scholarly journals The Influence of Jam Density and Merging Cyclists on the Queue Discharge Rate

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
M. J. Wierbos ◽  
V. L. Knoop ◽  
B. Goñi-Ros ◽  
S. P. Hoogendoorn
Keyword(s):  
Discharge Rate ◽  
Perpendicular Direction ◽  
Discharge Process ◽  
The Impact

An increasing number of people use the bicycle for urban trips resulting in local congestion at intersections, especially during peak hours. Understanding the queue dynamics is key to find the correct measures that can reduce the delays for cyclists without affecting other traffic modes. To this end, the discharge process of bicycle queues is studied, focusing on the impact of jam density on the queue discharge rate and how this process is affected by cyclists that merge into the queue during the discharge phase. The impact of merging cyclists is captured by a newly introduced bicycle equivalent (BE) value. This direction-specific BE value is used to convert a merging cyclist into a cyclist that is waiting in the original queue. Results show that the queue discharge rate increases with increasing density of the queue. Furthermore, cyclists that merge by overtaking contribute to the queue discharge rate, while cyclists who merge from a perpendicular direction hinder the discharge process, thereby decreasing the bicycle flow at the intersection. The insights can be used to develop measures which minimise delay at intersections and to design efficient infrastructure for bicyclists.

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

scholarly journals Kū Hou Kuapā: Cultural Restoration Improves Water Budget and Water Quality Dynamics in Heʻeia Fishpond

2018 ◽  
Author(s):  
Paula Mohlenkamp ◽  
Charles Kaiaka Beebe ◽  
Margaret A. McManus ◽  
Angela Hiʻilei Kawelo ◽  
Keliʻiahonui Kotubetey ◽  
...  
Keyword(s):  
Water Quality ◽  
Exchange Rates ◽  
Positive Impact ◽  
Discharge Rate ◽  
Quality Parameters ◽  
Stream Discharge ◽  
Bacterial Indicator ◽  
Average Abundance ◽  
Tidally Driven ◽  
The Impact

In Hawaiʻi, the transition from customary subsistence flooded taro agroecosystems, which regulate stream discharge rate trapping sediment and nutrients, to a plantation-style economy (c. the 1840s) led to nearshore sediment deposition - smothering coral reefs and destroying adjacent coastal fisheries and customary fishpond mariculture. To mitigate sediment transport, Rhizophora mangle was introduced in estuaries across Hawai’i (c. 1902) further altering fishpond ecosystems. Here, we examine the impact of cultural restoration between 2012-2018 at Heʻeia Fishpond, a 600-800-year-old walled fishpond. Fishpond water quality was assessed by calculating water exchange rates, residence times, salinity distribution, and abundance of microbial indicators prior to and after restoration. We hypothesized that R. mangle removal and concomitant reconstruction of sluice gates would increase mixing and decrease bacterial indicator abundance in the fishpond. We find that Heʻeia Fishpond’s physical environment is primarily tidally driven; wind forcing and river flux are secondary drivers. Post-restoration, two gates in the northeastern region account for >80% of relative flux in the fishpond. Increase in exchange rates during spring and neap tide and shorter minimum water residence time corresponded with the reconstruction of a partially obstructed 56 m gap together with the installation of an additional sluice gate in the fishpond wall. Lower mean salinities post-restoration suggests increased freshwater influx due to R. mangle removal. Spatial distribution of microbial bio-indicator species inversely correlated with salinity. Average abundance of Enterococcus and Bacteroidales did not significantly change after restoration efforts, however, average abundance of a biomarker specific to birds nesting in the mangroves decreased significantly after restoration. This study demonstrates the positive impact of biocultural restoration regimes on water flushing and water quality parameters, encouraging the prospect of revitalizing this and other culturally and economically significant sites for sustainable aquaculture in the future.

scholarly journals Psychiatric admission for homeless people: the impact of a specialist community mental health team

1997 ◽  
Vol 21 (5) ◽  
pp. 260-263 ◽  
Author(s):  
Martin Commander ◽  
Sue Odell ◽  
Sashi Sashidharan
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Homeless People ◽  
Discharge Process ◽  
Community Mental Health Team ◽  
Psychiatric Admission ◽  
Mental Health Team ◽  
Health Team ◽  
Before And After ◽  
The Impact

The difficulty in achieving good quality community mental health care for homeless people has received increasing attention during the last few years. Less consideration has been given to the provision of inpatient care. By comparing data collected before and after its inception, we examined the impact of a specialist community mental health team for homeless people on ‘no fixed abode’ admissions in Birmingham. Although the team was successfully involved in the admission and discharge process in a substantial proportion of cases, many admissions still took place out of hours and involved the police, while discharge was often against medical advice and occurred without follow-up. These findings and their implications for the provision of homeless services are discussed.

Chemical Current Source Express Diagnostics Using Noise Spectroscopy on the Example of Lithium-Thionyl Chloride Battery

2021 ◽  
pp. 136-143
Author(s):  
E.M. Petrenko ◽  
V.A. Semenova
Keyword(s):  
Thionyl Chloride ◽  
Discharge Rate ◽  
Current Source ◽  
Mean Value ◽  
Spectroscopy Method ◽  
Discharge Process ◽  
Absolute Deviation ◽  
Chemical Current Source ◽  
Measurement Analysis ◽  
Noise Spectroscopy

Lithium-thionyl chloride battery voltage is practically not changing during the discharge process and drops sharply being completely discharged. In this regard, the problem of non-destructive quality control of the chemical current sources (first of all, the discharge degree) before installation thereof in the equipment becomes of particular importance. Microcalorimetric studies make it possible to rather correctly determine the current source internal self-discharge rate, predict the LCCS shelf life and its performance term. However, the heat release absolute value in current sources with sufficient storability, i.e., with low self-discharge, is very small; therefore, it is necessary to use sensitive, stationary and large-sized equipment. This makes such diagnostics impossible when operating in the stand-alone conditions. The impedance spectroscopy method could be proposed to solve this problem. However, satisfactory results are only obtained in the 0--70 % residual capacitance range. Determination of residual capacitance in the 70--100 % range appears to be rather difficult due to the absence of noticeable alteration in the informative parameter within the limits of its absolute deviation from the mean value. In this regard, it looks advisable to use noise spectroscopy as a physically independent method in diagnosing the state of chemical current sources to expand the residual capacitance diagnostics range to the 70--100 % domain, as well as to increase reliability of the chemical current source diagnostic estimate in the range of 50--70 %. Results of the electrochemical noise measurement analysis confirm promising application of the noise spectroscopy method in estimating current state of the primary chemical current sources in their low discharge domains

scholarly journals Motor unit contributions to activation reduction and torque steadiness following active lengthening: a study of residual torque enhancement

2020 ◽  
Vol 123 (6) ◽  
pp. 2209-2216 ◽  
Author(s):  
Jennifer M. Jakobi ◽  
Samantha L. Kuzyk ◽  
Chris J. McNeil ◽  
Brian H. Dalton ◽  
Geoffrey A. Power
Keyword(s):  
Motor Unit ◽  
Discharge Rate ◽  
Motor Units ◽  
Electromyographic Activity ◽  
Torque Capacity ◽  
Active Motor ◽  
Motor Neuron Pool ◽  
Acute Condition ◽  
The Impact ◽  
Neuron Pool

Our findings indicate that lower electromyographic activity during the torque-enhanced condition following active lengthening compared with a purely isometric contraction arises from fewer active motor units and a lower discharge rate of those that are active. We used an acute condition of increased torque capacity to induce a decrease in net output of the motor neuron pool during a submaximal task to demonstrate, in humans, the impact of motor unit activity on torque steadiness.

scholarly journals Characteristics and the Potential Influence of Fugitive PM10 Emissions from Enclosed Storage Yards in Iron and Steel Plant

Atmosphere ◽  
2020 ◽  
Vol 11 (8) ◽  
pp. 833
Author(s):  
Zijie Lin ◽  
Fujiang Wang ◽  
Tao Ji ◽  
Baolong Ma ◽  
Linyan Xu ◽  
...  
Keyword(s):  
Wind Speed ◽  
Wind Direction ◽  
Discharge Rate ◽  
Particle Emission ◽  
Steel Plant ◽  
Fugitive Emission ◽  
Iron And Steel ◽  
Emission Estimation ◽  
The Impact ◽  
Pm10 Emissions

Fugitive particle emission of enclosed storage yards in iron and steel plant is a complicated and multivariable problem, which will have negative impacts on the environment and economy. Researchers have discussed methodologies of emission estimation in open storage yards, but rarely focused on enclosed ones. However, enclosed storage yards are commonly adopted in most industries in China. This paper links onsite observation and computational fluid dynamics (CFD) to estimate the impact of fugitive PM10 emissions from enclosed storage yards on the open air. By collecting and analyzing PM10 samples at three sites inside the yard and one site outside, The result shows that PM10 concentration is in the range of 7.3 ± 1.5~13.4 ± 4.2 mg/m3, which is extremely high in an enclosed storage yard, and significantly influences workers’ health inside and outside atmospheric aerosols. The CFD model simulation is conducted by considering particle deposition, particle emission sources of shovel loader and road dust emission, as well as different wind direction and wind speed. The result shows that PM10 discharge rate from the enclosed area to open-air is significantly influenced by wind velocity and direction, e.g., the result of northwest wind with wind speed in 12.7 m/s is eight times higher than wind speed in 2.5 m/s with the same wind direction, and are 47 and 62 times higher than the east and west wind direction with the same wind speed in 12.7 m/s, respectively. In this case, the PM10 discharge rate is about 131.7 ton/year, which contains about 38~55 ton/year iron-relating particles. This will directly contribute PM10 to open-air and may produce secondary aerosols, due to heterogeneous catalytic reaction. This work identifies the important contribution of fugitive emissions and provides an approach for fugitive emission estimation of industries to the surrounding air. The results provide a reference for material yard zoning and fugitive emission control from minimizing influence from the meteorological condition and reducing source discharge inside.

Reflections on the use of a specialist acute assessment and treatment unit for adults with intellectual disability

2015 ◽  
Vol 9 (3) ◽  
pp. 132-138 ◽  
Author(s):  
Kiran Purandare ◽  
Anusha Wijeratne
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Care Pathway ◽  
Average Distance ◽  
Community Services ◽  
Discharge Process ◽  
Treatment Unit ◽  
Content Type ◽  
Catchment Areas ◽  
The Impact

Purpose – The purpose of this paper is to evaluate the impact of a changing commissioning landscape on the provision of specialist acute inpatient care from the perspective of a small category 2 unit in London. Design/methodology/approach – The authors conducted a retrospective survey of all referrals to the unit in 2012 and 2013. Findings – There has been an increase in the referrals and admissions to the unit with referrals covering a wider catchment area. This has resulted in a doubling of the average distance between the unit and the respective catchment areas that patients and their relatives have to travel. The majority of admissions were transfers from mainstream mental health services. There has been a reduction in the mean length of stay. Research limitations/implications – This survey looks at trends in one category 2 unit in an outer London Borough and therefore, limits generalisability. The data collection was retrospective and there was no information on patients requiring admission but not being referred to the unit. Practical implications – There continues to be a need for category 2 admission units to serve the needs of a small group of patients with intellectual disability presenting with mental health needs and behavioural problems. Consideration needs to be given to the entire mental health and challenging behaviour care pathway, including the small but crucial element of specialist inpatient management if services are to remain local and responsive to the needs of this group of patients and their carers. Social implications – An ill-planned reduction in the number of specialist inpatient units without viable community services, risks perpetuating a situation where patients and their relatives have to travel long distances to obtain appropriate specialist help. Longer geographical distances could also potentially hamper closer liaison between the unit and the community services, thereby reducing the degree of oversight and prolonging the transition and discharge process. Originality/value – This survey highlights the impact of recent commissioning and service changes on delivery of specialist in patient services for adults with intellectual disability in the immediate aftermath of the Winterbourne Review.

scholarly journals THE IMPACT OF TARGETED TRAINING OF MEDICAL INTERNS ON THE SURVIVAL OF CARDIAC ARREST IN THE EMERGENCY ROOM

2021 ◽  
Vol 9 (11) ◽  
pp. 1167-1176
Author(s):  
Benmessaoudfz a ◽  
◽  
Tadilijawad b ◽  
Kettani Ali ◽  
Ahlam Chaieri ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Medical Training ◽  
Discharge Rate ◽  
National Registry ◽  
Primary Objective ◽  
University Hospital ◽  
Significant Difference ◽  
Medical Interns ◽  
The Impact

Introduction:The prognosis of patients with cardiac arrest is closely related to the quality of cardiopulmonary resuscitation (CPR). The aim of this work was to assess the impact of targeted training on CPR, in accordance with the latest international recommendations, on the management of cardiac arrests in SAUV. Methods:This is a prospective study carried out between January 1 and December 31, 2011 at the SAUV of Ibn Sina University Hospital in Rabat, including all adult patients who experienced cardiac arrest after admission. The main primary objective is to evaluate the impact of targeted training of medical interns on the survival of cardiac arrest in the ER expressed by the Hospital Discharge Survival (HDS) rate. Secondary objectives include the rate of recovery of circulatory activity (RCA), 48-hour survival, and quality of CPR performance. Results:342 patients were included, 159 before and 183 after training. There was no significant difference in terms of recovery from spontaneous circulation, 48h survival or discharge rate at home without sequelae. On the other hand, there was a statistically significant improvement in all the quality criteria for performing CPR. Conclusion:This work shows that the introduction of short training courses such improves the quality of CPR. The lack of impact on the improvement of patient survival seems to be related to numerous shortcomings, in particular basic medical training in emergency medicine, organization and protocolization of care, equipment of emergency rooms, supervision of emergency clerkship and the existence of a CA national registry. These are all areas to be developed in order to improve the prognosis of CA in our hospital structure.

scholarly journals Use of video education in post-operative patient counselling: A quality improvement initiative

2021 ◽  
Vol 15 (12) ◽  
Author(s):  
Luke D.E. Witherspoon ◽  
Ailsa M.L. Gan ◽  
Rodney H. Breau ◽  
Ginette Saumure ◽  
Jacqueline Shea ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Discharge Rate ◽  
Intervention Group ◽  
Quality Improvement Initiative ◽  
Discharge Process ◽  
Post Intervention ◽  
Data Repositories ◽  
Patient Counselling ◽  
Video Education

Introduction: This quality improvement study examined if a video-based resource could reduce delayed discharges after robotic prostatectomy while maintaining high levels of patient satisfaction. Methods: From April 2018 to February 2020, all patients undergoing robotic-assisted radical prostatectomy (RARP) were asked to complete an anonymous survey evaluating their perioperative experience. The quality improvement (QI) intervention started in March 2019 with a series of six educational videos being shown to all patients. The videos were used to supplement postoperative instruction. The discharge times of all patients were obtained from The Ottawa Hospital Data Repositories. A run chart analysis was used to detect change in discharge time (outcome measure). Patient satisfaction (balancing measure) was analyzed using Chi-squared analysis and descriptive statistics. Results: A total of 425 robotic prostatectomies (199 pre-intervention, 226 post-intervention) were available. Analysis of the run chart revealed non-random change favoring earlier discharge in the intervention group (p<0.05), with a pre-intervention late discharge rate of 64% and a post-intervention late discharge rate of 55%. A total of 140 surveys (59 pre-intervention, 81 post-intervention) assessing patient satisfaction were completed, corresponding with a response rate of 29.6% and 35.8%, respectively. Median score on a 10-point scale for overall satisfaction was equal between the intervention and non-intervention groups (9 [interquartile range (IQR 8–10) vs. 10 [IQR 8-10], p=0.92). Conclusions: Patient satisfaction with care and education was high for all patients and was not negatively impacted by this intervention. Video education tools may be one method to help improve the discharge process following RARP.

scholarly journals Patient discharge from intensive care: an updated scoping review to identify tools and practices to inform high-quality care

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Kara M. Plotnikoff ◽  
Karla D. Krewulak ◽  
Laura Hernández ◽  
Krista Spence ◽  
Nadine Foster ◽  
...  
Keyword(s):  
Intensive Care ◽  
Scoping Review ◽  
Organizational Level ◽  
Discharge Process ◽  
Provider Communication ◽  
Family Needs ◽  
High Quality ◽  
Icu Discharge ◽  
Facilitators And Barriers ◽  
The Impact

Abstract Background Critically ill patients require complex care and experience unique needs during and after their stay in the intensive care unit (ICU). Discharging or transferring a patient from the ICU to a hospital ward or back to community care (under the care of a general practitioner) includes several elements that may shape patient outcomes and overall experiences. The aim of this study was to answer the question: what elements facilitate a successful, high-quality discharge from the ICU? Methods This scoping review is an update to a review published in 2015. We searched MEDLINE, EMBASE, CINAHL, and Cochrane databases from 2013-December 3, 2020 including adult, pediatric, and neonatal populations without language restrictions. Data were abstracted using different phases of care framework models, themes, facilitators, and barriers to the ICU discharge process. Results We included 314 articles from 11,461 unique citations. Two-hundred and fifty-eight (82.2%) articles were primary research articles, mostly cohort (118/314, 37.6%) or qualitative (51/314, 16.2%) studies. Common discharge themes across all articles included adverse events, readmission, and mortality after discharge (116/314, 36.9%) and patient and family needs and experiences during discharge (112/314, 35.7%). Common discharge facilitators were discharge education for patients and families (82, 26.1%), successful provider-provider communication (77/314, 24.5%), and organizational tools to facilitate discharge (50/314, 15.9%). Barriers to a successful discharge included patient demographic and clinical characteristics (89/314, 22.3%), healthcare provider workload (21/314, 6.7%), and the impact of current discharge practices on flow and performance (49/314, 15.6%). We identified 47 discharge tools that could be used or adapted to facilitate an ICU discharge. Conclusions Several factors contribute to a successful ICU discharge, with facilitators and barriers present at the patient and family, health care provider, and organizational level. Successful provider-patient and provider-provider communication, and educating and engaging patients and families about the discharge process were important factors in a successful ICU discharge.

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