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

Feasibility of a Clinical Pathway with Early Oral Intake and Discharge for Laparoscopic Gastrectomy.

PubMed

Nakagawa, M; Tomii, C; Inokuchi, M; Otsuki, S; Kojima, K

2017-12-01

Although some studies have reported the safety of early oral intake after gastrectomy, it still remains controversial. This study focused on the feasibility of a clinical pathway with early oral intake and discharge setting for exclusively laparoscopic distal gastrectomy. A clinical pathway was applied to 403 patients until December 2014. In the protocol, patients are allowed to take a sip of water and a soft diet on the first and second days after the operation, respectively, and the discharge day is set as the fifth to seventh day after the operation. Clinicopathological variables were prospectively collected, and risk factors for discharge variances were analyzed. The completion rate of the clinical pathway was 76.9%. There were five re-admissions (1.2%). The overall morbidity rate was 18% ( n = 72), and major complications (Clavien-Dindo IIIa or greater) occurred in 13 patients (3%). Complications were the causes for discharge variances in 68 cases (73%), while the attending surgeons' judgment was the cause in 25 cases (27%). On multivariate analysis, age (odds ratio = 2.23, 95% confidence interval = 1.38-3.60, p = 0.001) and operative time (odds ratio = 2.38, 95% confidence interval = 1.45-3.98, p = 0.001) were independent risk factors for discharge variances. A high completion rate of a clinical pathway with early oral intake and discharge setting for laparoscopic distal gastrectomy was achievable with an acceptably low re-admission rate. Laparoscopic distal gastrectomy is recommended as a first step for a clinical pathway with an early oral intake and discharge protocol.

Early discharge with tube feeding at home for preterm infants is associated with longer duration of breast feeding.

PubMed

Meerlo-Habing, Z E; Kosters-Boes, E A; Klip, H; Brand, P L P

2009-07-01

Mothers of preterm infants are more likely to discontinue breast feeding early than mothers of term infants. We evaluated the effect of early discharge with tube feeding of preterm infants under close supervision by paediatric nurse specialists on the duration of breast feeding. Case-control study. Medium/high-care neonatal unit of a large district general hospital. Preterm infants (<37 weeks' gestational age). Early discharge with tube feeding under close supervision by paediatric nurse specialists or regular follow-up of preterm infants discharged with oral feeding. Duration of breast feeding assessed by telephone interview 6 months after birth. There were 50 preterm infants in the early discharge group and 78 in the control group. Mothers in the early discharge group continued to breast feed longer than mothers in the control group (log rank test, p = 0.028). Four months after discharge, 63% of preterm infants in the control group were fed formula compared to 36% in the early discharge group (95% CI for difference 9% to 43%, p = 0.04). The relative risk of breast feeding cessation 6 months after birth in the early discharge group compared to the control group was 0.63 (95% CI 0.41 to 0.96). After adjustment for smoking, gestational age and birth weight, this relative risk was 0.67 (95% CI 0.43 to 1.05). Close supervision and follow-up by paediatric nurse specialists of preterm infants discharged early with tube feeding appears to increase duration of breast feeding. A randomised controlled trial to confirm these findings is warranted.

Early weaning from incubator and early discharge of preterm infants: randomized clinical trial.

PubMed

Zecca, Enrico; Corsello, Mirta; Priolo, Francesca; Tiberi, Eloisa; Barone, Giovanni; Romagnoli, Costantino

2010-09-01

The goal was to assess the feasibility of earlier weaning from the incubator for preterm infants. This was a prospective, randomized study with preterm infants with birth weights of <1600 g who were admitted to a neonatal subintensive ward. Findings for 47 infants who were transferred from an incubator to an open crib at >1600 g (early transition group) were compared with those for 47 infants who were transferred from an incubator to an open crib at >1800 g (standard transition [ST] group). The primary outcome of the study was length of stay. Secondary outcomes were the number of infants returned to an incubator, the growth velocity in an open crib and during the first week at home, the proportions of breastfeeding at discharge and during the first week at home, and the hospital readmission rate. The length of stay was significantly shorter in the early transition group than in the standard transition group (23.5 vs 33 days; P=.0002). No infants required transfer back to the incubator. Only 1 infant in the standard transition group was readmitted to the hospital during the first week after discharge. Growth velocities and individual amounts of breastfeeding were similar between the 2 groups. In this study, weaning of moderately preterm infants from incubators to open cribs at 1600 g was safe and resulted in earlier discharge.

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 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.

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.

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 Efficacy of Telemedicine-Supported Discharge Within an In Home Model of Care.

PubMed

Greenup, Edwin P; McCusker, Melissa; Potts, Boyd A; Bryett, Andrew

2017-09-01

To determine if mobile videoconferencing technology can facilitate the discharge of low-acuity patients receiving in-home care without compromising short-term health outcomes. A 6-month trial commenced in July 2015 with 345 patients considered unsuited to Criteria Led Discharge (CLD) receiving in-home care included as participants. Nurses providing clinical support to patients in their homes were supplied with a tablet computer (Apple iPad) with Internet connectivity (Telstra 4G Network) and videoconferencing software (Cisco Jabber for Telepresence). Device usage data combined with hospital admission records were collected to determine (a) instances where a telemedicine-facilitated discharge occurred and (b) if the accepted measure of short-term health outcomes (readmission within 28 days) was adversely affected by this alternative method. Telemedicine technology facilitated the discharge of 10.1% (n = 35) of patients considered unsuitable for CLD from the Hospital in the Home model during the trial period. Statistically insignificant differences in rates of readmission between patients discharged in person versus those participating in the telemedicine-supported model suggest that the clinical standards of the service have been maintained. The results of evaluating telemedicine support for nurses providing low-acuity in-home care indicate that patients may be discharged remotely while maintaining the existing clinical standards of the service.

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

Discrepancies Between the Supports Needed for Discharge of Patients With Terminal Cancer to Family Caregivers and What Supports Were Actually Provided in Japan: Assessment of Palliative Care Unit Nurses.

PubMed

Oosono, Yasufumi; Yokoyama, Kazuhito; Itoh, Hiroaki; Enomoto, Miyuki; Ishiwata, Miki

2018-04-01

Even if patients with terminal cancer hope to spend the rest of their lives at home, they are often unable to leave the hospital early due to their family caregivers' anxiety. This study aimed to investigate in Japan the discrepancies between the supports needed by and actually provided by palliative care unit nurses (PCUNs) to the family caregivers for discharge of patients with terminal cancer. In this cross-sectional study, self-administered questionnaires including 6-point Likert-type scales assessing the reasons for difficulties in transition to home-based care were distributed to 1227 PCUNs. Using paired t tests, the differences between the scores on perceived importance and actual supports to family caregivers were examined. The supports actually provided were classified by factor analysis. The relationships between the PCUNs' characteristics and mean scores on the supports in each category were examined using multiple regression analysis. A total of 1023 (83.4%) completed questionnaires were returned. Scores on the actually provided supports for discharge to family caregivers were consistently and significantly lower than the corresponding scores on perceived importance for all 57 items ( P < .001). Factor analysis revealed that the supports actually provided to the family caregivers had a 4-factor structure. Multiple regression analyses revealed that gaining experience in palliative care, receiving necessary training, cooperating with palliative care staff, and cooperating with local service providers were significantly associated with higher levels of actual supply of supports to family caregivers. Our findings suggest that PCUNs need to be encouraged to provide further support to family caregivers for the discharge of patients with terminal cancer.

Craniosynostosis repair - discharge

MedlinePlus

... a child's skull to grow together (fuse) too early. ... Craniectomy - child - discharge; Synostectomy - discharge; Strip craniectomy - discharge; Endoscopy-assisted craniectomy - discharge; Sagittal craniectomy - discharge; Frontal-orbital advancement - discharge; FOA - discharge

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.

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.

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

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.

Cross-sectional survey of patients' need for information and support with medicines after discharge from hospital.

PubMed

Mackridge, Adam J; Rodgers, Ruth; Lee, Dan; Morecroft, Charles W; Krska, Janet

2017-11-20

Most patients experience changes to prescribed medicines during a hospital stay. Ensuring they understand such changes is important for preventing adverse events post-discharge and optimising patient understanding. However, little work has explored the information that patients receive about medicines or their perceived needs for information and support after discharge. To determine information that hospital inpatients who experience medicine changes receive about their medicines during admission and their needs and preferences for, and use of, post-discharge support. Cross-sectional survey with adult medical inpatients experiencing medicine changes in six English hospitals, with telephone follow-up 2-3 weeks post-discharge. A total of 444 inpatients completed surveys, and 99 of these were followed up post-discharge. Of the 444, 44 (10%) were unaware of changes to medicines and 65 (16%) did not recall discussing them with a health professional, but 305 (77%) reported understanding the changes. Type of information provided and patients' perceived need for post-discharge support differed between hospitals. Information about changes was most frequently provided by consultant medical staff (157; 39%) with pharmacists providing information least often (71; 17%). One third of patients surveyed considered community pharmacists as potential sources of information about medicines and associated support post-discharge. Post-discharge, just 5% had spoken to a pharmacist, although 35% reported medicine-related problems. In north-west England, patient inclusion in treatment decisions could be improved, but provision of information prior to discharge is reasonable. There is scope to develop hospital and community pharmacists' role in medicine optimisation to maximise safety and effectiveness of care. © 2017 Royal Pharmaceutical Society.

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.

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

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.

Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients.

PubMed

Hegerová, Petra; Dědková, Zuzana; Sobotka, Luboš

2015-01-01

An acute disease is regularly associated with inflammation, decreased food intake, and low physical activity; the consequence is loss of muscle mass. However, the restoration of muscle tissue is problematic, especially in older patients. Loss of muscle mass leads to further decrease of physical activity which leads, together with recurring disease, to the progressive muscle mass loss accompanied by loss of self-sufficiency. Early nutrition support and physical activity could reverse this situation. Therefore, the aim of this study was to determine whether an active approach based on early nutritional therapy and exercise would influence the development of sarcopenia and impaired self-sufficiency during acute illness. Two hundred patients >78 y were admitted to a hospital internal medicine department and participated in a prospective, randomized controlled study. The patients were randomized to a control group receiving standard treatment (n = 100) or to an intervention group (n = 100). The intervention consisted of nutritional supplements (600 kcal, 20 g/d protein) added to a standard diet and a simultaneous intensive rehabilitation program. The tolerance of supplements and their influence on spontaneous food intake, self-sufficiency, muscle strength, and body composition were evaluated during the study period. The patients were then regularly monitored for 1 y post-discharge. The provision of nutritional supplements together with early rehabilitation led to increased total energy and protein intake while the intake of standard hospital food was not reduced. The loss of lean body mass and a decrease in self-sufficiency were apparent at discharge from the hospital and 3 mo thereafter in the control group. Nutritional supplementation and the rehabilitation program in the study group prevented these alterations. A positive effect of nutritional intervention and exercise during the hospital stay was apparent at 6 mo post-discharge. The early nutritional intervention

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

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

PubMed

Bowles, Kathryn H; Hanlon, Alexandra; Holland, Diane; Potashnik, Sheryl L; Topaz, Maxim

2014-01-01

Hospital clinicians are overwhelmed with the volume of patients churning through the health care systems. The study purpose was to determine whether alerting case managers about high-risk patients by supplying decision support results in better discharge plans as evidenced by time to first hospital readmission. Four medical units at one urban, university medical center. A quasi-experimental study including a usual care and experimental phase with hospitalized English-speaking patients aged 55 years and older. The intervention included using an evidence-based screening tool, the Discharge Decision Support System (D2S2), that supports clinicians' discharge referral decision making by identifying high-risk patients upon admission who need a referral for post-acute care. The usual care phase included collection of the D2S2 information, but not sharing the information with case managers. The experimental phase included data collection and then sharing the results with the case managers. The study compared time to readmission between index discharge date and 30 and 60 days in patients in both groups (usual care vs. experimental). After sharing the D2S2 results, the percentage of referral or high-risk patients readmitted by 30 and 60 days decreased by 6% and 9%, respectively, representing a 26% relative reduction in readmissions for both periods. Supplying decision support to identify high-risk patients recommended for postacute referral is associated with better discharge plans as evidenced by an increase in time to first hospital readmission. The tool supplies standardized information upon admission allowing more time to work with high-risk admissions.

32 CFR 724.304 - Responsibility for Department of the Navy support of the Naval Discharge Review Board.

Code of Federal Regulations, 2011 CFR

2011-07-01

... support of the Naval Discharge Review Board. 724.304 Section 724.304 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NAVAL DISCHARGE REVIEW BOARD Director, Secretary of the Navy Council of Review Boards and President Naval Discharge Review Board; Responsibilities in...

32 CFR 724.304 - Responsibility for Department of the Navy support of the Naval Discharge Review Board.

Code of Federal Regulations, 2010 CFR

2010-07-01

... support of the Naval Discharge Review Board. 724.304 Section 724.304 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NAVAL DISCHARGE REVIEW BOARD Director, Secretary of the Navy Council of Review Boards and President Naval Discharge Review Board; Responsibilities in...

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…

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.

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.

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.

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.

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.

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

Quality Support Infrastructure in Early Childhood: Still (Mostly) Missing

ERIC Educational Resources Information Center

Azzi-Lessing, Lenette

2009-01-01

Support for early care and education among policy makers and the public is at an unprecedented high. As investments in early care and education programs in the United States continue to rise, the issue of quality becomes increasingly critical. This article addresses the need for adequate infrastructure to support high-quality early care and…

[The Role of Certified Nurse in Palliative Care to Promote the Discharge Support and Regional Cooperation for Cancer Patients].

PubMed

Matsumoto, Mina; Abe, Yasushi; Tanaka, Yukie; Ino, Akiko; Yamazaki, Yoshie

2015-12-01

The objective of this study is to understand the issues and solutions considered by certified nurses(CN)in palliative care (hereinafter referred to as"palliative care CN)regarding discharge support and regional cooperation for cancer patients, and to discover the roles and responsibilities of palliative care CN. Data obtained from training sessions for 22 palliative care CNs was reconfigured and analyzed. As a result, problems related to discharge support and regional cooperation for cancer patients were classified into 13 categories and 3 core categories. The following roles for palliative care CN were proposed to promote discharge support and regional cooperation for cancer patients: (1) Inter-professional sharing of knowledge about patients and their families to reconcile the intentions of the patient and family members with predictions of progression of the illness; (2) Enable hospital nurses to obtain information about patients after discharge in order to establish a clear image for medical treatment; and(3) Support for ward nurses regarding cooperation to alleviate symptoms and offer medical care to patients who are highly dependent on medical care, and to become a point of contact for cooperation with visiting nurses.

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.

Mining for liquid gold: midwifery language and practices associated with early breastfeeding support.

PubMed

Burns, Elaine; Fenwick, Jenny; Sheehan, Athena; Schmied, Virginia

2013-01-01

Internationally, women give mixed reports regarding professional support during the early establishment of breastfeeding. Little is known about the components of midwifery language and the support practices, which assist or interfere with the early establishment of breastfeeding. In this study, critical discourse analysis has been used to describe the language and practices used by midwives when supporting breastfeeding women during the first week after birth. Participant observation at two geographically distant Australian health care settings facilitated the collection of 85 observed audio-recorded dyadic interactions between breastfeeding women and midwives during 2008-2009. Additionally, 23 interviews with women post discharge, 11 interviews with midwives and four focus groups (40 midwives) have also been analysed. Analysis revealed three discourses shaping the beliefs and practices of participating midwives. In the dominant discourse, labelled 'Mining for Liquid Gold', midwives held great reverence for breast milk as 'liquid gold' and prioritised breastfeeding as the mechanism for transfer of this superior nutrition. In the second discourse, labelled 'Not Rocket Science', midwives constructed breastfeeding as 'natural' or 'easy' and something which all women could do if sufficiently committed. The least well-represented discourse constructed breastfeeding as a relationship between mother and infant. In this minority discourse, women were considered to be knowledgeable about their needs and those of their infant. The language and practices of midwives in this approach facilitated communication and built confidence. These study findings suggest the need for models of midwifery care, which facilitate relationship building between mother and infant and mother and midwife. © 2012 Blackwell Publishing Ltd.

Home Discharge and Out-of-Hospital Follow-Up of Total Artificial Heart Patients Supported by a Portable Driver System

PubMed Central

2014-01-01

To enhance ambulation and facilitate hospital discharge of total artificial heart (TAH)–supported patients, we adapted a mobile ventricular assistance device (VAD) driver (Excor) for TAH use and report on the performance of Excor-driven TAH patients discharged home. Ten patients stabilized on a TAH, driven by the CSS (“Circulatory Support System”), were progressively switched over to the Excor in hospital over 14 days as a pilot, with daily hemodynamics and laboratory parameters measured. Twenty-two stable TAH patients were subsequently placed on the Excor, trained, and discharged home. Clinical and hemodynamic parameters were followed. All pilot study patients were clinically stable on the Excor, with no decrease in TAH output noted (6.3 + 0.3 L/min [day 1] vs. 5.8 + 0.2 L/min [day 14], p = 0.174), with a trend suggesting improvement of both hepatic and renal function. Twenty-two TAH patients were subsequently successfully discharged home on the portable driver and were supported out of hospital for up to 598 days (range, 2–598; mean = 179 ± 140 days), remaining ambulatory, New York Heart Association (NYHA) class I or II, and free of readmission for 88.5% of the time of support. TAH patients may be effectively and safely supported by a mobile drive system. As such, the utility of the TAH may be extended to support patients beyond the hospital, at home, with overall ambulatory freedom. PMID:24577369

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- 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.

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

Precedents of perceived social support: personality and early life experiences.

PubMed

Kitamura, T; Kijima, N; Watanabe, K; Takezaki, Y; Tanaka, E

1999-12-01

In order to examine the effects of personality and early life experiences on perceived social support, a total of 97 young Japanese women were investigated. Current interpersonal relationships were measured by an interview modified from Henderson et al.'s Interview Schedule for Social Interaction (ISSI). Personality was measured by Cloninger et al.'s Temperament and Character Inventory. Early life experiences at home and outside of home were also identified in the interview. The number of sources of perceived support was correlated with self-directness, while satisfaction with perceived support was correlated with novelty seeking and with low harm avoidance. No early life experiences--early loss of a parent, perceived parenting, childhood abuse experiences, experiences of being bullied and/or other life events--showed significant correlations with the number or satisfaction of supportive people. The quantity and quality of perception of social support differ in their link to personality, and perceived social support may, to some extent, be explainable in terms of personality.

Elderly patients discharged from an accident and emergency department--their dependency and support.

PubMed Central

Currie, C T; Lawson, P M; Robertson, C E; Jones, A

1984-01-01

One hundred elderly patients who had attended an accident and emergency department and had been discharged were visited at home shortly afterwards. Compared to their previous level of function, 52 showed a minor or major increase in dependency, usually related to trauma. Scrutiny of accident and emergency records showed only scanty documentation of dependency, function and support arrangements. Available statutory services for dependent elderly in the community were under-utilized by these patients. In 39 of the 52 cases with increased dependency relatives had provided additional support. PMID:6100354

[Impact of attachment style, social support and the number of implantable cardioverter defibrillator (ICD) discharges on psychological strain of ICD patients].

PubMed

Simson, Udo; Perings, Christian; Plaskuda, Ariane; Schäfer, Ralf; Brehm, Michael; Bader, Doris; Tress, Wolfgang; Franz, Matthias

2006-12-01

OBJECTIVE It is well known fact, that the life of ICD patients is often affected by anxiety and depression. The number of ICD discharges is only a contributing factor explaining the variance of anxiety and depression. There have to be other factors that have more influence on the physical strain of ICD patients. In this study we examined the impact of attachment style and social support in addition to the number of ICD discharges. METHODS 119 out-patients at an out-patient ICD unit were examined consecutively with the following self report scales: (1) the State-Trait-Anxiety Inventory (STAI), (2) the Beck Depression Inventory (BDI), (3) a short form of a social support questionnaire (F-SOZU), (4) the Bielefeld Partnership Expectations Questionnaire (BFPE) and (5) a specifically designed questionnaire for the assessment of sociodemografic data. To determine the frequency and timing of the ICD discharges we analysed the ICD data. RESULTS 38 % of the ICD patients reported enhanced anxiety levels and 37 % reported enhanced depression levels. Only 38 % of the ICD patients received discharges at all. Elevated levels of anxiety and depression were found in patients who showed insecure attachment styles, low social support, long-term treatment in hospital and a higher number of ICD discharges. To explain the variance of anxiety we found social support, attachment style, and the number of ICD storms to be contributing factors. To explain the variance of depression we found social support and time spent in hospital in the previous year to be contributing factors. CONCLUSIONS Almost half of the ICD patients suffer considerably from anxiety and/or depression. These patients have to be identified and treated psychotherapeutically. Patients who show insecure attachment styles, receive low social support, undergo long-term treatment in hospital and receive a higher number of discharges, especially so called ICD storms, bear the highest risk to develop psychological strain

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

PubMed

Hidaka, Kumi; Matsuoka, Mio; Kajiwara, Kanako; Hinokiyama, Hiromi; Mito, Saori; Doi, Seiko; Konishi, Eriko; Ibata, Takeshi; Komuro, Ryutaro; lijima, Shohei

2013-12-01

Our nutrition support team (NST) designed the NST summary for cooperation among personnel providing medical care for nutritional management of high-need patients in our area. After the introduction of the NST fee under the health care system, the number of summary publications decreased. The requested NST fee is necessary for publication of a nutritional care plan and report upon patient discharge. We hypothesized that the nutritional care plan and discharge report were being substituted for the NST summary at the time of patient discharge. We retrospectively investigated 192 cases with NST fee. There were only 13 cases of overlapping publication, and the NST summary was necessary for 107 of 179 cases in which no NST summary had been prepared. Since the space on the report form is limited, it can provide only limited information. However, the NST summary can convey detailed supplementary information. Therefore, there is a high need for the NST summary, and publication of NST summaries for the appropriate cases must continue.

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

[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.

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.

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.

Application of Early Nutrition Support in Neurosurgical Coma Patients.

PubMed

Ren, Guoqin

2015-12-01

The present study was conducted to investigate the clinical efficacy of early parenteral and enteral nutrition (PN + EN) support in neurosurgical coma patients. Eighty cases of neurosurgical coma patients were randomly divided into intervention group and control group. The intervention group received early PN + EN support, and the control group received only total enteral nutritional (TEN) support. The levels of hemoglobin (HGB), serum albumin (ALB), prealbumin (PA), and retinol-binding protein (RBP) in two groups on days 1, 10, and 20 were observed. The incidences of pneumonia, stress ulcer, abnormal liver function, abdominal distension, and diarrhea between two groups were also compared. Results found that, on day 10, compared with the control group, the levels of HGB, PA, and RBP in the intervention group were significantly increased (P < 0.05). On day 20, ALB in the intervention group significantly increased (P < 0.05), and the incidences of pneumonia, abdominal distension, and diarrhea in the intervention group were significantly lower than those in the control group (P < 0.05). Compared with only TEN support, early PN + EN support can obviously improve the nutritional status of neurosurgical coma patients and reduce the occurrence of complications.

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.

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.

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.

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

Fast Facts about Early Support for Infants and Toddlers (ESIT)

ERIC Educational Resources Information Center

Washington State Department of Early Learning, 2017

2017-01-01

This brief report provides facts about Early Support for Infants and Toddlers (ESIT) on the following topics: (1) What is the purpose of the IDEA Part C early intervention?; (2) Early intervention service delivery in Washington, July 1, 2015 through June 30, 2016; (3) Primary early intervention services; (4) What are the expected child outcomes?;…

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.

Early Intervention in Portugal: Family Support and Benefits

ERIC Educational Resources Information Center

Correia Leite, Carina Sofia; Da Silva Pereira, Ana Paula

2013-01-01

This study investigated the support and benefits of early intervention (EI) in families with children with special needs. Data were gathered through a written questionnaire, "Family Benefits Inventory," completed by 126 families with children with special needs supported by EI teams, with ages from six months to six years in Portugal.…

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

HIGH ENERGY GASEOUS DISCHARGE DEVICES

DOEpatents

Josephson, V.

1960-02-16

The high-energy electrical discharge device described comprises an envelope, a pair of main discharge electrodes supported in opposition in the envelope, and a metallic shell symmetrically disposed around and spaced from the discharge path between the electrodes. The metallic shell comprises a first element of spaced helical turns of metallic material and a second element of spaced helical turns of methllic material insulatedly supported in superposition outside the first element and with the turns overlapping the gap between the turns of the first element.

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

Helium experiments on Alcator C-Mod in support of ITER early operations

DOE PAGES

Kessel, C. E.; Wolfe, S. M.; Reinke, M. L.; ...

2018-03-13

Helium majority experiments on Alcator C-Mod were performed to compare with deuterium discharges, and inform ITER early operations. ELMy H-modes were produced with a special plasma shape at B T = 5.3 T, I P = 0.9 MA, at q 95 ~ 3.8. The He fraction ranged over, n He,L/n L = 0.2–0.4, with n D,L/n L = 0.15–0.26, compared to D plasmas with n D,L/n L = 0.85–0.97. The power to enter the H-mode in He was found to be greater than ~2 times that for D discharges, in the low density region <1.4 × 10 20/m 3. However, it appears to follow the D threshold for higher densities. The stored energies in the He discharges were about 80% of those in D, and about 40% higher net power was required to sustain them compared to D. Global particle confinement times for tungsten ofmore » $$\\tau _{{\\rm W}}^{{\\rm *}}$$ /τ E ~ 4 were obtained with ELMy H-modes in He, however accumulation occurred when the ELMs were irregular and infrequent. The electron temperatures and densities in the pedestal were similar between D and He discharges, and the ΔT e/T e and Δn e/n e values were similar or larger in He than D. The higher net power required to access the H-mode, and sustain it in flattop, for He discharges in C-Mod, imply some limitations for He operation in ITER.« less

Helium experiments on Alcator C-Mod in support of ITER early operations

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

Kessel, C. E.; Wolfe, S. M.; Reinke, M. L.

Helium majority experiments on Alcator C-Mod were performed to compare with deuterium discharges, and inform ITER early operations. ELMy H-modes were produced with a special plasma shape at B T = 5.3 T, I P = 0.9 MA, at q 95 ~ 3.8. The He fraction ranged over, n He,L/n L = 0.2–0.4, with n D,L/n L = 0.15–0.26, compared to D plasmas with n D,L/n L = 0.85–0.97. The power to enter the H-mode in He was found to be greater than ~2 times that for D discharges, in the low density region <1.4 × 10 20/m 3. However, it appears to follow the D threshold for higher densities. The stored energies in the He discharges were about 80% of those in D, and about 40% higher net power was required to sustain them compared to D. Global particle confinement times for tungsten ofmore » $$\\tau _{{\\rm W}}^{{\\rm *}}$$ /τ E ~ 4 were obtained with ELMy H-modes in He, however accumulation occurred when the ELMs were irregular and infrequent. The electron temperatures and densities in the pedestal were similar between D and He discharges, and the ΔT e/T e and Δn e/n e values were similar or larger in He than D. The higher net power required to access the H-mode, and sustain it in flattop, for He discharges in C-Mod, imply some limitations for He operation in ITER.« less

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.

Supporting Early Math--Rationales and Requirements for High Quality Software

ERIC Educational Resources Information Center

Haake, Magnus; Husain, Layla; Gulz, Agneta

2015-01-01

There is substantial evidence that preschooler's performance in early math is highly correlated to math performance throughout school as well as academic skills in general. One way to help children attain early math skills is by using targeted educational software and the paper discusses potential gains of using such software to support early math…

Provider Opinions and Experiences Regarding Development of a Social Support Assessment to Inform Hospital Discharge: The Going Home Toolkit.

PubMed

Wallace, Andrea; Papke, Todd; Davisson, Erica; Spooner, Kara; Gassman, Laura

Despite over three decades of research linking social support and optimal health outcomes, social support is not systematically assessed or addressed during clinical care. This study sought input from health care providers to inform the design of an intervention intended to facilitate assessment of social support in a way that could aid in anticipatory planning during the process of hospital discharge. Using a purposive sampling strategy, data were collected from providers in two acute care settings serving rural patients, one academic and one community based. Opinions about what an assessment of social support would seek to accomplish, what is currently done and by whom, and the preferred format for delivery were elicited during a series of individual and group interviews. During phase two, feasibility was assessed with three inpatient nurses over 3 clinical days. Field notes were analyzed throughout the project using rapid data analysis techniques. Health care providers endorsed the creation of an assessment and stated that target users would include all members of the discharge team (e.g., clinical nurses, case managers, discharge coordinators, hospitalists, and specialty care). They identified the need for a patient-family resource (vs. a traditional provider-facing assessment). Participants stated that, although both the information collected and the interview process would meet a need to increase patient engagement in inpatient settings, competing clinical demands would require a tool that was easily completed by patients and family and seen as directly informing clinical activities. To this end, although focusing on the eventual development of an electronic tool seemed valuable, a hard-copy resource was considered more feasible for patient use at the present time. The preliminary test of the resulting hard-copy "Going Home Toolkit" demonstrated potential feasibility and usefulness during clinical practice. There is need for not only assessing patients

Effects of post-discharge nurse-led telephone supportive care for patients with chronic kidney disease undergoing peritoneal dialysis in China: a randomized controlled trial.

PubMed

Li, Juan; Wang, Huizhen; Xie, Hongzhen; Mei, Guiping; Cai, Wenzhi; Ye, Junsheng; Zhang, Jianlin; Ye, Guirong; Zhai, Huimin

2014-05-01

Patients with end-stage renal failure (ESRF) need integrated health care to maintain a desirable quality of life. Studies suggest that post-discharge nurseled telephone support has a positive effect for patients suffering from chronic diseases. But the post-discharge care is under-developed in mainland China and the effects of post-discharge care on patients with peritoneal dialysis have not been conclusive. The purpose of this study is to test the effectiveness of postdischarge nurse-led telephone support on patients with peritoneal dialysis in mainland China. A randomized controlled trial was conducted in the medical department of a regional hospital in Guangzhou. 135 patients were recruited, 69 in the study group and 66 in the control group. The control group received routine hospital discharge care. The study group received post-discharge nurse-led telephone support. The quality of life (Kidney Disease Quality of Life Short Form, KDQOL-SF), blood chemistry, complication control, readmission and clinic visit rates were observed at three time intervals: baseline before discharge (T1), 6 (T2) and 12 (T3) weeks after discharge. Statistically significant effects were found for symptom/problem, work status, staff encouragement, patient satisfaction and energy/fatigue in KDQOL-SF and 84-day (12-week) clinic visit rates between the two groups. The study group had more significant improvement than the control group for sleep, staff encouragement at both T2 and T3, and pain at T2 and patient satisfaction at T3. No significant differences were observed between the two groups for the baseline measures, other dimensions in KDQOL-SF, blood chemistry, complication control, readmission rates at all time intervals and clinic visit rates at the first two time intervals. Post-discharge nurse-led telephone support for patients undergoing peritoneal dialysis is effective to enhance patients' well-being in the transition from hospital to home in mainland China. Copyright © 2014

Parental Support, Partner Support, and the Trajectories of Mastery from Adolescence to Early Adulthood

ERIC Educational Resources Information Center

Surjadi, Florensia F.; Lorenz, Frederick O.; Wickrama, K. A. S.; Conger, Rand D.

2011-01-01

This study examines the long-term associations among parental support, extra-familial partner support, and the trajectories of sense of mastery from adolescence to the early adulthood years. Ten waves of panel data collected over a 16-year period from the Iowa Family Transitions Project (N = 527) were used to test the hypotheses. Results indicated…

Helium experiments on Alcator C-Mod in support of ITER early operations

NASA Astrophysics Data System (ADS)

Kessel, C. E.; Wolfe, S. M.; Reinke, M. L.; Hughes, J. W.; Lin, Y.; Wukitch, S. J.; Baek, S. G.; Bonoli, P. T.; Chilenski, M.; Diallo, A.; the Alcator C-Mod Team

2018-05-01

Helium majority experiments on Alcator C-Mod were performed to compare with deuterium discharges, and inform ITER early operations. ELMy H-modes were produced with a special plasma shape at B T  =  5.3 T, I P  =  0.9 MA, at q 95 ~ 3.8. The He fraction ranged over, n He,L/n L  =  0.2-0.4, with n D,L/n L  =  0.15-0.26, compared to D plasmas with n D,L/n L  =  0.85-0.97. The power to enter the H-mode in He was found to be greater than ~2 times that for D discharges, in the low density region  <1.4  ×  1020/m3. However, it appears to follow the D threshold for higher densities. The stored energies in the He discharges were about 80% of those in D, and about 40% higher net power was required to sustain them compared to D. Global particle confinement times for tungsten of τ W* /τ E ~ 4 were obtained with ELMy H-modes in He, however accumulation occurred when the ELMs were irregular and infrequent. The electron temperatures and densities in the pedestal were similar between D and He discharges, and the ΔT e/T e and Δn e/n e values were similar or larger in He than D. The higher net power required to access the H-mode, and sustain it in flattop, for He discharges in C-Mod, imply some limitations for He operation in ITER.

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-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.

Feeding preterm infants after hospital discharge: a commentary by the ESPGHAN Committee on Nutrition.

PubMed

Aggett, Peter J; Agostoni, Carlo; Axelsson, Irene; De Curtis, Mario; Goulet, Olivier; Hernell, Olle; Koletzko, Berthold; Lafeber, Harry N; Michaelsen, Kim F; Puntis, John W L; Rigo, Jacques; Shamir, Raanan; Szajewska, Hania; Turck, Dominique; Weaver, Lawrence T

2006-05-01

Survival of small premature infants has markedly improved during the last few decades. These infants are discharged from hospital care with body weight below the usual birth weight of healthy term infants. Early nutrition support of preterm infants influences long-term health outcomes. Therefore, the ESPGHAN Committee on Nutrition has reviewed available evidence on feeding preterm infants after hospital discharge. Close monitoring of growth during hospital stay and after discharge is recommended to enable the provision of adequate nutrition support. Measurements of length and head circumference, in addition to weight, must be used to identify those preterm infants with poor growth that may need additional nutrition support. Infants with an appropriate weight for postconceptional age at discharge should be breast-fed when possible. When formula-fed, such infants should be fed regular infant formula with provision of long-chain polyunsaturated fatty acids. Infants discharged with a subnormal weight for postconceptional age are at increased risk of long-term growth failure, and the human milk they consume should be supplemented, for example, with a human milk fortifier to provide an adequate nutrient supply. If formula-fed, such infants should receive special postdischarge formula with high contents of protein, minerals and trace elements as well as an long-chain polyunsaturated fatty acid supply, at least until a postconceptional age of 40 weeks, but possibly until about 52 weeks postconceptional age. Continued growth monitoring is required to adapt feeding choices to the needs of individual infants and to avoid underfeeding or overfeeding.

Influence of hope, social support, and self-esteem in early stage dementia.

PubMed

Cotter, Valerie T; Gonzalez, Elizabeth W; Fisher, Kathleen; Richards, Kathy C

2018-02-01

Background People in the early stages of dementia adjust to the illness through stages of awareness, coping, and evaluation. Studies have found that hope, social support, and self-esteem facilitate coping, adjustment, and adaptation in chronic illness. Objective The purpose of this descriptive study was to examine the relationships between hope, social support, and self-esteem in individuals with early stage dementia. Methods Data were obtained from 53 individuals with early stage dementia. The scores on the Herth Hope Index, Social Support Questionnaire Short-Form, and the State Self-Esteem Scale were analyzed using linear regression. Results Hope was moderately associated with self-esteem ( r = .49, p < .001). Hope accounted for 25% of the variance in self-esteem and was a key component in predicting self-esteem. No significant relationship was found between social support and self-esteem. Conclusion Findings suggest that hope may be an important factor to help individuals manage potential threats to self-esteem in the experience of early stage dementia. Strategies to inspire hope and then enhance self-esteem are promising for individuals living with early stage dementia.

Housing First: exploring participants' early support needs.

PubMed

Stergiopoulos, Vicky; Gozdzik, Agnes; O'Campo, Patricia; Holtby, Alixandra R; Jeyaratnam, Jeyagobi; Tsemberis, Sam

2014-04-13

related to substance use and a need for life skills training and support. Additional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs. Current Controlled Trials ISRCTN42520374.

Housing First: exploring participants’ early support needs

PubMed Central

2014-01-01

participants, as well as problems related to substance use and a need for life skills training and support. Conclusions Additional strategies can help support Housing First participants in the early stages of program participation and address potential causes of early difficulties, including lack of life skills and social isolation. This study highlights the importance of early and ongoing evaluation, monitoring and program adaptations to address consumer support needs. Trial registration Current Controlled Trials ISRCTN42520374 PMID:24725374

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.

Conceptualising Institutional Support for Early, Mid, and Later Career Teachers

ERIC Educational Resources Information Center

Fraser, Kym; Greenfield, Rosie; Pancini, Geri

2017-01-01

In this paper we argue that institutions need to support early career teachers to learn to teach in much the same way that students who are new to higher education are supported: through integrated and intentionally designed transition strategies. We take a published student transition typology and adapt it to identify ways of supporting early…

Early Services for Children with Special Needs: Transactions for Family Support.

ERIC Educational Resources Information Center

Healy, Alfred; And Others

The book is intended to link knowledge and application in early intervention services for very young disabled and at-risk children. An introductory chapter analyzes major issues and sources of controversy in the field: family support and the nature of early intervention, parental empowerment and involvement, the science of early intervention,…

The moderator-mediator role of social support in early adolescents.

PubMed

Yarcheski, A; Mahon, N E

1999-10-01

The purpose of this study was to examine social support as both a mediator and a moderator of the relationship between perceived stress and symptom patterns in early adolescents. Data were collected from 148 early adolescent boys and girls, ages 12 to 14, who responded to the Perceived Stress Scale, the Personal Resource Questionnaire 85-Part II, and the Symptom Pattern Scale. Using multiple regression analysis procedures specified for the testing of moderation and mediation, results indicated that social support did not play a moderating role in the relationship between perceived stress and symptom patterns, but social support did play a mediating role in this relationship. The findings are interpreted within the two major theoretical orientations that guided the study.

SELF (Supports for Early Learning Foundations): A Non-Directed Model Demonstration Project. Final Report.

ERIC Educational Resources Information Center

Harrison, Holly

This final report describes achievements and activities of Project SELF (Supports for Early Learning Foundations), a federally funded project in New Mexico which developed, evaluated, and replicated an innovative model that provides strategies for early interventionists and families to support early learning foundations. The project identified…

The ALMA OT in early science: supporting multiple customers

NASA Astrophysics Data System (ADS)

Bridger, Alan; Williams, Stewart; McLay, Stewart; Yatagai, Hiroshi; Schilling, Marcus; Biggs, Andrew; Tobar, Rodrigo; Warmels, Rein H.

2012-09-01

The ALMA Observatory is currently operating 'Early Science' observing. The Cycle0 and Cycle1 Calls for Proposals are part of this Early Science, and in both the ALMA Observing Tool plays a crucial role. This paper describes how the ALMA OT tackles the problem of making millimeter/sub-millimeter interferometry accessible to the wider community, while allowing "experts" the power and flexibility they need. We will also describe our approach to the challenges of supporting multiple customers, and explore the lessons learnt from the Early Science experiences. Finally we look ahead to the challenges presented by future observing cycles.

"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.

40 CFR 26.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Early termination of research support: Evaluation of applications and proposals. 26.123 Section 26.123 Protection of Environment ENVIRONMENTAL... Research Conducted or Supported by EPA § 26.123 Early termination of research support: Evaluation of...

40 CFR 26.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Early termination of research support... Research Conducted or Supported by EPA § 26.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

40 CFR 26.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Early termination of research support... Research Conducted or Supported by EPA § 26.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

40 CFR 26.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Early termination of research support... Research Conducted or Supported by EPA § 26.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

A comprehensive inpatient discharge system.

PubMed Central

O'Connell, E. M.; Teich, J. M.; Pedraza, L. A.; Thomas, D.

1996-01-01

Our group has developed a computer system that supports all phases of the inpatient discharge process. The system fills in most of the physician's discharge order form and the nurse's discharge abstract, using information available from sign-out, order entry, scheduling, and other databases. It supplies information for referrals to outside institutions, and provides a variety of instruction materials for patients. Discharge forms can be completed in advance, so that the patient is not waiting for final paperwork. Physicians and nurses can work on their components independently, rather than in series. Response to the system has been very favorable. PMID:8947755

Supporting Early Childhood Environmental Education through the Natural Start Alliance

ERIC Educational Resources Information Center

Merrick, Christy; Braus, Judy

2013-01-01

The Natural Start Alliance is a new initiative of the North American Association for Environmental Education. Natural Start was created to support and expand early childhood environmental education (ECEE) by creating a network of organizations, educators, parents, and others who care about using environmental education to support young children's…

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.

Social Support Seeking and Early Adolescent Depression and Anxiety Symptoms

ERIC Educational Resources Information Center

Vélez, Clorinda E.; Krause, Elizabeth D.; McKinnon, Allison; Brunwasser, Steven M.; Freres, Derek R.; Abenavoli, Rachel M.; Gillham, Jane E.

2016-01-01

This study examined how social support seeking and rumination interacted to predict depression and anxiety symptoms 6 months later in early adolescents (N = 118; 11-14 years at baseline). We expected social support seeking would be more helpful for adolescents engaging in low rather than high levels of rumination. Adolescents self-reported on all…

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.

Influence of Social Support and Self-Efficacy on Resilience of Early Career Registered Nurses.

PubMed

Wang, Lin; Tao, Hong; Bowers, Barbara J; Brown, Roger; Zhang, Yaqing

2018-05-01

The aim of this study was to examine the relationships among social support, self-efficacy, and resilience in early career registered nurses. A cross-sectional study was conducted with a convenience sample of 747 early career registered nurses. Data collection was performed between August and November 2015. Data were analyzed using structural equation modeling. Among the three factors of social support, only the impact of coworker support on nurse resilience is fully mediated by self-efficacy; friend support had a significant positive direct effect on self-efficacy and an indirect effect on nurse resilience. This would suggest the importance of administrators/managers understanding how to promote coworker support, increase self-efficacy, foster a positive work climate, and develop effective mentorship programs to improve early career registered nurses resilience and mitigate factors leading to turnover.

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

DISCHARGE DEVICE FOR RADIOACTIVE MATERIAL

DOEpatents

Ohlinger, L.A.

1958-09-23

A device is described fur unloading bodies of fissionable material from a neutronic reactor. It is comprised essentially of a wheeled flat car having a receptacle therein containing a liquid coolant fur receiving and cooling the fuel elements as they are discharged from the reactor, and a reciprocating plunger fur supporting the fuel element during discharge thereof prior to its being dropped into the coolant. The flat car is adapted to travel along the face of the reactor adjacent the discharge ends of the coolant tubes.

16 CFR 1028.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Early termination of research support: Evaluation of applications and proposals. 1028.123 Section 1028.123 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION GENERAL PROTECTION OF HUMAN SUBJECTS § 1028.123 Early termination of research support...

32 CFR 219.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 2 2010-07-01 2010-07-01 false Early termination of research support: Evaluation of applications and proposals. 219.123 Section 219.123 National Defense Department of Defense....123 Early termination of research support: Evaluation of applications and proposals. (a) The...

32 CFR 219.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 2 2011-07-01 2011-07-01 false Early termination of research support: Evaluation of applications and proposals. 219.123 Section 219.123 National Defense Department of Defense....123 Early termination of research support: Evaluation of applications and proposals. (a) The...

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.

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)

32 CFR 219.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 2 2012-07-01 2012-07-01 false Early termination of research support....123 Early termination of research support: Evaluation of applications and proposals. (a) The... finds an institution has materially failed to comply with the terms of this policy. (b) In making...

28 CFR 46.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Early termination of research support: Evaluation of applications and proposals. 46.123 Section 46.123 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROTECTION OF HUMAN SUBJECTS § 46.123 Early termination of research support: Evaluation of...

49 CFR 11.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 1 2010-10-01 2010-10-01 false Early termination of research support: Evaluation of applications and proposals. 11.123 Section 11.123 Transportation Office of the Secretary of Transportation PROTECTION OF HUMAN SUBJECTS § 11.123 Early termination of research support: Evaluation of...

28 CFR 46.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Early termination of research support: Evaluation of applications and proposals. 46.123 Section 46.123 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) PROTECTION OF HUMAN SUBJECTS § 46.123 Early termination of research support: Evaluation of...

22 CFR 225.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Early termination of research support: Evaluation of applications and proposals. 225.123 Section 225.123 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT PROTECTION OF HUMAN SUBJECTS § 225.123 Early termination of research support: Evaluation of...

22 CFR 225.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Early termination of research support: Evaluation of applications and proposals. 225.123 Section 225.123 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT PROTECTION OF HUMAN SUBJECTS § 225.123 Early termination of research support: Evaluation of...

49 CFR 11.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 1 2011-10-01 2011-10-01 false Early termination of research support: Evaluation of applications and proposals. 11.123 Section 11.123 Transportation Office of the Secretary of Transportation PROTECTION OF HUMAN SUBJECTS § 11.123 Early termination of research support: Evaluation of...

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.

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

Supports for Vocabulary Instruction in Early Language and Literacy Methods Textbooks

ERIC Educational Resources Information Center

Wright, Tanya S.; Peltier, Marliese R.

2016-01-01

The goal of this study was to examine the extent to which the content and recommendations in recently published early language and literacy methods textbooks may support early childhood teachers in learning to provide vocabulary instruction for young children. We completed a content analysis of 9 textbooks with coding at the sentence level.…

Mothers' and Fathers' Support for Child Autonomy and Early School Achievement

ERIC Educational Resources Information Center

Developmental Psychology, 2008

2008-01-01

Data were analyzed from 641 children and their families in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development to test the hypotheses that in the early school years, mothers' and fathers' sensitive support for autonomy in observed parent-child interactions would each make unique predictions…

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.

Supported self-management for patients with COPD who have recently been discharged from hospital: a systematic review and meta-analysis

PubMed Central

Majothi, Saimma; Jolly, Kate; Heneghan, Nicola R; Price, Malcolm J; Riley, Richard D; Turner, Alice M; Bayliss, Susan E; Moore, David J; Singh, Sally J; Adab, Peymané; Fitzmaurice, David A; Jordan, Rachel E

2015-01-01

Purpose Although many hospitals promote self-management to chronic obstructive pulmonary disease (COPD) patients post discharge from hospital, the clinical effectiveness of this is unknown. We undertook a systematic review of the evidence as part of a Health Technology Assessment review. Methods A comprehensive search strategy with no language restrictions was conducted across relevant databases from inception to May 2012. Randomized controlled trials of patients with COPD, recently discharged from hospital after an acute exacerbation and comparing a self-management intervention with control, usual care or other intervention were included. Study selection, data extraction, and risk of bias assessment were undertaken by two reviewers independently. Results Of 13,559 citations, 836 full texts were reviewed with nine randomized controlled trials finally included in quantitative syntheses. Interventions were heterogeneous. Five trials assessed highly supported multi-component interventions and four trials were less supported with fewer contacts with health care professionals and mainly home-based interventions. Total sample size was 1,466 (range 33–464 per trial) with length of follow-up 2–12 months. Trials varied in quality; poor patient follow-up and poor reporting was common. No evidence of effect in favor of self-management support was observed for all-cause mortality (pooled hazard ratio =1.07; 95% confidence interval [0.74 to 1.55]; I2=0.0%, [n=5 trials]). No clear evidence of effect on all-cause hospital admissions was observed (hazard ratio 0.88 [0.61, 1.27] I2=66.0%). Improvements in St George’s Respiratory Questionnaire score were seen in favor of self-management interventions (mean difference =3.84 [1.29 to 6.40]; I2=14.6%), although patient follow-up rates were low. Conclusion There is insufficient evidence to support self-management interventions post-discharge. There is a need for good quality primary research to identify effective approaches. PMID

28 CFR 46.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Early termination of research support... (CONTINUED) PROTECTION OF HUMAN SUBJECTS § 46.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

10 CFR 745.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Early termination of research support: Evaluation of... § 745.123 Early termination of research support: Evaluation of applications and proposals. (a) The... finds an institution has materially failed to comply with the terms of this policy. (b) In making...

49 CFR 11.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 1 2014-10-01 2014-10-01 false Early termination of research support: Evaluation... Transportation PROTECTION OF HUMAN SUBJECTS § 11.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

49 CFR 11.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 1 2013-10-01 2013-10-01 false Early termination of research support: Evaluation... Transportation PROTECTION OF HUMAN SUBJECTS § 11.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

34 CFR 97.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 1 2014-07-01 2014-07-01 false Early termination of research support: Evaluation of... Protection of Human Research Subjects) § 97.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

16 CFR 1028.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Early termination of research support... SAFETY COMMISSION GENERAL PROTECTION OF HUMAN SUBJECTS § 1028.123 Early termination of research support... requirements, when the department or agency head finds an institution has materially failed to comply with the...

28 CFR 46.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Early termination of research support... (CONTINUED) PROTECTION OF HUMAN SUBJECTS § 46.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

34 CFR 97.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 1 2013-07-01 2013-07-01 false Early termination of research support: Evaluation of... Protection of Human Research Subjects) § 97.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

34 CFR 97.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 1 2012-07-01 2012-07-01 false Early termination of research support: Evaluation of... Protection of Human Research Subjects) § 97.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

49 CFR 11.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 1 2012-10-01 2012-10-01 false Early termination of research support: Evaluation... Transportation PROTECTION OF HUMAN SUBJECTS § 11.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

28 CFR 46.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Early termination of research support... (CONTINUED) PROTECTION OF HUMAN SUBJECTS § 46.123 Early termination of research support: Evaluation of..., when the department or agency head finds an institution has materially failed to comply with the terms...

10 CFR 745.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Early termination of research support: Evaluation of applications and proposals. 745.123 Section 745.123 Energy DEPARTMENT OF ENERGY PROTECTION OF HUMAN SUBJECTS § 745.123 Early termination of research support: Evaluation of applications and proposals. (a) The...

10 CFR 745.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Early termination of research support: Evaluation of applications and proposals. 745.123 Section 745.123 Energy DEPARTMENT OF ENERGY PROTECTION OF HUMAN SUBJECTS § 745.123 Early termination of research support: Evaluation of applications and proposals. (a) The...

45 CFR 46.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 1 2011-10-01 2011-10-01 false Early termination of research support: Evaluation of applications and proposals. 46.123 Section 46.123 Public Welfare DEPARTMENT OF HEALTH AND HUMAN... Research Subjects § 46.123 Early termination of research support: Evaluation of applications and proposals...

34 CFR 97.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 1 2011-07-01 2011-07-01 false Early termination of research support: Evaluation of applications and proposals. 97.123 Section 97.123 Education Office of the Secretary, Department of Education... Protection of Human Research Subjects) § 97.123 Early termination of research support: Evaluation of...

The Tenth Step of the BFHI: What midwives need to know about optimal support for mothers, post-discharge.

PubMed

Thorley, Virginia

2015-09-01

This commentary discusses the 10th Step of the Baby-Friendly Hospital Initiative (BFHI), the only step that goes beyond the hospital to provide for the mother to receive breast-feeding support after she returns to the community. The reasons why such support is needed, and how this support has been provided in different settings, will be discussed. Post-discharge support for breast-feeding mothers takes many forms and is optimised when mothers can access both professional and peer support. The mother-baby dyad is best served by the right advice from the right person at the right time. Midwives who assist the new mother with information about easily accessible support in the community enable the care she has received during her short hospital stay and during any midwifery home visiting to continue when she is in an environment that may not be supportive of breast feeding. Copyright © 2015 Elsevier Ltd. All rights reserved.

15 CFR 27.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 15 Commerce and Foreign Trade 1 2013-01-01 2013-01-01 false Early termination of research support... Secretary of Commerce PROTECTION OF HUMAN SUBJECTS § 27.123 Early termination of research support... requirements, when the department or agency head finds an institution has materially failed to comply with the...

15 CFR 27.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 15 Commerce and Foreign Trade 1 2011-01-01 2011-01-01 false Early termination of research support: Evaluation of applications and proposals. 27.123 Section 27.123 Commerce and Foreign Trade Office of the Secretary of Commerce PROTECTION OF HUMAN SUBJECTS § 27.123 Early termination of research support...

15 CFR 27.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 15 Commerce and Foreign Trade 1 2010-01-01 2010-01-01 false Early termination of research support: Evaluation of applications and proposals. 27.123 Section 27.123 Commerce and Foreign Trade Office of the Secretary of Commerce PROTECTION OF HUMAN SUBJECTS § 27.123 Early termination of research support...

StreetWise: developing a serious game to support forensic mental health service users' preparation for discharge: a feasibility study.

PubMed

Reynolds, L M; Davies, J P; Mann, B; Tulloch, S; Nidsjo, A; Hodge, P; Maiden, N; Simpson, A

2017-05-01

WHAT IS KNOWN ON THE SUBJECT?: Serious gaming can support learning and development. The use of serious games for skills development and the rehearsal of the management of events that cannot be replicated in real life is well established. Few serious games have been used in mental health services, and none in forensic mental health care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: How a serious game may be coproduced by forensic mental health service users and game developers The acceptability of the therapeutic use of serious gaming by forensic mental health service users and providers. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Computer games may be used by practitioners in their therapeutic work with forensic mental health service users. Mental health nurses to use serious games to creatively and safely bridge the gap for service users between receiving care in controlled environments and living more independent in the community. Introduction Assessment of users' skills and confidence to safely respond to risky community-based situations underpins discharge planning. Serious games have been used for skills development, and this study trialled their use in forensic mental health services. Aim The aim was to develop and test the acceptability and usability of an innovative serious game to support forensic mental health service users' preparation for discharge. Method A prototype serious game was developed by service users and researchers. Acceptability and usability testing was undertaken and service providers interviewed about the acceptability of serious gaming for forensic mental health services. Result A prototype game was produced and successfully trialled by service users. However, both service users and providers identified that work needed to be done to develop and test a game with greater complexity. Discussion The acceptability and usability of using serious games to support service users to develop skills needed for successful discharge was demonstrated

Parents’ Support and Knowledge of Their Daughters’ Lives and Females’ Early Sexual Initiation in Nine European Countries

PubMed Central

Madkour, Aubrey Spriggs; Farhat, Tilda; Halpern, Carolyn Tucker; Nic Gabhainn, Saoirse; Godeau, Emmanuelle

2013-01-01

Context The association between early sexual initiation and parenting practices (e.g., support and knowledge) has not been tested in multiple European population-based samples using the same instrument. Methods Data provided by females (age 14-16) participating in the 2005-06 Health Behaviors in School-Aged Children (HBSC) survey conducted in Austria, Finland, Greece, Hungary, Iceland, Lithuania, Romania, Spain and Ukraine were used (n=7,466). The dependent variable was early sexual initiation (<16). The main independent variables were maternal and paternal support and knowledge of daily activities. Univariate, bivariate and multivariable analyses were run with standard error corrections and weights. Results Prevalence of early sexual initiation ranged from a low of 7% (Romania) to a high of 35% (Iceland). In bivariate analyses, maternal and paternal support were significantly negatively related to adolescent females’ early sexual initiation in a majority of countries. In models with demographic controls, parental support was significantly negatively related to early sexual initiation (AOR = 0.80 maternal, 0.74 paternal). After adding parental knowledge, early sexual initiation was no longer associated with parental support, but was significantly negatively related to parental knowledge (AOR = 0.69 maternal and paternal). These patterns held across countries. Conclusions Negative associations between parental support and early initiation were largely explained by parental knowledge, suggesting either that knowledge is more important than support or that knowledge mediates the association between support and early initiation. Providers should counsel parents regarding the importance of knowledge of their daughters’ daily lives, which may be enhanced through developing supportive relationships. PMID:22958661

Families as Partners: Supporting Family Resiliency through Early Intervention

ERIC Educational Resources Information Center

Frantz, Rebecca; Hansen, Sarah Grace; Squires, Jane; Machalicek, Wendy

2018-01-01

Child development occurs within the context of the child's family, neighborhood, and community environment. Early childhood providers support positive outcomes, not only for the children with whom they directly work with but also for their families. Families of children with developmental delays often experience unique challenges. A family…

Early Adolescent Family Experiences and Perceived Social Support in Young Adulthood

ERIC Educational Resources Information Center

Gayman, Mathew D.; Turner, R. Jay; Cislo, Andrew M.; Eliassen, A. Henry

2011-01-01

Although the protective role of social support is well established in the health literature, antecedents of perceived social support are not well understood. Research on family experiential factors during early adolescence, an important psychosocial developmental period in the life course, represents a promising line of inquiry. Using a sample of…

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

Voice Enabled Framework to Support Post-Surgical Discharge Monitoring

PubMed Central

Blansit, Kevin; Marmor, Rebecca; Zhao, Beiqun; Tien, Dan

2017-01-01

Unplanned surgical readmissions pose a challenging problem for the American healthcare system. We propose to combine consumer electronic voice recognition technology with the FHIR standard to create a post-surgical discharge monitoring app to identify and alert physicians to a patient’s deteriorating status. PMID:29854267

32 CFR 724.303 - Functions: President, Naval Discharge Review Board.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Functions: President, Naval Discharge Review... PERSONNEL NAVAL DISCHARGE REVIEW BOARD Director, Secretary of the Navy Council of Review Boards and President Naval Discharge Review Board; Responsibilities in Support of the Naval Discharge Review Board...

32 CFR 724.303 - Functions: President, Naval Discharge Review Board.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Functions: President, Naval Discharge Review... PERSONNEL NAVAL DISCHARGE REVIEW BOARD Director, Secretary of the Navy Council of Review Boards and President Naval Discharge Review Board; Responsibilities in Support of the Naval Discharge Review Board...

Supporting Early Childhood Practitioners through Relationship-Based, Reflective Supervision

ERIC Educational Resources Information Center

Bernstein, Victor J.; Edwards, Renee C.

2012-01-01

Reflective supervision is a relationship-based practice that supports the professional development of early childhood practitioners. Reflective supervision helps practitioners cope with the intense feelings and stress that are generated when working with at-risk children and families. It allows them to focus on the purpose and goals of the program…

Early Environmental Support and Elementary School Adjustment as Predictors of School Adjustment in Middle Adolescence.

ERIC Educational Resources Information Center

Carlson, Elizabeth A.; Sroufe, L. Alan; Collins, W. Andres; Jimerson, Shane; Weinfield, Nancy; Henninghausen, Katherine; Egeland, Byron; Hyson, Daniel M.; Anderson, Fione; Meyer, Stephanie E.

1999-01-01

This longitudinal study examined socioemotional antecedents of adolescent school adjustment. Findings indicated that early and later parental problem-solving support accounted for 13 percent of variance in high school adjustment. Early and later parental problem-solving support, peer competence, externalizing behavior, and emotional…

A Web-Based Tool to Support Data-Based Early Intervention Decision Making

ERIC Educational Resources Information Center

Buzhardt, Jay; Greenwood, Charles; Walker, Dale; Carta, Judith; Terry, Barbara; Garrett, Matthew

2010-01-01

Progress monitoring and data-based intervention decision making have become key components of providing evidence-based early childhood special education services. Unfortunately, there is a lack of tools to support early childhood service providers' decision-making efforts. The authors describe a Web-based system that guides service providers…

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

Corruption Early Prevention: Decision Support System for President of the Republic of Indonesia

NASA Astrophysics Data System (ADS)

Sasmoko; Widhoyoko, S. A.; Ariyanto, S.; Indrianti, Y.; Noerlina; Muqsith, A. M.; Alamsyah, M.

2017-01-01

Corruption is an extraordinary crime, and then the prevention must also be extraordinary, simultaneously (national) in the form of early warning that involves all elements; government, industry, and society. To realize it the system needs to be built which in this study is called the Corruption Early Prevention (CEP) as a Decision Support System for President of the Republic of Indonesia. This study aims to examine 1) how is the construct of the Corruption Early Prevention as a Decision Support System for President of the Republic of Indonesia?, and 2) how is the design form of the system of Corruption Early Prevention as a Decision Support System for President of Republic of Indonesia? The research method is using Neuro-Research which is the collaboration of qualitative and quantitative research methods and the model development of Information Technology (IT). The research found that: 1) the construct of CEP is theoretically feasible, valid and reliable by content to be developed in the context of the prevention of corruption in Indonesia as an early prevention system that diagnoses Indonesia simultaneously and in real time, and 2) the concept of system design and business process of CEP is predicted to be realized in the IT-based program.

A novel approach to early sickness absence management: The EASY (Early Access to Support for You) way.

PubMed

Demou, Evangelia; Brown, Judith; Sanati, Kaveh; Kennedy, Mark; Murray, Keith; Macdonald, Ewan B

2015-01-01

Sickness absence (SA) is multi-causal and remains a significant problem for employees, employers and society. This makes it necessary to concurrently manage a particular disabling condition and consider the working environment and employee-employer relationship. To describe and examine the components of a novel SA management service Early Access to Support for You (EASY) and discuss their potential influence on the intervention. A new sickness absence model, starting from day one of absence, was created called EASY. EASY is planned to support both employees and managers and comprises elements already found to be associated with reduction of SA, such as maintaining regular contact; early biopsychosocial case-management; physiotherapy; mental-health counselling; work modification; phased return-to-work; and health promotion activities. During the EASY implementation period, the SA rate at a health board reversed its trend of being one of the highest rates in the Scottish National Health Service (NHS) and EASY was considered helpful by both managers and employees. This paper describes an innovative occupational health intervention to sickness absence management based on the bio-psychosocial model to provide early intervention, and discusses the pros and cons of applying cognitive behavioural principles at an early stage in sickness-absence events, in order to improve return-to-work outcomes.

Early Parental Positive Behavior Support and Childhood Adjustment: Addressing Enduring Questions with New Methods

PubMed Central

Waller, Rebecca; Gardner, Frances; Dishion, Thomas; Sitnick, Stephanie L.; Shaw, Daniel S.; Winter, Charlotte E.; Wilson, Melvin

2016-01-01

A large literature provides strong empirical support for the influence of parenting on child outcomes. The current study addresses enduring research questions testing the importance of early parenting behavior to children’s adjustment. Specifically, we developed and tested a novel multi-method observational measure of parental positive behavior support at age 2. Next, we tested whether early parental positive behavior support was related to child adjustment at school age, within a multi-agent and multi-method measurement approach and design. Observational and parent-reported data from mother–child dyads (N = 731; 49 percent female) were collected from a high-risk sample at age 2. Follow-up data were collected via teacher report and child assessment at age 7.5. The results supported combining three different observational methods to assess positive behavior support at age 2 within a latent factor. Further, parents’ observed positive behavior support at age 2 predicted multiple types of teacher-reported and child-assessed problem behavior and competencies at 7.5 years old. Results supported the validity and predictive capability of a multi-method observational measure of parenting and the importance of a continued focus on the early years within preventive interventions. PMID:26997757

Early Parental Positive Behavior Support and Childhood Adjustment: Addressing Enduring Questions with New Methods.

PubMed

Waller, Rebecca; Gardner, Frances; Dishion, Thomas; Sitnick, Stephanie L; Shaw, Daniel S; Winter, Charlotte E; Wilson, Melvin

2015-05-01

A large literature provides strong empirical support for the influence of parenting on child outcomes. The current study addresses enduring research questions testing the importance of early parenting behavior to children's adjustment. Specifically, we developed and tested a novel multi-method observational measure of parental positive behavior support at age 2. Next, we tested whether early parental positive behavior support was related to child adjustment at school age, within a multi-agent and multi-method measurement approach and design. Observational and parent-reported data from mother-child dyads (N = 731; 49 percent female) were collected from a high-risk sample at age 2. Follow-up data were collected via teacher report and child assessment at age 7.5. The results supported combining three different observational methods to assess positive behavior support at age 2 within a latent factor. Further, parents' observed positive behavior support at age 2 predicted multiple types of teacher-reported and child-assessed problem behavior and competencies at 7.5 years old. Results supported the validity and predictive capability of a multi-method observational measure of parenting and the importance of a continued focus on the early years within preventive interventions.

Mothers' and fathers' support for child autonomy and early school achievement.

PubMed

2008-07-01

Data were analyzed from 641 children and their families in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development to test the hypotheses that in the early school years, mothers' and fathers' sensitive support for autonomy in observed parent-child interactions would each make unique predictions to children's reading and math achievement at Grade 3 (controlling for demographic variables), children's reading and math abilities at 54 months, and children's level of effortful control at 54 months and that these associations would be mediated by the level of and changes over time in children's observed self-reliance in the classroom from Grades 1 through 3. The authors found that mothers' and fathers' support for autonomy were significantly and uniquely associated with children's Grade 3 reading and math achievement with the above controls, but only for boys. For boys, the effect of mothers' support for child autonomy was mediated by higher self-reliance at Grade 1 and of fathers' support for child autonomy by greater increases in self-reliance from Grades 1 through 3.

Using Action Research to Support Quality Early Years Practice

ERIC Educational Resources Information Center

Bleach, Josephine

2013-01-01

This article examines the effectiveness of action research as a continuous professional development (CPD) tool. The aim of the CPD programme was to support 14 community-based Early Childhood Care and Education (ECCE) centres in Ireland to improve quality in their settings through the implementation of the national quality and curriculum frameworks…

Supporting Our Youngest Children: Early Head Start Programs in 2010. Brief No. 11

ERIC Educational Resources Information Center

Schmit, Stephanie; Ewen, Danielle

2012-01-01

Since 1965, Head Start has provided high quality early education and comprehensive support services to the nation's poorest children from ages 3 through school age. In 1994, the federal Early Head Start (EHS) program was created to address the comprehensive needs of poor children under age 3 and pregnant women. Head Start and Early Head Start's…

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.

Patient participation in discharge planning conference

PubMed Central

Bångsbo, Angela; Dunér, Anna; Lidén, Eva

2014-01-01

Introduction There is a need for individualized discharge planning to support frail older persons at hospital discharge. In this context, active participation on their behalf cannot be taken for granted. The aim of this study was to elucidate patient participation in discharge planning conferences, with a focus on frail older persons, supported by the theory of positioning described by Harré & van Langenhove. Methods The study was designed as a case study based on audio-recordings of multidisciplinary discharge planning conferences and interviews with health professionals elucidating their opinions on preconditions for patient participation in discharge planning. The analysis has been performed using qualitative content analysis and discourse analysis. Data collection took place during 2008–2009 and included 40 health professionals and 13 frail older persons in hospital or municipal settings. Results Findings revealed four different positions of participation, characterized by the older person's level of activity during the conference and his/her appearance as being reduced (patient) or whole (person). The positions varied dynamically from being an active person, passive person, active patient, or passive patient and the health professionals, next-of-kin, and the older persons themselves contributed to the positioning. Conclusions The findings showed how the institutional setting served as a purposeful structure or a confinement to patient participation. PMID:25411572

Model of Early Support of Child Development in Poland

ERIC Educational Resources Information Center

Czyz, Anna Katarzyna

2018-01-01

The development of a child, especially a child with a disability, is conditional upon the initiation of rehabilitation measures immediately after the problem has been identified. The quality of the reaction is conditioned by the functioning of the therapeutic team. The main purpose of the research was the diagnosis of early support system for…

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. �

Mourning Child Grief Support Group Curriculum: Early Childhood Edition, Kindergarten-Grade 2.

ERIC Educational Resources Information Center

Lehmann, Linda; Jimerson, Shane R.; Gaasch, Ann

The Mourning Child Early Childhood grief support curriculum is intended for use with early elementary-aged children, specifically children in kindergarten through grade two, who have experienced the death of someone special to them. It is designed for use by professionals who work in schools, hospitals, hospices, mental health agencies, or any…

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.

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.

7 CFR 1c.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 1 2013-01-01 2013-01-01 false Early termination of research support: Evaluation of... OF HUMAN SUBJECTS § 1c.123 Early termination of research support: Evaluation of applications and... department or agency head finds an institution has materially failed to comply with the terms of this policy...

7 CFR 1c.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 1 2011-01-01 2011-01-01 false Early termination of research support: Evaluation of applications and proposals. 1c.123 Section 1c.123 Agriculture Office of the Secretary of Agriculture PROTECTION OF HUMAN SUBJECTS § 1c.123 Early termination of research support: Evaluation of applications and...

7 CFR 1c.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 1 2010-01-01 2010-01-01 false Early termination of research support: Evaluation of applications and proposals. 1c.123 Section 1c.123 Agriculture Office of the Secretary of Agriculture PROTECTION OF HUMAN SUBJECTS § 1c.123 Early termination of research support: Evaluation of applications and...

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.

Perioperative Acute Kidney Injury: Prevention, Early Recognition, and Supportive Measures.

PubMed

Romagnoli, Stefano; Ricci, Zaccaria; Ronco, Claudio

2018-06-26

Acute kidney injury (AKI) is a frequent complication of both cardiac and major non-cardiac surgery. AKI is independently associated with morbidity, mortality, and long-term adverse events including chronic kidney disease in postsurgical patients. Since specific treatment options for kidney failure are very limited, early identification, diagnosis, and renal support strategies are key steps to improve patients' outcome. According to current Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, AKI diagnosis is based on 2 functional markers, serum creatinine increase and urine output decrease, that are not renal-specific and have important limitations. However, preoperative risk stratification for postoperative AKI and/or early diagnosis after surgery could be the best way to apply preventive or timely supportive therapeutic measures. Clinical prediction scores, renal functional reserve assessment, and new biomarkers of kidney stress (suppression of tumorigenicity-2, insulin-like growth factor binding protein-7, tissue inhibitor metalloproteinase-2) may help the clinicians to identify patients at risk of AKI and that could benefit from the application of nephroprotective bundles suggested by the KDIGO guidelines. In severe AKI patients with oligoanuria and fluid accumulation, renal replacement therapy is the only supportive measure even if mode and timing remain open to investigation. Key messages: Perioperative AKI is an important and underdiagnosed complication. Identifying patients at high risk of AKI and diagnosing AKI early are major goals. Preventive interventions are mainly based on the KDIGO guidelines and bundles. Furthermore, a personalized multidisciplinary approach should always be considered to minimize the progression of disease and the complications related to kidney damage. © 2018 S. Karger AG, Basel.

Concept formation: a supportive process for early career nurses.

PubMed

Thornley, Tracey; West, Sandra

2010-09-01

Individuals come to understand abstract constructs such as that of the 'expert' through the formation of concepts. Time and repeated opportunity for observation to support the generalisation and abstraction of the developing concept are essential if the concept is to form successfully. Development of an effective concept of the 'expert nurse' is critical for early career nurses who are attempting to integrate theory, values and beliefs as they develop their clinical practice. This study explores the use of a concept development framework in a grounded theory study of the 'expert nurse'. Qualitative. Using grounded theory methods for data collection and analysis, semi-structured interviews were conducted with registered nurses. The participants were asked to describe their concept of the 'expert nurse' and to discuss their experience of developing this. Participants reported forming their concept of the 'expert nurse', after multiple opportunities to engage with nurses identified as 'expert'. This identification did not necessarily relate to the designated position of the 'expert nurse' or assigned mentors. When the early career nurse does not successfully form a concept of the 'expert nurse', difficulties in personal and professional development including skill/knowledge development may arise. To underpin development of their clinical practice effectively, early career nurses need to be provided with opportunities that facilitate the purposive formation of their own concept of the 'expert nurse'. Formation of this concept is not well supported by the common practice of assigning mentors. Early career nurses must be provided with the time and the opportunity to individually develop and refine their concept of the 'expert nurse'. To achieve this, strategies including providing opportunities to engage with expert nurses and discussion of the process of concept formation and its place in underpinning personal judgments may be of assistance. © 2010 Blackwell Publishing

A novel approach to early sickness absence management: The EASY (Early Access to Support for You) way

PubMed Central

Demou, Evangelia; Brown, Judith; Sanati, Kaveh; Kennedy, Mark; Murray, Keith; Macdonald, Ewan B.

2015-01-01

BACKGROUND: Sickness absence (SA) is multi-causal and remains a significant problem for employees, employers and society. This makes it necessary to concurrently manage a particular disabling condition and consider the working environment and employee-employer relationship. OBJECTIVE: To describe and examine the components of a novel SA management service Early Access to Support for You (EASY) and discuss their potential influence on the intervention. METHODS: A new sickness absence model, starting from day one of absence, was created called EASY. EASY is planned to support both employees and managers and comprises elements already found to be associated with reduction of SA, such as maintaining regular contact; early biopsychosocial case-management; physiotherapy; mental-health counselling; work modification; phased return-to-work; and health promotion activities. RESULTS: During the EASY implementation period, the SA rate at a health board reversed its trend of being one of the highest rates in the Scottish National Health Service (NHS) and EASY was considered helpful by both managers and employees. CONCLUSIONS: This paper describes an innovative occupational health intervention to sickness absence management based on the bio-psychosocial model to provide early intervention, and discusses the pros and cons of applying cognitive behavioural principles at an early stage in sickness-absence events, in order to improve return-to-work outcomes. PMID:26409380

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

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.

Friend and Family Contact and Support in Early Widowhood

PubMed Central

2014-01-01

Objectives. This study explored the relative contributions of friends and family to the social and emotional well-being of women and men in the first 2–6 months following the death of their spouse or partner. Methods. Three hundred and twenty-eight widowed men (39%) and women aged 50 and older completed self-administered questionnaires that included measures of contact and satisfaction with friends and family, as well as measures of affective (i.e., grief and depression) and self-evaluative (i.e., coping self-efficacy, mastery, self-esteem) responses to loss. Results. Regression analyses supported the positive features of social support and interaction but particularly highlight the role of friends: ease of contact and satisfaction with friendship support were associated with more positive self-evaluative aspects of loss; greater frequency of friendship help was associated with more negative affective reactions, whereas higher satisfaction with friendship support was associated with more positive affective reactions. Discussion. These analyses support the voluntary and socializing functions of friendship and social support, bolstering individuals during stressful life transitions, advancing our understanding of the underexamined and particularly distinct functions of friendship in the early phases of spousal loss. PMID:24170717

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

Issues of Implementation of Early Childhood Education and Support Programs.

ERIC Educational Resources Information Center

Prinsen, Bert

This document comprises three papers related to the implementation of early childhood education, health care, and support programs. The first paper is a brief reflection on the nature of implementation, based on the contributions of Boudewijn Bekkers. The second is a proceedings chapter by Marian Hanrahan titled "Community Based Innovative…

Effects of early support intervention on workplace ergonomics--a two-year followup study.

PubMed

Turja, Johanna; Kaleva, Simo; Kivistö, Marketta; Seitsamo, Jorma

2012-01-01

The purpose of the controlled longitudinal study was to determine the effect of a tailored early support intervention method on workers' workplace ergonomics. The main areas of the early support intervention were training, guidance and support for supervisors in finding weak signals of impaired ergonomics. Supervisors were also trained to bring up these weak signals in discussion with employees and to make necessary changes at the workplace. The data consisted of 301 intervention subjects and 235 control subjects working in the field of commerce. The questionnaires were carried out in 2008 and in 2010, and the response rates among both groups were 45%. We used multivariate repeated measures analysis of variance (MANOVA) to test the difference in the groups at two points of time. The main result was that in the areas of work environment, the interaction between group and time was statistically significant (p=0.0004). The work environment improved in the intervention group, but deteriorated in the control. Working methods improved due to the interventions, but physical load factors increased over time in both groups. According to the study, tailored early support intervention has a generally beneficial impact on workers' workplace ergonomics in the areas of work methods, work environment and accident factors.

Can lay responder defibrillation programmes improve survival to hospital discharge following an out-of-hospital cardiac arrest?

PubMed

Smith, Leigh M; Davidson, Patricia M; Halcomb, Elizabeth J; Andrew, Sharon

2007-11-01

The importance of early defibrillation in improving outcomes and reducing morbidity following out-of-hospital cardiac arrest underscores the importance of examining novel approaches to treatment access. The increasing evidence to support the importance of early defibrillation has increased attention on the potential for lay responders to deliver this therapy. This paper seeks to critically review the literature that evaluates the impact of lay responder defibrillator programs on survival to hospital discharge following an out-of-hospital cardiac arrest in the adult population. The electronic databases, Medline and CINAHL, were searched using keywords including; "first responder", "lay responder", "defibrillation" and "cardiac arrest". The reference lists of retrieved articles and the Internet were also searched. Articles were included in the review if they reported primary data, in the English language, which described the effect of a lay responder defibrillation program on survival to hospital discharge from out-of-hospital cardiac arrest in adults. Eleven studies met the inclusion criteria. The small number of published studies, heterogeneity of study populations and study outcome methods prohibited formal meta-analysis. Therefore, narrative analysis was undertaken. Studies included in this report provided inconsistent findings in relation to survival to hospital discharge following out-of-hospital cardiac arrest. Although there are limited data, the role of the lay responder appears promising in improving the outcome from out-of-hospital cardiac arrest following early defibrillation. Despite the inherent methodological difficulties in studying this population, future research should address outcomes related to morbidity, mortality and cost-effectiveness.

Supporting Data-Informed Practice among Early Career Teachers: The Role of Mentors

ERIC Educational Resources Information Center

Jimerson, Jo Beth; Choate, Marnie R.; Dietz, Laurel K.

2015-01-01

Equipping teachers to use data is a critical piece of the school improvement puzzle. To help early career teachers (ECT) develop data-use acumen, some districts utilize mentoring supports. While research on mentoring in general is well-developed, research on how mentoring can or does support data-informed practice is not. To address this gap, we…

West Hackberry Strategic Petroleum Reserve site brine disposal monitoring, Year I report. Volume V. Supporting data for estuarine hydrology, discharge plume analysis, chemical oceanography, biological oceanography, and data management. Final report

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

DeRouen, L.R.; Hann, R.W.; Casserly, D.M.

1983-02-01

This project centers around the Strategic Petroleum Site (SPR) known as the West Hackberry salt dome which located in southwestern Louisiana, and which is designed to store 241 million barrels of crude oil. Oil storage caverns are formed by injecting water into salt deposits, and pumping out the resulting brine. Studies described in this report were designed as follow-on studies to three months of pre-discharge characterization work, and include data collected during the first year of brine leaching operations. The objectives were to: (1) characterize the environment in terms of physical, chemical and biological attributes; (2) determine if significant adversemore » changes in ecosystem productivity and stability of the biological community are occurring as a result of brine discharge; and (3) determine the magnitude of any change observed. Volume V contains appendices for the following: supporting data for estuarine hydrology and hydrography; supporting data analysis of discharge plume; supporting data for water and sediment chemistry; CTD/DO and pH profiles during biological monitoring; supporting data for nekton; and supporting data for data management.« less

Community-Based Learning to Support South African Early Group Care

ERIC Educational Resources Information Center

Casper, Virginia; Lamb-Parker, Faith

2012-01-01

The Developing Families Project-South Africa (DFP-SA) is a community-based model of education and training for the care, support and education of vulnerable children birth-to-three and their caregivers, guardians and families in rural and peri-urban townships. The approach fosters interactive learning among community members about early care and…

North Carolina State Supported Early Childhood Demonstration Centers. Second Annual Evaluation: 1970-1971.

ERIC Educational Resources Information Center

Learning Inst. of North Carolina, Durham.

The second year of a state supported early childhood education program was evaluated, using a pre-post evaluation design involving experimental and control groups. An Early Childhood Assessment Battery was administered to 720 five-year-olds enrolled in the kindergarten program by their teachers. The control group (178) were tested locally. Results…

South Korean Early Childhood Education Teachers' Perceptions of Program-Wide Positive Behavior Support

ERIC Educational Resources Information Center

Noh, Jina; Steed, Elizabeth A.; Kim, Kyungmin

2016-01-01

The authors conducted a survey of 169 South Korean early childhood education teachers regarding the importance and implementation of strategies associated with the Program-Wide Positive Behavior Support (PWPBS) framework (L. Fox & M. L. Hemmeter, 2009) to support social competence and prevent young children's challenging behavior. Analyses…

Post discharge problems in women recovering from coronary artery bypass graft surgery.

PubMed

Gallagher, Robyn; McKinley, Sharon; Dracup, Kathleen

2004-11-01

This study was conducted to describe the types and frequency of problems Australian women experience when recovering at home in the first 6 weeks following coronary artery bypass graft (CABG) surgery and the relationship between symptom experience and psychological distress. A convenience sample of 52 women (mean age 66.31 years, range 53-79 years) who had uncomplicated CABG surgery was selected from two tertiary hospitals in Sydney. A descriptive design was used with information related to post-operative problems collected by telephone interview at 1, 3 and 6 weeks post discharge using a semistructured questionnaire. Psychological distress was assessed at 12 weeks post discharge using the Hospital Anxiety and Depression Scale (HADS). Responses were categorised, collapsed and described using frequencies and percentages. Relationships were assessed by Spearman's r. The most common problems in the first and third weeks post discharge were sleeplessness and nausea or poor appetite and chest incision pain. Although problems improved over the first 6 weeks post-operatively, approximately one-quarter of the women still reported chest incision pain and almost 40% reported problems with leg wounds and oedema. The number of problems experienced at 6 weeks was significantly correlated with depression at 12 weeks. These findings support the importance of a preoperative education programme that includes anticipation of physical problems in the immediate post-operative period and a follow-up of female patients in the early transition period following hospital discharge.

Nutritional recommendations for the late-preterm infant and the preterm infant after hospital discharge.

PubMed

Lapillonne, Alexandre; O'Connor, Deborah L; Wang, Danhua; Rigo, Jacques

2013-03-01

Early nutritional support of preterm infants is critical to life-long health and well being. Numerous studies have demonstrated that preterm infants are at increased risk of mortality and morbidity, including disturbances in brain development. To date, much attention has focused on enhancing the nutritional support of very low and extremely low birth weight infants to improve survival and quality of life. In most countries, preterm infants are sent home before their expected date of term birth for economic or other reasons. It is debatable whether these newborns require special nutritional regimens or discharge formulas. Furthermore, guidelines that specify how to feed very preterm infants after hospital discharge are scarce and conflicting. On the other hand, the late-preterm infant presents a challenge to health care providers immediately after birth when decisions must be made about how and where to care for these newborns. Considering these infants as well babies may place them at a disadvantage. Late-preterm infants have unique and often-unrecognized medical vulnerabilities and nutritional needs that predispose them to greater rates of morbidity and hospital readmissions. Poor or inadequate feeding during hospitalization may be one of the main reasons why late-preterm infants have difficulty gaining weight right after birth. Providing optimal nutritional support to late premature infants may improve survival and quality of life as it does for very preterm infants. In this work, we present a review of the literature and provide separate recommendations for the care and feeding of late-preterm infants and very preterm infants after discharge. We identify gaps in current knowledge as well as priorities for future research. Copyright © 2013 Mosby, Inc. All rights reserved.

Predicting externalizing and internalizing behavior in kindergarten: examining the buffering role of early social support.

PubMed

Heberle, Amy E; Krill, Sarah C; Briggs-Gowan, Margaret J; Carter, Alice S

2015-01-01

This study tested an ecological model predicting children's behavior problems in kindergarten from risk and protective factors (parent psychological distress, parenting behavior, and social support) during early childhood. Study participants were 1,161 sociodemographically diverse mother-child pairs that participated in a longitudinal birth cohort study. The predictor variables were collected at two separate time points and based on parent reports; children were an average of 2 years old at Time 1 and 3 years old at Time 2. The outcome measures were collected when children reached kindergarten and were 6 years old on average. Our results show that early maternal psychological distress, mediated by suboptimal parenting behavior, predicts children's externalizing and internalizing behaviors in kindergarten. Moreover, early social support buffers the relations between psychological distress and later suboptimal parenting behavior and between suboptimal parenting behavior and later depressive/withdrawn behavior. Our findings have several implications for early intervention and prevention efforts. Of note, informal social support appears to play an important protective role in the development of externalizing and internalizing behavior problems, weakening the link between psychological distress and less optimal parenting behavior and between suboptimal parenting behavior and children's withdrawal/depression symptoms. Increasing social support may be a productive goal for family and community-level intervention.

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.

Parental Depression, Overreactive Parenting, and Early Childhood Externalizing Problems: Moderation by Social Support.

PubMed

Taraban, Lindsay; Shaw, Daniel S; Leve, Leslie D; Natsuaki, Misaki N; Ganiban, Jody M; Reiss, David; Neiderhiser, Jenae M

2018-02-20

This study used a large (N = 519), longitudinal sample of adoptive families to test overreactive parenting as a mediator of associations between parental depressive symptoms and early childhood externalizing, and parents' social support satisfaction as a moderator. Maternal parenting (18 months) mediated the association between maternal depressive symptoms (9 months) and child externalizing problems (27 months). Paternal parenting was not a significant mediator. Unexpectedly, we found a cross-over effect for the moderating role of social support satisfaction, such that partners' social support satisfaction reduced the strength of the association between each parent's own depressive symptoms and overreactive parenting. Results point to the importance of accounting for broader family context in predicting early childhood parenting and child outcomes. © 2018 The Authors. Child Development © 2018 Society for Research in Child Development, Inc.

45 CFR 690.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 3 2013-10-01 2013-10-01 false Early termination of research support: Evaluation of applications and proposals. 690.123 Section 690.123 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION PROTECTION OF HUMAN SUBJECTS § 690.123 Early termination...

14 CFR 1230.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Early termination of research support... AERONAUTICS AND SPACE ADMINISTRATION PROTECTION OF HUMAN SUBJECTS § 1230.123 Early termination of research... applicable program requirements, when the department or agency head finds an institution has materially...

45 CFR 690.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Early termination of research support: Evaluation of applications and proposals. 690.123 Section 690.123 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION PROTECTION OF HUMAN SUBJECTS § 690.123 Early termination...

14 CFR 1230.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Early termination of research support: Evaluation of applications and proposals. 1230.123 Section 1230.123 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION PROTECTION OF HUMAN SUBJECTS § 1230.123 Early termination of research...

14 CFR 1230.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Early termination of research support: Evaluation of applications and proposals. 1230.123 Section 1230.123 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION PROTECTION OF HUMAN SUBJECTS § 1230.123 Early termination of research...

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

Early Childhood Teachers' Professional Learning in Early Algebraic Thinking: A Model that Supports New Knowledge and Pedagogy

ERIC Educational Resources Information Center

Warren, Elizabeth

2009-01-01

The implementation of a new mathematics syllabus in the elementary context is problematic, especially if it contains a new content area. A professional development model, Transformative Teaching in the Early Years Mathematics (TTEYM) was specifically developed to support the implementation of the new Patterns and Algebra strand. The model was…

Life After the Event: A Review of Basic Life Support Training for Parents Following Apparent Life-Threatening Events and Their Experience and Practices Following Discharge.

PubMed

Macken, W L; Clarke, N; Nadeem, M; Coghlan, D

2017-05-10

Apparent Life-Threatening Events (ALTEs) are a common presentation to paediatric hospitals and represent a significant cause of parental anxiety. Basic Life Support (BLS) training is recommended for all caregivers following ALTEs. This study aimed to assess the rate of caregiver BLS training and reviewed parents experience following discharge. Parents were interviewed by phone following discharge. Over the study period 25 children attended the Emergency Department with ALTE, 17/25 (68%) were trained and 13/17 (76%) were contactable for interview. All parents found training decreased their anxiety level and were interested in attending for re-training. BLS resuscitation was subsequently required by 2/13 (15%) of children. Non-medical grade monitors were in use by 10/13 (77%) of caregivers following discharge. Caregivers are eager to engage in BLS training and it effectively reduces their caregiver anxiety. We recommend an increase in instructor staff and use of group re-training post discharge.

Social Validity: Perceptions of Check and Connect with Early Literacy Support

ERIC Educational Resources Information Center

Miltich Lyst, Aimee; Gabriel, Stacey; O'Shaughnessy, Tam E.; Meyers, Joel; Meyers, Barbara

2005-01-01

This article underscores the potential advantages of qualitative methods to illustrate the depth and complexity of social validity. This investigation evaluates the social validity of Check and Connect with Early Literacy Support (CCEL), through the perspectives of teachers and caregivers whose children participated in the intervention. Teachers…

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.

38 CFR 16.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Early termination of research support: Evaluation of applications and proposals. 16.123 Section 16.123 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS PROTECTION OF HUMAN SUBJECTS § 16.123 Early termination of...

38 CFR 16.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Early termination of research support: Evaluation of applications and proposals. 16.123 Section 16.123 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS PROTECTION OF HUMAN SUBJECTS § 16.123 Early termination of...

It's Not Rocket Science: The Perspectives of Indigenous Early Childhood Workers on Supporting the Engagement of Indigenous Families in Early Childhood Settings

ERIC Educational Resources Information Center

Grace, Rebekah; Trudgett, Michelle

2012-01-01

This paper presents the findings from semi-structured interviews with six Indigenous Australian early childhood workers who were asked about how Indigenous families might be better supported to engage with early childhood education and care services. The workers identified three key barriers to family participation: transport difficulties, family…

Do Children's Executive Functions Account for Associations Between Early Autonomy-Supportive Parenting and Achievement Through High School?

PubMed

Bindman, Samantha W; Pomerantz, Eva M; Roisman, Glenn I

2015-08-01

This study evaluated whether the positive association between early autonomy-supportive parenting and children's subsequent achievement is mediated by children's executive functions. Using observations of mothers' parenting from the NICHD Study of Early Child Care and Youth Development ( N = 1,306), analyses revealed that mothers' autonomy support over the first 3 years of life predicted enhanced executive functions (i.e., inhibition, delay of gratification, and sustained attention) during the year prior to kindergarten and academic achievement in elementary and high school even when mothers' warmth and cognitive stimulation, as well as other factors (e.g., children's early general cognitive skills and mothers' educational attainment) were covaried. Mediation analyses demonstrated that over and above other attributes (e.g., temperament), children's executive functions partially accounted for the association between early autonomy-supportive parenting and children's subsequent achievement.

The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization

PubMed Central

2018-01-01

PURPOSE: To evaluate the impact of a postdischarge ostomy support program as an adjunct to nurse-led ostomy care on preventable healthcare utilization. DESIGN: A cross-sectional study. SUBJECTS AND SETTING: A postdischarge support program offered by an ostomy product's manufacturer provides persons living with an ostomy with patient-centered and easily accessible assistance. Individuals who underwent ostomy surgery within 18 months prior to the survey date were selected from an ostomy patient database maintained by the ostomy patient support program provider. Of 7026 surveys sent to program enrollees, 493 (7%) responded, compared with 225 (5%) out of 4149 surveys sent to individuals in a comparison group. The 2 groups were similar in demographics. A majority of the survey respondents were female (60% of program enrollees vs 55% of respondents in the comparison group). Among the program enrollees, 44% had colostomy, 43% had ileostomy, 10% had urostomy, and 4% had at least 2 types of ostomy surgery compared with 52%, 32%, 12%, and 4% of the respondents in a comparison group, respectively. METHODS: The study compared hospital readmission and emergency room (ER) visit rates attributable to ostomy complications between program enrollees and respondents in the comparison group. The event rates were measured in 2 study periods: within the first month of discharge and after the first month of discharge. Eligible individuals received an online survey that included the following domains: characteristics of ostomy surgery; readmissions and ER visits within the first month or after the first month of discharge, including reasons for preventable events; and level of health care access. Multivariate logistic regressions controlling for covariates were applied to investigate associations between program enrollment and ostomy-related readmission or ER visit rates. RESULTS: Logistic regression analyses showed that, when compared with respondents in the comparison group, program

The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization.

PubMed

Rojanasarot, Sirikan

To evaluate the impact of a postdischarge ostomy support program as an adjunct to nurse-led ostomy care on preventable healthcare utilization. A cross-sectional study. A postdischarge support program offered by an ostomy product's manufacturer provides persons living with an ostomy with patient-centered and easily accessible assistance. Individuals who underwent ostomy surgery within 18 months prior to the survey date were selected from an ostomy patient database maintained by the ostomy patient support program provider. Of 7026 surveys sent to program enrollees, 493 (7%) responded, compared with 225 (5%) out of 4149 surveys sent to individuals in a comparison group. The 2 groups were similar in demographics. A majority of the survey respondents were female (60% of program enrollees vs 55% of respondents in the comparison group). Among the program enrollees, 44% had colostomy, 43% had ileostomy, 10% had urostomy, and 4% had at least 2 types of ostomy surgery compared with 52%, 32%, 12%, and 4% of the respondents in a comparison group, respectively. The study compared hospital readmission and emergency room (ER) visit rates attributable to ostomy complications between program enrollees and respondents in the comparison group. The event rates were measured in 2 study periods: within the first month of discharge and after the first month of discharge. Eligible individuals received an online survey that included the following domains: characteristics of ostomy surgery; readmissions and ER visits within the first month or after the first month of discharge, including reasons for preventable events; and level of health care access. Multivariate logistic regressions controlling for covariates were applied to investigate associations between program enrollment and ostomy-related readmission or ER visit rates. Logistic regression analyses showed that, when compared with respondents in the comparison group, program enrollees had a significantly lower likelihood of being

Supporting early career health investigators in Kenya: A qualitative study of HIV/AIDS research capacity building.

PubMed

Daniels, Joseph; Nduati, Ruth; Kiarie, James; Farquhar, Carey

2015-01-01

Strategies to transfer international health research training programs to sub-Saharan African institutions focus on developing cadres of local investigators who will lead such programs. Using a critical leadership theory framework, we conducted a qualitative study of one program to understand how collaborative training and research can support early career investigators in Kenya toward the program transfer goal. We used purposive sampling methods and a semi-structured protocol to conduct in-depth interviews with US (N = 5) and Kenyan (N = 5) independent investigators. Transcripts were coded using a two-step process, and then compared with each other to identify major themes. A limited local research environment, funding needs and research career mentorship were identified as major influences on early career researchers. Institutional demands on Kenyan faculty to teach rather than complete research restricted investigators' ability to develop research careers. This was coupled with lack of local funding to support research. Sustainable collaborations between Kenyan, US and other international investigators were perceived to mitigate these challenges and support early career investigators who would help build a robust local research environment for training. Mutually beneficial collaborations between Kenyan and US investigators developed during training mitigate these challenges and build a supportive research environment for training. In these collaborations, early career investigators learn how to navigate the complex international research environment to build local HIV research capacity. Shared and mutually beneficial resources within international research collaborations are required to support early career investigators and plans to transfer health research training to African institutions.

Predicting Externalizing and Internalizing Behavior in Kindergarten: Examining the Buffering Role of Early Social Support

PubMed Central

Heberle, Amy E.; Krill, Sarah C.; Briggs-Gowan, Margaret J.; Carter, Alice S.

2014-01-01

Objective This study tested an ecological model predicting children’s behavior problems in kindergarten from risk and protective factors (parent psychological distress, parenting behavior, and social support) during early childhood. Method Study participants were 1161 socio-demographically diverse mother-child pairs who participated in a longitudinal birth cohort study. The predictor variables were collected at two separate time points and based on parent reports; children were an average of two years old at Time 1 and three years old at Time 2. The outcome measures were collected when children reached Kindergarten and were six years old on average. Results Our results show that early maternal psychological distress, mediated by sub-optimal parenting behavior, predicts children’s externalizing and internalizing behaviors in kindergarten. Moreover, early social support buffers the relations between psychological distress and later sub-optimal parenting behaviors and between sub-optimal parenting behavior and later depressive/withdrawn behavior. Conclusions Our findings have several implications for early intervention and prevention efforts. Of note, informal social support appears to play an important protective role in the development of externalizing and internalizing behavior problems, weakening the link between psychological distress and less optimal parenting behavior and between sub-optimal parenting behavior and children’s withdrawal/depression symptoms. Increasing social support may be a productive goal for family and community-level intervention. PMID:24697587

Charging and discharging Teflon

NASA Technical Reports Server (NTRS)

Passenheim, B. C.; Vanlint, V. A. J.

1981-01-01

The charging and discharging characteristics of several common satellite materials exposed to 0-30KV electrons are measured. Teflon is discussed because the charging characteristics are radically altered immediately after a spontaneous discharge. The exterior geometry of the test structure is shown. In all cases dielectric samples were 82 cm in diameter mounted on the front of a 120 cm diameter cylinder supported on an 85 cm, 0.95 cm thick plexiglass disc. Dielectric materials investigated were: back surface aluminized Kapton, back surface silvered Teflon, silicon alkyd white thermal control paint, and 50 cm by 50 cm array of 0.030 cm thick MgF2 coated fused silica solar cell cover slips.

Do Children's Executive Functions Account for Associations Between Early Autonomy-Supportive Parenting and Achievement Through High School?

PubMed Central

Bindman, Samantha W.; Pomerantz, Eva M.; Roisman, Glenn I.

2015-01-01

This study evaluated whether the positive association between early autonomy-supportive parenting and children's subsequent achievement is mediated by children's executive functions. Using observations of mothers’ parenting from the NICHD Study of Early Child Care and Youth Development (N = 1,306), analyses revealed that mothers’ autonomy support over the first 3 years of life predicted enhanced executive functions (i.e., inhibition, delay of gratification, and sustained attention) during the year prior to kindergarten and academic achievement in elementary and high school even when mothers’ warmth and cognitive stimulation, as well as other factors (e.g., children's early general cognitive skills and mothers’ educational attainment) were covaried. Mediation analyses demonstrated that over and above other attributes (e.g., temperament), children's executive functions partially accounted for the association between early autonomy-supportive parenting and children's subsequent achievement. PMID:26366009

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

Yes They Can: Supporting Bachelor Degree Attainment for Early Childhood Practitioners

ERIC Educational Resources Information Center

Sakai, Laura; Kipnis, Fran; Whitebook, Marcy; Schaack, Diana

2014-01-01

As part of a longitudinal study, the authors interviewed 73 nontraditional students regarding their perceptions of the challenges experienced and supports received as they returned to school to earn bachelor's degrees. All participants were working in the early care and education field. Interviewees perceived the cohort structure of their B.A.…

Hospital Discharge Within 1 Day After Total Joint Arthroplasty From a Veterans Affairs Hospital Does Not Increase Complication and Readmission Rates.

PubMed

Kiskaddon, Eric M; Lee, Jessica H; Meeks, Brett D; Barnhill, Spencer W; Froehle, Andrew W; Krishnamurthy, Anil

2018-05-01

Attempts to control costs associated with total joint arthroplasty have included efforts to shorten hospital length of stay (LOS). Concerns related to patient outcomes and safety with decreased LOS persist. The purpose of this study was to investigate whether discharge on postoperative day (POD) 1 after joint replacement is associated with increased rates of 90-day return to the operating room, and 30-day readmissions and emergency department (ED) visits. After chart review, 447 patients admitted between January 2, 2013 and September 16, 2016 met inclusion criteria. All patients underwent one total joint arthroplasty. Patients were either discharged on POD 1 (subgroup 1) or POD 2 or 3 (subgroup 2). Statistical evaluation was performed using Wilcoxon-Mann-Whitney tests for continuous variables, and Fisher exact tests for categorical and frequency data. Statistical significance was established at P ≤ .05. Subgroup 1 had significantly fewer return trips to the operating room (P = .043) and significantly fewer 30-day readmissions (P = .033). ED visits were not significantly different between groups (P = .901). Early discharge after joint arthroplasty appears to be a viable practice and did not result in increased rates of reoperation within the 90-day global period, or rates of 30-day readmission and ED visits. Our results support the utilization of an early discharge protocol on POD 1, with no evidence that shorter LOS results in higher rates of short-term complications. Copyright © 2017 Elsevier Inc. All rights reserved.

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.

Early Warning Indicator System: Supporting K-12 Educators in the Identification, Support, and Monitoring of At-Risk Students

ERIC Educational Resources Information Center

Massachusetts Department of Elementary and Secondary Education, 2016

2016-01-01

A rise in data availability gives educators the opportunity to tailor instructional practices and interventions to student needs and invest resources in areas where students require the most support. Massachusetts developed the Early Warning Indicator System (EWIS), which synthesizes the wealth of student data available in the state, including…

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

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.

Safe discharge and outpatient investigation of ureteric colic: a retrospective analysis.

PubMed

Stewart, Michael

2017-07-12

Computed tomography of the kidneys, ureters and bladder is the recommended imaging modality for suspected urolithiasis. Early scanning is advised in guidelines, but there is limited published evidence to support this recommendation. In a retrospective study, we reviewed patients managed according to a local guideline. Patients without high-risk features were either imaged during their initial visit (if in the daytime) or discharged for outpatient scans. Complications, unplanned returns, final diagnosis, and intervention rates were compared between groups. Fifty-four patients were scanned during their initial visit and 151 were scanned as an outpatient at a median interval of 10 days. Unplanned return rates were lower in those scanned as outpatients (7.3 vs. 24.1%), with no significant difference in complications (2.0 vs. 3.7%; none leading to permanent harm). Those scanned as outpatients were less likely to have a stone proven by imaging (39.7 vs. 64.8%), but did not have a significantly higher rate of proven alternative diagnosis (9.3 vs. 13.0%). There is no evidence in this cohort that discharging patients for outpatient imaging is associated with poorer outcomes, provided that an appropriate clinical risk assessment is carried out.

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

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.

16 CFR § 1028.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Early termination of research support... PRODUCT SAFETY COMMISSION GENERAL PROTECTION OF HUMAN SUBJECTS § 1028.123 Early termination of research... applicable program requirements, when the department or agency head finds an institution has materially...

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.

Information and professional support: key factors in the provision of family-centred early childhood intervention services.

PubMed

Fordham, L; Gibson, F; Bowes, J

2012-09-01

Much has been written on the principles of family-centred practice and on the service delivery methods and skills required of its practitioners. Far less has been written from the perspective of families whose children have a disability. The aims of this study were twofold: firstly to understand families' experiences of family-centred early childhood intervention services and secondly to explore other factors that might impact on these experiences. One hundred and thirty families attending two established early childhood intervention services in New South Wales, Australia completed a survey incorporating the Measure of Processes of Care-56, the Family Empowerment Scale, the Family Support Scale and the Parenting Daily Hassles Scale. Consistent with previous research using the Measure of Processes of Care-56, 'respectful and supportive care' was the domain of care families rated to occur most and 'provision of general information' was the domain they rated to occur least. Significant positive relationships existed between families' ratings of family-centred care and feelings of empowerment. Being provided with general information was strongly correlated with family empowerment. Families' social support networks played an important role but support from professionals was most strongly correlated with families' experiences of family-centred care. Finally, families whose children's early intervention services were co-ordinated by a professional experienced significantly better care. The provision of general information and professional support are key components of family-centred early childhood intervention services. © 2011 Blackwell Publishing Ltd.

Early nutritional support in severe traumatic patients.

PubMed

Chuntrasakul, C; Siltharm, S; Chinswangwatanakul, V; Pongprasobchai, T; Chockvivatanavanit, S; Bunnak, A

1996-01-01

Multiple trauma is associated with altered metabolism, wasting of the lean body mass and compromised wound healing. Nutritional support is one way to improve the condition of these critically ill patients. We performed a prospective randomized study on the effect of early nutritional support in severely injured patients admitted to the Division of Traumatic Surgery, Siriraj Hospital between June 1992 and January 1994. Thirty-eight severe traumatic patients with ISS between 20-40 were randomly divided into control and study group. The 17 patients in the control group were treated in the conventional method with administration of hypo caloric intravenous regimen and supplement with oral diet as soon as the bowel function was returned. The 21 patients of the study group were fed either by enteral or parenteral feeding or both with an appropriate caloric and protein requirement as soon as hemodynamic status was stabilized. We found the study group had a lower mortality rate, a lower complication rate, a shorter period of ICU stay, and an earlier weaning from the ventilator than the control group. The study group also lost less weight than the control group. Nitrogen balance in the study group was significantly lower than the control group.

Predicting Early Spelling: The Contribution of Children's Early Literacy, Private Speech during Spelling, Behavioral Regulation, and Parental Spelling Support

ERIC Educational Resources Information Center

Aram, Dorit; Abiri, Shimrit; Elad, Lili

2014-01-01

The present study aimed to extend understanding of preschoolers' early spelling using the Vygotskian ("Mind in society: the development of higher psychological processes," Cambridge, Harvard University Press, 1978) paradigm of child development. We assessed the contribution of maternal spelling support in predicting children's word…

Spheres of discharge of springs

NASA Astrophysics Data System (ADS)

Springer, Abraham E.; Stevens, Lawrence E.

2009-02-01

Although springs have been recognized as important, rare, and globally threatened ecosystems, there is as yet no consistent and comprehensive classification system or common lexicon for springs. In this paper, 12 spheres of discharge of springs are defined, sketched, displayed with photographs, and described relative to their hydrogeology of occurrence, and the microhabitats and ecosystems they support. A few of the spheres of discharge have been previously recognized and used by hydrogeologists for over 80 years, but others have only recently been defined geomorphologically. A comparison of these spheres of discharge to classification systems for wetlands, groundwater dependent ecosystems, karst hydrogeology, running waters, and other systems is provided. With a common lexicon for springs, hydrogeologists can provide more consistent guidance for springs ecosystem conservation, management, and restoration. As additional comprehensive inventories of the physical, biological, and cultural characteristics are conducted and analyzed, it will eventually be possible to associate spheres of discharge with discrete vegetation and aquatic invertebrate assemblages, and better understand the habitat requirements of rare or unique springs species. Given the elevated productivity and biodiversity of springs, and their highly threatened status, identification of geomorphic similarities among spring types is essential for conservation of these important ecosystems.

Multiplex electric discharge gas laser system

NASA Technical Reports Server (NTRS)

Laudenslager, James B. (Inventor); Pacala, Thomas J. (Inventor)

1987-01-01

A multiple pulse electric discharge gas laser system is described in which a plurality of pulsed electric discharge gas lasers are supported in a common housing. Each laser is supplied with excitation pulses from a separate power supply. A controller, which may be a microprocessor, is connected to each power supply for controlling the application of excitation pulses to each laser so that the lasers can be fired simultaneously or in any desired sequence. The output light beams from the individual lasers may be combined or utilized independently, depending on the desired application. The individual lasers may include multiple pairs of discharge electrodes with a separate power supply connected across each electrode pair so that multiple light output beams can be generated from a single laser tube and combined or utilized separately.

Perceived Autonomy Support in the NIMH RAISE Early Treatment Program.

PubMed

Browne, Julia; Penn, David L; Bauer, Daniel J; Meyer-Kalos, Piper; Mueser, Kim T; Robinson, Delbert G; Addington, Jean; Schooler, Nina R; Glynn, Shirley M; Gingerich, Susan; Marcy, Patricia; Kane, John M

2017-09-01

This study examined perceived support for autonomy-the extent to which individuals feel empowered and supported to make informed choices-among participants in the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE ETP). The aims of this study were to evaluate whether NAVIGATE, the active treatment studied in RAISE ETP, was associated with greater improvements in perceived autonomy support over the two-year intervention, compared with community care, and to examine associations between perceived autonomy support and quality of life and symptoms over time and across treatment groups. This study examined perceived autonomy support among the 404 individuals with first-episode psychosis who participated in the RAISE ETP trial (NAVIGATE, N=223; community care, N=181). Three-level conditional linear growth modeling was used given the nested data structure. The results indicated that perceived autonomy support increased significantly over time for those in NAVIGATE but not in community care. Once treatment began, higher perceived autonomy support was related to higher quality of life at six, 12, and 18 months in NAVIGATE and at 12, 18, and 24 months in community care. Higher perceived autonomy support was related to improved scores on total symptoms and on excited symptoms regardless of treatment group and time. Overall, perceived autonomy support increased in NAVIGATE but not for those in community care and was related to improved quality of life and symptoms across both treatment groups. Future research should examine the impact of perceived autonomy support on a wider array of outcomes, including engagement, medication adherence, and functioning.

Early breastfeeding problems: A mixed method study of mothers' experiences.

PubMed

Feenstra, Maria Monberg; Jørgine Kirkeby, Mette; Thygesen, Marianne; Danbjørg, Dorthe B; Kronborg, Hanne

2018-06-01

Breastfeeding problems are common and associated with early cessation. Still length of postpartum hospital stay has been reduced. This leaves new mothers to establish breastfeeding at home with less support from health care professionals. The objective was to explore mothers' perspectives on when breastfeeding problems were the most challenging and prominent early postnatal. The aim was also to identify possible factors associated with the breastfeeding problems. In a cross-sectional study, a mixed method approach was used to analyse postal survey data from 1437 mothers with full term singleton infants. Content analysis was used to analyse mothers' open text descriptions of their most challenging breastfeeding problem. Multiple logistic regression was used to calculate odds ratios for early breastfeeding problems according to sociodemographic- and psychosocial factors. Up to 40% of the mothers had experienced early breastfeeding problems. The problems were associated with the mother, the infant and to lack of support from health care professionals. Most prominent problems were infant's inability to latch on (40%) and mothers having sore, wounded and cracked nipples (38%). Pain often occurred when experiencing breastfeeding problems. Factors associated with the problems were primiparity, lower self-efficacy and lower self-perceived knowledge of breastfeeding. Mothers with no or short education reported less frequently breastfeeding problems. Breastfeeding problems occurred frequently in the early postnatal period and often caused breastfeeding to be painful. Health care professionals should prepare mothers to deal with possible breastfeeding problems. New support options should be reviewed in an early postnatal discharge setting. Copyright © 2018 Elsevier B.V. All rights reserved.

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.

Evaluating and Supporting Early Childhood Teachers

ERIC Educational Resources Information Center

Passe, Angèle Sancho

2015-01-01

There's a lot of conversation in the early childhood community on evaluating teachers to improve their performance. Raising the quality of early care and education is a priority for policymakers and practitioners on local, state, and federal levels. As a result, much attention is being focused on early childhood educators to ensure that they do a…

A Mobile Early Stimulation Program to Support Children with Developmental Delays in Brazil.

PubMed

Dias, Raquel da Luz; Silva, Kátia Cristina Correa Guimarães; Lima, Marcela Raquel de Oliveira; Alves, João Guilherme Bezerra; Abidi, Syed Sibte Raza

2018-01-01

Developmental delay is a deviation development from the normative milestones during the childhood and it may be caused by neurological disorders. Early stimulation is a standardized and simple technique to treat developmental delays in children (aged 0-3 years), allowing them to reach the best development possible and to mitigate neuropsychomotor sequelae. However, the outcomes of the treatment depending on the involvement of the family, to continue the activities at home on a daily basis. To empower and educate parents of children with neurodevelopmental delays to administer standardized early stimulation programs at home, we developed a mobile early stimulation program that provides timely and evidence-based clinical decision support to health professionals and a personalized guidance to parents about how to administer early stimulation to their child at home.

Understanding rehospitalization risk: can hospital discharge be modified to reduce recurrent hospitalization?

PubMed

Strunin, Lee; Stone, Meg; Jack, Brian

2007-09-01

A high rate of unnecessary rehospitalization has been shown to be related to a poorly managed discharge processes. A qualitative study was conducted in order to understand the phenomenon of frequent rehospitalization from the perspective of discharged patients and to determine if activities at the time of discharge could be designed to reduce the number of adverse events and rehospitalization. Semistructured, open-ended interviews were conducted with 21 patients during their hospital stay at Boston Medical Center. Interviews assessed continuity of care after discharge, need for and availability of social support, and ability to obtain follow-up medical care. Difficult life circumstances posed a greater barrier to recuperation than lack of medical knowledge. All participants were able to describe their medical condition, the reasons they were admitted to the hospital, and the discharge instructions they received. All reported the types of medications being taken or the conditions for which the medications were prescribed. Recuperation was compromised by factors that contribute to undermining the ability of patients to follow their doctors' recommendations including support for medical and basic needs, substance use, and limitations in the availability of transportation to medical appointments. Distress, particularly depression, further contributed to poor health and undermined the ability to follow doctors' recommendations and the discharge plans. Discharge interventions that assess the need for social support and provide access and services have the potential to reduce chronic rehospitalization. (c) 2007 Society of Hospital Medicine.

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

Discharge, water quality, and native fish abundance in the Virgin River, Utah, Nevada, and Arizona, in support of Pah Tempe Springs discharge remediation efforts

USGS Publications Warehouse

Miller, Matthew P.; Lambert, Patrick M.; Hardy, Thomas B.

2014-01-01

Pah Tempe Springs discharge hot, saline, low dissolved-oxygen water to the Virgin River in southwestern Utah, which is transported downstream to Lake Mead and the Colorado River. The dissolved salts in the Virgin River negatively influence the suitability of this water for downstream agricultural, municipal, and industrial use. Therefore, various remediation scenarios to remove the salt load discharged from Pah Tempe Springs to the Virgin River are being considered. One concern about this load removal is the potential to impact the ecology of the Virgin River. Specifically, information is needed regarding possible impacts of Pah Tempe Springs remediation scenarios on the abundance, distribution, and survival of native fish in the Virgin River. Future efforts that aim to quantitatively assess how various remediation scenarios to reduce the load of dissolved salts from Pah Tempe Springs into the Virgin River may influence the abundance, distribution, and survival of native fish will require data on discharge, water quality, and native fish abundance. This report contains organized accessible discharge, water quality, and native fish abundance data sets from the Virgin River, documents the compilation of these data, and discusses approaches for quantifying relations between abiotic physical and chemical conditions, and fish abundance.

Supporting Early Learning Act

THOMAS, 113th Congress

Rep. Himes, James A. [D-CT-4

2014-02-03

House - 06/13/2014 Referred to the Subcommittee on Early Childhood, Elementary, and Secondary Education. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Radical prostatectomy - discharge

MedlinePlus

... prostatectomy - discharge; Laparoscopic radical prostatectomy - discharge; LRP - discharge; Robotic-assisted laparoscopic prostatectomy - discharge; RALP - discharge; Pelvic lymphadenectomy - discharge; Prostate cancer - prostatectomy

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

Very low rate of readmission after an early discharge outpatient model for autografting in multiple myeloma patients: an Italian multicenter retrospective study.

PubMed

Martino, Massimo; Montanari, Mauro; Ferrara, Felicetto; Ciceri, Fabio; Scortechini, Ilaria; Palmieri, Salvatore; Marktel, Sarah; Cimminiello, Michele; Messina, Giuseppe; Irrera, Giuseppe; Offidani, Massimo; Console, Giuseppe; Castagna, Luca; Milone, Giuseppe; Bruno, Benedetto; Tripepi, Giovanni; Lemoli, Roberto Massimo; Olivieri, Attilio

2014-07-01

We analyzed the main modalities and clinical outcomes of the early discharge outpatient model in autologous stem cell transplantation (EDOM-ASCT) for multiple myeloma in Italy. EDOM-ASCT was employed in 382 patients, for a total of 522 procedures, between 1998 and 2012. Our study showed high homogeneity among centers in terms of inclusion criteria, supportive care, and in hospital readmission criteria. Overall, readmissions during the aplastic phase occurred in 98 of 522 transplantations (18.8%). The major extrahematological complication was neutropenic fever in 161 cases (30.8%), which required readmission in 76 cases. The incidence of severe World Health Organization grade 3 to 4 mucositis was 9.6%. By univariate analysis, fever, mucositis, altered renal function at diagnosis, second transplantation, and transplantation performed late in the course of the disease were significantly correlated with readmission, whereas fever, mucositis, altered renal function, and timing of transplantation remained the only independent predictors by multivariate analysis. Overall, transplantation-related mortality was 1.0%. No center effect was observed in this study (P = .36). The safety and low rate of readmission of the EDOM-ASCT in myeloma trial suggest that this strategy could be extended to other transplantation centers if a stringent patient selection and appropriate management are applied. Copyright © 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Strategic Programming for Early University Entrants: Creating Support for Socio-Emotional Needs

ERIC Educational Resources Information Center

Lancour, Julie A.

2011-01-01

This article introduces "Resiliency Training," a program designed to support early university entrants as they take on the challenges and adventures of their sophomore and junior year at the University of Washington (UW). As the Academic Counselor and Counseling Services Coordinator for the Robinson Center, watching the students engage…

Experiences, Perceived Challenges, and Support Systems of Early College High School Students

ERIC Educational Resources Information Center

Sáenz, Karen P.; Combs, Julie P.

2015-01-01

In this qualitative study, the prior experiences, perceived challenges, and support systems of 17 Grade 12 Hispanic students at an early college high school were explored using the framework of social capital theory. Utilizing Moustakas's phenomenological design, data were collected using focus group and individuals interviews. Several themes…

Discharge start-up and ramp-up development for NSTX-U and MAST-U

NASA Astrophysics Data System (ADS)

Battaglia, D. J.; Boyer, M. D.; Gerhardt, S. P.; Menard, J. E.; Mueller, D.; Cunningham, G.; Kirk, A.; Kogan, L.; McArdle, G.; Pangione, L.; Thornton, A. J.; Ren, E.

2017-10-01

A collaborative modeling effort is underway to develop robust inductive start-up and ramp-up scenarios for NSTX-U and MAST-U. These complementary spherical tokamak devices aim to generate the physics basis for achieving steady-state, high-beta and high-confinement plasma discharges with a self-consistent solution for managing the divertor heat flux. High-performance discharges in these devices require sufficient plasma elongation (κ = 2.4 - 2.8) to maximize the bootstrap and beam-driven current drive, increase MHD stability at high Ip and high βN, and realize advanced divertor geometries such as the snowflake and super-X. Achieving the target elongation on NSTX-U is enabled by an L-H transition in the current ramp-up that slows the current diffusion and maintains a low internal inductance (li <= 0.8). Modeling focuses on developing scenarios that achieve a suitable field null for breakdown and discharge conditions conducive to an early L-H transition while maintaining vertical and MHD stability, with appropriate margin for variation in experimental conditions. The toroidal currents induced in conducting structures and the specifications of the real-time control and power supply systems are unique constraints for the two devices. Work Supported by U.S. DOE Contract No. DE-AC02-09CH11466 and the RCUK Energy Programme [Grant Number EP/P012450/1].

Preparing breast cancer patients for survivorship (PREP) - a pilot study of a patient-centred supportive group visit intervention.

PubMed

Thompson, Joanne; Coleman, Rob; Colwell, Brigitte; Freeman, Jenny; Greenfield, Diana; Holmes, Karen; Mathers, Nigel; Reed, Malcolm

2014-02-01

The process of breast cancer follow-up has psychosocial benefits for patients, notably reassurance, although attending hospital appointments can increase anxiety. Discharge from hospital follow-up can also invoke anxiety as many patients seek reassurance from continued specialist follow-up. Inevitably, due to increased survival and associated resource issues, opportunities for follow-up and support will be reduced. We delivered and evaluated an intervention which supported the transition from cancer patient to cancer survivor, for breast cancer patients being discharged to primary care. We delivered and evaluated a pilot of a patient-centred group intervention 'Preparing Patients for Discharge', aimed at reducing distress. Between January and September 2008, 172 participants were recruited and 74 (43%) expressed an interest in participating in the intervention; 32 of 74 took part, and participated in its evaluation using a semi-structured evaluation questionnaire, standardized measures [Hospital Anxiety and Depression Scale (HADS) and Clinical Outcomes for Routine Evaluation (CORE)] and independent qualitative interviews. The qualitative analysis of questionnaire data indicated key factors were 1) shared experience, 2) support and reassurance, and 3) positive views about cancer and being discharged. The interview data revealed that the intervention enabled participants to: share experiences, focus on emotional needs, and have open discussions about recurrence, while increasing confidence in being discharged and using alternative support services. However, no significant differences were found in pre-post-interventions scores of HADS and CORE. Providing a structured group intervention approach for breast cancer patients offers an early opportunity to support cancer survivors and facilitate and encourage self-management. Copyright © 2013 Elsevier Ltd. All rights reserved.

Citizen Science to Support Community-based Flood Early Warning and Resilience Building

NASA Astrophysics Data System (ADS)

Paul, J. D.; Buytaert, W.; Allen, S.; Ballesteros-Cánovas, J. A.; Bhusal, J.; Cieslik, K.; Clark, J.; Dewulf, A.; Dhital, M. R.; Hannah, D. M.; Liu, W.; Nayaval, J. L.; Schiller, A.; Smith, P. J.; Stoffel, M.; Supper, R.

2017-12-01

In Disaster Risk Management, an emerging shift has been noted from broad-scale, top-down assessments towards more participatory, community-based, bottom-up approaches. Combined with technologies for robust and low-cost sensor networks, a citizen science approach has recently emerged as a promising direction in the provision of extensive, real-time information for flood early warning systems. Here we present the framework and initial results of a major new international project, Landslide EVO, aimed at increasing local resilience against hydrologically induced disasters in western Nepal by exploiting participatory approaches to knowledge generation and risk governance. We identify three major technological developments that strongly support our approach to flood early warning and resilience building in Nepal. First, distributed sensor networks, participatory monitoring, and citizen science hold great promise in complementing official monitoring networks and remote sensing by generating site-specific information with local buy-in, especially in data-scarce regions. Secondly, the emergence of open source, cloud-based risk analysis platforms supports the construction of a modular, distributed, and potentially decentralised data processing workflow. Finally, linking data analysis platforms to social computer networks and ICT (e.g. mobile phones, tablets) allows tailored interfaces and people-centred decision- and policy-support systems to be built. Our proposition is that maximum impact is created if end-users are involved not only in data collection, but also over the entire project life-cycle, including the analysis and provision of results. In this context, citizen science complements more traditional knowledge generation practices, and also enhances multi-directional information provision, risk management, early-warning systems and local resilience building.

Assessing infant and maternal readiness for newborn discharge.

PubMed

Jing, Ling; Bethancourt, Casidhe-Nicole; McDonagh, Thomas

2017-10-01

The review highlights the shift from prescribed length of stay (LOS) to mother-infant dyad readiness as the basis for making discharge decisions for healthy term newborns. We describe the components of readiness that should be considered in making the decision, focusing on infant clinical readiness, and maternal and familial readiness. Although the Newborns' and Mothers' Health Protection Act of 1996 aimed to protect infants and mothers by establishing a minimum LOS, the American Academy of Pediatrics 2015 policy on newborn discharge acknowledges the shift from LOS-based to readiness-based discharge decision-making. Healthcare providers must consider a variety of infant and maternal characteristics in determining the appropriate time to discharge a dyad, and mothers should be actively involved in the decision-making process. Criteria for infant clinical readiness include the following: establishment of effective feeding, evaluation of jaundice risk, review and discussion of infant and household vaccination status, obtainment of specimen for metabolic screening, tests of hearing ability, assessment of sepsis risk factors, screening for congenital heart disease, and evaluation of parental knowledge about infant safety measures. Important consideration should also be given to the mother's sociodemographic vulnerabilities, maternal confidence and perception of discharge readiness, and availability of postdischarge care continuity. The timing of newborn discharge should be a joint decision made by the mother and healthcare providers based on readiness. The decision should consider the infant's health status, the mother's health status, the mother's perception of readiness, and the availability of social and familial support for the mother and infant. Accessible and comprehensive support postdischarge is also important for helping infants achieve optimal health outcomes.

14 CFR § 1230.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Early termination of research support... termination of research support: Evaluation of applications and proposals. (a) The department or agency head... prescribed in applicable program requirements, when the department or agency head finds an institution has...

Benefits of early specialized nutritional support in malnourished patients.

PubMed

Morán López, Jesús Manuel; Beneítez Moralejo, Belén; Piedra León, María; Enciso Izquierdo, Fidel Jesús; Luengo Pérez, Luis Miguel; Amado Señaris, José Antonio

2017-04-07

Disease related malnutrition (DRM) is highly prevalent in Spain, affecting 23% of in-hospital patients, and is associated with clinical complications. Specialized nutritional support (SNS) can reduce these complications. Prospective study carried out in standard clinical practice conditions to test if SNS during the first 5 days of hospitalization, or subsequently, was associated to a lower length of stay or reduced complications in patients with a NRS-2002 score≥3 points. In the group of patients who initiated early SNS, the length of stay was 8.83 days shorter than in the group with a later introduction (95% CI 3.55-14.10); nevertheless, the higher prevalence of male and oncological patients in this group could have impacted the results. A tendency towards a statistically significant lower mortality rate and a reduced amount of total complications was described. The early introduction of SNS (within the first 5 days of hospitalization) in patients with DRM was associated with a 32.4% reduction in the length of stay. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Discharge interventions for older patients leaving hospital: protocol for a systematic meta-review.

PubMed

O'Connell Francischetto, Elaine; Damery, Sarah; Davies, Sarah; Combes, Gill

2016-03-16

There is an increased need for additional care and support services for the elderly population. It is important to identify what support older people need once they are discharged from hospital and to ensure continuity of care. There is a large evidence base focusing on enhanced discharge services and their impact on patients. The services show some potential benefits, but there are inconsistent findings across reviews. Furthermore, it is unclear what elements of enhanced discharge interventions could be most beneficial to older people. This meta-review aims to identify existing systematic reviews of discharge interventions for older people, identify potentially effective elements of enhanced discharge services for this patient group and identify areas where further work may still be needed. The search will aim to identify English language systematic reviews that have assessed the effectiveness of discharge interventions for older people. The following databases will be searched: Medline, Embase, PsycINFO, HMIC, Social Policy and Practice, CINAHL, the Cochrane Library, ASSIA, Social Science Citation Index and the Grey Literature Report. The search strategy will comprise the keywords 'systematic reviews', 'older people' and 'discharge'. Discharge interventions must aim to support older patients before, during and/or after discharge from hospital. Outcomes of interest will include mortality, readmissions, length of hospital stay, patient health status, patient and carer satisfaction and staff views. Abstract, title and full text screening will be conducted independently by two reviewers. Data extracted from reviews will include review characteristics, patient population, review quality score, outcome measures and review findings, and a narrative synthesis will be conducted. This review will identify existing reviews of discharge interventions and appraise how these interventions can impact outcomes in older people such as readmissions, health status, length of

Effects of Need Supportive Teaching on Early Adolescents' Motivation and Engagement: A Review of the Literature

ERIC Educational Resources Information Center

Stroet, Kim; Opdenakker, Marie-Christine; Minnaert, Alexander

2013-01-01

In the present paper we systematically review the corpus of evidence on the effects of need supportive teaching on early adolescents' motivation and engagement for school. Based on Self-Determination Theory, we define need supportive teaching in terms of teachers' provision of autonomy support, structure, and involvement. The results of an…

Episodic representations support early semantic learning: evidence from midazolam induced amnesia.

PubMed

Merritt, Paul; Hirshman, Elliot; Zamani, Shane; Hsu, John; Berrigan, Michael

2006-07-01

Current controversy exists regarding the role of episodic representations in the formation of long-term semantic memories. Using the drug midazolam to induce temporary amnesia we tested participants' memories for newly learned facts in a semantic cue condition or an episodic and semantic cue condition. Following midazolam administration, memory performance was superior in the episodic and semantic condition, suggesting early semantic learning is supported by episodic representations.

45 CFR 690.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Welfare (Continued) NATIONAL SCIENCE FOUNDATION PROTECTION OF HUMAN SUBJECTS § 690.123 Early termination... require that department or agency support for any project be terminated or suspended in the manner...

45 CFR 690.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Welfare (Continued) NATIONAL SCIENCE FOUNDATION PROTECTION OF HUMAN SUBJECTS § 690.123 Early termination... require that department or agency support for any project be terminated or suspended in the manner...

45 CFR 690.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Welfare (Continued) NATIONAL SCIENCE FOUNDATION PROTECTION OF HUMAN SUBJECTS § 690.123 Early termination... require that department or agency support for any project be terminated or suspended in the manner...

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.

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.

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.

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.

Conceptual Foundations and Components of a Contextual Intervention to Promote Student Engagement during Early Adolescence: The Supporting Early Adolescent Learning and Social Success (SEALS) Model

ERIC Educational Resources Information Center

Farmer, Thomas W.; Hamm, Jill V.; Lane, Kathleen L.; Lee, David; Sutherland, Kevin S.; Hall, Cristin M.; Murray, Robert A.

2013-01-01

Decades of research indicate that many early adolescents are at risk for developing significant school adjustment problems in the academic, behavioral, and social domains during the transition to middle school. The Supporting Early Adolescent Learning and Social Success (SEALS) model has been developed as a professional development and…

[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

Impact of a new aggressive nutrition policy incorporating early introduction of parenteral nutrition and mother's own milk on growth of preterm infants.

PubMed

Low, Chuen Siang; Ho, Jacqueline J; Nallusamy, Revathy

2016-11-01

Most of the evidence on early feeding of preterm infants was derived from high income settings, it is equally important to evaluate whether it can be successfully implemented into less resourced settings. This study aimed to compare growth and feeding of preterm infants before and after the introduction of a new aggressive feeding policy in Penang Hospital, a tertiary referral hospital in a middle income country. The new aggressive feeding policy was developed mainly from Cochrane review evidence, using early parenteral and enteral nutrition with standardized breastfeeding counselling aimed at empowering mothers to provide early expressed milk. A total of 80 preterm babies (34 weeks and below) discharged from NICU were included (40 pre- and 40 post-intervention). Pre and post-intervention data were compared. The primary outcome was growth at day 7, 14, 21 and at discharge and secondary outcomes were time to full oral feeding, breastfeeding rates, and adverse events. Complete data were available for all babies to discharge. One baby was discharged prior to day 14 and 10 babies before day 21, so growth data for these babies were unavailable. Baseline data were similar in the two groups. There was no significant weight difference at 7, 14, 21 days and at discharge. More post-intervention babies were breastfed at discharge than pre-intervention babies (21 vs. 8, P=0.005). Nosocomial infection (11 vs. 4, P=0.045), and blood transfusion were significantly lower in the postintervention babies than in the pre-intervention babies (31 vs. 13, P=0.01). The post-intervention babies were more likely to achieve shorter median days (interquartile range) to full oral feeding [11 (6) days vs. 13 (11) days, P=0.058] and with lower number affecting necrotising enterocolitis (0 vs. 5, P=0.055). Early aggressive parenteral nutrition and early provision of mother's milk did not result in improved growth as evidenced by weight gain at discharge. However we found more breastfeeding babies

Effective partnership working: a case study of hospital discharge.

PubMed

Henwood, Melanie

2006-09-01

The process of discharging patients from hospital provides a critical indicator of the state of partnership working between health and social care agencies. In many ways, hospital discharge can be seen to epitomise the challenges which beset partnership working. For patients who have care needs which continue following their discharge from hospital, how well health and social care partners are able to coordinate their policies and practice is critical. Where arrangements work well, patients should experience a seamless transition; where things go wrong, patients are all too often caught in the middle of contested debate between health and social care authorities over who is responsible for what. In 2002, growing concerns over the numbers of mainly elderly people who were experiencing delays in being discharged from hospital led to the announcement that a system of 'cross-charging' would be introduced to target delayed discharges which were the responsibility of local authority social services departments. The government's proposals were widely criticised and were the focus of much antagonism. The intervention of the Change Agent Team (an agency with responsibility for providing practical support to tackle delayed discharges) marked a turning point in the presentation of the policy and in supporting local implementation efforts. This paper examines partnership working between health and social care by exploring the specific issues which this case study of hospital discharge provides. The analysis highlights the importance of understanding the dynamics of partnership working on the ground. It also underlines the need for a new relationship between central government and local agencies when old-style models of command and control are no longer fit for purpose. A new approach is required that addresses the complex and multiple relationships which characterise the new partnership agenda.

The Impact of Communities of Practice in Support of Early-Career Academics

ERIC Educational Resources Information Center

Cox, Milton D.

2013-01-01

This paper traces the history and impact of communities of practice (CoPs) in supporting early-career academics, although the primary focus here in the United States is on the faculty learning community (FLC) model, a special type of CoP in higher education. The initial development of this model, beginning in 1979, takes place over two decades at…

Submillimeter Wave Astronomy Satellite (SWAS) Launch and Early Orbit Support Experiences

NASA Technical Reports Server (NTRS)

Kirschner, S.; Sedlak, J.; Challa, M.; Nicholson, A.; Sande, C.; Rohrbaugh, D.

1999-01-01

The Submillimeter Wave Astronomy Satellite (SWAS) was successfully launched on December 6, 1998 at 00:58 UTC. The two year mission is the fourth in the series of Small Explorer (SMEX) missions. SWAS is dedicated to the study of star formation and interstellar chemistry. SWAS was injected into a 635 km by 650 km orbit with an inclination of nearly 70 deg by an Orbital Sciences Corporation Pegasus XL launch vehicle. The Flight Dynamics attitude and navigation teams supported all phases of the early mission. This support included orbit determination, attitude determination, real-time monitoring, and sensor calibration. This paper reports the main results and lessons learned concerning navigation, support software, star tracker performance, magnetometer and gyroscope calibrations, and anomaly resolution. This includes information on spacecraft tip-off rates, first-day navigation problems, target acquisition anomalies, star tracker anomalies, and significant sensor improvements due to calibration efforts.

Identifying barriers to medication discharge counselling by pharmacists.

PubMed

Walker, Sandra A N; Lo, Jennifer K; Compani, Sara; Ko, Emily; Le, Minh-Hien; Marchesano, Romina; Natanson, Rimona; Pradhan, Rahim; Rzyczniak, Grace; Teo, Vincent; Vyas, Anju

2014-05-01

discharge counselling by pharmacists. These findings should raise awareness of the challenges faced by pharmacists in busy hospital positions and may support avenues of change for their hospital discharge counselling programs.

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

Tools to Support Human Factors and Systems Engineering Interactions During Early Analysis

NASA Technical Reports Server (NTRS)

Thronesbery, Carroll; Malin, Jane T.; Holden, Kritina; Smith, Danielle Paige

2005-01-01

We describe an approach and existing software tool support for effective interactions between human factors engineers and systems engineers in early analysis activities during system acquisition. We examine the tasks performed during this stage, emphasizing those tasks where system engineers and human engineers interact. The Concept of Operations (ConOps) document is an important product during this phase, and particular attention is paid to its influences on subsequent acquisition activities. Understanding this influence helps ConOps authors describe a complete system concept that guides subsequent acquisition activities. We identify commonly used system engineering and human engineering tools and examine how they can support the specific tasks associated with system definition. We identify possible gaps in the support of these tasks, the largest of which appears to be creating the ConOps document itself. Finally, we outline the goals of our future empirical investigations of tools to support system concept definition.

Tools to Support Human Factors and Systems Engineering Interactions During Early Analysis

NASA Technical Reports Server (NTRS)

Thronesbery, Carroll; Malin, Jane T.; Holden, Kritina; Smith, Danielle Paige

2006-01-01

We describe an approach and existing software tool support for effective interactions between human factors engineers and systems engineers in early analysis activities during system acquisition. We examine the tasks performed during this stage, emphasizing those tasks where system engineers and human engineers interact. The Concept of Operations (ConOps) document is an important product during this phase, and particular attention is paid to its influences on subsequent acquisition activities. Understanding this influence helps ConOps authors describe a complete system concept that guides subsequent acquisition activities. We identify commonly used system engineering and human engineering tools and examine how they can support the specific tasks associated with system definition. We identify possible gaps in the support of these tasks, the largest of which appears to be creating the ConOps document itself. Finally, we outline the goals of our future empirical investigations of tools to support system concept definition.

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 ...

Background experiences, time allocation, time on teaching and perceived support of early-career college science faculty

NASA Astrophysics Data System (ADS)

Sagendorf, Kenneth S.

The purposes of this research were to create an inventory of the research, teaching and service background experiences of and to document the time allocation and time spent on teaching by early-career college science faculty members. This project is presented as three distinct papers. Thirty early-career faculty in the science disciplines from sixteen different institutions in their first year of employment participated in this study. For the first two papers, a new survey was developed asking participants to choose which experiences they had acquired prior to taking their current faculty position and asking them to document their time allocation and time spent on teaching activities in an average work week. In addition, a third component documents the support early-career college faculty in the sciences are receiving from the perspective of faculty members and their respective department chairpersons and identifies areas of disagreement between these two different groups. Twenty early-career college science faculty and their respective department chairpersons completed a newly-designed survey regarding the support offered to new faculty. The survey addressed the areas of feedback on performance, clarity of tenure requirements, mentoring, support for teaching and scholarship and balancing faculty life. This dissertation presents the results from these surveys, accounting for different demographic variables such as science discipline, gender and institutional category.

Early Support Development of Children with Disorders of the Biopsychosocial Functioning in Poland

ERIC Educational Resources Information Center

Czyz, Anna

2017-01-01

This article presents the results of a research study on the system of early child development support with developmental disabilities and their families in Poland. The analysis covered areas such as proximity and accessibility of services, infrastructural conditions, preparation of personnel, and occurrence of systemic barriers. The article…

Pathways from Mothers' Early Social Support to Children's Language Development at Age 3

ERIC Educational Resources Information Center

Chang, Young Eun

2017-01-01

The relationships between early maternal social support, maternal psychological well-being, the home learning environment, and children's language skills at age 3 in Korean families were examined. We hypothesized that maternal social support would predict children's language development through its effect on maternal psychological well-being and…

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.

Understanding the occupational and organizational boundaries to safe hospital discharge.

PubMed

Waring, Justin; Marshall, Fiona; Bishop, Simon

2015-01-01

Safe hospital discharge relies upon communication and coordination across multiple occupational and organizational boundaries. Our aim was to understand how these boundaries can exacerbate health system complexity and represent latent sociocultural threats to safe discharge. An ethnographic study was conducted in two local health and social care systems (health economies) in England, focusing on two clinical areas: stroke and hip fracture patients. Data collection involved 345 hours of observations and 220 semi-structured interviews with health and social care professionals, patients and their lay carers. Hospital discharge involves a dynamic network of interactions between heterogeneous health and social care actors, each characterized by divergent ways of organizing discharge activities; cultures of collaboration and interaction and understanding of what discharge involves and how it contributes to patient recovery. These interrelated dimensions elaborate the occupational and organisational boundaries that can influence communication and coordination in hospital discharge. Hospital discharge relies upon the coordination of multiple actors working across occupational and organizational boundaries. Attention to the sociocultural boundaries that influence communication and coordination can help inform interventions that might support enhanced discharge safety. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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.

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

Higher Quality and Lower Cost from Improving Hospital Discharge Decision Making*

PubMed Central

Cox, James C.; Sadiraj, Vjollca; Schnier, Kurt E.; Sweeney, John F.

2015-01-01

This paper reports research on improving decisions about hospital discharges – decisions that are now made by physicians based on mainly subjective evaluations of patients’ discharge status. We report an experiment on uptake of our clinical decision support software (CDSS) which presents physicians with evidence-based discharge criteria that can be effectively utilized at the point of care where the discharge decision is made. One experimental treatment we report prompts physician attentiveness to the CDSS by replacing the default option of universal “opt in” to patient discharge with the alternative default option of “opt out” from the CDSS recommendations to discharge or not to discharge the patient on each day of hospital stay. We also report results from experimental treatments that implement the CDSS under varying conditions of time pressure on the subjects. The experiment was conducted using resident physicians and fourth-year medical students at a university medical school as subjects. PMID:28239219

Do Children's Executive Functions Account for Associations between Early Autonomy-Supportive Parenting and Achievement through High School?

ERIC Educational Resources Information Center

Bindman, Samantha W.; Pomerantz, Eva M.; Roisman, Glenn I.

2015-01-01

This study evaluated whether the positive association between early autonomy-supportive parenting and children's subsequent achievement is mediated by children's executive functions. Using observations of mothers' parenting from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development (N…

Barriers and facilitators to implementing family support and education in Early Psychosis Intervention programmes: A systematic review.

PubMed

Selick, Avra; Durbin, Janet; Vu, Nhi; O'Connor, Karen; Volpe, Tiziana; Lin, Elizabeth

2017-10-01

Family support is a core component of the Early Psychosis Intervention (EPI) model, yet it continues to have relatively low rates of implementation in practice. This paper reports results of a literature review on facilitators and barriers to delivering family interventions in EPI programmes. A search was conducted of 4 electronic databases, Medline, EMBASE, PsycINFO and Joanna Briggs, from 2000 to 2015 using terms related to early onset psychosis, family work and implementation. Four thousand four hundred and two unique studies were identified, 7 of which met inclusion criteria. Barriers and facilitators were coded and aggregated to higher-level themes using a consensus approach. Five of 7 studies examined structured multifamily psychoeducation. Uptake by families was affected by: family/client interest and readiness to participate; ability to access supports; and support needs/preferences. Implementation by programmes was affected by staff access to training and resources to provide family support. A key finding across the identified studies was that families have different needs and preferences regarding the timing, length, intensity and content of the intervention. One size does not fit all and many families do not require the intensive psychoeducational programmes typically provided. The reviewed literature suggests that flexible, tiered approaches to care may better meet family needs and increase rates of uptake of family support. However, more research is needed on the effectiveness of different models of family support in early psychosis and how they can be successfully implemented. © 2017 John Wiley & Sons Australia, Ltd.

Earth Observing System (EOS) Aqua Launch and Early Mission Attitude Support Experiences

NASA Technical Reports Server (NTRS)

Tracewell, D.; Glickman, J.; Hashmall, J.; Natanson, G.; Sedlak, J.

2003-01-01

The Earth Observing System (EOS) Aqua satellite was successfully launched on May 4,2002. Aqua is the second in the series of EOS satellites. EOS is part of NASA s Earth Science Enterprise Program, whose goals are to advance the scientific understanding of the Earth system. Aqua is a three-axis stabilized, Earth-pointing spacecraft in a nearly circular, sun-synchronous orbit at an altitude of 705 km. The Goddard Space Flight Center (GSFC) Flight Dynamics attitude team supported all phases of the launch and early mission. This paper presents the main results and lessons learned during this period, including: real-time attitude mode transition support, sensor calibration, onboard computer attitude validation, response to spacecraft emergencies, postlaunch attitude analyses, and anomaly resolution. In particular, Flight Dynamics support proved to be invaluable for successful Earth acquisition, fine-point mode transition, and recognition and correction of several anomalies, including support for the resolution of problems observed with the MODIS instrument.

Association between History of Gestational Diabetes and Exclusive Breastfeeding at Hospital Discharge.

PubMed

Haile, Zelalem T; Oza-Frank, Reena; Azulay Chertok, Ilana R; Passen, Nina

2016-08-01

Exclusive breastfeeding is recommended in the first 6 months of life, especially for infants born to women with a history of gestational diabetes mellitus (GDM). Yet, women with a history of GDM face challenges with exclusive breastfeeding in the early postpartum period, a critical period for setting up longer term breastfeeding success. Minimal research has been published on associated risk factors for not exclusively breastfeeding. The purpose of this study was to examine the association between GDM and exclusive breastfeeding at hospital discharge. We conducted a cross-sectional analysis including 2038 women who participated in the population-based Infant Feeding Practices Study II between May 2005 and June 2007. Gestational diabetes mellitus prevalence was 5.8%. The crude prevalence of exclusive breastfeeding at hospital discharge was 62.2% among women with GDM compared to 75.4% of women without GDM (P < .01). After adjusting for sociodemographic, behavioral, and anthropometric factors, the odds of exclusive breastfeeding were lower among women with GDM compared to women without diabetes (odds ratio = 0.59; 95% confidence interval, 0.39-0.92). Furthermore, women who had gestational weight gain (GWG) below the Institute of Medicine guidelines had lower odds of exclusive breastfeeding compared to women who had normal GWG (odds ratio = 0.62; 95% confidence interval, 0.45-0.85). Women with GDM history and women with inadequate GWG may need additional education to promote exclusive breastfeeding during maternal hospital stay. It is important for health care providers to assess both factors when providing education on exclusive breastfeeding and to support these women's breastfeeding efforts in the early postpartum period to maximize potential for longer term breastfeeding success. © The Author(s) 2015.

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 ...

Early Human Testing Initiative Phase 1 Regenerative Life Support Systems

NASA Image and Video Library

1995-08-08

Early Human Testing (EHT) Initiative Phase 1 Regenerative Life Support Systems Laboratory (RLSSL). Nigel Packham activities in the Variable Pressure Growth Chamber which he lived inside for 15 days. A crowd of well-wishers outside the test chamber, at the console are John Lewis, Ed Mohr and Marybeth Edeen (15577). Packham exiting the chamber (15578-81). Packham is the focus of television cameras and reporters (15582-3). Don Henninger interviewed by reporters (15584). Packham is presented with a jacket after his stay in the chamber (15585). Packham inside the wheat growth chamber checking the condition of the plants (15586-7, 15597). Packham exercising on a recumbant bicycle (15588, 15592). Packham, through the window into the growth chamber, displays a handful of wheat plants to console monitor Dan Barta (15589-90). Group portrait of the team conducting the Early Human Testing Initiative Phase 1 Regenerative Life Support Systems test and include, front row, from left: Jeff Dominick and Don Overton and back row, from left, unidentified member, Marybeth Edeen, Nigel Packham, John Lewis, Ed Mohr, Dan Barta and Tim Monk (15591). Harry Halford prepares to send a package through the airlock to Packham (15593). Packham displays a handful of wheat plants (15594). Packham fixes himself a bowl of cereal (15595) and retrieves a carton of milk from the refrigerator (15596). Packham retrieves a package from the airlock (15598). Packham packs up trash in plastic bag (15599-600) and sends it back through the airlock (15601). Packham gets a cup of water (15602) and heats it in the microwave (15603).

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; ...

Influence of school support on early marriage experiences and health services utilization among young orphaned women in Zimbabwe

PubMed Central

Luseno, Winnie K.; Zhang, Lei; Iritani, Bonita J.; Hartman, Shane; Rusakaniko, Simbarashe; Hallfors, Denise Dion

2017-01-01

School support programs reduce school dropout, early marriage and early pregnancy for a majority of young orphaned women. We used a mixed methods approach to examine why these programs are less effective for a significant minority by exploring their influence on marriage and health services utilization. Participants were from a randomized controlled trial (RCT) testing school support as HIV prevention. Half as many intervention as control participants had been married; married intervention participants had one more year of education compared to married control participants. Receiving school support did not appear to improve health-related factors. Pregnancy was among the most common reasons for marriage across both groups. The greatest benefit of school support appears to be in delaying marriage and pregnancy while increasing educational attainment. PMID:27211856

Influence of school support on early marriage experiences and health services utilization among young orphaned women in Zimbabwe.

PubMed

Luseno, Winnie Kavulani; Zhang, Lei; Iritani, Bonita J; Hartman, Shane; Rusakaniko, Simbarashe; Hallfors, Denise Dion

2017-03-01

School support programs reduce school dropout, early marriage, and early pregnancy for a majority of young orphaned women. We used a mixed-methods approach to examine why these programs are less effective for a significant minority by exploring their influence on marriage and health services utilization. Participants were from a randomized controlled trial testing school support as HIV prevention. Half as many intervention as control participants had been married; married intervention participants had 1 more year of education compared with married control participants. Receiving school support did not appear to improve health-related factors. Pregnancy was among the most common reasons for marriage across both groups. The greatest benefit of school support appears to be in delaying marriage and pregnancy while increasing educational attainment.

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 Intervention to Support the Academic Recovery of First-Year Students at Risk of Non-Continuation

ERIC Educational Resources Information Center

Lizzio, Alf; Wilson, Keithia

2013-01-01

The widening participation agenda and related concerns about student retention require a more systematic focus on supporting student success. This paper describes a process designed with the dual goals of supporting the short-term academic recovery of students at risk of non-continuation due to early difficulties with assessment and developing…

Influence of Neighborhood-level Factors on Social Support in Early-stage Breast Cancer Patients and Controls

PubMed Central

Thompson, Tess; Rodebaugh, Thomas L.; Pérez, Maria; Struthers, Jim; Sefko, Julianne A.; Lian, Min; Schootman, Mario; Jeffe, Donna B.

2016-01-01

Rationale Low social support has been linked to negative health outcomes in breast cancer patients. Objective We examined associations between perceived social support, neighborhood socioeconomic deprivation, and neighborhood-level social support in early-stage breast cancer patients and controls. Methods This two-year longitudinal study in the United States included information collected from telephone interviews and clinical records of 541 early-stage patients and 542 controls recruited from 2003 to 2007. Social support was assessed using the Medical Outcomes Study Social Support Survey (MOS-SS). Residential addresses were geocoded and used to develop measures including neighborhood social support (based on MOS-SS scores from nearby controls) and neighborhood socioeconomic deprivation (a composite index of census tract characteristics). Latent trajectory models were used to determine effects of neighborhood conditions on the stable (intercept) and changing (slope) aspects of social support. Results In a model with only neighborhood variables, greater socioeconomic deprivation was associated with patients’ lower stable social support (standardized estimate = −0.12, p = .027); neighborhood-level social support was associated with social support change (standardized estimate = 0.17, p = .046). After adding individual-level covariates, there were no direct neighborhood effects on social support. In patients, neighborhood socioeconomic deprivation was associated with support indirectly through marriage, insurance status, negative affect, and general health. In controls, neighborhood socioeconomic deprivation was associated with support indirectly through marriage (p < .05). Conclusion Indirect effects of neighborhood socioeconomic deprivation on social support differed in patients and controls. Psychosocial and neighborhood interventions may help patients with low social support, particularly patients without partnered relationships in deprived areas. PMID

Influence of neighborhood-level factors on social support in early-stage breast cancer patients and controls.

PubMed

Thompson, Tess; Rodebaugh, Thomas L; Pérez, Maria; Struthers, James; Sefko, Julianne A; Lian, Min; Schootman, Mario; Jeffe, Donna B

2016-05-01

Low social support has been linked to negative health outcomes in breast cancer patients. We examined associations between perceived social support, neighborhood socioeconomic deprivation, and neighborhood-level social support in early-stage breast cancer patients and controls. This two-year longitudinal study in the United States included information collected from telephone interviews and clinical records of 541 early-stage patients and 542 controls recruited from 2003 to 2007. Social support was assessed using the Medical Outcomes Study Social Support Survey (MOS-SS). Residential addresses were geocoded and used to develop measures including neighborhood social support (based on MOS-SS scores from nearby controls) and neighborhood socioeconomic deprivation (a composite index of census tract characteristics). Latent trajectory models were used to determine effects of neighborhood conditions on the stable (intercept) and changing (slope) aspects of social support. In a model with only neighborhood variables, greater socioeconomic deprivation was associated with patients' lower stable social support (standardized estimate = -0.12, p = 0.027); neighborhood-level social support was associated with social support change (standardized estimate = 0.17, p = 0.046). After adding individual-level covariates, there were no direct neighborhood effects on social support. In patients, neighborhood socioeconomic deprivation was associated with support indirectly through marriage, insurance status, negative affect, and general health. In controls, neighborhood socioeconomic deprivation was associated with support indirectly through marriage (p < 0.05). Indirect effects of neighborhood socioeconomic deprivation on social support differed in patients and controls. Psychosocial and neighborhood interventions may help patients with low social support, particularly patients without partnered relationships in deprived areas. Copyright © 2016 Elsevier Ltd. All rights

Early illness experiences related to unexpected heart surgery: A qualitative descriptive study.

PubMed

Chang, Yu-Ling; Tsai, Yun-Fang

2017-09-01

Most studies on patients' experiences following emergency cardiac surgery focus on evaluation of patients after their discharge. Few studies have evaluated patients' experiences after being transferred from intensive care and before being discharged. This study aimed to describe patients' experiences in the early stages of recovery following emergency heart surgery. For this exploratory qualitative descriptive study, 13 patients were recruited from a medical centre in northern Taiwan. Participants had undergone emergency heart surgery and had resided in the cardiothoracic surgical ward for ≥6 days following transfer from the ICU; all expected to be discharged from the hospital within 3 days. Semi-structured, face-to-face interviews were conducted in private after the patients had been transferred to the cardiothoracic surgical wards. Audiotaped interviews were transcribed and analysed using content analysis. Data analysis identified four themes, which represented different recovery stages: sudden and serious symptoms, nightmares and vivid dreams, physical and emotional disturbances, and establishing a new life after emergency surgery. A fifth theme, support for a new lifestyle, occurred between the four stages. Participants experienced symptoms of physical and psychological stress during the early recovery stages following emergency heart surgery. A lack of understanding of the process of recovery increased these difficulties; participants wanted and needed multidisciplinary care and education. Emergency heart surgery does not allow healthcare professionals to inform patients of what to expect post-surgery. Our findings suggest that rather than waiting until discharge to offer disease information and treatment plans, multidisciplinary care should be initiated as soon as possible to facilitate recovery. Copyright © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Gallbladder removal - laparoscopic - discharge

MedlinePlus

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

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.

[Team Collaboration in Home Medical Care to Support Patients at the End-of-Life - Review of Service Personnel Meeting on Discharge Day].

PubMed

Ogiwara, Miyoko; Irino, Hiromi; Yamaoka, Keita; Fujimaki, Yoko; Watanabe, Mutsuko; Yamamoto, Takeshi; Hirohara, Masayoshi; Kushida, Kazuki

2018-03-01

Due to the rising number of patients at the terminal stage or with high dependence on medical care, the cooperation of 2 teams, the hospital discharge support team and the home support team, has become very important. The recent spread of the Internet has enabled both patients and their families who have chosen home care to obtain a wide range of information about home services, as well as diseases, and form a picture of what will happen. However, there are actually many cases in which patients and families find that things are not as they imagined, and they are uneasy and unsure of what to do. Here, we report a case in which the mismatch between the patient's and family's expectations created an unsatisfactory care situation.

A Gossip or a Good Yack? Reconceptualizing Parent Support in New Zealand Early Childhood Centre Based Programmes

ERIC Educational Resources Information Center

Duncan, Judith; Bowden, Chris; Smith, Anne B.

2006-01-01

Parental support has been an increasingly essential part of New Zealand early childhood (EC) education services over the last 20 years. This support has taken many shapes and forms over this time period, and has depended on the differing philosophies of the EC education services. What this support "looks like" and how it is delivered is…

High-Definition transcranial direct current stimulation in early onset epileptic encephalopathy: a case study.

PubMed

Meiron, Oded; Gale, Rena; Namestnic, Julia; Bennet-Back, Odeya; David, Jonathan; Gebodh, Nigel; Adair, Devin; Esmaeilpour, Zeinab; Bikson, Marom

2018-01-01

Early onset epileptic encephalopathy is characterized by high daily seizure-frequency, multifocal epileptic discharges, severe psychomotor retardation, and death at infancy. Currently, there are no effective treatments to alleviate seizure frequency and high-voltage epileptic discharges in these catastrophic epilepsy cases. The current study examined the safety and feasibility of High-Definition transcranial direct current stimulation (HD-tDCS) in reducing epileptiform activity in a 30-month-old child suffering from early onset epileptic encephalopathy. HD-tDCS was administered over 10 intervention days spanning two weeks including pre- and post-intervention video-EEG monitoring. There were no serious adverse events or side effects related to the HD-tDCS intervention. Frequency of clinical seizures was not significantly reduced. However, interictal sharp wave amplitudes were significantly lower during the post-intervention period versus baseline. Vital signs and blood biochemistry remained stable throughout the entire study. These exploratory findings support the safety and feasibility of 4 × 1 HD-tDCS in early onset epileptic encephalopathy and provide the first evidence of HD-tDCS effects on paroxysmal EEG features in electroclinical cases under the age of 36 months. Extending HD-tDCS treatment may enhance electrographic findings and clinical effects.

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.

Linking Family Support and Early Childhood Programs: Issues, Experiences, Opportunities. Best Practices Project. Commissioned Paper I.

ERIC Educational Resources Information Center

Larner, Mary

The "Guidelines for Effective Practice" series was begun in 1991 to meet the need for better definition and articulation of what constitutes best practice in family support programs. This guide, the first issue of the series, focuses on the importance and necessity of linkages between family support and early childhood programs. Chapter…

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.

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.

Does activity limitation predict discharge destination for postacute care patients?

PubMed

Chang, Feng-Hang; Ni, Pengsheng; Jette, Alan M

2014-09-01

This study aimed to examine the ability of different domains of activity limitation to predict discharge destination (home vs. nonhome settings) 1 mo after hospital discharge for postacute rehabilitation patients. A secondary analysis was conducted using a data set of 518 adults with neurologic, lower extremity orthopedic, and complex medical conditions followed after discharge from a hospital into postacute care. Variables collected at baseline include activity limitations (basic mobility, daily activity, and applied cognitive function, measured by the Activity Measure for Post-Acute Care), demographics, diagnosis, and cognitive status. The discharge destination was recorded at 1 mo after being discharged from the hospital. Correlational analyses revealed that the 1-mo discharge destination was correlated with two domains of activity (basic mobility and daily activity) and cognitive status. However, multiple logistic regression and receiver operating characteristic curve analyses showed that basic mobility functioning performed the best in discriminating home vs. nonhome living. This study supported the evidence that basic mobility functioning is a critical determinant of discharge home for postacute rehabilitation patients. The Activity Measure for Post-Acute Care-basic mobility showed good usability in discriminating home vs. nonhome living. The findings shed light on the importance of basic mobility functioning in the discharge planning process.

The Role of Computer Technology in Supporting Children's Learning in Jordanian Early Years Education

ERIC Educational Resources Information Center

Alkhawaldeh, Mustafa; Hyassat, Mizyed; Al-Zboon, Eman; Ahmad, Jamal

2017-01-01

The current research investigated early years teachers' perspectives regarding the role of computer technology in supporting children's learning in Jordanian kindergartens. Thirty semistructured interviews were conducted with preschool teachers. The sample of kindergartens in this study was purposefully selected from the targeted population of…

Classification of Partial Discharge Measured under Different Levels of Noise Contamination

PubMed Central

2017-01-01

Cable joint insulation breakdown may cause a huge loss to power companies. Therefore, it is vital to diagnose the insulation quality to detect early signs of insulation failure. It is well known that there is a correlation between Partial discharge (PD) and the insulation quality. Although many works have been done on PD pattern recognition, it is usually performed in a noise free environment. Also, works on PD pattern recognition in actual cable joint are less likely to be found in literature. Therefore, in this work, classifications of actual cable joint defect types from partial discharge data contaminated by noise were performed. Five cross-linked polyethylene (XLPE) cable joints with artificially created defects were prepared based on the defects commonly encountered on site. Three different types of input feature were extracted from the PD pattern under artificially created noisy environment. These include statistical features, fractal features and principal component analysis (PCA) features. These input features were used to train the classifiers to classify each PD defect types. Classifications were performed using three different artificial intelligence classifiers, which include Artificial Neural Networks (ANN), Adaptive Neuro-Fuzzy Inference System (ANFIS) and Support Vector Machine (SVM). It was found that the classification accuracy decreases with higher noise level but PCA features used in SVM and ANN showed the strongest tolerance against noise contamination. PMID:28085953

Classification of Partial Discharge Measured under Different Levels of Noise Contamination.

PubMed

Jee Keen Raymond, Wong; Illias, Hazlee Azil; Abu Bakar, Ab Halim

2017-01-01

Cable joint insulation breakdown may cause a huge loss to power companies. Therefore, it is vital to diagnose the insulation quality to detect early signs of insulation failure. It is well known that there is a correlation between Partial discharge (PD) and the insulation quality. Although many works have been done on PD pattern recognition, it is usually performed in a noise free environment. Also, works on PD pattern recognition in actual cable joint are less likely to be found in literature. Therefore, in this work, classifications of actual cable joint defect types from partial discharge data contaminated by noise were performed. Five cross-linked polyethylene (XLPE) cable joints with artificially created defects were prepared based on the defects commonly encountered on site. Three different types of input feature were extracted from the PD pattern under artificially created noisy environment. These include statistical features, fractal features and principal component analysis (PCA) features. These input features were used to train the classifiers to classify each PD defect types. Classifications were performed using three different artificial intelligence classifiers, which include Artificial Neural Networks (ANN), Adaptive Neuro-Fuzzy Inference System (ANFIS) and Support Vector Machine (SVM). It was found that the classification accuracy decreases with higher noise level but PCA features used in SVM and ANN showed the strongest tolerance against noise contamination.

Species-Specific Diversity of a Fixed Motor Pattern: The Electric Organ Discharge of Gymnotus

PubMed Central

Rodríguez-Cattaneo, Alejo; Pereira, Ana Carolina; Aguilera, Pedro A.; Crampton, William G. R.; Caputi, Angel A.

2008-01-01

Understanding fixed motor pattern diversity across related species provides a window for exploring the evolution of their underlying neural mechanisms. The electric organ discharges of weakly electric fishes offer several advantages as paradigmatic models for investigating how a neural decision is transformed into a spatiotemporal pattern of action. Here, we compared the far fields, the near fields and the electromotive force patterns generated by three species of the pulse generating New World gymnotiform genus Gymnotus. We found a common pattern in electromotive force, with the far field and near field diversity determined by variations in amplitude, duration, and the degree of synchronization of the different components of the electric organ discharges. While the rostral regions of the three species generate similar profiles of electromotive force and local fields, most of the species-specific differences are generated in the main body and tail regions of the fish. This causes that the waveform of the field is highly site dependant in all the studied species. These findings support a hypothesis of the relative separation of the electrolocation and communication carriers. The presence of early head negative waves in the rostral region, a species-dependent early positive wave at the caudal region, and the different relationship between the late negative peak and the main positive peak suggest three points of lability in the evolution of the electrogenic system: a) the variously timed neuronal inputs to different groups of electrocytes; b) the appearance of both rostrally and caudally innervated electrocytes, and c) changes in the responsiveness of the electrocyte membrane. PMID:18461122

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

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

Assessment and support during early labour for improving birth outcomes.

PubMed

Kobayashi, Shinobu; Hanada, Nobutsugu; Matsuzaki, Masayo; Takehara, Kenji; Ota, Erika; Sasaki, Hatoko; Nagata, Chie; Mori, Rintaro

2017-04-20

The progress of labour in the early or latent phase is usually slow and may include painful uterine contractions. Women may feel distressed and lose their confidence during this phase. Support and assessment interventions have been assessed in two previous Cochrane Reviews. This review updates and replaces these two reviews, which have become out of date. To investigate the effectiveness of assessment and support interventions for women during early labour.In order to measure the effectiveness of the interventions, we compared the duration of labour, the rate of obstetrical interventions, and the rate of other maternal or neonatal outcomes. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (31 October 2016) and reference lists of retrieved studies. Randomised controlled trials of any assessment or support intervention in the latent phase of labour. We planned to include cluster-randomised trials if they were eligible. We did not include quasi-randomised trials. Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We resolved any disagreement by discussion or by involving a third assessor. The quality of the evidence was assessed using the GRADE approach. We included five trials with a total of 10,421 pregnant women in this review update. The trials were conducted in the UK, Canada and America. The trials compared interventions in early labour versus usual care. We examined three comparisons: early labour assessment versus immediate admission to hospital; home visits by midwives versus usual care (telephone triage); and one-to-one structured midwifery care versus usual care. These trials were at moderate- risk of bias mainly because blinding women and staff to these interventions is not generally feasible. For important outcomes we assessed evidence using

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.

32 CFR 219.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 2 2014-07-01 2014-07-01 false Early termination of research support: Evaluation of applications and proposals. 219.123 Section 219.123 National Defense Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS PROTECTION OF HUMAN SUBJECTS § 219...

16 CFR 1028.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Early termination of research support: Evaluation of applications and proposals. 1028.123 Section 1028.123 Commercial Practices CONSUMER PRODUCT...: Evaluation of applications and proposals. (a) The department or agency head may require that department or...

Mode transition of a Hall thruster discharge plasma

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

Hara, Kentaro, E-mail: kenhara@umich.edu; Sekerak, Michael J., E-mail: msekerak@umich.edu; Boyd, Iain D.

2014-05-28

A Hall thruster is a cross-field plasma device used for spacecraft propulsion. An important unresolved issue in the development of Hall thrusters concerns the effect of discharge oscillations in the range of 10–30 kHz on their performance. The use of a high speed Langmuir probe system and ultra-fast imaging of the discharge plasma of a Hall thruster suggests that the discharge oscillation mode, often called the breathing mode, is strongly correlated to an axial global ionization mode. Stabilization of the global oscillation mode is achieved as the magnetic field is increased and azimuthally rotating spokes are observed. A hybrid-direct kinetic simulationmore » that takes into account the transport of electronically excited atoms is used to model the discharge plasma of a Hall thruster. The predicted mode transition agrees with experiments in terms of the mean discharge current, the amplitude of discharge current oscillation, and the breathing mode frequency. It is observed that the stabilization of the global oscillation mode is associated with reduced electron transport that suppresses the ionization process inside the channel. As the Joule heating balances the other loss terms including the effects of wall loss and inelastic collisions, the ionization oscillation is damped, and the discharge oscillation stabilizes. A wide range of the stable operation is supported by the formation of a space charge saturated sheath that stabilizes the electron axial drift and balances the Joule heating as the magnetic field increases. Finally, it is indicated from the numerical results that there is a strong correlation between the emitted light intensity and the discharge current.« less

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

[Factors facilitating the return of the elderly to their homes after discharge from a geriatric intermediate care facility].

PubMed

Ishizaki, T

1992-02-01

Geriatric intermediate care facilities (GICFs) were started with subsidies from the Ministry of Health and Welfare in 1987 to encourage return of the elderly from hospitals to their homes rather than other destinations such as nursing homes or hospitals. Contrary to the initial expectation, only half of users (the elderly) have returned home. In order to examine the factors influencing destination after discharge from GICFs, characteristics of the users of a GICF and their primary caregivers were analyzed in a rural community in Nagano. The users were grouped according to their discharge destinations (i.e. 1: home, 2: hospital, 3: nursing home and other GICFs) and compared with respect to the users' and caregivers' socio-demographic characteristics, the length of stay, the users' activities of daily living (ADL) and mental status, the type of place before admission and after discharge, and the caring capacity of the family (i.e. manpower, housing conditions, household economic level and social support). A multiple logistic regression analysis revealed that the following factors were correlated to their return home: good ADL, a short admission period, good level of health of caregivers, adequate space in the residence, negative perception of the caregivers regarding the costs of GICF, and economic level of the household. Evaluation of these factors at an early stage of admission to GICFs may enable prediction of whether or not a user can be successfully discharged to return home.

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 ...

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 ...

Extracting Prior Distributions from a Large Dataset of In-Situ Measurements to Support SWOT-based Estimation of River Discharge

NASA Astrophysics Data System (ADS)

Hagemann, M.; Gleason, C. J.

2017-12-01

The upcoming (2021) Surface Water and Ocean Topography (SWOT) NASA satellite mission aims, in part, to estimate discharge on major rivers worldwide using reach-scale measurements of stream width, slope, and height. Current formalizations of channel and floodplain hydraulics are insufficient to fully constrain this problem mathematically, resulting in an infinitely large solution set for any set of satellite observations. Recent work has reformulated this problem in a Bayesian statistical setting, in which the likelihood distributions derive directly from hydraulic flow-law equations. When coupled with prior distributions on unknown flow-law parameters, this formulation probabilistically constrains the parameter space, and results in a computationally tractable description of discharge. Using a curated dataset of over 200,000 in-situ acoustic Doppler current profiler (ADCP) discharge measurements from over 10,000 USGS gaging stations throughout the United States, we developed empirical prior distributions for flow-law parameters that are not observable by SWOT, but that are required in order to estimate discharge. This analysis quantified prior uncertainties on quantities including cross-sectional area, at-a-station hydraulic geometry width exponent, and discharge variability, that are dependent on SWOT-observable variables including reach-scale statistics of width and height. When compared against discharge estimation approaches that do not use this prior information, the Bayesian approach using ADCP-derived priors demonstrated consistently improved performance across a range of performance metrics. This Bayesian approach formally transfers information from in-situ gaging stations to remote-sensed estimation of discharge, in which the desired quantities are not directly observable. Further investigation using large in-situ datasets is therefore a promising way forward in improving satellite-based estimates of river discharge.

45 CFR 46.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 1 2013-10-01 2013-10-01 false Early termination of research support: Evaluation of applications and proposals. 46.123 Section 46.123 Public Welfare DEPARTMENT OF HEALTH AND HUMAN... rights and welfare of human subjects (whether or not the research was subject to federal regulation). ...

45 CFR 46.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 1 2014-10-01 2014-10-01 false Early termination of research support: Evaluation of applications and proposals. 46.123 Section 46.123 Public Welfare Department of Health and Human... rights and welfare of human subjects (whether or not the research was subject to federal regulation). ...

45 CFR 46.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 1 2012-10-01 2012-10-01 false Early termination of research support: Evaluation of applications and proposals. 46.123 Section 46.123 Public Welfare DEPARTMENT OF HEALTH AND HUMAN... rights and welfare of human subjects (whether or not the research was subject to federal regulation). ...

Building Partnerships: The Role of Nonprofit Organizations in Supporting Education Diplomacy in Early Childhood

ERIC Educational Resources Information Center

Tilhou, Rebecca; Rose, Brittney; Eckhoff, Angela; Glasgow, Jane

2018-01-01

Nonprofit organizations providing early childhood services that support the healthy growth, development, and education of young children and their families have a unique relationship with communities. In order to have significant impact on quality of life, these programs must be sustainable and committed to meeting local needs. This article…

Bringing It All Together: The Multiple Origins, Skills, and Environmental Supports of Early Literacy.

ERIC Educational Resources Information Center

Dickinson, David K.; McCabe, Allyssa

2001-01-01

Data from three studies investigating factors supporting literacy development of children from low-income families indicate: early levels of achievement are strongly linked to later success; kindergarten vocabulary is strongly reflective of the use of varied vocabulary during meal times; and teacher training in literacy is beneficial to classroom…

Early Intervention for Children with Hearing Loss: Information Parents Receive about Supporting Children's Language

ERIC Educational Resources Information Center

Decker, Kalli B.; Vallotton, Claire D.

2016-01-01

Family-centered early intervention for children with hearing loss is intended to strengthen families' interactions with their children to support children's language development, and should include providing parents with information they can use as part of their everyday routines. However, little is known about the information received by families…

34 CFR 97.123 - Early termination of research support: Evaluation of applications and proposals.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROTECTION OF HUMAN SUBJECTS Federal Policy for the Protection of Human Subjects (Basic ED Policy for Protection of Human Research Subjects) § 97.123 Early termination of research support: Evaluation of... the protection of the rights and welfare of human subjects (whether or not the research was subject to...

[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.

Results of a pilot randomised controlled trial to measure the clinical and cost effectiveness of peer support in increasing hope and quality of life in mental health patients discharged from hospital in the UK

PubMed Central

2014-01-01

Background Mental health patients can feel anxious about losing the support of staff and patients when discharged from hospital and often discontinue treatment, experience relapse and readmission to hospital, and sometimes attempt suicide. The benefits of peer support in mental health services have been identified in a number of studies with some suggesting clinical and economic gains in patients being discharged. Methods This pilot randomised controlled trial with economic evaluation aimed to explore whether peer support in addition to usual aftercare for patients during the transition from hospital to home would increase hope, reduce loneliness, improve quality of life and show cost effectiveness compared with patients receiving usual aftercare only, with follow-up at one and three-months post-discharge. Results A total of 46 service users were recruited to the study; 23 receiving peer support and 23 in the care-as-usual arm. While this pilot trial found no statistically significant benefits for peer support on the primary or secondary outcome measures, there is an indication that hope may be further increased in those in receipt of peer support. The total cost per case for the peer support arm of the study was £2154 compared to £1922 for the control arm. The mean difference between costs was minimal and not statistically significant. However, further analyses demonstrated that peer support has a reasonably high probability of being more cost effective for a modest positive change in the measure of hopelessness. Challenges faced in recruitment and follow-up are explored alongside limitations in the delivery of peer support. Conclusions The findings suggest there is merit in conducting further research on peer support in the transition from hospital to home consideration should be applied to the nature of the patient population to whom support is offered; the length and frequency of support provided; and the contact between peer supporters and mental health

Results of a pilot randomised controlled trial to measure the clinical and cost effectiveness of peer support in increasing hope and quality of life in mental health patients discharged from hospital in the UK.

PubMed

Simpson, Alan; Flood, Chris; Rowe, Julie; Quigley, Jody; Henry, Susan; Hall, Cerdic; Evans, Richard; Sherman, Paul; Bowers, Len

2014-02-05

Mental health patients can feel anxious about losing the support of staff and patients when discharged from hospital and often discontinue treatment, experience relapse and readmission to hospital, and sometimes attempt suicide. The benefits of peer support in mental health services have been identified in a number of studies with some suggesting clinical and economic gains in patients being discharged. This pilot randomised controlled trial with economic evaluation aimed to explore whether peer support in addition to usual aftercare for patients during the transition from hospital to home would increase hope, reduce loneliness, improve quality of life and show cost effectiveness compared with patients receiving usual aftercare only, with follow-up at one and three-months post-discharge. A total of 46 service users were recruited to the study; 23 receiving peer support and 23 in the care-as-usual arm. While this pilot trial found no statistically significant benefits for peer support on the primary or secondary outcome measures, there is an indication that hope may be further increased in those in receipt of peer support. The total cost per case for the peer support arm of the study was £2154 compared to £1922 for the control arm. The mean difference between costs was minimal and not statistically significant. However, further analyses demonstrated that peer support has a reasonably high probability of being more cost effective for a modest positive change in the measure of hopelessness. Challenges faced in recruitment and follow-up are explored alongside limitations in the delivery of peer support. The findings suggest there is merit in conducting further research on peer support in the transition from hospital to home consideration should be applied to the nature of the patient population to whom support is offered; the length and frequency of support provided; and the contact between peer supporters and mental health staff. There is no conclusive evidence to

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.

BK potassium channels facilitate high-frequency firing and cause early spike frequency adaptation in rat CA1 hippocampal pyramidal cells

PubMed Central

Gu, Ning; Vervaeke, Koen; Storm, Johan F

2007-01-01

Neuronal potassium (K+) channels are usually regarded as largely inhibitory, i.e. reducing excitability. Here we show that BK-type calcium-activated K+ channels enhance high-frequency firing and cause early spike frequency adaptation in neurons. By combining slice electrophysiology and computational modelling, we investigated functions of BK channels in regulation of high-frequency firing in rat CA1 pyramidal cells. Blockade of BK channels by iberiotoxin (IbTX) selectively reduced the initial discharge frequency in response to strong depolarizing current injections, thus reducing the early spike frequency adaptation. IbTX also blocked the fast afterhyperpolarization (fAHP), slowed spike rise and decay, and elevated the spike threshold. Simulations with a computational model of a CA1 pyramidal cell confirmed that the BK channel-mediated rapid spike repolarization and fAHP limits activation of slower K+ channels (in particular the delayed rectifier potassium current (IDR)) and Na+ channel inactivation, whereas M-, sAHP- or SK-channels seem not to be important for the early facilitating effect. Since the BK current rapidly inactivates, its facilitating effect diminishes during the initial discharge, thus producing early spike frequency adaptation by an unconventional mechanism. This mechanism is highly frequency dependent. Thus, IbTX had virtually no effect at spike frequencies < 40 Hz. Furthermore, extracellular field recordings demonstrated (and model simulations supported) that BK channels contribute importantly to high-frequency burst firing in response to excitatory synaptic input to distal dendrites. These results strongly support the idea that BK channels play an important role for early high-frequency, rapidly adapting firing in hippocampal pyramidal neurons, thus promoting the type of bursting that is characteristic of these cells in vivo, during behaviour. PMID:17303637

A Comparison of Workshop Training versus Intensive, Experiential Training for Improving Behavior Support Skills in Early Educators

ERIC Educational Resources Information Center

Fabiano, Gregory A.; Vujnovic, Rebecca K.; Waschbusch, Daniel A.; Yu, Jihnhee; Mashtare, Terry; Pariseau, Meaghan E.; Pelham, William E.; Parham, Brittany R.; Smalls, Kalima J.

2013-01-01

Effective behavior support is an important component of high-quality and nurturing early childhood classroom settings. At present, there are few studies that investigate the best way to train and support teachers in these strategies. The present study compared two different training approaches: (1) a workshop that included a one-day…

Policy Statement on Supporting the Development of Children Who Are Dual Language Learners in Early Childhood Programs

ERIC Educational Resources Information Center

US Department of Health and Human Services, 2016

2016-01-01

The purpose of this policy statement is to support early childhood programs and States by providing recommendations that promote the development and learning of young children, birth to age five, who are dual language learners (DLLs). The statement also provides support to tribal communities in their language revitalization efforts within tribal…

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 ...

Double-ended metal halide arc discharge lamp with electrically isolated containment shroud

NASA Technical Reports Server (NTRS)

Muzeroll, Martin M. (Inventor)

1994-01-01

A double-ended arc discharge lamp includes a sealed, light-transmissive outer jacket, a light-transmissive shroud mounted within the outer jacket and directly supported by the outer jacket, and an arc discharge tube mounted within the shroud. The arc tube is typically a metal halide arc discharge tube. In a preferred embodiment, the shroud includes an outwardly flared portion at each end. The outwardly flared portions space the shroud from the outer jacket and support the shroud within the outer jacket. The outwardly flared portions of the shroud can be affixed to the outer jacket by fusing. The outer jacket can be provided with inwardly extending dimples for locating the shroud with respect to the outer jacket. In another embodiment, the outer jacket includes reduced diameter portions near each end which are attached to the shroud.

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

Economic evaluation of the differential benefits of home visits with telephone calls and telephone calls only in transitional discharge support.

PubMed

Wong, Frances Kam Yuet; So, Ching; Chau, June; Law, Antony Kwan Pui; Tam, Stanley Ku Fu; McGhee, Sarah

2015-01-01

home visits and telephone calls are two often used approaches in transitional care, but their differential economic effects are unknown. to examine the differential economic benefits of home visits with telephone calls and telephone calls only in transitional discharge support. cost-effectiveness analysis conducted alongside a randomised controlled trial (RCT). patients discharged from medical units randomly assigned to control (control, N = 210), home visits with calls (home, N = 196) and calls only (call, N = 204). cost-effectiveness analyses were conducted from the societal perspective comparing monetary benefits and quality-adjusted life years (QALYs) gained. the home arm was less costly but less effective at 28 days and was dominating (less costly and more effective) at 84 days. The call arm was dominating at both 28 and 84 days. The incremental QALY for the home arm was -0.0002/0.0008 (28/84 days), and the call arm was 0.0022/0.0104 (28/84 days). When the three groups were compared, the call arm had a higher probability being cost-effective at 84 days but not at 28 days (home: 53%, call: 35% (28 days) versus home: 22%, call: 73% (84 days)) measuring against the NICE threshold of £20,000. the original RCT showed that the bundled intervention involving home visits and calls was more effective than calls only in the reduction of hospital readmissions. This study adds a cost perspective to inform policymakers that both home visits and calls only are cost-effective for transitional care support, but calls only have a higher chance of being cost-effective for a sustained period after intervention. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society.

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

Family Support for Early Literacy and Numeracy: Examining Events in the Home and Community

ERIC Educational Resources Information Center

Kennedy, Anne

2010-01-01

Early childhood educators often make assumptions about the nature of families' understandings and what they do at home to support their young children's literacy and numeracy development and learning. Sometimes educator's have a limited understanding of children's every day experiences at home or in their community and the potential for these to…

Evidence Supporting an Early as Well as Late Heavy Bombardment on the Moon

NASA Technical Reports Server (NTRS)

Frey, Herbert

2015-01-01

Evidence supporting an intense early bombardment on the Moon in addition to the traditional Late Heavy Bombardment at approx. 4 BY ago include the distribution of N(50) Crater Retention Ages (CRAs) for candidate basins, a variety of absolute age scenarios for both a "young" and an "old" Nectaris age, and the decreasing contrasts in both topographic relief and Bouguer gravity with increasing CRA.

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 ...

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 . ...

Simulating the inception of pulsed discharges near positive electrodes

NASA Astrophysics Data System (ADS)

Teunissen, Jannis; Ebert, Ute

2013-09-01

With 3D particle simulations we study the inception of pulsed discharges near positive electrodes. In different geometries, we first determine the breakdown voltage. Then we study the probability of inception for a fast voltage pulse. This probability mostly depends on the availability of seed electrons to generate the initial electron avalanches. These results are compared with experimental observations. Then we investigate how the shape of a starting discharge affects its further development. In particular, we discuss the formation of so-called ``inception clouds.'' JT was supported by STW-project 10755.

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

PubMed

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

2018-05-01

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

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.

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 ...

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.

HOspitals and patients WoRking in Unity (HOW R U?): telephone peer support to improve older patients’ quality of life after emergency department discharge in Melbourne, Australia—a multicentre prospective feasibility study

PubMed Central

Lennox, Alyse; Curtis, Andrea; Wilson, Gillian; Rosewarne, Cate; Smit, De Villiers; O’Brien, Debra; Browning, Colette Joy; Boyd, Lee; Smith, Cathie; Cameron, Peter

2018-01-01

Objectives To ascertain the feasibility and acceptability of the HOW R U? programme, a novel volunteer-peer postdischarge support programme for older patients after discharge from the emergency department (ED). Design A multicentre prospective mixed-methods feasibility study. Setting Two tertiary hospital EDs in metropolitan Melbourne, Australia. Participants A convenience sample of 39 discharged ED patients aged 70 years or over, with symptoms of social isolation, loneliness and/or depression. Intervention The HOW R U? intervention comprised weekly social support telephone calls delivered by volunteer peers for 3 months following ED discharge. Primary and secondary outcome measures The primary outcomes were feasibility of study processes, intervention acceptability to participants and retention in the programme. Secondary outcomes were changes in loneliness level (UCLA-3—3-item Loneliness Scale), mood (5-item Geriatric Depression Scale) and health-related quality of life (EQ-5D-5L and EQ-VAS) postintervention. Results Recruitment was feasible, with 30% of eligible patients successfully recruited. Seventeen volunteer peers provided telephone support to patient participants, in addition to their usual hospital volunteer role. HOW R U? was well received, with 87% retention in the patient group, and no attrition in the volunteer group. The median age of patients was 84 years, 64% were female, and 82% lived alone. Sixty-eight per cent of patients experienced reductions in depressive symptoms, and 53% experiencing reduced feelings of loneliness, and these differences were statistically significant Patient feedback was positive and volunteers reported great satisfaction with their new role. Conclusion HOW R U? was feasible in terms of recruitment and retention and was acceptable to both patients and volunteers. The overall results support the potential for further research in this area and provide data to support the design of a definitive trial to confirm the observed

Type D Personality, Social Support, and Depression Among Ethnic Chinese Coronary Artery Disease Patients Undergoing a Percutaneous Coronary Intervention: An Exploratory Study.

PubMed

Su, Shu-Fen; He, Chung-Ping

2018-01-01

This study investigated the relationships between Type D personality, depression, and social support among ethnic Chinese coronary artery disease (CAD) patients undergoing percutaneous coronary interventions. Type D personality is associated with CAD, and may increase patients' depression and mortality rate. However, very few studies have explored the relationships between depression and social support among ethnic Chinese Type D CAD patients. A longitudinal, repeated-measures design was used; 105 Taiwanese CAD patients undergoing a percutaneous coronary intervention were recruited between January and December 2015. A demographic questionnaire, Type D Scale, ENRICHD Social Support Inventory, and Patient Health Questionnaire-9 were completed by 102 participants (mean age = 64.42, SD = 13.67 years) at hospitalization, and at the second week and third month after discharge. Data were analyzed using t tests and a generalized estimating equation. Results indicated that 46.7% of participants who had Type D personality had lower social support and higher depression than did the remaining (non-Type D) participants. At two weeks after discharge, the improvement in social support was higher among Type D patients than non-Type D participants; the same was true for depression at two weeks and three months after discharge each. Type D Taiwanese CAD patients showed lower perceived social support and higher depression during hospitalization than did non-Type D participants. Furthermore, the more social support patients received at home, the lower was their depression. Health-care providers should provide continuous mental health care, conduct early screening of mental health issues, and ensure that patients receive sufficient social support to reduce depression.

Perceived Social Support Change in Patients with Early-stage Breast Cancer and Controls

PubMed Central

Thompson, Tess; Rodebaugh, Thomas L.; Pérez, Maria; Schootman, Mario; Jeffe, Donna B.

2014-01-01

Objective To identify variables associated with levels of and change in social support in a cohort of early-stage breast cancer patients and age-matched controls. Methods Telephone interviews measuring perceived social support and other demographic and psychosocial variables were conducted at 4–6 weeks and 6, 12, and 24 months after surgery (patients) or a normal/benign screening mammogram (controls). A latent trajectory model was used to model the intercept (starting point) and slope (changing) aspects of social support. Results Participants included 542 controls and 541 patients (77% White, 23% African American; mean age 57.7 [SD = 10.6]). Most participants reported high social support. Patients reported significantly higher levels of social support at baseline than controls. For patients, social support had a significant negative slope that significantly varied between individuals; the intercept of social support also varied significantly. Predictors of lower social support intercept in patients included not being married/partnered, being White, having lower perceived general health, and having higher negative affect (modeled as a latent variable defined by anxiety and depression symptom severity). Patients who were African American (vs. White) or had mastectomy (vs. lumpectomy) had steeper social support declines, and participants with both these characteristics had lower starting points as well as steeper declines. Social support among controls did not change significantly. Conclusions Clinicians might consider psychosocial interventions for patients reporting low social support around the time of diagnosis and surgical treatment, and for patients at risk for steeper declines in support, such as African Americans and women undergoing mastectomy. PMID:23477582

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 ...

Characterization of a suspected terrestrial deep groundwater discharge area on the Canadian Precambrian Shield

NASA Astrophysics Data System (ADS)

Sheppard, Marsha I.; Thibault, D. H.; Milton, G. M.; Reid, J. A. K.; Smith, P. A.; Stevens, K.

1995-03-01

Underground storage and disposal of hazardous wastes require an understanding of groundwater flow and the ability to locate recharge and discharge. Usually, recharge and discharge occur at a transition zone where dispersion/advection, molecular diffusion and biogeochemical processes control the fate of a contaminants leaving an underground facility. Appropriate landscape modelling for risk assessment cannot proceed until this interface is well defined and groundwater discharge can be mapped. Although discharge locations have traditionally been thought of as aquatic, the presence of animal licks suggests the possibility of terrestrial discharge. We have characterized a suspected terrestrial discharge, a well-used deer lick, (1) physically, through surficial mapping, and vegetation and soil profile analyses; (2) geophysically, through magnetic and very low-frequency electromagnetic tilt-angle surveys; (3) hydrogeologically, through water-table elevation measurements; (4) geochemically, through overburden analyses for 238U, 226Ra, 210Pb, Na, tritium, Cl and 36{Cl}/{Cl} atom ratios, as well as pore-water and groundwater analyses for pH, electrical conductivity (EC) and major anions and cations; and (5) thermally, through overburden-rock interface temperatures. Halophytic plants and sedges contained more Na, Cl and 238U than averages reported in the literature. Lineament alignment, coincident with elevated groundwater EC, supported the presence and position of a subsurface fracture. Groundwater chemistry suggested that interfering runoff from a nearby ridge masked the chemical signatures expected of deep groundwater but attest to the weak and possibly ephemeral nature of this discharge. Interpretation of the geochemical data was supported by solute transport modelling. Good agreement between the predictions using an unsaturated soil model, a simple wetland compartment model and the observed profile implied that evapotranspiration, seasonal water-table fluctuations 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.

How Early Bonding, Depression, Illicit Drug Use, and Perceived Support Work Together to Influence Drug-Dependent Mothers’ Caregiving

PubMed Central

Suchman, Nancy E.; McMahon, Thomas J.; Slade, Arietta; Luthar, Suniya S.

2007-01-01

In this study, the authors used an attachment framework to examine how drug-dependent mothers’ early bonding experience, depression, illicit drug use, and perceived support work together to influence the family environment. The authors hypothesized that (a) depression and drug use function as proxies for a stronger risk factor, the perceived absence of support available in everyday life, and (b) associations between mothers’ early bonding experience and family environment are mediated by perceptions of support and nurture available in everyday life. The authors used a “building block” analytic approach and data collected from 125 mothers enrolled in methadone maintenance to test hypotheses. Both hypotheses were confirmed for 1 outcome, family adaptability. For the 2nd outcome, family cohesion, only perceived support was a significant predictor. Although preliminary, the findings suggest that perceptions of relationships in everyday life play a critical role in the etiology of drug-dependent mothers’ parenting. PMID:16060738

Real-time decision support systems: the famine early warning system network

USGS Publications Warehouse

Funk, Christopher C.; Verdin, James P.

2010-01-01

A multi-institutional partnership, the US Agency for International Development’s Famine Early Warning System Network (FEWS NET) provides routine monitoring of climatic, agricultural, market, and socioeconomic conditions in over 20 countries. FEWS NET supports and informs disaster relief decisions that impact millions of people and involve billions of dollars. In this chapter, we focus on some of FEWS NET’s hydrologic monitoring tools, with a specific emphasis on combining “low frequency” and “high frequency” assessment tools. Low frequency assessment tools, tied to water and food balance estimates, enable us to evaluate and map long-term tendencies in food security. High frequency assessments are supported by agrohydrologic models driven by satellite rainfall estimates, such as the Water Requirement Satisfaction Index (WRSI). Focusing on eastern Africa, we suggest that both these high and low frequency approaches are necessary to capture the interaction of slow variations in vulnerability and the relatively rapid onset of climatic shocks.

Bradycardia and asystole during generalised interictal EEG discharges.

PubMed

Sforza, Emilia; Pichot, Vincent; Gschwind, Markus; Roche, Frédéric; Maeder-Ingvar, Malin

2014-12-01

Few studies have investigated the effects of interictal epileptic discharges on the cardiac autonomic system. This study reports the case of a 37-year-old man with refractory generalised epilepsy, who recently reported an increase in frequency of nocturnal tonic-clonic seizures, not responding to treatment. During the nocturnal video study, in non-rapid eye movements sleep, we recorded 106 generalised sharp- and polyspike-waves lasting for 3 to 7 seconds, associated with bradycardia and asystole, without behavioural changes and without increase in deltoid muscle activity. The asystole had a duration of between 3 and 8 seconds. In one case, a 7 second asystole was associated with a tonic-clonic generalised seizure. A 24-hour electrocardiographic study revealed a bradycardia and a Wenckebach atrioventricular block. Heart rate analysis at the time of the interictal epileptic discharges revealed an abrupt increase in the RR interval, occurring simultaneously with the onset of interictal epileptic discharges and followed by a return to values below baseline value. A cardiac pacemaker was installed with a reduction of asystole length during the interictal epileptic discharges. Our findings indicate, for the first time, the role of interictal generalised discharges in EEG-related asystole and bradycardia. These data support the hypothesis that some patients with epilepsy may be predisposed to disturbances of the autonomic cardiac system.

Discharge Criteria for the Late Preterm Infant: A Review of the Literature.

PubMed

Quinn, Jenny M; Sparks, Marteen; Gephart, Sheila M

2017-10-01

Standardized late preterm infant (LPI) discharge criteria ensure best practice and help guide the neonatal provider to determine the appropriate level of care following birth. However, the location can vary from the well newborn setting to the neonatal intensive care unit (NICU). The purpose of this review is to examine differences in LPI discharge criteria between the well newborn setting and the NICU by answering the clinical questions, "What are the recommended discharge criteria for the LPI and do they differ if admitted to the well newborn setting versus the NICU?" Databases searched include CINAHL, TRIP, PubMed, and the Cochrane Library. Focusing first on the highest level of evidence, position statements, policy statements, and clinical practice guidelines were reviewed, followed by original research. There were few differences shown between settings. Discharge criteria included physiological stability and completed screenings for hearing loss, hyperbilirubinemia, car seat safety, hypoglycemia, critical congenital heart disease, and sepsis. Parent education is provided on umbilical cord care, feeding, elimination, and weight gain norms. Recommended maternal assessment included screenings for depression, drug use, safe home environment, and presence of social support. In general, research supported protecting the mother-infant dyad. Developing a standardized approach for discharge criteria for LPIs may improve outcomes and reduce maternal stress. Research is needed to compare health and cost outcomes between settings.Video Abstract available at http://links.lww.com/ANC/A29.

Final Report: Risk assessment for produced water discharges to Louisiana open bays

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

Meinhold, A.F.; DePhillips, M.P.; Holtzman, S.

1996-03-01

Potential human health and environmental impacts from discharges of produced water to the Gulf of Mexico are of concern to regulators at the State and Federal levels, the public, environmental interest groups and industry. Current and proposed regulations require a zero discharge limit for coastal facilities, based primarily on studies in low energy, poorly flushed environments. However, produced water discharges in coastal Louisiana include a number of open bay sites, where potential human health and environmental impacts are likely to be smaller than those demonstrated for low energy canal environments, but greater than the minimal impacts associated with offshore discharges.more » Additional data and assessments are needed to support risk managers at the State and Federal levels in the development of regulations that protect human health and the environment without unnecessary cost to the economic welfare of the region and the nation. This project supports the Natural Gas and Oil Initiative objectives to: (1) improve coordination on environmental research; (2) streamline State and Federal regulation; (3) enhance State, and Federal regulatory decision making capability; (4) enhance dialogue through industry/government/public partnerships; and (5) work with States and Native American Tribes.« less

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

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

Home Visiting Family Support Programs: Benefits of the Maternal, Infant, and Early Childhood Home Visiting Program. Fact Sheet

ERIC Educational Resources Information Center

Home Visiting Campaign, 2015

2015-01-01

The federally funded, locally administered Maternal, Infant, and Early Childhood Home Visiting Program sponsors family support programs that are often called "home visiting" because they take place in the homes of at-risk families. These families often lack support, experience, and knowledge of basic parenting skills. Because children…

Pharmacist-managed inpatient discharge medication reconciliation: a combined onsite and telepharmacy model.

PubMed

Keeys, Christopher; Kalejaiye, Bamidele; Skinner, Michelle; Eimen, Mandana; Neufer, Joann; Sidbury, Gisele; Buster, Norman; Vincent, Joan

2014-12-15

The development, implementation, and pilot testing of a discharge medication reconciliation service managed by pharmacists with offsite telepharmacy support are described. Hospitals' efforts to prepare legible, complete, and accurate medication lists to patients prior to discharge continue to be complicated by staffing and time constraints and suboptimal information technology. To address these challenges, the pharmacy department at a 324-bed community hospital initiated a quality-improvement project to optimize patients' discharge medication lists while addressing problems that often resulted in confusing, incomplete, or inaccurate lists. A subcommittee of the hospital's pharmacy and therapeutics committee led the development of a revised medication reconciliation process designed to streamline and improve the accuracy and utility of discharge medication documents, with subsequent implementation of a new service model encompassing both onsite and remote pharmacists. The new process and service were evaluated on selected patient care units in a 19-month pilot project requiring collaboration by physicians, nurses, case managers, pharmacists, and an outpatient prescription drug database vendor. During the pilot testing period, 6402 comprehensive reconciled discharge medication lists were prepared; 634 documented discrepancies or medication errors were detected. The majority of identified problems were in three categories: unreconciled medication orders (31%), order clarification (25%), and duplicate orders (12%). The most problematic medications were the opioids, cardiovascular agents, and anticoagulants. A pharmacist-managed medication reconciliation service including onsite pharmacists and telepharmacy support was successful in improving the final discharge lists and documentation received by patients. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

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)

Patients' discharge experiences: returning home after open-heart surgery.

PubMed

Lapum, Jennifer; Angus, Jan E; Peter, Elizabeth; Watt-Watson, Judy

2011-01-01

This study explored patients' narratives of technology in heart surgery and recovery. A narrative inquiry was conducted with a sample of 16 individuals. Interviews were completed 2 to 4 days after transfer from cardiovascular intensive care, and 4 to 6 weeks after discharge. Participants completed journals between these 2 time periods. Discharge and the return home were highlighted as key transitions. These transitions were driven by a technological script that included teachings and texts provided upon discharge. Complicating participants' narratives were their own personal dramas and self-characterizations of vulnerability, as they struggled to incorporate this script into the particularities of their daily lives. Comprehensive conceptualizations of technology that involve the associated logics and pathways of recovery provide deep insights into patients' stories of recovery from heart surgery. It is salient that discharge programs consider the ways that technology enters into patients' narratives, and also consider dialogical approaches to communication, education, and supportive interventions that are offered at multiple intervals and continue in the home. Copyright © 2011 Elsevier Inc. All rights reserved.

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

Chutes or Ladders? Creating Support Services to Help Early Childhood Students Succeed in Higher Education

ERIC Educational Resources Information Center

Dukakis, Kara; Bellm, Dan; Seer, Natalie; Lee, Yuna

2007-01-01

This report explores efforts in California to generally support nontraditional students, and early care and education (ECE) nontraditional students in particular. It is recommended that institutions of higher education and local planners work together to assess the needs of nontraditional students in their ECE programs, the adequacy of existing…

Size Matters: The Link between Staff Size and Perceived Organizational Support in Early Childhood Education

ERIC Educational Resources Information Center

Ho, Dora; Lee, Moosung; Teng, Yue

2016-01-01

Purpose: The purpose of this paper is to examine the relationship between staff size and perceived organizational support (POS) in early childhood education (ECE) organizations. Design/methodology/approach: A territory-wide questionnaire survey was designed to investigate the perceptions of preschool teachers in Hong Kong on four dimensions of…

Longitudinal Relations between Beliefs Supporting Aggression,Anger Regulation, and Dating Aggression among Early Adolescents.

PubMed

Sullivan, Terri N; Garthe, Rachel C; Goncy, Elizabeth A; Carlson, Megan M; Behrhorst, Kathryn L

2017-05-01

Dating aggression occurs frequently in early to mid-adolescence and has negative repercussions for psychosocial adjustment and physical health. The patterns of behavior learned during this developmental timeframe may persist in future dating relationships, underscoring the need to identify risk factors for this outcome. The current study examined longitudinal relations between beliefs supporting aggression, anger regulation, and dating aggression. Participants were 176 middle school students in sixth, seventh, and eighth grade (50 % female; 82 % African American). No direct effects were found between beliefs supporting reactive or proactive aggression and dating aggression. Beliefs supporting reactive aggression predicted increased rates of anger dysregulation, and beliefs supporting proactive aggression led to subsequent increases in anger inhibition. Anger dysregulation and inhibition were associated with higher frequencies of dating aggression. An indirect effect was found for the relation between beliefs supporting reactive aggression and dating aggression via anger dysregulation. Another indirect effect emerged for the relation between beliefs supporting proactive aggression and dating aggression through anger inhibition. The study's findings suggested that beliefs supporting proactive and reactive aggression were differentially related to emotion regulation processes, and identified anger dysregulation and inhibition as risk factors for dating aggression among adolescents.

Opportunities in Public Policy to Support Infant and Early Childhood Mental Health: The Role of Psychologists and Policymakers

ERIC Educational Resources Information Center

Nelson, Florence; Mann, Tammy

2011-01-01

Infant and early childhood mental health practices can be supported by policies and professional standards of care that foster the healthy development of young children. Policies that support infants and toddlers include those that strengthen their families to provide a family environment that promotes mental wellness. Policy issues for infants,…

32 CFR 581.2 - Army Discharge Review Board.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 3 2013-07-01 2013-07-01 false Army Discharge Review Board. 581.2 Section 581.2 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY PERSONNEL PERSONNEL REVIEW BOARD... the efficient overall operation and support of the ADRB panels. (ii) Authenticates the case report and...

32 CFR 581.2 - Army Discharge Review Board.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 3 2011-07-01 2009-07-01 true Army Discharge Review Board. 581.2 Section 581.2 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY PERSONNEL PERSONNEL REVIEW BOARD... the efficient overall operation and support of the ADRB panels. (ii) Authenticates the case report and...

32 CFR 581.2 - Army Discharge Review Board.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 3 2014-07-01 2014-07-01 false Army Discharge Review Board. 581.2 Section 581.2 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY PERSONNEL PERSONNEL REVIEW BOARD... the efficient overall operation and support of the ADRB panels. (ii) Authenticates the case report and...

32 CFR 581.2 - Army Discharge Review Board.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Army Discharge Review Board. 581.2 Section 581.2 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY PERSONNEL PERSONNEL REVIEW BOARD... the efficient overall operation and support of the ADRB panels. (ii) Authenticates the case report and...

32 CFR 581.2 - Army Discharge Review Board.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 3 2012-07-01 2009-07-01 true Army Discharge Review Board. 581.2 Section 581.2 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY PERSONNEL PERSONNEL REVIEW BOARD... the efficient overall operation and support of the ADRB panels. (ii) Authenticates the case report and...

Early assessment and identification of posttraumatic stress disorder, satisfaction with appearance and coping in patients with burns.

PubMed

Dahl, Oili; Wickman, Marie; Björnhagen, Viveca; Friberg, Mona; Wengström, Yvonne

2016-12-01

The first year after severe burn is a psychologically challenging period for the patient. Patients may still struggle with burn-related physical and psychological problems such as posttraumatic stress disorder (PTSD) and body image dissatisfaction (BID). This study investigates the presence of PTSD, BID and coping, at three, six and twelve months after discharge for early identification of patients in need of focused support during rehabilitation. Fifty-two adult patients with different degrees of burns were followed at three, six and twelve months after discharge and 36 patients completed all assessment points. A standardized clinical protocol was used for systematic assessment of PTSD (IES-R), BID (SWAP-Swe) and Coping (CBQ). The follow-up included an intervention with a burn nurse as a complement to the existing program. Approximately half of the patients had a risk of developing PTSD three months after discharge from hospital, and body image dissatisfaction was found to potentially predict risk of PTSD during follow-up. The findings suggest that it is important to include patients with less extensive burns in follow-up as this group is at risk of development of PTSD. Using standardized questionnaires in early follow-up along with assessment of body image dissatisfaction may facilitate detection of psychological problems. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

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.

Expanding the Role of School Psychologists to Support Early Career Teachers: A Mixed-Method Study

ERIC Educational Resources Information Center

Shernoff, Elisa S.; Frazier, Stacy L.; Maríñez-Lora, Ané M.; Lakind, Davielle; Atkins, Marc S.; Jakobsons, Lara; Hamre, Bridget K.; Bhaumik, Dulal K.; Parker-Katz, Michelle; Neal, Jennifer Watling; Smylie, Mark A.; Patel, Darshan A.

2016-01-01

School psychologists have training and expertise in consultation and evidence-based interventions that position them well to support early career teachers (ECTs). The current study involved iterative development and pilot testing of an intervention to help ECTs become more effective in classroom management and engaging learners, as well as more…

Workshop for Early Career Geoscience Faculty: Providing resources and support for new faculty to succeed

NASA Astrophysics Data System (ADS)

Hill, T. M.; Beane, R. J.; Macdonald, H.; Manduca, C. A.; Tewksbury, B. J.; Allen-King, R. M.; Yuretich, R.; Richardson, R. M.; Ormand, C. J.

2015-12-01

A vital strategy to educate future geoscientists is to support faculty at the beginning of their careers, thus catalyzing a career-long impact on the early-career faculty and on their future students. New faculty members are at a pivotal stage in their careers as they step from being research-focused graduate students and post-doctoral scholars, under the guidance of advisors, towards launching independent careers as professors. New faculty commonly, and not unexpectedly, feel overwhelmed as they face challenges to establish themselves in a new environment, prepare new courses, begin new research, and develop a network of support. The workshop for Early Career Geoscience Faculty: Teaching, Research, and Managing Your Career has been offered annually in the U.S. since 1999. The workshop is currently offered through the National Association of Geoscience Teachers On the Cutting Edge professional development program with support from the NSF, AGU and GSA. This five-day workshop, with associated web resources, offers guidance for incorporating evidence-based teaching practices, developing a research program, and managing professional responsibilities in balance with personal lives. The workshop design includes plenary and concurrent sessions, individual consultations, and personalized feedback from workshop participants and leaders. Since 1999, more than 850 U.S. faculty have attended the Early Career Geoscience Faculty workshop. Participants span a wide range of geoscience disciplines, and are in faculty positions at two-year colleges, four-year colleges, comprehensive universities and research universities. The percentages of women (~50%) and underrepresented participants (~8%) are higher than in the general geoscience faculty population. Multiple participants each year are starting positions after receiving all or part of their education outside the U.S. Collectively, participants report that they are better prepared to move forward with their careers as a result of

A Post-Discharge Smoking-Cessation Intervention for Hospital Patients

PubMed Central

Rigotti, Nancy A.; Tindle, Hilary A.; Regan, Susan; Levy, Douglas E.; Chang, Yuchiao; Carpenter, Kelly M.; Park, Elyse R.; Kelley, Jennifer H.K.; Streck, Joanna M.; Reid, Zachary Z.; Ylioja, Thomas; Reyen, Michele; Singer, Daniel E.

2016-01-01

Introduction Hospitalization provides an opportunity for smokers to quit, but tobacco-cessation interventions started in hospital must continue after discharge to be effective. This study aimed to improve the scalability of a proven effective post-discharge intervention by incorporating referral to a telephone quitline, a nationally available cessation resource. Study design A three-site RCT compared Sustained Care, a post-discharge tobacco-cessation intervention, with Standard Care among hospitalized adult smokers who wanted to quit smoking and received in-hospital tobacco-cessation counseling. Setting/participants A total of 1,357 daily smokers admitted to three hospitals were enrolled from December 2012 to July 2014. Intervention Sustained Care started at discharge and included automated interactive voice response telephone calls and the patient’s choice of cessation medication for 3 months. Each automated call advised cessation, supported medication adherence, and triaged smokers seeking additional counseling or medication support directly to a telephone quitline. Standard Care provided only medication and counseling recommendations at discharge. Main outcome measures Biochemically confirmed past 7–day tobacco abstinence 6 months after discharge (primary outcome); self-reported tobacco abstinence and tobacco-cessation treatment use at 1, 3, and 6 months, and overall (0–6 months). Analyses were done in 2015–2016. Results Smokers offered Sustained Care (n=680), versus those offered Standard Care (n=677), did not have greater biochemically confirmed abstinence at 6 months (17% vs 16%, p=0.58). However, the Sustained Care group reported more tobacco-cessation counseling and medication use at each follow-up and higher rates of self-reported past 7–day tobacco abstinence at 1 month (43% vs 32%, p<0.0001) and 3 months (37% vs 30%, p=0.008). At 6 months, the difference narrowed (31% vs 27%, p=0.09). Overall, the intervention increased self-reported 7-day

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.

Delineating Landfill Leachate Discharge To An Arsenic Contaminated Waterway

EPA Science Inventory

Discharge of contaminated ground water may serve as a primary and on-going source of contamination to surface water. A field investigation was conducted at a Superfund site in Massachusetts, USA to define the locus of contaminant flux and support source identification for arseni...

Postpartum depression peer support: maternal perceptions from a randomized controlled trial.

PubMed

Dennis, Cindy-Lee

2010-05-01

Peer support in the early postpartum period is effective in the prevention of postpartum depression among women identified as high-risk. To describe maternal perceptions of peer support received while participating in a trial. Cross-sectional survey of women participating in a randomized controlled trial to evaluate the effect of peer support in the prevention of postpartum depression. Seven health regions across Ontario Canada. 701 women were recruited between November 2004 and September 2006. Women eligible for the study were all mothers with an Edinburgh Postnatal Depression Scale score >9 who were within 2 weeks postpartum, at least 18 years of age, able to speak English, had a live birth, and had been discharged home from the hospital. Exclusion criteria included an infant not discharged home with the mother and current use of antidepressant or antipsychotic medication. Two hundred and twenty-one mothers completed the mailed questionnaire. Women were randomly allocated to receive usual postpartum care (control group) or usual postpartum care plus telephone-based peer support (intervention group). Maternal perceptions of peer support were evaluated at 12 weeks postpartum using the validated Peer Support Evaluation Inventory. Interactions provided by the peer volunteer included the provision of emotional (92.7%), informational (72.4%), and appraisal (72.0%) support. Mothers reported high levels of positive relationship qualities such as trust (83.6%) and perceived acceptance (79.1%). Most (80.5%) mothers indicated they were very satisfied with their peer support experience. Maternal satisfaction was associated with the number and duration of peer volunteer contacts. The majority of mothers perceived their peer volunteer experience positively lending further support to telephone-based peer support as a preventative strategy for postpartum depression. The following program modifications were suggested: (a) adapt training to enhance the provision of appraisal

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

Caregiver and expecting caregiver support for early peanut introduction guidelines.

PubMed

Greenhawt, Matthew; Chan, Edmond S; Fleischer, David M; Hicks, Allison; Wilson, Rachel; Shaker, Marcus; Venter, Carina; Stukus, David

2018-03-07

Recent guidelines recommend early peanut introduction (EPI) beginning around 4 to 6 months of age in infants with severe eczema and/or egg allergy and around 6 months for all other infants. Caregiver preferences for such practices are unknown. We explored preferences for EPI and in-office allergy risk assessment (IRA) through a nationally representative survey of expecting (n = 1,000) and new caregivers of infants younger than 1 year (n = 1,000). Among a primarily female (99.7%), married (80.3%), and white (74.4%) sample, 29% had no or vague awareness of the new guidelines, 61% had no or minimal concern for their child developing food allergy, but 54% felt timing of food introduction has moderate to strong importance for developing food allergy. Only 31% expressed willingness for EPI before or around 6 months of age, with 40% reporting willingness to introduce peanut after 11 months of age, similar to tree nuts and seafood. However, 60% reported willingness to introduce egg before 8 months of age. A total of 51% and 56.8% were unwilling to allow IRA methods, such as skin testing and oral challenge, before 11 months of age, respectively. Odds of willingness to delay peanut introduction (odds ratio, 0.79; 95% confidence interval, 0.65-0.96) and undergo challenge (odds ratio, 0.67; 95% confidence interval, 0.54-0.82) after 6 months of age were lower among expecting caregivers. Among new and expecting caregivers, there is poor current willingness and questionable support for early allergenic solid food recommendations, including IRA before introduction. Willingness was better among expecting vs current caregivers. These trends underscore a need for broader formal implementation planning to facilitate early allergen introduction and maximize its preventive benefits. Copyright © 2018 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Smoking in young adulthood among African Americans: Interconnected effects of supportive parenting in early adolescence, proinflammatory epitype, and young adult stress.

PubMed

Beach, Steven R H; Lei, Man Kit; Brody, Gene H; Miller, Gregory E; Chen, Edith; Mandara, Jelani; Philibert, Robert A

2017-08-01

We examined two potentially interacting, connected pathways by which parental supportiveness during early adolescence (ages 1-13) may come to be associated with later African American young adult smoking. The first pathway is between parental supportiveness and young adult stress (age 19), with stress, in turn, predicting increased smoking at age 20. The second pathway is between supportive parenting and tumor necrosis factor (TNF) gene methylation (i.e., TNFm), a proinflammatory epitype, with low levels indicating greater inflammatory potential and forecasting increased risk for smoking in response to young adult stress. In a sample of 382 African American youth residing in rural Georgia, followed from early adolescence (age 10-11) to young adulthood (age 20), supportive parenting indirectly predicted smoking via associations with young adult stress, IE = -0.071, 95% confidence interval [-0.132, -0.010]. In addition, supportive parenting was associated with TNFm measured at age 20 (r = .177, p = .001). Further, lower TNFm was associated with a significantly steeper slope (b = 0.583, p = .003) of increased smoking in response to young adult stress compared to those with higher TNFm (b = 0.155, p = .291), indicating an indirect, amplifying role for supportive parenting via TNFm. The results suggest that supportive parenting in early adolescence may play a role in understanding the emergence of smoking in young adulthood.

Using the PDSI to Estimate Summer Stream Discharge in the Greater Yellowstone Ecosystem: Implications for 20th Century Riparian Habitat Variability

NASA Astrophysics Data System (ADS)

Persico, L.; Meyer, G. A.

2013-12-01

predictors of discharge (α < 0.05). The 1930s Dust Bowl drought was one of the most severe droughts in the past 300 years; from 1934-1935, average August discharge was reduced by 25-40% with respect to the anomalously wet early 20th century pluvial. Discharge estimates using reconstructed PDSI values for the 2- and 10-year MCA droughts (PDSI = -6 and -5, respectively) indicate that 60% of stream reaches where beaver were active in the late Holocene became ephemeral in these droughts. This analysis is supported by observations during the extreme drought of the 2000s, when ephemeral flow occurred along streams with known historical beaver activity in northern Yellowstone. Model predictions indicate that by 2030-2039 the GYE will endure persistent severe drought (mean annual PDSI = -4 to -6) (Dai, 2011), thus riparian area is likely to decrease in the coming decades. The early 20th century has been suggested to be an ideal reference for riparian habitat restoration despite anomalously wet conditions unlike current or likely future climate. Future efforts to restore riparian habitat by reducing elk browsing and increasing beaver damming will be hampered by reduced flows on small streams.

N-heptane decomposition in multi-needle to plate electrical discharge

NASA Astrophysics Data System (ADS)

Pekarek, Stanislav; Pospisil, Milan

2003-10-01

Plasma based technologies are becoming more and more important for destruction of volatile organic compounds in air streams. The most frequent electrical discharges tested for VOC decomposition are corona and dielectric barrier discharge. We proposed [1] multi-hollow needles to plate atmospheric pressure discharge enhanced by the flow of the mixture of air with VOC through the needles. In this case all reactive mixture will pass through the active zone of the discharge. The high-speed gas flow near the exit of the needle will also efficiently cool the electrodes. Hence the higher values of the discharge current can be obtained without the danger of the discharge transition to the spark. The chemical reactions leading to the VOC decomposition can therefore be enhanced [2]. We performed an experimental study of the n-heptane decomposition efficiency on its concentration in air in the input of the discharge. We choose n-heptane, an important part of organic solvents and part of automotive fuels, as a representative of saturated alkanes. We found that with decreasing n-heptane concentration the decomposition efficiency increases. Acknowledgement: This work was supported by the research program No: J04/98:212300016 "Pollution control and monitoring of the Environment" of the Czech Technical University in Prague. References [1] S. Pekárek, V. Køíha, M. Pospíil - J. Physics D, Appl. Physics, 34, 117 (2001). [2] O. Goosens, T. Callebaut, Y. Akishev, C. Leys - IEEE Trans. Plasma Sc. 30, 176 (2002).

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.