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1 – 10 of over 16000This article reports on the experiences and evaluations of piloting health and social care discharge co‐ordinators in acute and community hospital settings. Benefits were…
Abstract
This article reports on the experiences and evaluations of piloting health and social care discharge co‐ordinators in acute and community hospital settings. Benefits were felt with regard to length of stay, bed day use, and patient and staff experience, and were particularly notable where a discharge co‐ordinator employed by the community trust was put into the acute hospital setting. The pilots have supported a redesign of hospital discharge processes across Torbay Care Trust and South Devon Healthcare NHS Foundation Trust, and provided the foundation for improved partnership working and integrated service provision.
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Ba-Phu Nguyen, Ananta Man Singh Pradhan, Tan Hung Nguyen, Nhat-Phi Doan, Van-Quang Nguyen and Thanh-Canh Huynh
The consolidation behavior of prefabricated vertical drain (PVD)-installed soft deposits mainly depends on the PVD performance. The purpose of this study is to propose a…
Abstract
Purpose
The consolidation behavior of prefabricated vertical drain (PVD)-installed soft deposits mainly depends on the PVD performance. The purpose of this study is to propose a numerical solution for the consolidation of PVD-installed soft soil using the large-strain theory, in which the reduction of discharge capacity of PVD according to depth and time is simultaneously considered.
Design/methodology/approach
The proposed solution also takes into account the general constitute relationship of soft soil. Subsequently, the proposed solution is applied to analyze and compare with the monitoring data of two cases, one is the experimental test and another is the test embankment in Saga airport.
Findings
The results show that the reduction of PVD discharge capacity according to depth and time increased the duration required to achieve a certain degree of consolidation. The consolidation rate is more sensitive to the reduction of PVD discharge capacity according to time than that according to the depth. The effects of the reduction of PVD discharge capacity according to depth are more evident when PVD discharge capacity decreases. The predicted results using the proposed numerical solution were validated well with the monitoring data for both cases in verification.
Research limitations/implications
In this study, the variation of PVD discharge capacity is only considered in one-dimensional consolidation. However, it is challenging to implement a general expression for discharge capacity variation according to time in the two-dimensional numerical solution (two-dimensional plane strain model). This is the motivation for further study.
Practical implications
A geotechnical engineer could use the proposed numerical solution to predict the consolidation behavior of the drainage-improved soft deposit considering the PVD discharge capacity variation.
Originality/value
The large-strain consolidation of PVD-installed soft deposits could be predicted well by using the proposed numerical solution considering the PVD discharge capacity variations according to depth and time.
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Ruben Phipon, Ishwer Shivakoti and Ashis Sharma
This paper aims to present the performance of deionized water in electrical discharge machining (EDM) during machining of Inconel 718, copper tool electrode and deionized…
Abstract
Purpose
This paper aims to present the performance of deionized water in electrical discharge machining (EDM) during machining of Inconel 718, copper tool electrode and deionized water as dielectric. Three parameters, namely, pulse-on-time, pulse-off-time and discharge current were taken as control parameters with individual parameter having three levels. Influence of these control parameters on response such as tool wear rate (TWR), material removal rate (MRR) and surface roughness (Ra) is evaluated at various combinations of parametric levels. The results reveal deionized water can be effectively used as a sustainable dielectric and may substitute the hydrocarbon-based dielectric in electrical discharge machining. Also, the control parameters considered show significant impact on the process criteria. Super ranking method was adopted to achieve optimal integration of EDM control factors for obtaining higher MRR, lower TWR and Ra. Further, by applying analysis of variance test, discharge current is established as the dominant parameter during the machining process.
Design/methodology/approach
The experimentation was performed on Inconel 718 in SPARKONIX MOS, 35 A, ZNC EDM using deionized water as dielectric and copper tool as electrode. The dielectric circulatory system was developed without disturbing the existing dielectric circulation system. Figure 1 shows the EDM with newly developed dielectric system. The existing system consists of hydrocarbon-based dielectric, which has a number of drawbacks during the machining such as carbide deposition on the work material, which reduces removal of material from work material; carbon particle adhesion on tool, which results in inefficient discharge between the electrode; and the work material and production of CO and CH4 during machining, which makes the machining environment toxic. To overcome these drawbacks, a sustainable dielectric was adopted in present work. Trial experiments were conducted to select the ranges of parameters, namely, discharge current, pulse-on-time and pulse-off-time. The process characteristics were evaluated at different parametric combinations and the experimentation was designed as per Taguchi L9 orthogonal array. Table 1 shows the properties of Inconel 718. Table 2 shows the parameters considered with its ranges. Table 3 shows the experimental values. The difference of weight of work piece before and after was taken and divided by the machining time used for calculating the MWR. Similarly, the difference of weight of tool material before and after was taken and divided by machining time and is used for calculating TWR. Measurement of surface roughness was done using Talysurf surface roughness meter.
Findings
The experimentation was conducted at different parametric combination on Inconel 718 taking copper as electrode and deionized water as dielectric. The performance criteria was evaluated at considered parametric combination. The result shows that the EDM parameters have significant contribution on the performance criteria and deionized water can be effectively used as dielectric medium in EDM. The use of deionized water as dielectric will improve the process and sustainable green machining can be performed. Super ranking method has been implemented to achieve the best combination of control factors and it is obtained that the combination A1B1C3 (i.e. discharge current = 3 A, pulse-on-time = 1 µs and pulse-off-time = 3 µs) is best combination for obtaining the higher MRR and lower TWR and Ra. The contributing factor in the proposed research work is discharge current. Further, ANOVA was implemented to check the adequacy of these result. It was established that discharge current is the most influential factor followed by pulse-on-time and the least contributing factor as pulse-off-time. The findings of this paper may open the guidelines for researcher for performing research in the field of sustainable machining of difficult to cut materials such as Inconel 718 with sustainable dielectrics in engineering applications.
Originality/value
The paper is original in nature. The findings of this paper may open the guidelines for researcher for performing research in the field of sustainable machining.
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Tanya McDonnaugh, Alan Underwood and Amanda Williams
The purpose of this paper is to explore the experiences of mentally disordered offenders (MDOs) conditionally discharged from secure hospitals on a restrictive Section of…
Abstract
Purpose
The purpose of this paper is to explore the experiences of mentally disordered offenders (MDOs) conditionally discharged from secure hospitals on a restrictive Section of the Mental Health Act (Section 37/41).
Design/methodology/approach
Data were derived from seven semi-structured interviews from three forensic community teams.
Findings
Thematic analysis identified seven predominant themes: (1) the uncertainty of the discharge timeframe; (2) fear of jeopardising discharge; (3) progress; (4) engagement with community life; (5) barriers to social engagement; (6) evolving identity and (7) someone to turn to. Findings are discussed in relation to the recovery model and the good lives model.
Practical implications
The findings highlight the importance of fostering trust between MDOs and their care teams to encourage help-seeking. They also suggest that resources should be sequenced appropriately throughout the discharge process, to match the “window of engagement” and maximize impact and effectiveness.
Originality/value
This research gained rarely obtained first-hand perspectives from MDOs, with the findings contributing to a more effective evaluation of the discharge pathway.
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Shiyu Feng, Chenchen Wang, Xiaotian Peng, Yan Yan, Yang Deng and Jun Chen
The purpose of this paper is to analyze the effects of the PRD geometric parameters, including the area and aspect ratio, on the discharge and force characteristics of…
Abstract
Purpose
The purpose of this paper is to analyze the effects of the PRD geometric parameters, including the area and aspect ratio, on the discharge and force characteristics of pressure relief process under various plenum compartment pressures and Mach numbers.
Design/methodology/approach
Under various plenum compartment pressures and Mach numbers, the effect of the area and aspect ratio on the discharge and force characteristics of the PRD are numerically investigated via a three-dimensional steady Reynolds-averaged Navier–Stokes equations solver based on structured grid technology.
Findings
When the aspect ratio remains constant, the discharge coefficient CD, thrust coefficient CT and moment coefficient CM are not affected by the PRD. When the area is constant, the aspect ratio dramatically impacts the discharge and force characteristics because the aspect ratio increases, the discharge coefficient CD of the PRD decreases, and the thrust coefficient CT and the moment coefficient CM both increase. When the aspect ratio is 2, the discharge coefficient CD decreases by 14.7 per cent, the thrust coefficient CT increases by 10-15 per cent, and the moment coefficient CM increases by 10-23 per cent compared with when the aspect ratio is 1.
Practical implications
This study provides detailed data and conclusions for nacelle PRD researchers and actual engineering applications.
Originality/value
On the basis of considering the influence of operating conditions on the discharge and force characteristics of the nacelle PRD, the impact of geometric parameters, including the area and aspect ratio on the discharge and force characteristics is comprehensively considered.
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Justin Waring, Simon Bishop, Fiona Marshall, Natasha Tyler and Robert Vickers
The purpose of this paper is to investigate how three communication interventions commonly used during discharge planning and care transitions enable inter-professional…
Abstract
Purpose
The purpose of this paper is to investigate how three communication interventions commonly used during discharge planning and care transitions enable inter-professional knowledge sharing and learning as a foundation for more integrated working. These interventions include information communication systems, dedicated discharge planning roles and group-based planning activities.
Design/methodology/approach
A two-year ethnographic study was carried out across two regional health and care systems in the English National Health Service, focussing on the discharge of stroke and hip fracture patients. Data collection involved in-depth observations and 213 semi-structured interviews.
Findings
Information systems (e.g. e-records) represent a relatively stable conduit for routine and standardised forms of syntactic information exchange that can “bridge” time–space knowledge boundaries. Specialist discharge roles (e.g. discharge coordinators) support personalised and dynamic forms of “semantic” knowledge sharing that can “broker” epistemic and cultural boundaries. Group-based activities (e.g. team meetings) provide a basis for more direct “pragmatic” knowledge translation that can support inter-professional “bonding” at the cultural and organisational level, but where inclusion factors complicate exchange.
Research limitations/implications
The study offers analysis of how professional boundaries complicate discharge planning and care transition, and the potential for different communication interventions to support knowledge sharing and learning.
Originality/value
The paper builds upon existing research on inter-professional collaboration and patient safety by focussing on the problems of communication and coordination in the context of discharge planning and care transitions. It suggests that care systems should look to develop multiple complementary approaches to inter-professional communication that offer opportunities for dynamic knowledge sharing and learning.
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Kristy Buccieri, Abram Oudshoorn, Tyler Frederick, Rebecca Schiff, Alex Abramovich, Stephen Gaetz and Cheryl Forchuk
People experiencing homelessness are high-users of hospital care in Canada. To better understand the scope of the issue, and how these patients are discharged from…
Abstract
Purpose
People experiencing homelessness are high-users of hospital care in Canada. To better understand the scope of the issue, and how these patients are discharged from hospital, a national survey of key stakeholders was conducted in 2017. The paper aims to discuss this issue.
Design/methodology/approach
The Canadian Observatory on Homelessness distributed an online survey to their network of members through e-mail and social media. A sample of 660 stakeholders completed the mixed-methods survey, including those in health care, non-profit, government, law enforcement and academia.
Findings
Results indicate that hospitals and homelessness sector agencies often struggle to coordinate care. The result is that these patients are usually discharged to the streets or shelters and not into housing or housing with supports. The health care and homelessness sectors in Canada are currently structured in a way that hinders collaborative transfers of patient care. The three primary and inter-related gaps raised by survey participants were: communication, privacy and systems pressures.
Research limitations/implications
The findings are limited to those who voluntarily completed the survey and may indicate self-selection bias. Results are limited to professional stakeholders and do not reflect patient views.
Practical implications
Identifying systems gaps from the perspective of those who work within health care and homelessness sectors is important for supporting system reforms.
Originality/value
This survey was the first to collect nationwide stakeholder data on homelessness and hospital discharge in Canada. The findings help inform policy recommendations for more effective systems alignment within Canada and internationally.
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The purpose of this paper is to investigate the effect of power on pulsed plasma thruster (PPT) discharge current with respect to its peak, duration, and behavior while…
Abstract
Purpose
The purpose of this paper is to investigate the effect of power on pulsed plasma thruster (PPT) discharge current with respect to its peak, duration, and behavior while the power elevates in a low power range.
Design/methodology/approach
A rectangular parallel‐plate breech‐fed PPT has been developed with a self‐inductor coupling element connecting the PPT cathode to the ignitor plug cathode. The PPT has been operated in vacuum chamber at 10−6 mbar and its discharge current has been recorded using a Rogowski coil while input power has been changed by means of varying the capacitor voltage at given capacitance and frequency.
Findings
The analysis leads to elucidate the effects of input power on discharge current of a PPT employing a self‐inductor coupling element. The power varies within a range of less than 10 to more than 50 W. The results show that current peak rises from 5 to 10 kA while discharge duration and behavior seems to be independent of power within the operating range. Additionally, utilization of the coupling element seems to change the typical oscillating behavior of PPT discharge to a more efficient behavior.
Research limitations/implications
The analysis is mainly focused on breech‐fed PPTs while employing a coupling element.
Originality/value
The paper analyzes the influence of power on discharge current of a PPT employing a self‐inductor coupling element. It clarifies the behavior of current peak, duration and behavior while power varies in a low power range. The effect of coupling element is shown to be promising. The results can be a help in design of μPPTs.
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Yun Tae Kim, Ba-Phu Nguyen and Dae-Ho Yun
It is well-known that consolidation rate of prefabricated vertical drain (PVD)-installed ground is closely related to the discharge capacity of PVD, which decreases with…
Abstract
Purpose
It is well-known that consolidation rate of prefabricated vertical drain (PVD)-installed ground is closely related to the discharge capacity of PVD, which decreases with an increase in effective stress. This paper aims to present consolidation behaviors of PVD-improved ground considering a varied discharge capacity of PVD.
Design/methodology/approach
A simple equivalent vertical hydraulic conductivity (k′ve method) was proposed in plane strain numerical analysis, in which the effect of decreased discharge capacity with depth was considered. Numerical analysis was applied to analyze field behaviors of test embankment of soft mucky deposit.
Findings
Finite element method results indicated that consolidation behaviors of PVD-improved soil with a nonlinear distribution of discharge capacity with depth were in a good agreement with the observed field behaviors, compared with those with a constant discharge capacity and a linear distribution of discharge capacity. At a given time and depth, the consolidation rate in the case of discharge capacity with a nonlinear distribution is lower than that of a linear or constant distribution.
Practical implications
A geotechnical engineer could use the proposed method to predict consolidation behaviors of drainage-installed ground.
Originality/value
Consolidation behaviors of PVD-installed ground could be reasonably predicted by using the proposed method with considering effect of discharge capacity reduction.
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