Rock weirs are small dam-like structures composed of large loose rock commonly found in ecological engineering design. By appearing more natural than concrete structures, rock weirs are preferred for use as hydraulic control structures in river engineering, stormwater management, and constructed wetlands. Rock weirs increase hydraulic head upstream, and facilitate fish passage, channel stabilization, floodplain reconnection, and in-stream habitat creation. When used in constructed wetlands, rock weirs play a valuable role in developing appropriate wetland hydrology. Although rock weirs are commonly used, a deficit of knowledge exists relating to the stage-discharge relationship of these structures. Therefore, the goal of this research was to determine a weir equation and corresponding discharge coefficients that improve predictions of flow through rock weirs. A flume study was conducted to develop a rock weir equation and discharge coefficients. Scaled model rock weirs were tested in a 1 m x 8 m x 0.4 m recirculating flume. Rock weirs varied by length (0.152 m, 0.305 m, and 0.457 m), depth (0.152 m and 0.305 m), and minimum rock diameter (12.7 mm, 19.1 mm, 25.4 mm). Three channel slopes were used (0%, 0.5%, 1%), and the flume discharge was varied for five water stages for each rock weir. Buckingham Pi analysis was used to develop seven dimensionless parameters. Regression analyses were then used to develop a model for discharge and the discharge coefficient. Results showed that weir length and depth play a significant role in predicting the discharge coefficient of rock weirs. / Master of Science / Rock weirs are small dam-like structures composed of large loose rock; by appearing more natural, they are preferred for use in river engineering, stormwater management, and constructed wetlands. Rock weirs increase upstream water depth, improving fish passage, channel stabilization, floodplain reconnection, and in-stream habitat creation. When used in design of constructed wetlands, rock weirs are used to establish the necessary water depths for a given type of wetland. Although rock weirs are commonly used in engineering design, there are no equations to predict water velocity or flow rate across these structures. Therefore, the goal of this research was to determine a weir equation that improves predictions of flow through rock weirs. A flume study was conducted to develop a rock weir equation. Miniature rock weirs were tested in a 1 m x 8 m x 0.4 m recirculating laboratory channel. Rock weirs varied by length (0.152 m, 0.305 m, and 0.457 m), depth (0.152 m and 0.305 m), and minimum rock diameter (12.7 mm, 19.1 mm, 25.4 mm). Three channel slopes were used (0%, 0.5%, 1%), and the water flow rate was varied for five water depths for each rock weir. Statistical analyses were conducted to determine an equation that predicts water flow through rock weirs for use in engineering design. Results showed that weir length and depth played a significant role in predicting water flow through rock weirs.

Yes / This literature review aims to conduct an extensive systematic literature review of the nursing interventions on discharge planning among geriatric patients with hip fractures. Design: The review applied multiple research designs, and the literature search was based on PRISMA’s publication standard. Data Sources: The articles were selected from three primary online databases: Scopus, Science Direct and Web of Science and one supporting database, Google Scholar. Review Method: After searching the eligible articles, 15 articles were selected for thematic analysis. Results: The systematic review came out with five central themes 1) assessments of the patient’s and family member’s needs: 2) diagnosis of an individual discharge planning: 3) prescription of the appropriate nursing interventions; 4) implementation of the nursing interventions and 5) follow -up after the patients have been discharged from hospital. Conclusion: The review’s findings explained the nursing intervention implemented and its effectiveness on elderly patients with hip fractures. Apart from that, this review also highlighted the methodology approach and health outcomes measured, which will help the scholars better understand the study area. Impact: The review contributes needed information for future nursing research and practice of the elderly with hip fractures.

The research work presented here is concerned with numerical simulations of two different electrical phenomena: Long gap electrical discharges under switching impulses and the lightning attachment process associated with positive upward leaders. The development of positive upward leaders and the progression of discharges in long gaps are attributable to two intertwined physical phenomena, namely, the leader channel and the streamer zone. The physical description and the proposed calculations of the above-mentioned phenomena are based on experimental tests conducted in long spark gaps. The methodology presented here proposes a new geometrical approximation for the representation of the streamer and the calculation of the accumulated electrical charge. Furthermore, two different approaches to representing the leader channel are applied and compared. Statistical delays before the inception of the first corona, and random distributions to represent the tortuous nature of the path taken by the leader channel were included based on the behavior observed in experimental tests, with the intention of ensuring the discharge behaved in a realistic manner. A reasonable agreement was found between the physical model and the experimental test results. A model is proposed to simulate the negative discharges produced by switching impulses using the methodology developed to simulate positive leader discharges and the physics underlying the negative leader phenomena. The validation of the method demonstrated that phenomena such as the pilot leader and negative leader currents are successfully represented. In addition, based on previous work conducted on the physics of lightning and the lightning attachment process, a new methodology is developed and tested. In this new approach, the background electric field and the ionized region, considered in conjunction with the advance of the leader segment, are computed using a novel method. The proposed methodology was employed to test two engineering methods that are accepted in international standards, the mesh method and the electro-geometrical method. The results demonstrated that the engineering approximations are consistent with the physical approach. In addition to the electrical phenomena mentioned above, one should remember that, to simplify the calculation, there are certain real effects arising from the lightning attachment process that have not been considered. In fact, when a structure is subjected to a strong electric field, it is possible to generate multiple upward leaders from that structure. This effect has not been taken into account in the numerical models available previously, and therefore the process of generating multiple upward leaders incepted over a structure is incorporated here. The results have shown that a slight advantage from the background electric field is enough for one upward connecting leader to take over, thereby forcing the others to abort the attachment process.

Over 5 million older adults with diabetes are hospitalized each year. Though typically not the index condition that leads to hospitalization, diabetes control often decompensates during the course of an admission and necessitates changes in home self-management plans. The specific transitional care needs of older adults with diabetes have been largely unstudied. Transition theory provided the guiding framework for this research and proposes that each transition is a complex process created by the continuous interaction of personal, community, and societal-level conditions that facilitate or inhibit the health of a transition. Hospitalization has been described as a series of three successive, interrelated transitions. The aims of this study were to determine whether personal and community transition conditions impacted the early and intermediate post-discharge outcomes in a sample of older adults with diabetes. A simultaneous quantitative/qualitative mixed method design was used to identify factors that impacted the home recovery transition experiences in a sample of 96 older adults with a mean age of 75 years. A supplementary content analysis of free-response data gathered during administration of the Post-Discharge Coping Difficulty Scale (PDCDS) clarified difficulties encountered by elders and caregivers during in the first 30 days following discharge. Four overarching themes emerged: "the daily stuff is difficult"; "engineering care at home is difficult"; "life is stressful" and "difficulty managing complex health problems". Difficulties managing a complex medication regimen, regulating blood glucose, and managing a non-diabetes chronic health problem such as hypertension and chronic lung disease were subthemes that emerged during qualitative data analyses. These subthemes were transposed into discrete nominal level variables and served as additional indicators of post-discharge coping difficulty in the descriptive correlational core component of the research project. Participants in this study who experienced an event of recidivism had lower pre-discharge assessments of readiness on the Readiness for Hospital Discharge Scale (RHDS) (t = 2.274, df = 48, p =.028). Higher PDCDS scores were observed in patients who experienced an event of recidivism within 30 days of discharge (t = -3.363, df=24.7, p = .003) and also in respondents who described difficulties with managing medications, controlling diabetes, and managing a chronic illness. Binary logistic regression was used to identify factors that may predict recidivism risk. No condition-specific predictor variables were identified. A statistically significant three-variable model (X2 = 26.737, df = 3, p < .001) revealed that PDCDS scores at 7 days (Wald X2 =3.671, df = 1, p =.050), PDCDS scores at 30 days (Wald X2 = 6.723, df = 1, p =.010), and difficulty managing a chronic health condition (Wald X2 = 8.200, df = 1, p =.004) were predictive of an event of recidivism within 30 days of discharge. Difficulty managing a chronic health problem other than diabetes was particularly predictive of recidivism. The nurse's skill in delivering discharge education was a factor in limiting early postdischarge difficulties. Elders with residual information needs on the day of discharge as measured by scores the Quality of Discharge Teaching Scale (QDTS) reported a lower readiness for discharge (r = -.314, p = .003) and experienced greater difficulties with early post-discharge coping (r =. 288, p = .023). Greater satisfaction with the post-discharge transition was noted in participants with higher QDTS scores (r = .444, p < .001). Outcomes of the hospital-to-home transition experience were impacted by a variety of personal, hospital, and community factors. Findings of this study suggest that there is a need to better understand the sequential nature of the home recovery transition and the fluid needs of older adults during this high-risk phase of care. The environments in which older adults receive post-discharge care are complex and need to be thoroughly considered when planning the postdischarge transition. Metrics of institutional performance of transitional care practices need to extend beyond events to recidivism and include evaluations of post-discharge coping and transition satisfaction. The nurse as the primary provider of discharge education has the potential to significantly promote positive transition outcomes for older adults and their family care providers.

No description available.

Background: Diabetes mellitus (DM) affects more than 29.1 million Americans. Standardized clinical practice guidelines recommended by regulatory healthcare agencies are the standard of care for diabetic patients and must be adhered to by healthcare professionals providing care. Purpose: The purpose of this quality improvement project was to identify Centers for Medicare and Medicaid Services’, Joint Commission on Accreditation of Healthcare Organization’s, and other professional healthcare organizations’ guidelines for nurses’ knowledge of evidence-based discharge practices; determine level of nurses’ knowledge on evidence-based discharge practice process; develop a quality improvement plan, including development of an evidence-based guideline for diabetic discharge instructions; present guideline to stakeholders; implement the guideline in fall of 2017; and evaluate nursing compliance with the guideline at a for-profit adult care hospital in South Florida. Theoretical Framework: The chronic care model was utilized as the framework. This model has been used for improving practice and preventing many chronic illnesses. Methods: Two quantitative nonparametric descriptive designs were used, the Wilcoxon signed- rank test and a paired t test. An online demographic survey and pre- and posttest surveys were administered to determine nurses’ knowledge of diabetes discharge guideline practices. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) evaluation tool evaluated the guideline, and data were analyzed with Wilcoxon and paired t tests. Results: A statistically significant difference was found in the pre-posttest survey responses for question 5 (p=0.046 Wilcoxon; p=0.041t test), and question 13 (p= 0.022 Wilcoxon; p=0.018 t test), indicating improvement. With the AGREE II tool, the multidisciplinary team evaluated the guideline at 100%, and 76% of Advanced Practice Registered Nurses (APRNs) and Registered Nurses (RNs) demonstrated compliance with guideline use. Conclusion: A standardized diabetic discharge guideline incorporated into the hospital’s discharge process provided APRNs and RNs with tools for educating and providing diabetic patients for increase in quality of life after discharge. The guideline was recommended by the administrative team for continued use throughout the hospital. Implementation of an evidence-based standardized diabetic discharge guideline to promote nurses’ adherence results in effective nursing practices and an informed patient population.

The aim of this thesis is to put an interpretation on the institution of discharge with regard to an approval of the Act No. 294/2013 Coll., which changes the Act No. 182/2006 Coll., on decline and its solution strategies (Insolvency Act) and the Act No. 312/2006 Coll., on insolvency administrators (hereinafter referred to as "revising amendment"), to compare the amendment before and after its taking effect, with a main focus on discharge for entrepreneurs and individuals whose debts come from entrepreneurship, and on discharge for spouses. The thesis is divided into five chapters. The first chapter sums up the development of insolvency proceedings and insolvency law from Roman times to the present day. Thanks to this overview, the reader can see that insolvency proceedings and insolvency law are not only contemporary issues and owing to this, we are also able to map the development which led to the Insolvency Act as it stands. The main topic of the second chapter is decline and its solution strategies. As to the decline, I describe its two basic alternatives, insolvency and over-indebtedness. I mention also the imminent decline, which is followed by division of decline solution strategies into rehabilitation and liquidation, offering a brief specification of each of them. The whole third chapter...

Communication of hospital discharge instructions between patient and provider is an important component of hospital discharge to ensure that patients have the information they need to manage their post-acute care. Patient perception of this interaction is a key indicator of the quality of services provided. This study examined whether there is a correlation between hospital continuity and transition scores (a measure of patient perceptions of hospital discharge instructions) and hospital readmissions in Ontario. The final regression model for the outcome of all medical readmissions within three days of hospital discharge, showed a significant positive relationship (coefficient=0.0090, p=0.011). The estimate was smaller and not significant once the data was restricted to only community hospitals located outside of Toronto (coefficient=0.0085, p=0.060), and when restricted to urban community hospitals outside of Toronto (coefficient=0.0041, p=0.384). For the outcome of specific medical readmissions within 28 days of hospital discharge, no statistically significant relationship was found.

Communication of hospital discharge instructions between patient and provider is an important component of hospital discharge to ensure that patients have the information they need to manage their post-acute care. Patient perception of this interaction is a key indicator of the quality of services provided. This study examined whether there is a correlation between hospital continuity and transition scores (a measure of patient perceptions of hospital discharge instructions) and hospital readmissions in Ontario. The final regression model for the outcome of all medical readmissions within three days of hospital discharge, showed a significant positive relationship (coefficient=0.0090, p=0.011). The estimate was smaller and not significant once the data was restricted to only community hospitals located outside of Toronto (coefficient=0.0085, p=0.060), and when restricted to urban community hospitals outside of Toronto (coefficient=0.0041, p=0.384). For the outcome of specific medical readmissions within 28 days of hospital discharge, no statistically significant relationship was found.

No description available.