human milk alone (control) or around half of the HM received daily mixed with a multinutrient fortifier (intervention) for 12 weeks. Grating acuity (ie, visual acuity) and contrast sensitivity were assessed using sweep visual-evoked potential tests at 4 and 6 months corrected age. At 4 and 6 months corrected age, intervention infants demonstrated higher grating acuity compared to those in the control group (intervention: 7.8 ± 1.3 and 9.7 ± 1.2 [cycles/degree] vs control 6.9 ± 1.2 and 8.2 ± 1.3, P = .02). Differences in contrast sensitivity did not reach statistical significance (P = .11). Adding a multinutrient fortifier to a portion of the expressed breast milk provided to predominantly HM-fed LBW infants early after discharge improves their early visual development. Whether these subtle differences in visual development apply to other aspects of development or longer term neurodevelopment are worthy of future investigation.

Training Early Childhood Educators: Computer Assisted Instruction Courses in Diagnostic Teaching. Final Report.

ERIC Educational Resources Information Center

Pennsylvania State Univ., University Park. Computer-Assisted Instruction Lab.

The Computer Assisted Remedial Education (CARE) project developed two computer-assisted instructional (CAI) courses. The objective was to train educational personnel to use diagnostic teaching in working with preschool and primary grade children who exhibit learning problems. Emphasis was placed upon the use of new technology in providing…

A Case Study of Technical Assistance to Demonstration Programs for Young Handicapped Children. Part II.

ERIC Educational Resources Information Center

Behr, Shirley K.; And Others

A project to provide technical assistance to staffs of two demonstration programs for preschool handicapped children and their families is described. The focus was technical assistance developed and exercised by the Technical Assistance Development System (TADS), which assisted in the development of the Handicapped Children's Early Education…

A method for improving predictions of bed-load discharges to reservoirs

USGS Publications Warehouse

Lopes, V.L.; Osterkamp, W.R.; Bravo-Espinosa, M.

2007-01-01

Effective management options for mitigating the loss of reservoir water storage capacity to sedimentation depend on improved predictions of bed-load discharges into the reservoirs. Most predictions of bed-load discharges, however, are based on the assumption that the rates of bed-load sediment availability equal the transport capacity of the flow, ignoring the spatio-temporal variability of the sediment supply. This paper develops a semiquantitative method to characterize bed-load sediment transport in alluvial channels, assuming a channel reach is non-supply limited when the bed-load discharge of a given sediment particle-size class is functionally related to the energy that is available to transport that fraction of the total bed-load. The method was applied to 22 alluvial stream channels in the USA to determine whether a channel reach had a supply-limited or non-supply-limited bed-load transport regime. The non-supply-limited transport regime was further subdivided into two groups on the basis of statistical tests. The results indicated the pattern of bed-load sediment transport in alluvial channels depends on the complete spectrum of sediment particle sizes available for transport rather than individual particle-size fractions represented by one characteristic particle size. The application of the method developed in this paper should assist reservoir managers in selecting bed-load sediment transport equations to improve predictions of bed-load discharge in alluvial streams, thereby significantly increasing the efficiency of management options for maintaining the storage capacity of waterbodies. ?? 2007 Blackwell Publishing Asia Pty Ltd.

Determination of channel-morphology characteristics, bankfull discharge, and various design-peak discharges in western Montana

USGS Publications Warehouse

Lawlor, Sean M.

2004-01-01

Stream-restoration projects using natural stream designs typically are based on channel configurations that can accommodate a wide range of streamflow and sediment-transport conditions without excessive erosion or deposition. Bankfull discharge is an index of streamflow considered to be closely related to channel shape, size, and slope (channel morphology). Because of the need for more information about the relation between channel morphology and bankfull discharge, the U.S. Geological Survey (USGS), in cooperation with the Montana Department of Transportation and the U.S. Department of Agriculture-Lolo National Forest, conducted a study to collect channel-morphology and bankfull-discharge data at gaged sites and use these data to improve current (2004) methods of estimation of bankfull discharge and various design-peak discharges at ungaged sites. This report presents channel-morphology characteristics, bankfull discharge, and various design-peak discharges for 41 sites in western Montana. Channel shape, size, and slope and bankfull discharge were determined at 41 active or discontinued USGS streamflow-gaging sites in western Montana. The recurrence interval for the bankfull discharge for this study ranged from 1.0 to 4.4 years with a median value of 1.5 years. The relations between channel-morphology characteristics and various design-peak discharges were examined using regression analysis. The analyses showed that the only characteristics that were significant for all peak discharges were either bankfull width or bankfull cross-sectional area. Bankfull discharge at ungaged sites in most of the study area can be estimated by application of a multiplier after determining the 2-year peak discharge at the ungaged site. The multiplier, which is the ratio of bankfull discharge to the 2-year peak discharge determined at the 41 sites, ranged from 0.21 to 3.7 with a median value of 0.84. Regression relations between bankfull discharge and drainage area and between

Air velocity distributions inside tree canopies from a variable-rate air-assisted sprayer

USDA-ARS?s Scientific Manuscript database

A variable-rate, air assisted, five-port sprayer had been in development to achieve variable discharge rates of both liquid and air. To verify the variable air rate capability by changing the fan inlet diameter of the sprayer, air jet velocities impeded by plant canopies were measured at various loc...

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)

Robotic-assisted laparoscopic management of a caliceal diverticular calculus.

PubMed

Torricelli, Fabio Cesar Miranda; Batista, Lucas T; Colombo, Jose Roberto; Coelho, Rafael Ferreira

2014-08-21

To report the first case of robotic-assisted laparoscopic management of a symptomatic caliceal diverticular calculus and review the literature on laparoscopic treatment for this condition. A 33-year-old obese woman with a 2×1 cm calculus within an anterior caliceal diverticulum located in the middle pole of the left kidney was referred to our service. She had already undergone two flexible ureterorenoscopies without success. We considered that a percutaneous approach would be very challenging due to stone location, thus we elected to perform a robotic-assisted laparoscopic procedure for stone removal and diverticulum fulguration. The procedure was uneventfully performed with no intraoperative or postoperative complications. The patient was discharged from the hospital on the second postoperative day and after 1.5 years of follow-up she is asymptomatic with no recurrence. The robotic-assisted laparoscopic approach to caliceal diverticular calculi is feasible and safe, providing one more option for treatment of stones in challenging locations. 2014 BMJ Publishing Group Ltd.

Robotic-assisted laparoscopic management of a caliceal diverticular calculus

PubMed Central

Torricelli, Fabio Cesar Miranda; Batista, Lucas T; Colombo, Jose Roberto; Coelho, Rafael Ferreira

2014-01-01

Purpose To report the first case of robotic-assisted laparoscopic management of a symptomatic caliceal diverticular calculus and review the literature on laparoscopic treatment for this condition. Case report A 33-year-old obese woman with a 2×1 cm calculus within an anterior caliceal diverticulum located in the middle pole of the left kidney was referred to our service. She had already undergone two flexible ureterorenoscopies without success. We considered that a percutaneous approach would be very challenging due to stone location, thus we elected to perform a robotic-assisted laparoscopic procedure for stone removal and diverticulum fulguration. The procedure was uneventfully performed with no intraoperative or postoperative complications. The patient was discharged from the hospital on the second postoperative day and after 1.5 years of follow-up she is asymptomatic with no recurrence. Conclusions The robotic-assisted laparoscopic approach to caliceal diverticular calculi is feasible and safe, providing one more option for treatment of stones in challenging locations. PMID:25188925

Pending laboratory tests and the hospital discharge summary in patients discharged to sub-acute care.

PubMed

Walz, Stacy E; Smith, Maureen; Cox, Elizabeth; Sattin, Justin; Kind, Amy J H

2011-04-01

Previous studies have noted a high (41%) prevalence and poor discharge summary communication of pending laboratory (lab) tests at the time of hospital discharge for general medical patients. However, the prevalence and communication of pending labs within a high-risk population, specifically those patients discharged to sub-acute care (i.e., skilled nursing, rehabilitation, long-term care), remains unknown. To determine the prevalence and nature of lab tests pending at hospital discharge and their inclusion within hospital discharge summaries, for common sub-acute care populations. Retrospective cohort study. Stroke, hip fracture, and cancer patients discharged from a single large academic medical center to sub-acute care, 2003-2005 (N = 564) Pending lab tests were abstracted from the laboratory information system (LIS) and from each patient's discharge summary, then grouped into 14 categories and compared. Microbiology tests were sub-divided by culture type and number of days pending prior to discharge. Of sub-acute care patients, 32% (181/564) were discharged with pending lab tests per the LIS; however, only 11% (20/181) of discharge summaries documented these. Patients most often left the hospital with pending microbiology tests (83% [150/181]), particularly blood and urine cultures, and reference lab tests (17% [30/181]). However, 82% (61/74) of patients' pending urine cultures did not have 24-hour preliminary results, and 19% (13/70) of patients' pending blood cultures did not have 48-hour preliminary results available at the time of hospital discharge. Approximately one-third of the sub-acute care patients in this study had labs pending at discharge, but few were documented within hospital discharge summaries. Even after considering the availability of preliminary microbiology results, these omissions remain common. Future studies should focus on improving the communication of pending lab tests at discharge and evaluating the impact that this improved

Discharge Characteristics of Series Surface/Packed-Bed Discharge Reactor Diven by Bipolar Pulsed Power

NASA Astrophysics Data System (ADS)

Hu, Jian; Jiang, Nan; Li, Jie; Shang, Kefeng; Lu, Na; Wu, Yan; Mizuno, Akira

2016-03-01

The discharge characteristics of the series surface/packed-bed discharge (SSPBD) reactor driven by bipolar pulse power were systemically investigated in this study. In order to evaluate the advantages of the SSPBD reactor, it was compared with traditional surface discharge (SD) reactor and packed-bed discharge (PBD) reactor in terms of the discharge voltage, discharge current, and ozone formation. The SSPBD reactor exhibited a faster rising time and lower tail voltage than the SD and PBD reactors. The distribution of the active species generated in different discharge regions of the SSPBD reactor was analyzed by optical emission spectra and ozone analysis. It was found that the packed-bed discharge region (3.5 mg/L), rather than the surface discharge region (1.3 mg/L) in the SSPBD reactor played a more important role in ozone generation. The optical emission spectroscopy analysis indicated that more intense peaks of the active species (e.g. N2 and OI) in the optical emission spectra were observed in the packed-bed region. supported by National Natural Science Foundation of China (No. 51177007), the Joint Funds of National Natural Science Foundation of China (No. U1462105), and Dalian University of Technology Fundamental Research Fund of China (No. DUT15RC(3)030)

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

Investigation of airflow effects on the dielectric barrier discharge with single/double discharge channel arrangement

NASA Astrophysics Data System (ADS)

Fan, Zhihui; Yan, Huijie; Liu, Yidi; Guo, Hongfei; Wang, Yuying; Ren, Chunsheng

2018-05-01

Atmospheric-pressure dielectric barrier discharge (DBD) with airflow participation has been widely used in recent years. In this paper, effects of airflow on DBD characteristics are experimentally investigated by single/double pin-to-plate DBD arrangements with an AC exciting source. The discharge electrical characteristics and the movements of discharge channels in airflow are investigated with a single pin electrode arrangement. The current intensities increase in positive cycles and decrease in negative cycles with the increase in airflow velocity. The transition from a filamentary discharge to a diffuse discharge is observed under certain airflow conditions, and the discharge channels move with the airflow with a movement velocity less than the corresponding airflow velocity. In the cases of double pin electrode arrangements, the repulsion between double pin discharge channels is apparent at a 10 mm distance but is not obvious at a 20 mm distance. When the airflow is introduced into the discharge gap, not as in the case of single pin electrode arrangement, the movements of discharge channels in airflow are affected by adjacent discharge channels. The corresponding reasons are analyzed in the paper.

Individual risk factors associated with premature discharge from military service.

PubMed

Larsson, Helena; Broman, Lisbet; Harms-Ringdahl, Karin

2009-01-01

Research on military populations indicates that failure to complete training is a significant problem for armed forces around the world. The present study estimated the prevalence of musculoskeletal complaints or injuries and potential individual risk factors leading to premature discharge from Swedish military service. Male conscripts, n=469 answered a questionnaire and performed physical tests at the start of their military service. A high prevalence of complaints or injuries in lower back and knee was shown. Logistic regression analyses showed an increased risk of discharge (odds ratio, OR) when reporting current complaints or injuries in any part of the body (OR 4.6), being physically inactive (OR 2.0), cigarette smoking (OR 2.7), or poor mental health (OR 3.6). The findings highlight the need for improved preenlistment examination and/or early preventive strategies addressing both physical and psychological interventions.

Current Sheet Formation in a Conical Theta Pinch Faraday Accelerator with Radio-frequency Assisted Discharge

NASA Technical Reports Server (NTRS)

Polzin, Kurt A.; Hallock, Ashley K.; Choueiri, Edgar Y.

2008-01-01

Data from an inductive conical theta pinch accelerator are presented to gain insight into the process of inductive current sheet formation in the presence of a preionized background gas produced by a steady-state RF-discharge. The presence of a preionized plasma has been previously shown to allow for current sheet formation at lower discharge voltages and energies than those found in other pulsed inductive accelerator concepts, leading to greater accelerator efficiencies at lower power levels. Time-resolved magnetic probe measurements are obtained for different background pressures and pulse energies to characterize the effects of these parameters on current sheet formation. Indices are defined that describe time-resolved current sheet characteristics, such as the total current owing in the current sheet, the time-integrated total current ('strength'), and current sheet velocity. It is found that for a given electric field strength, maximums in total current, strength, and velocity occur for one particular background pressure. At other pressures, these current sheet indices are considerably smaller. The trends observed in these indices are explained in terms of the principles behind Townsend breakdown that lead to a dependence on the ratio of the electric field to the background pressure. Time-integrated photographic data are also obtained at the same experimental conditions, and qualitatively they compare quite favorably with the time-resolved magnetic field data.

[Anterior uveitis caused by electrical discharge in whole body injuries (fifteen years study)].

PubMed

Krásný, J; Brož, L; Kripner, J

2013-10-01

To inform about clinical analysis of early ophthalmologic complication (uveitis) in patients sustained electric discharge injury. The authors refer about fifteen years follow-up of pediatric patients at the Department of Burns Medicine, 3rd Medical Faculty, Charles University in Prague, Czech Republic, E.U., with electric discharge injury, in which the anterior uveitis was detected. Out of 43 patients after electric discharge injury, the always-unilateral iritis (iridocyclitis) was diagnosed in four (9 %) patients according to thorough going follow-up after first accidental diagnosis in the year 1998. Out of four boys aged 12 - 15 years, the first two were injured during the "play" - due to the contact with electrical trolley wire while running on railroad wagons roofs, and the two others were stuck by lighting under a tree by secondary electrical discharge. More serious skin burns were noticed in high-voltage current injury - 69 % or 55 % of body surface respectively, with the necessity of skin transplantation. The same was necessary in one boy injured by lighting with burns of 25 % of body surface, while the last one had on the skin the lighting signs only. In most of the patients, the resuscitation care due to unconsciousness and posttraumatic shock was necessary. The anterior uveitis was diagnosed subsequently, after initial preliminary diagnoses as conjunctivitis, episcleritis, or ophthalmia electrical. The iritis without visual function decrease was discovered in few days after the injury in three patients. Treatment and results: The inflammation was in these cases treated with short-term application of mydriatic and corticosteroid eye drops. Once only, the uveitis appeared after two months during the patients hospitalization and then the signs of iridocyclitis in the anterior chamber worsened and caused visual acuity decrease to hand movement in front of the eye. The condition was successfully treated by means of parabulbar betamethasone injection and long

Computer-assisted detection (CAD) methodology for early detection of response to pharmaceutical therapy in tuberculosis patients

NASA Astrophysics Data System (ADS)

Lieberman, Robert; Kwong, Heston; Liu, Brent; Huang, H. K.

2009-02-01

The chest x-ray radiological features of tuberculosis patients are well documented, and the radiological features that change in response to successful pharmaceutical therapy can be followed with longitudinal studies over time. The patients can also be classified as either responsive or resistant to pharmaceutical therapy based on clinical improvement. We have retrospectively collected time series chest x-ray images of 200 patients diagnosed with tuberculosis receiving the standard pharmaceutical treatment. Computer algorithms can be created to utilize image texture features to assess the temporal changes in the chest x-rays of the tuberculosis patients. This methodology provides a framework for a computer-assisted detection (CAD) system that may provide physicians with the ability to detect poor treatment response earlier in pharmaceutical therapy. Early detection allows physicians to respond with more timely treatment alternatives and improved outcomes. Such a system has the potential to increase treatment efficacy for millions of patients each year.

Study of Mechanisms of Filamentary Pulse Electric Discharge Interaction with Gaseous Flow of Nonuniform Composition

DTIC Science & Technology

2013-06-01

dynamic and localization in subsonic and supersonic airflow also at presence of second gas jet and spray jet of liquid hydrocarbons. The experiments...the specific localization of pulse filamentary discharge in vicinity of boundary between two gases and between liquid spray and gas . The...17, 1, 2010 3. M. A. Deminsky, I. V. Kochetov, S. B. Leonov, А. P. Napartovich, “Modeling of plasma assisted combustion in premixed supersonic gas

Bone marrow transplant – children - discharge

MedlinePlus

Transplant - bone marrow - children - discharge; Stem cell transplant - children - discharge; Hematopoietic stem cell transplant -children - discharge; Reduced intensity, non-myeloablative transplant - children - discharge; Mini transplant - children - discharge; Allogenic bone ...

Is patient-grouping on basis of condition on admission indicative for discharge destination in geriatric stroke patients after rehabilitation in skilled nursing facilities? The results of a cluster analysis.

PubMed

Buijck, Bianca I; Zuidema, Sytse U; Spruit-van Eijk, Monica; Bor, Hans; Gerritsen, Debby L; Koopmans, Raymond T C M

2012-12-04

Geriatric stroke patients are generally frail, have an advanced age and co-morbidity. It is yet unclear whether specific groups of patients might benefit differently from structured multidisciplinary rehabilitation programs. Therefore, the aims of our study are 1) to determine relevant patient characteristics to distinguish groups of patients based on their admission scores in skilled nursing facilities (SNFs), and (2) to study the course of these particular patient-groups in relation to their discharge destination. This is a longitudinal, multicenter, observational study. We collected data on patient characteristics, balance, walking ability, arm function, co-morbidity, activities of daily living (ADL), neuropsychiatric symptoms, and depressive complaints of 127 geriatric stroke patients admitted to skilled nursing facilities with specific units for geriatric rehabilitation after stroke. Cluster analyses revealed two groups: cluster 1 included patients in poor condition upon admission (n = 52), and cluster 2 included patients in fair/good condition upon admission (n = 75). Patients in both groups improved in balance, walking abilities, and arm function. Patients in cluster 1 also improved in ADL. Depressive complaints decreased significantly in patients in cluster 1 who were discharged to an independent- or assisted-living situation. Compared to 80% of the patients in cluster 2, a lower proportion (46%) of the patients in cluster 1 were discharged to an independent- or assisted-living situation. Stroke patients referred for rehabilitation to SNFs could be clustered on the basis of their condition upon admission. Although patients in poor condition on admission were more likely to be referred to a facility for long-term care, this was certainly not the case in all patients. Almost half of them could be discharged to an independent or assisted living situation, which implied that also in patients in poor condition on admission, discharge to an independent or

Safety of early discharge for low-risk patients with febrile neutropenia: a multicenter randomized controlled trial.

PubMed

Talcott, James A; Yeap, Beow Y; Clark, Jack A; Siegel, Robert D; Loggers, Elizabeth Trice; Lu, Charles; Godley, Paul A

2011-10-20

Febrile neutropenia commonly complicates cancer chemotherapy. Outpatient treatment may reduce costs and improve patient comfort but risk progression of undetected medical problems. By using our validated algorithm, we identified medically stable inpatients admitted for febrile neutropenia (neutrophils < 500/μL) after chemotherapy and randomly assigned them to continued inpatient antibiotic therapy or early discharge to receive identical antibiotic treatment at home. Our primary outcome was the occurrence of any serious medical complication, defined as evidence of medical instability requiring urgent medical attention. We enrolled 117 patients with 121 febrile neutropenia episodes before study termination for poor accrual. We excluded five episodes as ineligible and three because of inadequate documentation of the study outcome. Treatment groups were clinically similar, but sociodemographic imbalances occurred because of block randomization. The median presenting absolute neutrophil count was 100/μL. Hematopoietic growth factors were used in 38% of episodes. The median neutropenia duration was 4 days (range, 1 to 15 days). Five outpatients were readmitted to the hospital. Major medical complications occurred in five episodes (8%) in the hospital arm and four (9%) in the home arm (95% CI for the difference, -10% to 13%; P = .56). No study patient died. Patient-reported quality of life was similar on both arms. We found no evidence of adverse medical consequences from home care, despite a protocol designed to detect evidence of clinical deterioration. These results should reassure clinicians who elect to treat rigorously characterized low-risk patients with febrile neutropenia in suitable outpatient settings with appropriate surveillance for unexpected clinical deterioration.

Vessel Sewage Discharges

EPA Pesticide Factsheets

Vessel sewage discharges are regulated under Section 312 of the Clean Water Act, which is jointly implemented by the EPA and Coast Guard. This homepage links to information on marine sanitation devices and no discharge zones.

Radiofrequency ablation for hepatocellular carcinoma: assistant techniques for difficult cases.

PubMed

Inoue, Tatsuo; Minami, Yasunori; Chung, Hobyung; Hayaishi, Sousuke; Ueda, Taisuke; Tatsumi, Chie; Takita, Masahiro; Kitai, Satoshi; Hatanaka, Kinuyo; Ishikawa, Emi; Yada, Norihisa; Hagiwara, Satoru; Ueshima, Kazuomi; Kudo, Masatoshi

2010-07-01

To confirm the safety and effectiveness of techniques to assist radiofrequency ablation (RFA) for difficult cases, we retrospectively evaluated successful treatment rates, early complications and local tumor progressions. Between June 1999 and April 2009, a total of 341 patients with 535 nodules were treated as difficult cases. Artificial pleural effusion assisted ablation was performed on 64 patients with 82 nodules. Artificial ascites-assisted ablation was performed on 11 patients with 13 nodules. Cooling by endoscopic nasobiliary drainage (ENBD) tube-assisted ablation was performed on 6 patients with 8 nodules. When the tumors were not well visualized with conventional B-mode ultrasonography (US), contrast-enhanced US-assisted ablation with Levovist or Sonazoid or virtual CT sonography-assisted ablation was performed. Contrast-enhanced US-assisted ablation was performed on 139 patients with 224 nodules and virtual CT sonography-assisted ablation was performed on 121 patients with 209 nodules. In total, complete ablation was achieved in 514 of 535 (96%) nodules in difficult cases. For RFA with artificial pleural effusion, artificial ascites and ENBD, complete response was confirmed in all cases. For contrast-enhanced US- and CT sonography-assisted ablation, complete response was 95%. Early complications were recognized in 24 cases (4.5%). All cases recovered with no invasive treatment. Local tumor recurrence was investigated in 377 nodules of 245 patients, and 69 (18%) nodules were positive. Tumor recurrences in each assisted technique were 14.7% in artificial pleural effusion cases, 7% in artificial ascites, 12.5% in ENBD tube cases, 31% in virtual CT sonography, and 8.5% in contrast-enhanced US. Although local tumor progression needs to be carefully monitored, assisted techniques of RFA for difficult cases are well tolerated and expand the indications of RFA. Copyright (c) 2010 S. Karger AG, Basel.

Verification of 1921 peak discharge at Skagit River near Concrete, Washington, using 2003 peak-discharge data

USGS Publications Warehouse

Mastin, M.C.; Kresch, D.L.

2005-01-01

The 1921 peak discharge at Skagit River near Concrete, Washington (U.S. Geological Survey streamflow-gaging station 12194000), was verified using peak-discharge data from the flood of October 21, 2003, the largest flood since 1921. This peak discharge is critical to determining other high discharges at the gaging station and to reliably estimating the 100-year flood, the primary design flood being used in a current flood study of the Skagit River basin. The four largest annual peak discharges of record (1897, 1909, 1917, and 1921) were used to determine the 100-year flood discharge at Skagit River near Concrete. The peak discharge on December 13, 1921, was determined by James E. Stewart of the U.S. Geological Survey using a slope-area measurement and a contracted-opening measurement. An extended stage-discharge rating curve based on the 1921 peak discharge was used to determine the peak discharges of the three other large floods. Any inaccuracy in the 1921 peak discharge also would affect the accuracies of the three other largest peak discharges. The peak discharge of the 1921 flood was recalculated using the cross sections and high-water marks surveyed after the 1921 flood in conjunction with a new estimate of the channel roughness coefficient (n value) based on an n-verification analysis of the peak discharge of the October 21, 2003, flood. The n value used by Stewart for his slope-area measurement of the 1921 flood was 0.033, and the corresponding calculated peak discharge was 240,000 cubic feet per second (ft3/s). Determination of a single definitive water-surface profile for use in the n-verification analysis was precluded because of considerable variation in elevations of surveyed high-water marks from the flood on October 21, 2003. Therefore, n values were determined for two separate water-surface profiles thought to bracket a plausible range of water-surface slopes defined by high-water marks. The n value determined using the flattest plausible slope was 0

From Discharge Planner to “Concierge”: Recommendations for Hospital Social Work by Clients with Intracerebral Hemorrhage

PubMed Central

Linton, Kristen F.; Ing, Marissa M.; Vento, Megan A.; Nakagawa, Kazuma

2016-01-01

Purpose The Affordable Care Act and budget cuts have changed the role of hospital social workers by placing pressure on them to conduct speedy discharges and decrease readmission rates. This qualitative study aimed to assess if hospital social work is meeting the needs of clients in the hospital and post-discharge. Methods Semi-structured interviews with 10 clients with intracerebral hemorrhage (ICH) and 11 caregivers were conducted. Results Participants reported that social work services were not meeting their needs. Clients with ICH and their caregivers expressed needs from social workers that surpassed their roles as discharge planners, including counseling, help with finances and insurance, and advocacy. Participants wanted social work services to begin early in acute treatment with continuity post-discharge. Conclusion Social workers should conduct ethical social work by meeting clients where they are, addressing needs as prioritized by the client, and advocating individually and organizationally for clients. PMID:26252181

Evaluation of Early Enlistment Failures under the U.S. Army Trainee Discharge Program

DTIC Science & Technology

1975-11-01

by Group 1-4 3-8 PrImary Reason for Enlisting by Group 3.5 3-9 Person Who Most Influenced Enlistment Decicion b, Group 3-5 3-10 Father’s Influence on...Mother’s Reaction to Enlistment by Group 3.7 3-14 Preo.Inlistment Marijuana Use by Group 3-8 3-15 Pre-Enlistment Knowledge of TDP by’ Group 3-8 3.16 Personal ...what types of persons were being discharged undur the TDP in terms of their social and psychological characteristics. The exploratory research reported

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.

Pallidal neuronal discharge in Huntington's disease: support for selective loss of striatal cells originating the indirect pathway.

PubMed

Starr, Philip A; Kang, Gail A; Heath, Susan; Shimamoto, Shoichi; Turner, Robert S

2008-05-01

Chorea is the predominant motor manifestation in the early symptomatic phase of adult onset Huntington's disease (HD). Pathologically, this stage is marked by differential loss of striatal neurons contributing to the indirect pathway. This pattern of neuronal loss predicts decreased neuronal firing rates in GPi and increased firing rates in GPe, the opposite of the changes in firing rate known to occur in Parkinson's disease (PD). We present single-unit discharge characteristics (33 neurons) observed in an awake patient with HD (41 CAG repeats) undergoing microelectrode guided surgery for pallidal deep brain stimulation. Pallidal single-unit activity at "rest" and during voluntary movement was discriminated off line by principal component analysis and evaluated with respect to discharge rate, bursting, and oscillatory activity in the 0-200 Hz range. 24 GPi and 9 GPe units were studied, and compared with 132 GPi and 50 GPe units from 14 patients with PD. The mean (+/-SEM) spontaneous discharge rate for HD was 58+/-4 for GPi and 73+/-5 for GPe. This contrasted with discharge rates in PD of 95+/-2 for GPi and 57+/-3 for GPe. HD GPi units showed more bursting than PD GPi units but much less oscillatory activity in the 2-35 Hz frequency range at rest. These findings are consistent with selective early loss of striatal cells originating the indirect pathway.

Kinetics and Chemistry of Ionization Wave Discharges Propagating Over Dielectric Surfaces

NASA Astrophysics Data System (ADS)

Petrishchev, Vitaly

Experimental studies of near-surface ionization wave electric discharges generated by high peak voltage (20-30 kV), nanosecond duration pulses (full width at half-maximum 50-100 ns) of positive and negative polarity and propagating over dielectric surfaces have been performed. A novel way to sustain diffuse, reproducible, ns pulse surface plasmas at a liquid-vapor interface is demonstrated at buffer gas pressures ranging from 10 to 200 Torr. Generation of surface ionization waves well reproduced shot-to-shot and sustaining diffuse near-surface plasmas is one of the principal advantages of the use of ns pulse discharge waveforms. This makes possible characterization of these plasmas in repetitively pulsed experiments. Numerous applications of these plasmas include low-temperature plasma assisted combustion, plasma fuel reforming, plasma flow control, plasma materials processing, agriculture, biology, and medicine. The objectives of the present work are (i) to demonstrate that surface ionization wave discharge plasmas sustained at a liquid-vapor interface can be used as an experimental platform for studies of near-surface plasma chemical reaction kinetics, at the conditions when the interface acts as a high-yield source of radical species, and (ii) to obtain quantitative insight into dynamics, kinetics and chemistry of surface ionization wave discharges and provide experimental data for validation of kinetic models, to assess their predictive capability. Generation of the initial radical pool may trigger a number of plasma chemical processes leading to formation of a variety of stable product species, depending on the initial composition of the liquid and the buffer gas flow. One of the products formed and detected during surface plasma / liquid water interaction is hydroxyl radical, which is closely relevant to applications of plasmas for biology and medicine. The present work includes detailed studies of surface ionization wave discharges sustained in different

13 CFR 124.302 - What is graduation and what is early graduation?

Code of Federal Regulations, 2014 CFR

2014-01-01

... 13 Business Credit and Assistance 1 2014-01-01 2014-01-01 false What is graduation and what is early graduation? 124.302 Section 124.302 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION 8... Exiting the 8(a) Bd Program § 124.302 What is graduation and what is early graduation? (a) General. SBA...

13 CFR 124.302 - What is graduation and what is early graduation?

Code of Federal Regulations, 2013 CFR

2013-01-01

... 13 Business Credit and Assistance 1 2013-01-01 2013-01-01 false What is graduation and what is early graduation? 124.302 Section 124.302 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION 8... Exiting the 8(a) Bd Program § 124.302 What is graduation and what is early graduation? (a) General. SBA...

13 CFR 124.302 - What is graduation and what is early graduation?

Code of Federal Regulations, 2012 CFR

2012-01-01

... 13 Business Credit and Assistance 1 2012-01-01 2012-01-01 false What is graduation and what is early graduation? 124.302 Section 124.302 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION 8... Exiting the 8(a) Bd Program § 124.302 What is graduation and what is early graduation? (a) General. SBA...

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

A previously unrecognized path of early Holocene base flow and elevated discharge from Lake Minong to Lake Chippewa across eastern Upper Michigan

USGS Publications Warehouse

Loope, Walter L.; Jol, Harry M.; Fisher, Timothy G.; Blewett, William L.; Loope, Henry M.; Legg, Robert J.

2014-01-01

It has long been hypothesized that flux of fresh meltwater from glacial Lake Minong in North America's Superior Basin to the North Atlantic Ocean triggered rapid climatic shifts during the early Holocene. The spatial context of recent support for this idea demands a reevaluation of the exit point of meltwater from the Superior Basin. We used ground penetrating radar (GPR), foundation borings from six highway bridges, a GIS model of surface topography, geologic maps, U.S. Department of Agriculture–Natural Resources Conservation Service soils maps, and well logs to investigate the possible linkage of Lake Minong with Lake Chippewa in the Lake Michigan Basin across eastern Upper Michigan. GPR suggests that a connecting channel lies buried beneath the present interlake divide at Danaher. A single optical age hints that the channel aggraded to 225 m as elevated receipt of Lake Agassiz meltwater in the Superior Basin began to wane <10.6 ka. The large supply of sediment required to accommodate aggradation was immediately available at the channel's edge in the littoral shelves of abandoned Lake Algonquin and in distal parts of post-Algonquin fans. As discharge decreased further, the aggraded channel floor was quickly breached and interbasin flow to Lake Chippewa was restored. Basal radiocarbon ages on wood from small lakes along the discharge path and a GIS model of Minong's shoreline are consistent with another transgression of Minong after ca. 9.5 ka. At the peak of the latter transgression, the southeastern rim of the Superior Basin (Nadoway Drift Barrier) failed, ending Lake Minong. Upon Minong's final drop, aggradational sediments were deposited at Danaher, infilling the prior breach.

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

Effect of Discharge Summary Availability During Post-discharge Visits on Hospital Readmission

PubMed Central

van Walraven, Carl; Seth, Ratika; Austin, Peter C; Laupacis, Andreas

2002-01-01

OBJECTIVE To determine if the delivery of hospital discharge summaries to follow-up physicians decreases the risk of hospital readmission. SUBJECTS Eight hundred eighty-eight patients discharged from a single hospital following treatment for an acute medical illness. SETTING Teaching hospital in a universal health-care system. DESIGN We determined the date that each patient's discharge summary was printed and the physicians to whom it was sent. Summary receipt was confirmed by survey and phoning each physician's office. Each patient's hospital chart was reviewed to determine their acute and chronic medical conditions as well as their course in hospital. Using population-based administrative databases, all post-hospitalization visits were identified. For each of these visits, we determined whether the summary was available. MAIN OUTCOME MEASURES Time to nonelective hospital readmission during 3 months following discharge. RESULTS The discharge summary was available for only 568 of 4,639 outpatient visits (12.2%). Overall, 240 (27.0%) of patients were urgently readmitted to hospital. After adjusting for significant patient and hospitalization factors, we found a trend toward a decreased risk of readmission for patients who were seen in follow-up by a physician who had received a summary (relative risk 0.74, 95% confidence interval 0.50 to 1.11). CONCLUSIONS The risk of rehospitalization may decrease when patients are assessed following discharge by physicians who have received the discharge summary. Further research is required to determine if better continuity of patient information improves patient outcomes. PMID:11929504

Effect of discharge summary availability during post-discharge visits on hospital readmission.

PubMed

van Walraven, Carl; Seth, Ratika; Austin, Peter C; Laupacis, Andreas

2002-03-01

To determine if the delivery of hospital discharge summaries to follow-up physicians decreases the risk of hospital readmission. Eight hundred eighty-eight patients discharged from a single hospital following treatment for an acute medical illness. Teaching hospital in a universal health-care system. We determined the date that each patient's discharge summary was printed and the physicians to whom it was sent. Summary receipt was confirmed by survey and phoning each physician's office. Each patient's hospital chart was reviewed to determine their acute and chronic medical conditions as well as their course in hospital. Using population-based administrative databases, all post-hospitalization visits were identified. For each of these visits, we determined whether the summary was available. Time to nonelective hospital readmission during 3 months following discharge. The discharge summary was available for only 568 of 4,639 outpatient visits (12.2%). Overall, 240 (27.0%) of patients were urgently readmitted to hospital. After adjusting for significant patient and hospitalization factors, we found a trend toward a decreased risk of readmission for patients who were seen in follow-up by a physician who had received a summary (relative risk 0.74, 95% confidence interval 0.50 to 1.11). The risk of rehospitalization may decrease when patients are assessed following discharge by physicians who have received the discharge summary. Further research is required to determine if better continuity of patient information improves patient outcomes.

Virtual-Instrument-Based Online Monitoring System for Hands-on Laboratory Experiment of Partial Discharges

ERIC Educational Resources Information Center

Karmakar, Subrata

2017-01-01

Online monitoring of high-voltage (HV) equipment is a vital tool for early detection of insulation failure. Most insulation failures are caused by partial discharges (PDs) inside the HV equipment. Because of the very high cost of establishing HV equipment facility and the limitations of electromagnetic interference-screened laboratories, only a…

Impact of Pharmacist Involvement in Early Identification and Enrollment in Patient Assistance Programs on CMV Outcomes in Transplantation.

PubMed

Byrns, Jennifer S; Pilch, Nicole W; Taber, David J

2016-04-01

No data exist evaluating the utilization of patient assistance programs (PAPs) on cytomegalovirus (CMV)-related outcomes. To determine whether early identification and enrollment in PAPs can prevent CMV-related events. Retrospective analysis of patients at risk of CMV reactivation who received kidney and/or pancreas transplants. Two groups were evaluated with patients receiving oral valganciclovir for CMV prophylaxis through enrollment in PAPs or oral acyclovir with preemptive CMV monitoring. Primary outcomes include the incidence of CMV infection. Secondary outcomes include a cost benefit analysis, incidence of rejection, patient/graft survival, and time to CMV infection. There were 97 patients identified; valganciclovir through PAPs (n = 39) and preemptive CMV quantitative nucleic acid testing monitoring (n = 58). The incidence of CMV viremia was lower in the PAP group (12.8% vs 36.2%, respectively; P = .021). There were no significant differences in CMV syndrome/disease, acute rejection, graft loss, or death between the groups. The time to CMV infection was shorter in the preemptive group. Cost benefit analysis found that hiring a full time pharmacy employee for enrolling patients in PAPs was cost beneficial for the institution/health care system. Early identification and enrollment of patients in PAPs reduces the incidence of CMV viremia. Pharmacists play a crucial role in this process. © The Author(s) 2014.

Johann Wilhelm Hittorf and the material culture of nineteenth-century gas discharge research.

PubMed

Müller, Falk

2011-06-01

In the second half of the nineteenth century, gas discharge research was transformed from a playful and fragmented field into a new branch of physical science and technology. From the 1850s onwards, several technical innovations-powerful high-voltage supplies, the enhancement of glass-blowing skills, or the introduction of mercury air-pumps- allowed for a major extension of experimental practices and expansion of the phenomenological field. Gas discharge tubes served as containers in which resources from various disciplinary contexts could be brought together; along with the experimental apparatus built around them the tubes developed into increasingly complex interfaces mediating between the human senses and the micro-world. The focus of the following paper will be on the physicist and chemist Johann Wilhelm Hittorf (1824-1914), his educational background and his attempts to understand gaseous conduction as a process of interaction between electrical energy and matter. Hittorf started a long-term project in gas discharge research in the early 1860s. In his research he tried to combine a morphological exploration of gas discharge phenomena-aiming at the experimental production of a coherent phenomenological manifold--with the definition and precise measurements of physical properties.

Early Infectious Diseases Specialty Intervention Is Associated with Shorter Hospital Stays and Lower Readmission Rates: A Retrospective Cohort Study.

PubMed

Schmitt, Steven; MacIntyre, Ann T; Bleasdale, Susan C; Ritter, J Trees; Nelson, Sandra B; Berbari, Elie F; Burdette, Steven D; Hewlett, Angela; Miles, Matthew; Robinson, Philip A; Siddiqui, Javeed; Trotman, Robin; Martinelli, Lawrence; Zeitlin, Gary; Rodriguez, Andrés; Smith, Mark W; McQuillen, Daniel P

2018-06-13

Intervention by infectious diseases (ID) physicians improves outcomes for inpatients in Medicare, but patients with other insurance types could fare differently. We assessed whether ID involvement leads to better outcomes among privately insured patients under age 65 hospitalized with common infections. We performed a retrospective analysis of administrative claims data from community hospital and post-discharge ambulatory care. Patients were privately insured individuals under 65 years old with an acute-care stay in 2014 for selected infections, classed as having early (by day 3) or late (after day 3) ID intervention, or none. Key outcomes were mortality, cost, length of the index stay; readmission rate, mortality and total cost of care over the first 30 days after discharge. Patients managed with early ID involvement had shorter length of stay, lower spending, and lower mortality in the index stay than those patients managed without ID involvement. Relative to late, early ID involvement was associated with shorter length of stay and lower cost. Individuals with early ID intervention during hospitalization had fewer readmissions and lower healthcare payments after discharge. Relative to late, those with early ID intervention experienced lower readmission, lower spending, and lower mortality. Among privately insured patients under 65 years old, treated in a hospital, early intervention with an ID physician was associated with lower mortality rate and shorter length of stay. Patients who received early ID intervention during their hospital stay were less likely to be readmitted after discharge and had lower total healthcare spending.

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.

Feeding preterm infants after hospital discharge: growth and development at 18 months of age.

PubMed

Cooke, R J; Embleton, N D; Griffin, I J; Wells, J C; McCormick, K P

2001-05-01

We have shown that preterm infants fed a preterm formula grow better than those fed a standard term infant formula after hospital discharge. The purpose of this follow-up study was to determine whether improved early growth was associated with later growth and development. Preterm infants (< or =1750 g birth weight, < or =34 wk gestation) were randomized to be fed either a preterm infant formula (discharge to 6 mo corrected age), or a term formula (discharge to 6 mo), or the preterm (discharge to term) and the term formula (term to 6 mo). Anthropometry was performed at 12 wk and 6, 12, and 18 mo. Mental and psychomotor development were assessed using the Bayley Scales of Infant Development II at 18 mo. Differences in growth observed at 12 wk were maintained at 18 mo. At 18 mo, boys fed the preterm formula were 1.0 kg heavier, 2 cm longer, and had a 1.0 cm greater occipitofrontal circumference than boys fed the term formula. Boys fed the preterm formula were also 600 g heavier and 2 cm longer than girls fed the preterm formula. However, no differences were noted in MDI or PDI between boys fed the preterm formula and boys fed the term formula or between the boys fed preterm formula and girls fed the preterm formula. Overall, boys had significantly lower MDI than girls (mean difference, 6.0; p < 0.01), primarily reflecting lower scores in boys fed the term formula. Thus, early diet has long-term effects on growth but not development at 18 mo of age. Sex remains an important confounding variable when assessing growth and developmental outcome in these high-risk infants.

Technical Assistance Model for Long-Term Systems Change: Three State Examples

ERIC Educational Resources Information Center

Kasprzak, Christina; Hurth, Joicey; Lucas, Anne; Marshall, Jacqueline; Terrell, Adriane; Jones, Elizabeth

2010-01-01

The National Early Childhood Technical Assistance Center (NECTAC) Technical Assistance (TA) Model for Long-Term Systems Change (LTSC) is grounded in conceptual frameworks in the literature on systems change and systems thinking. The NECTAC conceptual framework uses a logic model approach to change developed specifically for states' infant and…

The influence of peri-operative factors for accelerated discharge following laparoscopic colorectal surgery when combined with an enhanced recovery after surgery (ERAS) pathway.

PubMed

Chand, Manish; De'Ath, Henry D; Rasheed, Shahnawaz; Mehta, Chaitanya; Bromilow, James; Qureshi, Tahseen

2016-01-01

Laparoscopic surgery is well established in the modern management of colorectal disease. More recently, enhanced recovery after surgery (ERAS) protocols have been introduced to further promote accelerated discharge and faster recovery. However, not all patients are suitable for early discharge. The purpose of this study was to evaluate the early outcomes of patients undergoing such a regime to determine which peri-operative factors may predict safe accelerated discharge. Data were prospectively collected on consecutive patients undergoing laparoscopic colorectal surgery. All patients followed the institution's ERAS protocol and were discharged once specific criteria were fulfilled. Clinical characteristics and outcomes were compared between patients who were discharged before and after 72 h post-surgery. Thereafter, the peri-operative factors that were associated with delayed discharge were determined using a binary logistic model. Three hundred patients were included in the analysis. The most common operation was laparoscopic anterior resection (n = 123, 41%). Mean length of stay was 4.8 days (standard deviation 5.9), with 185 (62%) patients discharged within 72 h. Ten (3%) patients had a post-operative complication. Three independent predictors of delayed discharge were identified; BMI (OR 1.06, 95%CI 1.01-1.11), operation length (OR 0.99, 95%CI 0.98-0.99) and complications (OR 16.26, 95%CI 4.88-54.08). A combined approach of laparoscopic surgery and ERAS leads to reduced length of stay. This enables more than 60% of patients to be discharged within 72 h. Increased BMI, duration of operation and complications post-operatively independently predict a longer length of stay. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Optimizing Computer Assisted Instruction By Applying Principles of Learning Theory.

ERIC Educational Resources Information Center

Edwards, Thomas O.

The development of learning theory and its application to computer-assisted instruction (CAI) are described. Among the early theoretical constructs thought to be important are E. L. Thorndike's concept of learning connectisms, Neal Miller's theory of motivation, and B. F. Skinner's theory of operant conditioning. Early devices incorporating those…

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),…

HOLLOW CARBON ARC DISCHARGE

DOEpatents

Luce, J.S.

1960-10-11

A device is described for producing an energetic, direct current, hollow, carbon-arc discharge in an evacuated container and within a strong magnetic field. Such discharges are particularly useful not only in dissociation and ionization of high energy molecular ion beams, but also in acting as a shield or barrier against the instreaming of lowenergy neutral particles into a plasma formed within the hollow discharge when it is used as a dissociating mechanism for forming the plasma. There is maintained a predetermined ratio of gas particles to carbon particles released from the arc electrodes during operation of the discharge. The carbon particles absorb some of the gas particles and are pumped along and by the discharge out of the device, with the result that smaller diffusion pumps are required than would otherwise be necessary to dispose of the excess gas.

77 FR 47501 - Applications for New Awards; Technical Assistance on State Data Collection, Analysis, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-08

... Awards; Technical Assistance on State Data Collection, Analysis, and Reporting--National IDEA Technical Assistance Center on Early Childhood Longitudinal Data Systems; Notice #0;#0;Federal Register / Vol. 77 , No... for New Awards; Technical Assistance on State Data Collection, Analysis, and Reporting--National IDEA...

Inpatient rehabilitation outcomes for patients receiving left ventricular assist device.

PubMed

Alsara, Osama; Reeves, Ronald K; Pyfferoen, Mary D; Trenary, Tamra L; Engen, Deborah J; Vitse, Merri L; Kessler, Stacy M; Kushwaha, Sudhir S; Clavell, Alfredo L; Thomas, Randal J; Lopez-Jimenez, Francisco; Park, Soon J; Perez-Terzic, Carmen M

2014-10-01

The aim of this study was to evaluate outcomes of patients participating in inpatient rehabilitation program after left ventricular assist device (LVAD) implantation. Medical records of 94 patients who received LVADs between January 1, 2008, and June 30, 2010, at the Mayo Clinic in Rochester, MN, were retrospectively reviewed for demographic data, and inpatient rehabilitation functional outcomes were measured by the Functional Independence Measure scale. After successful implantation of LVAD, the patients were either discharged directly home from acute care (44%) or admitted to inpatient rehabilitation (56%). The patients admitted to inpatient rehabilitation were older than those discharged home. They were also more medically complex and more likely to have the LVAD placed as destination therapy. At discharge, significant improvement occurred in 17 of the 18 activities evaluated by the Functional Independence Measure scale. The mean total Functional Independence Measure scale score at admission was 77.1 compared with a score of 95.2 at discharge (P < 0.0001). Approximately half of the patients who received LVAD therapy were admitted in the inpatient rehabilitation. After the implantation of LVAD and inpatient rehabilitation, significant functional improvements were observed. Further studies addressing the role of inpatient rehabilitation for LVAD patients are warranted.

[Factors associated with early weaning in a Spanish region].

PubMed

Rius, J M; Ortuño, J; Rivas, C; Maravall, M; Calzado, M A; López, A; Aguar, M; Vento, M

2014-01-01

Breastfeeding has undoubtedly great benefits. Previous studies have foundan early dropout. Only a few studies have investigated related factors. Our aim was to find out on-going breastfeeding rates along the first 12 months after birth and analyse factors associated with early weaning. This is a prospective study including consecutive pairs (mother and newborn) till completion of the required sample. Variables were collected performing a structured program of surveys to the mothers. Bivariate and multivariate analysis of the data was performed. A total of 452 pairs were recruited. It was found that 81% of them started breastfeeding, with a prevalence of breastfeeding of 39% and 21% at 3 and 6 months after birth, respectively. Factors associated with early discontinuation of breastfeeding were: pregnancy induced by assisted reproduction methods (OR=5.58; 95% CI: 2.62-11.91), maternal smoking (OR=1.56; 95% CI: 1.10-2.22), poor maternal expectations about the duration of breastfeeding (OR=2.19; 95% CI: 1.49-3.23), use of nipple shields for breastfeeding (OR=2.57; 95% CI: 1.69-3.90), pacifier use on a regular basis during the first month after delivery (OR=1.39; 95% CI: 1.02-1.91), maternal university educational level (OR=0,59; 95% CI: 0,40-0,88), attending birth preparation programs during pregnancy (OR=0,68; 95% CI: 0,49-0,94), and believing having enough milk output at the time of discharge (OR=0,66; 95% CI: 0,47-0,92). International recommendations about duration of breastfeeding are not achieved in our country because of high rates of early weaning. We describe the known factors involved and other novel factors. The implementation of interventions to increase breastfeeding rates and to prevent early weaning are strongly recommended. Copyright © 2012 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

13 CFR 124.302 - What is early graduation?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What is early graduation? 124.302 Section 124.302 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION 8(a) BUSINESS DEVELOPMENT/SMALL DISADVANTAGED BUSINESS STATUS DETERMINATIONS 8(a) Business Development Exiting the 8(a) Bd Program...

13 CFR 124.302 - What is early graduation?

Code of Federal Regulations, 2011 CFR

2011-01-01

... 13 Business Credit and Assistance 1 2011-01-01 2011-01-01 false What is early graduation? 124.302 Section 124.302 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION 8(a) BUSINESS DEVELOPMENT/SMALL DISADVANTAGED BUSINESS STATUS DETERMINATIONS 8(a) Business Development Exiting the 8(a) Bd Program...

Glow discharge detector

DOEpatents

Koo, Jackson C.; Yu, Conrad M.

2002-01-01

A highly sensitive electronic ion cell for the measurement of trace elements in He carrier gas which involves glow discharge. A constant wave (CW) glow discharge detector which is controlled through a biased resistor, can detect the change of electron density caused by impurities in the He carrier gas by many orders of magnitude larger than that caused by direct ionization or electron capture. The glow discharge detector utilizes a floating pseudo-electrode to form a probe in or near the plasma. By using this probe, the large variation of electron density due to trace amounts of impurities can be directly measured.

The risk of urinary retention following robot-assisted radical prostatectomy and its impact on early continence outcomes.

PubMed

Alnazari, Mansour; Zanaty, Marc; Ajib, Khaled; El-Hakim, Assaad; Zorn, Kevin C

2017-12-22

We aimed to evaluate the risk factors of acute urinary retention (AUR) following robot-assisted radical prostatectomy (RARP), as well as the relationship of AUR with early continence outcomes. The records of 740 consecutive patients who underwent RARP by two experienced surgeons at our institution were retrospectively reviewed from a prospectively collected database. Multiple factors, including age, body mass index (BMI), international prostate symptom score (IPSS), prostate volume, presence of median lobe, nerve preservation status, anastomosis time, and catheter removal time (Day 4 vs. 7), were evaluated as risk factors for AUR using univariate and multivariate analysis. The relation between AUR and early return of continence (one and three months) post-RARP was also evaluated. The incidence of clinically significant vesico-urethral anastomotic (VUA) leak and AUR following catheter removal were 0.9% and 2.2% (17/740), respectively. In men who developed AUR, there was no significant relationship with regards to age, BMI, IPSS, prostatic volume, median lobe, nerve preservation, or anastomosis time; however, the incidence of AUR was significantly higher for men with catheter removal at Day 4 (4.5% [16/351]) vs. Day 7 (0.2% [1/389]) (p=0.004). Moreover, patients with early removal of the catheter (Day 4) who developed AUR had an earlier one-month return of 0-pad continence 87.5% (14/16) compared to patients without AUR 45.6% (153/335), with no significant difference at three months. While AUR is an uncommon complication of RARP, its incidence is much higher than VUA leakage. Further, it is often not well-discussed during patient counselling preoperatively. Moreover, earlier return of urinary continence was observed in patients experiencing AUR following RARP exclusively with catheter removal at Day 4. Future studies are warranted to validate the long-term impact of AUR on continence outcomes.

Discharge rates in electromyography distinguish early between peripheral and central paresis.

PubMed

Jürgens, Tim P; Puchner, Christoph; Schulte-Mattler, Wilhelm J

2012-10-01

Abnormally increased discharge rates (DRs) of motor unit potentials on concentric needle electromyography (CNEMG) indicate a loss of motor units in peripheral neurogenic lesions. To determine when increased DRs occur during the course of a peripheral nerve lesion, we retrospectively analyzed CNEMG recordings of 19 patients with acute weakness of peripheral origin. The initial CNEMG studies took place from 3.7 hours to 10 days after the onset of the lesion. Abnormally increased DRs (≥20/s) were found in all but 1 of the muscles in which MRC grade was <4. Peripheral neurogenic damage was confirmed in all patients thereafter. The DRs depended on neither the kind of lesion nor the time between onset and CNEMG examination. The measurement of DRs of motor unit potentials is helpful immediately after a sudden paresis of MRC grade 3 or worse to differentiate between a central and a peripheral lesion. Copyright © 2012 Wiley Periodicals, Inc.

Taser X26 discharges in swine: ventricular rhythm capture is dependent on discharge vector.

PubMed

Valentino, Daniel J; Walter, Robert J; Dennis, Andrew J; Margeta, Bosko; Starr, Frederic; Nagy, Kimberly K; Bokhari, Faran; Wiley, Dorion E; Joseph, Kimberly T; Roberts, Roxanne R

2008-12-01

Data from our previous studies indicate that Taser X26 stun devices can acutely alter cardiac function in swine. We hypothesized that most transcardiac discharge vectors would capture ventricular rhythm, but that other vectors, not traversing the heart, would fail to capture the ventricular rhythm. Using an Institutional Animal Care and Use Committee (IACUC) approved protocol, four Yorkshire pigs (25-36 kg) were anesthetized, paralyzed with succinylcholine (2 mg/kg), and then exposed to 10 second discharges from a police-issue Taser X26. For most discharges, the barbed darts were pushed manually into the skin to their full depth (12 mm) and were arranged in either transcardiac (such that a straight line connecting the darts would cross the region of the heart) or non-transcardiac vectors. A total of 11 different vectors and 22 discharge conditions were studied. For each vector, by simply rotating the cartridge 180-degrees in the gun, the primary current-emitting dart was changed and the direction of current flow during the discharge was reversed without physically moving the darts. Echocardiography and electrocardiograms (ECGs) were performed before, during, and after all discharges. p values < 0.05 were considered significant. ECGs were unreadable during the discharges because of electrical interference, but echocardiography images clearly demonstrated that ventricular rhythm was captured immediately in 52.5% (31 of 59) of the discharges on the ventral surface of the animal. In each of these cases, capture of the ventricular rhythm with rapid ventricular contractions consistent with ventricular tachycardia (VT) or flutter was seen throughout the discharge. A total of 27 discharges were administered with transcardiac vectors and ventricular capture occurred in 23 of these discharges (85.2% capture rate). A total of 32 non-transcardiac discharges were administered ventrally and capture was seen in only eight of these (25% capture rate). Ventricular fibrillation (VF

Risk factors for discharge to an acute care hospital from inpatient rehabilitation among stroke patients.

PubMed

Roberts, Pamela S; DiVita, Margaret A; Riggs, Richard V; Niewczyk, Paulette; Bergquist, Brittany; Granger, Carl V

2014-01-01

To identify medical and functional health risk factors for being discharged directly to an acute-care hospital from an inpatient rehabilitation facility among patients who have had a stroke. Retrospective cohort study. Academic medical center. A total of 783 patients with a primary diagnosis of stroke seen from 2008 to 2012; 60 were discharged directly to an acute-care hospital and 723 were discharged to other settings, including community and other institutional settings. Logistic regression analysis. Direct discharge to an acute care hospital compared with other discharge settings from the inpatient rehabilitation unit. No significant differences in demographic characteristics were found between the 2 groups. The adjusted logistic regression model revealed 2 significant risk factors for being discharged to an acute care hospital: admission motor Functional Independence Measure total score (odds ratio 0.97, 95% confidence interval 0.95-0.99) and enteral feeding at admission (odds ratio 2.87, 95% confidence interval 1.34-6.13). The presence of a Centers for Medicare and Medicaid-tiered comorbidity trended toward significance. Based on this research, we identified specific medical and functional health risk factors in the stroke population that affect the rate of discharge to an acute-care hospital. With active medical and functional management, early identification of these critical components may lead to the prevention of stroke patients from being discharged to an acute-care hospital from the inpatient rehabilitation setting. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Ignition and Flameholding in a Supersonic Combustor by an Electrical Discharge Combined with a Fuel Injector

DTIC Science & Technology

2014-01-01

W.F. O’Brien, J.A. Schetz - Plasma torch atomizer-igniter for supersonic combustion of liquid hydrocarbon fuels // AIAA Paper 2006-7970. 6. H. Do...A. Deminsky, I. V. Kochetov, A. P. Napartovich, S. B. Leonov, - “Modeling of Plasma Assisted Combustion in Premixed Supersonic Gas Flow...1 Ignition and Flameholding in a Supersonic Combustor by an Electrical Discharge Combined with a Fuel Injector K. V. Savelkin 1 , D. A

Self-pulsing in a low-current hollow cathode discharge: From Townsend to glow discharge

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

Qin, Yu; School of Aerospace Engineering, Beijing Institute of Technology, Beijing 100081; Xie, Kan, E-mail: xiekan@bit.edu.cn

We investigate the self-pulsing phenomenon of a low current cavity discharge in a cylindrical hollow cathode in pure argon. The waveforms of pulsed current and voltage are measured, and the time-averaged and time-resolved images of hollow cathode discharge are recorded by using high-speed intensified charge coupled device camera. The results show that the self-pulsing is a mode transition between low-current stage of Townsend discharge and high-current stage of glow discharge. During the self-pulsing, the current rising time relates to the dissipation of space charges, and the decay time relates to the reconstruction of the virtual anode by the accumulation ofmore » positive ions. Whether or not space charges can form and keep the virtual anode is responsible for the discharge mode and hence plays an important role in the self-pulsing phenomenon in low current hollow cathode discharge.« less

Motor unit potential induced repetitive discharges (MIRDs): description of an unusual iterative discharge.

PubMed

So, Noel F; Rubin, Devon I; Jones, Lyell K; Litchy, William J; Sorenson, Eric J

2013-12-01

Repetitive discharges may be recorded during nerve conduction studies (NCS) or during needle electromyography in a muscle at rest. Repetitive discharges that occur during voluntary activation and are time-locked to voluntary motor unit potentials (MUP) have not been described. Retrospective review of motor unit potential induced repetitive discharges (MIRDs) identified in the EMG laboratory. Characteristics of each MIRD, patient demographics, other EMG findings in the same muscle, and electrophysiological diagnosis were analyzed. MIRDs were observed in 15 patients. The morphology and number of spikes and duration of MIRDs varied. The discharges fired at rates of 50-200 Hz. All but 2 patients had EMG findings of a chronic neurogenic disorder. MIRDs are rare iterative discharges time-locked to a voluntary MUP. The pathophysiology of MIRDs is unclear, but their presence may indicate a chronic neurogenic process. Copyright © 2013 Wiley Periodicals, Inc.

Current Trends in Discharge Disposition and Post-discharge Care After Total Joint Arthroplasty.

PubMed

Tarity, T David; Swall, Marion M

2017-09-01

The purpose of this manuscript is to review published literature over the last 5 years to assess recent trends and influencing factors regarding discharge disposition and post-discharge care following total joint arthroplasty. We evaluated instruments proposed to predict a patient's discharge disposition and summarize reports investigating the safety in sending more patients home by reviewing complications and readmission rates. Current literature supports decreased length of hospital stay and increased discharge to home with cost savings and stable readmission rates. Surgeons with defined clinical pathways and those who shape patient expectations may more effectively control costs than those without defined pathways. Further research is needed analyzing best practices in care coordination, managing patient expectations, and cost-effective analysis of home discharge while at the same time ensuring patient outcomes are optimized following total joint arthroplasty.

Time-resolved study of the electron temperature and number density of argon metastable atoms in argon-based dielectric barrier discharges

NASA Astrophysics Data System (ADS)

Desjardins, E.; Laurent, M.; Durocher-Jean, A.; Laroche, G.; Gherardi, N.; Naudé, N.; Stafford, L.

2018-01-01

A combination of optical emission spectroscopy and collisional-radiative modelling is used to determine the time-resolved electron temperature (assuming Maxwellian electron energy distribution function) and number density of Ar 1s states in atmospheric pressure Ar-based dielectric barrier discharges in presence of either NH3 or ethyl lactate. In both cases, T e values were higher early in the discharge cycle (around 0.8 eV), decreased down to about 0.35 eV with the rise of the discharge current, and then remained fairly constant during discharge extinction. The opposite behaviour was observed for Ar 1s states, with cycle-averaged values in the 1017 m-3 range. Based on these findings, a link was established between the discharge ionization kinetics (and thus the electron temperature) and the number density of Ar 1s state.

Same versus next day discharge after elective transradial PCI: The RAdial SAme Day DischArge after PCI trial. (The RASADDA-PCI trial).

PubMed

Rodriguez-Araujo, Gerardo; Cilingiroglu, Mehmet; Mego, David; Hakeem, Abdul; Lendel, Vasili; Cawich, Ian; Paixao, Andre; Marmagkiolis, Konstantinos; Flaherty, Patrick; Rollefson, William

2018-06-02

Transradial percutaneous coronary intervention (TR-PCI) has been increasingly popular over the last decade in the US. Previous studies have shown that same-day (SD) discharge after elective PCI is as safe as overnight (ON) observation. Our study was performed to assess the clinical and financial impact of early discharge in patients undergoing TR-PCI. This is a single center registry of patients undergoing elective TR-PCI. Timing of discharge was determined by the treating physician. (Groups: Same Day Discharge -SD-; Overnight Stay -ON-). Demographic data, procedural characteristics and adverse outcomes were recorded. Outcomes included 30 day-MACE and procedure- related complications, as well as total operative costs in patients from both groups. Propensity score matching for patient demographics, coronary symptoms and procedure indicators was used to compare both groups. The entire cohort included 852 patients (429 in SD group and 423 in ON group) and the propensity score matched groups of 245 patients in the SD group and 245 patients in the ON group. The two groups had no significant baseline clinical differences, and had similar clinical outcomes. Specifically, no significant difference was noted in procedural complications (3.7% vs 2.5%, p = 0.43), re-hospitalization (4.1% vs 4.1%, p = 0.92), re-intervention (2.5% vs 2.1%, p = 0.77), myocardial infarction (0% vs 0.08%, p = 0.15), stroke (0% vs 0%, p = 1.0) and all-cause mortality (0% vs 0%, p = 1.0). SD Group patients had a significant lower procedure-related cost compared to overnight stay patients ($3,346.45 vs $4,681.99, p < 0.0001) and lower 30-day post procedure-associated cumulative costs/total operating costs ($4,493.22 vs $7,112.21, p < 0.0001). In elective patients undergoing low risk TR-PCI, same-day discharge seems to be a safe and feasible clinical practice, with significant potential savings to the US healthcare system. Copyright © 2018 Elsevier Inc. All rights

Laser flash-photolysis and gas discharge in N2O-containing mixture: kinetic mechanism

NASA Astrophysics Data System (ADS)

Kosarev, Ilya; Popov, Nikolay; Starikovskaia, Svetlana; Starikovskiy, Andrey; mipt Team

2011-10-01

The paper is devoted to further experimental and theoretical analysis of ignition by ArF laser flash-photolysis and nanosecond discharge in N2O-containing mixture has been done. Additional experiments have been made to assure that laser emission is distributed uniformly throughout the cross-section. The series of experiments was proposed and carried out to check validity of O(1D) determination in experiments on plasma assisted ignition initiated by flash-photolysis. In these experiments, ozone density in the given mixture (mixture composition and kinetics has been preliminary analyzed) was measured using UV light absorption in Hartley band. Good coincidence between experimental data and results of calculations have been obtained Temporal behavior of energy input, electric field and electric current has been measured and analyzed. These data are considered as initial conditions for numerical modeling of the discharge in O2:N2O:H2:Ar = 0.3:1:3:5 mixture. Ion-molecular reactions and reactions of active species production in Ar:H2:O2:N2O mixture were analyzed. The set of reactions to describe chemical transformation in the system due to the discharge action has been selected.

The military veteran to physician assistant pathway: building the primary care workforce.

PubMed

Brock, Douglas; Bolon, Shannon; Wick, Keren; Harbert, Kenneth; Jacques, Paul; Evans, Timothy; Abdullah, Athena; Gianola, F J

2013-12-01

The physician assistant (PA) profession emerged to utilize the skills of returning Vietnam-era military medics and corpsmen to fortify deficits in the health care workforce. Today, the nation again faces projected health care workforce shortages and a significant armed forces drawdown. The authors describe national efforts to address both issues by facilitating veterans' entrance into civilian PA careers and leveraging their skills.More than 50,000 service personnel with military health care training were discharged between 2006 and 2010. These veterans' health care experience and maturity make them ideal candidates for civilian training as primary care providers. They trained and practiced in teams and functioned under minimal supervision to care for a broad range of patients. Military health care personnel are experienced in emergency medicine, urgent care, primary care, public health, and disaster medicine. However, the PA profession scarcely taps this valuable resource. Fewer than 4% of veterans with health care experience may ever apply for civilian PA training.The Health Resources and Services Administration (HRSA) implements two strategies to help prepare and graduate veterans from PA education programs. First, Primary Care Training and Enhancement (PCTE) grants help develop the primary care workforce. In 2012, HRSA introduced reserved review points for PCTE: Physician Assistant Training in Primary Care applicants with veteran-targeted activities, increasing their likelihood of receiving funding. Second, HRSA leads civilian and military stakeholder workgroups that are identifying recruitment and retention activities and curricula adaptations that maximize veterans' potential as PAs. Both strategies are described, and early outcomes are presented.

[Maternal discharge: conditions and organization for mothers and newborns returning home. The French National Authority for Health recommendations update].

PubMed

Hascoët, J-M; Petitprez, K

2014-09-01

In light of changes in both medical practices and the organization of medical care, the French National Authority for Health (Haute Autorité de santé, HAS) proposed new recommendations on the discharge of mothers and newborns, updating its 2004 recommendations on early discharge of mothers and newborns. This decision in turn made it necessary to define optimal discharge conditions and accompanying measures for mothers and infants returning home. The problem was approached by adopting the usual HAS methodology for drafting good practice recommendations. This involved establishing a working group bringing together representatives of all medical and care fields related to perinatology as well as patient representatives. This working group submitted draft recommendations, based on updated published references, to a committee. The committee then proposed amendments to the recommendations, which the working group was free to accept or reject. The updated recommendations that emerged from this process apply four essential principles : first, preparing for discharge as early as the prenatal period, ideally during the third trimester of pregnancy, in particular by providing expectant mothers with information on how the discharge will be organized and anticipating problems that might arise; second, ensuring care continuity between hospitalization, discharge to home, and follow-up; third, ensuring optimal conditions for discharge after a maternity stay of 72-96 h for normal delivery or 96-120 h in case of caesarean section (this hospital stay duration allows for neonatal screening); and fourth, defining how mothers and children are to be accompanied during the first postnatal month. In conclusion, these recommendations resulted in an increase in the duration of as well as an improvement in routine newborn surveillance, whether in hospital or after discharge, in what is a critical phase of infant development. They encourage ambulatory postnatal monitoring. The new

Adaptation to Early Adulthood by a Sample of Youth Discharged from a Residential Education Placement

ERIC Educational Resources Information Center

Jones, Loring

2008-01-01

Three years of outcome data for foster youth (n = 106) discharged from a one-of-kind residential education service are presented. Findings were that 50% of respondents attended college at some point. Youth reported having 2 or 3 jobs a year with at least one bout of unemployment. Most of the non-college bound youth reported working in low-wage…

Safety of Early Discharge for Low-Risk Patients With Febrile Neutropenia: A Multicenter Randomized Controlled Trial

PubMed Central

Talcott, James A.; Yeap, Beow Y.; Clark, Jack A.; Siegel, Robert D.; Loggers, Elizabeth Trice; Lu, Charles; Godley, Paul A.

2011-01-01

Purpose Febrile neutropenia commonly complicates cancer chemotherapy. Outpatient treatment may reduce costs and improve patient comfort but risk progression of undetected medical problems. Patients and Methods By using our validated algorithm, we identified medically stable inpatients admitted for febrile neutropenia (neutrophils < 500/μL) after chemotherapy and randomly assigned them to continued inpatient antibiotic therapy or early discharge to receive identical antibiotic treatment at home. Our primary outcome was the occurrence of any serious medical complication, defined as evidence of medical instability requiring urgent medical attention. Results We enrolled 117 patients with 121 febrile neutropenia episodes before study termination for poor accrual. We excluded five episodes as ineligible and three because of inadequate documentation of the study outcome. Treatment groups were clinically similar, but sociodemographic imbalances occurred because of block randomization. The median presenting absolute neutrophil count was 100/μL. Hematopoietic growth factors were used in 38% of episodes. The median neutropenia duration was 4 days (range, 1 to 15 days). Five outpatients were readmitted to the hospital. Major medical complications occurred in five episodes (8%) in the hospital arm and four (9%) in the home arm (95% CI for the difference, −10% to 13%; P = .56). No study patient died. Patient-reported quality of life was similar on both arms. Conclusion We found no evidence of adverse medical consequences from home care, despite a protocol designed to detect evidence of clinical deterioration. These results should reassure clinicians who elect to treat rigorously characterized low-risk patients with febrile neutropenia in suitable outpatient settings with appropriate surveillance for unexpected clinical deterioration. PMID:21931024

Exploring SWOT discharge algorithm accuracy on the Sacramento River

NASA Astrophysics Data System (ADS)

Durand, M. T.; Yoon, Y.; Rodriguez, E.; Minear, J. T.; Andreadis, K.; Pavelsky, T. M.; Alsdorf, D. E.; Smith, L. C.; Bales, J. D.

2012-12-01

Scheduled for launch in 2019, the Surface Water and Ocean Topography (SWOT) satellite mission will utilize a Ka-band radar interferometer to measure river heights, widths, and slopes, globally, as well as characterize storage change in lakes and ocean surface dynamics with a spatial resolution ranging from 10 - 70 m, with temporal revisits on the order of a week. A discharge algorithm has been formulated to solve the inverse problem of characterizing river bathymetry and the roughness coefficient from SWOT observations. The algorithm uses a Bayesian Markov Chain estimation approach, treats rivers as sets of interconnected reaches (typically 5 km - 10 km in length), and produces best estimates of river bathymetry, roughness coefficient, and discharge, given SWOT observables. AirSWOT (the airborne version of SWOT) consists of a radar interferometer similar to SWOT, but mounted aboard an aircraft. AirSWOT spatial resolution will range from 1 - 35 m. In early 2013, AirSWOT will perform several flights over the Sacramento River, capturing river height, width, and slope at several different flow conditions. The Sacramento River presents an excellent target given that the river includes some stretches heavily affected by management (diversions, bypasses, etc.). AirSWOT measurements will be used to validate SWOT observation performance, but are also a unique opportunity for testing and demonstrating the capabilities and limitations of the discharge algorithm. This study uses HEC-RAS simulations of the Sacramento River to first, characterize expected discharge algorithm accuracy on the Sacramento River, and second to explore the required AirSWOT measurements needed to perform a successful inverse with the discharge algorithm. We focus on several specific research questions affecting algorithm performance: 1) To what extent do lateral inflows confound algorithm performance? We examine the ~100 km stretch of river from Colusa, CA to the Yolo Bypass, and investigate how the

Principals Discuss Early Implementation of the ASSISTments Online Homework Tutor for Mathematics. ASSISTments Efficacy Study Report 2

ERIC Educational Resources Information Center

Fairman, Janet; Porter, Michael; Fisher, Susannah

2015-01-01

This report presents the findings from interviews with principals about their schools' participation in the ASSISTments efficacy study on seventh-grade mathematics. The purpose of the interviews was to explore the following areas: To what extent schools had policies or expectations regarding homework practice and completion; To what extent schools…

Discharge lamp technologies

NASA Technical Reports Server (NTRS)

Dakin, James

1994-01-01

This talk is an overview of discharge lamp technology commonly employed in general lighting, with emphasis on issues pertinent to lighting for plant growth. Since the audience is primarily from the plant growth community, and this begins the light source part of the program, we will start with a brief description of the discharge lamps. Challenges of economics and of thermal management make lamp efficiency a prime concern in controlled environment agriculture, so we will emphasize science considerations relating to discharge lamp efficiency. We will then look at the spectra and ratings of some representative lighting products, and conclude with a discussion of technological advances.

Factors Related to Breastfeeding Discontinuation Between Hospital Discharge and 2 Weeks Postpartum

PubMed Central

Brand, Elizabeth; Kothari, Catherine; Stark, Mary Ann

2011-01-01

Although breastfeeding is known to be beneficial to both mother and infant, many women encounter barriers to breastfeeding, even after successful breastfeeding initiation, which may put them at greater risk for early cessation of breastfeeding. The objectives of this study were to conduct a secondary analysis of data from a longitudinal study of postpartum depression to (a) examine factors related to very early discontinuation of breastfeeding (at 2 weeks postpartum) following hospital discharge and (b) identify women’s reasons for very early cessation of breastfeeding. The results of this study support findings from previous research. Having a perceived support system, whether it is personal or professional, may have an effect on both the initiation and duration of breastfeeding. Educating expectant and new mothers, especially women who encounter multiple barriers and are at risk for very early cessation of breastfeeding, of the benefits of breastfeeding and supporting them in developing efficient techniques and problem-solving skills can help increase the duration of breastfeeding. PMID:22211058

Discharge cell for optogalvanic spectroscopy having orthogonal relationship between the probe laser and discharge axis

NASA Technical Reports Server (NTRS)

Webster, C. R. (Inventor)

1986-01-01

A method and apparatus for an optogalvanic spectroscopy system are disclosed. Orthogonal geometry exists between the axis of a laser probe beam and the axis of a discharge created by a pair of spaced apart and longituduinally aligned high voltage electrodes. The electrodes are movable to permit adjustment of the location of a point in the discharge which is to irradiated by a laser beam crossing the discharge region. The cell dimensions are selected so that the cross section of the discharge region is substantly comparable in size to the cross section of the laser beam passing orthogonally through the discharge region.

Surfactant-assisted synthesis and electrochemical performances of Cu{sub 3}P dendrites

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

Liu, Shuling, E-mail: liusl8888@yahoo.com.cn; Li, Shu; Wang, Jingping

2012-11-15

Highlights: ► Dendrite-like Cu{sub 3}P microstructures have been synthesized by a low-temperature method. ► The surfactant SDS was used as template. ► The as-obtained Cu{sub 3}P dendrites exhibit a high first discharge capacity. -- Abstract: Well-defined Cu{sub 3}P hierarchical dendrites were successfully synthesized by a facile and effective surfactant-assisted hydrothermal approach. X-ray powder diffraction (XRD) and scanning electron microscopy (SEM) indicated that the as-obtained Cu{sub 3}P had a well-crystallized hexagonal phase and consisted of a wealth of Cu{sub 3}P dendritic microstructures. A surfactant-assisted growth accompanied by the Ostwald ripening process was proposed for the formation. As anode materials for lithiummore » ion batteries, the electrochemical property of the Cu{sub 3}P dendrites was also examined. The results showed that the initial discharge capacity of the Cu{sub 3}P dendrites exceeded 1300 mA h/g and it still kept at 291 mA h/g after 20 cycles, which might be related to the size of Cu{sub 3}P particles and their assembly structure.« less

Deep vein thrombosis - discharge

MedlinePlus

... Post-phlebitic syndrome - discharge; Post-thrombotic syndrome - discharge Images Pressure stockings References Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST ...

A randomized comparison of home visits and hospital-based group follow-up visits after early postpartum discharge.

PubMed

Escobar, G J; Braveman, P A; Ackerson, L; Odouli, R; Coleman-Phox, K; Capra, A M; Wong, C; Lieu, T A

2001-09-01

Short postpartum stays are common. Current guidelines provide scant guidance on how routine follow-up of newly discharged mother-infant pairs should be performed. We aimed to compare 2 short-term (within 72 hours of discharge) follow-up strategies for low-risk mother-infant pairs with postpartum length of stay (LOS) of <48 hours: home visits by a nurse and hospital-based follow-up anchored in group visits. We used a randomized clinical trial design with intention-to-treat analysis in an integrated managed care setting that serves a largely middle class population. Mother-infant pairs that met LOS and risk criteria were randomized to the control arm (hospital-based follow-up) or to the intervention arm (home nurse visit). Clinical utilization and costs were studied using computerized databases and chart review. Breastfeeding continuation, maternal depressive symptoms, and maternal satisfaction were assessed by means of telephone interviews at 2 weeks postpartum. During a 17-month period in 1998 to 1999, we enrolled and randomized 1014 mother-infant pairs (506 to the control group and 508 to the intervention group). There were no significant differences between the study groups with respect to maternal age, race, education, household income, parity, previous breastfeeding experience, early initiation of prenatal care, or postpartum LOS. There were no differences with respect to neonatal LOS or Apgar scores. In the control group, 264 mother-infant pairs had an individual visit only, 157 had a group visit only, 64 had both a group and an individual visit, 4 had a home health and a hospital-based follow-up, 13 had no follow-up within 72 hours, and 4 were lost to follow-up. With respect to outcomes within 2 weeks after discharge, there were no significant differences in newborn or maternal hospitalizations or urgent care visits, breastfeeding discontinuation, maternal depressive symptoms, or a combined clinical outcome measure indicating whether a mother-infant pair had

A quality improvement project to improve the rate of early breast milk expression in mothers of preterm infants.

PubMed

Murphy, Lindsey; Warner, Diane D; Parks, Jessica; Whitt, Jenny; Peter-Wohl, Sigal

2014-11-01

Providing breast milk is challenging for non-nursing mothers of premature infants. Early breast milk expression results in successful and longer lactation in mothers of very low birth weight (VLBW) infants. This quality improvement initiative sought to increase the rate of early milk expression in mothers of VLBW infants and increase the proportion of infants receiving maternal breast milk (MBM) at 28 days of age and at discharge. Phase 1 (n = 45) occurred between April 1, 2012, and August 31, 2012. Phase 2 (n = 58) occurred between September 1, 2012, and February 28, 2013. Pre-phase 2 actions included increased lactation consultant workforce, early lactation consultation, tracking of MBM supply, and physician education. Inborn infants < 1500 grams were eligible. Primary outcomes were the time of first maternal milk expression (TFME) and infant feeding type at 28 days of age and at discharge. The median TFME decreased from 9 (25th, 75th percentile; 6, 16) hours to 6 (5, 11) hours after implementation (P = .06). The proportion of infants receiving exclusive MBM at 28 days and at discharge was 64% and 74%, respectively (P = .40), and the proportion of infants receiving exclusive MBM at discharge increased from 37% to 59% (P = .046). In conclusion, a multidisciplinary initiative aimed at improving the rate of early milk expression was associated with more VLBW infants receiving exclusive MBM at discharge. © The Author(s) 2014.

Two-Dimensional Electron Density Measurement of Positive Streamer Discharge in Atmospheric-Pressure Air

NASA Astrophysics Data System (ADS)

Inada, Yuki; Ono, Ryo; Kumada, Akiko; Hidaka, Kunihiko; Maeyama, Mitsuaki

2016-09-01

The electron density of streamer discharges propagating in atmospheric-pressure air is crucially important for systematic understanding of the production mechanisms of reactive species utilized in wide ranging applications such as medical treatment, plasma-assisted ignition and combustion, ozone production and environmental pollutant processing. However, electron density measurement during the propagation of the atmospheric-pressure streamers is extremely difficult by using the conventional localized type measurement systems due to the streamer initiation jitters and the irreproducibility in the discharge paths. In order to overcome the difficulties, single-shot two-dimensional electron density measurement was conducted by using a Shack-Hartmann type laser wavefront sensor. The Shack-Hartmann sensor with a temporal resolution of 2 ns was applied to pulsed positive streamer discharges generated in an air gap between pin-to-plate electrodes. The electron density a few ns after the streamer initiation was 7*1021m-3 and uniformly distributed along the streamer channel. The electron density and its distribution profile were compared with a previous study simulating similar streamers, demonstrating good agreement. This work was supported in part by JKA and its promotion funds from KEIRIN RACE. The authors like to thank Mr. Kazuaki Ogura and Mr. Kaiho Aono of The University of Tokyo for their support during this work.

Bloody otorrhea after robotically assisted laparoscopic prostatectomy.

PubMed

Cohen, Andrew; Ledezma-Rojas, Rodrigo; Mhoon, Ernest; Zagaja, Gregory

2015-06-01

Bilateral bloody otorrhea is a rare complication of surgery and to our knowledge a previously unpublished event. We review the case of a 50-year-old male who underwent robotic-assisted laparoscopic radical prostatectomy (RALP) with bilateral lymphadenectomy for Gleason's Score 4 + 4 = 8 prostate cancer. Bloody discharge from bilateral auditory canals was noted upon removal of the surgical drapes. Otolaryngologic examination revealed bilateral anterior auditory canal hematomas without any loss of hearing. Steep Trendelenburg position in combination with perioperative anticoagulants may have contributed to this complication. Given the rarity of this event no specific risk factors are identified.

One-Dimensional Porous Silicon Nanowires with Large Surface Area for Fast Charge⁻Discharge Lithium-Ion Batteries.

PubMed

Chen, Xu; Bi, Qinsong; Sajjad, Muhammad; Wang, Xu; Ren, Yang; Zhou, Xiaowei; Xu, Wen; Liu, Zhu

2018-04-27

In this study, one-dimensional porous silicon nanowire (1D⁻PSiNW) arrays were fabricated by one-step metal-assisted chemical etching (MACE) to etch phosphorus-doped silicon wafers. The as-prepared mesoporous 1D⁻PSiNW arrays here had especially high specific surface areas of 323.47 m²·g -1 and were applied as anodes to achieve fast charge⁻discharge performance for lithium ion batteries (LIBs). The 1D⁻PSiNWs anodes with feature size of ~7 nm exhibited reversible specific capacity of 2061.1 mAh·g -1 after 1000 cycles at a high current density of 1.5 A·g -1 . Moreover, under the ultrafast charge⁻discharge current rate of 16.0 A·g -1 , the 1D⁻PSiNWs anodes still maintained 586.7 mAh·g -1 capacity even after 5000 cycles. This nanoporous 1D⁻PSiNW with high surface area is a potential anode candidate for the ultrafast charge⁻discharge in LIBs with high specific capacity and superior cycling performance.

The use and application of assistive technology to promote literacy in early childhood: a systematic review.

PubMed

Burne, Brian; Knafelc, Valerie; Melonis, Maureen; Heyn, Patricia C

2011-01-01

The Individuals with Disabilities Act was implemented in 1975 to assure that all children aged 0-21 years old have access and the right to an equal education. However, young children with disabilities continue to need additional support to meet the reading readiness standards as outlined in The No Child Left Behind legislation (2004). Although all children benefit from readiness skills, it is essential for children with special needs. With the technology boom of the past decade, assistive technology (AT) has been used increasingly to enhance emerging literacy skills. In order to identify current trends in the use of AT as a means to enhance emergent literacy skills in young children with disabilities, a systematic review of the literature was undertaken. The findings from this review support the scarcity of empirical research demonstrating the benefit of AT to promote emergent literacy with young children with disabilities. We also found a need for evidence supporting education approaches for the proper use of AT in early childhood literacy as well as little family knowledge regarding the implementation and instructional use of AT.

13.000 years of multicentennial variability in Nile discharge: The link between solar activity, Indian monsoon, and Sapropel S1 formation

NASA Astrophysics Data System (ADS)

Hennekam, Rick; Jilbert, Tom; Schnetger, Bernhard; De Lange, Gert J.

2014-05-01

Sediments in the southeast Mediterranean are characterized by high accumulation rates, being influenced by suspended matter from the Nile plume. Therefore, the sediments from this area offer an invaluable high-resolution climate archive. Earlier work has shown that Nile River outflow has influenced water chemistry in this region throughout the entire Holocene, being well recorded in the oxygen isotopic ratio of the planktic foraminifer Globigerinoides ruber (δ18Oruber). The deposition of organic-rich layers (sapropels) during precession minima is often linked to Nile discharge. Here we present a multi-proxy study of a well-dated sediment core from the southeast Mediterranean basin to study in high-resolution the variability in Nile discharge during the early- to mid-Holocene. High sedimentation rates and sample resolution allow for recognition of (multi-)centennial variability in Nile discharge as recorded by δ18Oruber. Moreover, we measured bulk sediment Ba/Al (representing export-productivity), V/Al (representing redox conditions), and total organic carbon (Corg) during deposition of sapropel S1 (~6-10 kyr BP). Nile discharge is influenced by moisture transport from both the Atlantic and Indian Oceans, being presently dominated by Atlantic moisture. We show that Nile discharge during the early- to mid-Holocene was dominated by Indian Ocean moisture transport. This is supported by the maximum in Nile discharge at ~9.5 cal. kyr BP, similar to the maximum intensity of Indian Ocean-influenced southwest Indian summer monsoon. Moreover, the strong solar activity signal observed in multi-centennial oscillations in Nile discharge during this time interval concords with those recorded in contemporaneous Indian Ocean-derived monsoon records, but not with those from the Atlantic Ocean. Solar-induced variability in Nile discharge also influenced the conditions relating to Sapropel S1 formation. During its deposition, similar multi-centennial variability is found in bulk