A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

Abstract Background Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation. Specific objectives The primary objective of this protocol is to determine the effect of a nurse-initiated intervention, which couples low-intensity inpatient counseling with sustained proactive telephone counseling, on smoking abstinence in hospitalized patients. Key secondary aims are to determine the impact of the intervention on staff nurses' attitudes toward providing smoking cessation counseling; to identify barriers and facilitators to implementation of smoking cessation guidelines in VA hospitals; and to determine the short-term cost-effectiveness of implementing the intervention. Design Pre-post study design in four VA hospitals Participants Hospitalized patients, aged 18 or older, who smoke at least one cigarette per day. Intervention The intervention will include: nurse training in delivery of bedside cessation counseling, electronic medical record tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy), computerized referral of motivated inpatients for proactive telephone counseling, and use of internal nursing facilitators to provide coaching to staff nurses practicing in non-critical care inpatient units. Outcomes The primary endpoint is seven-day point prevalence abstinence at six months following hospital admission and prolonged abstinence after a one-month grace period. To compare abstinence rates during the intervention and baseline periods, we will use random effects logistic regression models, which take the clustered nature of the data within nurses and hospitals into account. We will assess attitudes of staff nurses toward cessation counseling by questionnaire and will identify barriers and facilitators to implementation by using clinician focus groups. To determine the short-term incremental cost per quitter from the perspective of the VA health care system, we will calculate cessation-related costs incurred during the initial hospitalization and six-month follow-up period. Trial number NCT00816036http://deepblue.lib.umich.edu/bitstream/2027.42/112349/1/13012_2009_Article_190.pd

Numerical simulation of porosity on thermal properties and fire resistance of foamed concrete

The relationship between thermal insulation properties and porosity of fly ash based foam concrete was built, in which effective density, effective heat conductivity, and effective specific heat of fly ash based foam concrete were deduced as functions of porosity. Using the model, the effective heat conductivity of density of 580 kg/m3 fly ash based foam concrete was the theoretically calculated as 0.145 W/(m K) while the experimental measured value was 0.142 W/(m K). The relative error of heat conductivity was very low at 2.1%. The effective specific heat within the model was 967.05 J/kg K and the experimental value was 920 J/kg K with a relative error of 5.1%. Then, the effective heat conductivity and specific heat models were incorporated into heat transferring model to calculate the temperature field of fly ash based foam concrete wall during a fire incident. Finally, the temperature field of fly ash based foam concrete wall and traditional dense concrete wall during fire incident were calculated and compared. Comparing the temperature field of the fly ash based foam concrete wall with the traditional concrete wall, it was found that at close to fire-side surface, the temperature in the fly ash based foam concrete wall could reach 1039 °C, while the lowest temperature in the fly ash based foam concrete wall remained at 20 °C for a thickness of 7 mm. In contrast, at close to fire side of surface, the temperature of traditional concrete wall was 987.2 °C at 360 s and the lowest temperature in the traditional wall was 102.9 °C at the opposite side-wall surface far away from the fire direction. As expected, the data demonstrated that the use of fly ash based foam concrete in wall construction adds greatly to the time for people to leave in safety