Search results for: discharge against medical advice

Authors: Rania Mustafa, Anfal Gadour

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Specialty area: Manchester University NHS Foundation Trust, Wythenshawe Hospital Accident and Emergency Department. About, Documentation of verbal and written head injury advice given to all adults presenting following a head injury. Our aim was to assess verbal & written head injury advice for an adult patient attending ED in Wythenshawe hospital during the period from January 2022 to May 2022, with a view to evaluating the NICE head injury guidelines concerning discharge advice and also to review the clinical notes to ensure that all adult patients presenting with a head injury are documented to have received both verbal & written head injury advice as per the NICE guidelines. Here we collected data from a random sample over a 1 month period. This data was furtherly filtered to include the adult patient >16 years and resulted in 54 patients with head injuries attending ED during this time period; then patient’s age, sex and hospital number were used to identify the discharge advice for the purpose of chart review and to assess the documentation of head injuries compliance with recommendation for NICE assessment. Data were checked between January 2022 up to May 2022 to allow more intervals for better assessment. Our finding indicates that documentation of verbal advice, 26% of patients were not recorded to have received this in January compared to only 3% in May & Written advice was not recorded in 44% of patients studied in January compared to 1% in May.

Keywords: head, injuries, advice, leaflets

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Authors: Mohammad Mohammadi, Mohammad Pashmchi

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Background: Malnutrition commonly develops and worsens following gastric cancer surgery, particularly after discharge, which is associated with adverse outcomes. Former studies have primarily focused on patients during their hospital stay period, and there is limited evidence regarding the recommendation of nutritional interventions for patients after discharge from the hospital following gastric cancer surgery. This review is aimed to evaluate the efficiency of post-discharge dietary counseling with oral nutritional supplements (ONS), and dietary counseling alone on post-surgical nutritional outcomes in patients undergoing gastric cancer surgery. Methods: The four databases of Embase, PubMed, web of science, and google scholar were searched up to November 2022 for relevant randomized controlled trials. The Cochrane Collaboration’s assessment tool for randomized trials was used to evaluate the quality of studies. Results: Compared to patients who only received dietary counseling, patients who received both dietary counseling and ONS had considerably higher SMI, BMI, and less weight loss and sarcopenia occurrence rate. The patients who had received dietary counseling and ONS had significantly lower risk of chemotherapy intolerance. No differences in the readmission rate between the two groups was found. In terms of the quality of life, concomitant dietary advice and ONS significantly was associated with lower appetite loss and fatigue rate, but there was no difference in the other outcomes between the two groups. Conclusions: Post-discharge dietary advice with ONS following gastric cancer surgery may improve skeletal muscle maintenance, nutritional outcomes, quality of life variables, and chemotherapy tolerance. This evidence supports the recommendation of post-discharge dietary advice with ONS for patients who underwent gastric cancer surgery.

Keywords: gastric cancer surgery, oral nutritional supplements, malnutrition, gastric cancer

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Authors: Mohammed Alateeq, Abdulaziz Alrshoud

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Objectives: To examine the attitude and practice of family physicians in giving smoking cessation advice at King Abdul-Aziz Medical City for National Guard, Riyadh. Methods: Cross sectional study using validated self-reported questionnaire that distributed to all family physicians and primary health care doctors at the four main family medicine and primary health care centers, KAMC, Riyadh. Results: 73 physicians are contributed in this study. 28 (38.4%) physicians were from (KASHM ALAN) clinic, 26 (35.6%) physicians were from (UM ALHAMAM) Clinic. 13 (17.8%) physicians were from (ISKAN) clinic. 6 (8.2%) physicians were from the Employee Health Clinic. 73 (100%) of the target population agreed that giving brief smoking cessation advice is part of their duties. 67 (91.7%) agreed that Presence of hospital guidelines and special clinics for smoking cessation will encourage them to provide advice. Only 5 (6.84%) received training courses (1-4 weeks) in smoking cessation interventions. Conclusion: Most of the target population agreed that brief smoking cessation advice is part of their duties. Also, they agreed that Presence of hospital guidelines and special clinics for smoking cessation will encourage them to provide advice although most of them did not received a formal training in smoking cessation advice.

Keywords: advice, attitude, cessation, family physicians, smoking

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Authors: Ajay Kumar Yadav, Masum Paudel, Ritesh Chaudhary

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Background: Understanding the diagnosis and the treatment plan is very important for the patient which reflects the effectiveness of the patient care as well as counseling. Large groups of patients do not understand their emergency care plan or their discharge instructions. With only a little more than 2/3ʳᵈ of the adult population is literate and poorly distributed health service institutions in Nepal, exploring the current status of patient understanding of their diagnosis and treatment would help identify interventions to improve patient compliance with the provided care and the treatment outcomes. Objectives: This study was conducted to identify and describe the areas of patients’ understanding and confusion regarding emergency care and discharge instructions at the Emergency ward of B. P. Koirala Institute of Health Sciences teaching hospital, Dharan, Nepal. Methods: A cross-sectional study was conducted among 426 patients discharged from the emergency unit of BPKIHS. Cases who are leaving against medical advice absconded cases and those patients who came just for vaccination are excluded from the study. Patients’ understanding of the treatment plan and diagnosis was measured. Results: There were 60% men in this study. More than half of the participants reported not being able to read English. More than 90% of the respondents reported they could not read their prescription at all. While patient could point out their understanding of their diagnosis at discharge, most of them could not tell the names and the dosage of all the drugs prescribed to them at discharge. More than 95% of the patients could not tell the most common side effects of the drugs that they are prescribed. Conclusions: There is a need to further explore the factors influencing the understanding of the patients regarding their treatment plan. Interventions to understand the health literacy needs and ways to improve the health literacy of the patients are needed.

Keywords: discharge instruction, emergency ward, health literacy, treatment plan

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Authors: Mohammad Abu-Taleb

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The final report of the Royal Commission into Australian financial services misconduct, released in February 2019, has had a significant impact on the financial advice industry. The recommendations released in the Commissioner’s final report include changes to ongoing fee arrangements, a new disciplinary system for financial advisers, and mandatory reporting of compliance concerns. This thesis aims to explore the impact of the Royal Commission’s recommendations on the operating model of financial advice firms in terms of advice products, processes, delivery models, and customer segments. Also, this research seeks to investigate whether the Royal Commission’s outcome has accelerated the use of enhanced technology solutions within the operating model of financial advice firms. And to identify the key challenges confronting financial advice firms whilst implementing the Commissioner’s recommendations across their operating models. In order to achieve the objectives of this thesis, a qualitative research design has been adopted through semi-structured in-depth interviews with 24 financial advisers and managers who are engaged in the operation of financial advice services. The study used the thematic analysis approach to interpret the qualitative data collected from the interviews. The findings of this thesis reveal that customer-centric operating models will become more prominent across the financial advice industry in response to the Commissioner’s final report. And the Royal Commission’s outcome has accelerated the use of advice technology solutions within the operating model of financial advice firms. In addition, financial advice firms have started more than before using simpler and more automated web-based advice services, which enable financial advisers to provide simple advice in a greater scale, and also to accelerate the use of robo-advice models and digital delivery to mass customers in the long term. Furthermore, the study identifies process and technology changes as, long with technical and interpersonal skills development, as the key challenges encountered financial advice firms whilst implementing the Commissioner’s recommendations across their operating models.

Keywords: hayne royal commission, financial planning advice, operating model, advice products, advice processes, delivery models, customer segments, digital advice solutions

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Authors: Nurzarimah Jamil, Mohd Nazaruddin Jamil

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This paper is a preliminary study about The Importance of Political Advice in Islam: Ḥadīth Thematical Study by showing the concept and proper ways to advice to politician based on hadith Prophet Muhammad (PBUH). The unique of political advice in Islam that Muslim already have the strong and fulfil example that can be apply in nowadays governance that is the way of political and leadership Prophet Muhammad show in his time. As a political leader, the Prophet Muhammad (PBUH) established a great state whose capital was Madinah. However, his real political leadership was in the realm of morality and spirituality in which he conducted himself perfectly in situations of weakness as well as strength. His way of dealing in Makkah and Madinah indicates his great political leadership. Based on fact nowadays some of the country not practicing the proper way to advice to rulers or governance that make a lot of madness around them. This paper also aims the concept and the proper way that can be following to all Muslim to advising by the politeness, justice and kindness.

Keywords: Hadith, leadership, political advice, Prophet Muhammad

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Authors: Asma AlAmri, Ahmed Hassab Errasoul

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Background & Objectives: Psychiatric disorders are common, affecting approximately one of five adults (17.6%) of the population. While most patients can be successfully treated as outpatients, admission to psychiatric wards is required during relapses or as part of crisis intervention. The first 72h of admission could be particularly critical due to increased risk of physical violence, non-medical discharge and absconding. Many patients requiring interventions such as seclusion, physical restrain, PRN psychotropic medications. This study aims to investigate the relationship between demographical, clinical and pharmacological factors in one hand and certain outcomes (physical aggression, use of PRN medications, need for seclusions and non-medical discharges) within the first 72hours of admission to acute psychiatric wards in KKUH/Riyadh Methods: All admissions to psychiatric wards over a 20 month period, between (May 2015- January 2017) were included. Data was collected on demographics, diagnosis, psychotropic medications prescription, documented physical aggression, and seclusion, self-discharge and absconding. Results: 134 males and 171 females were admitted over the study period. Mean age was 34.2 years (SD 11.96).48.9% (n=149) were single and most patients (n=198) were either unemployed or in educations. Bipolar disorder was the most frequent diagnosis recorded on admission (39.3%, n=120); followed by Schizophrenia and related disorders (34.8%; n=106). Most patients (77.4%, n= 236) received regular psychotropic medications on admission. Vis a vis, 223 patients (73%) received PRN medications. Nominal regression model revealed positive relationship between “no psychotropics prescribed on admission” and self-discharge in women but not in men. No statistically significant relationship was found between age, gender, admission diagnosis and use of regular psychotropic medications on admission and need for seclusion, time spent in seclusion, documented physical aggression and use of PRN medications. Conclusion: Contrary to what is expected, our study does not show association between gender, physical aggression and need for seclusion. This could be due to poor documentation practices by nursing staff in male ward comparing with those in the female ward. Use of PRN psychotropics in the first 72 hours of admission was quite high possibly leading to a “ceiling effect”. A limitation of this study is the retrospective data collection.

Keywords: discharge against medical advice, physical aggression, psychotropics, seclusion

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Authors: M. T. Bouziane, A. Benkhaled, B. Achour

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In this study, data from 30 catchments in the Chott Melghir basin in the semiarid region of southern East Algeria were analyzed to investigate changes in annual discharge, annual precipitation over the 1965-2005 period. These data were analyzed with the aid of Kendall test trend and regression analysis. The results indicate that the major variations in all catchments discharge in Chott Melghir correspond well to the precipitation. Changes in total annual discharge of Chott Melghir were lower than changes in annual precipitation. Annual precipitation decreased by 66 percent and annual discharge decreased by 4 percent. No significant trend is detected for annual discharge and precipitation at major catchments up to 95% confidence level. The decreasing trend in Chott Melghir discharge is mainly attributed to the decrease of precipitation.

Keywords: trends, climate change, precipitation, discharge, Kendall test, regression analysis, Chott Melghir catchments

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Authors: Razieh Karimian, Kim Burton, Mohammad Mehdi Naghizadeh, Maryam Karimian

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Introduction: Habitual upper body postures are associated with online learning during the COVID-19 pandemic. This study explored whether adding an exercise routine to an ergonomic advice intervention improves these postures. Methods: In this randomized trial, 42 male adolescent students with a forward head posture were randomly divided into two equal groups, one allocated to ergonomic advice alone and the other to ergonomic advice plus an exercise routine. The angles of forward head, shoulder, and back postures were measured with a photogrammetric profile technique before and after the 8-week intervention period. Findings: During home quarantine, 76% of the students used their mobile phones, while 35% used a table-chair-computer for online learning. While significant reductions of the forward, shoulder, and back angles were found in both groups (P < 0.001), the effect was significantly greater in the exercise group (P < 0.001: forward head, shoulder, and back angles reduced by some 9, 6, and 5 degrees respectively, compared with 4 degrees in the forward head, and 2 degrees in the shoulder and back angles for ergonomic advice alone. Conclusion: The exercise routine produced a greater improvement in habitual upper body postures than ergonomic advice alone, a finding that may extend beyond online learning at home.

Keywords: randomized trial, online learning, adolescent, posture, exercise, ergonomic advice

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Authors: K. Roushanger, A. Soleymanzadeh

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Weirs are structures often used in irrigation techniques, sewer networks and flood protection. However, the hydraulic behavior of this type of weir is complex and difficult to predict accurately. An accurate flow prediction over a weir mainly depends on the proper estimation of discharge coefficient. In this study, the Genetic Expression Programming (GEP) approach was used for predicting trapezoidal and rectangular sharp-crested side weirs discharge coefficient. Three different performance indexes are used as comparing criteria for the evaluation of the model’s performances. The obtained results approved capability of GEP in prediction of trapezoidal and rectangular side weirs discharge coefficient. The results also revealed the influence of downstream Froude number for trapezoidal weir and upstream Froude number for rectangular weir in prediction of the discharge coefficient for both of side weirs.

Keywords: discharge coefficient, genetic expression programming, trapezoidal weir

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Authors: Arijit Basuray

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It is well known that if an electrical insulation system is stressed under high voltage then discharge may occur in various form and if the system is made of composite dielectric having interfaces of materials having different dielectric constant discharge may occur due to gross mismatch of dielectric constant causing intense local field in the interfaces. Here author has studied, firstly, behavior of discharges in gaseous dielectric circuit under AC and DC voltages. A gaseous dielectric circuit is made such that a pair of electrode of typical geometry is used to make the discharges occur under application of AC and DC voltages. Later on, composite insulation system with air gap is also studied. Discharge response of the dielectric circuit is measured across a typically designed impedance. The time evolution of the discharge characteristics showed some interesting chaotic behavior. Author here proposed some analysis of such behavior of the discharge pattern and discussed about the possibility of presence of such discharge circuit in lumped electric circuit.

Keywords: electrical insulation system, EIS, composite dielectric, discharge, chaos

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Authors: M. A. Ansari, A. Hussain, A. Uddin

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A side weir is a flow diversion structure provided in the side wall of a channel to divert water from the main channel to a branch channel. The trapezoidal labyrinth weir is a special type of weir in which crest length of the weir is increased to pass higher discharge. Experimental and numerical studies related to the coefficient of discharge of trapezoidal labyrinth weir in an open channel have been presented in the present study. Group Method of Data Handling (GMDH) with the transfer function of quadratic polynomial has been used to predict the coefficient of discharge for the side trapezoidal labyrinth weir. A new model is developed for coefficient of discharge of labyrinth weir by regression method. Generalized models for predicting the coefficient of discharge for labyrinth weir using Group Method of Data Handling (GMDH) network have also been developed. The prediction based on GMDH model is more satisfactory than those given by traditional regression equations.

Keywords: discharge coefficient, group method of data handling, open channel, side labyrinth weir

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Authors: W. Benstaali, A. Belasri

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In this work we study a planar lamp filled with neon-xenon gas. We use a one-dimensional particle in a cell with Monte Carlo simulation (PIC-MCC) to investigate the effect xenon concentration on the energy deposited on excitation, ionization and ions. A Xe-Ne discharge is studied for a gas pressure of 400 torr. The results show an efficient Xe20-Ne mixture with an applied voltage of 1.2KV; the xenon excitation energy represents 65% form total energy dissipated in the discharge. We have also studied electrical properties and the energy balance a discharge for Xe50-Ne which needs a voltage of 2kv; the xenon energy is than more important.

Keywords: dielectric barrier discharge, efficiency, excitation, lamps

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Authors: Kechnit Djamel, Ammarri Abdelhadi, Raphael Tshimang, Mark Trrig

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One of the most important aspects of monitoring rivers is navigation. The variation of discharge in the river generally produces a change in available draft for a vessel, particularly in the low flow season, which can impact the navigable water path, especially when the water depth is less than the normal one, which allows safe navigation for boats. The water depth is related to the bathymetry of the channel as well as the discharge. For a seasonal update of the navigation maps, a daily discharge value is required. Many novel approaches based on earth observation and remote sensing have been investigated for large rivers. However, it should be noted that most of these approaches are not currently able to directly estimate river discharge. This paper discusses the application of remote sensing tools using the analysis of the reflectance value of MODIS imagery and is combined with field measurements for the estimation of discharge. This approach is applied in the lower reach of the Congo River (Pool Malebo) for the period between 2019 and 2021. The correlation obtained between the observed discharge observed in the gauging station and the reflectance ratio time series is 0.81. In this context, a Discharge Reflectance Model (DRM) was developed to express discharge as a function of reflectance. This model introduces a non-contact method that allows discharge monitoring using earth observation. DRM was validated by field measurements using ADCP, in different sections on the Pool Malebo, over two different periods (dry and wet seasons), as well as by the observed discharge in the gauging station. The observed error between the estimated and measured discharge values ranges from 1 to 8% for the ADCP and from (1% to 11%) for the gauging station. The study of the uncertainties will give us the possibility to judge the robustness of the DRM.

Keywords: discharge monitoring, navigation, MODIS, empiric, ADCP, Congo River

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Authors: Ayliana Dharmawan, Heng Yong Sheng, Zhang Xiaojin, Tan Thai Lian

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To facilitate discharge planning, doctors are presently required to assign an Estimated Discharge Date (EDD) for each patient admitted to the hospital. This assignment of the EDD is largely based on the doctor’s judgment. This can be difficult for cases which are complex or relatively new to the doctor. It is hypothesized that a data-driven approach would be able to facilitate the doctors to make accurate estimations of the discharge date. Making use of routinely collected data on inpatient discharges between January 2013 and May 2016, a predictive model was developed using machine learning techniques to predict the Length of Stay (and hence the EDD) of inpatients, at the point of admission. The predictive performance of the model was compared to that of the clinicians using accuracy measures. Overall, the best performing model was found to be able to predict EDD with an accuracy improvement in Average Squared Error (ASE) by -38% as compared to the first EDD determined by the present method. It was found that important predictors of the EDD include the provisional diagnosis code, patient’s age, attending doctor at admission, medical specialty at admission, accommodation type, and the mean length of stay of the patient in the past year. The predictive model can be used as a tool to accurately predict the EDD.

Keywords: inpatient, estimated discharge date, EDD, prediction, data-driven

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Authors: Sajia Islam, T. Tahsina, S. Raihana, M. M. Rahman, Q. S. Rahman, T. M. Huda, S. E. Arifeen, M. J. Dibley

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Early neonatal sepsis accounts for more than two-thirds of all deaths in the first year of life. This study assessed the counseling during antenatal, perinatal, post natal periods and its association with possible sepsis in rural Bangladesh. Method: Data were collected from a large community-based trial in Bangladesh where pregnant women were enrolled from 2013-2015 covering 29,497 newborns. Sepsis was defined using neonatal danger signs reported by 'The Young-Infants Clinical Science Study Group. 'Result: Signs of sepsis was found among 15% of the neonates. Neonatal sepsis was higher among those who did not receive advice on TT vaccinations (15.4% vs. 11%, p < 0.05) and danger signs (14.8% vs. 12.8%, p < 0.05) during pregnancy. Advice on delivering in well-lit place was significantly associated with lower incidence of sepsis (12.7% vs. 14.8% p < 0.05). Sepsis was lower among neonates whose mothers were counseled on immediate newborn care for bathing after 3 days of delivery (13.4% vs. 15.2% p=0), breastfeeding within 1hr of birth (13.82 % vs. 15.28% p=0), apply nothing on the cord (11.54 vs. 15.06 p=0), immediate drying of child (12.62% vs. 14.89%, p=0). Neonatal sepsis was lower among children whose mothers received 2-4 advice [OR=0.91(95% CI: 0.85-0.97)] compared to neonates whose mothers received only 1 or none. Overall, children to mothers who received ≥ 5 advice had lowest incidence of sepsis [OR=0.83 (95% CI: 0.71-0.97)] Conclusion: Advice on antenatal, prenatal and post natal is significantly reduced with early newborn sepsis. Further research is required to identify specific type of counseling messages that translate into practices and reduce pathways towards early-newborn morbidities.

Keywords: ante natal care, counseling, neonatal sepsis, post natal care

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Authors: N. Bendimerad, M. Lemerini, A. Guen

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In this work, we propose to determine the density of neutral particles of an electric discharge peak - Plan types performed in air at atmospheric pressure by applying a technique based on laser interferometry. The experimental methods used so far as the shadowgraph or stereoscopy, give rather qualitative results with regard to the determination of the neutral density. The neutral rotational temperature has been subject of several studies but direct measurements of kinetic temperature are rare. The aim of our work is to determine quantitatively and experimentally depopulation with a Mach-Zehnder type interferometer. This purely optical appearance of the discharge is important when looking to know the refractive index of any gas for any physicochemical applications.

Keywords: laser source, Mach-Zehnder interferometer, refractive index, corona discharge

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Authors: Mathew Saxon A, Aneeh Rajan, Sajeev P

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Many fluid flow applications employ different types of orifices to control the flow rate or to reduce the pressure. Discharge coefficients generally vary from 0.6 to 0.95 depending on the type of the orifice. The tabulated value of discharge coefficients of various types of orifices available can be used in most common applications. The upstream and downstream flow condition of an orifice is hardly considered while choosing the discharge coefficient of an orifice. But literature shows that the discharge coefficient can be affected by the presence of cross flow. Cross flow is defined as the condition wherein; a fluid is injected nearly perpendicular to a flowing fluid. Most researchers have worked on water being injected into a cross-flow of water. The present work deals with water to gas systems in which water is injected in a normal direction into a flowing stream of gas. The test article used in the current work is called thermal regulator, which is used in a liquid rocket engine to reduce the temperature of hot gas tapped from the gas generator by injecting water into the hot gas so that a cooler gas can be supplied to the turbine. In a thermal regulator, water is injected through an orifice in a normal direction into the hot gas stream. But the injection orifice had been calibrated under backpressure by maintaining a stagnant gas medium at the downstream. The motivation of the present study aroused due to the observation of a lower Cd of the orifice in flight compared to the calibrated Cd. A systematic experimental investigation is carried out in this paper to study the effect of cross-flow on the discharge coefficient of an orifice in water to a gas system. The study reveals that there is an appreciable reduction in the discharge coefficient with cross flow compared to that without cross flow. It is found that the discharge coefficient greatly depends on the ratio of momentum of water injected to the momentum of the gas cross flow. The effective discharge coefficient of different orifices was normalized using the discharge coefficient without cross-flow and it is observed that normalized curves of effective discharge coefficient of different orifices with momentum ratio collapsing into a single curve. Further, an equation is formulated using the test data to predict the effective discharge coefficient with cross flow using the calibrated Cd value without cross flow.

Keywords: cross flow, discharge coefficient, orifice, momentum ratio

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Authors: Qasim Khan, Furkan Ahmad, Asfar A. Khan, M. Saad Alam, Faiz Ahmad

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In this paper, partial discharge analysis is performed in cavities artificially created in insulation. The setup is according with Cigre-II Method. Circular Samples created from Perspex Sheet with different configuration with changing number of cavities. Assessment of insulation health can be performed by Partial Discharge measurement as this has been found to be important means of condition monitoring. The experiments are done using MPD 540, which is a modern partial discharge measurement system. By analyzing the PD activity obtained for various voids/cavities, it is observed that the PD voltages show variation for cavity’s diameter, depth even for its ratios. This can be employed for scrutiny of insulation system.

Keywords: partial discharges, condition monitoring, insulation defects, degradation and corrosion, PMMA

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Authors: Rudinë Fetahaj, Flaka Isufi, Kristina Hansson

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While evidence shows that in most European countries’ multilingualism is rising, unfortunately, the focus of Speech and Language Therapy (SLT) is still monolingualism. Furthermore, there is sparse information on how the needs of multilingual children with language disorders such as Developmental Language Disorder (DLD) are being met and which factors affect the intervention approach of SLTs when treating DLD. This study aims to examine the relationship and correlation between the number of languages SLTs speak, years of experience, and length of education with the advice they give to parents of multilingual children with DLD regarding which language to be spoken. This is a cross-sectional study where a survey was completed online by 2608 SLTs across Europe and data has been used from a 2017 COST-action project. IBM-SPSS-28 was used where descriptive analysis, correlation and Kruskal-Wallis test were performed.SLTs mainly advise the parents of multilingual children with DLD to speak their native language at home. Besides years of experience, language status and the level of education showed to have no association with the type of advice SLTs give. Results showed a non-significant moderate positive correlation between SLTs years of experience and their advice regarding the native language, whereas language status and length of education showed no correlation with the advice SLTs give to parents.

Keywords: quantitative study, developmental language disorders, multilingualism, speech and language therapy, children, European context

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Authors: Syed Hammad Ali, Rijan Bhakta Kayastha, Danial Hashmi, Richard Armstrong, Ahuti Shrestha, Iram Bano, Javed Hassan

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This paper presents the results of a semi-distributed modified positive degree-day model (MPDDM) for estimating snow and ice melt contributions to discharge from the glacierized Hunza River basin, Pakistan. The model uses daily temperature data, daily precipitation data, and positive degree day factors for snow and ice melt. The model is calibrated for the period 1995-2001 and validated for 2002-2013, and demonstrates close agreements between observed and simulated discharge with Nash–Sutcliffe Efficiencies of 0.90 and 0.88, respectively. Furthermore, the Weather Research and Forecasting model projected temperature, and precipitation data from 2016-2050 are used for representative concentration pathways RCP4.5 and RCP8.5, and bias correction was done using a statistical approach for future discharge estimation. No drastic changes in future discharge are predicted for the emissions scenarios. The aggregate snow-ice melt contribution is 39% of total discharge in the period 1993-2013. Snow-ice melt contribution ranges from 35% to 63% during the high flow period (May to October), which constitutes 89% of annual discharge; in the low flow period (November to April) it ranges from 0.02% to 17%, which constitutes 11 % of the annual discharge. The snow-ice melt contribution to total discharge will increase gradually in the future and reach up to 45% in 2041-2050. From a sensitivity analysis, it is found that the combination of a 2°C temperature rise and 20% increase in precipitation shows a 10% increase in discharge. The study allows us to evaluate the impact of climate change in such basins and is also useful for the future prediction of discharge to define hydropower potential, inform other water resource management in the area, to understand future changes in snow-ice melt contribution to discharge, and offer a possible evaluation of future water quantity and availability.

Keywords: climate variability, future discharge projection, positive degree day, regional climate model, water resource management

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Authors: Ji-Hyok Kim, Il-Gyong Paek, Yong-Jun Kim

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We propose a numerical model based on drift-diffusion theory and lattice Boltzmann method (LBM) to analyze the electro-hydrodynamic behavior in low-pressure direct current (DC) glow discharge plasmas. We apply the drift-diffusion theory for 4-species and employ the standard lattice Boltzmann model (SLBM) for the electron, the finite difference-lattice Boltzmann model (FD-LBM) for heavy particles, and the finite difference model (FDM) for the electric potential, respectively. Our results are compared with those of other methods, and emphasize the necessity of a two-dimensional analysis for glow discharge.

Keywords: glow discharge, lattice Boltzmann method, numerical analysis, plasma simulation, electro-hydrodynamic

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Authors: Jie Yang, Qifu Cheng, Yafang Liu, Zhijie Gu

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Controlled emissions of effluent from nuclear power plants are an important means of ensuring environmental safety. In order to fully grasp the actual discharge level of nuclear power plant in China's nuclear power plant in the pressurized water reactor and heavy water reactor, it will use the global average nuclear power plant effluent discharge as a reference to the standard analysis of China's nuclear power plant environmental discharge status. The results show that the average normalized emission of liquid tritium in PWR nuclear power plants in China is slightly higher than the global average value, and the other nuclides emissions are lower than the global average values.

Keywords: radioactive effluent, HWR, PWR, nuclear power plant

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Authors: War War Min Swe, Aung Myat Thu, Khin Cho Thet, Zaw Moe Htet, Thuzar Mon

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The main parameter of the orifice hole diameter was designed according to the range of throttle diameter ratio which gave the required discharge coefficient. The discharge coefficient is determined by difference diameter ratios. The value of discharge coefficient is 0.958 occurred at throttle diameter ratio 0.5. The throttle hole diameter is 80 mm. The flow analysis is done numerically using ANSYS 17.0, computational fluid dynamics. The flow velocity was analyzed in the upstream and downstream of the orifice meter. The downstream velocity of non-standard orifice meter is 2.5% greater than that of standard orifice meter. The differential pressure is 515.379 Pa in standard orifice.

Keywords: CFD-CFX, discharge coefficients, flow characteristics, inclined

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Authors: Asma Perveen, M. P. Jahan

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Ni alloys have managed to cover wide range of applications such as automotive industries, oil gas industries, and aerospace industries. However, these alloys impose challenges while using conventional machining technologies. On the other hand, Micro-Electro-Discharge machining (micro-EDM) is a non-conventional machining method that uses controlled sparks energy to remove material irrespective of the materials hardness. There has been always a huge interest from the industries for developing optimum methodology and parameters in order to enhance the productivity of micro-EDM in terms of reducing machining time and tool wear for different alloys. Therefore, the aims of this study are to investigate the effects of the micro-EDM process parameters, in order to find their optimal values. The input process parameters include voltage, capacitance, and electrode rotational speed, whereas the output parameters considered are machining time, entrance diameter of hole, overcut, tool wear, and crater size. The surface morphology and element characterization are also investigated with the use of SEM and EDX analysis. The experimental result indicates the reduction of machining time with the increment of discharge energy. Discharge energy also contributes to the enlargement of entrance diameter as well as overcut. In addition, tool wears show reduction with the increase of discharge energy. Moreover, crater size is found to be increased in size along with the increment of discharge energy.

Keywords: micro holes, micro EDM, Ni Alloy, discharge energy

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Authors: Chan Hui-Ya, Ding Shin-Tan

Abstract:

Background and Aim: The discharge planning is considered helpful to reduce the hospital length of stay and readmission rate, and then increased satisfaction with healthcare for patients and professionals. In order to decrease the waiting time of long-term care and boost the care quality of patients after discharge from the hospital, the Ministry of Health and Welfare department in Taiwan initiates a program “discharge planning connects with long-term care 2.0 services” in 2017. The purpose of this study is to investigate the outcome of the pilot of this program in a medical center. Methods: By purpose sampling, the study chose five wards in a medical center as pilot units. The researchers compared the beds of service, the numbers of cases which were transferred to the long-term care center and transferred rates per month between the pilot units and the other units, and analyze the basic data, the long-term care service needs and the approval service items of cases transfer to the long-term care center in pilot units. Results: From June to September 2017, a total of 92 referrals were made, and 51 patients were enrolled into the pilot program. There is a significant difference of transferring rate between the pilot units and the other units (χ = 702.6683, p < 0.001). Only 20 cases (39.2% success rate) were approved to accept the parts of service items of long-term care in the pilot units. The most approval item was respite care service (n = 13; 65%), while it was third at needs ranking of service lists during linking services process. Among the reasons of patients who cancelled the request, 38.71% reasons were related to the services which could not match the patients’ needs and expectation. Conclusion: The results indicate there is a requirement to modify the long-term care services to fit the needs of cases. The researchers suggest estimating the potential cases by screening data from hospital informatics systems and to hire more case manager according the service time of potential cases. Meanwhile, the strategies shortened the assessment scale and authorized hospital case managers to approve some items of long-term care should be considered.

Keywords: discharge planning, long-term care, case manager, patient care

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Authors: Chueh Chi-An, Chan Hui-Ya

Abstract:

Background and Aim: National Health Insurance (NHI) Administration released a new reimbursement policy for hospital patients who received a superior discharge plan on April 1, 2016. Each case could be claimed 1,500 points for fee-of service with related documents. The policy is considered a solution to help reducing the crowding in the emergency department, the length of stay of hospital, unplanned readmission rate and unplanned ER visit. This study aim is to explore the effect of the new reimbursement policy for discharge planning service in a medical center. Methods: The discharge team explained to general wards the new policy and encouraged early assessment, communication and connecting to community care for patients. They stated the benefit from the policy and asked documenting for reimbursement claiming from April to May 2016. The imbursement fee of NHI declaration from June 2015 to October 2017 was collected. The indicators included hospital occupancy rate, hospital bed turnover rate, long-term hospitalization rate, and patients’ satisfaction were analyzed after the policy implemented. Results: The results showed that the amount of service declaration was increasing from 2 cases in February 2016 to 110 cases in October 2017, the application rate was increasing from 0.029% to 1.576% of all inpatient cases, and the average payment from NHI was around 148,500 NT dollars per month in 2017. There are no significant differences in the indicators among hospital occupancy rate, hospital bed turnover rate, long-term hospitalization rate, and patients’ satisfaction. Conclusion: To provide a good discharge plan require a specialized case manager, the new reimbursement policy is too complicated and the total fee-of-service hospital could claim is too limited to hiring one. The results suggest more strategies combine with the new reimbursement policy will be needed.

Keywords: discharge planning, reimbursement, unplanned ER visit, readmission rate

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Authors: Arash Ahmadi, Amirreza Kavousizadeh, Sanaz Heidarzadeh

Abstract:

Stage-discharge curve is one of the conventional methods for continuous river flow measurement. In this paper, an innovative approach is proposed for predicting the stage-discharge relationship using the application of isovel contours. Using the proposed method, it is possible to estimate the stage-discharge curve in the whole section with only using discharge information from just one arbitrary water level. For this purpose, multivariate relationships are used to determine the mean velocity in a cross-section. The unknown exponents of the proposed relationship have been obtained by using the second version of the Strength Pareto Evolutionary Algorithm (SPEA2), and the appropriate equation was selected by applying the TOPSIS (Technique for Order Preferences by Similarity to an Ideal Solution) approach. Results showed a close agreement between the estimated and observed data in the different cross-sections.

Keywords: rating curves, SPEA2, natural rivers, bed roughness distribution

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Authors: E. Keramaris, V. Kanakoudis

Abstract:

In this study the water flow in an open channel over a sharp-crested weir is investigated experimentally. For this reason a series of laboratory experiments were performed in an open channel with a sharp-crested weir. The maximum head expected over the weir, the total upstream water height and the downstream water height of the impact in the constant bed of the open channel were measured. The discharge was measured using a tank put right after the open channel. In addition, the discharge and the upstream velocity were also calculated using already known equations. The main finding is that the relative error percentage for the majority of the experimental measurements is ± 4%, meaning that the calculation of the discharge with a sharp-crested weir gives very good results compared to the numerical results from known equations.

Keywords: sharp-crested weir, weir height, flow measurement, open channel flow

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Authors: Merle Talvik, Taimi Tulva, Kristi Puusepp, Ülle Ernits

Abstract:

Background data. This is a study in the field of health humanities. The 1930s were years of rapid cultural and economic development in Europe and in Estonia. The urban way of life the glamorous lifestyle gained popularity, although the society of Estonia in the 1930s had traditionally been agrarian. People's free time increased, which needed to be filled with activities either at home or outside the home. Therefore, the number of popular magazines aimed at housewives increased. More than 200 magazines and bulletins were published in the Republic of Estonia before the Second World War (in 1934, the population of Estonia was 1,126,000). In the 1930s, the Republic of Estonia faced several challenges in healthcare. Infectious diseases, alcoholism, prostitution and child mortality had to be dealt with. Healers without medical education operated in the villages. For the average person, medical care was quite expensive, and despite efforts, by 1940, only 20% of the population was covered by health insurance. Advice published in popular family magazines provided help in solving, understanding and preventing health problems. Aim. The aim of the study is to analyze the health counseling through magazines during the Republic of Estonia (1930-1940) in historical and cultural context. Method. In total, 420 magazine issues were processed. An extensive textual analysis, as well as an analysis of photographs and illustrations from the aspect of health advice was carried out to achieve the research objective. Results. Health counseling was written by well-known doctors of the time, leaders of the abstinence movement and others. There was advice in various areas: prevention of infectious and non-infectious diseases and their treatment with simple methods, first aid, combating sexually transmitted diseases, women's and children's health, mental health, folk medicine techniques, abstinence, healthy eating, skin care, hygiene, introducing pharmacy products. Advice was offered in both written and visual form. Photos and illustrations helped to empower the health advice. Folk heritage and health knowledge of the time were relied upon, and a scientific point of view was popularized. Aspirations towards a European lifestyle were reflected in articles and illustrations. Contribution. The article has an ethnological attitude, and its impact comes down to understanding the history of health care in its socio-cultural context. The health counseling topics of the 1930s are also applicable in today's health education and research. Health counseling builds on the legacy of the past, and it helps to understand that the past is in the future and the main principles of health counseling arise from our history and background.

Keywords: estonian republic, health counseling, lifestyle, magazines, media

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