Perceived Readiness for Hospital Discharge in Adult Medical-Surgical Patients

Purpose: The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients\u27 perceptions of their readiness for hospital discharge. Design: A correlational, prospective, longitudinal design with path analyses was used to explore relationships among transition theory-related variables. Setting: Midwestern tertiary medical center. Sample: 147 adult medical-surgical patients. Methods: Predictor variables included patient characteristics, hospitalization factors, and nursing practices that were measured prior to hospital discharge using a study enrollment form, the Quality of Discharge Teaching Scale, and the Care Coordination Scale. Discharge readiness was measured using the Readiness for Hospital Discharge Scale administered within 4 hours prior to discharge. Outcomes were measured 3 weeks postdischarge with the Post-Discharge Coping Difficulty Scale and self-reported utilization of health services. Findings: Living alone, discharge teaching (amount of content received and nurses\u27 skill in teaching delivery), and care coordination explained 51% of readiness for discharge score variance. Patient age and discharge readiness explained 16% of variance in postdischarge coping difficulty. Greater readiness for discharge was predictive of fewer readmissions. Conclusions: Quality of the delivery of discharge teaching was the strongest predictor of discharge readiness. Study results provided support for Meleis\u27 transitions theory as a useful model for conceptualizing and investigating the discharge transition. Implications for Practice: The study results have implications for the CNS role in patient and staff education, system building for the postdischarge transition, and measurement of clinical care outcomes

Contrasting response of sea-level change to orbital eccentricity in greenhouse and icehouse climates

Climate-controlled changes in eustatic sea level (ESL) are linked to transfers of water between ocean and land, thus offering a rare insight into the past hydrological cycle. In this study, we examine the timing and phase of Milankovitch-scale ESL cycles in the peak Cretaceous greenhouse, the early Turonian (∼93–94 million years, Myr, ago). A high-resolution astronomical framework established for the Bohemian Cretaceous Basin (central Europe) suggests a ∼400-kyr pace and a distinct asymmetry of interpreted ESL cycles. The rising limbs of ESL change constitute only 20–30 % of the cycle, and are encased entirely within the falling phase of the 405-kyr eccentricity; the intervening ESL falls (≤6 m in magnitude) are more protracted, starting within 70 kyr prior to the eccentricity minima and culminating ∼60 kyr after the 405-kyr eccentricity maxima. Despite similarities to the sawtooth shape of ∼100-kyr glacioeustatic oscillations of the Late Pleistocene, the time scales and phasing are unparalleled in the Pleistocene icehouse. A similar, 405-kyr pace is found in ice-volume variations of the early Miocene, but the timing of glacioeustatic change relative to eccentricity forcing is incompatible with the phase of greenhouse sea-level oscillations. The phasing points to major differences in the geographic location and insolation sensitivity of the key hydrological reservoirs under icehouse and greenhouse regimes. The inferred structure of greenhouse eustasy points to low- or middle-latitude water storage, likely aquifers, that charge (expand) with rising seasonality variations and discharge (contract) with declining seasonality amplitudes on the 405-kyr scale. The net volume of water transferred on these time scales is within 2.2 × 106 km3, equivalent to ≤10 % of the present-day storage in the uppermost 2 km of continental crust; potential additive interference with steric eustasy, proportionally relevant during greenhouse regimes, could reduce the volumes required for continental storage

Treatment of gastrointestinal hemorrhage

Background: We assessed the value of selective arteriography in the diagnosis and management of acute gastrointestinal hemorrhage. Methods: We reviewed the records of 107 consecutive patients who had gastrointestinal hemorrhage and underwent selective arteriography between January 1992 and October 2003: 10 had upper gastrointestinal bleeding, 79 had lower gastrointestinal bleeding, and 18 had varicose bleeding with portal hypertension. Selective embolization was attempted in 15 patients to obtain hemostasis. Angiographic findings were reviewed and prospective reports were compared with the final diagnosis and outcome. Results: Of 129 angiographic studies, 36 correctly revealed the bleeding site and 93 were negative. Extravasation was seen in 24 cases at the level of stomach (n = 2), duodenum (n = 1), small bowel (n = 5), or colon (n = 16). Indirect signs of bleeding sources were identified in 12 patients (stomach in one, small bowel in four, large bowel in four, liver in three). Transcatheter embolization induced definitive hemostasis in 11 of 15 patients (73%), namely in the stomach (n = 2), small bowel (n = 3), colon (n = 7), and liver (n = 3). Three patients required surgery after embolization. Conclusion: Abdominal arteriography may localize gastrointestinal bleeding sources in approximately one-third of cases. Selective embolization may provide definitive hemostasis in most instance

Gravitational Waves from the Dynamical Bar Instability in a Rapidly Rotating Star

A rapidly rotating, axisymmetric star can be dynamically unstable to an m=2 "bar" mode that transforms the star from a disk shape to an elongated bar. The fate of such a bar-shaped star is uncertain. Some previous numerical studies indicate that the bar is short lived, lasting for only a few bar-rotation periods, while other studies suggest that the bar is relatively long lived. This paper contains the results of a numerical simulation of a rapidly rotating gamma=5/3 fluid star. The simulation shows that the bar shape is long lived: once the bar is established, the star retains this shape for more than 10 bar-rotation periods, through the end of the simulation. The results are consistent with the conjecture that a star will retain its bar shape indefinitely on a dynamical time scale, as long as its rotation rate exceeds the threshold for secular bar instability. The results are described in terms of a low density neutron star, but can be scaled to represent, for example, a burned-out stellar core that is prevented from complete collapse by centrifugal forces. Estimates for the gravitational-wave signal indicate that a dynamically unstable neutron star in our galaxy can be detected easily by the first generation of ground based gravitational-wave detectors. The signal for an unstable neutron star in the Virgo cluster might be seen by the planned advanced detectors. The Newtonian/quadrupole approximation is used throughout this work.Comment: Expanded version to be published in Phys. Rev. D: 13 pages, REVTeX, 13 figures, 9 TeX input file

Accuracy of Multiple Pour Cast from Various Elastomer Impression Methods

The accurate duplicate cast obtained from a single impression reduces the profession clinical time, patient inconvenience, and extra material cost. The stainless steel working cast model assembly consisting of two abutments and one pontic area was fabricated. Two sets of six each custom aluminum trays were fabricated, with five mm spacer and two mm spacer. The impression methods evaluated during the study were additional silicone putty reline (two steps), heavy-light body (one step), monophase (one step), and polyether (one step). Type IV gypsum casts were poured at the interval of one hour, 12 hours, 24 hours, and 48 hours. The resultant cast was measured with traveling microscope for the comparative dimensional accuracy. The data obtained were subjected to Analysis of Variance test at significance level <0.05. The die obtained from two-step putty reline impression techniques had the percentage of variation for the height −0.36 to −0.97%, while diameter was increased by 0.40–0.90%. The values for one-step heavy-light body impression dies, additional silicone monophase impressions, and polyether were −0.73 to −1.21%, −1.34%, and −1.46% for the height and 0.50–0.80%, 1.20%, and −1.30% for the width, respectively

USGS44, a new high purity calcium carbonate reference material for δ13 C measurements

RATIONALE: The stable carbon isotopic (δ13 C) reference material (RM) LSVEC Li2 CO3 has been found to be unsuitable for δ13 C standardization work because its δ13 C value increases with exposure to atmospheric CO2 . A new CaCO3 RM, USGS44, has been prepared to alleviate this situation. METHODS: USGS44 was prepared from 8 kg of Merck high purity CaCO3 . Two sets of δ13 C values of USGS44 were determined. The first set of values was determined by on-line combustion, continuous-flow (CF) isotope-ratio mass spectrometry (IRMS) of NBS 19 CaCO3 (δ13 CVPDB = +1.95 milliurey (mUr) exactly, where mUr = 0.001 = 1 ‰), and LSVEC Li2 CO3 (δ13 CVPDB = -46.6 mUr exactly), and normalized to the two-anchor δ13 CVPDB-LSVEC isotope-delta scale. The second set of values was obtained by dual-inlet (DI) IRMS of CO2 evolved by reaction of H3 PO4 with carbonates, corrected for cross contamination, and normalized to the single anchor δ13 CVPDB scale. RESULTS: USGS44 is stable and isotopically homogeneous to within 0.02 mUr in 100-μg amounts. It has a δ13 CVPDB-LSVEC value of -42.21 ± 0.05 mUr. Single-anchor δ13 CVPDB values of -42.08 ± 0.01 and -41.99 ± 0.02 mUr were determined by DI-IRMS with corrections for cross contamination. CONCLUSIONS: The new high-purity, well homogenized calcium carbonate isotopic reference material USGS44 is stable and has a δ13 CVPDB-LSVEC value of -42.21 ± 0.05 mUr for both EA-IRMS and DI-IRMS measurements. As a carbonate relatively depleted in 13 C, it is intended for daily use as a secondary isotopic reference material to normalize stable carbon isotope-delta measurements to the δ13 CVPDB-LSVEC scale. It is useful in quantifying drift with time, determining mass-dependent isotopic fractionation (linearity correction), and adjusting isotope-ratio-scale contraction. Due to its fine grain size (smaller than 63 μm), it is not suitable as a δ18 O reference material. A δ13 CVPDB-LSVEC value of -29.99 ± 0.05 mUr was determined for NBS 22 oil

The cost of cooking a meal. The case of Nyeri County, Kenya

Energy for cooking is considered essential in achieving modern energy access. Despite this, almost three billion people worldwide still use solid fuels to meet their cooking needs. To better support practitioners and policy-makers, this paper presents a new model for comparing cooking solutions and its key output metric: the 'levelized cost of cooking a meal' (LCCM). The model is applied to compare several cooking solutions in the case study area of Nyeri County in Kenya. The cooking access targets are connected to the International Workshop Agreement and Global Tracking Framework's tiers of cooking energy access. Results show how an increased energy access with improved firewood and charcoal cookstoves could reduce both household's LCCMs and the total costs compared to traditional firewood cooking over the modelling period. On the other hand, switching to cleaner cooking solutions, such as LPG- and electricity, would result in higher costs for the end-user highlighting that this transition is not straightforward. The paper also contextualizes the results into the wider socio-economic context. It finds that a tradeoff is present between minimizing costs for households and meeting household priorities, thus maximizing the potential benefits of clean cooking without dismissing the use of biomass altogether

Long-range corrected DFT calculations of charge-transfer integrals in model metal-free phthalocyanine complexes

An assessment of several widely used exchange--correlation potentials in computing charge-transfer integrals is performed. In particular, we employ the recently proposed Coulomb-attenuated model which was proven by other authors to improve upon conventional functionals in the case of charge-transfer excitations. For further validation, two distinct approaches to compute the property in question are compared for a phthalocyanine dimer