Influence of Different Dielectrics on Process Performance for Electrical Discharge-Assisted Milling of Titanium Alloy

Electrical discharge-assisted milling (EDAM) is an effective method for machining titanium alloys according to previous research. In this study, the influence of three different dielectrics (kerosene, EDM oil, and deionized water) on the EDAM performance was studied. Experimental studies reveal the influence of different dielectrics by analyzing the discharged signal, surface morphology, and elemental composition of the electrode. The results show that kerosene and EDM oil have a higher discharge frequency than deionized water. After a long discharge time, carbides and debris were generated during the machining process, which affected the micro-hardness and the discharge stability of the machined material. In EDAM, EDM oil can produce the best surface quality, and the surface roughness value was 34.93%, 87.92%, and 121.68% higher than that of kerosene, deionized water, and conventional milling (CM), respectively.

Graphdiyne Oxide Composite Membranefor Active Electrolyte Enhanced Supercapacitor with super long self-discharge time

Activate electrolyte enhanced supercapacitors (AEESCs) are considered as promising tools for power capacity due to their high specific capacitance and simple creation form. However, there are many challenges, such as...

Method for assessing the state and residual life of the insulation based on analysis of the time of discharge of the capacity of electric cables

As of today, the problem of the lack of non-destructive methods for assessing the state and determining the residual life of the insulation of electrical cables is relevant for cable lines in operation, and especially for lines that have exhausted their service life. The research presented in the framework of this article is aimed at creating a non-destructive technique for assessing the state and residual life of electrical cables insulation. The study was carried out using computer simulation methods and using the basic theoretical laws of physics and electrical engineering. A method for assessing the condition and residual life of electrical cable insulation has been developed, which is based on the analysis of the discharge time of the cable capacity. The applicability of the method is determined, instructions are given on its applicability and the analysis of the output data. The obtained results can be used by power grid companies and industrial enterprises to analyze the state of the insulation of electrical cables.

An Interdisciplinary Dashboard to Streamline Medication Processing at Patient Discharge: A Quality Improvement Initiative

ABSTRACT Introduction The purpose of this quality improvement project was to develop and evaluate the use of an electronic medication request dashboard to reduce the amount of time required for medication processing and decrease time lost to workflow interruptions during patient discharge. Delayed discharges are associated with increased health care costs and adverse patient outcomes. Processing of medication requests at discharge contributes to these delays and to workflow interruptions for nursing and pharmacy staff at the project site. Electronic dashboards have been successfully implemented in multiple medical settings to streamline patient processing and enhance communication. Materials and Methods The Human Protections Office at Carl R. Darnall Army Medical Center (Fort Hood, TX) reviewed and approved the project with a non-human research determination. A multi-disciplinary workgroup with representatives from nursing, pharmacy, and health information technology (HIT) was formed to develop the dashboard. Based on a logic flow diagram of the desired communication, HIT created a medication request form and status dashboard using SharePoint and Nintex workflows. The dashboard was implemented for a 30-day pilot on a 25-bed medical/surgical nursing unit. The time required for medication processing, the time from discharge order to patient exit, the number of phone calls between nursing and pharmacy, and the usability of the medication request process were measured before and after implementation. The results were analyzed with descriptive statistics and evaluated for statistical significance with a P value ≤.05. Results With implementation of the dashboard, the average medication processing time decreased from 125 minutes to 48 minutes (P < .0001), and the average patient discharge time decreased from 137 minutes to 117 minutes (P = .002). The usability score of the medication request process increased from 40 to 87 for nursing (P < .0001) and from 62 to 85 for pharmacy (P = .003). The total number of voice calls between nursing and pharmacy decreased from 1,115 to 434, while the total time on voice calls decreased from 33 hours and 50 minutes to 13 hours and 19 minutes (P < .0001). Conclusions The electronic dashboard is an effective method to enhance interdisciplinary communication during patient discharge and significantly reduces medication processing times. However, despite the medication processing time decreasing by over an hour, the discharge time only decreased by 20 minutes. Additional investigation is needed to evaluate other contributors to delayed discharge. A key limitation of this study was the convenience sampling used over a 30-day pilot on a single unit. The process has since been adopted by the entire hospital, and additional analysis could better reveal the impact to the organization. This communication system shows high usability and reduces phone call interruptions for both nursing and pharmacy staff. Additionally, this technology could easily be applied to other communication pathways or request processes across military medicine.

Investigating The Prolonged Discharge Process in Pediatric Teaching Hospital of Tehran, Iran: A Cross-Sectional Study

Background The patient discharge process is one of the most important factors affecting patient satisfaction, which can affect the quality of services of hospitals, and its prolongation can be detrimental in bed management and result in admission delays for new patients. This study aimed to investigate the factors contributing to the prolongation of the discharge process in Tehran's pediatric teaching hospital. Methods The present study was a descriptive cross-sectional study carried out on 300 patients discharged from one of the pediatric teaching hospitals in Tehran in 2019. This study was conducted using a mixed-method and composed of two parts: quantitative and qualitative. Initially, in the quantitative stage, the statistical form was used, the average discharge time in different wards of the hospital was measured using the stopwatch method, and the data were analyzed using SPSS V. 25 software and descriptive statistics. Subsequently, to identify the causes of the prolonged process in some departments and identify practical solutions, a qualitative approach was used, including observations, file reviews, Focus Group Discussion (FGD), brainstorming with experts from the Quality Improvement Office, ward secretaries, clearance unit experts, pharmacy experts, and ward supervisors. Finally, the factors were prioritized and approved using the nominal group method. Results The average discharge time was 3 hours and 7 minutes; the shortest discharge time belonged to the blood ward, and the longest discharge time belonged to the kidney ward. The causes of delay in discharge were divided into two categories: organizational and human factors. The most crucial elements were the time required to issue discharge orders, write patient summaries, and maintain patient files. Conclusion For improving the quality of the discharge process and patient satisfaction, solutions such as having assistants write file summaries before the morning round, sending files out of the ward on time, hiring a circular secretary to collect patients' files from various wards, and controlling them using a standard checklist, nurses' training, and continuous supervision were proposed.

Is JJ Ureteral Stenting Inferior to Percutaneous Nephrostomy as a Drainage Method in Emphysematous Pyelonephritis?

<b><i>Introduction:</i></b> The aim of the study was to examine the efficacy of JJ stenting in comparison with percutaneous nephrostomy (PCN) as a drainage method in patients with emphysematous pyelonephritis (EPN). <b><i>Methods:</i></b> We retrospectively identified patients with EPN between January 2000 and January 2021. Platelet-to-leukocytic ratio (PLR) at the time of hospital admission and discharge, time taken to clear air locules and to normalize leukocytic count, and air locule volume in mm³ were identified. Renal drainage by either PCN or JJ stent was required if symptoms persist for ≥3 days or in obstructed renal units. Failure of drainage method was defined as conversion to another method of drainage, need for intensive care unit admission, salvage nephrectomy, and mortality. <b><i>Results:</i></b> Twenty-nine patients were managed by JJ stent. Treatment success was identified in 20 patients and 19 patients who were managed by PCN and JJ stent, respectively. Higher air locule volume ≥16.7 mm³ and lower PLR ≤18.4 increased the risk of drainage failure (<i>p</i> = 0.009 and 0.001, respectively). <b><i>Conclusion:</i></b> Ureteral JJ stenting is an effective method for EPN drainage with a comparable overall success to the PCN use. Higher air locule volume and lower PLR increased the risk of drainage failure.

Subjective global assessment of malnutrition and dysphagia effect on the clinical and Para-clinical outcomes in elderly ischemic stroke patients: a community-based study

Background Malnutrition as a result of insufficient intake or uptake of nutrition leads to increasing rate of chronic diseases such as stroke. Stroke is one of the most common causes of death in western countries and its increasing trend has attracted lots of attention. In this regard, it seems logical to focus on modifiable risk factors such as nutrition, in order to reduce the resulting complications. Accordingly, this study aimed at evaluating nutrition status of stroke patients to estimate its relationship with clinical outcomes of stroke. Methods In the present cross-sectional study, 349 patients were recruited. Nutrition assessment was performed using Patient-Generated Subjective Global Assessment (PG-SGA). In addition, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and biochemical tests were performed. Results Our findings elucidated a significant positive correlation of mRS with PG-SGA and consciousness score, as well as a negative correlation with BMI, calf circumference, mid-arm circumference, and triceps skinfold at admission time (P ≤ 0.002). Moreover, a direct correlation was found between mRS and PG-SGA and consciousness score at discharge time (P ≤ 0.001). In contrast, an inverse correlation was established between mRS and mid-arm circumference (P = 0.02). Furthermore, univariate analysis indicated significant associations between mRS ≥ 3 and age (OR: 1.02; 95%CI: 1.00–1.04), PG-SGA (OR: 1.08; 95%CI: 1.03–1.13), NIHSS (OR: 1.04; 95%CI: 1.02–1.07), dysphagia (OR: 1.69; 95%CI: 1.03–2.77), consciousness (OR: 1.48; 95%CI: 1.07–2.04), and mid-arm circumference (OR: 0.95; 95%CI: 0.90–1.00). In addition, these associations remained significant in multivariate analysis for PG-SGA (OR: 1.07; 95%CI: 1.00–1.13) and NIHSS (OR: 1.04; 95%CI: 1.01–1.07). Conclusion This study revealed a positive correlation between mRS and consciousness status and PG-SGA score, as well as a negative one between mRS and MAC at discharge time.

Spatio-Temporal Variability of Hydroclimatology in the Upper Cauca River Basin in Southwestern Colombia: Pre- and Post-Salvajina Dam Perspective

The Cauca River rises in the Colombian Andes and is the main tributary of the Magdalena River, which drains to the Caribbean Sea. The La Balsa station monitors the Upper Cauca basin and is located just downstream of La Salvajina hydroelectric facility. At this station, the discharge time series for November–January during 1950–2019 shows a statistically significant downward break, and change of distribution after 1986 has been documented after La Salvajina started operation. We assessed the spatio-temporal variability of hydroclimatology in the upper Cauca River basin during the pre- and post-Salvajina dam periods to better understand this break. Post-Salvajina, low (high) discharge events are linked to negative (positive) precipitation and soil moisture anomalies that are greater in magnitude and extension than those recorded in the pre-Salvajina period in response to the more intense El Niño events (more intense and frequent central La Niña events) after 1986. Therefore, it is necessary to consider possible future rainfall scenarios and non-infrastructure measures (i.e., reforestation, territorial planning, integrated watershed management, etc.) to mitigate floods and droughts impacts. The contribution of this study is to provide evidence for the need for foresight in the design of any structural or non-structural flood measures.

High-Efficiency Electrocatalyst Phthalocyanine in Li/SOCl2 Batteries: From Experimental to Theoretical Investigation

Li/SOCl2 batteries, which are used in various fields due to theirs easy-carry and brilliant electrochemical properties, have attracted much research. However, the existence of the voltage hysteresis has limited further practical application of this tiny device. Herein, three series of nineteen kinds of metal phthalocyanine electrocatalysts with excellent electronic conductivity were synthesized to improve Li/SOCl2 battery performance. The structure of the catalysts was verified by infrared spectroscopy, ultraviolet-visible spectroscopy, thermogravimetric analysis, and elemental analysis,. and these materials were used to develop the discharge time, output voltage, and discharge capacity of the Li/SOCl2 battery. With the addition of the phthalocyanine, the discharge time of the Li/SOCl2 battery lengthens by approximately 20%, and the voltage can be increased by 0.02~0.20 V. In addition, the actual battery capacity can also be raised by 20~50 %. Density functional theory was used to calculate the relationship between the metal center and catalytic activity and the results are in good agreement with the experimental which implies the electron density of the center metal is the key point in the electrocatalyst reaction.

Implementation of Electronic Patient Discharge: A Successful Strategy to Increase Hospital Bed Capacity During the COVID-19 Pandemic

Background: The ongoing COVID-19 pandemic increased the need for inpatient beds, indicating the need for hospitals to increase the efficiency of beds. Objectives: This study aimed to increase hospital bed capacity using the implementation of Electronic Patient Discharge (EPD). Methods: This qualitative-quantitative study was conducted in a tertiary care hospital using the pre-and post-intervention designs, and the main outcome was patient discharge time. By applying the Six Sigma model, including definition, measurement, analysis, improvement, and control, the patient discharge process was assessed and improved by some interventions such as EPD. All hospitalized patients with COVID-19 from 21 March 2020 to 22 July 2021 were examined for the post-intervention. In addition, data were collected from the hospital information system (HIS). Results: By the use of EPD, patient discharge time decreased to 47.70% (from 10.19 h to 5.33 h) (P < 0.000). According to the Sigma level, the yield and defects per million opportunities of the discharge process also increased to 55%. Conclusion: Six Sigma methodology can be an effective change management tool to improve discharge time to cover the demand created during pandemics. According to the results of the present study and the obtained saved time, one bed is added to the hospital capacity for every five discharges.