Emergency department discharge prescription interventions by emergency medicine pharmacists.

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Cesarz, Joseph L; Steffenhagen, Aaron L; Svenson, James; Hamedani, Azita G

2013-02-01

We determine the rate and details of interventions associated with emergency medicine pharmacist review of discharge prescriptions for patients discharged from the emergency department (ED). Additionally, we evaluate care providers' satisfaction with such services provided by emergency medicine pharmacists. This was a prospective observational study in the ED of an academic medical center that serves both adult and pediatric patients. Details of emergency medicine pharmacist interventions on discharge prescriptions were compiled with a standardized form. Interventions were categorized as error prevention or optimization of therapy. The staff of the ED was surveyed related to the influence and satisfaction of this new emergency medicine pharmacist-provided service. The 674 discharge prescriptions reviewed by emergency medicine pharmacists during the study period included 602 (89.3%) for adult patients and 72 (10.7%) for pediatric patients. Emergency medicine pharmacists intervened on 68 prescriptions, resulting in an intervention rate of 10.1% (95% confidence interval [CI] 8.0% to 12.7%). The intervention rate was 8.5% (95% CI 6.4% to 11.1%) for adult prescriptions and 23.6% for pediatric prescriptions (95% CI 14.7% to 35.3%) (difference 15.1%; 95% CI 5.1% to 25.2%). There were a similar number of interventions categorized as error prevention and optimization of medication therapy, 37 (54%) and 31 (46%), respectively. More than 95% of survey respondents believed that the new pharmacist services improved patient safety, optimized medication regimens, and improved patient satisfaction. Emergency medicine pharmacist review of discharge prescriptions for discharged ED patients has the potential to significantly improve patient care associated with suboptimal prescriptions and is highly valued by ED care providers. Copyright © 2012. Published by Mosby, Inc.

Rehospitalizations and Emergency Department Visits after Hospital Discharge in Patients Receiving Maintenance Hemodialysis.

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Harel, Ziv; Wald, Ron; McArthur, Eric; Chertow, Glenn M; Harel, Shai; Gruneir, Andrea; Fischer, Hadas D; Garg, Amit X; Perl, Jeffrey; Nash, Danielle M; Silver, Samuel; Bell, Chaim M

2015-12-01

Clinical outcomes after a hospital discharge are poorly defined for patients receiving maintenance in-center (outpatient) hemodialysis. To describe the proportion and characteristics of these patients who are rehospitalized, visit an emergency department, or die within 30 days after discharge from an acute hospitalization, we conducted a population-based study of all adult patients receiving maintenance in-center hemodialysis who were discharged between January 1, 2003, and December 31, 2011, from 157 acute care hospitals in Ontario, Canada. For patients with more than one hospitalization, we randomly selected a single hospitalization as the index hospitalization. Of the 11,177 patients included in the final cohort, 1926 (17%) were rehospitalized, 2971 (27%) were treated in the emergency department, and 840 (7.5%) died within 30 days of discharge. Complications of type 2 diabetes mellitus were the most common reason for rehospitalization, whereas heart failure was the most common reason for an emergency department visit. In multivariable analysis using a cause-specific Cox proportional hazards model, the following characteristics were associated with 30-day rehospitalization: older age, the number of hospital admissions in the preceding 6 months, the number of emergency department visits in the preceding 6 months, higher Charlson comorbidity index score, and the receipt of mechanical ventilation during the index hospitalization. Thus, a large proportion of patients receiving maintenance in-center hemodialysis will be readmitted or visit an emergency room within 30 days of an acute hospitalization. A focus on improving care transitions from the inpatient setting to the outpatient dialysis unit may improve outcomes and reduce healthcare costs. Copyright © 2015 by the American Society of Nephrology.

Inability of Physicians and Nurses to Predict Patient Satisfaction in the Emergency Department

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DeLaney, Matthew C.; Page, David B.; Kunstadt, Ethan B.; Ragan, Matt; Rodgers, Joel; Wang, Henry E.

2015-01-01

Introduction Patient satisfaction is a commonly assessed dimension of emergency department (ED) care quality. The ability of ED clinicians to estimate patient satisfaction is unknown. We sought to evaluate the ability of emergency medicine resident physicians and nurses to predict patient-reported satisfaction with physician and nursing care, pain levels, and understanding of discharge instructions. Methods We studied a convenience sample of 100 patients treated at an urban academic ED. Patients rated satisfaction with nursing care, physician care, pain level at time of disposition and understanding of discharge instructions. Resident physicians and nurses estimated responses for each patient. We compared patient, physician and nursing responses using Cohen’s kappa, weighting the estimates to account for the ordinal responses. Results Overall, patients had a high degree of satisfaction with care provided by the nurses and physicians, although this was underestimated by providers. There was poor agreement between physician estimation of patient satisfaction (weighted κ=0.23, standard error: 0.078) and nursing estimates of patient satisfaction (weighted κ=0.11, standard error: 0.043); physician estimation of patient pain (weighted κ=0.43, standard error: 0.082) and nursing estimates (weighted κ=0.39, standard error: 0.081); physician estimates of patient comprehension of discharge instruction (weighted κ=0.19, standard error: 0.082) and nursing estimates (weighted κ=0.13, standard error: 0.078). Providers underestimated pain and patient comprehension of discharge instructions. Conclusion ED providers were not able to predict patient satisfaction with nurse or physician care, pain level, or understanding of discharge instructions. PMID:26759661

Availability of mobile phones for discharge follow-up of pediatric Emergency Department patients in western Kenya.

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House, Darlene R; Cheptinga, Philip; Rusyniak, Daniel E

2015-01-01

Objective. Mobile phones have been successfully used for Emergency Department (ED) patient follow-up in developed countries. Mobile phones are widely available in developing countries and may offer a similar potential for follow-up and continued care of ED patients in low and middle-income countries. The goal of this study was to determine the percentage of families with mobile phones presenting to a pediatric ED in western Kenya and rate of response to a follow-up phone call after discharge. Methods. A prospective, cross-sectional observational study of children presenting to the emergency department of a government referral hospital in Eldoret, Kenya was performed. Documentation of mobile phone access, including phone number, was recorded. If families had access, consent was obtained and families were contacted 7 days after discharge for follow-up. Results. Of 788 families, 704 (89.3%) had mobile phone access. Of those families discharged from the ED, successful follow-up was made in 83.6% of cases. Conclusions. Mobile phones are an available technology for follow-up of patients discharged from a pediatric emergency department in resource-limited western Kenya.

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

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

2013-09-01

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

A mobile phone text message program to measure oral antibiotic use and provide feedback on adherence to patients discharged from the emergency department.

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Suffoletto, Brian; Calabria, Jaclyn; Ross, Anthony; Callaway, Clifton; Yealy, Donald M

2012-08-01

Nonadherence to prescribed medications impairs therapeutic benefits. The authors measured the ability of an automated text messaging (short message service [SMS]) system to improve adherence to postdischarge antibiotic prescriptions. This was a randomized controlled trial in an urban emergency department (ED) with an annual census of 65,000. A convenience sample of adult patients being discharged with a prescription for oral antibiotics was enrolled. Participants received either a daily SMS query about prescription pickup, and then dosage taken, with educational feedback based on their responses (intervention), or the usual printed discharge instructions (control). A standardized phone follow-up interview was used on the day after the intended completion date to determine antibiotic adherence: 1) the participant filled prescription within 24 hours of discharge and 2) no antibiotic pills were left on the day after intended completion of prescription. Of the 200 patients who agreed to participate, follow-up was completed in 144 (72%). From the 144, 26% (95% confidence interval [CI] = 19% to 34%) failed to fill their discharge prescriptions during the first 24 hours, and 37% (95% CI = 29% to 45%) had pills left over, resulting in 49% (95% CI = 40% to 57%) nonadherent patients. There were no differences in adherence between intervention participants and controls (57% vs. 45%; p = 0.1). African American race, greater than twice-daily dosing, and self-identifying as expecting to have difficulty filling or taking antibiotics at baseline were associated with nonadherence. Almost one-half (49%) of our patients do not adhere to antibiotic prescriptions after ED discharge. Future work should improve the design and deployment of SMS interventions to optimize their effect on improving adherence to medication after ED discharge. © 2012 by the Society for Academic Emergency Medicine.

Assessment of orofacial pain management in a pediatric emergency department and at home after discharge.

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Aguilar de la Red, Yurena; Manrique Martín, Gema; Guerrero Marquez, Gloria; González Herrero, Concepción; Vázquez López, Paula; Míguez Navarro, Concepción

2018-02-01

An inadequate pain management is common in the emergency department. Our objective was to analyze pain management among children with an orofacial infection or trauma in the emergency department and to assess compliance and satisfaction with analgesia prescribed at discharge. Cross-sectional, observational and analytical study in children attending the emergency department for an orofacial infection or trauma over 2 months. Pain management in the emergency department, analgesia prescribed at home and, following a call to parents, treatment provided and its adequacy to control pain were registered. In total, 252patients (mean age: 4.5 years, SD: 3.89) were included. Pain assessment was recorded at the triage for 8.7%, and in the medical report, for 3.6%. Analgesia was administered to 41.3% in the emergency room. At discharge, no analgesia was prescribed to 13.9%; scheduled analgesia, to 25.4%; and as needed, to 60.3%. Pediatricians prescribed scheduled analgesia more frequently than surgeons (34.4% versus 16.5%, p Pain assessment and management was scarce in the emergency department. The most common prescription was as needed, contrary to what is recommended in the guidelines. Analgesic control worked better for trauma injuries than for infections. Sociedad Argentina de Pediatría

European Society of Cardiology - Acute Cardiovascular Care Association position paper on safe discharge of acute heart failure patients from the emergency department.

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Miró, Òscar; Peacock, Frank W; McMurray, John J; Bueno, Héctor; Christ, Michael; Maisel, Alan S; Cullen, Louise; Cowie, Martin R; Di Somma, Salvatore; Martín Sánchez, Francisco J; Platz, Elke; Masip, Josep; Zeymer, Uwe; Vrints, Christiaan; Price, Susanna; Mebazaa, Alexander; Mueller, Christian

2017-06-01

Heart failure is a global public health challenge frequently presenting to the emergency department. After initial stabilization and management, one of the most important decisions is to determine which patients can be safely discharged and which require hospitalization. This is a complex decision that depends on numerous subjective factors, including both the severity of the patient's underlying condition and an estimate of the acuity of the presentation. An emergency department observation period may help select the correct option. Ideally, during an observation period, risk stratification should be carried out using parameters specifically designed for use in the emergency department. Unfortunately, there is little objective literature to guide this disposition decision. An objective and reliable definition of low-risk characteristics to identify early discharge candidates is needed. Benchmarking outcomes in patients discharged from the emergency department without hospitalization could aid this process. Biomarker determinations, although undoubtedly useful in establishing diagnosis and predicting longer-term prognosis, require prospective validation for emergency department disposition guidance. The challenge of identifying emergency department acute heart failure discharge candidates will only be overcome by future multidisciplinary research defining the current knowledge gaps and identifying potential solutions.

Risks predicting prolonged hospital discharge boarding in a regional acute care hospital.

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Shaikh, Sajid A; Robinson, Richard D; Cheeti, Radhika; Rath, Shyamanand; Cowden, Chad D; Rosinia, Frank; Zenarosa, Nestor R; Wang, Hao

2018-01-30

Prolonged hospital discharge boarding can impact patient flow resulting in upstream Emergency Department crowding. We aim to determine the risks predicting prolonged hospital discharge boarding and their direct and indirect effects on patient flow. Retrospective review of a single hospital discharge database was conducted. Variables including type of disposition, disposition boarding time, case management consultation, discharge medications prescriptions, severity of illness, and patient homeless status were analyzed in a multivariate logistic regression model. Hospital charges, potential savings of hospital bed hours, and whether detailed discharge instructions provided adequate explanations to patients were also analyzed. A total of 11,527 admissions was entered into final analysis. The median discharge boarding time was approximately 2 h. Adjusted Odds Ratio (AOR) of patients transferring to other hospitals was 7.45 (95% CI 5.35-10.37), to court or law enforcement custody was 2.51 (95% CI 1.84-3.42), and to a skilled nursing facility was 2.48 (95% CI 2.10-2.93). AOR was 0.57 (95% CI 0.47-0.71) if the disposition order was placed during normal office hours (0800-1700). AOR of early case management consultation was 1.52 (95% CI 1.37-1.68) versus 1.73 (95% CI 1.03-2.89) for late consultation. Eighty-eight percent of patients experiencing discharge boarding times within 2 h of disposition expressed positive responses when questioned about the quality of explanations of discharge instructions and follow-up plans based on satisfaction surveys. Similar results (86% positive response) were noted among patients whose discharge boarding times were prolonged (> 2 h, p = 0.44). An average charge of $6/bed/h was noted in all hospital discharges. Maximizing early discharge boarding (≤ 2 h) would have resulted in 16,376 hospital bed hours saved thereby averting $98,256.00 in unnecessary dwell time charges in this study population alone. Type of disposition, case

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

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Stover, Pamela R; Harpin, Scott

2015-12-01

Limited capacity in a psychiatric unit contributes to long emergency department (ED) admission wait times. Regulatory and accrediting agencies urge hospitals nationally to improve patient flow for better access to care for all types of patients. The purpose of the current study was to decrease psychiatric admission wait time from 10.5 to 8 hours and increase the proportion of patients discharged by 11 a.m. from 20% to 50%. The current study compared pre- and post-intervention data. Plan-Do-Study-Act cycles aimed to improve discharge processes and timeliness through initiation of new practices. Admission wait time improved to an average of 5.1 hours (t = 3.87, p = 0.006). The proportion of discharges occurring by 11 a.m. increased to 46% (odds ratio = 3.42, p planning processes and timeliness in a psychiatric unit significantly decreased admission wait time from the ED, improving access to psychiatric care. Copyright 2015, SLACK Incorporated.

Contracting for Statewide Student Achievement Tests: A Review. Department of Public Instruction 98-4.

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Wisconsin State Legislative Audit Bureau, Madison.

The Wisconsin legislature has required the Department of Public Instruction to adopt or approve standardized tests for statewide use to measure student attainment of knowledge and concepts in grades 4, 8, and 10. Although school districts generally gave high ratings to the contents of TerraNova (McGraw Hill), the testing instrument most recently…

Effectiveness of pharmaceutical care at discharge in the emergency department: study protocol of a randomized controlled trial.

Science.gov (United States)

Kuhmmer, Regina; Lima, Karine Margarites; Ribeiro, Rodrigo Antonini; Hammes, Luciano Serpa; Bastos, Gisele Alsina Nader; Cotta de Souza, Maria Claudia Schardosim; Polanczyk, Carisi Anne; Soares Rollin, Guilherme Alcides Flores; Caon, Suhelen; Guterres, Cátia Moreira; Araújo Leite, Leni Everson; Delabary, Tássia Scholante; Falavigna, Maicon

2015-02-25

Patient education on pharmacological therapy may increase medication adherence and decrease hospitalizations. Our aim is to evaluate the effectiveness of pharmaceutical care at emergency department discharge in patients with hypertension and/or diabetes. This is a randomized controlled trial. Participants will be recruited from a public emergency department at Restinga district in Porto Alegre, southern Brazil. A total of 380 patients will be randomly assigned into 2 groups at the moment of emergency department discharge after receiving medical orientations: an intervention group, consisting of a structured individual counseling session by a pharmacist in addition to written orientations, or a control group, consisting only of written information about the disease. Outcomes will be assessed in an ambulatory visit 2 months after the randomization. The primary outcome is the proportion of patients with high medication adherence assessed using the Morisky-Green Test and the Brief Medication Questionnaire. The secondary outcomes are reduction of blood pressure, glycated hemoglobin, fasting plasma glucose, quality of life and number of visits to the emergency department. Pharmaceutical care interventions have shown to be feasible and effective in increasing medication adherence in both hospital outpatient and community pharmacy settings. However, there have been no previous assessments of the effectiveness of pharmacy care interventions initiated in patients discharged from emergency departments. Our hypothesis is that pharmaceutical counseling is also effective in this population. ClinicalTrials.gov registration number: NCT01978925 (11 November 2013) and Brazilian Registry of Clinical Trials U1111-1149-8922 (5 November 2013).

Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?

Directory of Open Access Journals (Sweden)

Stoneking LR

2016-08-01

Full Text Available LR Stoneking,1 AL Waterbrook,1 J Garst Orozco,2 D Johnston,1 A Bellafiore,1 C Davies,3 T Nuño,1 J Fatás-Cabeza,4 O Beita,5 V Ng,1 KH Grall,6 W Adamas-Rappaport7 1Department of Emergency Medicine, University of Arizona, Tucson, AZ, 2Department of Emergency Medicine, Sinai Health System, Chicago, IL, 3Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, 4Department of Spanish and Portuguese, University of Arizona, Tucson, AZ, 5Department of Family and Community Medicine, University of Arizona, Tucson, AZ, 6Department of Emergency Medicine, Regions Hospital, St Paul, MN, 7Department of Surgery, University of Arizona, Tucson, AZ, USA Background: After emergency department (ED discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.Objectives: To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.Methods: Our ED has two Emergency Medicine Residency Programs, University Campus (UC and South Campus (SC. SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient’s native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions.Results: Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study

Boarding inpatients in the emergency department increases discharged patient length of stay.

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White, Benjamin A; Biddinger, Paul D; Chang, Yuchiao; Grabowski, Beth; Carignan, Sarah; Brown, David F M

2013-01-01

Boarding of inpatients in the Emergency Department (ED) has been widely recognized as a major contributor to ED crowding and a cause of adverse outcomes. We hypothesize that these deleterious effects extend to those patients who are discharged from the ED by increasing their length of stay (LOS). This study investigates the impact of boarding inpatients on the ED LOS of discharged patients. This retrospective, observational, cohort study investigated the association between ED boarder burden and discharged patient LOS over a 3-year period in an urban, academic tertiary care ED. Median ED LOS of 179,840 discharged patients was calculated for each quartile of the boarder burden at time of arrival, and Spearman correlation coefficients were used to summarize the relationship. Subgroup analyses were conducted, stratified by patient acuity defined by triage designation, and hour of arrival. Overall median discharged patient ED LOS increased by boarder burden quartile (205 [95% confidence interval (CI) 203-207], 215 [95% CI 214-217], 221 [95% CI 219-223], and 221 [95% CI 219-223] min, respectively), with a Spearman correlation of 0.25 between daily total boarder burden hours and median LOS. When stratified by patient acuity and hour of arrival (11:00 a.m.-11:00 p.m.), LOS of medium-acuity patients increased significantly by boarder burden quartile (252 [95% CI 247-255], 271 [95% CI 267-275], 285 [95% CI 95% CI 278-289], and 309 [95% CI 305-315] min, respectively) with a Spearman correlation of 0.18. In this retrospective study, increasing boarder burden was associated with increasing LOS of patients discharged from the ED, with the greatest effect between 11:00 a.m. and 11:00 p.m. on medium-acuity patients. This relationship between LOS and ED capacity limitation by inpatient boarders has important implications, as ED and hospital leadership increasingly focus on ED LOS as a measure of efficiency and throughput. Copyright © 2013 Elsevier Inc. All rights reserved.

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

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Ojeda, Patricia I; Kara, Areeba

2017-12-01

The period following discharge from the hospital is one of heightened vulnerability. Discharge instructions serve as a guide during this transition. Yet, clinicians receive little feedback on the quality of this document that ties into the patients' experience. We reviewed the issues voiced by discharged patients via a call-back program and compared them to the discharge instructions they had received. At our institution, patients receive an automated call forty-eight hours following discharge inquiring about progress. If indicated by the response to the call, they are directed to a nurse who assists with problem solving. We reviewed the nursing documentation of these encounters for a period of nine months. The issues voiced were grouped into five categories: communication, medications, durable medical equipment/therapies, follow up and new or ongoing symptoms. The discharge instructions given to each patient were reviewed. We retrieved data on the number of discharges from each specialty from the hospital over the same period. A total of 592 patients voiced 685 issues. The numbers of patients discharged from medical or surgical services identified as having issues via the call-back line paralleled the proportions discharged from medical and surgical services from the hospital during the same period. Nearly a quarter of the issues discussed had been addressed in the discharge instructions. The most common category of issues was related to communication deficits including missing or incomplete information which made it difficult for the patient to enact or understand the plan of care. Medication prescription related issues were the next most common. Resource barriers and questions surrounding medications were often unaddressed. Post discharge issues affect patients discharged from all services equally. Data from call back programs may provide actionable targets for improvement, identify the inpatient team's 'blind spots' and be used to provide feedback to clinicians.

The Instructional Capacitor

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Walton, Elizabeth

2012-01-01

Many administrators are so overwhelmed by the basic responsibilities of their daily work that there seems to be little or no time left for providing quality leadership in instruction. Instead, schools employ department chairs, instructional specialists, and coordinators to provide instructional leadership. How can administrators find time in the…

Discharge communication from inpatient care: an audit of written medical discharge summary procedure against the new National Health Service Standard for clinical handover.

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Reid, Daniel Brooks; Parsons, Shaun R; Gill, Stephen D; Hughes, Andrew J

2015-04-01

To audit written medical discharge summary procedure and practice against Standard Six (clinical handover) of the Australian National Safety and Quality Health Service Standards at a major regional Victorian health service. Department heads were invited to complete a questionnaire about departmental discharge summary practices. Twenty-seven (82%) department heads completed the questionnaire. Seven (26%) departments had a documented discharge summary procedure. Fourteen (52%) departments monitored discharge summary completion and 13 (48%) departments monitored the timeliness of completion. Seven (26%) departments informed the patient of the content of the discharge summary and six (22%) departments provided the patient with a copy. Seven (26%) departments provided training for staff members on how to complete discharge summaries. Completing discharge summaries was usually delegated to the medical intern. The introduction of the National Service Standards prompted an organisation-wide audit of discharge summary practices against the external criterion. There was substantial variation in the organisation's practices. The Standards and the current audit results highlight an opportunity for the organisation to enhance and standardise discharge summary practices and improve communication with general practice.

THE INSTRUCTIONAL DELIVERY OF WRITING COURSE AT ENGLISH DEPARTMENT OF UMS: A NATURALISTIC STUDY

Directory of Open Access Journals (Sweden)

Fibrian Anindyawati

2017-08-01

Full Text Available The objective of this research is to get a thorough description of the teaching learning process of Writing Course at English Department of Muhammadiyah University of Surakarta, covering the syllabuses, the learning objectives, the instructional materials, the teachers’ roles, the students’ roles, the classroom techniques, the classroom procedures, the teaching media, and the assessment models. The data of this research were collected through observation, interview, and documentation. This research was a naturalistic study. The result shows that the syllabus used in Writing I & II is grammatical syllabus and Writing III & IV task-based syllabus. The learning objectives categorized into two namely, general objectives and specific objectives. The instructional materials were divided into three categories: printed materials, visual materials, and materials from the internet. The teachers’ roles were as organizer, consultant, feedback provider, assessor, and motivator. The students’ roles were as active participant, peer reviewer, and peer editor. The classroom techniques consist of brainstorming, discussion, question and answer, self-correction, assignment. The classroom procedures of Writing I & II were BKOF-MOT-ICOT; Writing III were reviewing, gathering ideas, organizing, build writing activity; and Writing IV were reviewing, explaining the materials, gathering ideas, organizing, build writing activity. The media used were LCD Projector, board, slides, and videos. The assessment model consisted of: multiple choices, weekly assignments, quizzes, mid-test, and final-test.     Keywords: Instruction, writing course, teaching writing

State Waste Discharge Permit application, 183-N Backwash Discharge Pond

Energy Technology Data Exchange (ETDEWEB)

1994-06-01

As part of the Hanford Federal Facility Agreement and Consent Order negotiations (Ecology et al. 1994), the US Department of Energy, Richland Operations Office, the US Environmental Protection Agency, and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground on the Hanford Site which affect groundwater or have the potential to affect groundwater would be subject to permitting under the structure of Chapter 173--216 (or 173--218 where applicable) of the Washington Administrative Code, the State Waste Discharge Permit Program. As a result of this decision, the Washington State Department of Ecology and the US Department of Energy, Richland Operations Office entered into Consent Order No. DE91NM-177, (Ecology and DOE-RL 1991). The Consent Order No. DE91NM-177 requires a series of permitting activities for liquid effluent discharges. Liquid effluents on the Hanford Site have been classified as Phase I, Phase II, and Miscellaneous Streams. The Consent Order No. DE91NM-177 establishes milestones for State Waste Discharge Permit application submittals for all Phase I and Phase II streams, as well as the following 11 Miscellaneous Streams as identified in Table 4 of the Consent Order No. DE91NM-177.

32 CFR 724.117 - Discharge review.

Science.gov (United States)

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Discharge review. 724.117 Section 724.117 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NAVAL DISCHARGE REVIEW BOARD Definitions § 724.117 Discharge review. A nonadversary administrative reappraisal at the level of...

The Epidemiology of Emergency Department Trauma Discharges in the United States.

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DiMaggio, Charles J; Avraham, Jacob B; Lee, David C; Frangos, Spiros G; Wall, Stephen P

2017-10-01

Injury-related morbidity and mortality is an important emergency medicine and public health challenge in the United States. Here we describe the epidemiology of traumatic injury presenting to U.S. emergency departments (EDs), define changes in types and causes of injury among the elderly and the young, characterize the role of trauma centers and teaching hospitals in providing emergency trauma care, and estimate the overall economic burden of treating such injuries. We conducted a secondary retrospective, repeated cross-sectional study of the Nationwide Emergency Department Data Sample (NEDS), the largest all-payer ED survey database in the United States. Main outcomes and measures were survey-adjusted counts, proportions, means, and rates with associated standard errors (SEs) and 95% confidence intervals. We plotted annual age-stratified ED discharge rates for traumatic injury and present tables of proportions of common injuries and external causes. We modeled the association of Level I or II trauma center care with injury fatality using a multivariable survey-adjusted logistic regression analysis that controlled for age, sex, injury severity, comorbid diagnoses, and teaching hospital status. There were 181,194,431 (SE = 4,234) traumatic injury discharges from U.S. EDs between 2006 and 2012. There was a mean year-to-year decrease of 143 (95% CI = -184.3 to -68.5) visits per 100,000 U.S. population during the study period. The all-age, all-cause case-fatality rate for traumatic injuries across U.S. EDs during the study period was 0.17% (SE = 0.001%). The case-fatality rate for the most severely injured averaged 4.8% (SE = 0.001%), and severely injured patients were nearly four times as likely to be seen in Level I or II trauma centers (relative risk = 3.9 [95% CI = 3.7 to 4.1]). The unadjusted risk ratio, based on group counts, for the association of Level I or II trauma centers with mortality was risk ratio = 4.9 (95% CI = 4.5 to 5.3); however, after sex, age

Development and feasibility testing of the Pediatric Emergency Discharge Interaction Coding Scheme.

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Curran, Janet A; Taylor, Alexandra; Chorney, Jill; Porter, Stephen; Murphy, Andrea; MacPhee, Shannon; Bishop, Andrea; Haworth, Rebecca

2017-08-01

Discharge communication is an important aspect of high-quality emergency care. This study addresses the gap in knowledge on how to describe discharge communication in a paediatric emergency department (ED). The objective of this feasibility study was to develop and test a coding scheme to characterize discharge communication between health-care providers (HCPs) and caregivers who visit the ED with their children. The Pediatric Emergency Discharge Interaction Coding Scheme (PEDICS) and coding manual were developed following a review of the literature and an iterative refinement process involving HCP observations, inter-rater assessments and team consensus. The coding scheme was pilot-tested through observations of HCPs across a range of shifts in one urban paediatric ED. Overall, 329 patient observations were carried out across 50 observational shifts. Inter-rater reliability was evaluated in 16% of the observations. The final version of the PEDICS contained 41 communication elements. Kappa scores were greater than .60 for the majority of communication elements. The most frequently observed communication elements were under the Introduction node and the least frequently observed were under the Social Concerns node. HCPs initiated the majority of the communication. Pediatric Emergency Discharge Interaction Coding Scheme addresses an important gap in the discharge communication literature. The tool is useful for mapping patterns of discharge communication between HCPs and caregivers. Results from our pilot test identified deficits in specific areas of discharge communication that could impact adherence to discharge instructions. The PEDICS would benefit from further testing with a different sample of HCPs. © 2017 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Environmental Compliance Guide. Guidance manual for Department of Energy compliance with the Clean Water Act: National Pollutant Discharge Elimination System (NPDES)

Energy Technology Data Exchange (ETDEWEB)

1982-07-01

This manual provides general guidance for Department of Energy (DOE) officials for complying with Sect. 402 of the Clean Water Act (CWA) of 1977 and amendments. Section 402 authorizes the US Environmental Protection Agency (EPA) or states with EPA approved programs to issue National Pollutant Discharge Elimination System (NPDES) permits for the direct discharge of waste from a point source into waters of the United States. Although the nature of a project dictates the exact information requirements, every project has similar information requirements on the environmental setting, type of discharge(s), characterization of effluent, and description of operations and wastewater treatment. Additional information requirements for projects with ocean discharges, thermal discharges, and cooling water intakes are discussed. Guidance is provided in this manual on general methods for collecting, analyzing, and presenting information for an NPDES permit application. The NPDES program interacts with many sections of the CWA; therefore, background material on pertinent areas such as effluent limitations, water quality standards, toxic substances, and nonpoint source pollutants is included in this manual. Modifications, variances, and extensions applicable to NPDES permits are also discussed.

Impact of Internally Developed Electronic Prescription on Prescribing Errors at Discharge from the Emergency Department.

Science.gov (United States)

Hitti, Eveline; Tamim, Hani; Bakhti, Rinad; Zebian, Dina; Mufarrij, Afif

2017-08-01

Medication errors are common, with studies reporting at least one error per patient encounter. At hospital discharge, medication errors vary from 15%-38%. However, studies assessing the effect of an internally developed electronic (E)-prescription system at discharge from an emergency department (ED) are comparatively minimal. Additionally, commercially available electronic solutions are cost-prohibitive in many resource-limited settings. We assessed the impact of introducing an internally developed, low-cost E-prescription system, with a list of commonly prescribed medications, on prescription error rates at discharge from the ED, compared to handwritten prescriptions. We conducted a pre- and post-intervention study comparing error rates in a randomly selected sample of discharge prescriptions (handwritten versus electronic) five months pre and four months post the introduction of the E-prescription. The internally developed, E-prescription system included a list of 166 commonly prescribed medications with the generic name, strength, dose, frequency and duration. We included a total of 2,883 prescriptions in this study: 1,475 in the pre-intervention phase were handwritten (HW) and 1,408 in the post-intervention phase were electronic. We calculated rates of 14 different errors and compared them between the pre- and post-intervention period. Overall, E-prescriptions included fewer prescription errors as compared to HW-prescriptions. Specifically, E-prescriptions reduced missing dose (11.3% to 4.3%, p prescriptions, however, were associated with a significant increase in duplication errors, specifically with home medication (1.7% to 3%, p=0.02). A basic, internally developed E-prescription system, featuring commonly used medications, effectively reduced medication errors in a low-resource setting where the costs of sophisticated commercial electronic solutions are prohibitive.

Thromboprophylaxis for Patients with High-risk Atrial Fibrillation and Flutter Discharged from the Emergency Department

Directory of Open Access Journals (Sweden)

E. Margaret Warton

2018-02-01

Full Text Available Introduction: Many patients with atrial fibrillation or atrial flutter (AF/FL who are high risk for ischemic stroke are not receiving evidence-based thromboprophylaxis. We examined anticoagulant prescribing within 30 days of receiving dysrhythmia care for non-valvular AF/FL in the emergency department (ED. Methods: This prospective study included non-anticoagulated adults at high risk for ischemic stroke (ATRIA score ≥7 who received emergency AF/FL care and were discharged home from seven community EDs between May 2011 and August 2012. We characterized oral anticoagulant prescribing patterns and identified predictors of receiving anticoagulants within 30 days of the index ED visit. We also describe documented reasons for withholding anticoagulation. Results: Of 312 eligible patients, 128 (41.0% were prescribed anticoagulation at ED discharge or within 30 days. Independent predictors of anticoagulation included age (adjusted odds ratio [aOR] 0.89 per year, 95% confidence interval [CI] 0.82–0.96; ED cardiology consultation (aOR 1.89, 95% CI [1.10–3.23]; and failure of sinus restoration by time of ED discharge (aOR 2.65, 95% CI [1.35–5.21]. Reasons for withholding anticoagulation at ED discharge were documented in 139 of 227 cases (61.2%, the most common of which were deferring the shared decision-making process to the patient’s outpatient provider, perceived bleeding risk, patient refusal, and restoration of sinus rhythm. Conclusion: Approximately 40% of non-anticoagulated AF/FL patients at high risk for stroke who presented for emergency dysrhythmia care were prescribed anticoagulation within 30 days. Physicians were less likely to anticoagulate older patients and those with ED sinus restoration. Opportunities exist to improve rates of thromboprophylaxis in this high-risk population.

An Analysis of Department of Defense Instruction 8500.2 'Information Assurance (IA) Implementation.'

Energy Technology Data Exchange (ETDEWEB)

Campbell, Philip LaRoche

2012-01-01

The Department of Defense (DoD) provides its standard for information assurance in its Instruction 8500.2, dated February 6, 2003. This Instruction lists 157 'IA Controls' for nine 'baseline IA levels.' Aside from distinguishing IA Controls that call for elevated levels of 'robustness' and grouping the IA Controls into eight 'subject areas' 8500.2 does not examine the nature of this set of controls, determining, for example, which controls do not vary in robustness, how this set of controls compares with other such sets, or even which controls are required for all nine baseline IA levels. This report analyzes (1) the IA Controls, (2) the subject areas, and (3) the Baseline IA levels. For example, this report notes that there are only 109 core IA Controls (which this report refers to as 'ICGs'), that 43 of these core IA Controls apply without variation to all nine baseline IA levels and that an additional 31 apply with variations. This report maps the IA Controls of 8500.2 to the controls in NIST 800-53 and ITGI's CoBIT. The result of this analysis and mapping, as shown in this report, serves as a companion to 8500.2. (An electronic spreadsheet accompanies this report.)

The Necessity and Applicability Levels of the Courses that are Offered in the Departments of Computer Education and Instructional Technologies (CEIT)

Science.gov (United States)

Acat, M. Bahaddin; Kilic, Abdurrahman; Girmen, Pinar; Anagun, Senegul S.

2007-01-01

The main purpose of this study is to identify the levels of the necessity and applicability of the courses offered in the Departments of Computer Education and Instructional Technologies based on the views of the fourth grade and graduated students. In the study descriptive research model was used. The population of the study were final-year and…

Students and Instructors Opinions about Piano Instruction

Science.gov (United States)

Kilic, Deniz Beste Çevik

2016-01-01

This study examined the opinions of the students and piano instructors in the Turkish Education Faculties' Fine Arts Instruction Departments' music instruction programs about piano instruction. The study data were collected using a questionnaire administered to the piano instructors and the students who took lessons from them. The study results…

Risk prediction of emergency department revisit 30 days post discharge: a prospective study.

Directory of Open Access Journals (Sweden)

Shiying Hao

Full Text Available Among patients who are discharged from the Emergency Department (ED, about 3% return within 30 days. Revisits can be related to the nature of the disease, medical errors, and/or inadequate diagnoses and treatment during their initial ED visit. Identification of high-risk patient population can help device new strategies for improved ED care with reduced ED utilization.A decision tree based model with discriminant Electronic Medical Record (EMR features was developed and validated, estimating patient ED 30 day revisit risk. A retrospective cohort of 293,461 ED encounters from HealthInfoNet (HIN, Maine's Health Information Exchange (HIE, between January 1, 2012 and December 31, 2012, was assembled with the associated patients' demographic information and one-year clinical histories before the discharge date as the inputs. To validate, a prospective cohort of 193,886 encounters between January 1, 2013 and June 30, 2013 was constructed. The c-statistics for the retrospective and prospective predictions were 0.710 and 0.704 respectively. Clinical resource utilization, including ED use, was analyzed as a function of the ED risk score. Cluster analysis of high-risk patients identified discrete sub-populations with distinctive demographic, clinical and resource utilization patterns.Our ED 30-day revisit model was prospectively validated on the Maine State HIN secure statewide data system. Future integration of our ED predictive analytics into the ED care work flow may lead to increased opportunities for targeted care intervention to reduce ED resource burden and overall healthcare expense, and improve outcomes.

State waste discharge permit application: Hydrotest, maintenance and construction discharges. Revision 0

International Nuclear Information System (INIS)

1995-11-01

On December 23, 1991, the US DOE< Richland Operation Office (RL) and the Washington State Department of Ecology (Ecology) agreed to adhere to the provisions of the Department of Ecology Consent Order No. DE91NM-177 (216 Consent Order) (Ecology and US DOE 1991). The 216 Consent Order list regulatory milestones for liquid effluent streams at the Hanford Site and requires compliance with the permitting requirements of Washington Administrative Code. Hanford Site liquid effluent streams discharging to the soil column have been categorized on the 216 Consent Order as follows: Phase I Streams; Phase II Streams; Miscellaneous Streams. Phase I and Phase II Streams were initially addressed in two report. Miscellaneous Streams are subject to the requirements of several milestones identified in the 216 Consent Order. This document constitutes the Categorical State Waste Discharge Permit application for hydrotest,maintenance and construction discharges throughout the Hanford Site. This categorical permit application form was prepared and approved by Ecology

State waste discharge permit application: Hydrotest, maintenance and construction discharges. Revision 0

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-11-01

On December 23, 1991, the US DOE< Richland Operation Office (RL) and the Washington State Department of Ecology (Ecology) agreed to adhere to the provisions of the Department of Ecology Consent Order No. DE91NM-177 (216 Consent Order) (Ecology and US DOE 1991). The 216 Consent Order list regulatory milestones for liquid effluent streams at the Hanford Site and requires compliance with the permitting requirements of Washington Administrative Code. Hanford Site liquid effluent streams discharging to the soil column have been categorized on the 216 Consent Order as follows: Phase I Streams; Phase II Streams; Miscellaneous Streams. Phase I and Phase II Streams were initially addressed in two report. Miscellaneous Streams are subject to the requirements of several milestones identified in the 216 Consent Order. This document constitutes the Categorical State Waste Discharge Permit application for hydrotest,maintenance and construction discharges throughout the Hanford Site. This categorical permit application form was prepared and approved by Ecology.

The revolving door syndrome in internal medicine: a study on 11,846 subjects discharged from all Internal Medicine Departments of Tuscany with diagnosis of heart failure and pneumonia

Directory of Open Access Journals (Sweden)

Matteo Tellini

2015-05-01

Full Text Available Rehospitalization is the return of a patient to a surgical or medical department within 30 days from discharge. We have limited information on the frequency and patterns of rehospitalization in Italy. Our purpose is to describe this phenomenon in Tuscany. We analyzed regional hospital discharge abstract data in Tuscany 2012, to describe 30-day all cause readmissions. We studied patients aged 18 or more (11,846 discharged with diagnoses of heart failure and pneumonia from Internal Medicine Departments. Relationships between 30-day readmission rates, demographic and clinical characteristics have been analyzed. 18% and 15% of subjects respectively discharged with diagnosis of heart failure and pneumonia were readmitted within 30 days. Risk factors significantly related to readmissions were longer length of stay, increasing number of different medications taken during the year preceding hospitalization and greater number of hospitalizations during the semester preceding admission. From the analysis of risk factors we found that frailty and complexity of patients (identified by long hospitalization stays, high number of drugs and previous admissions are the most important factors for unplanned readmissions.

25 CFR 67.15 - Special instructions.

Science.gov (United States)

2010-04-01

... Area Director, the Assistant Secretary may issue special instructions not inconsistent with the... 25 Indians 1 2010-04-01 2010-04-01 false Special instructions. 67.15 Section 67.15 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR TRIBAL GOVERNMENT PREPARATION OF A ROLL OF INDEPENDENT...

Computer Assisted Instruction

Science.gov (United States)

Higgins, Paul

1976-01-01

Methodology for developing a computer assisted instruction (CAI) lesson (scripting, programing, and testing) is reviewed. A project done by Informatics Education Ltd. (IEL) for the Department of National Defense (DND) is used as an example. (JT)

Predictors and Outcomes of Revisits in Older Adults Discharged from the Emergency Department.

Science.gov (United States)

de Gelder, Jelle; Lucke, Jacinta A; de Groot, Bas; Fogteloo, Anne J; Anten, Sander; Heringhaus, Christian; Dekkers, Olaf M; Blauw, Gerard J; Mooijaart, Simon P

2018-04-01

To study predictors of emergency department (ED) revisits and the association between ED revisits and 90-day functional decline or mortality. Multicenter cohort study. One academic and two regional Dutch hospitals. Older adults discharged from the ED (N=1,093). At baseline, data on demographic characteristics, illness severity, and geriatric parameters (cognition, functional capacity) were collected. All participants were prospectively followed for an unplanned revisit within 30 days and for functional decline and mortality 90 days after the initial visit. The median age was 79 (interquartile range 74-84), and 114 participants (10.4%) had an ED revisit within 30 days of discharge. Age (hazard ratio (HR)=0.96, 95% confidence interval (CI)=0.92-0.99), male sex (HR=1.61, 95% CI=1.05-2.45), polypharmacy (HR=2.06, 95% CI=1.34-3.16), and cognitive impairment (HR=1.71, 95% CI=1.02-2.88) were independent predictors of a 30-day ED revisit. The area under the receiver operating characteristic curve to predict an ED revisit was 0.65 (95% CI=0.60-0.70). In a propensity score-matched analysis, individuals with an ED revisit were at higher risk (odds ratio=1.99 95% CI=1.06-3.71) of functional decline or mortality. Age, male sex, polypharmacy, and cognitive impairment were independent predictors of a 30-day ED revisit, but no useful clinical prediction model could be developed. However, an early ED revisit is a strong new predictor of adverse outcomes in older adults. © 2018 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

[The Health Department of Sicily "Regional recommendations for hospital discharge and communication with patients after admission due to a cardiologic event" decree].

Science.gov (United States)

Abrignani, Maurizio Giuseppe; De Luca, Giovanni; Gabriele, Michele; Tourkmani, Nidal

2014-06-01

Mortality and rehospitalizations still remain high after discharge for an acute cardiologic event. In this context, hospital discharge represents a potential pitfall for heart disease patients. In the setting of care transitions, the discharge letter is the main instrument of communication between hospital and primary care. Communication, besides, is an integral part of high-quality, patient-centered interventions aimed at improving the discharge process. Inadequate information at discharge significantly affects the quality of treatment compliance and the adoption of lifestyle modifications for an effective secondary prevention. The Health Department of Sicily, in 2013, established a task force with the aim to elaborate "Regional recommendations for hospital discharge and communication with patients after admission due to a cardiologic event", inviting to participate GICR-IACPR and many other scientific societies of cardiology and primary care, as discharge letter and communication are fundamental junctions of care transitions in cardiology. These recommendations have been published as a specific decree and contain: a structured model of discharge letter, which includes all of the parameters characterizing patients at high clinical risk, high thrombotic risk and low risk according to the Consensus document ANMCO/GICR-IACPR/GISE; is thus possible to identify these patients, choosing consequently the most appropriate follow-up pathways. A particular attention has been given to the "Medication Reconciliation" and to the identification of therapeutic targets; an educational Kit, with different forms on cardiac diseases, risk factors, drugs and lifestyle; a check-list about information given to the patient and caregivers. The "Recommendations" represent, in conclusion, the practical realization of the fruitful cooperation between scientific societies and political-administrative institutions that has been realized in Sicily in the last years.

25 CFR 61.15 - Special instructions.

Science.gov (United States)

2010-04-01

... Secretary may issue special instructions not inconsistent with the regulations in this part 61. ... 25 Indians 1 2010-04-01 2010-04-01 false Special instructions. 61.15 Section 61.15 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR TRIBAL GOVERNMENT PREPARATION OF ROLLS OF INDIANS § 61...

Usefulness of Videotape Instruction in an Academic Department of Neurology.

Science.gov (United States)

Kaufman, David M.; Kaufman, Rita G.

1983-01-01

Videotape instruction produced better performance in identification in only certain areas in a neurology clerkship: neuropsychologic phenomena, disorders with subtle or unique movements, and seizures. The choice and cost of equipment and some professional assurances are discussed. (Author/MLW)

Novel combined patient instruction and discharge summary tool improves timeliness of documentation and outpatient provider satisfaction

Directory of Open Access Journals (Sweden)

Meredith Gilliam

2017-03-01

Full Text Available Background: Incomplete or delayed access to discharge information by outpatient providers and patients contributes to discontinuity of care and poor outcomes. Objective: To evaluate the effect of a new electronic discharge summary tool on the timeliness of documentation and communication with outpatient providers. Methods: In June 2012, we implemented an electronic discharge summary tool at our 145-bed university-affiliated Veterans Affairs hospital. The tool facilitates completion of a comprehensive discharge summary note that is available for patients and outpatient medical providers at the time of hospital discharge. Discharge summary note availability, outpatient provider satisfaction, and time between the decision to discharge a patient and discharge note completion were all evaluated before and after implementation of the tool. Results: The percentage of discharge summary notes completed by the time of first post-discharge clinical contact improved from 43% in February 2012 to 100% in September 2012 and was maintained at 100% in 2014. A survey of 22 outpatient providers showed that 90% preferred the new summary and 86% found it comprehensive. Despite increasing required documentation, the time required to discharge a patient, from physician decision to discharge note completion, improved from 5.6 h in 2010 to 4.1 h in 2012 (p = 0.04, and to 2.8 h in 2015 (p < 0.001. Conclusion: The implementation of a novel discharge summary tool improved the timeliness and comprehensiveness of discharge information as needed for the delivery of appropriate, high-quality follow-up care, without adversely affecting the efficiency of the discharge process.

46 CFR 201.7 - Information; special instructions.

Science.gov (United States)

2010-10-01

... 46 Shipping 8 2010-10-01 2010-10-01 false Information; special instructions. 201.7 Section 201.7 Shipping MARITIME ADMINISTRATION, DEPARTMENT OF TRANSPORTATION POLICY, PRACTICE AND PROCEDURE RULES OF PRACTICE AND PROCEDURE General Information (Rule 1) § 201.7 Information; special instructions. Information...

Tritium control and accountability instructions

International Nuclear Information System (INIS)

Wall, W.R.; Cruz, S.L.

1985-08-01

This instruction describes the tritium accountability procedures practiced by the Tritium Research Laboratory, at Sandia National Laboratories, Livermore. The accountability procedures are based upon the Sandia National Laboratories, Livermore, Nuclear Materials Operations Manual, SAND83-8036. The Nuclear Materials Operations Manual describes accountability techniques which are in compliance with the Department of Energy 5630 series Orders, Code of Federal Regulations, and Sandia National Laboratories Instructions

Tritium control and accountability instructions

International Nuclear Information System (INIS)

Wall, W.R.

1981-03-01

This instruction describes the tritium accountability procedures practiced by the Tritium Research Laboratory, Building 968 at Sandia National Laboratories, Livermore. The accountability procedures are based upon the Sandia National Laboratories, Livermore, Nuclear Materials Operations Manual, SAND78-8018. The Nuclear Materials Operations Manual describes accountability techniques which are in compliance with the Department of Energy Manual, Code of Federal Regulations, and Sandia National Laboratories Instructions

Text messages improve pain management post-discharge from the paediatric emergency department

Directory of Open Access Journals (Sweden)

J. Boyd*

2013-12-01

Conclusion: This study demonstrates that sending text message reminders post-discharge significantly increases the number of analgesia doses administered, reduces the frequency of patients reporting pain and is an effective method of communicating with parents. With increasing accessibility of mobile phones worldwide this is a viable, cost-effective and reproducible method of optimising analgesia post-discharge from the Paediatric ED.

Treatment Episode Data Set: Discharges (TEDS-D-2011)

Data.gov (United States)

U.S. Department of Health & Human Services — The Treatment Episode Data Set -- Discharges (TEDS-D) is a national census data system of annual discharges from substance abuse treatment facilities. TEDS-D...

Treatment Episode Data Set: Discharges (TEDS-D-2008)

Data.gov (United States)

U.S. Department of Health & Human Services — The Treatment Episode Data Set -- Discharges (TEDS-D) is a national census data system of annual discharges from substance abuse treatment facilities. TEDS-D...

Treatment Episode Data Set: Discharges (TEDS-D-2010)

Data.gov (United States)

U.S. Department of Health & Human Services — The Treatment Episode Data Set -- Discharges (TEDS-D) is a national census data system of annual discharges from substance abuse treatment facilities. TEDS-D...

Treatment Episode Data Set: Discharges (TEDS-D-2007)

Data.gov (United States)

U.S. Department of Health & Human Services — The Treatment Episode Data Set -- Discharges (TEDS-D) is a national census data system of annual discharges from substance abuse treatment facilities. TEDS-D...

Treatment Episode Data Set: Discharges (TEDS-D-2006)

Data.gov (United States)

U.S. Department of Health & Human Services — The Treatment Episode Data Set -- Discharges (TEDS-D) is a national census data system of annual discharges from substance abuse treatment facilities. TEDS-D...

Treatment Episode Data Set: Discharges (TEDS-D-2009)

Data.gov (United States)

U.S. Department of Health & Human Services — The Treatment Episode Data Set -- Discharges (TEDS-D) is a national census data system of annual discharges from substance abuse treatment facilities. TEDS-D...

Parental Language and Return Visits to the Emergency Department After Discharge.

Science.gov (United States)

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

2017-06-01

Return visits to the emergency department (ED) are used as a marker of quality of care. Limited English proficiency, along with other demographic and disease-specific factors, has been associated with increased risk of return visit, but the relationship between language, short-term return visits, and overall ED use has not been well characterized. This is a planned secondary analysis of a prospective cohort examining the ED discharge process for English- or Spanish-speaking parents of children aged 2 months to 2 years with fever and/or respiratory illness. At 1 year after the index visit, a standardized chart review was performed. The primary outcome was the number of ED visits within 72 hours of the index visit. Multivariable logistic regression was used to examine the relative importance of predictor variables and adjust for confounders. There were 202 parents eligible for inclusion, of whom 23% were Spanish speaking. In addition, 6.9% of the sample had a return visit within 72 hours. After adjustment for confounders, Spanish language was associated with return visit within 72 hours (odds ratio, 3.49; 95% confidence interval, 1.02-11.90) but decreased risk of a second visit within the year (odds ratio, 0.28; 95% confidence interval, 0.12-0.66). Spanish-speaking parents are at an increased risk of 72-hour return ED visit but do not seem to be at increased risk of ED use during the year after their ED visit.

46 CFR 169.817 - Master to instruct ship's company.

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Master to instruct ship's company. 169.817 Section 169.817 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) NAUTICAL SCHOOLS SAILING SCHOOL VESSELS Operations § 169.817 Master to instruct ship's company. The master shall conduct drills and give instructions as necessary to insure that al...

State waste discharge permit application, 200-E chemical drain field

Energy Technology Data Exchange (ETDEWEB)

1994-06-01

As part of the Hanford Federal Facility Agreement and Consent Order negotiations (Ecology et al. 1994), the US Department of Energy, Richland Operations Office, the US Environmental Protection Agency, and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground on the Hanford Site which affect groundwater or have the potential to affect ground would be subject to permitting under the structure of Chapter 173-216 (or 173-218 where applicable) of the Washington Administrative Code, the State Waste Discharge Permit Program. As a result of this decision, the Washington State Department of Ecology and the US Department of Energy, Richland Operations Office entered into Consent Order No. DE 91NM-177, (Ecology and DOE-RL 1991). The Consent Order No. DE 91NM-177 requires a series of permitting activities for liquid effluent discharges. This document presents the State Waste Discharge Permit (SWDP) application for the 200-E Chemical Drain Field. Waste water from the 272-E Building enters the process sewer line directly through a floor drain, while waste water from the 2703-E Building is collected in two floor drains, (north and south) that act as sumps and are discharged periodically. The 272-E and 2703-E Buildings constitute the only discharges to the process sewer line and the 200-E Chemical Drain Field.

State waste discharge permit application, 200-E chemical drain field

International Nuclear Information System (INIS)

1994-06-01

As part of the Hanford Federal Facility Agreement and Consent Order negotiations (Ecology et al. 1994), the US Department of Energy, Richland Operations Office, the US Environmental Protection Agency, and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground on the Hanford Site which affect groundwater or have the potential to affect ground would be subject to permitting under the structure of Chapter 173-216 (or 173-218 where applicable) of the Washington Administrative Code, the State Waste Discharge Permit Program. As a result of this decision, the Washington State Department of Ecology and the US Department of Energy, Richland Operations Office entered into Consent Order No. DE 91NM-177, (Ecology and DOE-RL 1991). The Consent Order No. DE 91NM-177 requires a series of permitting activities for liquid effluent discharges. This document presents the State Waste Discharge Permit (SWDP) application for the 200-E Chemical Drain Field. Waste water from the 272-E Building enters the process sewer line directly through a floor drain, while waste water from the 2703-E Building is collected in two floor drains, (north and south) that act as sumps and are discharged periodically. The 272-E and 2703-E Buildings constitute the only discharges to the process sewer line and the 200-E Chemical Drain Field

Typology of after-hours care instructions for patients

Science.gov (United States)

Bordman, Risa; Bovett, Monica; Drummond, Neil; Crighton, Eric J.; Wheler, David; Moineddin, Rahim; White, David

2007-01-01

OBJECTIVE To develop a typology of after-hours care (AHC) instructions and to examine physician and practice characteristics associated with each type of instruction. DESIGN Cross-sectional telephone survey. Physicians’ offices were called during evenings and weekends to listen to their messages regarding AHC. All messages were categorized. Thematic analysis of a subset of messages was conducted to develop a typology of AHC instructions. Logistic regression analysis was used to identify associations between physician and practice characteristics and the instructions left for patients. SETTING Family practices in the greater Toronto area. PARTICIPANTS Stratified random sample of family physicians providing office-based primary care. MAIN OUTCOME MEASURES Form of response (eg, answering machine), content of message, and physician and practice characteristics. RESULTS Of 514 after-hours messages from family physicians’ offices, 421 were obtained from answering machines, 58 were obtained from answering services, 23 had no answer, 2 gave pager numbers, and 10 had other responses. Message content ranged from no AHC instructions to detailed advice; 54% of messages provided a single instruction, and the rest provided a combination of instructions. Content analysis identified 815 discrete instructions or types of response that were classified into 7 categories: 302 instructed patients to go to an emergency department; 122 provided direct contact with a physician; 115 told patients to go to a clinic; 94 left no directions; 76 suggested calling a housecall service; 45 suggested calling Telehealth; and 61 suggested other things. About 22% of messages only advised attending an emergency department, and 18% gave no advice at all. Physicians who were female, had Canadian certification in family medicine, held hospital privileges, or had attended a Canadian medical school were more likely to be directly available to their patients. CONCLUSION Important issues identified

46 CFR 14.305 - Entries in continuous discharge book.

Science.gov (United States)

2010-10-01

... 46 Shipping 1 2010-10-01 2010-10-01 false Entries in continuous discharge book. 14.305 Section 14.305 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY MERCHANT MARINE OFFICERS AND SEAMEN SHIPMENT... discharge book. If the merchant mariner holds a continuous discharge book, the master or individual in...

76 FR 52643 - Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students...

Science.gov (United States)

2011-08-23

... DEPARTMENT OF EDUCATION Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students With Disabilities AGENCY: U. S. Department of Education, Office of Special Education and Rehabilitative Services, Advisory Commission on Accessible Instructional Materials in...

76 FR 63289 - Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students...

Science.gov (United States)

2011-10-12

... DEPARTMENT OF EDUCATION Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students With Disabilities AGENCY: U.S. Department of Education, Office of Special Education and Rehabilitative Services, Advisory Commission on Accessible Instructional Materials in...

75 FR 55789 - Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students...

Science.gov (United States)

2010-09-14

... DEPARTMENT OF EDUCATION Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students With Disabilities AGENCY: U.S. Department of Education, Office of Special Education and Rehabilitative Services, Advisory Commission on Accessible Instructional Materials in...

75 FR 80481 - Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students...

Science.gov (United States)

2010-12-22

... DEPARTMENT OF EDUCATION Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students with Disabilities AGENCY: U. S. Department of Education, Office of Special Education and Rehabilitative Services, Advisory Commission on Accessible Instructional Materials in...

76 FR 61349 - Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students...

Science.gov (United States)

2011-10-04

... DEPARTMENT OF EDUCATION Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students With Disabilities AGENCY: U.S. Department of Education, Office of Special Education and Rehabilitative Services, Advisory Commission on Accessible Instructional Materials in...

Treatment Episode Data Set: Discharges (TEDS-D-2006-2011)

Data.gov (United States)

U.S. Department of Health & Human Services — The Treatment Episode Data Set -- Discharges (TEDS-D) is a national census data system of annual discharges from substance abuse treatment facilities. TEDS-D...

76 FR 19984 - Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students...

Science.gov (United States)

2011-04-11

... DEPARTMENT OF EDUCATION Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students With Disabilities AGENCY: U.S. Department of Education, Office of Special Education....gov or by mail to Advisory Commission on Accessible Instructional Materials in Postsecondary Education...

Department of Defense Facilities Energy Conservation Policies and Spending

National Research Council Canada - National Science Library

Andrews, Anthony

2008-01-01

.... This report reviews energy conservation legislation and Executive Orders that apply to the Department of Defense, directives and instructions to the military departments and agencies on implementing...

Evaluation of a pictograph enhancement system for patient instruction: a recall study.

Science.gov (United States)

Zeng-Treitler, Qing; Perri, Seneca; Nakamura, Carlos; Kuang, Jinqiu; Hill, Brent; Bui, Duy Duc An; Stoddard, Gregory J; Bray, Bruce E

2014-01-01

We developed a novel computer application called Glyph that automatically converts text to sets of illustrations using natural language processing and computer graphics techniques to provide high quality pictographs for health communication. In this study, we evaluated the ability of the Glyph system to illustrate a set of actual patient instructions, and tested patient recall of the original and Glyph illustrated instructions. We used Glyph to illustrate 49 patient instructions representing 10 different discharge templates from the University of Utah Cardiology Service. 84 participants were recruited through convenience sampling. To test the recall of illustrated versus non-illustrated instructions, participants were asked to review and then recall a set questionnaires that contained five pictograph-enhanced and five non-pictograph-enhanced items. The mean score without pictographs was 0.47 (SD 0.23), or 47% recall. With pictographs, this mean score increased to 0.52 (SD 0.22), or 52% recall. In a multivariable mixed effects linear regression model, this 0.05 mean increase was statistically significant (95% CI 0.03 to 0.06, pillustration is a novel approach to improve the comprehension and recall of discharge instructions. Our results showed a statistically significant in recall with automated illustrations. Subjects with no-colleague education and younger subjects appeared to benefit more from the illustrations than others. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

7 CFR 1212.103 - Instructions.

Science.gov (United States)

2010-01-01

... Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (MARKETING AGREEMENTS..., PROMOTION, CONSUMER EDUCATION AND INDUSTRY INFORMATION ORDER Referendum Procedures § 1212.103 Instructions... information sources, without incurring advertising expense, to publicize the dates, places, method of voting...

Public Health Emergency Management Within the Department of Defense

Science.gov (United States)

2010-03-05

February 20071 (aa) DoD Instruction 1100.21, “ Voluntary Services in the Department of Defense,” March 11, 2002 (ab) DoD Instruction 5210.25...include eradication of disease, identification of affected animals, animal quarantine implementation, euthanasia , carcass disposal, cleaning and

State Waste Discharge Permit application, 100-N Sewage Lagoon

International Nuclear Information System (INIS)

1994-06-01

As part of the Hanford Federal Facility Agreement and Consent Order negotiations (Ecology et al. 1994), the US Department of Energy, Richland Operations Office, the US Environmental Protection Agency, and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground on the Hanford Site which affect groundwater or have the potential to affect groundwater would be subject to permitting under the structure of Chapter 173--216 (or 173--218 where applicable) of the Washington Administrative Code, the State Waste Discharge Permit Program. As a result of this decision, the Washington State Department of Ecology and the US Department of Energy, Richland Operations Office entered into Consent Order No. DE 91NM-177, (Ecology and DOE-RL 1991). This document constitutes the State Waste Discharge Permit application for the 100-N Sewage Lagoon. Since the influent to the sewer lagoon is domestic waste water, the State Waste Discharge Permit application for Public Owned Treatment Works Discharges to Land was used. Although the 100-N Sewage Lagoon is not a Public Owned Treatment Works, the Public Owned Treatment Works application is more applicable than the application for industrial waste water. The 100-N Sewage Lagoon serves the 100-N Area and other Hanford Site areas by receiving domestic waste from two sources. A network of sanitary sewer piping and lift stations transfers domestic waste water from the 100-N Area buildings directly to the 100-N Sewage Lagoon. Waste is also received by trucks that transport domestic waste pumped from on site septic tanks and holding tanks. Three ponds comprise the 100-N Sewage Lagoon treatment system. These include a lined aeration pond and stabilization pond, as well as an unlined infiltration pond. Both piped-in and trucked-in domestic waste is discharged directly into the aeration pond

32 CFR 70.9 - Discharge review standards.

Science.gov (United States)

2010-07-01

... ability to adjust to military service. (B) Family and Personal Problems. This includes matters in... National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE PERSONNEL, MILITARY AND CIVILIAN... change in discharge. Neither a DRB nor the Secretary of the Military Department concerned shall be bound...

Graduates perception towards instructional methods of emergency ...

African Journals Online (AJOL)

Graduates perception towards instructional methods of emergency medicine: affecting their self-confidence in emergency departments. Mohamed Daffalla Awadalla, Ahmed Abd Elrahman Abdalla, Sami Mahjoub Taha ...

Facility transition instruction

International Nuclear Information System (INIS)

Morton, M.R.

1997-01-01

The Bechtel Hanford, Inc. facility transition instruction was initiated in response to the need for a common, streamlined process for facility transitions and to capture the knowledge and experience that has accumulated over the last few years. The instruction serves as an educational resource and defines the process for transitioning facilities to long-term surveillance and maintenance (S and M). Generally, these facilities do not have identified operations missions and must be transitioned from operational status to a safe and stable configuration for long-term S and M. The instruction can be applied to a wide range of facilities--from process canyon complexes like the Plutonium Uranium Extraction Facility or B Plant, to stand-alone, lower hazard facilities like the 242B/BL facility. The facility transition process is implemented (under the direction of the US Department of Energy, Richland Operations Office [RL] Assistant Manager-Environmental) by Bechtel Hanford, Inc. management, with input and interaction with the appropriate RL division and Hanford site contractors as noted in the instruction. The application of the steps identified herein and the early participation of all organizations involved are expected to provide a cost-effective, safe, and smooth transition from operational status to deactivation and S and M for a wide range of Hanford Site facilities

76 FR 14385 - Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students...

Science.gov (United States)

2011-03-16

... DEPARTMENT OF EDUCATION Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students With Disabilities Meeting AGENCY: Advisory Commission on Accessible Instructional... Commission on Accessible Instructional Materials in Postsecondary Education for Students With Disabilities...

76 FR 34068 - Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students...

Science.gov (United States)

2011-06-10

... DEPARTMENT OF EDUCATION Advisory Commission on Accessible Instructional Materials in Postsecondary... Commission on Accessible Instructional Materials in Postsecondary Education for Students with Disabilities... or by mail to Advisory Commission on Accessible Instructional Materials in Postsecondary Education...

Emergency Department Care in the Postpartum Period: California Births, 2009-2011.

Science.gov (United States)

Batra, Priya; Fridman, Moshe; Leng, Mei; Gregory, Kimberly D

2017-11-01

To use population data to identify patient characteristics associated with a postpartum maternal emergency department visit within 90 days of discharge after birth. This retrospective cross-sectional study analyzed linked maternal discharge and emergency department data for all live California births from 2009 to 2011. The primary outcome was at least one emergency department visit within 90 days of hospital discharge after birth. Secondary outcomes included three or more visits within 90 days ("high utilization") and inpatient readmission. Independent variables included demographics (age, race or ethnicity, payer, income) and clinical characteristics (length of stay, antepartum complications, mode of delivery, and severe maternal morbidity at delivery). Multilevel logistic regression identified variables associated study outcomes; we validated the predictive model with a split-sample approach and receiver operating characteristic curve analysis. Of 1,071,232 deliveries included, 88,674 women (8.3%) visited the emergency department at least once in the 90 days after delivery discharge. Emergency department use was significantly associated with Medicaid insurance (adjusted odds ratio [OR] 2.15, 95% CI 2.08-2.21), age younger than 20 years (adjusted OR 2.08, 95% CI 1.98-2.19), severe maternal morbidity at delivery (adjusted OR 1.58, 95% CI 1.49-1.71), antepartum complications (adjusted OR 1.46, 95% CI 1.42-1.50), and cesarean delivery (adjusted OR 1.40, 95% CI 1.37-1.44). Approximately one fifth of visits occurred within 4 days of discharge, and more than half were within 3 weeks. High utilizers comprised 0.5% of the entire sample (5,171 women) and only 1.2% of women presenting for emergency department care were readmitted. Receiver operating curve model analysis using the validation sample supported predictive accuracy for postpartum emergency department use (area under the curve=0.95). One in 12 California women visited the emergency department in the first 90 days

Improving the accuracy of operation coding in surgical discharge summaries

Science.gov (United States)

Martinou, Eirini; Shouls, Genevieve; Betambeau, Nadine

2014-01-01

Procedural coding in surgical discharge summaries is extremely important; as well as communicating to healthcare staff which procedures have been performed, it also provides information that is used by the hospital's coding department. The OPCS code (Office of Population, Censuses and Surveys Classification of Surgical Operations and Procedures) is used to generate the tariff that allows the hospital to be reimbursed for the procedure. We felt that the OPCS coding on discharge summaries was often incorrect within our breast and endocrine surgery department. A baseline measurement over two months demonstrated that 32% of operations had been incorrectly coded, resulting in an incorrect tariff being applied and an estimated loss to the Trust of £17,000. We developed a simple but specific OPCS coding table in collaboration with the clinical coding team and breast surgeons that summarised all operations performed within our department. This table was disseminated across the team, specifically to the junior doctors who most frequently complete the discharge summaries. Re-audit showed 100% of operations were accurately coded, demonstrating the effectiveness of the coding table. We suggest that specifically designed coding tables be introduced across each surgical department to ensure accurate OPCS codes are used to produce better quality surgical discharge summaries and to ensure correct reimbursement to the Trust. PMID:26734286

State Waste Discharge Permit application: 200-W Powerhouse Ash Pit

Energy Technology Data Exchange (ETDEWEB)

Atencio, B.P.

1994-06-01

As part of the Hanford Federal Facility Agreement and Consent Order negotiations; the US Department of Energy, Richland Operations Office, the US Environmental Protection Agency, and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground on the Hanford Site which affect groundwater or have the potential to affect groundwater would be subject to permitting under the structure of Chapter 173-216 (or 173-218 where applicable) of the Washington Administrative Code, the State Waste Discharge Permit Program. This document constitutes the State Waste Discharge Permit application for the 200-W Powerhouse Ash Pit. The 200-W Powerhouse Ash Waste Water discharges to the 200-W Powerhouse Ash Pit via dedicated pipelines. The 200-W Powerhouse Ash Waste Water is the only discharge to the 200-W Powerhouse Ash Pit. The 200-W Powerhouse is a steam generation facility consisting of a coal-handling and preparation section and boilers.

State Waste Discharge Permit application: 200-E Powerhouse Ash Pit

Energy Technology Data Exchange (ETDEWEB)

Atencio, B.P.

1994-06-01

As part of the Hanford Federal Facility Agreement and Consent Order negotiations, the US Department and Energy, Richland Operations Office, the US Environmental Protection Agency, and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground on the Hanford Site which affect groundwater or have the potential to affect groundwater would be subject to permitting under the structure of Chapter 173-216 (or 173-218 where applicable) of the Washington Administrative Code, the State Waste Discharge Permit Program. This document constitutes the State Waste Discharge Permit application for the 200-E Powerhouse Ash Pit. The 200-E Powerhouse Ash Waste Water discharges to the 200-E Powerhouse Ash Pit via dedicated pipelines. The 200-E Ash Waste Water is the only discharge to the 200-E Powerhouse Ash Pit. The 200-E Powerhouse is a steam generation facility consisting of a coal-handling and preparation section and boilers.

46. The goals of safety engineering department of the plant

International Nuclear Information System (INIS)

Ivanov, A.V.

1993-01-01

The goals of safety engineering department of the plant, including elaboration of instructions on safety engineering on all specialities, safety engineering training of all labours working on the plant and control for abidance by the instructions on safety engineering were discussed.

[The influence of counseling for patients with cancer on their discharge from the palliative care support department of the community health care service of Minoh City Hospital].

Science.gov (United States)

Suita, Tomoko; Kato, Rika; Fujita, Misao; Hidaka, Kumi; Iijima, Shohei

2014-12-01

Counseling for patients with cancer by a certified nurse in palliative care began in April 2011 in Minoh City Hospital. Counseling was provided immediately after a patient was informed by the treating physician of a primary diagnosis of cancer, a metastatic recurrence, or a decision to terminate cancer therapy. We examined the patient's support system after the counseling ended. The number of patients receiving end-of-life support with home or hospital care rapidly increased from 118 prior to the program's beginning to 186. The number of patients counseled was comparable to the rapid increase in their number(n=68). New cases in the outpatient department comprised 59% of all patients, of which, 45% began supportive counseling, with 43%of them ultimately returning home. Of the new cases receiving counseling in the hospital, 34%eventually returned home after discharge, and the highest percentage of discharges were to a palliative care unit or hospice program (48%). The initiation of counseling in the outpatient department allowed us to provide sufficient time to make decisions about appropriate places for end-of-life care. Cooperation with the patients' physicians was necessary to provide counseling from the outpatient department. Our findings suggest the importance of sharing the patients' medical and social information among the staff when necessary.

A sex risk reduction text-message program for young adult females discharged from the emergency department.

Science.gov (United States)

Suffoletto, Brian; Akers, Aletha; McGinnis, Kathleen A; Calabria, Jaclyn; Wiesenfeld, Harold C; Clark, Duncan B

2013-09-01

To pilot test a text message (SMS) sex risk reduction program among at-risk young adult female patients discharged from an emergency department (ED). A convenience sample of 52 female patients with hazardous drinking behavior and recent risky sexual encounters were recruited from an urban ED and randomized to the SMS program (n = 23) or a control group (n = 29). All participants completed a web-based questionnaire in the ED and at 3-month follow-up. For 12 weeks, SMS participants were asked to report whether they had a risky sexual encounter in the past week, received theory-based feedback, and were asked if they were willing set a goal to refrain from having another risky encounter. Thirty-nine percent of SMS participants completed all weeks of SMS reports, and noncompletion increasing from 12% on week 1 to a 33% by week 12. Three-month follow-up was completed in 56% of participants. In the intervention group, there was an increase in the proportion with condom use with last vaginal sex from 20% (95% CI 4%-48%) to 53% (95% CI 27%-79%) and an increase in always condom use over the past 28 days from 0% (95% CI 0%-22%) to 33% (95% CI 12%-62%). These changes were not statistically different from control participants. SMS programs may be useful to reduce risk for sexually transmitted diseases among at-risk young adults being discharged from the ED. Future trials should examine ways to improve adherence to SMS dialog over time and measure objective outcomes in a larger sample. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

"I don't know what I was expecting": Home visits by neonatology fellows for infants discharged from the NICU.

Science.gov (United States)

Hobbs, Janice E; Tschudy, Megan M; Hussey-Gardner, Brenda; Jennings, Jacky M; Boss, Renee D

2017-12-01

When families transition from the neonatal intensive care unit (NICU) to the home, they become responsible for their infant's daily medical needs. Though neonatology physicians prepare families for hospital discharge, it is unclear how much clinicians understand about how their teaching and instructions translate into home care. The goal of this study was to evaluate the influence of a home visiting program on neonatology fellows' understanding of family needs soon after hospital discharge. Neonatology fellows conducted a home visit for an infant recently discharged. Before the visit, fellows reviewed their original discharge instructions, along with information about the family's neighborhood. During the home visit, fellows reviewed their discharge planning with families and discussed any challenges experienced. Afterwards, fellows completed a semi-structured interview; these transcriptions were manually coded for themes. Fellows identified several common women/family discharge challenges. These challenges fall into four domains: (1) inadequate discharge preparation, (2) medicalization of the home, (3) family adjustment to new "normal," and (4) the relevance of social context to discharge planning. Most (90%) fellows reported the home visit experience would affect their future NICU discharge practices and all agreed that home visits should be a part of neonatology training. Home visits allowed neonatology fellows to examine how their discharge preparation did, or did not, meet the family's needs. Incorporating home visits into neonatology training could help fellows learn about the relevance of social and community factors that are difficult to assess in the inpatient setting. © 2017 Wiley Periodicals, Inc.

7 CFR 29.127 - Demonstrations and courses of instruction.

Science.gov (United States)

2010-01-01

... Section 29.127 Agriculture Regulations of the Department of Agriculture AGRICULTURAL MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE COMMODITY STANDARDS AND STANDARD... instruction. Charges, not in excess of the cost thereof, as may be approved by the Director, may be made for...

Feasibility and Acceptability of Utilizing a Smartphone Based Application to Monitor Outpatient Discharge Instruction Compliance in Cardiac Disease Patients around Discharge from Hospitalization

Directory of Open Access Journals (Sweden)

Aimee M. Layton

2014-01-01

Full Text Available The purpose of this study was to determine the feasibility and acceptability of utilizing a smartphone based application to monitor compliance in patients with cardiac disease around discharge. For 60 days after discharge, patients’ medication compliance, physical activity, follow-up care, symptoms, and reading of education material were monitored daily with the application. 16 patients were enrolled in the study (12 males, 4 females, age 55 ± 18 years during their hospital stay. Five participants were rehospitalized during the study and did not use the application once discharged. Seven participants completed 1–30 days and four patients completed >31 days. For those 11 patients, medication reminders were utilized 37% (1–30-day group and 53% (>31-day group of the time, education material was read 44% (1–30 and 53% (>31 of the time, and physical activity was reported 25% (1–30 and 42% (>31 of the time. Findings demonstrated that patients with stable health utilized the application, even if only minimally. Patients with decreased breath sounds by physical exam and who reported their health as fair to poor on the day of discharge were less likely to utilize the application. Acceptability of the application to report health status varied among the stable patients.

7 CFR 900.310 - Supplementary instructions.

Science.gov (United States)

2010-01-01

... Conduct of Referenda To Determine Producer Approval of Milk Marketing Orders To Be Made Effective Pursuant to Agricultural Marketing Agreement Act of 1937, as Amended § 900.310 Supplementary instructions. The... Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing...

The impact of post-discharge patient call back on patient satisfaction in two academic emergency departments.

Science.gov (United States)

Guss, David A; Leland, Hyuma; Castillo, Edward M

2013-01-01

Patients' satisfaction is a common parameter tracked by health care systems and Emergency Departments (EDs). To determine whether telephone calls by health care providers to patients after discharge from the ED was associated with improved patient satisfaction. Retrospective analysis of Press Ganey (PG; Press Ganey Associates, South Bend, IN) surveys from two EDs operated by the University of California San Diego Health System. Responses to the YES/NO question, "After discharge, did you receive a phone call from an ED staff member?" was compared to the responses to the question "likelihood of recommending this ED to others" (LR). This variable could be ranked with a score of 1 (very poor) to 5 (very good). Responses were dichotomized into two groups, 1-4 and 5. Chi-squared was performed to assess LR between those answering YES vs. NO to the call back question. Differences in proportion, 95% confidence interval (CI), and p-value are reported. Rankings for percentage of 5s across all EDs in the PG database were compared based upon YES/NO responses. In the 12-month study period, about 30,000 surveys were mailed and 2250 (7.5%) were returned. Three hundred forty-seven (15.4%) checked off YES for the call back question. Percentage of 5s for LR for NO call back was 51.1% and for YES call back was 70.6% (difference = 19.5; 95% CI 14.0-24.6; p < 0.001).These values correlated with an ED ranking of 14(th) and 85(th) percentile, respectively. This retrospective study demonstrated a strong association between post-visit patient call back and LR. Further prospective study with control for co-variables is warranted. Copyright © 2013 Elsevier Inc. All rights reserved.

33 CFR 159.315 - Sewage and graywater discharge record book.

Science.gov (United States)

2010-07-01

... record book. 159.315 Section 159.315 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND... by Cruise Vessel Operations § 159.315 Sewage and graywater discharge record book. (a) While operating... and Graywater Discharge Record Book with the vessel's name and official number listed on the front...

Typology of after-hours care instructions for patients: telephone survey and multivariate analysis.

Science.gov (United States)

Bordman, Risa; Bovett, Monica; Drummond, Neil; Crighton, Eric J; Wheler, David; Moineddin, Rahim; White, David

2007-03-01

To develop a typology of after-hours care (AHC) instructions and to examine physician and practice characteristics associated with each type of instruction. Cross-sectional telephone survey. Physicians' offices were called during evenings and weekends to listen to their messages regarding AHC. All messages were categorized. Thematic analysis of a subset of messages was conducted to develop a typology of AHC instructions. Logistic regression analysis was used to identify associations between physician and practice characteristics and the instructions left for patients. Family practices in the greater Toronto area. Stratified random sample of family physicians providing office-based primary care. Form of response (eg, answering machine), content of message, and physician and practice characteristics. Of 514 after-hours messages from family physicians' offices, 421 were obtained from answering machines, 58 were obtained from answering services, 23 had no answer, 2 gave pager numbers, and 10 had other responses. Message content ranged from no AHC instructions to detailed advice; 54% of messages provided a single instruction, and the rest provided a combination of instructions. Content analysis identified 815 discrete instructions or types of response that were classified into 7 categories: 302 instructed patients to go to an emergency department; 122 provided direct contact with a physician; 115 told patients to go to a clinic; 94 left no directions; 76 suggested calling a housecall service; 45 suggested calling Telehealth; and 61 suggested other things. About 22% of messages only advised attending an emergency department, and 18% gave no advice at all. Physicians who were female, had Canadian certification in family medicine, held hospital privileges, or had attended a Canadian medical school were more likely to be directly available to their patients. Important issues identified included the recommendation to use an emergency department as the sole source of AHC

Instructional Design: Its Relevance for CALL.

Science.gov (United States)

England, Elaine

1989-01-01

Describes an interdisciplinary (language and educational technology departments) instructional design program that is intended to develop back-up computer programs for students taking supplementary English as a second language classes. The program encompasses training programs, the psychology of screen reading, task analysis, and color cueing.…

31 CFR 211.4 - Implementing instructions.

Science.gov (United States)

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Implementing instructions. 211.4 Section 211.4 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE DELIVERY OF CHECKS AND WARRANTS TO...

34 CFR 686.42 - Discharge of agreement to serve.

Science.gov (United States)

2010-07-01

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

Cardiopulmonary resuscitation training of family members before hospital discharge using video self-instruction: a feasibility trial.

Science.gov (United States)

Blewer, Audrey L; Leary, Marion; Decker, Christopher S; Andersen, James C; Fredericks, Amanda C; Bobrow, Bentley J; Abella, Benjamin S

2011-09-01

Bystander cardiopulmonary resuscitation (CPR) is a crucial therapy for sudden cardiac arrest (SCA), yet rates of bystander CPR are low. This is especially the case for SCA occurring in the home setting, as family members of at-risk patients are often not CPR trained. To evaluate the feasibility of a novel hospital-based CPR education program targeted to family members of patients at increased risk for SCA. Prospective, multicenter, cohort study. Inpatient wards at 3 hospitals. Family members of inpatients admitted with cardiac-related diagnoses. Family members were offered CPR training via a proctored video-self instruction (VSI) program. After training, CPR skills and participant perspectives regarding their training experience were assessed. Surveys were conducted one month postdischarge to measure the rate of "secondary training" of other individuals by enrolled family members. At the 3 study sites, 756 subjects were offered CPR instruction; 280 agreed to training and 136 underwent instruction using the VSI program. Of these, 78 of 136 (57%) had no previous CPR training. After training, chest compression performance was generally adequate (mean compression rate 90 ± 26/minute, mean depth 37 ± 12 mm). At 1 month, 57 of 122 (47%) of subjects performed secondary training for friends or family members, with a calculated mean of 2.1 persons trained per kit distributed. The hospital setting offers a unique "point of capture" to provide CPR instruction to an important, undertrained population in contact with at-risk individuals. Copyright © 2010 Society of Hospital Medicine.

33 CFR 151.67 - Operating requirements: Discharge of plastic prohibited.

Science.gov (United States)

2010-07-01

... of plastic prohibited. 151.67 Section 151.67 Navigation and Navigable Waters COAST GUARD, DEPARTMENT... Sewage § 151.67 Operating requirements: Discharge of plastic prohibited. No person on board any ship may discharge into the sea, or into the navigable waters of the United States, plastic or garbage mixed with...

76 FR 45236 - Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students...

Science.gov (United States)

2011-07-28

... DEPARTMENT OF EDUCATION Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students with Disabilities AGENCY: Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students with Disabilities, Office of Special Education and...

76 FR 7181 - Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students...

Science.gov (United States)

2011-02-09

... DEPARTMENT OF EDUCATION Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students With Disabilities AGENCY: Advisory Commission on Accessible Instructional Materials in Postsecondary Education for Students with Disabilities, Office of Special Education and...

Patient education and follow-up as an intervention for hypertensive patients discharged from an emergency department: a randomized control trial study protocol.

Science.gov (United States)

Gleason-Comstock, Julie; Streater, Alicia; Ager, Joel; Goodman, Allen; Brody, Aaron; Kivell, Laura; Paranjpe, Aniruddha; Vickers, Jasmine; Mango, LynnMarie; Dawood, Rachelle; Levy, Phillip

2015-12-21

Persistently elevated blood pressure (BP) is a leading risk factor for cardiovascular disease development, making effective hypertension management an issue of considerable public health importance. Hypertension is particularly prominent among African Americans, who have higher disease prevalence and consistently lower BP control than Whites and Hispanics. Emergency departments (ED) have limited resources for chronic disease management, especially for under-served patients dependent upon the ED for primary care, and are not equipped to conduct follow-up. Kiosk-based patient education has been found to be effective in primary care settings, but little research has been done on the effectiveness of interactive patient education modules as ED enhanced discharge for an under-served urban minority population. Achieving Blood Pressure Control Through Enhanced Discharge (AchieveBP) is a behavioral RCT patient education intervention for patients with a history of hypertension who have uncontrolled BP at ED discharge. The project will recruit up to 200 eligible participants at the ED, primarily African-American, who will be asked to return to a nearby clinical research center for seven, thirty and ninety day visits, with a 180 day follow-up. Consenting participants will be randomized to either an attention-control or kiosk-based interactive patient education intervention. To control for potential medication effects, all participants will be prescribed similar, evidenced-based anti-hypertensive regimens and have their prescription filled onsite at the ED and during visits to the clinic. The primary target endpoint will be success in achieving BP control assessed at 180 days follow-up post-ED discharge. The secondary aim will be to assess the relationship between patient activation and self-care management. The AchieveBP trial will determine whether using interactive patient education delivered through health information technology as ED enhanced discharge with subsequent

LANGUAGE LEARNING UNDER CLASSROOM CONDITIONS DURING THE TRANSITION TO HYBRID INSTRUCTION: A CASE-STUDY OF STUDENT PERFORMANCE DURING THE IMPLEMENTATION OF INSTRUCTIONAL TECHNOLOGY

OpenAIRE

Lisbeth O. Swain; Timothy D. Swain

2017-01-01

We examined the unmanipulated performance of students under real classroom conditions in order to assess the effect of a technology-enhanced hybrid learning approach to second language, (L2) instruction on beginning and advanced Spanish language learners. This research focused on the transition period of technology implementation when the entire section of Spanish of a modern language department of a liberal arts university transitioned from traditional face-to-face instruction, to a technolo...

Post-Discharge Follow-Up Visits and Hospital Utilization

Data.gov (United States)

U.S. Department of Health & Human Services — Analysis reported in Post-Discharge Follow-Up Visits and Hospital Utilization by Medicare Patients, 2007-2010, published in Volume 4, Issue 2 of Medicare and...

A survey of prosthetic eye wearers to investigate mucoid discharge

Directory of Open Access Journals (Sweden)

Pine K

2012-05-01

Full Text Available Keith Pine1, Brian Sloan2, Joanna Stewart3, Robert J Jacobs11Department of Optometry and Vision Science, 2Department of Ophthalmology, New Zealand National Eye Centre, 3Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New ZealandBackground: This study aimed to better understand the causes and treatments of mucoid discharge associated with prosthetic eye wear by reviewing the literature and surveying anophthalmic patients.Methods: An anonymous questionnaire was completed by 429 prosthetic eye wearers who used visual analog scales to self-measure their discharge experience for four discharge characteristics: frequency, color, volume, and viscosity. These characteristics were analyzed with age, ethnicity, years wearing a prosthesis, eye loss cause, removal and cleaning regimes, hand-washing behavior, age of current prosthesis, and professional repolishing regimes as explanatory variables. Eighteen ocularists’ Web sites containing comments on the cause and treatment of discharge were surveyed.Results: Associations were found between discharge frequency and cleaning regimes with more frequent cleaning accompanying more frequent discharge. Color was associated with years of wearing and age, with more years of wearing and older people having less colored discharge. Volume was associated with cleaning regimes with more frequent cleaners having more volume. Viscosity was associated with cleaning regimes and years of wearing with more frequent cleaning and shorter wearing time accompanying more viscous discharge. No associations were found between discharge characteristics and ethnicity, eye loss cause, hand washing, age of current prosthesis, or repolishing regimes. Forty-seven percent of ocularists’ Web sites advised that discharge was caused by surface deposits on the prosthesis, 29% by excessive handling of the prosthesis, and 24% by other causes.Conclusions: A standardized treatment

Department-Head Leadership for School Improvement

Science.gov (United States)

Leithwood, Kenneth

2016-01-01

This review of research was prompted by the widespread belief that at least in a significant number of secondary schools, department heads are an underutilized, if not untapped, source of instructional leadership, the type of leadership critical to secondary-school improvement initiatives. Forty-two methodologically diverse empirical studies were…

[Appropriateness of the prescriptions of conventional versus new oral anticoagulants at discharge from a department of internal medicine].

Science.gov (United States)

Bochatay, L; Beney, J; Jordan-von Gunten, V; Petignat, P A; Roulet, L

2016-09-01

The recently introduced oral direct anticoagulants (ODAs), presumably safer, and with comparable efficacy to the vitamin K antagonists (VKAs), may reshape the world of anticoagulation medicine. This study aimed to assess the prescription appropriateness of ODAs and VKAs at discharge from hospital. We performed a one year retrospective study between August 2012 and July 2013 in the department of internal medicine of a regional hospital (HVs Sion) using Electronic Medical Records. All patients receiving an ODA were included and matched to a patient treated with a VKA. The appropriateness of prescription at discharge was defined by an adequate indication and dosing, the absence of contraindication, a minimal risk of drug-drug interactions and no major bleeding or venous thromboembolism during the hospitalization. The bleeding risk was evaluated with the HAS-BLED score when the indication was atrial fibrillation (AF). Out of the 44patients included (22 with an ODA and 22 with a VKA), 38 received an appropriate prescription according to all criteria. Two patients had an inadequate dosing. A potential drug-drug interaction was detected in 3patients receiving a VKA and in 1patient receiving an ODA. No major contraindication was found, but a relative contraindication was discussed in 3cases. The majority of patients receiving an ODA for an AF had a minor bleeding risk. No significant difference was ascertained between the two groups regarding the appropriateness of prescription. Our results suggest that ODAs were cautiously used in our setting. Copyright © 2015 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

588 Department of Water Resources and Environmental

African Journals Online (AJOL)

USER

2017-06-06

Jun 6, 2017 ... Department of Civil Engineering, Faculty of Engineering and Technology, University of ... Health Organization (WHO) and Nigerian Standard for Drinking Water Quality (NSDWQ) .... discharges of industrial contaminants into.

14 CFR 99.7 - Special security instructions.

Science.gov (United States)

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Special security instructions. 99.7 Section 99.7 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES SECURITY CONTROL OF AIR TRAFFIC General § 99.7 Special...

Discharge Planning in Chronic Conditions

Science.gov (United States)

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

Nuclear medicine. The management of patients coming out of a nuclear medicine department - Radiation protection sheet ED 4242

International Nuclear Information System (INIS)

2006-03-01

This sheet aims at providing elements for the preparation of the management of a patient by a department or unit other than a nuclear medicine department after this patient has been submitted to an examination or treatment involving the use of radionuclides in unsealed sources, as this exposure may result in an internal or external exposure risk for the personnel, other persons and relatives. It briefly describes the modalities of performance of nuclear medicine act, the modalities of information of patients and of their relatives, indicates instructions to departments hosting the patient (instruction regarding the patient and wastes), and instructions for pregnant or breast feeding women

Out of Classroom Instruction in the Flipped Classroom

DEFF Research Database (Denmark)

Triantafyllou, Evangelia; Timcenko, Olga

2015-01-01

This article presents experiences and student perceptions on the introduction of the flipped classroom model in two consecutive semesters at Media Technology department of Aalborg University, Copenhagen, Denmark. We introduced the flipped instruction model to a statistics course and a mathematics...

State waste discharge permit application 400 Area secondary cooling water. Revision 2

International Nuclear Information System (INIS)

1996-01-01

This document constitutes the Washington Administrative Code 173-216 State Waste Discharge Permit Application that serves as interim compliance as required by Consent Order DE 91NM-177, for the 400 Area Secondary Cooling Water stream. As part of the Hanford Federal Facility Agreement and Consent Order negotiations, the US Department of Energy, Richland Operations Office, the US Environmental Protection Agency, and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground on the Hanford Site that affect groundwater or have the potential to affect groundwater would be subject to permitting under the structure of Chapter 173-216 of the Washington Administrative Code, the State Waste Discharge Permitting Program. As a result of this decision, the Washington State Department of Ecology and the US Department of Energy, Richland Operations Office entered into Consent Order DE 91NM-177. The Consent Order DE 91NM-177 requires a series of permitting activities for liquid effluent discharges. Based upon compositional and flow rate characteristics, liquid effluent streams on the Hanford Site have been categorized into Phase 1, Phase 2, and Miscellaneous streams. This document only addresses the 400 Area Secondary Cooling Water stream, which has been identified as a Phase 2 stream. The 400 Area Secondary Cooling Water stream includes contribution streams from the Fuels and Materials Examination Facility, the Maintenance and Storage Facility, the 481-A pump house, and the Fast Flux Test Facility

42 CFR 412.104 - Special treatment: Hospitals with high percentage of ESRD discharges.

Science.gov (United States)

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective Payment System for Inpatient... established that ESRD beneficiary discharges, excluding discharges classified into MS-DRG 652 (Renal Failure...

Measures of Rehospitalization, Emergency Room Visit, and Community Discharge

Data.gov (United States)

U.S. Department of Health & Human Services — Measures of the Rate of Rehospitalization, Emergency Room Visit, and Community Discharge for Medicare Beneficiaries. These rates are based on Medicare claims data.

Discharge and infection in retinoblastoma post-enucleation sockets

Directory of Open Access Journals (Sweden)

Mourits DL

2017-03-01

Full Text Available Daphne L Mourits,1 Dyonne T Hartong,1 Andries E Budding,2 Machteld I Bosscha,1 H Stevie Tan,1 Annette C Moll1 1Department of Ophthalmology, VU University Medical Center, 2Department of Microbiology, Academic Medical Center, Amsterdam, the Netherlands Purpose: To investigate the causes and treatment options for socket discharge and infection in patients enucleated for retinoblastoma (Rb. Methods: A questionnaire was filled out by (parents of ocular prosthesis-wearing patients with a history of enucleation as treatment for Rb. We collected data on patients’ characteristics, cleaning habits of the prosthesis, frequency of socket irritation, discharge, and infection, and use of antibiotics. With ordinal logistic regression analysis, factors related to the outcome parameters (frequency of irritation, mucoid and purulent discharge were identified. In a subset of young asymptomatic and symptomatic patients, a swab culture of the socket was performed to determine the presence of microorganisms. Results: A total of 186 patients or their parents (mean age of the patients: 17.3 years, ranging from 0.8 to 88.3 years filled out the questionnaire. Irritation, mucoid discharge, and purulent discharge were frequently (once a month or more often experienced in 75 (39.5%, 127 (66.8%, and 15 (13.2% sockets, respectively. Younger age was associated with a higher frequency of mucoid and purulent discharge. Radiation therapy, chemotherapy, gender, age at surgery, cleaning frequency, and nocturnal wear were not associated with the outcome parameters. In a subgroup of 26 patients, the sockets were swabbed and cultured. All symptomatic patients had a positive bacterial culture versus 15% (2/13 of the asymptomatic patients (P<0.001. Common cold was correlated with both symptoms and presence of bacteria. Haemophilus influenzae and Staphylococcus aureus were the species most frequently cultured. Conclusion: Ocular prosthesis-wearing patients often experienced mucoid

Interactive video instruction - Establishing a positive alternative

International Nuclear Information System (INIS)

Schillinger, F.J.; McCulloch, B.P.

1991-01-01

This paper discusses The New York Power Authority's (NYPA's) efforts to establish and implement a viable interactive video instruction program to provide an alternative to traditional instructor-led classroom training. The NYPA training department was looking for alternative methods of providing adequate training for a new apprenticeship program being developed for its nonnuclear plant employees. They were also looking for another way to provide cost-effective basic computer training for an ever-increasing number of company computer users. Interactive video instruction was selected because it offered an interesting and fresh approach to self-paced learning. The paper describes problems associated with startup, implementation, and administration, benefits expected, and obtaining college accreditation

Angina - discharge

Science.gov (United States)

Chest pain - discharge; Stable angina - discharge; Chronic angina - discharge; Variant angina - discharge; Angina pectoris - discharge; Accelerating angina - discharge; New-onset angina - discharge; Angina-unstable - discharge; ...

Instructional Partners, Principals, Teachers, and Instructional Assistants.

Science.gov (United States)

Indiana State Dept. of Public Instruction, Indianapolis.

This handbook examines various topics of interest and concern to teachers as they work with instructional assistants forming a classroom instructional partnership and functioning as a team. These topics include: (1) instructional assistant qualifications; (2) duties--instructional, classroom clerical, auxillary; (3) factors to be considered when…

Comprehension and compliance with the discharge advice and quality of life at home among the postoperative neurosurgery patients discharged from PGIMER, Chandigarh, India

Science.gov (United States)

Kumar, Vishal; Singh, Amarjeet; Tewari, Manoj K.; Kaur, Sukhpal

2016-01-01

Problem Statement: Neurosurgical patients require special care not only in the hospital but also after their discharge from the hospital. Comprehension and compliance to the instructions given by the doctors/nurses at the time of discharge is important in home care of these patients. Many such patients suffer from various co-morbidities. Variable periods of convalescence affect health-related quality of life in these patients. Purpose of the Study: To determine the degree of compliance of neurosurgery patients and their family caregivers with the discharge advice given by the consultantsTo evaluate the quality of life of these patientsTo know the problems faced by these patients at home. Materials and Methods: This cross-sectional interview-based descriptive study was conducted in 2010 in Chandigarh. These patients were visited at their home. A scale was evolved to evaluate comprehension and compliance to the advice given at the time of discharge, according to the criteria developed by Clark et al. Lawton Brody instrumental activity of daily life and Spitzer quality of life index were used to assess patients' quality of life after the operation. Verbatim responses were recorded for the purpose of qualitative research. Results: Overall, 58 patients and their caregivers were interviewed at home. Mean age of the patients was 38.9 years. Out of 37 patients, 35 showed good comprehension and 33 patients had a good compliance with the instructions given for medication. The condition of 74.1% patients improved after the operation. Depression was reported in 31% of the patients. Many (36.2%) patients had to quit their job due to the disease. Almost half (47.4%) of the patients were independent in daily activities of their life while being evaluated on Barthel activity of daily life index. Conclusion and Recommendations: It is in the long term that the true complexity and impact of operations become apparent. After operation, such patients are likely to have a range of

7 CFR 319.24a - Administrative instructions relating to entry of corn into Guam.

Science.gov (United States)

2010-01-01

... 7 Agriculture 5 2010-01-01 2010-01-01 false Administrative instructions relating to entry of corn...) ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE FOREIGN QUARANTINE NOTICES Corn Diseases Quarantine § 319.24a Administrative instructions relating to entry of corn into Guam. Corn may be...

7 CFR 91.41 - Charges for demonstrations and courses of instruction.

Science.gov (United States)

2010-01-01

... MARKETING SERVICE (Standards, Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED... demonstrations and courses of instruction. Charges, not in excess of the cost thereof and as approved by the...

42 CFR Appendix C to Part 130 - Petition Form, Petition Instructions, and Documentation Checklist

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Petition Form, Petition Instructions, and Documentation Checklist C Appendix C to Part 130 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND... C to Part 130—Petition Form, Petition Instructions, and Documentation Checklist ER31MY00.004...

Assessment of the effect of effluent discharge from coffee refineries ...

African Journals Online (AJOL)

Admin

2Department of Environmental Health, Jimma University, Jimma, Ethiopia. ... cherries, transport them hydraulically through the pulping ..... Table 2. Interaction effects of effluent discharges by coffee refineries on physical characteristics between.

Predictors of Adverse Outcomes of Patients with Chest Pain and Primary Diagnosis of Non-Cardiac Pain at the Time of Discharge from Emergency Department: A 30-Days Prospective Study.

Science.gov (United States)

Soltani, Mohammadhossien; Mirzaei, Masoud; Amin, Ahmad; Emami, Mahmoud; Aryanpoor, Reza; Shamsi, Farimah; Sarebanhassanabadi, Mohammadtaghi

2016-07-01

Chest pain is a common symptom for referring patients to emergency departments (ED). Among those referred, some are admitted to hospitals with a definite or tentative diagnosis of acute coronary syndrome and some are discharged with primary diagnosis of non-cardiac chest pain. This study aimed at investigating 30 days' adverse outcomes of patients discharged from ED of a major heart center in Iran. Out of 1638 chest pain admissions to the centre during 2010-2011, 962 patients (mean age= 50.9±15.9 years) who were admitted to Afshar Heart Center's ED with chest pain as their chief complaint, and discharged with primary diagnosis of non-cardiac chest pain, were followed for any adverse cardiac events 30 days post discharge. The adverse events were: unstable angina, non-ST-elevated myocardial infarction (NSTEMI), ST elevated myocardial infarction (STEMI), coronary revascularization (percutaneous angioplasty, coronary artery bypass grafting) and death. Adverse cardiac events, including acute coronary syndrome (ACS), revascularization and death were observed in 30 patients (3.1%) including: acute MI n=5 (0.5%, sudden cardiac death inn=1 (0.1%, coronary revascularization in n=8 (0.8%) and hospitalization due to unstable angina/NSTEMI in n=16 (1-7%). Adverse events were seen more frequently in patients with history of hypertension, dyslipidemia and previous coronary artery disease. In univariate analysis, the chance of postdischarge adverse cardiac events was higher in patients with hypertension (OR=9.36, CI=3.24-27.03), previous coronary artery disease (OR= 3.8, CI=1.78-8.0), dyslipidemia (OR=3.5, CI=1.7-7.38) and discharge against medical advice (OR=2.85, CI= 1.37-5.91). The extent of adverse cardiac events in patients with a primary diagnosis of non-cardiac chest pain within 30 days of discharge was significant, mandating nation-wide registries to provide better care for these patients.

Early Childhood Teacher Candidates\\' Attitudes towards Computer and Computer Assisted Instruction

OpenAIRE

Oğuz, Evrim; Ellez, A. Murat; Akamca, Güzin Özyılmaz; Kesercioğlu, Teoman İ.; Girgin, Günseli

2011-01-01

The aim of this research is to evaluate preschool candidates’ attitudes towards computers andattitudes towards use of computer assisted instruction. The sample of this study includes 481 early childhoodeducation students who attended Dokuz Eylül University’s department of Early Childhood Education. Data werecollected by using “Scale of Computer Assisted Instruction Attitudes” developed by the Arslan (2006),“Computer Attitudes Scale” developed by Çelik & Bindak (2005) and “General Info...

Notice of intent to discharge water contaminants. Waste Isolation Pilot Plant, Eddy County, NM

International Nuclear Information System (INIS)

Hart, J.S.; Porter, K.R.; Register, J.K.

1983-04-01

This report provides information in support of a ''Notice of Intent to Discharge Water Contaminants,'' pursuant to Section 1-201 of the New Mexico Water Quality Control Commission Regulations. The anticipated discharges are not expected to move directly or indirectly into groundwater. These discharges will be caused by activities related to the construction of the Waste Isolation Pilot Plant (WIPP), a US Department of Energy (DOE) research and development program to demonstrate the safe disposal of radioactive wastes resulting from defense activities and programs of the United States. The facility is to be developed in deep layers of bedded salt. The WIPP site is located in Eddy County, New Mexico, about 26 miles east of Carlsbad. The US Department of Energy, WIPP Project Office, Albuquerque, New Mexico, as the sponsor of the project, is responsible for any discharges from the site. The following sections describe generally the WIPP construction activities. Pertinent site conditions, potential sources of discharges and their expected effects, and proposed groundwater monitoring efforts are also described

A CRITICAL REVIEW OF INSTRUCTIONAL DESIGN PROCESS OF DISTANCE LEARNING SYSTEM

Directory of Open Access Journals (Sweden)

Muhammad Ajmal CHAUDRY

2010-07-01

Full Text Available Instructional design refers to planning, development, delivery and evaluation of instructional system. It is an applied field of study aiming at the application of descriptive research outcomes in regular instructional settings. The present study was designed to critically review the process of instructional design at Allama Iqbal Open University (AIOU. It was survey study. Population of the study consisted of 120 academicians of different academic department of AIOU. Survey was conducted through questionnaire for academic staff. It was revealed that need assessment is not done before conceiving the outlines of a course. Also the course did not contain sufficient activities, picture and illustrations. It was also found that did not confirm the course objectives. The study recommended that proper of the course writers for distance learning may be arranged.

7 CFR 792.18 - Referral of debts to Department of Justice.

Science.gov (United States)

2010-01-01

... 7 Agriculture 7 2010-01-01 2010-01-01 false Referral of debts to Department of Justice. 792.18... § 792.18 Referral of debts to Department of Justice. (a) Debts that exceed $100,000.00 exclusive of... referred to the Department of Justice before they can be discharged. (b) Debts which cannot be compromised...

Orange County Littoral Cell CRSMP Wastewater and Power Plant Discharge Structures

Data.gov (United States)

California Department of Resources — Graphical depiction of wastewater and power plant discharge pipelines/outlets locations in Southern California.The shapefile was collected by Everest International...

Long multiplication by instruction sequences with backward jump instructions

NARCIS (Netherlands)

Bergstra, J.A.; Middelburg, C.A.

2013-01-01

For each function on bit strings, its restriction to bit strings of any given length can be computed by a finite instruction sequence that contains only instructions to set and get the content of Boolean registers, forward jump instructions, and a termination instruction. Backward jump instructions

THE EXPLICIT COMPREHENSION-STRATEGY INSTRUCTION: QUESTION-ANSWER RELATIONSHIP VS SELF-QUESTIONING

Directory of Open Access Journals (Sweden)

Lalu Thohir

2017-12-01

Full Text Available This study was aimed at examining and comparing the effectiveness of the Question-Answer Relationship (QAR and Self-Questioning (SQ strategies in improving the reading ability of the undergraduate students. This study was a quasi-experimental study in which two out of three classes of the third semester students at English department of Mataram University were selected randomly to receive either QAR strategy or SQ strategy instructions for ten weekly meetings. The findings of pre- and posttest with multiple-choice questions revealed that both comprehension strategies were effective in improving the undergraduate students‘ reading ability. The findings from the posttest with multiple-choice questions indicated the students who received SQ strategy instruction scored significantly higher than those students who received QAR strategy instruction. On the other hand, the students who received QAR strategy instruction scored slightly higher than those students who received SQ strategy instruction in the posttest with open-ended questions.

Investigation of Ozone Yield of Air Fed Ozonizer by High Pressure Homogeneous Dielectric Barrier Discharge

Science.gov (United States)

2013-07-01

around 2 ms and 12 ms in this figure, and during the discharge period, the current was continuous without any pulse . Once a discharge generated in...electron avalanches [10]. Fig. 1. High pressure ozone generator. (a) Top view (b) Side view Fig. 2. Barrier discharge device. Table 1... discharge N. Osawa P1 P, UY. Yoshioka UP2 P, R. Hanaoka P1 P 1 Center for Electric, Optic and Energy applications, Department of Electric and

Improving hospital discharge time: a successful implementation of Six Sigma methodology.

Science.gov (United States)

El-Eid, Ghada R; Kaddoum, Roland; Tamim, Hani; Hitti, Eveline A

2015-03-01

Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions. The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process. This is a quantitative pre and post-intervention study. Three hundred and eighty-six bed tertiary care hospital. A series of Six Sigma driven interventions over a 10-month period. The primary outcome was discharge time (time from discharge order to patient leaving the room). Secondary outcome measures included percent of patients whose discharge order was written before noon, percent of patients leaving the room by noon, hospital length of stay (LOS), and LOS of admitted ED patients. Discharge time decreased by 22.7% from 2.2 hours during the preintervention period to 1.7 hours post-intervention (P Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific.

48 CFR 1371.102 - Method of payment and invoicing instructions for ship repair.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Method of payment and invoicing instructions for ship repair. 1371.102 Section 1371.102 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE DEPARTMENT SUPPLEMENTAL REGULATIONS ACQUISITIONS INVOLVING SHIP CONSTRUCTION AND SHIP REPAIR Provisions and Clauses 1371.102...

8 CFR 215.7 - Instructions from the Administrator required in certain cases.

Science.gov (United States)

2010-01-01

... IMMIGRATION REGULATIONS CONTROLS OF ALIENS DEPARTING FROM THE UNITED STATES § 215.7 Instructions from the... authority conferred by § 215.2 in the case of any alien who seeks to depart from the United States in the... United Nations and the United States of America regarding the Headquarters of the United Nations (61 Stat...

Enhancing Instruction through Constructivism, Cooperative Learning, and Cloud Computing

Science.gov (United States)

Denton, David W.

2012-01-01

Cloud computing technologies, such as Google Docs and Microsoft Office Live, have the potential to enhance instructional methods predicated on constructivism and cooperative learning. Cloud-based application features like file sharing and online publishing are prompting departments of education across the nation to adopt these technologies.…

Patients` compliance with instructions after oral surgery in Nigeria

African Journals Online (AJOL)

2Department of Dental Surgery, Military Hospital, Port Harcourt, Nigeria. KEY WORDS: ... Objective: To prospectively study the behaviour of oral surgery patients given verbal and written instructions ..... This is intriguing in view of the general belief in the dental .... comply with the antibiotic prescription while the response.

Nursing Assessment and Intervention to Geriatric Patients Discharged From Emergency Department

DEFF Research Database (Denmark)

Rosted, Elizabeth Emilie; Poulsen, Ingrid; Hendriksen, Carsten

% of geriatric patients have complex and often unresolved caring needs. Objective: To examine the effect of a two-stage nursing assessment and intervention to address the patients uncompensated problems given just after discharge from ED and one and six months after. Method: We conducted a prospective...... nursing assessment comprising a checklist of 10 physical, mental, medical and social items. The focus was on unresolved problems which require medical intervention, new or different home care services, or comprehensive geriatric assessment. Following this the nurses made relevant referrals...... to the geriatric outpatient clinic, community health centre, primary physician or arrangements with next-of-kin. Findings: Primary endpoints will be presented as unplanned readmission to ED; admission to nursing home; and death. Secondary endpoints will be presented as physical function; depressive symptoms...

Radioactive liquid wastes discharged to ground in the 200 areas during 1985

International Nuclear Information System (INIS)

Aldrich, R.C.

1986-03-01

This document summarizes radioactive liquids discharged to the ground in the 200 areas of the Hanford site and is provided pursuant to Department of Energy (DOE) Order 5484.1A, ''Environmental Protection, Safety, and Health Protection Information Reporting Requirements.'' There are twenty-eight liquid discharge streams in the 200 areas excluding sanitary sewers. Twenty-five streams were normally or potentially contaminated with radioactive material in 1985. Two streams had no potential for radioactive contamination but were included as adjustments in this report to maintain an accurate record of the total volume of the discharges to each disposal site. One stream, the 242-S Evaporator cooling water discharge, was not used during 1985

Geriatric Nursing Assessment and Intervention in an Emergency Department – a Pilot Study

DEFF Research Database (Denmark)

Rosted, Elizabeth Emilie; Wagner, Lis; Henriksen, Carsten

2012-01-01

Aim To describe and test a model for structured nursing assessment and intervention to older people discharged from Emergency Department (ED). Background Older people recently discharged from hospital are at high risk of readmission. This risk may increase when they are discharged straight home...... and intervenes at discharge from ED, and at follow-up. However a randomized controlled test should be carried out to confirm this. Relevance to clinical practice Nursing assessment and intervention should be implemented in the ED to reduce older peoples’ unrevealed problems....

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

Science.gov (United States)

2016-03-01

Hospital providers voice concerns about a proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would require providers to devote more resources to discharge planning. The rule would apply to inpatients as well as emergency patients requiring comprehensive discharge plans as opposed to discharge instructions. CMS states that the rule would ensure the prioritization of patient preferences and goals in the discharge planning process, and also would prevent avoidable complications and readmissions. However, hospital and emergency medicine leaders worry that community resources are not yet in place to facilitate the links and follow-up required in the proposed rule, and that the costs associated with implementation would be prohibitive. The proposed rule would apply to acute care hospitals, EDs, long-term care facilities, inpatient rehabilitation centers, and home health agencies. Regardless of the setting, though, CMS is driving home the message that patient preferences should be given more weight during the discharge planning process. Under the rule, hospitals or EDs would need to develop a patient-centered discharge plan within 24 hours of admission or registration, and complete the plan prior to discharge or transfer to another facility. Under the rule, emergency physicians would determine which patients require a comprehensive discharge plan. Both the American Hospital Association and the American College of Emergency Physicians worry that hospitals will have to take on more staff, invest in training, and make changes to their electronic medical record systems to implement the provisions in the proposed rule.

The Past, Present, and Future of Discharge Planning in Taiwan

Directory of Open Access Journals (Sweden)

Shu-Chuan Lin

2013-06-01

Full Text Available Discharge planning is an interdisciplinary approach to provide continuity of care; it is a process that includes identification, assessment, goal setting, planning, implementation, coordination, and evaluation. Discharge planning has been viewed as a major way to enhance a smooth transition for patients from the hospital to home or other chronic care units and as a solution to solve problems associated with postdischarge care. The promotion of discharge planning began in the United States in the 1960s. Nursing scholars from Taiwan learned about the concept of discharge planning from the United States in the early 1980s and subsequently introduced it to Taiwanese medical institutions in 1985. A policy to promote discharge planning in Taiwan was announced by the Executive Yuan, Department of Health in 1993. Following the healthcare reforms in 1995, discharge planning has since been strongly promoted. Studies concerning discharge planning in Taiwan showed some promising results, including increased satisfaction of patients and their families, improved preparation of caregivers, and improved quality of life for patients. However, patients receiving interdisciplinary discharge planning services were still in the minority. There was no standard evaluation procedure for interdisciplinary discharge planning, and a high percentage of patients thought that hospitals handled the postdischarge long-term care services referral procedure inadequately. Despite the positive attitudes toward discharge planning, many physicians still demonstrate an unsatisfactory level of knowledge and behaviors with regard to discharge planning. To enhance the implementation of discharge planning, a standard evaluation procedure for interdisciplinary discharge planning and improved physician awareness concerning the importance of discharge planning are needed. In Taiwan, the improvement of discharge planning in the foreseeable future is promising with the accreditation of the

Site-specific waste management instruction for the 100-KR-4 Operable Unit drilling

International Nuclear Information System (INIS)

Hadley, J.T.

1996-07-01

This site-specific waste management instruction provides guidance for the management of waste generated as a result of groundwater well installations in the 100-KR-4 Operable Unit (OU). The well installations are necessary to implement the Remedial Action (RA) option (pump-and-treat using ion exchange) to prevent discharge of hexavalent chromium at levels above those considered protective of aquatic life in the Columbia River and riverbed sediments

Early discharge care with ongoing follow-up support may reduce hospital readmissions in COPD

Directory of Open Access Journals (Sweden)

Maria Lawlor

2008-10-01

Full Text Available Maria Lawlor1, Sinead Kealy1, Michelle Agnew1, Bettina Korn1, Jennifer Quinn1, Ciara Cassidy1, Bernard Silke2, Finbarr O’Connell1, Rory O’Donnell11Department of Respiratory Medicine, CResT Directorate, St. James’ Hospital, Dublin 8, Ireland; 2Department of General Internal Medicine, Gems Directorate, St. James’ Hospital, Dublin 8, IrelandBackground: Early discharge care and self-management education, although effective in the management of chronic obstructive pulmonary disease (COPD, do not typically reduce hospital re-admission rates for exacerbations of the disease. We hypothesized that a respiratory outreach programme that comprises early discharge care followed by continued rapid-access out-patient support would reduce the need for hospital readmission in these patients.Methods: Two hundred and forty-six patients, acutely admitted with exacerbations of COPD, were recruited to the respiratory outreach programme that included early discharge care, followup education, telephone support and rapid future access to respiratory out-patient clinics. Sixty of these patients received self-management education also. Emergency department presentations and admission rates were compared at six and 12 months after, compared to prior to, participation in the programme for the same patient cohort.Results: The frequency of both emergency department presentations and hospital admissions was significantly reduced after participation in the programme.Conclusions: Provision of a respiratory outreach service that includes early discharge care, followed by education, telephone support and ongoing rapid access to out-patient clinics is associated with reduced readmission rates in COPD patients.Keywords: COPD management outreach, follow-up, out-patient clinics

Using Interactive Video Instruction To Enhance Public Speaking Instruction.

Science.gov (United States)

Cronin, Michael W.; Kennan, William R.

Noting that interactive video instruction (IVI) should not and cannot replace classroom instruction, this paper offers an introduction to interactive video instruction as an innovative technology that can be used to expand pedagogical opportunities in public speaking instruction. The paper: (1) defines the distinctive features of IVI; (2) assesses…

Pancreatitis - discharge

Science.gov (United States)

Chronic pancreatitis - discharge; Pancreatitis - chronic - discharge; Pancreatic insufficiency - discharge; Acute pancreatitis - discharge ... You were in the hospital because you have pancreatitis. This is a swelling of the pancreas. You ...

Estimated discharge of treated wastewater in Florida, 1990

Science.gov (United States)

Marella, R.L.

1994-01-01

According to the Florida Department of Environ- mental Protection, 5,100 wastewater treatment systems were in operation during 1990. Of this total, 72 percent were domestic wastewater facilities and 28 percent were industrial waste- water facilities. The number of wastewater systems inventoried for 1990 was 1,062 (systems that treated and discharged more than 0.01 Mgal/d or had a plant capacity of greater than 0.04 Mgal/d. Based on this inventory, the estimated discharge of treated wastewater in Florida during 1990 totaled 1,638 million gallons per day. Approxi- mately 65 percent of this water was discharged to surface water during 1990 and the remaining 35 percent was discharged to ground water. Discharge to surface water includes effluent outfalls into the Atlantic Ocean (32 percent), while the re- maining (68 percent) is discharged into the Gulf of Mexico, bays, rivers, wetlands, and other surface water bodies throughout Florida. Discharge to ground-water includes treated effluent outfalls to land application systems (reuse systems and spray fields), drain fields, percolation ponds (51 percent), and to injection wells (49 percent). An estimated 322 million gallons per day of the treated domestic and industrial wastewater was reused during 1990. Discharge of treated domestic wastewater from the 994 systems inventoried in Florida during 1990 totaled 1,353 million gallons per day and served an estimated 8.58 million people (66 percent of the population of Florida in 1990). The remaining 34 percent of the popu- lation (4.36 million) are served by the 2,700 smaller domestic wastewater systems or have individual septic tanks. In 1990, there were 1.56 million septic tanks in Florida. Discharge of industrial wastewater was inventoried for 68 systems in 1990 and totaled 285 million gallons per day. Discharge of domestic wastewater in- creased more than 20 percent and industrial wastewater discharge increased 5 percent from 1985 to 1990. (USGS)

Economic Literacy Indicators at the Department of Computer Education & Instructional Technologies

Directory of Open Access Journals (Sweden)

Sevgi GEREK

2010-06-01

Full Text Available Developments in technology and communication in the 21st century have led to increased expectations from individuals. One of these expectation areas is literacy. As a requirement of the information age, it can be said that the economic literacy is one of the most important areas of literacy. Economic literacy can be defined in terms of ability to revise the alternatives for interpreting economic problems and finding solutions to these problems, to define the cost and profits, to investigate the effects of changes in economic conditions and in public policies, to gather and organize economy-related data and to balance the profits and costs. One of the tools that affect the life can be said economic literacy but it is a neglected area in most higher education programs. In this study, Computer Education and Instructional Technology program courses were examined within the framework of economic literacy indicators

Identifying the Computer Competency Levels of Recreation Department Undergraduates

Science.gov (United States)

Zorba, Erdal

2011-01-01

Computer-based and web-based applications are as major instructional tools to increase undergraduates' motivation at school. In the recreation field usage of, computer and the internet based recreational applications has become more prevalent in order to present visual and interactive entertainment activities. Recreation department undergraduates…

78 FR 58986 - Dry Cargo Residue Discharges in the Great Lakes

Science.gov (United States)

2013-09-25

...), U.S. Department of Transportation, West Building Ground Floor, Room W12-140, 1200 New Jersey Avenue... impacts would be included through a prohibition of limestone and clean stone DCR discharges within 3...

Radioactive waste discharges from UKAEA establishments during 1996 and associated monitoring results

International Nuclear Information System (INIS)

Morton, A.K.M.; Forbes, S.A.; Hughes, B.; Richardson, E.

1997-08-01

This annual report is published by the Safety Directorate of the United Kingdom Atomic Energy Authority (UKAEA) and provides information on radioactive discharges from its sites. The Culcheth site was closed and then redeveloped during the end of 1993 and the Springfields site became part of BNFL in October 1994. No operations involving the need to discharge radioactivity are undertaken at the Risley site. After discussions with the Authorising Departments at that time, the discharge authorisations were revoked on 1 July 1994. These sites are therefore no longer included in this report. UKAEA has published annual radioactive waste discharges and associated monitoring results since 1963. This report is intended to give a relatively short factual overview of UKAEA waste discharge and disposal, and its impact on the environment. Additional information may be found in annual discharge reports published by the individual UKAEA establishments and the UKAEA Report on Safety and the Environment 1996-97 due to be issued at the end of September 1997. (UK)

Heart pacemaker - discharge

Science.gov (United States)

Cardiac pacemaker implantation - discharge; Artificial pacemaker - discharge; Permanent pacemaker - discharge; Internal pacemaker - discharge; Cardiac resynchronization therapy - discharge; CRT - discharge; ...

HOspitals and patients WoRking in Unity (HOW R U?): protocol for a prospective feasibility study of telephone peer support to improve older patients' quality of life after emergency department discharge

OpenAIRE

Lowthian, Judy A; Lennox, Alyse; Curtis, Andrea; Dale, Jeremy; Browning, Colette; Smit, De Villiers; Wilson, Gillian; O'Brien, Debra; Rosewarne, Cate; Boyd, Lee; Garner, Cath; Cameron, Peter

2016-01-01

Introduction Older people presenting to an emergency department (ED) have a higher likelihood of social isolation, loneliness and depression; which are all associated with negative health outcomes and increased health service use, including higher rates of ED attendance. The HOW R U? study aims to ascertain the feasibility and acceptability of a postdischarge telephone support programme for older ED patients following discharge. The intervention, which aims to improve quality of life, will be...

Follow-up services for stroke survivors after hospital discharge--a randomized control study

DEFF Research Database (Denmark)

Andersen, Hanne Elkjaer; Eriksen, Karen; Brown, Anne

2002-01-01

OBJECTIVE: To evaluate whether follow-up services for stroke survivors could improve functional outcome and reduce readmission rate. In this paper results of functional outcome are reported. DESIGN: Randomized controlled trial allocating patients to one of three different types of aftercare: (1......) follow-up home visits by a physician, (2) physiotherapist instruction in the patient's home, or (3) standard aftercare. SUBJECTS: Stroke patients with persisting impairment and disability who, after completing inpatient rehabilitation, were discharged to their homes. OUTCOME MEASURES: Six months after...... discharge, functional outcome was assessed with Functional Quality of Movement, Barthel Index, Frenchay Activity Index and Index of Extended Activites of Daily Living. RESULTS: One-hundred and fifty-five stroke patients were included in the study. Fifty-four received follow-up home visits by a physician, 53...

Shoulder replacement - discharge

Science.gov (United States)

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

32 CFR 728.53 - Department of Labor, Office of Workers' Compensation Programs (OWCP) beneficiaries.

Science.gov (United States)

2010-07-01

... DEPARTMENT FACILITIES Beneficiaries of Other Federal Agencies § 728.53 Department of Labor, Office of Workers... injury) incurred while engaged in: (i) Training. (ii) Flight instructions. (iii) Travel to or from... injury.) This category includes but is not limited to: (i) Civilian student employees in training at Navy...

Students’ Aesthetics Experience, Creative Self-Efficacy and Creativity: Is Creativity Instruction Effective?

Directory of Open Access Journals (Sweden)

Yuan-Cheng Chang

2016-12-01

Full Text Available Based on creativity component theory, creativity system theory and creative self-efficacy theory, this study aims to explore the influence of college students’ aesthetics experience and creative self-efficacy on their creativity and the role of creativity instruction as a mediator variable. The participants were 338 college design majors in 50 teams who were working on their graduation exhibitions, and 50 advising professors from departments related to design. Hierarchical Linear Models were applied for analysis. The result showed that instruction on enhancing students’ creative intention positively affect students’ aesthetics experience. Students’ aesthetics experience affects their creativity and creative self-efficacy. Creativity instruction with focus on creativity skills by means of promoting aesthetic attitude, aesthetic understanding, and offering complete experiences had a moderating effect on students’ perception toward creative product. However, there was a negative moderating effect of creative instruction on perceived aesthetic pleasure and students’ perception toward creative product. There was no moderating effect of creative instruction on the relationship between students’ creative self-efficacy and creativity. Accordingly, the study concluded that in order to enhance students’ creativity, universities should stress on the development of students’ aesthetics experiences and re-evaluation of approaches to creativity instruction.

21 CFR 1250.51 - Railroad conveyances; discharge of wastes.

Science.gov (United States)

2010-04-01

..., Center for Food Safety and Applied Nutrition, Manager, Interstate Travel Sanitation Sub-Program, HFF-312... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Railroad conveyances; discharge of wastes. 1250.51 Section 1250.51 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

Plasma Discharge Process in a Pulsed Diaphragm Discharge System

Science.gov (United States)

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.

Vaginal discharge: perceptions and health seeking behavior among Nepalese women.

Science.gov (United States)

Rizvi, Narjis; Luby, Stephen

2004-12-01

To understand women's perceptions and health seeking behavior and the association between vaginal discharge, clinical signs and laboratory findings as a presentation of sexually transmitted diseases (STD). We conducted five focus group discussions with women attending the outpatient department in a large public hospital in Katmandu, Nepal, during May-June 1997. We also interviewed seventy women presenting with vaginal discharge to the same hospital, through structured questionnaire. Women presenting with discharge were also examined and investigated for six common sexually transmitted diseases and reproductive tract infections. In the focus groups vaginal discharge was identified as a common disease distinct from STDs, for which women can seek treatment. STDs were considered as social diseases transmitted to women through multiple sexual partners and not from husband. Patients with vaginal discharge preferred traditional healers and pharmacist. Clinical signs were inconclusive for type of infection. Simple laboratory tests identified etiologic agent in 64 (91%) patients and the three commonest infections were Moniliasis (78%), Bacterial Vaginosis (25%) and Trichomoniasis (17%). Vaginal discharge may be used as a risk marker for identification of STDs by Primary Health Workers. Low cost investigations should be made available at the secondary care level for identification of most common Reproductive Tract Infections. Communication campaigns should target the misconceptions that exist in the communities local context related to the prevention, treatment and control of vaginal discharge and STDs.

Barriers to discharge in an acute care medical teaching unit: a qualitative analysis of health providers’ perceptions

Directory of Open Access Journals (Sweden)

Okoniewska B

2015-02-01

Full Text Available Barbara Okoniewska,1 Maria Jose Santana,1 Horacio Groshaus,2 Svetlana Stajkovic,3 Jennifer Cowles,4 David Chakrovorty,5 William A Ghali1 1Department of Community Health Sciences, W21C Research and Innovation Centre, Institute of Public Health, 2Department of Internal Medicine, University of Calgary, 3Community Based Practice, 4Foothills Medical Centre, 5Department of Quality and Healthcare Improvement, Alberta Health Services, Calgary, AB, Canada Background: The complex process of discharging patients from acute care to community care requires a multifaceted interaction between all health care providers and patients. Poor communication in a patient’s discharge can result in post hospital adverse events, readmission, and mortality. Because of the gravity of these problems, discharge planning has been emphasized as a potential solution. The purpose of this paper is to identify communication barriers to effective discharge planning in an acute care unit of a tertiary care center and to suggest solutions to these barriers. Methods: Health care providers provided comments to a single open-ended question: “What are the communication barriers between the different health care providers that limit an effective discharge of patients from Unit 36?” We conducted qualitative thematic analysis by identifying themes related to communication barriers affecting a successful discharge process. Results: Three broad themes related to barriers to the discharge process were identified: communication, lack of role clarity and lack of resources. We also identified two themes for opportunities for improvement, ie, structure and function of the medical team and need for leadership. Conclusion: While it was evident that poor communication was an overarching barrier identified by health care providers, other themes emerged. In an effort to increase inter-team communication, “bullet rounds”, a condensed form of discharge rounds, were introduced to the medical

Double discharges in unipolar-pulsed dielectric barrier discharge xenon excimer lamps

International Nuclear Information System (INIS)

Liu Shuhai; Neiger, Manfred

2003-01-01

Excitation of dielectric barrier discharge xenon excimer lamps by unipolar short square pulses is studied in this paper. Two discharges with different polarity are excited by each voltage pulse (double discharge phenomenon). The primary discharge occurs at the top or at the rising flank of the applied unipolar square pulse, which is directly energized by the external circuit. The secondary discharge with the reversed polarity occurs at the falling flank or shortly after the falling flank end (zero external voltage) depending on the pulse width, which is energized by the energy stored by memory charges deposited by the primary discharge. Fast-speed ICCD imaging shows the primary discharge has a conic discharge appearance with a channel broadening on the anode side. This channel broadening increases with increasing the pulse top level. Only the anode-side surface discharge is observed in the primary discharge. The surface discharge on the cathode side which is present in bipolar sine voltage excitation is not observed. On the contrary, the secondary discharge has only the cathode-side surface discharge. The surface discharge on the anode side is not observed. The secondary discharge is much more diffuse than the primary discharge. Time-resolved emission measurement of double discharges show the secondary discharge emits more VUV xenon excimer radiation but less infrared (IR) xenon atomic emission than the primary discharge. It was found that the IR xenon atomic emission from the secondary discharge can be reduced by shortening the pulse width. The energy efficiency of unipolar-pulsed xenon excimer lamps (the overall energy efficiency of double discharges) is much higher than that obtained under bipolar sine wave excitation. The output VUV spectrum under unipolar pulse excitation is found to be identical to that under sine wave excitation and independent of injected electric power

Expert Graphics System Research in the Department of the Navy.

Science.gov (United States)

Duff, Jon M.

1987-01-01

Presents current trends in the development of expert systems within the Department of the Navy, particularly research into expert graphics systems intended to support the Authoring Instructional Methods (AIM) research project. Defines artificial intelligence and expert systems. Discusses the operations and functions of the Navy's intelligent…

Early discharge care with ongoing follow-up support may reduce hospital readmissions in COPD.

LENUS (Irish Health Repository)

Lawlor, Maria

2012-02-01

BACKGROUND: Early discharge care and self-management education, although effective in the management of chronic obstructive pulmonary disease (COPD), do not typically reduce hospital re-admission rates for exacerbations of the disease. We hypothesized that a respiratory outreach programme that comprises early discharge care followed by continued rapid-access out-patient support would reduce the need for hospital readmission in these patients. METHODS: Two hundred and forty-six patients, acutely admitted with exacerbations of COPD, were recruited to the respiratory outreach programme that included early discharge care, follow-up education, telephone support and rapid future access to respiratory out-patient clinics. Sixty of these patients received self-management education also. Emergency department presentations and admission rates were compared at six and 12 months after, compared to prior to, participation in the programme for the same patient cohort. RESULTS: The frequency of both emergency department presentations and hospital admissions was significantly reduced after participation in the programme. CONCLUSIONS: Provision of a respiratory outreach service that includes early discharge care, followed by education, telephone support and ongoing rapid access to out-patient clinics is associated with reduced readmission rates in COPD patients.

Site-specific waste management instruction for the 100-KR-4 Operable Unit drilling. Revision 1

International Nuclear Information System (INIS)

Hadley, J.T.

1996-08-01

This site-specific waste management instruction provides guidance for the management of waste generated as a result of groundwater well installations in the 100-KR-4 Operable Unit (OU). The well installations are necessary to implement the Remedial Action (RA) option (pump-and-treat using ion exchange) to prevent discharge of hexavalent chromium at levels above those considered protective of aquatic life in the Columbia River and riverbed sediments

Miscellaneous flow discharge measurements collected downstream of Brandon Road Lock and Dam

Data.gov (United States)

Department of the Interior — Flow discharges were measured in the Des Plaines River from approximately river mile 286 to river mile 284 on October 19–21, 2015 using Teledyne Rio Grande 1200 kHz...

Inquiry-Oriented Instruction: A Conceptualization of the Instructional Principles

Science.gov (United States)

Kuster, George; Johnson, Estrella; Keene, Karen; Andrews-Larson, Christine

2018-01-01

Research has highlighted that inquiry-based learning (IBL) instruction leads to many positive student outcomes in undergraduate mathematics. Although this research points to the value of IBL instruction, the practices of IBL instructors are not well-understood. Here, we offer a characterization of a particular form of IBL instruction:…

46 CFR 108.437 - Pipe sizes and discharge rates for enclosed ventilation systems for rotating electrical equipment.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Pipe sizes and discharge rates for enclosed ventilation systems for rotating electrical equipment. 108.437 Section 108.437 Shipping COAST GUARD, DEPARTMENT OF... Systems Fixed Carbon Dioxide Fire Extinguishing Systems § 108.437 Pipe sizes and discharge rates for...

Annual report on radioactive discharges from Winfrith and monitoring the environment 1991

International Nuclear Information System (INIS)

1992-05-01

This annual report, the seventh, aims to provide full information on our discharges and environmental monitoring. The report is mainly graphical, comparing past and current levels with authorised limits, derived limits or the recommended limits of the International Commission on Radiological Protection (ICRP). Discharges from Winfrith are subject to Authorisations issued jointly by the Department of the Environment (DOE) and the Ministry of Agriculture, Fisheries and Food (MAFF). These Authorisations, one for discharges to the sea and one for discharges to the atmosphere, require that Winfrith establish a need to discharge; that we apply Best Practicable Means (BPM) to reduce our discharges; that our discharges are below set Authorised Limits; and that schedules of effluent and environmental monitoring are established. As a 'back stop', discharges at the limits must not result in doses to the most potentially exposed part of the local population - the critical group -exceeding 0.5 mSv per year. The limit recommended by the International Commission on Radiological Protection (ICRP) for dose to a member of the general public is 1.0 mSv per year. In September 1990 Winfrith's Steam Generating Heavy Water Reactor (SGHWR) was shut down therefore the pattern of discharges for 1991 differs from previous years. Discharges are generally reduced resulting in an even lower dose to the critical group, well below 1% of the ICRP limit and much less than 1% of the UK average natural background dose. (author)

Quality of medication information in discharge summaries from hospitals: an audit of electronic patient records.

Science.gov (United States)

Garcia, Beate Hennie; Djønne, Berit Svendsen; Skjold, Frode; Mellingen, Ellen Marie; Aag, Trine Iversen

2017-12-01

Background Low quality of medication information in discharge summaries from hospitals may jeopardize optimal therapy and put the patient at risk for medication errors and adverse drug events. Objective To audit the quality of medication information in discharge summaries and explore factors associated with the quality. Setting Helgelandssykehuset Mo i Rana, a rural hospital in central Norway. Method For each month in 2013, we randomly selected 60 discharge summaries from the Department of Medicine and Surgery (totally 720) and evaluated the medication information using eight Norwegian quality criteria. Main outcome measure Mean score per discharge summary ranging from 0 (lowest quality) to 16 (highest quality). Results Mean score per discharge summary was 7.4 (SD 2.8; range 0-14), significantly higher when evaluating medications used regularly compared to mediations used as needed (7.80 vs. 6.52; p < 0.001). Lowest score was achieved for quality criteria concerning generic names, indications for medication use, reasons why changes had been made and information about the source for information. Factors associated with increased quality scores are increasing numbers of medications and male patients. Increasing age seemed to be associated with a reduced score, while type of department was not associated with the quality. Conclusion In discharge summaries from 2013, we identified a low quality of medication information in accordance with the Norwegian quality criteria. Actions for improvement are necessary and follow-up studies to monitor quality are needed.

Motivational Measure of the Instruction Compared: Instruction Based on the ARCS Motivation Theory vs Traditional Instruction in Blended Courses

Science.gov (United States)

Colakoglu, Ozgur M.; Akdemir, Omur

2012-01-01

The ARCS Motivation Theory was proposed to guide instructional designers and teachers who develop their own instruction to integrate motivational design strategies into the instruction. There is a lack of literature supporting the idea that instruction for blended courses if designed based on the ARCS Motivation Theory provides different…

Nipple Discharge

Science.gov (United States)

... any unexpected nipple discharge evaluated by a doctor. Nipple discharge in men under any circumstances could be a problem and needs further evaluation. One or both breasts may produce a nipple discharge, either spontaneously or when you squeeze your ...

Experience of ALARA in controlling radiocaesium discharges to the Irish Sea

International Nuclear Information System (INIS)

Hunt, G.J.

1984-01-01

Radiocaesium discharges to the Irish Sea, which primarily originate from corrosion of magnox fuel in the Sellafield storage ponds, are a source of public radiation exposure mainly through the fish and shellfish consumption pathway. Experience of ALARA in the context of reducing these discharges is described. The operators, British Nuclear Fuels Limited (BNFL), in consultation with Government Departments, decided to install an ion exchange plant to remove radioactivity from pond effluents. This plant is scheduled for commissioning in 1984 and optimisation will play a major part in determining its operating regime. Meanwhile, measures have been taken to reduce discharges using skips of zeolite installed in the ponds. Experience of ALARA in determining the optimum replacement rate of skips is described. A major consideration was differential cost-benefit analysis. Following installation of skips at the rate thereby indicated, discharges are being reduced by about half. A further major reduction is expected when the ion exchange plant becomes available. (author)

Lung surgery - discharge

Science.gov (United States)

... Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge ... milk) for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open surgery. ...

THE USE OF RESEARCH PAPER WRITING INSTRUCTIONAL MATERIALSTO IMPROVE STUDENTS‟ACADEMIC WRITING: A CLASSROOM ACTION RESEARCH

Directory of Open Access Journals (Sweden)

M. Ali Ghufron

2017-04-01

Full Text Available Most of students in English Education Department of IKIP PGRI Bojonegoro frequently consider that academic writing, in term of writing scientific paper, is not easy task to do. The result of their academic writing performance at preliminary research indicated that they achieved low scores in writing a scientific article. Consequently, they are not motivated in academic writing. For this case, I used Research Paper Writing Instructional Materials as sources in teaching and learning. This research investigatedwhether the use of Research Paper Writing Instructional Materials can improve students‘ academic writing andhow class situation is when Research Paper Writing Instructional Materials are used as a source of teaching and learning process. This is a Classroom Action Research (CAR which is conducted at the fourth semester students of English Education Department of IKIP PGRI Bojonegoro in the academic year of 2014/2015. This research was done in two cycles. Each cycle consisted of four steps: Planning, Acting, Observing, and Reflecting. The qualitative data were collected through observation and interview. The quantitative data were collected through test. The research findings revealed that the use of Research Paper Writing Instructional Materialscan improve students‘ academic writing and improve students‘ motivation in academic writing class.Derived from the findings, it can be concluded that the use of Research Paper Writing Instructional Materialscan improve students‘ academic writing and class situation. Therefore, it is recommended for the lecturers to use Research Paper Writing Instructional Materialsas it can improve students‘ academic writing as well as class situation.

Urine Collection in the Emergency Department: What Really Happens in There?

Directory of Open Access Journals (Sweden)

Harrison Alter

2012-12-01

Full Text Available Introduction: In women with suspected urinary tract infection (UTI, a non-contaminated voidedspecimen is considered important for valid urinalysis and culture results. We assess whethermidstream parted-labia catch (MSPC instructions were provided by nurses, understood, andperformed correctly, according to the patient.Methods: We conducted a cross-sectional survey of English- and Spanish-speaking female patientssubmitting voided urine samples for urinalysis for suspected UTI. The survey was conducted in apublic teaching hospital emergency department (ED from June to December 2010, beginning 2months after development and dissemination of a nursing MSPC instructions protocol. Researchassistants administered the survey within 2 hours of urine collection. Nurses were unaware of thestudy purpose.Results: Of 129 patients approached, 74 (57% consented and were included in the analysis.Median age was 35; 44% were Latino. Regarding instructions from nurses, patients reported thefollowing: 45 (61%; 95% CI 50-72% received any instructions; of whom 37 (82%; 95% CI 71-93%understood them completely. Sixteen (36%; 95% CI 22-51% were instructed to collect midstream;and 7 (16%; 95% CI 6-29% to part the labia. Regardless of receiving or understanding instructions,33 (45%; 95% CI 33-57% reported actually collecting midstream, and 11 (15%, 95% CI 8-25%parting the labia.Conclusion: In this ED, instructions for MSPC urine collection frequently were not given, despite anursing protocol, and patients rarely performed the essential steps. An evidence-based approachto urine testing in the ED that considers urine collection technique, is needed.

Discharged of the nuclear wastes by health service centres

International Nuclear Information System (INIS)

Mazur, G.; Jednorog, S.

1993-01-01

In this paper Polish national regulation in radiation protection on nuclear medical domain was discussed. The method of utilized nuclear wastes in medical and science centres was deliberate. From many years activity of wastes from Nuclear Medicine Department of Central Clinical Hospital Armed Forces Medical Academy and Radiation Protection Department of Armed Forces Institute of Hygiene and Epidemiology was measured. In debate centres radiation monitoring was performed. In this purpose the beta global activity and gamma spectrometry measurement of discharged wastes occurred. From last year in discussed centres wastes activity do not increased permissible levels. (author). 3 refs, 5 tabs

Computational Study of Anomalous Transport in High Beta DIII-D Discharges with ITBs

Science.gov (United States)

Pankin, Alexei; Garofalo, Andrea; Grierson, Brian; Kritz, Arnold; Rafiq, Tariq

2015-11-01

The advanced tokamak scenarios require a large bootstrap current fraction and high β. These large values are often outside the range that occurs in ``conventional'' tokamak discharges. The GLF23, TGLF, and MMM transport models have been previously validated for discharges with parameters associated with ``conventional'' tokamak discharges. It has been demonstrated that the TGLF model under-predicts anomalous transport in high β DIII-D discharges [A.M. Garofalo et al. 2015 TTF Workshop]. In this research, the validity of MMM7.1 model [T. Rafiq et al. Phys. Plasmas 20 032506 (2013)] is tested for high β DIII-D discharges with low and high torque. In addition, the sensitivity of the anomalous transport to β is examined. It is shown that the MMM7.1 model over-predicts the anomalous transport in the DIII-D discharge 154406. In particular, a significant level of anomalous transport is found just outside the internal transport barrier. Differences in the anomalous transport predicted using TGLF and MMM7.1 are reviewed. Mechanisms for quenching of anomalous transport in the ITB regions of high-beta discharges are investigated. This research is supported by US Department of Energy.

Suggested instructions for the completion of delivery commitment schedules

International Nuclear Information System (INIS)

Vance, S.A.

1992-01-01

This presentation discusses the Delivery Commitment Schedule form contained in Appendix C of the Standard Contract for Disposal of Spent Nuclear Fuel and/or High-Level Radioactive Waste (the Standard Contract). In particular, the presentation describes some preliminary suggested instructions for completing the form in a manner that may aid the US Department of Energy (DOE) in the development of the Federal Waste Management System (FWMS)

Adrenaline in anaphylaxis treatment and self-administration: experience from an inner city emergency department.

Science.gov (United States)

Mostmans, Y; Grosber, M; Blykers, M; Mols, P; Naeije, N; Gutermuth, J

2017-03-01

Anaphylaxis is a life-threatening emergency of which reliable epidemiological data are lacking. This study aimed to analyze how quickly patients presenting with anaphylaxis were treated in emergency and whether treatment followed the European Academy of Allergy and Clinical Immunology (EAACI) guidelines. Patient data were collected between April 2009 and April 2013. Emergency doctors completed a questionnaire for adult patients presenting at the emergency department (ED) of the St. Pierre hospital in Brussels with anaphylaxis. Inclusion criteria were based on the Sampson criteria of anaphylaxis. Data were analyzed using a Microsoft Excel database. About 0.04% (100/230878) of all emergency visits in adults presented with anaphylaxis. 64% of patients received their first medical help later than 30 min after symptom onset. 67% of patients received adrenaline, 85% oral antihistamines, and 89% received IV glucocorticosteroids. 46/100 patients were discharged directly from the ED, of which 87% received further medical prescriptions for self-administration: 67% corticosteroids, 83% antihistamines, and 9% intramuscular adrenaline. 74% were instructed to consult an allergologist for adequate diagnosis. 54/100 patients were hospitalized. The majority of patients were treated according to the EAACI guidelines for management of anaphylaxis, but only a minority received the recommended adrenaline auto-injector for self-administration at discharge. Because the majority of patients received medical help later than 30 min after symptom onset, adrenaline auto-injector prescription is a necessity. The low rate of doctors prescribing adrenaline auto-injectors in the ED setting underlines the need to train doctors of various backgrounds in prevention and treatment of anaphylaxis and the close collaboration with allergologists. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Spent nuclear fuel discharges from US reactors 1993

International Nuclear Information System (INIS)

1995-02-01

The Energy Information Administration (EIA) of the U.S. Department of Energy (DOE) administers the Nuclear Fuel Data Survey, Form RW-859. This form is used to collect data on fuel assemblies irradiated at commercial nuclear reactors operating in the United States, and the current inventories and storage capacities of those reactors. These data are important to the design and operation of the equipment and facilities that DOE will use for the future acceptance, transportation, and disposal of spent fuels. The data collected and presented identifies trends in burnup, enrichment, and spent nuclear fuel discharged form commercial light-water reactor as of December 31, 1993. The document covers not only spent nuclear fuel discharges; but also site capacities and inventories; canisters and nonfuel components; and assembly type characteristics

Vessel Sewage Discharges: No-Discharge Zones (NDZs)

Science.gov (United States)

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.

Discharge against medical advice at a tertiary center in southeastern Nigeria: sociodemographic and clinical dimensions

Directory of Open Access Journals (Sweden)

Boniface Eze

2010-09-01

Full Text Available Boniface Eze1, Kenneth Agu2, Jones Nwosu31Department of Ophthalmology, 2Department of Surgery, 3Department of Otorhinolaryngology, University of Nigeria Teaching Hospital (UNTH, Ituku-Ozalla, Enugu, Enugu State, Nigeria Objective: To assess the sociodemographic and clinical characteristics of patients discharged against medical advice (DAMA at the University of Nigeria Teaching Hospital (UNTH, Enugu, Nigeria.Methods: The UNTH’s admission and discharge records between 1997 and 2006 were examined. Patients DAMA were identified; relevant sociodemographic and clinical data were extracted from their recalled clinical charts. Data were analyzed to generate rates, percentages, and proportions, and a level of P < 0.05 (one degree of freedom was considered statistically significant.Results: Of the 64,856 admissions (45.2% male, 54.8% female, 113 (0.002%; males: 54%, females: 46% were discharged against medical advice. DAMA rate was highest in Surgery (0.4%, and lowest in Obstetrics and Gynecology (0.1% and Pediatrics (0.1%. Infections (32.7%, trauma (29.2%, and cancer (16.8% were the leading diagnoses in patients DAMA. Financial constraints (37.2%, unsatisfactory response to treatment (17.7%, and dissatisfaction with hospital environment (15.0% were the main reasons for patients choosing to discharge themselves. DAMA was associated with a short admission period (P < 0.05, patients having high levels of formal education (P < 0.05, and those who had not been previously hospitalized (P < 0.05; but not with age (P = 0.398, gender (P = 0.489, or employment (P = 0.091.Conclusion: Comparatively, the rate of DAMA at UNTH is low. The causes of DAMA are preventable; for example, strengthening of the national health insurance scheme, enhancement of doctor-patient communication, and improvement of hospital environment would further reduce DAMA rate. Keywords: discharge against medical advice, tertiary center, sociodemographic characteristics, clinical

Multimedia instructions and cognitive load theory: effects of modality and cueing.

Science.gov (United States)

Tabbers, Huib K; Martens, Rob L; van Merriënboer, Jeroen J G

2004-03-01

Recent research on the influence of presentation format on the effectiveness of multimedia instructions has yielded some interesting results. According to cognitive load theory (Sweller, Van Merriënboer, & Paas, 1998) and Mayer's theory of multimedia learning (Mayer, 2001), replacing visual text with spoken text (the modality effect) and adding visual cues relating elements of a picture to the text (the cueing effect) both increase the effectiveness of multimedia instructions in terms of better learning results or less mental effort spent. The aim of this study was to test the generalisability of the modality and cueing effect in a classroom setting. The participants were 111 second-year students from the Department of Education at the University of Gent in Belgium (age between 19 and 25 years). The participants studied a web-based multimedia lesson on instructional design for about one hour. Afterwards they completed a retention and a transfer test. During both the instruction and the tests, self-report measures of mental effort were administered. Adding visual cues to the pictures resulted in higher retention scores, while replacing visual text with spoken text resulted in lower retention and transfer scores. Only a weak cueing effect and even a reverse modality effect have been found, indicating that both effects do not easily generalise to non-laboratory settings. A possible explanation for the reversed modality effect is that the multimedia instructions in this study were learner-paced, as opposed to the system-paced instructions used in earlier research.

Preliminary Characterization of the Liquid Discharge of the Mexico Hospital

International Nuclear Information System (INIS)

Hernandez Rojas, A

2001-01-01

The generation and wrong handling of hospital waste constitutes a serious problem at national level. In this work, a preliminary characterization of the discharge it liquidates of the Mexico Hospital is carried out. For it, different pouring points were analyzed inside the institution; they are: Laundry, Central Kitchen, Clinical Laboratory, X-Rays, Laboratory of Biomass, Morgue, and the final discharge of the hospital. This with the purpose of knowing the handling of the liquid waste in the health center, the sanitary quality of these liquids and their influence in the raw waters of the Mexico Hospital in the receiving body. For this study, we first coordinated with the personnel of each department to know about the handling and type of liquid residuals that are discharged to the system of pipes. Later on the physical-chemical and biological tests were carried out with base in two compound samplings done the days October 26 and November 4 1998. Among the carried out tests we have: pH, DBO, DQO, SAAM, Fatty and Oils, Temperature, Nitrogen and Faecal Coniforms, depending on the characteristics of their origin point. At the end of the study, the obtained results were evaluated for each studied pouring point, and then the influence of these focuses on the quality of the raw waters of the hospital that discharge in a gulch located to the northwest side of the facilities was analyzed. The obtained results allow to preliminarily know the characterization of the liquid discharge of the Mexico Hospital and it was classified as a source of contamination. The Hospital requires of a biological treatment plant for those biodegradable poured liquids, and of a system of chemical treatment for that type of products used in the processes characteristic of each department. It is also required to take into account measures of reduction of contamination that diminish the quantity of waste from the source. (Author) [es

Submittal of SWMU Assessment Report for Building 9960 Surface Discharge

Energy Technology Data Exchange (ETDEWEB)

Dotson, Patrick Wells [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

2015-03-01

Sandia National Laboratories is a multi-purpose engineering and science laboratory owned by the U.S. Department of Energy (DOE)/National Nuclear Security Administration and managed and operated by Sandia Corporation (Sandia), a wholly-owned subsidiary of Lockheed Martin Corporation. This Solid Waste Management Unit (SWMU) Assessment Report (SAR) for the Sandia National Laboratories, New Mexico (SNL/NM), Coyote Test Field, Building 9960 Surface Discharge, has been prepared in accordance with Section V of the Compliance Order on Consent (the Consent Order) between the New Mexico Environment Department (NMED), DOE, and Sandia (NMED April 2004). The DOE and Sandia formally notified the NMED of this newly identified or suspected SWMU or Area of Concern (AOC) by letter dated December 9, 2014. This SAR is being submitted in accordance with the NMED Hazardous Waste Bureau (HWB) letter dated February 16, 2015 letter (Kieling February 2015). This SAR presents the available information for the Building 9960 Surface Discharge, including location, designation of type and function, a general description, the operational dates, waste characteristics, and a summary of existing analytical wastewater and soil data

ExStroke Pilot Trial of the effect of repeated instructions to improve physical activity after ischaemic stroke: a multinational randomised controlled clinical trial

DEFF Research Database (Denmark)

Boysen, Gudrun; Krarup, Lars-Henrik; Zeng, Xianrong

2009-01-01

training programme before discharge and at five follow-up visits during 24 months. Control patients had follow-up visits with the same frequency but without instructions in physical activity. MAIN OUTCOME MEASURES: Physical activity assessed with the Physical Activity Scale for the Elderly (PASE) at each......OBJECTIVES: To investigate if repeated verbal instructions about physical activity to patients with ischaemic stroke could increase long term physical activity. DESIGN: Multicentre, multinational, randomised clinical trial with masked outcome assessment. SETTING: Stroke units in Denmark, China...... infarction, or falls and fractures. CONCLUSION: Repeated encouragement and verbal instruction in being physically active did not lead to a significant increase in physical activity measured by the PASE score. More intensive strategies seem to be needed to promote physical activity after ischaemic stroke...

Delayed neuropsychological sequelae after carbon monoxide poisoning: predictive risk factors in the Emergency Department. A retrospective study

Directory of Open Access Journals (Sweden)

Botti Primo

2011-03-01

Full Text Available Abstract Background Delayed neuropsychological sequelae (DNS commonly occur after recovery from acute carbon monoxide (CO poisoning. The preventive role and the indications for hyperbaric oxygen therapy in the acute setting are still controversial. Early identification of patients at risk in the Emergency Department might permit an improvement in quality of care. We conducted a retrospective study to identify predictive risk factors for DNS development in the Emergency Department. Methods We retrospectively considered all CO-poisoned patients admitted to the Emergency Department of Careggi University General Hospital (Florence, Italy from 1992 to 2007. Patients were invited to participate in three follow-up visits at one, six and twelve months from hospital discharge. Clinical and biohumoral data were collected; univariate and multivariate analysis were performed to identify predictive risk factors for DNS. Results Three hundred forty seven patients were admitted to the Emergency Department for acute CO poisoning from 1992 to 2007; 141/347 patients participated in the follow-up visit at one month from hospital discharge. Thirty four/141 patients were diagnosed with DNS (24.1%. Five/34 patients previously diagnosed as having DNS presented to the follow-up visit at six months, reporting a complete recovery. The following variables (collected before or upon Emergency Department admission were associated to DNS development at one month from hospital discharge in the univariate analysis: CO exposure duration >6 hours, a Glasgow Coma Scale (GCS score Conclusions Our study identified several potential predictive risk factors for DNS. Treatment algorithms based on an appropriate risk-stratification of patients in the Emergency Department might reduce DNS incidence; however, more studies are needed. Adequate follow-up after hospital discharge, aimed at correct recognition of DNS, is also important.

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

International Nuclear Information System (INIS)

Specht, W.L.

2000-01-01

The Savannah River Site currently has 33 permitted NPDES outfalls that have been permitted by the South Carolina Department of Health an Environmental Control to discharge to SRS streams and the Savannah River. In order to determine the cumulative impacts of these discharges to the receiving streams, a study plan was developed to perform in-stream assessments of the fish assemblages, macroinvertebrate assemblages, and habitats of the receiving streams

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

Energy Technology Data Exchange (ETDEWEB)

Specht, W.L.

2000-02-28

The Savannah River Site currently has 33 permitted NPDES outfalls that have been permitted by the South Carolina Department of Health an Environmental Control to discharge to SRS streams and the Savannah River. In order to determine the cumulative impacts of these discharges to the receiving streams, a study plan was developed to perform in-stream assessments of the fish assemblages, macroinvertebrate assemblages, and habitats of the receiving streams.

Evaluation of Head Trauma Cases in the Emergency Department

Directory of Open Access Journals (Sweden)

Alim Cokuk

2013-02-01

Full Text Available Aim: In this study, we aimed to determine the epidemiological characteristics, morbidity and mortality rates of patients admitted to the emergency department with head trauma. Material and Methods: In this study, ambulatory and hospitalized patients over the age of 18 brought to the Emergency Department because of head trauma between 01.12.2009 - 31.12.2010 were analyzed retrospectively. Patient data were recorded to standard data entry form. SPSS 17.0 package program was used for statistical analysis of data. The statistical significance level of all tests was p <0.05. Results: 5200 patients were included in this study. The average age of the patients was 39.97 ± 16.66 years. 4682'si patients (90 % were discharged from the emergency department. The most common reason for admission to the emergency department was falls (41.81 % in the discharged patients. 518 (10 % patients were hospitalized. Gender of these patients was 110 female (21:24% and 408 male (78.76%. 256 patients (48.35% were injured as a result of a traffic accident. 201(38.8% of the cerebral CT were reported as normal and 89 (17.2% of the cerebral CT were reported as traumatic subarachnoid hemorrhage (SAH in hospitalized patients. The fracture of lumbar spine (12 % was detected as an additional pathological disease in patients. 75 patients hospitalized because of head trauma (14.5% had died (1.44 % of all patients. Cervical spine fracture was the most common (14 patients, 18.68 % additional pathology in patients who died. Thoracic trauma was detected as the second most common (13 patients, 17.33 % additional pathology. Conclusion: Most of the patients admitted to the emergency department with head injury had a minor trauma. Patients can be discharged from the emergency department after a thorough physical examination and simple medical intervention. Most of the head injury patients admitted to hospital were male. The most common reason of the patients with head injury admitted to

EFL LEARNERS’ READING LEARNING IN WEB BASED INSTRUCTION SETTING

OpenAIRE

Yusup Supriyono

2018-01-01

This research is aimed at exploring reading learning performed by English foreign language learners when Web based instruction is integrated into reading classroom. Teaching learning activity follows the steps:  orientation, discussion, material exploration, action, test, and reflection.  Two data collecting methods—journal and interview are administered to three students of the fourth semester of English Department in University of Siliwangi Tasikmalaya Indonesia after the selected individua...

Plasma Physics Department annual report, 1990

International Nuclear Information System (INIS)

1991-01-01

The main fields in which researches have been carried out during 1990 at the Wills Plasma Physics Department are briefly discussed. These include investigations of shear Alfven waves at frequencies above the ion cyclotron frequency; the use of submillimetre lasers to detect by far forward scattering density fluctuation associated with waves in Tortus during Alfven wave heating experiments; basic physics of laser induced fluorescence in plasma and in particular the process which determine the population of excited states, as well as magnetron discharge studies and application of the vacuum arc as ion sources for accelerators and as sputtering device for producing thin film coating. A list of publications and papers presented at various conferences by the members of the Department is given in the Appendix

Engaging Pre-Service Teachers to Teach Science Contextually with Scientific Approach Instructional Video

Science.gov (United States)

Susantini, E.; Kurniasari, I.; Fauziah, A. N. M.; Prastowo, T.; Kholiq, A.; Rosdiana, L.

2018-01-01

Contextual teaching and learning/CTL presents new concepts in real-life experiences and situations where students can find out the meaningful relationship between abstract ideas and practical applications. Implementing contextual teaching by using scientific approach will foster teachers to find the constructive ways of delivering and organizing science content. This research developed an instructional video that represented a modeling of using a scientific approach in CTL. The aim of this research are to engage pre-service teachers in learning how to teach CTL and to show how pre-service teachers’ responses about learning how to teach CTL using an instructional video. The subjects of this research were ten pre-service teachers in Department of Natural Sciences, Universitas Negeri Surabaya, Indonesia. All subjects observed the instructional video which demonstrated contextual teaching and learning combined with the scientific approach as they completed a worksheet to analyze the video content. The results showed that pre-service teachers could learn to teach contextually as well as applying the scientific approach in science classroom through a modeling in the instructional video. They also responded that the instructional video could help them to learn to teach each component contextual teaching as well as scientific approach.

State waste discharge permit application for cooling water and condensate discharges

Energy Technology Data Exchange (ETDEWEB)

Haggard, R.D.

1996-08-12

The following presents the Categorical State Waste Discharge Permit (SWDP) Application for the Cooling Water and Condensate Discharges on the Hanford Site. This application is intended to cover existing cooling water and condensate discharges as well as similar future discharges meeting the criteria set forth in this document.

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

International Nuclear Information System (INIS)

Zhang, Dingzong; Wang, Yanhui; Wang, Dezhen

2013-01-01

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 the 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

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

Energy Technology Data Exchange (ETDEWEB)

Zhang, Dingzong; Wang, Yanhui; Wang, Dezhen [School of Physics and Optoelectronic Technology, Dalian University of Technology, Dalian 116024 (China)

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 the 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.

Computer Education and Instructional Technology Teacher Trainees' Opinions about Cloud Computing Technology

Science.gov (United States)

Karamete, Aysen

2015-01-01

This study aims to show the present conditions about the usage of cloud computing in the department of Computer Education and Instructional Technology (CEIT) amongst teacher trainees in School of Necatibey Education, Balikesir University, Turkey. In this study, a questionnaire with open-ended questions was used. 17 CEIT teacher trainees…

Hysterectomy - vaginal - discharge

Science.gov (United States)

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 ...

[Acute complicated and uncomplicated pyelonephritis in the emergency department: process-of-care indicators and outcomes].

Science.gov (United States)

Delgado Vicente, Miriam; Lecaroz Agara, Mª Concepción; Barrios Andrés, José Luis; Canut Blasco, Andrés

2017-02-01

To assess process-of-care indicators and outcomes in acute pyelonephritis (APN) in a general hospital emergency department, and compare them between uncomplicaed and complicated APN. Retrospective study of consecutive patients discharged with a diagnosis of APN. We studied health processof- care indicators (percentage admitted, avoidable hospitalization, appropriate initial antibiotic therapy, urine and blood cultures) and outcomes (hospital length of stay [LOS], discharge from the emergency department, revisits, mortality, yields of microbiological tests ordered). A total of 529 cases (59% of them complicated) were included. Patients with uncomplicated APN were significantly younger on average (mean, 39 years) than patients with complicated APN (56 years). Escherichia coli was the most common pathogen identified, although the percentage of E coli infection was lower in patients with complicated APN (78%) than in patients with uncomplicated APN (95%). The rates of admission and orders for urine and blood cultures were significantly higher and hospital LOS was longer in the group with complicated APN. Moreover, these patients had even longer stays if the initial antibiotic therapy was inappropriate. Significantly more patients with uncomplicated APN were discharged from the emergency department. Sixty-one percent of patients with uncomplicated APN were admitted; 9% of these cases were considered avoidable hospitalizations. Complicated APN is diagnosed more often in older patients, and E coli infection causes a smaller proportion of these cases. Hospital LOS is longer in complicated APN and more urine and blood cultures are ordered. Patients with uncomplicated APN are more often discharged from the emergency department, although the number of avoidable hospitalizations seems high based on the rate found in this study.

Strategy Instruction in Mathematics.

Science.gov (United States)

Goldman, Susan R.

1989-01-01

Experiments in strategy instruction for mathematics have been conducted using three models (direct instruction, self-instruction, and guided learning) applied to the tasks of computation and word problem solving. Results have implications for effective strategy instruction for learning disabled students. It is recommended that strategy instruction…

Emergency department case management: the dyad team of nurse case manager and social worker improve discharge planning and patient and staff satisfaction while decreasing inappropriate admissions and costs: a literature review.

Science.gov (United States)

Bristow, Darlene P; Herrick, Charlotte A

2002-01-01

A model of emergency department (ED) case management consisting of a social worker and a nurse case manager can prevent inappropriate admissions, improve discharge planning, decrease cost, and enhance patient satisfaction. The individual and combined roles of the dyad team of social worker and nurse case manager are discussed. A literature review includes how a case management dyad team of social worker and nurse case manager in the ED can decrease utilization of the ED for nonemergent visits, promote the use of community resources, and improve discharge planning to avoid excessive costs. The importance of the dyad team working with the interdisciplinary team in the ED, the primary care physician (PCP), and other community health care providers in order to provide a holistic approach to care is addressed. A discussion about the improvement of both patient and staff satisfaction demonstrates the results of case management strategies that support and advocate for patients to receive quality, cost-effective care across the health care continuum, while decreasing the use of the ED for nonemergent care.

Geospatial database of estimates of groundwater discharge to streams in the Upper Colorado River Basin

Science.gov (United States)

Garcia, Adriana; Masbruch, Melissa D.; Susong, David D.

2014-01-01

The U.S. Geological Survey, as part of the Department of the Interior’s WaterSMART (Sustain and Manage America’s Resources for Tomorrow) initiative, compiled published estimates of groundwater discharge to streams in the Upper Colorado River Basin as a geospatial database. For the purpose of this report, groundwater discharge to streams is the baseflow portion of streamflow that includes contributions of groundwater from various flow paths. Reported estimates of groundwater discharge were assigned as attributes to stream reaches derived from the high-resolution National Hydrography Dataset. A total of 235 estimates of groundwater discharge to streams were compiled and included in the dataset. Feature class attributes of the geospatial database include groundwater discharge (acre-feet per year), method of estimation, citation abbreviation, defined reach, and 8-digit hydrologic unit code(s). Baseflow index (BFI) estimates of groundwater discharge were calculated using an existing streamflow characteristics dataset and were included as an attribute in the geospatial database. A comparison of the BFI estimates to the compiled estimates of groundwater discharge found that the BFI estimates were greater than the reported groundwater discharge estimates.

Hip fracture - discharge

Science.gov (United States)

... neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - discharge ... in the hospital for surgery to repair a hip fracture, a break in the upper part of ...

30 CFR 77.1708 - Safety program; instruction of persons employed at the mine.

Science.gov (United States)

2010-07-01

... at the mine. 77.1708 Section 77.1708 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR COAL MINE SAFETY AND HEALTH MANDATORY SAFETY STANDARDS, SURFACE COAL MINES AND SURFACE WORK AREAS OF UNDERGROUND COAL MINES Miscellaneous § 77.1708 Safety program; instruction of persons...

Radiographer-led discharge in accident and emergency - The results of a pilot project

International Nuclear Information System (INIS)

Snaith, Beverly A.

2007-01-01

Introduction: The radiographers role in trauma has been traditionally limited to image acquisition, but has evolved to include responsibility for image interpretation. The contribution to ongoing patient management has been limited, despite pressure on A and E systems to decrease any potential delays. Background: Three experienced reporting radiographers were trained to discharge patients with a normal radiology report or refer to A and E for further management, following a documented management plan by the examining clinician in A and E. Discharge included advice on the acute management of soft tissue injuries including analgesia and exercise. Methodology: Over a 4-month period in early 2004 all patients whose examinations received a report at the time of attendance (hot report) were included and data were collected in relation to those who were discharged including journey times and further A and E attendances. Data were also collected regarding patients recalled to the A and E department due to misinterpretation of radiographs during the study period. Results: The radiographers hot reported 1760 examinations, discharging 88 (5%) and referring a further 26 (2%) directly for treatment. The number of patients recalled due to misinterpretation of the radiographs was decreased by 52% when compared with the previous 3 years data. Conclusion: Radiographers can safely extend their roles outside of the radiology department and contribute to the management of patients whilst decreasing risk of radiographic misinterpretation by A and E

Travelling-wave-sustained discharges

International Nuclear Information System (INIS)

Schlueter, Hans; Shivarova, Antonia

2007-01-01

This review is on discharges maintained by travelling waves: new plasma sources, discovered in 1974 and considered as a prototype of the gas discharges according to their definition as nonlinear systems which unify in a self-consistent manner plasmas and fields. In the presentation here of the fluid-plasma models of the diffusion-controlled regime of the travelling-wave-sustained discharges (TWSDs), the basic features of the discharge maintenance-the discharge self-consistency and the electron heating in the high-frequency field-are stressed. Operation of stationary and pulsed discharges, discharge maintenance without and in external magnetic fields as well as discharge production in different gases (argon, helium, helium-argon gas mixtures and hydrogen) are covered. Modulation instability of diffusion-controlled discharges and discharge filamentation at higher gas pressures are also included in the review. Experimental findings which motivate aspects of the reported modelling are pointed out

Ankle replacement - discharge

Science.gov (United States)

... total - discharge; Total ankle arthroplasty - discharge; Endoprosthetic ankle replacement - discharge; Osteoarthritis - ankle ... You had an ankle replacement. Your surgeon removed and reshaped ... an artificial ankle joint. You received pain medicine and were ...

Asthma - child - discharge

Science.gov (United States)

Pediatric asthma - discharge; Wheezing - discharge; Reactive airway disease - discharge ... Your child has asthma , which causes the airways of the lungs to swell and narrow. In the hospital, the doctors and nurses helped ...

Glow discharging device

International Nuclear Information System (INIS)

Maeno, Katsuki; Kawasaki, Kozo; Hiratsuka, Hajime; Kawashima, Shuichi.

1989-01-01

In a thermonuclear device, etc. impurities adsorbed to inner walls of a vacuum vessel by glow discharge are released to clean the vacuum vessel for preventing intrusion of the impurities into plasmas. The object of the present invention is to minimize the capacity of a power source equipment for the glow discharge device to the least extent. That is, a stabilization resistance is connected in series between each of a plurality of anodes which are inserted and arranged at the inside of a vacuum vessel as a cathode and a power source respectively. The resistance value R is selected so as to satisfy the relation: R < (Vi - Vm)/Ii, in which Vi: glow discharge starting voltage, Vm: glow discharge keeping voltage, Ii: glow discharge starting current. Accordingly, if a voltage is applied from a power source to a plurality of anodes, scattering of electric discharge between the anodes can be suppressed and the effect of voltage drop during discharge by the stabilization resistance can be eliminated. As a result, it is possible to provide an economically advantageous glow discharge device with the capacity for the power source facility being to the least extent. (K.M.)

An Instructional Design Framework to Improve Student Learning in a First-Year Engineering Class

Science.gov (United States)

Yelamarthi, Kumar; Drake, Eron; Prewett, Matthew

2016-01-01

Increasingly, numerous universities have identified benefits of flipped learning environments and have been encouraging instructors to adapt such methodologies in their respective classrooms, at a time when departments are facing significant budget constraints. This article proposes an instructional design framework utilized to strategically…

Effluent Information System (EIS) / Onsite Discharge Information System (ODIS): 1986 executive summary

International Nuclear Information System (INIS)

Watanabe, T.

1987-09-01

Department of Energy (DOE) data base systems aid DOE-Headquarters and Field Offices in managing the radioactive air and liquid effluents from DOE facilities. Data on effluents released offsite are entered into effluent information system (EIS) and data on effluents discharged onsite and retained onsite are entered into Onsite Discharge Information System (ODIS). This document is a summary of information obtained from the CY 1986 effluent data received from all DOE and DOE contractor facilities and entered in the data bases. Data from previous years are also included. The summary consists of information for effluents released offsite, and information for effluents retained onsite

[Prevention of cardiovascular complications associated with diabetes mellitus: hospital emergency department involvement].

Science.gov (United States)

Agudo Villa, Teresa; Álvarez-Rodríguez, Esther; Caurel Sastre, Zaida; Martín Martínez, Alfonso; Merinero Palomares, Raúl; Alvarez Rodríguez, Virginia; Portero Sánchez, Isabel

2015-06-01

To analyze the risk profile of patients with diabetes who seek care from hospital emergency departments and emergency department involvement in preventing cardiovascular complications in these patients. Cross-sectional analysis of case series from 2 Spanish hospital emergency departments. We included all patients with a history or final diagnosis of diabetes mellitus who were treated in the emergency department between November 1, 2010, and June 30, 2011. Each patient's cardiovascular risk profile was analyzed. The main outcome was the appropriate of prescribed treatment to prevent cardiovascular complications according to the 2012 guidelines of the American Diabetes Association on the patient's discharge from emergency care. A total of 298 patients were included; 275 (92%) had type II diabetes. Ninety percent of the series (269 patients) had at least 1 cardiovascular risk factor and 147 (49%) had prior target organ damage; target organ damage was newly diagnosed in 41 (14%). Fifty-eight percent (172 patients) were discharged home from the emergency department. Although 215 patients (72%) were not adhering to at least 1 previously prescribed preventive treatment and 30 (10%) were not adhering to any prescribed treatment, drug prescriptions were modified only in 1.1% to 3.3% of patients and no follow-up was recommended in 42 cases (24%). Although diabetic patients treated in emergency departments are at high risk for cardiovascular complications, their visit is not used to optimize preventive treatment for these complications or ensure appropriate follow-up.

Inclusive differentiated instruction

Directory of Open Access Journals (Sweden)

Jerković Ljiljana S.

2017-01-01

Full Text Available Inclusive differentiated instruction is a new model of didactic instruction, theoretically described and established in this paper for the first time, after being experimentally verified through teaching of the mother tongue (instruction in reading and literature. Inclusive individually planned instruction is based on a phenomenological and constructivist didactic instructional paradigm. This type of teaching is essentially developmental and person-oriented. The key stages of inclusive differentiated instruction of literature are: 1 recognition of individual students' potential and educational needs regarding reading and work on literary texts; 2 planning and preparation of inclusive individually planned instruction in reading and literature; 3 actual class teaching of lessons thus prepared; and 4 evaluation of the student achievement following inclusive differentiated instruction in reading and literature. A highly important element of the planning and preparation of inclusive differentiated instruction is the creation of student profiles and inclusive individualized syllabi. Individualized syllabi specify the following: 1. a brief student profile; 2. the student position on the continuum of the learning outcomes of instruction in the Serbian language; 3. reverse-engineered macro-plan stages of instruction in the Serbian language (3.1. identifying expected outcomes and fundamental qualities of learners' work, 3.2. defining acceptable proofs of their realisation, 3.3. planning learning and teaching experiences, and 3.4. providing material and technical requisites for teaching; 4 the contents and procedure of individualized lessons targeting the student; 5 a plan of syllabus implementation monitoring and evaluation. The continuum of the learning outcomes of inclusive differentiated instruction in literature exists at three main levels, A, B and C. The three levels are: A reading techniques and learning about the main literary theory concepts; B

State waste discharge permit application: 200 Area Treated Effluent Disposal Facility (Project W-049H)

Energy Technology Data Exchange (ETDEWEB)

1994-08-01

As part of the original Hanford Federal Facility Agreement and Concent Order negotiations, US DOE, US EPA and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground to the Hanford Site are subject to permitting in the State Waste Discharge Permit Program (SWDP). This document constitutes the SWDP Application for the 200 Area TEDF stream which includes the following streams discharged into the area: Plutonium Finishing Plant waste water; 222-S laboratory Complex waste water; T Plant waste water; 284-W Power Plant waste water; PUREX chemical Sewer; B Plant chemical sewer, process condensate, steam condensate; 242-A-81 Water Services waste water.

State waste discharge permit application: 200 Area Treated Effluent Disposal Facility (Project W-049H)

International Nuclear Information System (INIS)

1994-08-01

As part of the original Hanford Federal Facility Agreement and Concent Order negotiations, US DOE, US EPA and the Washington State Department of Ecology agreed that liquid effluent discharges to the ground to the Hanford Site are subject to permitting in the State Waste Discharge Permit Program (SWDP). This document constitutes the SWDP Application for the 200 Area TEDF stream which includes the following streams discharged into the area: Plutonium Finishing Plant waste water; 222-S laboratory Complex waste water; T Plant waste water; 284-W Power Plant waste water; PUREX chemical Sewer; B Plant chemical sewer, process condensate, steam condensate; 242-A-81 Water Services waste water

Angioplasty and stent - heart - discharge

Science.gov (United States)

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

On-the-job training in the department of energy from past to present

International Nuclear Information System (INIS)

Yoder, J.A.; Ludholtz, R.E.; Dodd, C.E.; Pearrell, J.P.

1996-01-01

This paper briefly discusses the approach the United States Department of Energy (DOE) has taken to promote high quality, consistent OJT at DOE-owned, contractor operated nuclear facilities. DOE undertook the challenge of improving OJT because of inconsistencies in training methods being used in the workplace and the increased emphasis on properly trained personnel. To improve consistency for the Department's workforce, a Guide to Good Practices for On-the-Job Training was developed. This guide established standards to be used for conducting OJT. A train-the-trainer course was also developed to provide first line supervisors and subject matter experts with the skills necessary to conduct and evaluate OJT. The need for refresher training was identified and the Department developed an On-the-Job Training Refresher course. The OJT instructor course provides 24 hours of demonstrations, instruction, and evaluated practice covering OJT instructional techniques, and developing learning objectives, OJT guides, and performance evaluations. The OJT refresher course provides experienced instructors review of the OJT process, effective techniques, OJT materials, and ''lessons learned''. Through these courses and field application of the good practices, DOE has laid the foundation for high quality OJT. (author). 8 refs

Improving Reading Instruction through Research-Based Instructional Strategies

Science.gov (United States)

Nash, Vickie Lynn

2010-01-01

The diverse population of students in grades 1- 3 at a suburban elementary school has created a challenge for teachers when differentiating instruction in reading. The purpose of this doctoral project study was to explore the lived experiences of these teachers as they have acquired research-based instructional strategies in reading that support…

Should diagnosis codes from emergency department data be used for case selection for emergency department key performance indicators?

Science.gov (United States)

Howell, Stuart C; Wills, Rachael A; Johnston, Trisha C

2014-02-01

The aim of the present study was to assess the suitability of emergency department (ED) discharge diagnosis for identifying patient cohorts included in the definitions of key performance indicators (KPIs) that are used to evaluate ED performance. Hospital inpatient episodes of care with a principal diagnosis that corresponded to an ED-defined KPI were extracted from the Queensland Hospital Admitted Patient Data Collection (QHAPDC) for the year 2010-2011. The data were then linked to the corresponding ED patient record and the diagnoses applied in the two settings were compared. The asthma and injury cohorts produced favourable results with respect to matching the QHAPDC principal diagnosis with the ED discharge diagnosis. The results were generally modest when the QHAPDC principal diagnosis was upper respiratory tract infection, poisoning and toxic effects or a mental health diagnosis, and were quite poor for influenza. There is substantial variation in the capture of patient cohorts using discharge diagnosis as recorded on Queensland Hospital Emergency Department data. WHAT IS KNOWN ABOUT THE TOPIC? There are several existing KPIs that are defined according to the diagnosis recorded on ED data collections. However, there have been concerns over the quality of ED diagnosis in Queensland and other jurisdictions, and the value of these data in identifying patient cohorts for the purpose of assessing ED performance remains uncertain. WHAT DOES THIS PAPER ADD? This paper identifies diagnosis codes that are suitable for use in capturing the patient cohorts that are used to evaluate ED performance, as well as those codes that may be of limited value. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? The limitations of diagnosis codes within ED data should be understood by those seeking to use these data items for healthcare planning and management or for research into healthcare quality and outcomes.

Re-examination of demonstration gas discharge tubes

International Nuclear Information System (INIS)

Maharaj, H.P.

1991-01-01

Gas discharge tubes in which electrons or ions are accelerated at voltages on the order of kilovolts to produce observable atomic effects are potential x-ray sources. These tubes come in various shapes, sizes and designs, and are still in use in science classrooms despite the decline predicted in the 1970s. Because of current applications, a representative sample consisting of fifteen tubes marketed over a recent 2-year period was reexamined for regulatory compliance, product identification and advertising. The results revealed that: poor quality control and design can affect x-ray emissions; and deficiencies exist in product identification, safe use guidelines and operating instructions. This paper reports that these findings, together with the dose estimates, implications and subjective indicators, strongly suggest a user group of unknown size is at increased risk. A combination of enhanced surveillance and promotion of user awareness strategies is adopted to reduce and possible eliminate the potential health risks

Content-Based Instruction Approach In Instructional Multimedia For English Learning

OpenAIRE

Farani, Rizki

2016-01-01

Content-based Instruction (CBI) is an approach in English learning that integrates certain topic and English learning objectives. This approach focuses on using English competencies as a “bridge” to comprehend certain topic or theme in English. Nowadays, this approach can be used in instructional multimedia to support English learning by using computer. Instructional multimedia with computer system refers to the sequential or simultaneous use of variety of media formats in a given presentatio...

Pediatric heart surgery - discharge

Science.gov (United States)

... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

Documenting Instructional Practices in Large Introductory STEM Lecture Courses

Science.gov (United States)

Vu, Viet Quoc

STEM education reform in higher education is framed around the need to improve student learning outcomes, increase student retention, and increase the number of underrepresented minorities and female students in STEM fields, all of which would ultimately contribute to America's competitiveness and prosperity. To achieve these goals, education reformers call for an increase in the adoption of research-based "promising practices" in classrooms. Despite efforts to increase the adoption of more promising practices in classrooms, postsecondary instructors are still likely to lecture and use traditional teaching approaches. To shed light on this adoption dilemma, a mix-methods study was conducted. First, instructional practices in large introductory STEM courses were identified, followed by an analysis of factors that inhibit or contribute to the use of promising practices. Data were obtained from classroom observations (N = 259) of large gateway courses across STEM departments and from instructor interviews (N = 67). Results show that instructors are already aware of promising practices and that change strategies could move from focusing on the development and dissemination of promising practices to focusing on improving adoption rates. Teaching-track instructors such as lecturers with potential for security of employment (LPSOE) and lecturers with security of employment (LSOE) have adopted promising practices more than other instructors. Interview data show that LPSOEs are also effective at disseminating promising practices to their peers, but opinion leaders (influential faculty in a department) are necessary to promote adoption of promising practices by higher ranking instructors. However, hiring more LPSOEs or opinion leaders will not be enough to shift instructional practices. Variations in the adoption of promising practices by instructors and across departments show that any reform strategy needs to be systematic and take into consideration how information is

Discharge current characteristics as an 'electrical method' for glow discharge plasma diagnosis

International Nuclear Information System (INIS)

Toma, M.; Paraschivescu, Alina; Morminches, Anisoara

2001-01-01

In its simplest form, the glow discharge can be established by passing an electric current through gas between two electrodes. The gas and the electrodes are contained in an insulating envelope. In many technological applications, and not only, the plasma devices are often treated like a black box. There is a series of external parameters or control variables which can be adjusted to obtain a desired effect, namely, the operating voltage, gas pressure, gas nature, gas flow rate, magnetic field strength and magnetic field configuration, electric field geometry, interelectrode distance, and cathode characteristics. The discharge current can be controlled by each of the above control variables. The core idea of this work is the following: a lot of information about the phenomena from the discharge volume, at electrodes or at the discharge bounding wall surface, can be obtained knowing how the change of one of the control parameters influences the discharge current. The following regimes were analyzed: dark discharges (background ionization, saturation regime, Townsend regime, corona regime), glow discharge (the normal and abnormal discharge) and arc discharge (glow to arc transition, non-thermal arcs, thermal arcs). It was concluded that the nonlinearity in the shape of the discharge current characteristics as a function of an external control parameter, can be correlated with the elementary processes and the dynamics of different space charge structures generated in plasma devices. (authors)

Heart attack - discharge

Science.gov (United States)

... and lifestyle Cholesterol - drug treatment Controlling your high blood pressure Deep vein thrombosis - discharge Dietary fats explained Fast food tips Heart attack - discharge Heart attack - what to ask your doctor Heart bypass ... pacemaker - discharge High blood pressure - what to ask your doctor How to read ...

New pathways to physics instruction: Blending a MOOC and in-person discussion to train physics graduate students and postdocs in evidence-based teaching

Science.gov (United States)

Goldberg, Bennett

A challenge facing physics education is how to encourage and support the adoption of evidence-based instructional practices that decades of physics education research has shown to be effective. Like many STEM departments, physics departments struggle to overcome the barriers of faculty knowledge, motivation and time; institutional cultures and reward systems; and disciplinary traditions. Research has demonstrated successful transformation of department-level approaches to instruction through local learning communities, in-house expertise, and department administrative support. In this talk, I will discuss how physics and other STEM departments can use a MOOC on evidence-based instruction together with in-person seminar discussions to create a learning community of graduate students and postdocs, and how such communities can affect departmental change in teaching and learning. Four university members of the 21-university network working to prepare future faculty to be both excellent researchers and excellent teachers collaborated on an NSF WIDER project to develop and deliver two massive open online courses (MOOCs) in evidence-based STEM instruction. A key innovation is a new blended mode of delivery where groups of participants engaged with the online content and then meet weekly in local learning communities to discuss content, communicate current experiences, and delve deeper into particular techniques of local interest. The MOOC team supported these so-called MOOC-Centered Learning Communities, or MCLCs, with detailed facilitator guides complete with synopses of online content, learning goals and suggested activities for in-person meetings, as well as virtual MCLC communities for sharing and feedback. In the initial run of the first MOOC, 40 MCLCs were created; in the second run this past fall, more than 80 MCLCs formed. Further, target audiences of STEM graduate students and postdocs completed at a 40-50% rate, indicating the value they place in building their

Cervical cytopathological changes among women with vaginal discharge attending teaching hospital.

Science.gov (United States)

Salih, Magdi M; AlHag, Fatma Tage El Sir; Khalifa, Mohammed Ahmed; El Nabi, Abdulla H

2017-01-01

To find cytology changes among women attending obstetrics and gynaecology clinic with complaints of vaginal discharges. This descriptive hospital-based cytological study was conducted at the outpatient clinic of the obstetrics and gynaecology department. Two hundred women with complaints of vaginal discharge were selected. Their detailed histories were documented on a special request form. Pap smears were then obtained and sent for cytological examination to the cytopathology department. All low-grade squamous intraepithelial lesion (LSIL) cases were advised to follow-up with Pap smears in the next 6-12 months. Those with high-grade squamous intraepithelial lesion (HSIL) were further investigated by a cervical biopsy and managed accordingly. The statistical analysis was performed using, the Statistical Package for Social Science (SPSS). Chi-square and cross-tabulation were used in this study. The cytological examination of Pap smears showed no changes (i.e. negative findings) in 88 (44%) cases, while Candida species infection was the most prevalent, which was found in 67 (33.5%) of the cases. Bacterial vaginosis was found in 39 women (19.5%); 6 women (3%) were reported with dyskaryotic changes. Two cases were found to have LSIL and 4 women had HSIL. Infection is common among the illiterate group of women. Women with vaginal discharges should undergo screening tests for evaluation by cervical smear for the early detection of cervical precancer conditions. There is an urgent need to establish a screening program for cervical cancer in Sudan.

25 CFR 16.4 - Exchange of information within the Department.

Science.gov (United States)

2010-04-01

... Section 16.4 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR PROBATE ESTATES OF INDIANS OF... information may be useful in discharging the duties covered by the regulations in this part, the Bureau shall..., concerning the estate and status of an Indian of the Five Civilized Tribes for whom legal assistance should...

Post-Discharge Care Duration, Charges, and Outcomes Among Medicare Patients After Primary Total Hip and Knee Arthroplasty.

Science.gov (United States)

Ponnusamy, Karthikeyan E; Naseer, Zan; El Dafrawy, Mostafa H; Okafor, Louis; Alexander, Clayton; Sterling, Robert S; Khanuja, Harpal S; Skolasky, Richard L

2017-06-07

. Among Medicare patients, discharge disposition and number of comorbidities were most strongly associated with readmission. Inpatient rehabilitation and the West region had the strongest associations with higher charges. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

7 CFR 330.210a - Administrative instructions listing approved packing materials for plant pests.

Science.gov (United States)

2010-01-01

... materials for plant pests. 330.210a Section 330.210a Agriculture Regulations of the Department of... PEST REGULATIONS; GENERAL; PLANT PESTS; SOIL, STONE, AND QUARRY PRODUCTS; GARBAGE Movement of Plant Pests § 330.210a Administrative instructions listing approved packing materials for plant pests. (a) The...

Leven estuary project. Fisheries Department final report

OpenAIRE

Bayliss, B.D.

1997-01-01

This is the report on the Leven estuary project: Fisheries Department final report produced by the Environment Agency North West in 1997. This report contains information about Leven estuary, river Leven catchment, river Crake catchment and the Ulverston Discharges. The Leven estuary is characterised by being very shallow, and shares the extremely variable tides and currents that characterize the whole of Morecambe Bay. There was little detailed knowledge of the impact on the Leven estuary, a...

COGNITIVE LEARNING STRATEGIES OF NON-ENGLISH DEPARTMENT STUDENTS ON NOUN STRUCTURE

Directory of Open Access Journals (Sweden)

Shierly Novalita Yappy

2006-01-01

Full Text Available Learning English for non-English department students is not as easy as it seems. Besides, as much as it is necessary to know how successful learners learn, not less important is to know how less successful learners learn. Using think aloud method, this study aims at finding out the cognitive strategies used by the engineering department students in answering incorrectly problems on TOEFL noun structure-the grammar point in which students made the most errors. Findings uncover the students' strategies and reasoning upon which pedagogical implications can be put forth so that more effective and fruitful instruction can be tailored.

Organizational factors affecting length of stay in the emergency department: initial observational study.

Science.gov (United States)

Bashkin, Osnat; Caspi, Sigalit; Haligoa, Rachel; Mizrahi, Sari; Stalnikowicz, Ruth

2015-01-01

Length of stay (LOS) is considered a key measure of emergency department throughput, and from the perspective of the patient, it is perceived as a measure of healthcare service quality. Prolonged LOS can be caused by various internal and external factors. This study examined LOS in the emergency department and explored the main factors that influence LOS and cause delay in patient care. Observations of 105 patients were performed over a 3-month period at the emergency room of a community urban hospital. Observers monitored patients from the moment of entrance to the department until discharge or admission to another hospital ward. Analysis revealed a general average total emergency department LOS of 438 min. Significant differences in average LOS were found between admitted patients (Mean = 544 min, SD = 323 min) and discharged patients (Mean = 291 min, SD = 286 min). In addition, nurse and physician change of shifts and admissions to hospital wards were found to be significant factors associated with LOS. Using an Ishikawa causal diagram, we explored various latent organizational factors that may prolong this time. The study identified several factors that are associated with high average emergency department LOS. High LOS may lead to increases in expenditures and may have implications for patient safety, whereas certain organizational changes, communication improvement, and time management may have a positive effect on it. Interdisciplinary methods can be used to explore factors causing prolonged emergency department LOS and contribute to a better understanding of them.

CO-AXIAL DISCHARGES

Science.gov (United States)

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.

Standard distribution for unclassified scientific and technical reports: instructions and category scope notes

International Nuclear Information System (INIS)

1980-12-01

The US Department of Energy Technical Information Center (DOE/TIC) uses a subject category scheme for classifying and distributing DOE-originated or -sponsored unclassified scientific and technical reports. This document contains the subject category scope notes used for these purposes. Originators of DOE or DOE-sponsored scientific and technical reports are urged to adhere to the instructions contained this publication. A limited number of copies of the unabridged version (addresses included) are available to Department of Energy offices and their contractors as DOE/TIC-4500(Rev.69)(Unabridged)

BIBLIOGRAPHY ON INDIVIDUALIZED INSTRUCTION.

Science.gov (United States)

Harvard Univ., Cambridge, MA. Graduate School of Education.

THIS BIBLIOGRAPHY LISTS MATERIAL ON VARIOUS ASPECTS OF INDIVIDUALIZED INSTRUCTION. APPROXIMATELY 85 UNANNOTATED REFERENCES ARE PROVIDED TO DOCUMENTS DATING FROM 1958 TO 1966. JOURNALS, BOOKS, AND REPORT MATERIALS ARE LISTED. SUBJECT AREAS INCLUDED ARE PROGRAMED INSTRUCTION, TEACHING MACHINES, RESPONSE MODE, SELF-INSTRUCTION, AND COMPUTER-ASSISTED…

Demonstrating Empathy: A Phenomenological Study of Instructional Designers Making Instructional Strategy Decisions for Adult Learners

Science.gov (United States)

Vann, Linda S.

2017-01-01

Instructional designers are tasked with making instructional strategy decisions to facilitate achievement of learning outcomes as part of their professional responsibilities. While the instructional design process includes learner analysis, that analysis alone does not embody opportunities to assist instructional designers with demonstrations of…

Written instructions for the transport of hazardous materials: Accident management instruction sheets

International Nuclear Information System (INIS)

Ridder, K.

1988-01-01

In spite of the regulations and the safety provisions taken, accidents are not entirely avoidable in the transport of hazardous materials. For managing an accident and preventing further hazards after release of dangerous substances, the vehicle drivers must carry with them the accident management instruction sheets, which give instructions on immediate counter measures to be taken by the driver, and on information to be given to the police and the fire brigades. The article in hand discusses the purpose, the contents, and practice-based improvement of this collection of instruction sheets. Particular reference is given to the newly revised version of June 15, 1988 (Verkehrsblatt 1/88) of the 'Directives for setting up accident management instruction sheets - written instructions - for road transport of hazardous materials', as issued by the Federal Ministry of Transport. (orig./HP) [de

Connecting Inspiration with Information: Studio Art Students and Information Literacy Instruction

Directory of Open Access Journals (Sweden)

Katie Greer

2015-06-01

Full Text Available This article discusses the partnership between the library and the studio art faculty at [Institution name], that led to the integration of information literacy instruction into the studio art curriculum. The author outlines the importance of information literacy to artistic practice and student success, and discusses the program of instruction and learning outcomes. Early assessment of student needs and the program’s effectiveness, using both citation analysis and anecdotal feedback, reveals that the program has contributed to the maturation of student research and inquiry skills, and positively affected the relationship between the department and the library, and provides preliminary conclusions about undergraduate studio art information behaviors. An ongoing further program of study to more fully describe the information needs of undergraduate studio art students is also outlined.

Estimation of the Relationship Between Remotely Sensed Anthropogenic Heat Discharge and Building Energy Use

Science.gov (United States)

Zhou, Yuyu; Weng, Qihao; Gurney, Kevin R.; Shuai, Yanmin; Hu, Xuefei

2012-01-01

This paper examined the relationship between remotely sensed anthropogenic heat discharge and energy use from residential and commercial buildings across multiple scales in the city of Indianapolis, Indiana, USA. The anthropogenic heat discharge was estimated with a remote sensing-based surface energy balance model, which was parameterized using land cover, land surface temperature, albedo, and meteorological data. The building energy use was estimated using a GIS-based building energy simulation model in conjunction with Department of Energy/Energy Information Administration survey data, the Assessor's parcel data, GIS floor areas data, and remote sensing-derived building height data. The spatial patterns of anthropogenic heat discharge and energy use from residential and commercial buildings were analyzed and compared. Quantitative relationships were evaluated across multiple scales from pixel aggregation to census block. The results indicate that anthropogenic heat discharge is consistent with building energy use in terms of the spatial pattern, and that building energy use accounts for a significant fraction of anthropogenic heat discharge. The research also implies that the relationship between anthropogenic heat discharge and building energy use is scale-dependent. The simultaneous estimation of anthropogenic heat discharge and building energy use via two independent methods improves the understanding of the surface energy balance in an urban landscape. The anthropogenic heat discharge derived from remote sensing and meteorological data may be able to serve as a spatial distribution proxy for spatially-resolved building energy use, and even for fossil-fuel CO2 emissions if additional factors are considered.

46 CFR 160.151-59 - Operating instructions and information for the ship's training manual.

Science.gov (United States)

2010-10-01

... 46 Shipping 6 2010-10-01 2010-10-01 false Operating instructions and information for the ship's training manual. 160.151-59 Section 160.151-59 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) EQUIPMENT, CONSTRUCTION, AND MATERIALS: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Inflatable Liferafts (SOLAS) § 160.151-59...

33 CFR 338.2 - Activities involving the discharge of dredged or fill material into waters of the U.S.

Science.gov (United States)

2010-07-01

... 33 Navigation and Navigable Waters 3 2010-07-01 2010-07-01 false Activities involving the discharge of dredged or fill material into waters of the U.S. 338.2 Section 338.2 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE OTHER CORPS ACTIVITIES INVOLVING...

An Emergency Department Intervention to Increase Parent-Child Tobacco Communication: A Pilot Study

Science.gov (United States)

Mahabee-Gittens, E. Melinda; Huang, Bin; Slap, Gail B.; Gordon, Judith S.

2008-01-01

We conducted a randomized trial of parents and their 9- to 16-year-old children to pilot test an emergency department (ED)-based intervention designed to increase parent-child tobacco communication. Intervention group (IG) parents received verbal/written instructions on how to relay anti-tobacco messages to their children; control group (CG)…

Discharge lamp technologies

Energy Technology Data Exchange (ETDEWEB)

Dakin, J. [GE Lighting, Cleveland, OH (United States)

1994-12-31

This talk is an overview of discharge lamp technology commonly employed in general lighting, with emphasis on issues pertinent to lighting for plant growth. Since the audience is primarily from the plant growth community, and this begins the light source part of the program, we will start with a brief description of the discharge lamps. Challenges of economics and of thermal management make lamp efficiency a prime concern in controlled environment agriculture, so we will emphasize science considerations relating to discharge lamp efficiency. We will then look at the spectra and ratings of some representative lighting products, and conclude with a discussion of technological advance. A general overview of discharge lighting technology can be found in the book of Waymouth (1971). A recent review of low pressure lighting discharge science is found in Dakin (1991). The pioneering paper of Reiling (1964) provides a good introduction to metal halide discharges. Particularly relevant to lighting for plant growth, a recent and thorough treatment of high pressure Na lamps is found in the book by deGroot and vanVliet (1986). Broad practical aspects of lighting application are thoroughly covered in the IES Lighting Handbook edited by Kaufman (1984).

Tennis elbow surgery - discharge

Science.gov (United States)

... epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... long as you are told. This helps ensure tennis elbow will not return. You may be prescribed a ...

Epidemiology and clinico-investigative study of organisms causing vaginal discharge

Science.gov (United States)

Venugopal, Swetha; Gopalan, Kannan; Devi, Asha; Kavitha, A.

2017-01-01

Background: Abnormal vaginal discharge is a common clinical problem in reproductive age group. It is the second most common problem after abnormal uterine bleeding. It is a neglected health problem, most commonly caused due to vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis (BV). Objectives: The present study was conducted to determine the prevalence of common organisms causing vaginal discharge and also to know the variety of clinical presentation. Materials and Methods: A cross-sectional descriptive study was conducted in the Skin and STD Outpatient Department of Vinayaka Mission Kirupananda Variyar Medical College Hospital, Salem, who presented with abnormal vaginal discharge between September 2012 and September 2014. A total of 100 women in the reproductive age group who had symptoms of vaginitis were examined. Data were coded and analyzed. Results: Out of the 100 patients examined, 77 (77%) cases were organism positive. Among the positive cases, BV (27%) was the most common microbiological cause of abnormal vaginal discharge, followed by trichomoniasis (25%), vaginal candidiasis (22%), combined infection (Candida and BV) (3%), and nonspecific cases (23%). Conclusion: Out of 100 cases, few cases showed discordance between clinical and laboratory diagnosis. This discordance can be due to pitfalls in identifying the causative agent clinically or obscuring of the findings due to improper treatment received for other ailments. Thus, clinico-investigative correlation is more important than other clinical findings alone. PMID:28442807

Patient journey in decompensated heart failure: An analysis in departments of cardiology and geriatrics in the Greater Paris University Hospitals.

Science.gov (United States)

Laveau, Florent; Hammoudi, Nadjib; Berthelot, Emmanuelle; Belmin, Joël; Assayag, Patrick; Cohen, Ariel; Damy, Thibaud; Duboc, Denis; Dubourg, Olivier; Hagege, Albert; Hanon, Olivier; Isnard, Richard; Jondeau, Guillaume; Labouree, Florian; Logeart, Damien; Mansencal, Nicolas; Meune, Christophe; Pautas, Eric; Wolmark, Yves; Komajda, Michel

2017-01-01

Hospitalization for worsening/acute heart failure is increasing in France, and limited data are available on referral/discharge modalities. To evaluate patients' journeys before and after hospitalization for this condition. On 1 day per week, between October 2014 and February 2015, this observational study enrolled 260 consecutive patients with acute/worsening heart failure in all 10 departments of cardiology and four of the departments of geriatrics in the Greater Paris University Hospitals. First medical contact was an emergency unit in 45% of cases, a general practitioner in 16% of cases, an emergency medical ambulance in 13% of cases and a cardiologist in 13% of cases; 78% of patients were admitted directly after first medical contact. In-hospital stay was 13.2±11.3 days; intensive care unit stay (38% of the population) was 6.4±5 days. In-hospital mortality was 2.7%. Overall, 63% of patients were discharged home, whereas 21% were transferred to rehabilitation units. A post-discharge outpatient visit was made by only 72% of patients within 3 months (after a mean of 45±28 days). Only 53% of outpatient appointments were with a cardiologist. Emergency departments, ambulances and general practitioners are the main points of entry before hospitalization for acute/worsening heart failure. Home discharge occurs in two of three cases. Time to first patient post-discharge visit is delayed. Therefore, actions to improve the patient journey should target primary care physicians and emergency structures, and efforts should be made to reduce the time to the first visit after discharge. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Postoperative Calcium Management in Same-Day Discharge Thyroid and Parathyroid Surgery.

Science.gov (United States)

Nelson, Kurt L; Hinson, Andrew M; Lawson, Bradley R; Middleton, Derek; Bodenner, Donald L; Stack, Brendan C

2016-05-01

To describe a safe and effective postoperative prophylactic calcium regimen for same-day discharge thyroid and parathyroid surgery. Case series with chart review. Tertiary referral academic institution. In total, 162 adult patients who underwent total thyroidectomy, completion thyroidectomy, unilateral parathyroidectomy, parathyroidectomy with bilateral neck exploration, or revision parathyroidectomy were identified preoperatively to be candidates for same-day discharge. All patients in this study were successfully discharged the same day on our standard prophylactic calcium regimen. Less than 1% (1/162) of patients re-presented to the hospital within 30 days of surgery, and that patient was successfully discharged from the emergency department after negative workup for hypocalcemia. There was no significant difference between preoperative and postoperative calcium levels in the total/completion thyroidectomy groups (9.3 vs 9.2 mg/dL, respectively; P = .14). The average postoperative calcium level in the parathyroid group was well within normal limits (9.5 mg/dL), and the difference in postoperative calcium levels between revision and primary parathyroidectomy cases was not significantly different (P = .34). The reported calcium regimen demonstrates a safe, effective, and objective means of postoperative calcium management in outpatient thyroid and parathyroid surgery in appropriately selected patients. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Elementary Students' Retention of Environmental Science Knowledge: Connected Science Instruction versus Direct Instruction

Science.gov (United States)

Upadhyay, Bhaskar; DeFranco, Cristina

2008-01-01

This study compares 3rd-grade elementary students' gain and retention of science vocabulary over time in two different classes--"connected science instruction" versus "direct instruction." Data analysis yielded that students who received connected science instruction showed less gain in science knowledge in the short term compared to students who…

Non-invasive coronary angiography for patients with acute atypical chest pain discharged after negative screening including maximal negative treadmill stress test. A prospective study.

Science.gov (United States)

Bonello, L; Armero, S; Jacquier, A; Com, O; Sarran, A; Sbragia, P; Panuel, M; Arques, S; Paganelli, F

2009-05-01

Among patients admitted in the emergency department for acute atypical chest pain those with an acute coronary syndrome (ACS) who are mistakenly discharged home have high mortality. A recent retrospective study has demonstrated that multislice computed tomography (MSCT) coronary angiography could improve triage of these patients. We aimed to prospectively confirm these data on patients with a negative screening including maximal treadmill stress. 30 patients discharged from the emergency department after negative screening for an ACS were included. All patients underwent MSCT angiography of the coronary artery. Patients with coronary atheroma on MSCT had an invasive coronary angiography to confirm these findings. Seven patients (23%) had obstructive coronary artery disease on MSCT. Invasive coronary angiography (ICA) confirmed the diagnosis in all patients. In patients with no previously known coronary artery disease admitted to the emergency department with atypical acute chest pain and discharged after negative screening, including maximal treadmill stress test, MSCT coronary angiography is useful for the diagnosis of obstructive coronary artery disease.

Home Antibiotics at Discharge for Pediatric Complicated Appendicitis: Friend or Foe?

Science.gov (United States)

Anderson, K Tinsley; Bartz-Kurycki, Marisa A; Kawaguchi, Akemi L; Austin, Mary T; Holzmann-Pazgal, Galit; Kao, Lillian S; Lally, Kevin P; Tsao, Kuojen

2018-04-20

The role of home antibiotics (HA) at discharge in children after perforated appendicitis is unclear. This study evaluates the outcomes of complicated appendicitis in patients being discharged with or without HA after initial operation and inpatient treatment. The 2015 and 2016 NSQIP-Pediatric database was queried for patients younger than 18 years of age with complicated appendicitis. Home antibiotics were prescribed or not (no home antibiotics [NHA]). Patients were stratified based on presence or absence of predischarge surgical site infection (SSI) and postoperative day of discharge (≤5 days or >5 days). The primary end point was 30-day postdischarge composite morbidity, including emergency department visit, readmission, postdischarge reoperation, and SSI. Multivariable logistic regression was used to adjust for baseline covariables. Of 6,412 patients with complicated appendicitis, the majority were discharged with HA (HA 56.4%; NHA 43.6%). Patients receiving HA had higher preoperative leukocytosis, longer procedures, higher incidence of sepsis, more predischarge SSIs, and longer length of stay than the NHA cohort (all p 5 days post operation (aOR 1.14; 95% CI 0.89 to 1.46). Although the majority of pediatric patients with complicated appendicitis are discharged with HA, NSQIP-Pediatric data suggest there is no evidence of a significant benefit. There might be a cohort of patients with more severe disease who require continued antibiotics. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

30 CFR 48.25 - Training of new miners; minimum courses of instruction; hours of instruction.

Science.gov (United States)

2010-07-01

...; minimum courses of instruction; hours of instruction. (a) Each new miner shall receive no less than 24...: Provided, That no less than 8 hours of training shall in all cases be given to new miners before they are... instruction; hours of instruction. 48.25 Section 48.25 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION...

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

International Nuclear Information System (INIS)

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

2016-01-01

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. (paper)

Impact of supplemental instruction leader on the success of supplemental instruction model

Science.gov (United States)

Mahabaduge, Hasitha; Haslam, Jeanne

Supplemental instruction utilizes peer-assisted study sessions to provide review sessions on course material and an opportunity to discuss and work out problems. The impact of supplemental instruction on student performance is well researched and used in a large number of universities around the world due to its proven success. However, the impact of the student leader who plays a significant role in this model is rarely discussed in the literature. We present a case study on the impact of student leader on the success of supplemental instruction model. This case study was done for an Introductory Physics course correlating student performance and the supplemental instruction sessions they attended. Further analysis revealed that the academic performance and work ethics of the student leader has a significant impact on the success of the supplemental instruction model. Important factors to consider when selecting a student leader, the challenges and possible remedies will also be discussed.

Department of Plasma Physics and Technology - Overview

International Nuclear Information System (INIS)

Sadowski, M.

1997-01-01

In 1996 the main activities of Department P-5 (until December 1996 known as the Department of Thermonuclear Research) were concentrated on 5 topics: 1. Selected problems of plasma theory, 2. Studies of phenomena within high-current plasma concentrators, 3. Development of plasma diagnostic methods, 4. Studies in the field of fusion technology, 5. Research on new plasma-ion technologies. Theoretical studies mainly concerned elementary processes occurring within a plasma, and particularly those within near-electrode regions of microwave discharges as well as those within near-wall layers (SOL) of tokamaks. We also developed computational packages for parameter identification and modelling of physical phenomena in pulse plasma coaxial accelerators. Experimental studies were concentrated on the generation of a dense magnetized plasma in different high-current PF (Plasma Focus) facilities and small Z-Pinch devices. We carried out investigations of X-rays, relativistic electron beams (REBs), accelerated primary ions, and fast products of fusion reactions for deuterium discharges. Research on plasma diagnostics comprised the development of methods and equipment for studies of X-ray emission, pulsed electron beams, and fast ions, using special Cherenkov-type detectors of electrons and solid-state nuclear track detectors (SSNTDs) of ions. New diagnostic techniques were developed. Studies in the field of fusion technology concerned the design, construction, and testing of different high-voltage pulse generators. We also developed special opto-electronic systems for control and data transmission. Research on plasma-ion technology concentrated on the generation of pulsed high-power plasma-ion streams and their applications for the surface modification of semiconductors, pure metals and alloys. The material engineering studies were carried out in close collaboration with our P-9 Department and other domestic and foreign research centers

Prostate brachytherapy - discharge

Science.gov (United States)

Implant therapy - prostate cancer - discharge; Radioactive seed placement - discharge ... You had a procedure called brachytherapy to treat prostate cancer. Your treatment lasted 30 minutes or more, ...

Quantifying Construction Site Sediment Discharge Risk and Treatment Potential

Science.gov (United States)

Ferrell, L.; Beighley, R. E.

2006-12-01

Dealing with soil erosion and sediment transport can be a significant challenge during the construction process due to the potentially large spatial and temporal extent and conditions of bare soils. Best Management Practices (BMP) are commonly used to eliminate or reduce offsite discharge of sediment. However, few efforts have investigated the time varying risk of sediment discharge from construction sites, which often have dynamic soil conditions and the potential for less than optimal BMP installations. The goal of this research is to improve the design, implementation and effectiveness of sediment and erosion control at construction sites using site specific, temporal distributions of sediment discharge risk. Sediment risk is determined from individual factors leading to sediment expert, such as rainfall frequency, the adequacy of BMP installations, and the extent and duration of bare soil conditions. This research specifically focuses on quantifying: (a) the effectiveness of temporary sediment and control erosion control BMPs in preventing, containing, and/or treating construction site sediment discharge at varying levels of "proper" installation, and (b) sediment discharge potential from construction sites during different phases of construction, (ex., disturbed earth operations). BMPs are evaluated at selected construction sites in southern California and at the Soil Erosion Research Laboratory (SERL) in the Civil and Environmental Engineering department at San Diego State University. SERL experiments are performed on a 3-m by 10-m tilting soil bed with soil depths up to 1 meter, slopes ranging from 0 to 50 percent, and rainfall rates up to 150 mm/hr (6 in/hr). BMP performance is assessed based on experiments where BMPs are installed per manufacture specifications, potential less than optimal installations, and no treatment conditions. Soil conditions are also varied to represent site conditions during different phases of construction (i.e., loose lifts

20 CFR 726.207 - Discharge by the carrier of obligations and duties of operator.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Discharge by the carrier of obligations and duties of operator. 726.207 Section 726.207 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, AS AMENDED BLACK LUNG BENEFITS...

Reconstructing the history of 14C discharges from Sellafield. Part 2. Aquatic discharges

International Nuclear Information System (INIS)

Cook, G.T.; MacKenzie, A.B.; Naysmith, F.H.; Anderson, R.; Naysmith, P.; Kershaw, P.J.

2004-01-01

Prior to 1984, the reported marine 14 C discharges from Sellafield were estimates: 0.2 TBq per annum from 1952 to 1969 and 1 TBq per annum until 1984 when measurements commenced. The relationship between the net excess 14 C activity in annually collected Nori (Porphyra umbilicalis) seaweed samples and the annual discharges (estimated and measured) implies that the discharges were not as constant as the estimates. Based on the relationship between post-1984 measured discharges and the excess 14 C in the seaweed, two simple empirical models were used to re-calculate the discharges between 1967 and 1984. Gamma-spectrometry measurements on the seaweed also indicate that Porphyra is a sensitive indicator of changes in discharge of other radionuclides, brought about by the introduction of new waste clean-up technologies within Sellafield. (author)

48 CFR 1352.271-71 - Method of payment and invoicing instructions for ship repair.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Method of payment and invoicing instructions for ship repair. 1352.271-71 Section 1352.271-71 Federal Acquisition Regulations System DEPARTMENT OF COMMERCE CLAUSES AND FORMS SOLICITATION PROVISIONS AND CONTRACT CLAUSES Text of Provisions and Clauses 1352.271-71 Method of...

The impact of inquiry-based instructional professional development upon instructional practice: An action research study

Science.gov (United States)

Broom, Frances A.

This mixed method case study employs action research, conducted over a three month period with 11 elementary math and science practitioners. Inquiry as an instructional practice is a vital component of math and science instruction and STEM teaching. Teachers examined their beliefs and teaching practices with regard to those instructional factors that influence inquiry instruction. Video-taped lessons were compared to a rubric and pre and post questionnaires along with two interviews which informed the study. The results showed that while most beliefs were maintained, teachers implemented inquiry at a more advanced level after examining their teaching and reflecting on ways to increase inquiry practices. Because instructional practices provide only one component of inquiry-based instruction, other components need to be examined in a future study.

NIPPLE DISCHARGE

Directory of Open Access Journals (Sweden)

T. N. Bukharova

2008-01-01

Full Text Available According to the data available in the literature, as high as 50% of women have benign breast tumors frequently accompanied by nip- ple discharge. Nipple discharge may be serous, bloody, purulent, and colostric. The most common causes are breast abscess, injury, drugs, prolactinoma, intraductal pappiloma, ductal ectasia, intraductal cancer (not more than 10%.

The Instructional Network: Using Facebook to Enhance Undergraduate Mathematics Instruction

Science.gov (United States)

Gregory, Peter; Gregory, Karen; Eddy, Erik

2014-01-01

Facebook is a website with over one billion users worldwide that is synonymous with social-networking. However, in this study, Facebook is used as an "instructional network". Two sections of an undergraduate calculus course were used to study the effects of participating in a Facebook group devoted solely to instruction. One section was…

Role of secondary emission on discharge dynamics in an atmospheric pressure dielectric barrier discharge

Energy Technology Data Exchange (ETDEWEB)

Tay, W. H.; Kausik, S. S.; Yap, S. L.; Wong, C. S., E-mail: cswong@um.edu.my [Plasma Technology Research Centre, Department of Physics, Faculty of Science, University of Malaya, 50603 Kuala Lumpur (Malaysia)

2014-04-15

The discharge dynamics in an atmospheric pressure dielectric barrier discharge (DBD) is studied in a DBD reactor consisting of a pair of stainless steel parallel plate electrodes. The DBD discharge has been generated by a 50 Hz ac high voltage power source. The high-speed intensified charge coupled device camera is used to capture the images of filaments occurring in the discharge gap. It is observed that frequent synchronous breakdown of micro discharges occurs across the discharge gap in the case of negative current pulse. The experimental results reveal that secondary emissions from the dielectric surface play a key role in the synchronous breakdown of plasma filaments.

Site Specific Waste Management Instruction for the 116-F-4 soil storage unit

International Nuclear Information System (INIS)

Hopkins, G.G.

1996-08-01

This Site Specific Waste Management Instruction provides guidance for management of waste generated during the excavation and remediation of soil and debris from the 116-4 soil storage unit located at the Hanford Site in Richland, Washington. This document outlines the waste management practices that will be performed in the field to implement federal, state, and US Department of Energy requirements

Slowing Entropy: Instructional Policy Design in New York City, 2011-12. Policy Brief #14-3

Science.gov (United States)

Supovitz, Jonathan

2014-01-01

How do policymakers craft policies, particularly centered on the Common Core State Standards, to be more resilient and less likely to disintegrate during enactment? Researcher Jonathan Supovitz in "Slowing Entropy: Instructional Policy Design in New York City, 2011-12" examines the design of a New York City Department of Education policy…

Waste Generator Instructions: Key to Successful Implementation of the US DOE's 435.1 for Transuranic Waste Packaging Instructions (LA-UR-12-24155) - 13218

International Nuclear Information System (INIS)

French, David M.; Hayes, Timothy A.; Pope, Howard L.; Enriquez, Alejandro E.; Carson, Peter H.

2013-01-01

In times of continuing fiscal constraints, a management and operation tool that is straightforward to implement, works as advertised, and virtually ensures compliant waste packaging should be carefully considered and employed wherever practicable. In the near future, the Department of Energy (DOE) will issue the first major update to DOE Order 435.1, Radioactive Waste Management. This update will contain a requirement for sites that do not have a Waste Isolation Pilot Plant (WIPP) waste certification program to use two newly developed technical standards: Contact-Handled Defense Transuranic Waste Packaging Instructions and Remote-Handled Defense Transuranic Waste Packaging Instructions. The technical standards are being developed from the DOE O 435.1 Notice, Contact-Handled and Remote-Handled Transuranic Waste Packaging, approved August 2011. The packaging instructions will provide detailed information and instruction for packaging almost every conceivable type of transuranic (TRU) waste for disposal at WIPP. While providing specificity, the packaging instructions leave to each site's own discretion the actual mechanics of how those Instructions will be functionally implemented at the floor level. While the Technical Standards are designed to provide precise information for compliant packaging, the density of the information in the packaging instructions necessitates a type of Rosetta Stone that translates the requirements into concise, clear, easy to use and operationally practical recipes that are waste stream and facility specific for use by both first line management and hands-on operations personnel. The Waste Generator Instructions provide the operator with step-by-step instructions that will integrate the sites' various operational requirements (e.g., health and safety limits, radiological limits or dose limits) and result in a WIPP certifiable waste and package that can be transported to and emplaced at WIPP. These little known but widely productive Waste

Instructed Pragmatics at a Glance: Where Instructional Studies Were, Are, and Should Be Going

Science.gov (United States)

Taguchi, Naoko

2015-01-01

This paper brings together the research and developments of instructed pragmatics over the past three decades by reporting the synthesis findings of instructional intervention studies in interlanguage pragmatics. Two questions have guided this investigation: (1) is instruction effective in learning pragmatics?; and (2) what methods are most…

Modelling electric discharge chemistry

International Nuclear Information System (INIS)

McFarlane, J.; Wren, J.C.

1991-07-01

The chemistry occurring in a electric discharge was modelled to predict how it would be influenced by discharge conditions. The discharge was characterized by a calculated Boltzmann electron-energy distribution, from which rate constants for electron-molecule processes in air were determined. These rate constants were used in a chemical kinetics calculation that also included reactions between neutral molecules, ions, free radicals and electronically excited species. The model describes how the discharge chemistry was influenced by humidity, electric field, electron number density, and concentrations of key reagents identified in the study. The use of an electric discharge to destroy airborne contaminant molecules was appraised, the targeted contaminants being CF 2 Cl 2 , HCN, and SO 2 . The modelling results indicate that an electric discharge should be able to remove HCN and CF 2 Cl 2 effectively, especially if the discharge conditions have been optimized. Effective destruction is achieved with a moderate electric field (over 1 x 10 -15 V.cm 2 ), a substantial electron number density (over 1 x 10 12 cm -3 ), and the presence of H 2 0 in the process air. The residence time in the discharge was also shown to be important in contaminant destruction. An attempt was made to explain the results of the electric discharge abatement of SO 2 , a component of a simulated flue-gas mixture. Results from the model indicate that the discharge parameters that increase the concentration of hydroxyl radical also increase the rate of decomposition of SO 2 . An objective of the study was to explain the apparent enhancement of SO 2 destruction by the presence of a small amount of NO 2 . It was thought that a likely explanation would be the stabilization of HOSO 2 , an important intermediate in the oxidation of SO 2 by NO 2 . (49 figs., 14 tabs., 75 refs.)

Improvement of ozone yield by a multi-discharge type ozonizer using superposition of silent discharge plasma

International Nuclear Information System (INIS)

Song, Hyun-Jig; Chun, Byung-Joon; Lee, Kwang-Sik

2004-01-01

In order to improve ozone generation, we experimentally investigated the silent discharge plasma and ozone generation characteristics of a multi-discharge type ozonizer. Ozone in a multi-discharge type ozonizer is generated by superposition of a silent discharge plasma, which is simultaneously generated in separated discharge spaces. A multi-discharge type ozonizer is composed of three different kinds of superposed silent discharge type ozonizers, depending on the method of applying power to each electrode. We observed that the discharge period of the current pulse for a multi discharge type ozonizer can be longer than that of silent discharge type ozonizer with two electrodes and one gap. Hence, ozone generation is improved up to 17185 ppm and 783 g/kwh in the case of the superposed silent discharge type ozonizer for which an AC high voltages with a 180 .deg. phase difference were applied to the internal electrode and the external electrode, respectively, with the central electrode being grounded.

Generating and executing programs for a floating point single instruction multiple data instruction set architecture

Science.gov (United States)

Gschwind, Michael K

2013-04-16

Mechanisms for generating and executing programs for a floating point (FP) only single instruction multiple data (SIMD) instruction set architecture (ISA) are provided. A computer program product comprising a computer recordable medium having a computer readable program recorded thereon is provided. The computer readable program, when executed on a computing device, causes the computing device to receive one or more instructions and execute the one or more instructions using logic in an execution unit of the computing device. The logic implements a floating point (FP) only single instruction multiple data (SIMD) instruction set architecture (ISA), based on data stored in a vector register file of the computing device. The vector register file is configured to store both scalar and floating point values as vectors having a plurality of vector elements.

Programmed Instruction Revisited.

Science.gov (United States)

Skinner, B. F.

1986-01-01

Discusses the history and development of teaching machines, invented to restore the important features of personalized instruction as public school class size increased. Examines teaching and learning problems over the past 50 years, including motivation, attention, appreciation, discovery, and creativity in relation to programmed instruction.…

Validation of patient and nurse short forms of the Readiness for Hospital Discharge Scale and their relationship to return to the hospital.

Science.gov (United States)

Weiss, Marianne E; Costa, Linda L; Yakusheva, Olga; Bobay, Kathleen L

2014-02-01

To validate patient and nurse short forms for discharge readiness assessment and their associations with 30-day readmissions and emergency department (ED) visits. A total of 254 adult medical-surgical patients and their discharging nurses from an Eastern US tertiary hospital between May and November, 2011. Prospective longitudinal design, multinomial logistic regression analysis. Nurses and patients independently completed an eight-item Readiness for Hospital Discharge Scale on the day of discharge. Patient characteristics, readmissions, and ED visits were electronically abstracted. Nurse assessment of low discharge readiness was associated with a six- to nine-fold increase in readmission risk. Patient self-assessment was not associated with readmission; neither was associated with ED visits. Nurse discharge readiness assessment should be added to existing strategies for identifying readmission risk. © Health Research and Educational Trust.

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

Science.gov (United States)

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

2011-04-01

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

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

Science.gov (United States)

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)

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

Science.gov (United States)

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

2018-05-01

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

Diffusion of condenser water discharge

International Nuclear Information System (INIS)

Iwakiri, Toshio

1977-01-01

Thermal and nuclear power stations in Japan are mostly located in coastal area, and the cooling water is discharged into sea as warm water. Recently, large interest is taken in this matter, and it is desirable to predict the diffusion of warm discharge accurately and to take effective measures for lowering the temperature. As for the methods of predicting the diffusion of warm discharge, simplified estimation, mathematical analysis and hydrographical model experiment are used corresponding to objects and conditions. As for the measures to lower temperature, the method of discharging warm water into deep sea bottom was confirmed to be very effective. In this paper, the phenomena of diffusion of warm discharge in sea, the methods of predicting the diffusion of warm discharge, and the deep sea discharge as the measure for lowering temperature are outlined. The factors concerning the diffusion of warm discharge in sea are the conditions of discharge, topography and sea state, and the diffusion is roughly divided into mixing diffusion in the vicinity of warm water outlet and eddy diffusion in distant region. It is difficult to change artificially the conditions of diffusion in distant region, and the measures of raising the rate of dilution in near region are effective, therefore the deep sea discharge is adopted. (Kako, I.)

Motivational elements in user instructions

NARCIS (Netherlands)

Loorbach, N.R.

2013-01-01

Concerning the design of user instructions, two view can be distinguished. The traditional view considers instructions as purely instrumental documents. The more and more emerging affective view still assumes that above all, instructions should enable readers to perform tasks. But in order to

Use of telehealth in the management of non-critical emergencies in rural or remote emergency departments: a systematic review.

Science.gov (United States)

du Toit, Marie; Malau-Aduli, Bunmi; Vangaveti, Venkat; Sabesan, Sabe; Ray, Robin A

2017-01-01

Background Telehealth has been used extensively in emergency departments to improve healthcare provision. However, its impact on the management of non-critical emergency presentations within rural and remote emergency department settings has not been adequately explored. The objective of this systematic review is to identify how telehealth has been used to assist in the management of non-critical presentations in rural and remote emergency departments and the outcomes. Methods Articles were identified through database searches of CINAHL, Cochrane, MEDLINE (OVID), Informit and SCOPUS, as well as the screening of relevant article reference and citation lists. To determine how telehealth can assist in the management of non-critical emergencies, information was extracted relating to telehealth programme model, the scope of service and participating health professionals. The outcomes of telehealth programmes were determined by analysing the uptake and usage of telehealth, the impact on altering a diagnosis or management plan as well as patient disposition including patient transfer, discharge, local hospital admission and rates of discharge against medical advice. Results Of the 2532 identified records, 15 were found to match the eligibility criteria and were included in the review. Uptake and usage increased for telehealth programmes predominantly utilised by nursing staff with limited local medical support. Teleconsultation conservatively altered patient diagnosis or management in 18-66% of consultations. Although teleconsultation was associated with increased patient transfer rates, unnecessary transfers were reduced. Simultaneously, an increase in local hospital admission was noted and fewer patients were discharged home. Discharge against medical advice rates were low at 0.9-1.1%. Conclusion The most widely implemented hub-and-spoke telehealth model could be incorporated into existing referral frameworks. Telehealth programmes may assist in reducing unnecessary

Intelligent Instructional Systems in Military Training.

Science.gov (United States)

Fletcher, J.D.; Zdybel, Frank

Intelligent instructional systems can be distinguished from more conventional approaches by the automation of instructional interaction and choice of strategy. This approach promises to reduce the costs of instructional materials preparation and to increase the adaptability and individualization of the instruction delivered. Tutorial simulation…

Vessel Sewage Discharges

Science.gov (United States)

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

Capacitor discharge engineering

CERN Document Server

Früngel, Frank B A

1976-01-01

High Speed Pulse Technology, Volume III: Capacitor Discharge Engineering covers the production and practical application of capacitor dischargers for the generation and utilization of high speed pulsed of energy in different forms. This nine-chapter volume discusses the principles of electric current, voltage, X-rays, gamma rays, heat, beams of electrons, neutrons and ions, magnetic fields, sound, and shock waves in gases and liquids. Considerable chapters consider the applications of capacitor discharges, such as impulse hardening of steel, ultrapulse welding of precision parts, X-ray flash t

Profile and results of frail patient assessed by advanced practice nursing in an Emergency Department.

Science.gov (United States)

Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Puigoriol-Juvanteny, Emma; Nubó-Puntí, Núria; Chabrera-Sanz, Carolina; Subirana-Casacuberta, Mireia

2017-06-02

To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice. Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied. 190 patients were included of whom 13 were readmitted (6.8%). 122 (59.8%) cases from the Emergency Department were referred to to intermediate care facilities, 71 (34.8%) cases for domiciliary care, 10 (4.9%) cases were referred to an acute care hospital and 1 (0.5%) died. Patients referred to intermediate care were more complex, presented geriatric syndromes as their reason for admission and diagnosed with dementia, while those referred to home care presented more respiratory and cardiovascular illnesses (p <0.05). The mean Barthel Index and polypharmacy before emergency admission were higher than at the time of discharge from the alternative healthcare resource (p <0.05). Patients presenting with advanced age, complexity, comorbidity, are referred to intermediate care facilities or domiciliary care, they are admitted to acute care hospitasl and are readmitted less than other patients. After being discharged from the alternative resource, they lose functional capacity and present less polypharmacy. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Intelligent Frameworks for Instructional Design.

Science.gov (United States)

Spector, J. Michael; And Others

1992-01-01

Presents a taxonomy describing various uses of artificial intelligence techniques in automated instructional development systems. Instructional systems development is discussed in relation to the design of computer-based instructional courseware; two systems being developed at the Air Force Armstrong Laboratory are reviewed; and further research…

SU-F-E-18: Training Monthly QA of Medical Accelerators: Illustrated Instructions for Self-Learning

International Nuclear Information System (INIS)

Court, L; Wang, H; Aten, D; Chi, P; Gao, S; Aristophanous, M; Balter, P; Brown, D; Yock, A; Maddox, B; MacGregor, H

2016-01-01

Purpose: To develop and test clear illustrated instructions for training of monthly mechanical QA of medical linear accelerators. Methods: Illustrated instructions were created for monthly mechanical QA with tolerance tabulated, and underwent several steps of review and refinement. Testers with zero QA experience were then recruited from our radiotherapy department (1 student, 2 computational scientists and 8 dosimetrists). The following parameters were progressively de-calibrated on a Varian C-series linac: Group A = gantry angle, ceiling laser position, X1 jaw position, couch longitudinal position, physical graticule position (5 testers); Group B = Group A + wall laser position, couch lateral and vertical position, collimator angle (3 testers); Group C = Group B + couch angle, wall laser angle, and optical distance indicator (3 testers). Testers were taught how to use the linac, and then used the instructions to try to identify these errors. A physicist observed each session, giving support on machine operation, as necessary. The instructions were further tested with groups of therapists, graduate students and physics residents at multiple institutions. We have also changed the language of the instructions to simulate using the instructions with non-English speakers. Results: Testers were able to follow the instructions. They determined gantry, collimator and couch angle errors within 0.4, 0.3, and 0.9degrees of the actual changed values, respectively. Laser positions were determined within 1mm, and jaw positions within 2mm. Couch position errors were determined within 2 and 3mm for lateral/longitudinal and vertical errors, respectively. Accessory positioning errors were determined within 1mm. ODI errors were determined within 2mm when comparing with distance sticks, and 6mm when using blocks, indicating that distance sticks should be the preferred approach for inexperienced staff. Conclusion: Inexperienced users were able to follow these instructions, and catch

SU-F-E-18: Training Monthly QA of Medical Accelerators: Illustrated Instructions for Self-Learning

Energy Technology Data Exchange (ETDEWEB)

Court, L; Wang, H; Aten, D; Chi, P; Gao, S; Aristophanous, M; Balter, P [UT MD Anderson Cancer Center, Houston, TX (United States); Brown, D; Yock, A [University of California, San Diego, La Jolla, CA (United States); Maddox, B [Brigham & Women’s Hospital, Boston, MA (United States); MacGregor, H [University of Cape Town (South Africa)

2016-06-15

Purpose: To develop and test clear illustrated instructions for training of monthly mechanical QA of medical linear accelerators. Methods: Illustrated instructions were created for monthly mechanical QA with tolerance tabulated, and underwent several steps of review and refinement. Testers with zero QA experience were then recruited from our radiotherapy department (1 student, 2 computational scientists and 8 dosimetrists). The following parameters were progressively de-calibrated on a Varian C-series linac: Group A = gantry angle, ceiling laser position, X1 jaw position, couch longitudinal position, physical graticule position (5 testers); Group B = Group A + wall laser position, couch lateral and vertical position, collimator angle (3 testers); Group C = Group B + couch angle, wall laser angle, and optical distance indicator (3 testers). Testers were taught how to use the linac, and then used the instructions to try to identify these errors. A physicist observed each session, giving support on machine operation, as necessary. The instructions were further tested with groups of therapists, graduate students and physics residents at multiple institutions. We have also changed the language of the instructions to simulate using the instructions with non-English speakers. Results: Testers were able to follow the instructions. They determined gantry, collimator and couch angle errors within 0.4, 0.3, and 0.9degrees of the actual changed values, respectively. Laser positions were determined within 1mm, and jaw positions within 2mm. Couch position errors were determined within 2 and 3mm for lateral/longitudinal and vertical errors, respectively. Accessory positioning errors were determined within 1mm. ODI errors were determined within 2mm when comparing with distance sticks, and 6mm when using blocks, indicating that distance sticks should be the preferred approach for inexperienced staff. Conclusion: Inexperienced users were able to follow these instructions, and catch

Designing Preclinical Instruction of Psychomotor Skills (IV)--Instructional Engineering: Evaluation Phase.

Science.gov (United States)

Guenzel, Pamela J.; And Others

1995-01-01

The fourth article in a four-part series on instructional design discusses evaluation of a psychomotor skills unit taught in preclinical dental education. Issues examined include piloting of instructional materials, analysis and revision of materials based on student performance, syllabus design and content, influence of faculty characteristics,…

Instructable autonomous agents. Ph.D. Thesis

Science.gov (United States)

Huffman, Scott Bradley

1994-01-01

In contrast to current intelligent systems, which must be laboriously programmed for each task they are meant to perform, instructable agents can be taught new tasks and associated knowledge. This thesis presents a general theory of learning from tutorial instruction and its use to produce an instructable agent. Tutorial instruction is a particularly powerful form of instruction, because it allows the instructor to communicate whatever kind of knowledge a student needs at whatever point it is needed. To exploit this broad flexibility, however, a tutorable agent must support a full range of interaction with its instructor to learn a full range of knowledge. Thus, unlike most machine learning tasks, which target deep learning of a single kind of knowledge from a single kind of input, tutorability requires a breadth of learning from a broad range of instructional interactions. The theory of learning from tutorial instruction presented here has two parts. First, a computational model of an intelligent agent, the problem space computational model, indicates the types of knowledge that determine an agent's performance, and thus, that should be acquirable via instruction. Second, a learning technique, called situated explanation specifies how the agent learns general knowledge from instruction. The theory is embodied by an implemented agent, Instructo-Soar, built within the Soar architecture. Instructo-Soar is able to learn hierarchies of completely new tasks, to extend task knowledge to apply in new situations, and in fact to acquire every type of knowledge it uses during task performance - control knowledge, knowledge of operators' effects, state inferences, etc. - from interactive natural language instructions. This variety of learning occurs by applying the situated explanation technique to a variety of instructional interactions involving a variety of types of instructions (commands, statements, conditionals, etc.). By taking seriously the requirements of flexible

A Performance-Based Instructional Theory

Science.gov (United States)

Lawson, Tom E.

1974-01-01

The rationale for a performanced- based instructional theory has arisen from significant advances during the past several years in instructional psychology. Four major areas of concern are: analysis of subject-matter content in terms of performance competencies, diagnosis of pre-instructional behavior, formulation of an instructional…

The Mere Exposure Instruction Effect.

Science.gov (United States)

Van Dessel, Pieter; Mertens, Gaëtan; Smith, Colin Tucker; De Houwer, Jan

2017-09-01

The mere exposure effect refers to the well-established finding that people evaluate a stimulus more positively after repeated exposure to that stimulus. We investigated whether a change in stimulus evaluation can occur also when participants are not repeatedly exposed to a stimulus, but are merely instructed that one stimulus will occur frequently and another stimulus will occur infrequently. We report seven experiments showing that (1) mere exposure instructions influence implicit stimulus evaluations as measured with an Implicit Association Test (IAT), personalized Implicit Association Test (pIAT), or Affect Misattribution Procedure (AMP), but not with an Evaluative Priming Task (EPT), (2) mere exposure instructions influence explicit evaluations, and (3) the instruction effect depends on participants' memory of which stimulus will be presented more frequently. We discuss how these findings inform us about the boundary conditions of mere exposure instruction effects, as well as the mental processes that underlie mere exposure and mere exposure instruction effects.

Hydrogen discharges operating at atmospheric pressure in a semiconductor gas discharge system

Energy Technology Data Exchange (ETDEWEB)

Aktas, K; Acar, S; Salamov, B G [Physics Department, Faculty of Arts and Sciences, Gazi University, 06500 Ankara (Turkey)

2011-08-15

Analyses of physical processes which initiate electrical breakdown and spatial stabilization of current and control it with a photosensitive cathode in a semiconductor gas discharge system (SGDS) are carried out in a wide pressure range up to atmospheric pressure p, interelectrode distance d and diameter D of the electrode areas of the semiconductor cathode. The study compares the breakdown and stability curves of the gas discharge in the planar SGDS where the discharge gap is filled with hydrogen and air in two cases. The impact of the ionizing component of the discharge plasma on the control of the stable operation of the planar SGDS is also investigated at atmospheric pressure. The loss of stability is primarily due to modification of the semiconductor-cathode properties on the interaction with low-energy hydrogen ions and the formation of a space charge of positive ions in the discharge gap which changes the discharge from Townsend to glow type. The experimental results show that the discharge current in H{sub 2} is more stable than in air. The breakdown voltages are measured for H{sub 2} and air with parallel-plane electrodes, for pressures between 28 and 760 Torr. The effective secondary electron emission (SEE) coefficient is then determined from the breakdown voltage results and compared with the experimental results. The influence of the SEE coefficient is stated in terms of the differences between the experimental breakdown law.

Discharges from nuclear power stations

International Nuclear Information System (INIS)

1991-02-01

HM Inspectorate of Pollution commissioned, with authorising responsibilities in England and Wales, a study into the discharges of radioactive effluents from Nuclear Power Stations. The study considered arisings from nuclear power stations in Europe and the USA and the technologies to treat and control the radioactive discharges. This report contains details of the technologies used at many nuclear power stations to treat and control radioactive discharges and gives, where information was available, details of discharges and authorised discharge limits. (author)

Early discharge following birth

DEFF Research Database (Denmark)

Nilsson, Ingrid M. S.; Kronborg, Hanne; Knight, Christopher H.

2017-01-01

.26–0.48) and primiparous compared to multiparous had an OR of 0.22 (CI 0.17–0.29) for early discharge. Other predictors for early discharge were: no induction of labour, no epidural painkiller, bleeding less than 500 ml during delivery, higher gestational age, early expected discharge and positive breastfeeding experience...

Predictors of premature discontinuation of outpatient treatment after discharge of patients with posttraumatic stress disorder

Directory of Open Access Journals (Sweden)

Wang HR

2015-03-01

Full Text Available Hee Ryung Wang, Young Sup Woo, Tae-Youn Jun, Won-Myong Bahk Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea Objective: This study aimed to examine the sociodemographic and disease-related variables associated with the premature discontinuation of psychiatric outpatient treatment after discharge among patients with noncombat-related posttraumatic stress disorder. Methods: We retrospectively reviewed the medical records of patients who were discharged with a diagnosis of posttraumatic stress disorder. Results: Fifty-five percent of subjects (57/104 prematurely discontinued outpatient treatment within 6 months of discharge. Comparing sociodemographic variables between the 6-month non-follow-up group and 6-month follow-up group, there were no variables that differed between the two groups. However, comparing disease-related variables, the 6-month follow-up group showed a longer hospitalization duration and higher Global Assessment of Function score at discharge. The logistic regression analysis showed that a shorter duration of hospitalization predicted premature discontinuation of outpatient treatment within 6 months of discharge. Conclusion: The duration of psychiatric hospitalization for posttraumatic stress disorder appeared to influence the premature discontinuation of outpatient treatment after discharge. Keywords: posttraumatic stress disorder, discontinuation, compliance, predictor

Short-term reconsultation, hospitalisation, and death rates after discharge from the emergency department in patients with acute heart failure and analysis of the associated factors. The ALTUR-ICA Study.

Science.gov (United States)

Miró, Òscar; Gil, Víctor; Martín-Sánchez, Francisco Javier; Herrero, Pablo; Jacob, Javier; Sánchez, Carolina; Xipell, Carolina; Aguiló, Sira; Llorens, Pere

2018-03-09

The aim of this study was to define the following in patients with acute heart failure (AHF) discharged directly from accident and emergency (A&E): rates of reconsultation to A&E and hospitalisation for AHF, and all-cause death at 30 days, rate of combined event at 7 days and the factors associated with these rates. The study included patients consecutively diagnosed with AHF during 2 months in 27 Spanish A&E departments who were discharged from A&E without hospitalisation. We collected 43 independent variables, monitored patients for 30 days and evaluated predictive factors for adverse events using Cox regression analysis. We evaluated 785 patients (78±9) years, 54.7% women). The rates of reconsultation, hospitalisation, and death at 30 days and the combined event at 7 days were: 26.1, 15.7, 1.7 and 10.6%, respectively. The independent factors associated with reconsultation were no endovenous diuretics administered in A&E (HR 2.86; 95% CI 2.01-4.04), glomerular filtration rate (GFR)<60ml/min/m 2 (1.94; 1.37-2.76) and previous AHF episodes (1.48; 1.02-2.13); for hospitalisation these factors were no endovenous diuretics in A&E (2.97; 1.96-4.48), having heart valve disease (1.61; 1.04-2.48), blood oxygen saturation at arrival to A&E<95% (1.60; 1.06-2.42); and for the combined event no endovenous diuretics in A&E (3.65; 2.19-6.10), GFR<60ml/min/m 2 (2.22; 1.31-3.25), previous AHF episodes (1.95; 1.04-3.25), and use of endovenous nitrates (0.13; 0.02-0.99). This is the first study in Spain to describe the rates of adverse events in patients with AHF discharged directly from A&E and define the associated factors. These data should help establish the most adequate approaches to managing these patients. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Instructional Leadership Practices in Singapore

Science.gov (United States)

Ng, Foo Seong David; Nguyen, Thanh Dong; Wong, Koon Siak Benjamin; Choy, Kim Weng William

2015-01-01

This paper presents a review of the literature on principal instructional leadership in Singapore. The authors investigated the dimensions of instructional leadership in the practices of Singapore principals and highlighted the strategies these leaders adopt to enact their instructional roles. Singapore principals were found to play an active role…

Putting instruction sequences into effect

NARCIS (Netherlands)

Bergstra, J.A.

2011-01-01

An attempt is made to define the concept of execution of an instruction sequence. It is found to be a special case of directly putting into effect of an instruction sequence. Directly putting into effect of an instruction sequences comprises interpretation as well as execution. Directly putting into

Meta-Analysis of Inquiry-Based Instruction Research

Science.gov (United States)

Hasanah, N.; Prasetyo, A. P. B.; Rudyatmi, E.

2017-04-01

Inquiry-based instruction in biology has been the focus of educational research conducted by Unnes biology department students in collaboration with their university supervisors. This study aimed to describe the methodological aspects, inquiry teaching methods critically, and to analyse the results claims, of the selected four student research reports, grounded in inquiry, based on the database of Unnes biology department 2014. Four experimental quantitative research of 16 were selected as research objects by purposive sampling technique. Data collected through documentation study was qualitatively analysed regarding methods used, quality of inquiry syntax, and finding claims. Findings showed that the student research was still the lack of relevant aspects of research methodology, namely in appropriate sampling procedures, limited validity tests of all research instruments, and the limited parametric statistic (t-test) not supported previously by data normality tests. Their consistent inquiry syntax supported the four mini-thesis claims that inquiry-based teaching influenced their dependent variables significantly. In other words, the findings indicated that positive claims of the research results were not fully supported by good research methods, and well-defined inquiry procedures implementation.

Effect of waveforms of inspired gas tension on the respiratory oscillations of carotid body discharge.

Science.gov (United States)

Kumar, P; Nye, P C; Torrance, R W

1991-07-01

The responses of carotid body chemoreceptor discharge to repeated ramps (20- to 60-s forcing cycle durations) of inspired gas tensions were studied in spontaneously breathing and in artificially ventilated pentobarbitone-anesthetized cats. In all animals the mean intensity of chemoreceptor discharge followed the frequency of the forcing cycle, and superimposed on this were oscillations at the frequency of ventilation (breath-by-breath oscillations). The amplitude of the breath-by-breath oscillations in discharge was often large, and it waxed and waned with the forcing cycle. It was greatest when the mean level of discharge was falling and smallest near the peak of mean discharge. No qualitative differences were observed between PO2-alone forcing in constant normocapnia and PCO2-alone forcing in constant hypoxia. The variation in the amplitudes of breath-by-breath oscillations was shown to be due primarily to variations in the amplitudes of the downslope component of the discharge oscillation. Variations in the upslope component of individual oscillations were small. The factors responsible for the breath-by-breath oscillations are discussed, and it is concluded that the shape of the waveform of arterial gas tensions that stimulate the peripheral chemoreceptors departs markedly from that of a line joining end-tidal gas tensions. This causes breath-by-breath oscillations of discharge to be very large after an "off" stimulus. Reflex studies involving the forcing of respiratory gases should therefore include consideration of these effects.

Understanding discharge communication behaviours in a pediatric emergency care context: a mixed methods observation study protocol.

Science.gov (United States)

Curran, Janet A; Bishop, Andrea; Plint, Amy; MacPhee, Shannon; Zemek, Roger; Chorney, Jill; Jabbour, Mona; Porter, Stephen; Sawyer, Scott

2017-04-17

One of the most important transitions in the continuum of care for children is discharge to home. Optimal discharge communication between healthcare providers and caregivers (e.g., parents or other guardians) who present to the emergency department (ED) with their children is not well understood. The lack of policies and considerable variation in practice regarding discharge communication in pediatric EDs pose a quality and safety risk for children and their parents. The aim of this mixed methods study is to better understand the process and structure of discharge communication in a pediatric ED context to contribute to the design and development of discharge communication interventions. We will use surveys, administrative data and real-time video observation to characterize discharge communication for six common illness presentations in a pediatric ED: (1) asthma, (2) bronchiolitis, (3) abdominal pain, (4) fever, (5) diarrhea and vomiting, and (6) minor head injury. Participants will be recruited from one of two urban pediatric EDs in Canada. Video recordings will be analyzed using Observer XT. We will use logistic regression to identify potential demographic and visit characteristic cofounders and multivariate logistic regression to examine association between verbal and non-verbal behaviours and parent recall and comprehension. Video recording of discharge communication will provide an opportunity to capture important data such as temporality, sequence and non-verbal behaviours that might influence the communication process. Given the importance of better characterizing discharge communication to identify potential barriers and enablers, we anticipate that the findings from this study will contribute to the development of more effective discharge communication policies and interventions.

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

Science.gov (United States)

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

2013-01-01

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

The changes and factors associated with post-discharge self-care behaviors among Chinese patients with heart failure

Directory of Open Access Journals (Sweden)

Hu XL

2015-11-01

Full Text Available Xiaolin Hu,1 Xiuying Hu,1 Yonglin Su,2 Moying Qu,3 Mary A Dolansky41Department of Nursing, 2Department of Rehabilitation Medicine, 3Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China; 4Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USABackground: Self-care behavior is essential for achieving good outcomes among patients with heart failure. Understanding the factors associated with self-care over time is important for the provision of appropriate and targeted interventions. However, little is known regarding the changes and factors associated with post-discharge self-care behaviors among Chinese patients with heart failure.Objective: To investigate the changes and factors of self-care behaviors during the first 3 months following discharge among patients with heart failure in the People’s Republic of China.Methods: A descriptive design with a convenience sample was utilized in this study. Patients (N=128 from two hospitals, West China Hospital and Angjin Hospital, in Chengdu, People’s Republic of China, were recruited from June 2013 to June 2014. The instruments used in the study included the following: the Social Support Rating Scale, the Hospital Anxiety and Depression Scale, the Self-Efficacy for Managing Chronic Disease 6-Item Scale, and the European Heart Failure Self-Care Behaviour Scale. Multivariate linear regression analyses were used to identify the factors related to self-care behaviors at baseline, 1 month, and 3 months following discharge.Results: Patients’ self-care behaviors were poor and decreased significantly over time (F=4.09, P<0.05. The factors associated with self-care behaviors at baseline included the following: education level, comorbidities, and social support. The factors related to self-care behaviors at 1 and 3 months following discharge included the following: education level, comorbidities, social

Molar Pregnancy in the Emergency Department

Directory of Open Access Journals (Sweden)

Masterson, Lori

2009-11-01

Full Text Available A 15-year-old female presented to the emergency department with complaints of vaginal bleeding. She was pale, anxious, cool and clammy with tachycardic, thready peripheral pulses and hemoglobin of 2.4g/dL. Her abdomen was gravid appearing, approximately early to mid-second trimester in size. Pelvic examination revealed 2 cm open cervical os with spontaneous discharge of blood, clots and a copious amount of champagne-colored grapelike spongy material. After 2L boluses of normal saline and two units of crossmatched blood, patient was transported to the operating room. Surgical pathology confirmed a complete hydatidiform mole.[West J Emerg Med. 2009;10(4:295-296.

[The effect of dental health instruction before treatment on anxiety of patients with acute pulpitis].

Science.gov (United States)

Tang, Yu; Du, Rong

2015-08-01

To evaluate the effect of dental health instruction before treatment on dental anxiety of patients with acute pulpitis. One hundred and fifty-four patients with acute pulpitis treated in our department from July 2011 to June 2013, and aged from 19 years to 64 years, were selected. They were randomly divided into experimental group and control group. Seventy-eight patients of the experimental group accepted dental health instruction before treatment, while 76 cases in the control group received regular treatment. Two questionaires of dental anxiety were proceeded to both groups respectively before treatment. The data was analyzed for Student's t test and Chi-square test using SPSS12.0 software package. Dental anxiety (DA) points of the experimental group after dental health instruction were significantly lower than that before treatment (t=4.1346, Ppulpitis before treatment are helpful to reduce the pressure and relieve the anxiety during the treatment, so that the patients will complete the first and the following treatment successfully.

Students’ Aesthetics Experience, Creative Self-Efficacy and Creativity: Is Creativity Instruction Effective?

OpenAIRE

Yuan-Cheng Chang; Chia-Chun Hsiao

2016-01-01

Based on creativity component theory, creativity system theory and creative self-efficacy theory, this study aims to explore the influence of college students’ aesthetics experience and creative self-efficacy on their creativity and the role of creativity instruction as a mediator variable. The participants were 338 college design majors in 50 teams who were working on their graduation exhibitions, and 50 advising professors from departments related to design. Hierarchical Linear Models were ...

Application of an antenna excited high pressure microwave discharge to compact discharge lamps

International Nuclear Information System (INIS)

Kando, M; Fukaya, T; Ohishi, Y; Mizojiri, T; Morimoto, Y; Shido, M; Serita, T

2008-01-01

A novel type of high pressure microwave discharge has been investigated to feed the microwave power at the centre of the compact high pressure discharge lamps using the antenna effect. This method of microwave discharge is named as the antenna excited microwave discharge (AEMD). The 2.45 GHz microwave of around 50 W from the solid state microwave generator can sustain a stable plasma column in the small gap between a couple of antennas fitted on the compact lamp filled with discharge gases at a pressure higher than atmosphere. The AEMD has been applied to a compact metal halide lamp and an extremely high pressure mercury discharge lamp. As a result, the metal halide lamp showed high luminous efficacy of around 130 lm W -1 . The excellent lamp properties obtained here can be explained by the low heating loss at the antennas and the lamp wall. The profiles of the microwave electric field in the lamp and the microwave launcher have been numerically calculated to consider the microwave power supply into the lamp

Very Long Instruction Word Processors

Indian Academy of Sciences (India)

Explicitly Parallel Instruction Computing (EPIC) is an instruction processing paradigm that has been in the spot- light due to its adoption by the next generation of Intel. Processors starting with the IA-64. The EPIC processing paradigm is an evolution of the Very Long Instruction. Word (VLIW) paradigm. This article gives an ...

The Measurement of Instructional Accomplishments.

Science.gov (United States)

Fraley, Lawrence E.; Vargas, Ernest A.

Instructional System Technology in recent years has been characterized by an increase in individualized instruction and the modularization of the curriculum. In traditional systems the learners are forced to take blocks of instruction the size of entire courses and these are much too large. The courses can now be broken down into conceptual…

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

Science.gov (United States)

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

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

The Effect of the Instructional Media Based on Lecture Video and Slide Synchronization System on Statistics Learning Achievement

Directory of Open Access Journals (Sweden)

Partha Sindu I Gede

2018-01-01

Full Text Available The purpose of this study was to determine the effect of the use of the instructional media based on lecture video and slide synchronization system on Statistics learning achievement of the students of PTI department . The benefit of this research is to help lecturers in the instructional process i to improve student's learning achievements that lead to better students’ learning outcomes. Students can use instructional media which is created from the lecture video and slide synchronization system to support more interactive self-learning activities. Students can conduct learning activities more efficiently and conductively because synchronized lecture video and slide can assist students in the learning process. The population of this research was all students of semester VI (six majoring in Informatics Engineering Education. The sample of the research was the students of class VI B and VI D of the academic year 2016/2017. The type of research used in this study was quasi-experiment. The research design used was post test only with non equivalent control group design. The result of this research concluded that there was a significant influence in the application of learning media based on lectures video and slide synchronization system on statistics learning result on PTI department.

Interactive Instruction in Bayesian Inference

DEFF Research Database (Denmark)

Khan, Azam; Breslav, Simon; Hornbæk, Kasper

2018-01-01

An instructional approach is presented to improve human performance in solving Bayesian inference problems. Starting from the original text of the classic Mammography Problem, the textual expression is modified and visualizations are added according to Mayer’s principles of instruction. These pri......An instructional approach is presented to improve human performance in solving Bayesian inference problems. Starting from the original text of the classic Mammography Problem, the textual expression is modified and visualizations are added according to Mayer’s principles of instruction....... These principles concern coherence, personalization, signaling, segmenting, multimedia, spatial contiguity, and pretraining. Principles of self-explanation and interactivity are also applied. Four experiments on the Mammography Problem showed that these principles help participants answer the questions...... that an instructional approach to improving human performance in Bayesian inference is a promising direction....

Instructional skills evaluation in nuclear industry training

International Nuclear Information System (INIS)

Mazour, T.J.; Ball, F.M.

1985-11-01

This report provides information to nuclear power plant training managers and their staffs concerning the job performance requirements of instructional personnel to implement prformance-based training programs (also referred to as the Systems Approach Training). The information presented in this report is a compilation of information and lessons learned in the nuclear power industry and in other industries using performance-based training programs. The job performance requirements in this report are presented as instructional skills objectives. The process used to develop the instructional skills objectives is described. Each objective includes an Instructional Skills Statement describing the behavior that is expected and an Instructional Skills Standard describing the skills/knowledge that the individual should possess in order to have achieved mastery. The instructional skills objectives are organized according to the essential elements of the Systems Approach to Training and are cross-referenced to three categories of instructional personnel: developers of instruction, instructors, and instructional managers/supervisors. Use of the instructional skills objectives is demonstrated for reviewing instructional staff training and qualification programs, developing criterion-tests, and reviewing the performance and work products of individual staff members. 22 refs

Current Trends in Discharge Disposition and Post-discharge Care After Total Joint Arthroplasty.

Science.gov (United States)

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.

The Implementation of a Cost Effectiveness Analyzer for Web-Supported Academic Instruction: An Example from Life Science

Science.gov (United States)

Cohen, Anat; Nachmias, Rafi

2012-01-01

This paper describes implementation of a quantitative cost effectiveness analyzer for Web-supported academic instruction that was developed in our University. The paper presents the cost effectiveness analysis of one academic exemplary course in Life Science department and its introducing to the course lecturer for evaluation. The benefits and…

Effectiveness of Analogy Instructional Strategy on Undergraduate Student's Acquisition of Organic Chemistry Concepts in Mutah University, Jordan

Science.gov (United States)

Samara, Nawaf Ahmad Hasan

2016-01-01

This study aimed at investigating the effectiveness of analogy instructional strategy on undergraduate students' acquisition of organic chemistry concepts in Mutah University, Jordan. A quasi-experimental design was used in the study; Participants were 97 students who enrolled in organic chemistry course at the department of chemistry during the…

The Impact of Explicit Instruction and Metalinguistic Awareness on Crosslinguistic Interference: Path Framing in Motion Events

Directory of Open Access Journals (Sweden)

Abdurrahaman KİLİMCİ

2017-10-01

Full Text Available The study aimed to investigate the influence of the cross-linguistic variation on the construction of boundarycrossing motion events in the translation production of the Turkish speakers of L2 English and to measure the impact of explicit instruction and metalinguistic awareness on the learners’ understanding of typological differences and hence their development of L2 ways of expressing motion events. To this aim, the study followed a pre-test post-test quasi-experimental research design, involving a treatment and a control group. A total of 46 second-year university students participated in the study. They were all majoring in English at the English Language Teaching Department, at a state university in Turkey. The control (18 females and 5 males and the treatment group (14 females and 9 males received a two-week instructional treatment, the first group receiving an implicit instruction, and the second an explicit instruction of the boundary-crossing motion event constructions. Prior to the instructional intervention, a pre-test was administered to the participants. Mann-Whitney U test run on the mean scores obtained from the pre-tests indicated no significant differences between the control and the treatment group, U = 282.5, z = .416, p = .678. Within-group analysis based on post-test results after the termination of the instructional treatment revealed that while the implicit instruction had no effect on learners’ acquisition of motion events, z = 1.842, p = .066., the explicit instruction had a significant effect on L1 Turkish learners’ development of their knowledge of L2-like English patterns in construing motion events. Similarly, between-group analysis revealed that the treatment group (Mdn = 4.00, who received an explicit instruction significantly outperformed the control group (Mdn = 2.00, who received implicit instruction, U = 410.5, z = 3.257, p = .001. The study concluded with the implications of findings for English

Waste Generator Instructions: Key to Successful Implementation of the US DOE's 435.1 for Transuranic Waste Packaging Instructions (LA-UR-12-24155) - 13218

Energy Technology Data Exchange (ETDEWEB)

French, David M. [LANL EES-12, Carlsbad, NM, Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545 (United States); Hayes, Timothy A. [LANL EES-12, Carlsbad, NM, Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545 (United States); Pope, Howard L. [Aspen Resources Ltd., Inc., P.O. Box 3038, Boulder, CO 80307 (United States); Enriquez, Alejandro E. [LANL NCO-4, Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545 (United States); Carson, Peter H. [LANL NPI-7, Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM 87545 (United States)

2013-07-01

In times of continuing fiscal constraints, a management and operation tool that is straightforward to implement, works as advertised, and virtually ensures compliant waste packaging should be carefully considered and employed wherever practicable. In the near future, the Department of Energy (DOE) will issue the first major update to DOE Order 435.1, Radioactive Waste Management. This update will contain a requirement for sites that do not have a Waste Isolation Pilot Plant (WIPP) waste certification program to use two newly developed technical standards: Contact-Handled Defense Transuranic Waste Packaging Instructions and Remote-Handled Defense Transuranic Waste Packaging Instructions. The technical standards are being developed from the DOE O 435.1 Notice, Contact-Handled and Remote-Handled Transuranic Waste Packaging, approved August 2011. The packaging instructions will provide detailed information and instruction for packaging almost every conceivable type of transuranic (TRU) waste for disposal at WIPP. While providing specificity, the packaging instructions leave to each site's own discretion the actual mechanics of how those Instructions will be functionally implemented at the floor level. While the Technical Standards are designed to provide precise information for compliant packaging, the density of the information in the packaging instructions necessitates a type of Rosetta Stone that translates the requirements into concise, clear, easy to use and operationally practical recipes that are waste stream and facility specific for use by both first line management and hands-on operations personnel. The Waste Generator Instructions provide the operator with step-by-step instructions that will integrate the sites' various operational requirements (e.g., health and safety limits, radiological limits or dose limits) and result in a WIPP certifiable waste and package that can be transported to and emplaced at WIPP. These little known but widely

Comparing Two Modes of Instruction in English Passive Structures (Processing and Meaning-Based Output Instruction

Directory of Open Access Journals (Sweden)

Asma Dabiri

2018-04-01

Full Text Available This research compared the effects of two types of instruction: Processing Instruction (PI and Meaning-based Output Instruction (MOI on the interpretation and production of English passive structures.  Ninety EFL intermediate tertiary level female students (PI group= 30, MOI group= 30 and control group = 30 participated in this study. The instruments were a proficiency test, a test to assess English passive structures and two instructional materials (PI and MOI. The data were analyzed by running one-way analysis of variance (ANOVA and mixed between-within ANOVA. The study indicated the effectiveness of PI and MOI on English passive structures. PI had considerable enhancement on interpretation tasks all the time. It supported the use of PI rather than the use of traditional instructions in which mechanical components were emphasized. Also, the PI and MOI had long term effects on the interpretation and production of English passive sentences.  This study supported the use of PI and MOI rather than the use of traditional instruction (TI in EFL settings. The implication for particularly classroom teaching is that successful grammar instruction has to related to ultimate learning outcomes. Also, creating communicative tasks to offer opportunities for teaching grammar can lead to long-lasting learning effects.

New discharge tube with virtual cathode

International Nuclear Information System (INIS)

Seidelmann, L.; Aubrecht, L.

2003-01-01

Till this time known methods of the excitation of the discharge between electrodes are using either secondary or thermo emission of electrons by the cathode. Usually we speak about the self-maintained discharge. Lifetime of the cathode, that is shortened by the emission, limits in principle, the lifetime of the whole discharge tube. The discharge can, according to the present state of the art, be induced also by the inductive way. Arrangement for excitation of such discharge is rather expensive. The construction of the inductive excited discharge tube is considerably influenced by the necessity of the limitation of the losses in excitation magnetic circuits. Especially length of the discharge and pressure of the working gas are limited by the economic standpoints. Function of the discharge is always connected with unwanted electromagnetic radiation, whose restraint is expensive and represents limiting factor for arrangement of the discharge tube (Authors)

Editorial - Instructions

DEFF Research Database (Denmark)

Kastberg, Peter; Grinsted, Annelise

2007-01-01

Why you may wonder - have we chosen a topic which at first glance may seem trivial, and even a bit dull? Well, looks can be deceiving, and in this case they are! There are many good reasons for taking a closer look at instructions.......Why you may wonder - have we chosen a topic which at first glance may seem trivial, and even a bit dull? Well, looks can be deceiving, and in this case they are! There are many good reasons for taking a closer look at instructions....

Teaching about teaching and instruction on instruction: a challenge for health sciences library education.

Science.gov (United States)

Detlefsen, Ellen Gay

2012-10-01

This is a review of the master's-level curricula of the fifty-eight America Library Association-accredited library and information science programs and iSchools for evidence of coursework and content related to library instruction. Special emphasis is placed on the schools and programs that also offer coursework in medical or health sciences librarianship. Fifty-eight school and program websites were reviewed. Course titles and course descriptions for seventy-three separate classes were analyzed. Twenty-three syllabi were examined. All North American library education programs offer at least one course in the general area of library instruction; some programs offer multiple courses. No courses on instruction, however, are focused directly on the specialized area of health sciences librarianship. Master's degree students can take appropriate classes on library instruction, but the medical library profession needs to offer continuing education opportunities for practitioners who want to have specific instruction for the specialized world of the health sciences.

Computer Assisted Instructional Design for Computer-Based Instruction. Final Report. Working Papers.

Science.gov (United States)

Russell, Daniel M.; Pirolli, Peter

Recent advances in artificial intelligence and the cognitive sciences have made it possible to develop successful intelligent computer-aided instructional systems for technical and scientific training. In addition, computer-aided design (CAD) environments that support the rapid development of such computer-based instruction have also been recently…

Universal Design for Instruction: Extending the Universal Design Paradigm to College Instruction

Science.gov (United States)

McGuire, Joan M.; Scott, Sally S.

2006-01-01

Universal design for instruction (UDI) represents the systematic application of universal design, the construct from architecture and product development, to instructional practices in higher education. In addition to a description of the deliberative process by which UDI was developed, this article provides confirmatory evidence of the validity…

A Systematic Review of Interventions to Follow-Up Test Results Pending at Discharge.

Science.gov (United States)

Darragh, Patrick J; Bodley, T; Orchanian-Cheff, A; Shojania, K G; Kwan, J L; Cram, P

2018-05-01

Patients are frequently discharged from the hospital before all test results have been finalized. Thirty to 40% of tests pending at discharge (TPADs) return potentially actionable results that could necessitate change in the patients' management, often unbeknownst to their physicians. Delayed follow-up of TPADs can lead to patient harm. We sought to synthesize the existing literature on interventions intended to improve the management of TPADs, including interventions designed to enhance documentation of TPADs, increase physician awareness when TPAD results finalize post-discharge, decrease adverse events related to missed TPADs, and increase physician satisfaction with TPAD management. We searched Medline, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Database of Controlled Clinical Trials and Medline (January 1, 2000-November 10, 2016) for randomized controlled trials and prospective, controlled observational studies that evaluated interventions to improve follow-up of TPADs for adult patients discharged from acute care hospitals or emergency department settings. From each study we extracted characteristics of the intervention being evaluated and its impact on TPAD management. Nine studies met the criteria for inclusion. Six studies evaluated electronic discharge summary templates with a designated field for documenting TPADs, and three of six of these studies reported a significant improvement in documentation of TPADs in discharge summaries in pre- and post-intervention analysis. One study reported that auditing discharge summaries and providing feedback to physicians were associated with improved TPAD documentation in discharge summaries. Two studies found that email alerts when TPADs were finalized improved physicians' awareness of the results and documentation of their follow-up actions. Of the four studies that assessed patient morbidity, two showed a positive effect; however, none specifically measured the impact of their interventions

TRUPACT-II Operating and Maintenance Instructions

Energy Technology Data Exchange (ETDEWEB)

Westinghouse Electric Corporation, Waste Isolation Division

1999-12-31

The purpose of this document is to provide the technical requirements for preparation for use, operation, inspection, and maintenance of a Transuranic Package Transporter Model II (TRUPACT-II) Shipping Package and directly related components. This document complies with the minimum requirements as specified in the TRUPACT-II Safety Analysis Report for Packaging (SARP) and Nuclear Regulatory Commission (NRC) Certificate of Compliance (C of C) 9218. In the event there is a conflict between this document and the TRUPACT-II SARP, the TRUPACT-II SARP shall govern. TRUPACT-II C of C number 9218 states, ''... each package must be prepared for shipment and operated in accordance with the procedures described in Chapter 7.0, Operating Procedures, of the application.'' It further states, ''... each package must be tested and maintained in accordance with the procedures described in Chapter 8.0, Acceptance Tests and Maintenance Program of the application.'' Chapter 9 of the TRUPACT-II SARP charges the Westinghouse Electric Corporation Waste Isolation Division (WID) with assuring that the TRUPACT-II is used in accordance with the requirements of the C of C. To meet this requirement and verify consistency of operations when loading and unloading the TRUPACT-II on the trailer, placing a payload in the packaging, unloading the payload from the packaging, or performing maintenance, the U.S. Department of Energy Carlsbad Area Office (U.S. DOE/CAO) finds it necessary to implement the changes that follow. This TRUPACT-II maintenance document represents a change to previous philosophy regarding site specific procedures for the use of the TRUPACT-II. This document details the instructions to be followed to consistently operate and maintain the TRUPACT-II. The intent of these instructions is to ensure that all users of the TRUPACT-II follow the same or equivalent instructions. Users may achieve this intent by any of the following methods: (1

Heart bypass surgery - minimally invasive - discharge

Science.gov (United States)

... invasive direct coronary artery bypass - discharge; MIDCAB - discharge; Robot assisted coronary artery bypass - discharge; RACAB - discharge; Keyhole ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

Annual report on radioactive discharges from Winfrith and monitoring the environment 1990

International Nuclear Information System (INIS)

1991-06-01

This annual report, the sixth of its type, aims to provide full information on discharges and environmental monitoring. The report is mainly graphical, comparing past and current levels with authorised limits, derived limits or the recommended limits of the International Commission on Radiological Protection (ICRP). All the data are presented at the end of the report in tabular form. Discharges from Winfrith are subject to Authorisations issued jointly by the Department of the Environment (DOE) and the Ministry of Agriculture, Fisheries and Food (MAFF). The numerical values of the Authorised Limits are based on past performance, future requirements and the application of Best Practicable Means (BPM). As a ''back stop'', discharges at the limits must not result in doses to the most potentially exposed part of the local population - the critical group - exceeding 0.5 mSv per year. The limit recommended by the International Commission on Radiological Protection (ICRP) for dose to a member of the general public is 1.0 mSv per year. In September 1990 Winfrith's Steam Generating Heavy Water Reactor (SGHWR) was shut down and a decision taken, later, that reactor operation would cease. The pattern of discharges thus changed in the last quarter of the year and discharges in future will be lower, and of a different pattern, than those of the past twenty years. The dose to the critical group, which is already less than 2% of the ICRP limit and less than 1% of the UK average natural background dose will drop further in future years. (Author)

Discharge lamp technologies

Science.gov (United States)

Dakin, James

1994-01-01

This talk is an overview of discharge lamp technology commonly employed in general lighting, with emphasis on issues pertinent to lighting for plant growth. Since the audience is primarily from the plant growth community, and this begins the light source part of the program, we will start with a brief description of the discharge lamps. Challenges of economics and of thermal management make lamp efficiency a prime concern in controlled environment agriculture, so we will emphasize science considerations relating to discharge lamp efficiency. We will then look at the spectra and ratings of some representative lighting products, and conclude with a discussion of technological advances.

Career development resource: educational leadership in a department of surgery: vice chairs for education.

Science.gov (United States)

Sanfey, Hilary; Boehler, Margaret; DaRosa, Debra; Dunnington, Gary L

2012-07-01

The growing appreciation of the need to adopt an evidence-based approach to teaching and assessment has led to a demand for faculty who are well versed in best practices in education. Surgeons with interest and expertise in instruction, curriculum development, educational research, and evaluation can have an important impact on the educational mission of a department of surgery. The increased fervor for accountability in education together with the challenges imposed by accreditation agencies and hospitals has made educational leadership responsibilities more time consuming and complex. In response to this, an increasing number of department chairs created Vice Chair for Education positions to support clerkship and program directors and ensure the department's education mission statement is fulfilled. Copyright © 2012 Elsevier Inc. All rights reserved.

ARS-Media for excel instruction manual

Science.gov (United States)

ARS-Media for Excel Instruction Manual is the instruction manual that explains how to use the Excel spreadsheet ARS-Media for Excel application. ARS-Media for Excel Instruction Manual is provided as a pdf file....

Vaginal Discharge: What's Normal, What's Not

Science.gov (United States)

... Staying Safe Videos for Educators Search English Español Vaginal Discharge: What's Normal, What's Not KidsHealth / For Teens / ... Discharge: What's Normal, What's Not Print What Is Vaginal Discharge? Vaginal discharge is fluid that comes from ...

A comparison of video modeling, text-based instruction, and no instruction for creating multiple baseline graphs in Microsoft Excel.

Science.gov (United States)

Tyner, Bryan C; Fienup, Daniel M

2015-09-01

Graphing is socially significant for behavior analysts; however, graphing can be difficult to learn. Video modeling (VM) may be a useful instructional method but lacks evidence for effective teaching of computer skills. A between-groups design compared the effects of VM, text-based instruction, and no instruction on graphing performance. Participants who used VM constructed graphs significantly faster and with fewer errors than those who used text-based instruction or no instruction. Implications for instruction are discussed. © Society for the Experimental Analysis of Behavior.

Galactography in non-lactating nipple discharge

Energy Technology Data Exchange (ETDEWEB)

Suh, Myung Ok; Lee, Joo Mi; Moon, Jang Ho; Kang, Ik Won; Chung, Soo Young; Bae, Sang Hoon; Park, Soo Sung [Hallym University College of Medicine, Seoul (Korea, Republic of)

1988-08-15

Nipple discharge in non-lactating breast is classified as 2 groups. The first group is stagnation discharge which is determined by an apocrino-like exfoliation and stagnation within the ductal system. The second group is hyperplastic or neoplastic group. The secretory breast disease combined with nipple discharge can not be diagnosed by simple X-ray mammography of ultrasonography. For differential diagnosis of secretory breast disease and for localization of lesions, the galactography is necessary. We analysed 49 cases of galactography is non-lactating breat and obtained following results. 1. The most common cause of discharge was duct ectasis (39%) in stagnation discharge group and papilloma (23%) in hyperplastic discharge group. 2. Hyperplastic discharge group occurred most frequently in 5th decade of age and was discovered more frequently in fatty parenchymal pattern on simple mammography. 3. The most frequent type of nipple discharge was cloudy-milky type in stagnation group and bloody nature in hyperplastic group. 4. The most common cause of bloody discharge was papilloma (58%). 5. The bloody nipple discharge among 56 cases of breast cancer during 4 years occurred only in 5 cases (9%)

Taser X26 discharges in swine: ventricular rhythm capture is dependent on discharge vector.

Science.gov (United States)

Valentino, Daniel J; Walter, Robert J; Dennis, Andrew J; Margeta, Bosko; Starr, Frederic; Nagy, Kimberly K; Bokhari, Faran; Wiley, Dorion E; Joseph, Kimberly T; Roberts, Roxanne R

2008-12-01

Data from our previous studies indicate that Taser X26 stun devices can acutely alter cardiac function in swine. We hypothesized that most transcardiac discharge vectors would capture ventricular rhythm, but that other vectors, not traversing the heart, would fail to capture the ventricular rhythm. Using an Institutional Animal Care and Use Committee (IACUC) approved protocol, four Yorkshire pigs (25-36 kg) were anesthetized, paralyzed with succinylcholine (2 mg/kg), and then exposed to 10 second discharges from a police-issue Taser X26. For most discharges, the barbed darts were pushed manually into the skin to their full depth (12 mm) and were arranged in either transcardiac (such that a straight line connecting the darts would cross the region of the heart) or non-transcardiac vectors. A total of 11 different vectors and 22 discharge conditions were studied. For each vector, by simply rotating the cartridge 180-degrees in the gun, the primary current-emitting dart was changed and the direction of current flow during the discharge was reversed without physically moving the darts. Echocardiography and electrocardiograms (ECGs) were performed before, during, and after all discharges. p values captured immediately in 52.5% (31 of 59) of the discharges on the ventral surface of the animal. In each of these cases, capture of the ventricular rhythm with rapid ventricular contractions consistent with ventricular tachycardia (VT) or flutter was seen throughout the discharge. A total of 27 discharges were administered with transcardiac vectors and ventricular capture occurred in 23 of these discharges (85.2% capture rate). A total of 32 non-transcardiac discharges were administered ventrally and capture was seen in only eight of these (25% capture rate). Ventricular fibrillation (VF) was seen with two vectors, both of which were transcardiac. In the remaining animals, VT occurred postdischarge until sinus rhythm was regained spontaneously. For most transcardiac vectors

Submarine groundwater discharge at Kahana Bay, Oahu, 1997-2001: in situ CTD and water chemistry tracer data (NODC Accession 0011399)

Data.gov (United States)

National Oceanic and Atmospheric Administration, Department of Commerce — Submarine groundwater discharge (SGD) is neither well understood nor commonly investigated in Hawaii, but it is recognized as a potential pollution source to coastal...

Boundary Effect of Planar Glow Dielectric Barrier Discharge and Its Influence on the Discharge Structure

International Nuclear Information System (INIS)

Xu Shaowei; Li Lulu; Ouyang Jiting

2015-01-01

The dielectric barrier discharge (DBD) in the glow regime in neon has been investigated by experiment and two-dimensional (2D) fluid modeling. The discharge was carried out in a planar DBD system with segmented-electrodes driven by square-wave voltage. The results show that the glow DBD originates in the center of the electrode and expands outward to the electrode edge during each half cycle of the voltage, forming a radial structure. The discharge decays firstly in the inner area but sustains longer in the edge area, showing a reversed discharge area. The discharge cannot completely cover the entire electrode surface, but remains a border of non- or weak discharge. The fluid modeling shows a similar result in agreement with the experiments. The simulations indicate that the electric field in the edge area is distorted due to the boundary effect so that the electric field and charge distribution are different from that in the inner part. The distorted field reduces the longitudinal component near the edge and causes the local field to be lower than that in the center, and hence makes the discharge behindhand. It also induces a transverse field that makes the discharge extend radially outward to the edge. The boundary effect plays an important role in the glow DBD structure. (paper)

Medical audit on asthma in an emergency department.

Science.gov (United States)

Linares, T; Campos, A; Torres, M; Reyes, J

2006-01-01

To determine the management of acute bronchial asthma in an adult emergency department. A retrospective medical audit of 46 consecutive adult patients with acute asthma exacerbations was performed. We collected information from 48 episodes of acute asthma over a 5-month period. Using classical audit methodology, four indicators were examined: severity evaluation, diagnostic tests, specific treatment, and discharge treatment plans. The least recorded severity indicators were respiratory rate (27 %), heart rate (50 %) and peak expiratory flow (20 %). Heart and respiratory auscultation were recorded in all patients and oxygen saturation was recorded in 93 %. Laboratory blood test and chest radiograph were performed in all patients. Arterial blood gas was tested in 57 %, electrocardiography in 17 %, and coagulation in 39 %. No treatment was provided in 12 % of patients. Bronchodilator medications were administered in all treated patients and oxygen was prescribed in 60 %. Systemic corticosteroids (methylprednisolone or hydrocortisone) were administered in 80 % of treated patients. Seventeen percent of patients were discharged from hospital with no change to their usual treatment. The following weak points were identified: 1) Severity assessment is inadequate, 2) use of diagnostic tests is excessive, 3) patients discharged to home with no treatment plan. Opportunities for improvement consisted of: 1) greater availability of peak expiratory flow meters, 2) individualized use of diagnostic tests, and 3) management protocols.

Mortality risk factors during readmission at the Department of Medicine.

Science.gov (United States)

Trakulthong, Chayanis; Phunmanee, Anakapong

2017-01-01

Readmission is an indicator of quality of inpatient care. A study from Hong Kong found readmission mortality rate to be 5.1%. There are limited reports on risk factors for mortality other than co-morbid diseases in readmission patients. This study, thus, aims to evaluate risk factors for mortality during readmission. This study was conducted at a university hospital in Thailand. The inclusion criteria were patients aged ≥15 years and readmission to internal medicine wards within 28 days after discharge. The outcome of the study was death during readmission. Risk factors for readmission mortality were analyzed using multivariate logistic regression analysis. There were 10,389 admissions to the Department of Medicine, Khon Kaen University, of which 407 required readmission (3.90%). Of those patients, 75 (18.43%) died during readmission. There were 6 independent factors associated with death in patients who were readmitted, including advanced age (>60 years), presence of more than 2 co-morbid diseases, admission duration of >14 days, fever at previous discharge, low hemoglobin (readmission duration, presence of low hemoglobin at previous discharge, and numbers of procedures at readmission were significantly associated with increased mortality risk for readmission patients.

Numerical study on the discharge characteristics and nonlinear behaviors of atmospheric pressure coaxial electrode dielectric barrier discharges

International Nuclear Information System (INIS)

Zhang Ding-Zong; Wang Yan-Hui; Wang De-Zhen

2017-01-01

The discharge characteristics and temporal nonlinear behaviors of the atmospheric pressure coaxial electrode dielectric barrier discharges are studied by using a one-dimensional fluid model. It is shown that the discharge is always asymmetrical between the positive pulses and negative pulses. The gas gap severely affects this asymmetry. But it is hard to acquire a symmetrical discharge by changing the gas gap. This asymmetry is proportional to the asymmetric extent of electrode structure, namely the ratio of the outer electrode radius to the inner electrode radius. When this ratio is close to unity, a symmetrical discharge can be obtained. With the increase of frequency, the discharge can exhibit a series of nonlinear behaviors such as period-doubling bifurcation, secondary bifurcation and chaotic phenomena. In the period-doubling bifurcation sequence the period- n discharge becomes more and more unstable with the increase of n . The period-doubling bifurcation can also be obtained by altering the discharge gas gap. The mechanisms of two bifurcations are further studied. It is found that the residual quasineutral plasma from the previous discharges and corresponding electric field distribution can weaken the subsequent discharge, and leads to the occurrence of bifurcation. (paper)

The effect of an auxiliary discharge on anode sheath potentials in a transverse discharge

International Nuclear Information System (INIS)

Foster, J.E.; Gallimore, A.D.

1997-01-01

A novel scheme that employs the use of an auxiliary discharge has been shown to reduce markedly anode sheath potentials in a transverse discharge. An 8.8 A low-pressure argon discharge in the presence of a transverse magnetic field was used as the plasma source in this study. In such discharges, the transverse flux that is collected by the anode is severely limited due to marked reductions in the transverse diffusion coefficient. Findings of this study indicate that the local electron number density and the transverse flux increase when the auxiliary discharge is operated. Changes in these parameters are reflected in the measured anode sheath voltage. Anode sheath potentials, estimated by using Langmuir probes, were shown to be reduced by over 33% when the auxiliary discharge is operated. These reductions in anode sheath potentials translated into significant reductions in anode power flux as measured using water calorimeter techniques. The reductions in anode power flux also correlate well with changes in the electron transverse flux. Finally, techniques implementing these positive effects in real plasma accelerators are discussed. copyright 1997 American Institute of Physics

Exploring the Amount and Type of Writing Instruction during Language Arts Instruction in Kindergarten Classrooms

Science.gov (United States)

Puranik, Cynthia S.; Al Otaiba, Stephanie; Sidler, Jessica Folsom; Greulich, Luana

2014-01-01

The objective of this exploratory investigation was to examine the nature of writing instruction in kindergarten classrooms and to describe student writing outcomes at the end of the school year. Participants for this study included 21 teachers and 238 kindergarten children from nine schools. Classroom teachers were videotaped once each in the fall and winter during the 90 minute instructional block for reading and language arts to examine time allocation and the types of writing instructional practices taking place in the kindergarten classrooms. Classroom observation of writing was divided into student-practice variables (activities in which students were observed practicing writing or writing independently) and teacher-instruction variables (activities in which the teacher was observed providing direct writing instruction). In addition, participants completed handwriting fluency, spelling, and writing tasks. Large variability was observed in the amount of writing instruction occurring in the classroom, the amount of time kindergarten teachers spent on writing and in the amount of time students spent writing. Marked variability was also observed in classroom practices both within and across schools and this fact was reflected in the large variability noted in kindergartners’ writing performance. PMID:24578591

Exploring the Amount and Type of Writing Instruction during Language Arts Instruction in Kindergarten Classrooms.

Science.gov (United States)

Puranik, Cynthia S; Al Otaiba, Stephanie; Sidler, Jessica Folsom; Greulich, Luana

2014-02-01

The objective of this exploratory investigation was to examine the nature of writing instruction in kindergarten classrooms and to describe student writing outcomes at the end of the school year. Participants for this study included 21 teachers and 238 kindergarten children from nine schools. Classroom teachers were videotaped once each in the fall and winter during the 90 minute instructional block for reading and language arts to examine time allocation and the types of writing instructional practices taking place in the kindergarten classrooms. Classroom observation of writing was divided into student-practice variables (activities in which students were observed practicing writing or writing independently) and teacher-instruction variables (activities in which the teacher was observed providing direct writing instruction). In addition, participants completed handwriting fluency, spelling, and writing tasks. Large variability was observed in the amount of writing instruction occurring in the classroom, the amount of time kindergarten teachers spent on writing and in the amount of time students spent writing. Marked variability was also observed in classroom practices both within and across schools and this fact was reflected in the large variability noted in kindergartners' writing performance.

Gas-discharge sources with charged particle emission from the plasma of glow discharge with a hollow cathode

CERN Document Server

Semenov, A P

2001-01-01

One studied properties of a magnetron discharge with a cold hollow and uncooled rod cathodes. One demonstrated the dominant effect of thermoelectron emission of a rod cathode heated in a discharge on characteristics of discharge and on emission properties of a gas-discharge plasma and the possibility pf a smooth transition of glow discharge to diffusion mode of arc discharge combustion. Paper describes sources of ions and electrons with improved physical and generalized design and engineering parameters. One shows the promise of the electrode structure of a hollow cathode magnetron discharge to be used as a source, in particular, of the atomic hydrogen and of atom flow of a working rod cathode

Discharge cleaning for a tokamak

International Nuclear Information System (INIS)

Ishii, Shigeyuki

1983-01-01

Various methods of discharge cleaning for tokamaks are described. The material of the first walls of tokamaks is usually stainless steel, inconel, titanium and so on. Hydrogen is exclusively used as the discharge gas. Glow discharge cleaning (GDC), Taylor discharge cleaning (TDC), and electron cyclotron resonance discharge cleaning (ECR-DC) are discussed in this paper. The cleaning by GDC is made by moving a movable anode to the center of a tokamak vassel. Taylor found the good cleaning effect of induced discharge by high pressure and low power discharge. This is called TDC. When the frequency of high frequency discharge in a magnetic field is equal to that of the electron cyclotron resonance, the break down potential is lowered if the pressure is sufficiently low. The ECR-CD is made by using this effect. In TDC and ECR-DC, the electron temperature, which has a close relation to the production rate of H 0 , can be controlled by the pressure. In GDC, the operating pressure was improved by the radio frequency glow (RG) method. However, there is still the danger of arcing. In case of GDC and ECR-DC, the position of plasma can be controlled, but not in case of TDC. The TDC is accepted by most of takamak devices in the world. (Kato, T.)

An Instructional Design Model for Developing a Computer Curriculum To Increase Employee Productivity in a Pharmaceutical Company.

Science.gov (United States)

Stumpf, Mark R.

This report presents an instructional design model that was developed for use by the End-Users Computing department of a large pharmaceutical company in developing effective--but not lengthy--microcomputer training seminars to train office workers and executives in the proper use of computers and thus increase their productivity. The 14 steps of…

Technology Use in Higher Education Instruction

Science.gov (United States)

Elzarka, Sammy

2012-01-01

The significance of integrating technology use in higher education instruction is undeniable. The benefits include those related to access to instruction by underserved populations, adequately preparing students for future careers, capitalizing on best instructional practices, developing higher order thinking activities, and engaging students…

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

Science.gov (United States)

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

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

Fashions in Instructional Development.

Science.gov (United States)

Knapper, Christopher K.

This paper on instructional development notes the trend toward teaching improvement efforts, classifies instructional development centers in terms of their differing philosophies of operation, and identifies some general problems that have been encountered in institutional efforts to improve teaching and learning. Centers in North America, Europe,…

Filamentary and diffuse barrier discharges

International Nuclear Information System (INIS)

Kogelschatz, U.

2001-01-01

Barrier discharges, sometimes also referred to as dielectric-barrier discharges or silent discharges, are characterized by the presence of at least one insulating layer in contact with the discharge between two planar or cylindrical electrodes connected to an ac power supply. The main advantage of this type of electrical discharge is, that non-equilibrium plasma conditions in atmospheric-pressure gases can be established in an economic and reliable way. This has led to a number of important applications including industrial ozone generation, surface modification of polymers, plasma chemical vapor deposition, excitation of CO 2 lasers, excimer lamps and, most recently, large-area flat plasma display panels. Depending on the application, the width of the discharge gap can range from less than 0.1 mm to about 100 mm and the applied frequency from below line frequency to several gigahertz. Typical materials used for the insulating layer (dielectric barrier) are glass, quartz, ceramics but also thin enamel or polymer layers

Waste water discharges into natural waters

International Nuclear Information System (INIS)

Marri, P.; Barsanti, P.; Mione, A.; Posarelli, M.

1996-12-01

The aqueous discharges into natural waters is a very technical solution expecially for surface buoyant discharges. It is not only convenient to limit the concentration levels of the discharges, but also to improve the turbolent processes that diluite the discharge. Mostly these processes depend by some geometric parameters of the discharge and by some physical parameters of the effluent and of the receiving water body. An appropriate choice of some parameters, using also suitable mathematical models, allows to design discharges with a very high dilution; so the decreasing of the pollutant levels is improved and the environmental impact can be reduced versus a not diluted effluent. The simulations of a mathematical model, here described, prove that in some circumstances, expecially in case of discharges of fresh water into saline water bodies with a low velocity of the current, the dilution is poor; the effluent can be trapped in a narrow water surface layer where the pollutant concentrations remain high. also far away from the discharge point

Chaos in gas discharges

International Nuclear Information System (INIS)

Piel, A.

1993-01-01

Many gas discharges exhibit natural oscillations which undergo a transition from regular to chaotic behavior by changing an experimental parameter or by applying external modulation. Besides several isolated investigations, two classes of discharge phenomena have been studied in more detail: ionization waves in medium pressure discharges and potential relaxation oscillations in filament cathode discharges at very low pressure. The latter phenomenon will be discussed by comparing experimental results from different discharge arrangements with particle-in-cell simulations and with a model based on the van-der-Pol equation. The filament cathode discharge has two stable modes of operation: the low current anode-glow-mode and the high current temperature-limited-mode, which form the hysteresis curve in the I(U) characteristics. Close to the hysteresis point of the AGM periodic relaxation oscillations occur. The authors demonstrate that the AGM can be understood by ion production in the anode layer, stopping of ions by charge exchange, and trapping in the virtual cathode around the filament. The relaxation oscillations consist of a slow filling phase and a rapid phase that invokes formation of an unstable double-layer, current-spiking, and ion depletion from the cathodic plasma. The relaxation oscillations can be mode-locked by external modulation. Inside a mode-locked state, a period doubling cascade is observed at high modulation degree

The effect of discharge chamber geometry on the characteristics of low-pressure RF capacitive discharges

Energy Technology Data Exchange (ETDEWEB)

Lisovskiy, V.A. [Ecole Polytech, Lab Phys and Technol Plasmas, F-91128 Palaiseau, (France); Booth, J.P. [Lam Res Corp, Fremont, CA 94538 (United States); Landry, K. [Unaxis, F-38100 Grenoble, (France); Douai, D. [CEA Cadarache, Dept Rech Fus Controlee, EURATOM Assoc, F-13108 St Paul Les Durance, (France); Cassagne, V. [Riber, F-95873 Bezons, (France); Yegorenkov, V.D. [Kharkov Natl Univ, Dept Phys, UA-61077 Kharkov, (Ukraine)

2007-07-01

We report the measured extinction curves and current voltage characteristics (CVCs) in several gases of RF capacitive discharges excited at 13.56 MHz in chambers of three different geometries: 1) parallel plates surrounded by a dielectric cylinder ('symmetric parallel plate'); 2) parallel plates surrounded by a metallic cylinder ('asymmetric confined'); and 3) parallel plates inside a much larger metallic chamber ('asymmetric unconfined'), similar to the gaseous electronics conference reference cell. The extinction curves and the CVCs show differences between the symmetric, asymmetric confined, and asymmetric unconfined chamber configurations. In particular, the discharges exist over a much broader range of RF voltages and gas pressures for the asymmetric unconfined chamber. For symmetric and asymmetric confined discharges, the extinction curves are close to each other in the regions near the minima and at lower pressure, but at higher pressure, the extinction curve of the asymmetric confined discharge runs at a lower voltage than the one for the discharge in a symmetric chamber. In the particular cases of an 'asymmetric unconfined chamber' discharge or 'asymmetric confined' one, the RF discharge experiences the transition from a 'weak-current' mode to a 'strong-current' one at lower RF voltages than is the case for a 'symmetric parallel-plate' discharge. (authors)

Review of Instructional Approaches in Ethics Education.

Science.gov (United States)

Mulhearn, Tyler J; Steele, Logan M; Watts, Logan L; Medeiros, Kelsey E; Mumford, Michael D; Connelly, Shane

2017-06-01

Increased investment in ethics education has prompted a variety of instructional objectives and frameworks. Yet, no systematic procedure to classify these varying instructional approaches has been attempted. In the present study, a quantitative clustering procedure was conducted to derive a typology of instruction in ethics education. In total, 330 ethics training programs were included in the cluster analysis. The training programs were appraised with respect to four instructional categories including instructional content, processes, delivery methods, and activities. Eight instructional approaches were identified through this clustering procedure, and these instructional approaches showed different levels of effectiveness. Instructional effectiveness was assessed based on one of nine commonly used ethics criteria. With respect to specific training types, Professional Decision Processes Training (d = 0.50) and Field-Specific Compliance Training (d = 0.46) appear to be viable approaches to ethics training based on Cohen's d effect size estimates. By contrast, two commonly used approaches, General Discussion Training (d = 0.31) and Norm Adherence Training (d = 0.37), were found to be considerably less effective. The implications for instruction in ethics training are discussed.

Motorcycle Safety Education Programs: Report of a Survey of State Departments of Education and of Colleges and Universities.

Science.gov (United States)

American Driver and Traffic Safety Education Association, Washington, DC.

A survey of State departments of education and colleges and universities, conducted by the Motorcycle Industry Council Safety and Education Foundation, revealed the need for more teacher education programs, instructional materials, and organized workshops that promote motorcycle safety education. The primary interest indicated by State departments…

Illustrated instructions for mechanical quality assurance of a medical linear accelerator.

Science.gov (United States)

Court, Laurence; Wang, He; Aten, David; Brown, Derek; MacGregor, Hannelie; du Toit, Monique; Chi, Melinda; Gao, Song; Yock, Adam; Aristophanous, Michalis; Balter, Peter

2018-03-03

The purpose of this study was to develop and test a set of illustrated instructions for effective training for mechanical quality assurance (QA) of medical linear accelerators (linac). Illustrated instructions were created for mechanical QA and underwent several steps of review, testing, and refinement. Eleven testers with no recent QA experience were then recruited from our radiotherapy department (one student, two computational scientists, and eight dosimetrists). This group was selected because they have experience of radiation therapy but no preconceived ideas about how to do QA. The following parameters were progressively decalibrated on a Varian C-series linac: Group A = gantry angle, ceiling laser position, X1 jaw position, couch longitudinal position, physical graticule position (five testers); Group B = Group A + wall laser position, couch lateral and vertical position, collimator angle (three testers); Group C = Group B + couch angle, wall laser angle, and optical distance indicator (three testers). Testers were taught how to use the linac and then used the instructions to try to identify these errors. An experienced physicist observed each session, giving support on machine operation as necessary. Testers were able to follow the instructions. They determined gantry, collimator, and couch angle errors within 0.4°, 0.3°, and 0.9° of the actual changed values, respectively. Laser positions were determined within 1 mm and jaw positions within 2 mm. Couch position errors were determined within 2 mm and 3 mm for lateral/longitudinal and vertical errors, respectively. Accessory-positioning errors were determined within 1 mm. Optical distance indicator errors were determined within 2 mm when comparing with distance sticks and 6 mm when using blocks, indicating that distance sticks should be the preferred approach for inexperienced staff. Inexperienced users were able to follow these instructions and catch errors within the criteria suggested

Ignition Features of Plasma-Beam Discharge in Gas-Discharge Electron Gun Operation

Directory of Open Access Journals (Sweden)

Valery A. Tutyk

2013-01-01

Full Text Available The current paper presents the results of experimental researches to determine the mode features of plasma-beam discharge (PBD generation by an electron beam injected by a low-vacuum gasdischarge electron gun (LGEG with the cold cathode and hollow anode on the basis of the high-voltage glow discharge and in the range of helium pressure of P ? 10 ÷ 130 Pa. The PBD boundaries and their dependences on parameters of an electron beam are found. The influence of PBD on parameters of low-vacuum gas-discharge electron gun is revealed. It causes an avalanche increase of electron beam current and burning of plasma-beam discharge in the whole space of the vacuum chamber volume and generation of electromagnetic radiation is revealed. Achieved results will be used for implementation of various vacuum technologies in the medium of reaction gas and generated electromagnetic radiation.

Envisioning Instructional Communication Research as a Multi-Paradigmatic Response to Neoliberalism's Effect on Instruction. Forum: The Future of Instructional Communication

Science.gov (United States)

Kahl, David H., Jr.

2017-01-01

Throughout its history, instructional communication research has played an important role in the discipline of Communication. In tracing its lineage, Myers (2010) explains that instructional communication research has focused on communicative behaviors that instructors use with their students to better understand and facilitate affective and…

Systematic Instruction for Retarded Children: The Illinois Program - Experimental Edition. Part IV: Motor Performance and Recreation Instruction.

Science.gov (United States)

Linford, Anthony G.; Jeanrenaud, Claudine Y.

The manual of programed instruction for motor skills and recreational activities for trainable mentally handicapped children includes guidelines on basic recreation movements, rhythm in music, handicrafts, and miscellaneous activities. The guidelines employ principles of behavior change and direct instruction. Detailed programed instruction lists…

A Qualitative Evaluation of Instructors' Exam Questions at a Primary Education Department in Terms of Certain Variables

Science.gov (United States)

Demir, Mehmet Kaan; Eryaman, Mustafa Yunus

2012-01-01

The purpose of this qualitative research study is to analyze instructors' exam questions at a Primary Education Department in terms of the exam's period, the comprehensibility of the instructions, cognitive level, and the appropriateness to the critical thinking. This qualitative study is based on document analysis method. 100 randomly selected…

Piano instruction for nursery school trainees

OpenAIRE

新海, 節; Makoto, SHINKAI; 藤女子大学人間生活学部保育学科

2012-01-01

It is important piano instruction in childcare training schools be viewed primarily as "music for childcare". To this end,it is also important that the view of piano instruction for nursery school trainees be switched from one mainly focused on the technical aspects of performance using many etudes to a form of instruction based on developing the musicality of the trainees and their ability to display emotion through music. Further, through this instruction, the trainees need to develop the a...

Classification of electrical discharges in DC Accelerators

Energy Technology Data Exchange (ETDEWEB)

Banerjee, Srutarshi, E-mail: sruban.stephens@gmail.com [Accelerator and Pulse Power Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085 (India); Deb, A.K. [Department of Electrical Engineering, Indian Institute of Technology Kharagpur, Kharagpur 721302 (India); Rajan, Rehim N. [Accelerator and Pulse Power Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085 (India); Kishore, N.K. [Department of Electrical Engineering, Indian Institute of Technology Kharagpur, Kharagpur 721302 (India)

2016-08-11

Controlled electrical discharge aids in conditioning of the system while uncontrolled discharges damage its electronic components. DC Accelerator being a high voltage system is no exception. It is useful to classify electrical discharges according to the severity. Experimental prototypes of the accelerator discharges are developed. Photomultiplier Tubes (PMTs) are used to detect the signals from these discharges. Time and Frequency domain characteristics of the detected discharges are used to extract features. Machine Learning approaches like Fuzzy Logic, Neural Network and Least Squares Support Vector Machine (LSSVM) are employed to classify the discharges. This aids in detecting the severity of the discharges.

Using Principles of Programmed Instruction

Science.gov (United States)

Huffman, Harry

1971-01-01

Although programmed instruction in accounting is available, it is limited in scope and in acceptance. Teachers, however, may apply principles of programming to the individualizing of instruction. (Author)

Effective Instruction: A Mathematics Coach's Perspective

Science.gov (United States)

Nebesniak, Amy L.

2012-01-01

Effective instruction is multifaceted, dependent largely on the context and, consequently, on numerous variables. Although "effective instruction" is difficult to define, in the author's experience--and as the work of mathematics education specialists and researchers indicates--three key features of quality instruction stand out: (1) Teaching…

Only reappraisers profit from reappraisal instructions: Effects of instructed and habitual reappraisal on stress responses during interpersonal conflicts.

Science.gov (United States)

Mauersberger, Heidi; Hoppe, Annekatrin; Brockmann, Gudrun; Hess, Ursula

2018-04-22

Conflicts are an undesirable yet common aspect of daily interactions with wide-ranging negative consequences. The present research aimed to examine the buffering effect of experimentally instructed reappraisal on self-reported, physiological and behavioral stress indices during interpersonal conflicts, taking into account habitual emotion regulation strategies. For this, 145 participants experienced a standardized laboratory conflict with the instruction to either reappraise (n = 48), to suppress (n = 50), or with no instruction (n = 47) while cardiovascular and neuroendocrine measures were taken. Participants were allowed to eat sweet and salty snacks during the conflict situation. Prior to as well as after the conflict, participants reported on their subjective stress level. Reappraisal instructions were only effective for high habitual reappraisers who exhibited lower cardiovascular and cortisol reactivity and demonstrated fewer snack-eating behaviors under reappraisal instructions than under suppression or no instructions. The opposite pattern emerged for low habitual reappraisers. Neither experimentally instructed nor habitual reappraisal by itself reduced the negative effects of conflicts. Our findings complement the literature on the diverging effects of instructed reappraisal in tense social interactions. © 2018 Society for Psychophysiological Research.

Computer-Based Oral Hygiene Instruction versus Verbal Method in Fixed Orthodontic Patients

Science.gov (United States)

Moshkelgosha, V.; Mehrvarz, Sh.; Saki, M.; Golkari, A.

2017-01-01

Statement of Problem: Fixed orthodontic appliances in the oral cavity make tooth cleaning procedures more complicated. Objectives: This study aimed to compare the efficacy of computerized oral hygiene instruction with verbal technique among fixed orthodontic patients referred to the evening clinic of Orthodontics of Shiraz Dental School. Materials and Methods: A single-blind study was performed in Orthodontic Department of Shiraz, Islamic Republic of Iran, from January to May 2015 following the demonstrated exclusion and inclusion criteria. The sample size was considered 60 patients with 30 subjects in each group. Bleeding on probing and plaque indices and dental knowledge were assessed in the subjects to determine pre-intervention status. A questionnaire was designed for dental knowledge evaluation. The patients were randomly assigned into the computerized and verbal groups. Three weeks after the oral hygiene instruction, indices of bleeding on probing and plaque index and the dental knowledge were evaluated to investigate post-intervention outcome. The two groups were compared by chi-square and student t tests. The pre- and post-intervention scores in each group were compared using paired t-test. Results: In the computerized group, the mean score for plaque index and bleeding on probing index was significantly decreased while dental health knowledge was significantly increased after oral hygiene instruction, in contrast to the verbal group. Conclusions: Within the limitations of the current study, computerized oral hygiene instruction is proposed to be more effective in providing optimal oral health status compared to the conventional method in fixed orthodontic patients. PMID:28959765

Department of Thermonuclear Research. Annual report 1988

International Nuclear Information System (INIS)

Sadowski, M.

1989-01-01

Department of Thermonuclear Research annual report 1988 presents a short review of theoretical, experimental and technological studies performed within a framework of two research programs: diagnostics of high-temperature plasma and nuclear technology. We describe theoretical investigations on the modelling of Tokamak edge plasmas, ion motions, atomic collisions, high-voltage electrode systems and plasma-focus (PF) facilities. The experimental studies on plasma-ion streams, high-current discharges of the PF-type, and on the interaction of ion beams with gaseous targets, are shortly summarized. Also presented are technological studies on electronic and high-voltage systems, as well as applications of the IONOTRON type plasma devices. (author)

Wills Plasma Physics Department annual report, 1989

International Nuclear Information System (INIS)

1991-01-01

An overview of the collaborative researches carried out during the 1989 at the Wills Plasma Physics Department is given. The main activities included the study of hydromagnetic surface waves and RF heating using the Tortus tokamak; the development of diagnostic techniques, particularly those based on submillimetre lasers and tunable gyrotrons; gas discharge studies and investigations of apparent cold nuclear fusion in deuterated palladium. The small research tokamak Tortus was upgraded during the year, thus enabling the machine to be routinely and reliably operated at toroidal currents around 40 kA. A list of papers published or presented at various conferences during the year is included in the Appendix

Does providing prescription information or services improve medication adherence among patients discharged from the emergency department? A randomized controlled trial.

Science.gov (United States)

McCarthy, Melissa L; Ding, Ru; Roderer, Nancy K; Steinwachs, Donald M; Ortmann, Melinda J; Pham, Julius Cong; Bessman, Edward S; Kelen, Gabor D; Atha, Walter; Retezar, Rodica; Bessman, Sara C; Zeger, Scott L

2013-09-01

We determine whether prescription information or services improve the medication adherence of emergency department (ED) patients. Adult patients treated at one of 3 EDs between November 2010 and September 2011 and prescribed an antibiotic, central nervous system, gastrointestinal, cardiac, or respiratory drug at discharge were eligible. Subjects were randomly assigned to usual care or one of 3 prescription information or services intervention groups: (1) practical services to reduce barriers to prescription filling (practical prescription information or services); (2) consumer drug information from MedlinePlus (MedlinePlus prescription information or services); or (3) both services and information (combination prescription information or services). Self-reported medication adherence, measured by primary adherence (prescription filling) and persistence (receiving medicine as prescribed) rates, was determined during a telephone interview 1 week postdischarge. Of the 3,940 subjects enrolled and randomly allocated to treatment, 86% (N=3,386) completed the follow-up interview. Overall, primary adherence was 88% and persistence was 48%. Across the sites, primary adherence and persistence did not differ significantly between usual care and the prescription information or services groups. However, at site C, subjects who received the practical prescription information or services (odds ratio [OR]=2.4; 95% confidence interval [CI] 1.4 to 4.3) or combination prescription information or services (OR=1.8; 95% CI 1.1 to 3.1) were more likely to fill their prescription compared with usual care. Among subjects prescribed a drug that treats an underlying condition, subjects who received the practical prescription information or services were more likely to fill their prescription (OR=1.8; 95% CI 1.0 to 3.1) compared with subjects who received usual care. Prescription filling and receiving medications as prescribed was not meaningfully improved by offering patients patient

Impact of the emergency department streaming decision on patients' outcomes.

Science.gov (United States)

Kim, S W; Horwood, C; Li, J Y; Hakendorf, P H; Teubner, D J O; Thompson, C H

2015-12-01

Streaming occurs in emergency department (ED) to reduce crowding, but misallocation of patients may impact patients' outcome. The study aims to determine the outcomes of patients misallocated by the ED process of streaming into likely admission or discharge. This is a retrospective cohort study, at an Australian, urban, tertiary referral hospital's ED between January 2010 and March 2012, using propensity score matching for comparison. Total and partitioned ED lengths of stay, inpatient length of stay, in-hospital mortality and 7- and 28-day unplanned readmission rate were compared between patients who were streamed to be admitted against those streamed to be discharged. Total ED length of stay did not differ significantly for admitted patients if allocated to the wrong stream (median 7.6 h, interquartile range 5.7-10.6, cf. 7.5 h, 5.3-11.2; P = 0.34). The median inpatient length of stay was shorter for those initially misallocated to the discharge stream (1.8 days, 1.1-3.0, cf. 2.4 days, 1.4-3.9; P stream stayed in the ED longer than those appropriately allocated (5.2 h, 3.7-7.3, cf. 4.6 h, 3.3-6.4; P streaming process. Patients' discharge from the ED was slower if they had been allocated to the admission stream. Streaming carries few risks for patients misallocated by such a process. © 2015 Royal Australasian College of Physicians.

Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome.

Science.gov (United States)

Chauhan, Vidyalaxmi; Shah, Maitri C; Patel, Sangita V; Marfatia, Yogesh S; Zalavadiya, Dhara

2016-01-01

In spite of a few shortcomings such as over diagnosis and over treatment, syndromic management is a recommended practice in India for sexually transmitted infections (STIs). This study tries to find out the efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. The objective of the study is to find out the effectiveness of syndromic management in terms of symptomatic improvement among females with vaginal discharge syndrome. A longitudinal study was conducted in Gynecology Department of Tertiary Care Hospital including 180 symptomatic females having vaginal discharge syndrome. Demographic profile, presenting complaints, menstrual history, obstetric history, partner history, and contraceptive history were noted. This was followed by clinical examination and specimen collection for laboratory tests and blood tests to find out type of STI including viral STI such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), and hepatitis B surface antigen (HBsAg). Treatment was given according to syndromic management on the same day. All the participants were asked to come for follow-up after 15 days and their improvement in symptoms was noted as complete improvement, some improvement or no improvement on a five point scale. 63.9% cases showed complete improvement, while 36.1% showed some improvement. None of the patients was without any improvement. Vaginal discharge syndrome was most common between 20 and 30 years (43.4%), and 67.8% of symptomatic females with vaginal discharge syndrome belonged to the lower socioeconomic group. HSV infection was the most common (15%) associated viral infection with vaginal discharge syndrome, while hepatitis B infection was the least common (0.5%). HIV was reactive in 2.8% cases only. Syndromic management was found to be effective in relieving symptoms in most of the cases of vaginal discharge syndrome.

Recurrent vaginal discharge in children.

Science.gov (United States)

McGreal, Sharon; Wood, Paul

2013-08-01

Childhood vaginal discharge remains a frequent reason for referral from primary to secondary care. The Pediatric and Adolescent Gynecology (PAG) service at Kettering General Hospital was established in 1993 and provides a specialized service that meets the needs of children with gynaecological conditions. To investigate recurrent vaginal discharge noting symptomatology, defining pathogens, common and rarer causes, exploring management regimes, and any changes in practice over time. Retrospective review spanning 15 years identifying prepubertal children attending the outpatient PAG clinic with recurrent vaginal discharge. We reviewed the medical notes individually. 110 patients were identified; 85% were referred from primary care. The age distribution was bimodal at four and eight years. Thirty-five percent of our patients were discharged after the initial consultation. The commonest cause of discharge was vulvovaginitis (82%). Other important causes included suspected sexual abuse (5%), foreign body (3%), labial adhesions (3%), vaginal agenesis (2%). 35% of patients were admitted for vaginoscopy. Vaginal discharge is the most common gynecological symptom in prepubertal girls and can cause repeated clinical episodes. Vulvovaginitis is the most common cause and often responds to simple hygiene measures. Awareness of the less common causes of vaginal discharge is essential. Copyright © 2013 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Activity measurements using recessed ionization chambers (activity meters) as performed in the Department for Nuclear Medicine at the Hanover Medical School

International Nuclear Information System (INIS)

Meyer, G.J.; Matzke, K.H.; Kuehn, J.

1992-01-01

Recessed ionization chambers have an application in the production and dose determination of radiopharmaceuticals. The measuring instrumentation installed in the radiochemical department, service instructions, quality assurance measures and relevant practical experiences are described in brief. (DG) [de

Radiological discharges

International Nuclear Information System (INIS)

Woodliffe, J.

1990-01-01

Current practice of North Sea States on the discharge and disposal of liquid radioactive wastes to the North Sea are based on the declaration issued at the Second International Conference on the Protection of the North Sea, known as the London Declaration. This has three main points the first of which emphasises the application of the Best Available Technology to protect the North Sea, the second provides a framework on which future controls on radioactive discharges should be based. The third identifies two parts of the framework; to take into account the recommendations of international organizations and that any repositories of radioactive waste which are built should not pollute the North Sea. This chapter looks at how the concensus based on the London Declaration is working, gauges the progress made in the implementation of the policy goal, identifies existing and future areas for concern and proposes ways of strengthening the control of radioactive discharges. The emphasis is on the United Kingdom practice and regulations for liquid wastes, most of which comes from the Sellafield Reprocessing Plant. (author)

Emergency department visits by pediatric patients for poisoning by prescription opioids.

Science.gov (United States)

Tadros, Allison; Layman, Shelley M; Davis, Stephen M; Bozeman, Rachel; Davidov, Danielle M

2016-09-01

Prescription medication abuse is an increasingly recognized problem in the United States. As more opioids are being prescribed and abused by adults, there is an increased risk of both accidental and intentional exposure to children and adolescents. The impact of pediatric exposures to prescription pain pills has not been well studied. We sought to evaluate emergency department (ED) visits for poisoning by prescription opioids in pediatric patients. This retrospective study looked at clinical and demographic data from the Nationwide Emergency Department Sample (NEDS) from 2006 to 2012. There were 21,928 pediatric ED visits for prescription opioid poisonings and more than half were unintentional. There was a bimodal age distribution of patients, with slightly more than half occurring in females. The majority of patients were discharged from the ED. More visits in the younger age group (0-5 years) were unintentional, while the majority of visits in the adolescent age group (15-17 years) were intentional. Mean charge per discharge was $1,840 and $14,235 for admissions and surmounted to over $81 million in total charges. Poisonings by prescription opioids largely impact both young children and adolescents. These findings can be used to help target this population for future preventive efforts.

Pharmacy services at admission and discharge in adult, acute, public hospitals in Ireland.

LENUS (Irish Health Repository)

Grimes, Tamasine

2012-02-01

OBJECTIVES: to describe hospital pharmacy involvement in medication management in Ireland, both generally and at points of transfer of care, and to gain a broad perspective of the hospital pharmacy workforce. METHODS: a survey of all adult, acute, public hospitals with an accident and emergency (A&E) department (n = 36), using a semi-structured telephone interview. KEY FINDINGS: there was a 97% (n = 35) response rate. The majority (n = 25, 71.4%) of hospitals reported delivery of a clinical pharmacy service. On admission, pharmacists were involved in taking or verifying medication histories in a minority (n = 15, 42.9%) of hospitals, while few (n = 6,17.1%) deployed staff to the A&E\\/acute medical admissions unit. On discharge, the majority (n = 30,85.7%) did not supply any take-out medication, a minority (n =5,14.3%) checked the discharge prescription, 51.4% (n = 18) counselled patients, 42.9% (n = 15) provided medication compliance charts and one hospital (2.9%) communicated with the patient\\'s community pharmacy. The number of staff employed in the pharmacy department in each hospital was not proportionate to the number of inpatient beds, nor the volume of admissions from A&E. There were differences identified in service delivery between hospitals of different type: urban hospitals with a high volume of admissions from A&E were more likely to deliver clinical pharmacy. CONCLUSIONS: the frequency and consistency of delivering pharmacy services to facilitate medication reconciliation at admission and discharge could be improved. Workforce constraints may inhibit service expansion. Development of national standards of practice may help to eliminate variation between hospitals and support service development.

On a Work Expected to the Department of Emergency and Critical Care Medicine and the Emergency Unit of the Niigata University Hospital

OpenAIRE

小山, 真; Koyama, Shin

2001-01-01

The author would like to celebrate the start of the Department of emergency and critical care medicine and the Emergency unit of the Niigata University Hospital. The author also wishes to express his opinion, which is mentioned below, on preparing the Department and the Emergency unit for their future activity. 1 . The stuff members of the Department are expected to instruct undergraduate students in the knowledge and technique of Triage and the first aid in emergency exactly. 2 . The Emergen...

Pediatric hospital discharge interventions to reduce subsequent utilization: a systematic review.

Science.gov (United States)

Auger, Katherine A; Kenyon, Chén C; Feudtner, Chris; Davis, Matthew M

2014-04-01

Reducing avoidable readmission and posthospitalization emergency department (ED) utilization has become a focus of quality-of-care measures and initiatives. For pediatric patients, no systematic efforts have assessed the evidence for interventions to reduce these events. We sought to synthesize existing evidence on pediatric discharge practices and interventions to reduce hospital readmission and posthospitalization ED utilization. PubMed and the Cumulative Index to Nursing and Allied Health Literature. Studies available in English involving pediatric inpatient discharge interventions with at least 1 outcome of interest were included. We utilized a modified Cochrane Good Practice data extraction tool and assessed study quality with the Downs and Black tool. Our search identified a total of 1296 studies, 14 of which met full inclusion criteria. All included studies examined multifaceted discharge interventions initiated in the inpatient setting. Overall, 2 studies demonstrated statistically significant reductions in both readmissions and subsequent ED visits, 4 studies demonstrated statistically significant reductions in either readmissions or ED visits, and 2 studies found statistically significant increases in subsequent utilization. Several studies were not sufficiently powered to detect changes in either subsequent utilization outcome measure. Interventions that demonstrated reductions in subsequent utilization targeted children with specific chronic conditions, providing enhanced inpatient feedback and education reinforced with postdischarge support. Interventions seeking to reduce subsequent utilization should identify an individual or team to assume responsibility for the inpatient-to-outpatient transition and offer ongoing support to the family via telephone or home visitation following discharge. © 2013 Society of Hospital Medicine.

The Department of Defense Information Security Process: A Study of Change Acceptance and Past-Performance-Based Outsourcing

Science.gov (United States)

Hackney, Dennis W. G.

2011-01-01

Subchapter III of Chapter 35 of Title 44, United States Code, Federal Information Security Management Act of 2002; Department of Defense (DoD) Directive 8500.01E, Information Assurance, October 24, 2002; DoD Directive 8100.1, Global Information Grid Overarching Policy, September 19, 2002; and DoD Instruction 8500.2, Information Assurance…

Electric discharge during electrosurgery.

Science.gov (United States)

Shashurin, Alexey; Scott, David; Zhuang, Taisen; Canady, Jerome; Beilis, Isak I; Keidar, Michael

2015-04-16

Electric discharge utilized for electrosurgery is studied by means of a recently developed method for the diagnostics of small-size atmospheric plasma objects based on Rayleigh scattering of microwaves on the plasma volume. Evolution of the plasma parameters in the near-electrode sheaths and in the positive column is measured and analyzed. It is found that the electrosurgical system produces a glow discharge of alternating current with strongly contracted positive column with current densities reaching 10(3) A/cm(2). The plasma electron density and electrical conductivities in the channel were found be 10(16) cm(-3) and (1-2) Ohm(-1) cm(-1), respectively. The discharge interrupts every instance when the discharge-driving AC voltage crosses zero and re-ignites again every next half-wave at the moment when the instant voltage exceeds the breakdown threshold.

The Multimodal Possibilities of Online Instructions

DEFF Research Database (Denmark)

Kampf, Constance

2006-01-01

The WWW simplifies the process of delivering online instructions through multimodal channels because of the ease of use for voice, video, pictures, and text modes of communication built into it.  Given that instructions are being produced in multimodal format for the WWW, how do multi-modal analy......The WWW simplifies the process of delivering online instructions through multimodal channels because of the ease of use for voice, video, pictures, and text modes of communication built into it.  Given that instructions are being produced in multimodal format for the WWW, how do multi...

Risk assessment for produced water discharges to Louisiana open bays. Final report

International Nuclear Information System (INIS)

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

1996-01-01

The US Department of Energy (USDOE) has a program of research in the environmental aspects of oil and gas extraction. This sampling project will characterize the environmental impacts associated with the discharge of naturally occurring radioactive materials (NORM), metals and organics in produced water. This report is part of a series of studies of the health and ecological risks from discharges of produced water to the Gulf of Mexico, supported by the USDOE. These assessments are being coordinated with the field study, using the collected data to perform human health and ecological risk assessments. These assessments will provide input to regulators in the development of guidelines and permits, and to industry in the development and use of appropriate discharge practices. The initial human health and ecological risk assessments consist of conservative screening analyses meant to identify potentially important contaminants, and to eliminate others from further consideration. More quantitative assessments were done for contaminants identified, in the screening analysis, as being of potential concern. Section 2 gives an overview of human health and ecological risk assessment to help put the analyses presented here in perspective. Section 3 provides the hazard assessment portion of the risk assessment, and identifies the important receptors and pathways of concern. Section 3 also outlines the approach taken to the risk assessments presented in the rest of the report. The remaining sections (4 through 9) present the human health and ecological risk assessments for discharges of produced water to open bays in Louisiana

Predicting tile drainage discharge

DEFF Research Database (Denmark)

Iversen, Bo Vangsø; Kjærgaard, Charlotte; Petersen, Rasmus Jes

used in the analysis. For the dynamic modelling, a simple linear reservoir model was used where different outlets in the model represented tile drain as well as groundwater discharge outputs. This modelling was based on daily measured tile drain discharge values. The statistical predictive model...... was based on a polynomial regression predicting yearly tile drain discharge values using site specific parameters such as soil type, catchment topography, etc. as predictors. Values of calibrated model parameters from the dynamic modelling were compared to the same site specific parameter as used...

Estimating sediment discharge: Appendix D

Science.gov (United States)

Gray, John R.; Simões, Francisco J. M.

2008-01-01

Sediment-discharge measurements usually are available on a discrete or periodic basis. However, estimates of sediment transport often are needed for unmeasured periods, such as when daily or annual sediment-discharge values are sought, or when estimates of transport rates for unmeasured or hypothetical flows are required. Selected methods for estimating suspended-sediment, bed-load, bed- material-load, and total-load discharges have been presented in some detail elsewhere in this volume. The purposes of this contribution are to present some limitations and potential pitfalls associated with obtaining and using the requisite data and equations to estimate sediment discharges and to provide guidance for selecting appropriate estimating equations. Records of sediment discharge are derived from data collected with sufficient frequency to obtain reliable estimates for the computational interval and period. Most sediment- discharge records are computed at daily or annual intervals based on periodically collected data, although some partial records represent discrete or seasonal intervals such as those for flood periods. The method used to calculate sediment- discharge records is dependent on the types and frequency of available data. Records for suspended-sediment discharge computed by methods described by Porterfield (1972) are most prevalent, in part because measurement protocols and computational techniques are well established and because suspended sediment composes the bulk of sediment dis- charges for many rivers. Discharge records for bed load, total load, or in some cases bed-material load plus wash load are less common. Reliable estimation of sediment discharges presupposes that the data on which the estimates are based are comparable and reliable. Unfortunately, data describing a selected characteristic of sediment were not necessarily derived—collected, processed, analyzed, or interpreted—in a consistent manner. For example, bed-load data collected with

Discharge Dialogue

DEFF Research Database (Denmark)

Horsbøl, Anders

2012-01-01

For several years, efforts have been made to strengthen collaboration between health professionals with different specializations and to improve patient transition from hospital to home (care). In the Danish health care system, these efforts have concentrated on cancer and heart diseases, whereas...... coordinator, employed at the hospital, is supposed to anticipate discharge and serve as mediator between the hospital and the municipal home care system. Drawing on methods from discourse and interaction analysis, the paper studies the practice of the discharge coordinator in two encounters between patients...... how the home context provides different resources for identification of patient needs and mutual decision making....

Exercise after Stroke: Patient Adherence and Beliefs after Discharge from Rehabilitation.

Science.gov (United States)

Miller, Kristine K; Porter, Rebecca E; DeBaun-Sprague, Erin; Van Puymbroeck, Marieke; Schmid, Arlene A

2017-03-01

Most people complete post-stroke rehabilitation within the first 6 months after stroke even though benefits from exercise are believed to persist well beyond 6 months. Physical and Occupational therapists provide home exercise programs (HEP) to instruct patients on exercises to continue after discharge from rehabilitation. Unfortunately, there is little known about HEP adherence rates in adults with stroke. The objectives of this project were to (1) determine the adherence rate with post-rehabilitation HEP and reasons for non-adherence, (2) assess for interactions between HEP adherence and self-report of depression and fatigue, and (3) determine patient beliefs about the benefit of exercise during stroke recovery. This was a cross-sectional, survey study. A survey was developed and distributed during stroke support group meetings to determine adherence rates with post rehabilitation HEP, reasons for non-adherence, and patient beliefs about the benefit of exercise. Eighty-nine percent of participants reported receiving a HEP and 65.3% of those reported being adherent with at least part of the HEP. Several reasons for non-adherence were identified, including 'doing different exercises than the ones given by the physical therapist', as the most frequently given reason. Study participants identified positive roles of exercise in their recovery from stroke. Patient adherence with HEP after discharge from rehabilitation is less than ideal. Reasons for non-adherence are varied. Rehabilitation therapists need to be able to identify and help patients manage barriers to HEP adherence to promote management of residual deficits.

Discharge residence of TLD tagged fish

International Nuclear Information System (INIS)

Romberg, G.P.; Prepejchal, W.

1974-01-01

Although visual observations suggested that fish remained in the discharge for considerable periods, temperature-sensitive tags indicated the majority of fish spend less than 50 hr or 10 percent of the time at discharge temperatures. During 1974 a second fish tagging study was conducted, using temperature-sensitive tags to yield discharge residence times of Lake Michigan salmonids at Point Beach thermal discharge. Preliminary results revealed that many fish tag values were close to Unit I line indicating that calculated maximum discharge residence times for these fish will be nearly 100 percent of the elapsed time

Expansion of a nitrogen discharge by sound

International Nuclear Information System (INIS)

Antinyan, M.A.; Galechyan, G.A.; Tavakalyan, L.B.

1992-01-01

When the background pressure and the discharge current in a gas discharge are raised the plasma column is tightened up into a filament. Then the discharge occupies a region of the discharge tube whose transverse dimensions are substantially less than those of the tube. This contraction phenomenon in discharges restricts the range of parameters used in various devices to the range of relatively low discharge currents and low gas pressures. This contraction interferes with creating high-power gas lasers, since it acts destructively on the lasing process. In order to suppress filamentation of discharges the working gas has been pumped through the system at high speed, with considerable success. The turbulent mixing in the stream plays an important role in creating an uncontracted discharge at high pressures. The purpose of the present work is to study the possibility of undoing the contraction of a nitrogen discharge, which is one of the main components in the operation of a CO 2 laser, by introducing an intense sound wave in the discharge tube. Discharge contraction and the effect of a sound wave propagating along the plasma column have been investigated experimentally in nitrogen by studying the current-voltage characteristics of a contracted discharge. 6 refs., 3 figs

Closing the circle of care: implementation of a web-based communication tool to improve emergency department discharge communication with family physicians.

Science.gov (United States)

Hunchak, Cheryl; Tannenbaum, David; Roberts, Michael; Shah, Thrushar; Tisma, Predrag; Ovens, Howard; Borgundvaag, Bjug

2015-03-01

Postdischarge emergency department (ED) communication with family physicians is often suboptimal and negatively impacts patient care. We designed and piloted an online notification system that electronically alerts family physicians of patient ED visits and provides access to visitspecific laboratory and diagnostic information. Nine (of 10 invited) high-referring family physicians participated in this single ED pilot. A prepilot chart audit (30 patients from each family physician) determined the baseline rate of paper-based record transmission. A webbased communication portal was designed and piloted by the nine family physicians over 1 year. Participants provided usability feedback via focus groups and written surveys. Review of 270 patient charts in the prepilot phase revealed a 13% baseline rate of handwritten chart and a 44% rate of any information transfer between the ED and family physician offices following discharge. During the pilot, participant family physicians accrued 880 patient visits. Seven and two family physicians accessed online records for 74% and 12% of visits, respectively, an overall 60.7% of visits, corresponding to an overall absolute increase in receipt of patient ED visit information of 17%. The postpilot survey found that 100% of family physicians reported that they were ''often'' or ''always'' aware of patient ED visits, used the portal ''always'' or ''regularly'' to access patients' health records online, and felt that the web portal contributed to improved actual and perceived continuity of patient care. Introduction of a web-based ED visit communication tool improved ED-family physician communication. The impact of this system on improved continuity of care, timeliness of follow-up, and reduced duplication of investigations and referrals requires additional study.

Improve Student Understanding Ability Through Gamification in Instructional Media Based Explicit Instruction

Science.gov (United States)

Firdausi, N.; Prabawa, H. W.; Sutarno, H.

2017-02-01

In an effort to maximize a student’s academic growth, one of the tools available to educators is the explicit instruction. Explicit instruction is marked by a series of support or scaffold, where the students will be guided through the learning process with a clear statement of purpose and a reason for learning new skills, a clear explanation and demonstration of learning targets, supported and practiced with independent feedback until mastery has been achieved. The technology development trend of todays, requires an adjustment in the development of learning object that supports the achievement of explicit instruction targets. This is where the gamification position is. In the role as a pedagogical strategy, the use of gamification preformance study class is still relatively new. Gamification not only use the game elements and game design techniques in non-game contexts, but also to empower and engage learners with the ability of motivation on learning approach and maintains a relaxed atmosphere. With using Reseach and Development methods, this paper presents the integration of technology (which in this case using the concept of gamification) in explicit instruction settings and the impact on the improvement of students’ understanding.

The nature of instructional effects in color constancy.

Science.gov (United States)

Radonjić, Ana; Brainard, David H

2016-06-01

The instructions subjects receive can have a large effect on experimentally measured color constancy, but the nature of these effects and how their existence should inform our understanding of color perception remains unclear. We used a factorial design to measure how instructional effects on constancy vary with experimental task and stimulus set. In each of 2 experiments, we employed both a classic adjustment-based asymmetric matching task and a novel color selection task. Four groups of naive subjects were instructed to make adjustments/selections based on (a) color (neutral instructions); (b) the light reaching the eye (physical spectrum instructions); (c) the actual surface reflectance of an object (objective reflectance instructions); or (d) the apparent surface reflectance of an object (apparent reflectance instructions). Across the 2 experiments we varied the naturalness of the stimuli. We find clear interactions between instructions, task, and stimuli. With simplified stimuli (Experiment 1), instructional effects were large and the data revealed 2 instruction-dependent patterns. In 1 (neutral and physical spectrum instructions) constancy was low, intersubject variability was also low, and adjustment-based and selection-based constancy were in agreement. In the other (reflectance instructions) constancy was high, intersubject variability was large, adjustment-based constancy deviated from selection-based constancy and for some subjects selection-based constancy increased across sessions. Similar patterns held for naturalistic stimuli (Experiment 2), although instructional effects were smaller. We interpret these 2 patterns as signatures of distinct task strategies-1 is perceptual, with judgments based primarily on the perceptual representation of color; the other involves explicit instruction-driven reasoning. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Patient Satisfaction With Postpartum Teaching Methods.

Science.gov (United States)

Wagner, Debra L; Washington, Cynthia

2016-01-01

Postpartum discharge instructions are a crucial part of a mother's birth experience. Finding the method to provide those discharge instructions in a manner that increases the mother's satisfaction with her hospital experience is important. This quasi-experimental study examined the relationship between new mothers' interaction with nurses providing postpartum instructions by the traditional and class methods and their satisfaction with discharge teaching. The results indicated new mothers were satisfied with both methods of discharge teaching; however, they were more likely to report stronger agreement with overall satisfaction with the traditional method of discharge teaching than with attending the discharge class.

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

Science.gov (United States)

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.

Feasibility of wear compensation in micro EDM milling based on discharge counting and discharge population characterization

DEFF Research Database (Denmark)

Bissacco, Giuliano; Hansen, Hans Nørgaard; Tristo, G.

2011-01-01

This paper investigates the applicability of real time wear compensation in micro EDM milling based on discharge counting and discharge population characterization. Experiments were performed involving discharge counting and tool electrode wear measurement in a wide range of process parameters...

Scaffolding in Assisted Instruction

Directory of Open Access Journals (Sweden)

2007-01-01

Full Text Available On-The-Job Training, developed as direct instruction, is one of the earliest forms of training. This method is still widely in use today because it requires only a person who knows how to do the task, and the tools the person uses to do the task. This paper is intended to be a study of the methods used in education in Knowledge Society, with more specific aspects in training the trainers; as a result of this approach, it promotes scaffolding in assisted instruction as a reflection of the digital age for the learning process. Training the trainers in old environment with default techniques and designing the learning process in assisted instruction, as an application of the Vygotskian concept of the zone of proximal development (ZPD to the area of computer literacy for the younger users, generate diversity in educational communities and requires standards for technology infrastructure, standards for the content, developed as a concepts map, and applications for personalized in-struction, based on ZPD theory.

Equations for estimating bankfull channel geometry and discharge for streams in Massachusetts

Science.gov (United States)

Bent, Gardner C.; Waite, Andrew M.

2013-01-01

Regression equations were developed for estimating bankfull geometry—width, mean depth, cross-sectional area—and discharge for streams in Massachusetts. The equations provide water-resource and conservation managers with methods for estimating bankfull characteristics at specific stream sites in Massachusetts. This information can be used for the adminstration of the Commonwealth of Massachusetts Rivers Protection Act of 1996, which establishes a protected riverfront area extending from the mean annual high-water line corresponding to the elevation of bankfull discharge along each side of a perennial stream. Additionally, information on bankfull channel geometry and discharge are important to Federal, State, and local government agencies and private organizations involved in stream assessment and restoration projects. Regression equations are based on data from stream surveys at 33 sites (32 streamgages and 1 crest-stage gage operated by the U.S. Geological Survey) in and near Massachusetts. Drainage areas of the 33 sites ranged from 0.60 to 329 square miles (mi2). At 27 of the 33 sites, field data were collected and analyses were done to determine bankfull channel geometry and discharge as part of the present study. For 6 of the 33 sites, data on bankfull channel geometry and discharge were compiled from other studies done by the U.S. Geological Survey, Natural Resources Conservation Service of the U.S. Department of Agriculture, and the Vermont Department of Environmental Conservation. Similar techniques were used for field data collection and analysis for bankfull channel geometry and discharge at all 33 sites. Recurrence intervals of the bankfull discharge, which represent the frequency with which a stream fills its channel, averaged 1.53 years (median value 1.34 years) at the 33 sites. Simple regression equations were developed for bankfull width, mean depth, cross-sectional area, and discharge using drainage area, which is the most significant explanatory

Ultrasound-Guided Peripheral Intravenous Access in the Emergency Department: Patient-Centered Survey

Directory of Open Access Journals (Sweden)

Keith Boniface

2011-05-01

Full Text Available Introduction: To assess characteristics, satisfaction, and disposition of emergency department (ED patients who successfully received ultrasound (US-guided peripheral intravenous (IV access. Methods: This is a prospective observational study among ED patients who successfully received US-guided peripheral IV access by ED technicians. Nineteen ED technicians were taught to use US guidance to obtain IV access. Training sessions consisted of didactic instruction and hands-on practice. The US guidance for IV access was limited to patients with difficult access. After successfully receiving an US-guided peripheral IV, patients were approached by research assistants who administered a 10-question survey. Disposition information was collected after the conclusion of the ED visit by accessing patients’ electronic medical record. Results: In total, 146 surveys were completed in patients successfully receiving US-guided IVs. Patients reported an average satisfaction with the procedure of 9.2 of 10. Forty-two percent of patients had a body mass index (BMI of greater than 30, and 17.8% had a BMI of more than 35. Sixty-two percent reported a history of central venous catheter placement. This patient population averaged 3 ED visits per year in the past year. Fifty-three percent of the patients were admitted. Conclusion: Patients requiring US-guided IVs in our ED are discharged home at the conclusion of their ED visit about half of the time. These patients reported high rates of both difficult IV access and central venous catheter placement in the past. Patient satisfaction with US-guided IVs was very high. These data support the continued use of US-guided peripheral IVs in this patient population. [West J Emerg Med. 2011;12(4:475–477.

Chronic obstructive pulmonary disease - adults - discharge

Science.gov (United States)

... coughing up dark mucus Your fingertips or the skin around your fingernails are blue Alternative Names COPD - adults - discharge; Chronic obstructive airways disease - adults - discharge; Chronic obstructive lung disease - adults - discharge; ...

[Severe vaginal discharge following rectal surgery].

Science.gov (United States)

Burg, L C; Bremers, A J A; Heesakkers, J P F A; Kluivers, K B

2018-01-01

Almost 50% of women who have had rectal surgery subsequently develop vaginal discharge. Due to the recurrent and unexpected nature of this heavy discharge, they often experience it as very distressing. Many of these women undergo extensive diagnostic tests that are mainly focused on identifying fistula formation. If no fistula is found, in most cases no other cause for severe vaginal discharge can be demonstrated. In our practice, we saw three patients (49-, 54- and 74-years-old, respectively) with similar severe vaginal discharge after rectal surgery and in whom no explanation for the vaginal discharge could be found. For this reason we conducted a literature search into this condition. Anatomical changes appear to be responsible for heavy vaginal discharge following rectal surgery. Changes in pelvic floor muscles and compression of the distal part of the vagina may lead to pooling of fluid in the proximal part of the vagina, resulting in severe discharge. Symptomatic treatment may reduce the symptoms.

GYNOTEL: telephone advice to gynaecological surgical patients after discharge.

Science.gov (United States)

Caljouw, Monique A A; Hogendorf-Burgers, Marja E H J

2010-12-01

To investigate in surgical gynaecological patients the types of health problems arising or persisting up to six weeks after discharge and the effectiveness of telephone advice. The decreasing length of hospital stay has increased the need for specific instructions about the postdischarge period. Telephone advice could be a valuable tool to address this problem. To our knowledge, postdischarge health problems and the value of telephone advice have not been investigated among gynaecological patients. Randomised controlled trial. Gynaecological patients expected to stay in the ward longer than 24 hour were invited to participate. A pilot study showed that wound healing, pain, mobility, urination, defecation and vaginal bleeding were the most common health problems postdischarge. Based on that information, guidelines were formulated that were used by trained nurses to give telephone advice to the intervention group (n=235), in addition to the usual care. The control group of gynaecological patients (n=233) received usual care only. Of all 468 participants, about 50% were operated for general gynaecology. At discharge, wound pain (56%), mobility problems (54%) and constipation (27%) were the most frequently mentioned problems in both groups. Participants who completely followed the advice with regard to wound healing (p=0.02), pain (p=0.01), vaginal bleeding (p=0.03) and mobility (p=0.04) experienced greater improvement than participants who did not follow, or only partly followed, the advice. The telephone advice appears to make a significant contribution to help gynaecological surgical patients to solve or reduce their postdischarge health problems. The positive effect of such advice can be interpreted as an improvement in the quality of life of the postoperative gynaecological patient. © 2010 Blackwell Publishing Ltd.

Stage-discharge relationship in tidal channels

Science.gov (United States)

Kearney, W. S.; Mariotti, G.; Deegan, L.; Fagherazzi, S.

2016-12-01

Long-term records of the flow of water through tidal channels are essential to constrain the budgets of sediments and biogeochemical compounds in salt marshes. Statistical models which relate discharge to water level allow the estimation of such records from more easily obtained records of water stage in the channel. While there is clearly structure in the stage-discharge relationship, nonlinearity and nonstationarity of the relationship complicates the construction of statistical stage-discharge models with adequate performance for discharge estimation and uncertainty quantification. Here we compare four different types of stage-discharge models, each of which is designed to capture different characteristics of the stage-discharge relationship. We estimate and validate each of these models on a two-month long time series of stage and discharge obtained with an Acoustic Doppler Current Profiler in a salt marsh channel. We find that the best performance is obtained by models which account for the nonlinear and time-varying nature of the stage-discharge relationship. Good performance can also be obtained from a simplified version of these models which approximates the fully nonlinear and time-varying models with a piecewise linear formulation.

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

Science.gov (United States)

Kageyama, Yoko; Asano, Midori

2017-12-01

The accelerating trend towards shorter hospital stays in Japan has made modes of decision-making essential for effective patient transition from the hospital to recuperation in the regional community, and the ageing of the population has brought a rise in surrogate decision-making by the families of patients lacking decision-making ('self-decision') capacity. To verbalise and elucidate the practical wisdom of discharge planning nurses by focusing on the perceptions and judgements, they apply in practice and describing their methodology in concrete terms. Participants were six discharge planning nurses and one person with previous experience as a discharge planning nurse, all working at discharge planning departments of acute care hospitals. Separate, semi-structured, interactive interviews were conducted with each participant. The study design was qualitative descriptive in form with qualitative content analysis. All participants provided written informed consent to participate in the study, which was approved by the study institution. Three concepts were extracted as the basis for discharge planning nurses' perception and judgement at acute care hospitals: working for mutual envisionment of the available postdischarge options; helping the family act as spokesperson(s) for the patient's wishes; and understanding the family inclusive of the patient as a relationship of strongly interaffecting interests. The practical wisdom of the nurse, working in mutual envisionment with the family, and collaborative decision-making through discussion with those who know the patient, leads to rational discharge assistance. © 2017 Nordic College of Caring Science.

Do Instructional Videos on Sputum Submission Result in Increased Tuberculosis Case Detection? A Randomized Controlled Trial.

Science.gov (United States)

Mhalu, Grace; Hella, Jerry; Doulla, Basra; Mhimbira, Francis; Mtutu, Hawa; Hiza, Helen; Sasamalo, Mohamed; Rutaihwa, Liliana; Rieder, Hans L; Seimon, Tamsyn; Mutayoba, Beatrice; Weiss, Mitchell G; Fenner, Lukas

2015-01-01

We examined the effect of an instructional video about the production of diagnostic sputum on case detection of tuberculosis (TB), and evaluated the acceptance of the video. Randomized controlled trial. We prepared a culturally adapted instructional video for sputum submission. We analyzed 200 presumptive TB cases coughing for more than two weeks who attended the outpatient department of the governmental Municipal Hospital in Mwananyamala (Dar es Salaam, Tanzania). They were randomly assigned to either receive instructions on sputum submission using the video before submission (intervention group, n = 100) or standard of care (control group, n = 100). Sputum samples were examined for volume, quality and presence of acid-fast bacilli by experienced laboratory technicians blinded to study groups. Median age was 39.1 years (interquartile range 37.0-50.0); 94 (47%) were females, 106 (53%) were males, and 49 (24.5%) were HIV-infected. We found that the instructional video intervention was associated with detection of a higher proportion of microscopically confirmed cases (56%, 95% confidence interval [95% CI] 45.7-65.9%, sputum smear positive patients in the intervention group versus 23%, 95% CI 15.2-32.5%, in the control group, p sex, modified the effectiveness of the intervention by improving it positively. When asked how well the video instructions were understood, the majority of patients in the intervention group reported to have understood the video instructions well (97%). Most of the patients thought the video would be useful in the cultural setting of Tanzania (92%). Sputum submission instructional videos increased the yield of tuberculosis cases through better quality of sputum samples. If confirmed in larger studies, instructional videos may have a substantial effect on the case yield using sputum microscopy and also molecular tests. This low-cost strategy should be considered as part of the efforts to control TB in resource-limited settings. Pan African

Basic Studies of Distributed Discharge Limiters

Science.gov (United States)

2014-02-10

electron avalanche ionization discharges induced by a focused 110 GHz millimeter-wave beam in atmospheric air. Discharges take place in a free volume of...plasma. 3.1.7 Vacuum Ultraviolet emission from pulsed discharges at atmospheric pressure. Fig. 6. Energy level diagram for molecular and...the utilized spectral simulation software, SPECTRAPLOT. 3.1.8 Non-intrusive diagnostic method for dissociation degree in pulsed discharges

Newborn jaundice - discharge

Science.gov (United States)

... Biliary atresia Bili lights Bilirubin blood test Bilirubin encephalopathy Exchange transfusion Jaundice and breastfeeding Newborn jaundice Premature infant Rh incompatibility Patient Instructions Newborn ...

Supersonic CO electric-discharge lasers

Science.gov (United States)

Hason, R. K.; Mitchner, M.; Stanton, A.

1975-01-01

Laser modeling activity is described which involved addition of an option allowing N2 as a second diatomic gas. This option is now operational and a few test cases involving N2/CO mixtures were run. Results from these initial test cases are summarized. In the laboratory, a CW double-discharge test facility was constructed and tested. Features include: water-cooled removable electrodes, O-ring construction to facilitate cleaning and design modifications, increased discharge length, and addition of a post-discharge observation section. Preliminary tests with this facility using N2 yielded higher power loadings than obtained in the first-generation facility. Another test-section modification, recently made and as yet untested, will permit injection of secondary gases into the cathode boundary layer. The objective will be to vary and enhance the UV emission spectrum from the auxiliary discharge, thereby influencing the level of photoionization in the main discharge region.

The ASDEX Upgrade discharge schedule

International Nuclear Information System (INIS)

Neu, G.; Engelhardt, K.; Raupp, G.; Treutterer, W.; Zasche, D.; Zehetbauer, T.

2007-01-01

ASDEX Upgrade's recently commissioned discharge control system (DCS) marks the transition from a traditional programmed system to a highly flexible 'data driven' one. The allocation of application processes (APs) to controllers, the interconnection of APs through uniquely named signals, and AP control parameter values are all defined as data, and can easily be adapted to the requirements of a particular discharge. The data is laid down in a set of XML documents which APs request via HTTP from a configuration server before a discharge. The use of XML allows for easy parsing, and structural validation through (XSD) schemas. The central input to the configuration process is the discharge schedule (DS), which embodies the dynamic behaviour of a planned discharge as reference trajectories grouped in segments, concatenated through transition conditions. Editing, generation and validation tools, and version control through CVS allow for efficient management of DSs

The practice of terminal discharge.

Science.gov (United States)

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

2017-01-01

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

Who breaches the four-hour emergency department wait time target? A retrospective analysis of 374,000 emergency department attendances between 2008 and 2013 at a type 1 emergency department in England.

Science.gov (United States)

Bobrovitz, Niklas; Lasserson, Daniel S; Briggs, Adam D M

2017-11-02

The four-hour target is a key hospital emergency department performance indicator in England and one that drives the physical and organisational design of the ED. Some studies have identified time of presentation as a key factor affecting waiting times. Few studies have investigated other determinants of breaching the four-hour target. Therefore, our objective was to describe patterns of emergency department breaches of the four-hour wait time target and identify patients at highest risk of breaching. This was a retrospective cohort study of a large type 1 Emergency department at an NHS teaching hospital in Oxford, England. We analysed anonymised individual level patient data for 378,873 emergency department attendances, representing all attendances between April 2008 and April 2013. We examined patient characteristics and emergency department presentation circumstances associated with the highest likelihood of breaching the four-hour wait time target. We used 374,459 complete cases for analysis. In total, 8.3% of all patients breached the four-hour wait time target. The main determinants of patients breaching the four-hour wait time target were hour of arrival to the ED, day of the week, patient age, ED referral source, and the types of investigations patients receive (p target were older, presented at night, presented on Monday, received multiple types of investigation in the emergency department, and were not self-referred (p target including patient age, ED referral source, the types of investigations patients receive, as well as the hour, day, and month of arrival to the ED. Efforts to reduce the number of breaches could explore late-evening/overnight staffing, access to diagnostic tests, rapid discharge facilities, and early assessment and input on diagnostic and management strategies from a senior practitioner.

Prospect for Cell Phones as Instructional Tools in the EFL Classroom: A Case Study of Jahangirnagar University, Bangladesh

Science.gov (United States)

Begum, Roksana

2011-01-01

The aim of this study was to investigate the potentiality of cell phone use in the EFL classroom of Bangladesh as an instructional tool. The researcher conducted a case study on Jahangirnagar University of Bangladesh. For the study, some SMS based class tests were conducted in the English Department of the university where one hundred…

Evaluation of a Theory of Instructional Sequences for Physics Instruction

Science.gov (United States)

Wackermann, Rainer; Trendel, Georg; Fischer, Hans E.

2010-05-01

The background of the study is the theory of basis models of teaching and learning, a comprehensive set of models of learning processes which includes, for example, learning through experience and problem-solving. The combined use of different models of learning processes has not been fully investigated and it is frequently not clear under what circumstances a particular model should be used by teachers. In contrast, the theory under investigation here gives guidelines for choosing a particular model and provides instructional sequences for each model. The aim is to investigate the implementation of the theory applied to physics instruction and to show if possible effects for the students may be attributed to the use of the theory. Therefore, a theory-oriented education programme for 18 physics teachers was developed and implemented in the 2005/06 school year. The main features of the intervention consisted of coaching physics lessons and video analysis according to the theory. The study follows a pre-treatment-post design with non-equivalent control group. Findings of repeated-measures ANOVAs show large effects for teachers' subjective beliefs, large effects for classroom actions, and small to medium effects for student outcomes such as perceived instructional quality and student emotions. The teachers/classes that applied the theory especially well according to video analysis showed the larger effects. The results showed that differentiating between different models of learning processes improves physics instruction. Effects can be followed through to student outcomes. The education programme effect was clearer for classroom actions and students' outcomes than for teachers' beliefs.

A girl of Klippel-Trenaunay Weber syndrome coexistence of recurrent bloody vaginal discharge.

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Turkmen, Mehmet; Kavukçu, Salih; Çakmakci, Handan; Soylu, Alper; Aktan, Sebnem; Çağan, Yeliz

2010-09-01

Klippel-Trenaunay Weber syndrome (KTWS) is the coexistence of capillary vascular malformations, varicose veins, dilated arteries and arteriovenous fistulas, soft tissue and/or bone hypertrophy. We present a girl of KTWS associated with hypertrophied left kidney, enlargement in venous structures of the left kidney, recurrent bloody vaginal discharge and angiokeratomas. A 6-year-old girl was admitted to our department with complaints of recurrent bloody vaginal discharge and swelling in the left inguinal region. Physical examination revealed hypertrophy of the left lower extremity. Vaginoscopy and cystoscopy revealed normal findings. Abdominal ultrasound revealed an enlarged left kidney. Enlargement in the venous structures of the hypertrophied left kidney was detected by abdominal magnetic resonance imaging, and arteriovenous fistulas were revealed by conventional angiography. The patient was diagnosed KTWS. Ophthalmic examination was normal. Galactosidase A (GLA) level was found to be at the lower limit of the normal range, and mutation was not detected in the GLA gene. In conclusion, we have emphasized that the girls with recurrent vaginal discharge might be KTWS. Angiokeratoma may be considered as a dermatological finding of KTWS. KTWS may also have enlarged kidney and enlargement in venous structures of the kidney in hypertrophied side.

Teachers' Beliefs, Instructional Behaviors, and Students' Engagement in Learning from Texts with Instructional Pictures

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Schroeder, Sascha; Richter, Tobias; McElvany, Nele; Hachfeld, Axinja; Baumert, Jurgen; Schnotz, Wolfgang; Horz, Holger; Ullrich, Mark

2011-01-01

This study investigated the relations between teachers' pedagogical beliefs and students' self-reported engagement in learning from texts with instructional pictures. Participants were the biology, geography, and German teachers of 46 classes (Grades 5-8) and their students. Teachers' instructional behaviors and students' engagement in learning…

Instructional Design as Knowledge Management: A Knowledge-in-Practice Approach to Choosing Instructional Methods

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McIver, Derrick; Fitzsimmons, Stacey; Flanagan, David

2016-01-01

Decisions about instructional methods are becoming more complex, with options ranging from problem sets to experiential service-learning projects. However, instructors not trained in instructional design may make these important decisions based on convenience, comfort, or trends. Instead, this article draws on the knowledge management literature…

FDX: a fast discharge homopolar generator

International Nuclear Information System (INIS)

Weldon, W.F.; Rylander, H.G.; Woodson, H.H.

1977-01-01

A study was undertaken to determine the fundamental limitations to the discharge times of homopolar generators. As a result of the study, a Fast Discharge Experiment (FDX) was proposed. FDX is a small (365 kJ), counterrotating disk type homopolar generator designed to explore the limits to homopolar generator discharge times. The FDX rotors are forged aluminum alloy with flame sprayed copper slip rings. Solid copper graphite brushes are used with a 95% packing factor on the slip rings. The high magnetic field required for fast discharge (3.6 T average) is provided by discharging the CEM 5.0 MJ homopolar generator into a four-turn, graphite-reinforced, room temperature copper coil. Since the field is pulsed and FDX rotors cannot be self motored, they are brought up to speed with two 37 kW air turbines. The two aluminum rotors are 30 cm in diameter and of a rimmed, modified constant stress configuration. They are designed for a maximum operating speed of 28,000 r/min at which point they each store 182.5 kJ and develop 104 V. The aluminum discharge coax is approximately 38 cm in diameter and is designed to carry the 1.88 MA anticipated from a half speed (14,000 r/min) short circuit discharge which would stop the rotors in 1.0 ms. It is predicted that the machine will ring on its own internal impedance for approximately five cycles in this mode. The discharge coax is shorted by four very fast making switches. Additional impedance can be introduced into the discharge circuit by extending the switch coaxes to allow full speed 1.4 MA discharges in approximately 3.5 ms

Early hospital discharge and early puerperal complications.

Science.gov (United States)

Ramírez-Villalobos, Dolores; Hernández-Garduño, Adolfo; Salinas, Aarón; González, Dolores; Walker, Dilys; Rojo-Herrera, Guadalupe; Hernández-Prado, Bernardo

2009-01-01

To evaluate the association between time of postpartum discharge and symptoms indicative of complications during the first postpartum week. Women with vaginal delivery at a Mexico City public hospital, without complications before the hospital discharge, were interviewed seven days after delivery. Time of postpartum discharge was classified as early (25 hours). The dependent variable was defined as the occurrence and severity of puerperal complication symptoms. Out of 303 women, 208 (68%) were discharged early. However, women with early discharge and satisfactory prenatal care had lower odds of presenting symptoms in early puerperium than women without early discharge and inadequate prenatal care (OR 0.36; 95% confidence intervals = 0.17-0.76). There was no association between early discharge and symptoms of complications during the first postpartum week; the odds of complications were lower for mothers with early discharge and satisfactory prenatal care.

Treatment of Patients in the Vulnerable Phase (at Discharge or Early After Discharge

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Yuri Lopatin

2017-01-01

Full Text Available The clinical course of heart failure includes a period in which the patient is at increased risk of death or rehospitalisation for HF. This period is termed the “vulnerable phase” and occurs during the peri-acute HF phase, due to microenvironmental changes in the cardiovascular system. Typically, the vulnerability phase starts from the onset of an acute HF event leading to admission, continues through a peri-discharge period and lasts up to 6 months after discharge.These poor post-discharge outcomes also represent a significant socioeconomic burden. This articles reviews treatments that are beneficial in this important phase.

Self-Paced Instruction: Hello, Education

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Leuba, Richard J.; Flammer, Gordon H.

1975-01-01

Answers criticisms of self-paced instruction (SPI) by citing advantages of SPI over lecture methods. Concludes that criticisms of SPI are useful since they indicate in which areas further research should be conducted to improve this method of instruction. (MLH)

Utility of microbiological profile of symptomatic vaginal discharge in rural women of reproductive age group.

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Masand, Deepa Lokwani; Patel, Jaya; Gupta, Sweta

2015-03-01

Symptomatic vaginal discharge is the most frequent symptom in women of reproductive age group. Owing to social stigma majority of affected women hesitate to seek medical consultation. Therefore the actual incidence of vaginal discharge is much more than what is reported. The aim of the study is to determine the microbiological profile of symptomatic vaginal discharge in rural area and its utility in the management of genital tract infection. This was a descriptive type of observational study, conducted in sexually active women of reproductive age group (18-45 years) attending the OPD/IPD of Obstetrics and Gynaecology Department of National Institute of Medical Sciences, Shobhanagar, Jaipur (Rajasthan), over a period of 18 months from June 2012 to December 2013. Hundred sexually active non pregnant women of reproductive age group (18-45 years) were included in the study. After taking consent general physical examination along with pelvic examination was performed. Two high vaginal swabs and blood sample were collected for various tests. Hanging drop preparation was immediately made. This was followed by gram staining and culture. Chlamydia trachomatis IgM antibody was detected by ELISA method. Out of 100 women with symptomatic vaginal discharge, specific diagnosis was obtained in 89% of cases whereas no specific aetiology was found in 11% cases. Mean age was 32.60 years. Fifty-three percent patient had Bacterial vaginosis, candidiasis was found in 14% cases, 16% had Chlamydia trachomatis infection while Trichomonas vaginalis infection was detected in 6% cases. Homogenous discharge was most prevalent (52%), followed by mucopurulant discharge in 23% of women. Patient with symptomatic vaginal discharge need to be actively managed with appropriate antimicrobial agents. Judicious management may be helpful in prevention of HIV, HPV, CIN and post infection sequelae.

Microwave discharges in capillary tubes

International Nuclear Information System (INIS)

Dervisevic, Emil

1984-01-01

This research thesis aims at being a contribution to the study of microwave discharge by a surface wave, and more precisely focusses on the discharge in capillary tubes filled with argon. The author first present theoretical models which describe, on the one hand, the propagation of the surface wave along the plasma column, and, on the other hand, longitudinal and radial profiles of the main discharge characteristics. The second part addresses the study of the influence of parameters (gas pressure and tube radius) on discharge operation and characteristics. Laws of similitude as well as empirical relationships between argon I and argon II emission line intensities, electron density, and electric field in the plasma have been established [fr

Survival after hospital discharge for ST-segment elevation and non-ST-segment elevation acute myocardial infarction: a population-based study

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Darling CE

2013-07-01

Full Text Available Chad E Darling,1 Kimberly A Fisher,2 David D McManus,3,4 Andrew H Coles,5 Frederick A Spencer,5,6 Joel M Gore,3,4 Robert J Goldberg31Department of Emergency Medicine, 2Division of Pulmonary Critical Care, 3Department of Quantitative Health Sciences, 4Department of Medicine, 5Program for Gene Function and Expression, University of Massachusetts Medical School, Worcester, MA, USA; 6Department of Medicine, McMaster University, Hamilton, Ontario, CanadaBackground: Limited recent data are available describing differences in long-term survival, and factors affecting prognosis, after ST-segment elevation myocardial infarction (STEMI and non-ST-segment elevation myocardial infarction (NSTEMI, especially from the more generalizable perspective of a population-based investigation. The objectives of this study were to examine differences in post-discharge prognosis after hospitalization for STEMI and NSTEMI, with a particular focus on factors associated with reduced long-term survival.Methods: We reviewed the medical records of residents of the Worcester, MA, USA metropolitan area hospitalized at eleven central Massachusetts medical centers for acute myocardial infarction (AMI during 2001, 2003, 2005, and 2007.Results: A total of 3762 persons were hospitalized with confirmed AMI; of these, 2539 patients (67.5% were diagnosed with NSTEMI. The average age of study patients was 70.3 years and 42.9% were women. Patients with NSTEMI experienced higher post-discharge death rates with 3-month, 1-year, and 2-year death rates of 12.6%, 23.5%, and 33.2%, respectively, compared to 6.1%, 11.5%, and 16.4% for patients with STEMI. After multivariable adjustment, patients with NSTEMI were significantly more likely to have died after hospital discharge (adjusted hazards ratio 1.28; 95% confidence interval 1.14–1.44. Several demographic (eg, older age and clinical (eg, history of stroke factors were associated with reduced long-term survival in patients with NSTEMI and

Evaluation of Performance Indexes of Emergency Department

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Alireza Baratloo

2015-02-01

Full Text Available Introduction: The importance of evaluating performance indicators in the emergency department, as one of the most important departments of hospital, is obvious to everyone. Therefore, in this study we aimed to appraise the five performance indicators, approved by the ministry of health, in Shohadaye Tajrish hospital, Tehran, Iran. Methods: In a descriptive cross-sectional study based on the profiles of all the patients admitted to the emergency department, performance indicators in the emergency department were evaluated. The study was divided into 2 parts about the establishment of emergency medicine system and training the medical staff: the first 6 months of 1392 and the second. Then these 2 periods were compared using Mann-Whitney U test while P< 0.05 was considered as the level of significance. Results: Of the studied indicators, mean triage time was 6.04 minutes in the first 6 months which was reduced to 1.5 minutes in the second 6 months (p=0.016. In addition, the percentage of patients who moved out of the department in 12 hours was lowered from 97.3% in the first period to 90.4% in the second (p=0.004. While, the percentage of patients who were decided upon in 6 hours (p=0.2, unsuccessful CPR percentage (p=0.34 and patients discharged against medical advice (p=0.42 showed no significant difference. Conclusion: The results of this study showed that the establishment of the emergency medicine system in the emergency department could lead to more efficient triage. Due to the differences made after their establishment including: different pattern of the patients admitted, increased stay of the patients in the department due to their need for prolonged intensive care, a raise in patient referral to the hospital by pre-hospital services and a higher percentage of occupied hospital beds, other indicators have not shown a significant improvement.

Computer-based instruction system DIDAK and its application

International Nuclear Information System (INIS)

Gvozdjak, L.; Hanulova, L.; Jankovicova, A.; Scepanek, L.

1983-01-01

The DIDAK system has been developed for the instruction and training of specialized personnel of nuclear power plants. The structure of the instruction system comprises three processes: the author process, the instruction process and the administration process. Author processes provide the didactic data structure with instruction texts. In the text data base the instruction material is stored in 6 direct access nonformatted files. The instruction system receives information from the text data base and presents it to the student. According to the student's response it creates the preconditions for the further operation of the system which it stores in the data base for administration of instruction. This base contains data on the identification of students, on the instruction process of the individual and the instruction process as a whole. Administrative processes take place in the final stage. They provide information on the general course of instruction and make final evaluations. From the data base of products of the instruction process the said administrative processes produce output information for the teacher. The subject matter of each subject is divided into a finite number of elementary units of subject matter. Each elementary unit provides basic information on the explained subject matter and is followed by a check of the student's knowledge. In dependence on the results of this check the student either advances to a higher level elementary unit or proceeds to an alternative branch of the initial unit. (E.S.)

Comparison of glow discharge cleaning with Taylor-type discharge cleaning on JFT-2

International Nuclear Information System (INIS)

Yokokura, Kenji; Matsuzaki, Yoshimi; Tani, Takashi

1983-01-01

Method of glow discharge cleaning (GDC) was applied to JFT-2 tokamak and the cleaning effect of GDC was compared with that of taylor-type discharge cleaning (TDC) on the same machin. Results show clearly their individual characteristics to remove light impurities. Their abilities of surface cleaning were compared each other by observing cleanliness of sample surfaces with a AES and by measuring decay times of produced gas pressures during discharge cleanings with a mass-analyser. It was shown that TDC method is better by several times than GDC method from a mass-analyser measurement. Moreover discharge cleaning time necessary to reduce light impurities in the normal plasma to a certain level was compared by monitoring time evolution of radiation loss power with a bolometer, and the time by TDC was only one fifth of that by GDC. The advantage of TDC may come from the excellently high hydrogen flux which interacts with the limiter and the wall. (author)

Self-stabilized discharge filament in plane-parallel barrier discharge configuration: formation, breakdown mechanism, and memory effects

Science.gov (United States)

Tschiersch, R.; Nemschokmichal, S.; Bogaczyk, M.; Meichsner, J.

2017-10-01

Single self-stabilized discharge filaments were investigated in the plane-parallel electrode configuration. The barrier discharge was operated inside a gap of 3 mm shielded by glass plates to both electrodes, using helium-nitrogen mixtures and a square-wave feeding voltage at a frequency of 2 kHz. The combined application of electrical measurements, ICCD camera imaging, optical emission spectroscopy and surface charge diagnostics via the electro-optic Pockels effect allowed the correlation of the discharge development in the volume and on the dielectric surfaces. The formation criteria and existence regimes were found by systematic variation of the nitrogen admixture to helium, the total pressure and the feeding voltage amplitude. Single self-stabilized discharge filaments can be operated over a wide parameter range, foremost, by significant reduction of the voltage amplitude after the operation in the microdischarge regime. Here, the outstanding importance of the surface charge memory effect on the long-term stability was pointed out by the recalculated spatio-temporally resolved gap voltage. The optical emission revealed discharge characteristics that are partially reminiscent of both the glow-like barrier discharge and the microdischarge regime, such as a Townsend pre-phase, a fast cathode-directed ionization front during the breakdown and radially propagating surface discharges during the afterglow.

Ballooning stability of JET discharges

International Nuclear Information System (INIS)

Huysmans, G.T.A.; Goedbloed, J.P.; Galvao, R.M.O.; Lazzaro, E.; Smeulders, P.

1989-01-01

Conditions under which ballooning modes are expected to be excited have recently been obtained in two different types of discharges in JET. In the first type, extremely large pressure gradients have been produced in the plasma core through pellet injections in the current rise phase followed by strong additional heating. In the second type, the total pressure of the discharge is approaching the Troyon limit. The stability of these discharges with respect to the ideal MHD ballooning modes has been studied with the stability code HBT. The equilibria are reconstructed with the IDENTC code using the external magnetic measurements and the experimental pressure profile. The results show that the evaluated high beta discharge is unstable in the central region of the plasma. This instability is related to the low shear and not to a large pressure gradient, as expected at the Troyon limit. In the pellet discharges the regions with the large pressure gradients are unstable to ballooning modes at the time of the beta decay, which ends the period of enhanced performance. The maximum pressure gradient in these discharges is limited by the boundary of the first region of stability. The observed phenomena at the beta decay are similar to those observed at the beta limit in DIII-D and TFTR. (author)

On regulation of radioactive airborne discharge

International Nuclear Information System (INIS)

Stroganov, A.A.; Kuryndin, A.V.; Shapovalov, A.S.; Orlov, M.Yu.

2013-01-01

Authors present the Russian regulatory basis of radioactive airborne discharges which was updated after enactment of the Methodology for airborne discharge limits development. Criteria for establishing of airborne discharge limits, scope and other features of methodology are also considered in the article [ru

Preparing for Further Introduction of Computing Technology in Vancouver Community College Instruction. Report of the Instructional Computing Committee.

Science.gov (United States)

Vancouver Community Coll., British Columbia.

After examining the impact of changing technology on postsecondary instruction and on the tools needed for instruction, this report analyzes the status and offers recommendations concerning the future of instructional computing at Vancouver Community College (VCC) in British Columbia. Section I focuses on the use of computers in community college…

Numerical simulation of transitions between back discharge regimes

International Nuclear Information System (INIS)

Jansky, Jaroslav; Lemont, Florent; Bessieres, Delphine; Paillol, Jean

2014-01-01

This paper presents numerical simulations of transitions between back discharge regimes. Back discharge refers to any discharge initiated at or near a dielectric layer covering a passive electrode. In this work, a pinhole in a dielectric layer on a plane anode serves as a model for back discharge activity. We have studied transitions between back discharge regimes by varying the surface charge density on the dielectric layer and the electric field in front of the pinhole. From the variation of these two independent parameters, the back discharge regimes have been depicted as a mode diagram inspired by the experimental study of Masuda and Mizuno. The resulting diagram includes the different discharge regimes that are commonly observed in experiments. The propagation of a positive ionizing wave inside the pinhole toward its edge, and the resulting formation of a plasma zone at its exit constitute the onset stage of back discharge. From this stage, the transitions to volume discharge or surface discharge can occur. The volume discharge regime consists of the propagation of a discharge in space toward the cathode which can be superimposed with the propagation of a discharge above the dielectric layer surface. The diagram reveals the conditions for transitions between back discharge regimes. (authors)

Capacitor discharges, magnetohydrodynamics, X-rays, ultrasonics

CERN Document Server

Früngel, Frank B A

1965-01-01

High Speed Pulse Technology, Volume 1: Capacitor Discharges - Magnetohydrodynamics - X-Rays - Ultrasonics deals with the theoretical and engineering problems that arise in the capacitor discharge technique.This book discusses the characteristics of dielectric material, symmetrical switch tubes with mercury filling, and compensation conductor forms. The transformed discharge for highest current peaks, ignition transformer for internal combustion engines, and X-ray irradiation of subjects in mechanical motion are also elaborated. This text likewise covers the transformed capacitor discharge in w

Explicit Instruction Elements in Core Reading Programs

Science.gov (United States)

Child, Angela R.

2012-01-01

Classroom teachers are provided instructional recommendations for teaching reading from their adopted core reading programs (CRPs). Explicit instruction elements or what is also called instructional moves, including direct explanation, modeling, guided practice, independent practice, discussion, feedback, and monitoring, were examined within CRP…

21 CFR 1309.03 - Information; special instructions.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Information; special instructions. 1309.03 Section... MANUFACTURERS, DISTRIBUTORS, IMPORTERS AND EXPORTERS OF LIST I CHEMICALS General Information § 1309.03 Information; special instructions. Information regarding procedures under these rules and instructions...

21 CFR 1301.03 - Information; special instructions.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 9 2010-04-01 2010-04-01 false Information; special instructions. 1301.03 Section... MANUFACTURERS, DISTRIBUTORS, AND DISPENSERS OF CONTROLLED SUBSTANCES General Information § 1301.03 Information; special instructions. Information regarding procedures under these rules and instructions supplementing...

How can we make user instructions motivational?

NARCIS (Netherlands)

Steehouder, M.F.; Loorbach, N.R.

2004-01-01

Good technical instructions are often viewed as 'cool, concise and professional', but there are good arguments to pay attention to their persuasive and motivational aspects as well. Until now, only analyses of existing instructions have been published, while guidelines for making instructions

Sexually transmitted infections in women: A correlation of clinical and laboratory diagnosis in cases of vaginal discharge syndrome

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Vidyalaxmi Chauhan

2014-01-01

Full Text Available Aims: This study compares the clinical and laboratory diagnosis of vaginal discharge syndrome. Settings and Design: This cross-sectional study was carried out at the gynaecology outpatient department of a tertiary care hospital in Gujarat, India. Material and Methods: Total of 180 females diagnosed as vaginal discharge or cervicitis based on syndromic approach and were recruited for the study. Their clinical profile was noted and they were investigated for bacterial vaginosis, trichomoniasis, candidiasis, gonorrhoea and chlamydia infection. Results: Lower abdominal pain (35% followed by burning micturition (23.9% were the common associated complaints. Bacterial vaginosis was the most common clinical diagnosis, while trichomoniasis was least common. Upon laboratory investigation, 35.6% of cases of vaginal discharge and 12% of cases of cervicitis tested positive. Percentage of cases confirmed by laboratory investigation was 50, 27.8 and 41.7 for bacterial vaginosis, trichomoniasis and candidiasis respectively. Conclusion: Among all the females diagnosed as vaginal discharge syndrome, a very small percentage actually turned out to be positive upon laboratory testing.

Flowing with the changing needs of hydrogeology instruction

Science.gov (United States)

Gleeson, T.; Allen, D. M.; Ferguson, G.

2012-01-01

Hydrogeology is now taught in a broad spectrum of departments and institutions to students with diverse backgrounds. Successful instruction in hydrogeology thus requires a variety of pedagogical approaches depending on desired learning outcomes and the diverse background of students. We review the pedagogical literature in hydrogeology to highlight recent advances and analyze a 2005 survey of 68 hydrogeology instructors. The literature and survey results suggest there are ~15 topics that are considered crucial by most hydrogeologists and >100 other topics that are considered crucial by some hydrogeologists. The crucial topics focus on properties of aquifers and fundamentals of groundwater flow, and should likely be part of all undergraduate hydrogeology courses. Other topics can supplement and support these crucial topics, depending on desired learning outcomes. Classroom settings continue to provide a venue for emphasizing fundamental knowledge. However, recent pedagogical advances are biased towards field and laboratory instruction with a goal of bolstering experiential learning. Field methods build on the fundamentals taught in the classroom and emphasize the collection of data, data uncertainty, and the development of vocational skills. Laboratory and computer-based exercises similarly build on theory, and offer an opportunity for data analysis and integration. The literature suggests curricula at all levels should ideally balance field, laboratory, and classroom pedagogy into an iterative and integrative whole. An integrated approach leads to greater student motivation and advancement of theoretical and vocational knowledge.

Active Learning through Online Instruction

Science.gov (United States)

Gulbahar, Yasemin; Kalelioglu, Filiz

2010-01-01