Discharge planning in the emergency department : a comprehensive approach

Discharge planning has become increasingly important, with current trends toward shorter hospital stays, increased health care costs, and more community-based health services. Effective discharge planning ensures the safety and ongoing care for patients,1 and it also benefits health care providers and organizations. It results in shorter hospital stays, fewer readmissions, higher access rates to post-hospitalization services, greater patient satisfaction with the discharge, and improved quality of life and continuity of care.[2] and [3] All acute care patients and their caregivers require some degree of preparation for discharge home—education about their health status, risks, and treatment; help setting health goals and maintaining a good level of self-care; information about community resources; and follow-up appointments and referrals to appropriate community health providers. Inadequate preparation exposes the patient to unnecessary risks of recurrence or complications of the acute complaint, neglect of nonacute comorbidities, mismanagement and side effects of medication, disruption of family and social life, emotional distress, and financial loss.[2], [3] and [4] The result may be re-presentation to the emergency department. It is noteworthy that up to 18% of ED presentations are revisits within 72 hours of the original visit5; many of these are considered preventable.6 It is a primary responsibility of nurses to ensure that patients return to the community adequately prepared and with appropriate support in place. Up to 65% of ED patients are discharged home from the emergency department,7 and the characteristics of the emergency department and its patient population make the provision of a high standard of discharge planning uniquely difficult. In addition, discharge planning is neglected in contemporary emergency nursing—there are no monographs devoted to the subject, and there is little published research. In this article 3 issues are explored: the importance of emergency nurses’ participation in the discharge-planning process, impediments to their participation; and strategies to improve discharge planning in the emergency department.

Full scale fire tests of a new light gauge steel floor-ceiling system

Cold-formed steel members can be assembled in various combinations to provide cost-efficient and safe light gauge floor systems for buildings. Such Light gauge Steel Framing (LSF) systems are widely accepted in industrial and commercial building construction. An example application is in floor-ceiling systems. Light gauge steel floor-ceiling systems must be designed to serve as fire compartment boundaries and provide adequate fire resistance. Fire-rated floor-ceiling assemblies formed with new materials and construction methodologies have been increasingly used in buildings. However, limited research has been undertaken in the past and hence a thorough understanding of their fire resistance behaviour is not available. Recently a new composite floor-ceiling system has been developed to provide higher fire rating under standard fire conditions. But its increased fire rating could not be determined using the currently available design methods. Therefore a research project was carried out to investigate its structural and fire resistance behaviour under standard fire conditions. In this research project full scale experimental tests of the new LSF floor system based on a composite ceiling unit were undertaken using a gas furnace at the Queensland University of Technology. Both the conventional and the new steel floor-ceiling systems were tested under structural and fire loads. Full scale fire tests provided a good understanding of the fire behaviour of the LSF floor-ceiling systems and confirmed the superior performance of the new composite system. This paper presents the details of this research into the structural and fire behaviour of light gauge steel floor systems protected by the new composite panel, and the results.

Improvements to the fire performance of light gauge steel floor systems

Light gauge steel frame (LSF) structures are increasingly used in commercial and residential buildings because of their non-combustibility, dimensional stability and ease of installation. A common application is in floor-ceiling systems. The LSF floor-ceiling systems must be designed to serve as fire compartment boundaries and provide adequate fire resistance. Fire-rated floor-ceiling assemblies have been increasingly used in buildings. However, limited research has been undertaken in the past and hence a thorough understanding of their fire resistance behaviour is not available. Recently a new composite floor-ceiling system has been developed to provide higher fire rating. But its increased fire rating could not be determined using the currently available design methods. Therefore a research project was conducted to investigate its structural and fire resistance behaviour under standard fire conditions. This paper presents the results of full scale experimental investigations into the structural and fire behaviour of the new LSF floor system protected by the composite ceiling unit. Both the conventional and the new floor systems were tested under structural and fire loads. It demonstrates the improvements provided by the new composite panel system in comparison to conventional floor systems. Numerical studies were also undertaken using the finite element program ABAQUS. Measured temperature profiles of floors were used in the numerical analyses and their results were compared with fire test results. Tests and numerical studies provided a good understanding of the fire behaviour of the LSF floor-ceiling systems and confirmed the superior performance of the new composite system.

Correlating vehicle forces and track profile

A research project was conducted at Queensland University of Technology on the relationship between the forces at the wheel-rail interface in track and the rate of degradation of track. Data for the study was obtained from an instrumented vehicle which ran repeatedly over a section of Queensland Rail's track in Central Queensland over a 6-month period. The wheel-rail forces had to be correlated with the elements of roughness in the test track profile, which were measured with a variety of equipment. At low frequencies, there was strong correlation between forces and profile, as expected, but diminishing correlation as frequencies increased.

Overview of the INEX 2009 XML mining track : clustering and classification of XML documents

This report explains the objectives, datasets and evaluation criteria of both the clustering and classification tasks set in the INEX 2009 XML Mining track. The report also describes the approaches and results obtained by the different participants.

Internal audit department characteristics/activities and audit fees : some evidence from Hong Kong firms

This study provides preliminary support for the notion that internal audit function assists in reducing external audit effort and fees. Data on internal audit characteristics and activities are obtained from survey respondents of Hong Kong companies and audit fee model data are acquired from their annual reports. The results of this study suggest that the external auditor of firms in Hong Kong rely on the internal audit function and subsequently charge a lower fee. Lower external audit fees are associated with a larger internal audit department and certain activities carried out by the internal audit. Specifically, lower external audit fees are associated with more internal audit effort spent on activities relating to financial statements, systems development and maintenance, operating efficiency and effectiveness, fraud investigations and unlimited access to internal auditors’ working papers. The results of this study suggest that the contribution of the internal audit may substitute for some substantive external auditing processes and lower monitoring costs.

An integrated rail track degradation model

There has been a worldwide trend to increase axle loads and train speeds. This means that railway track degradation will be accelerated, and track maintenance costs will be increased significantly. There is a need to investigate the consequences of increasing traffic load. The aim of the research is to develop a model for the analysis of physical degradation of railway tracks in response to changes in traffic parameters, especially increased axle loads and train speeds. This research has developed an integrated track degradation model (ITDM) by integrating several models into a comprehensive framework. Mechanistic relationships for track degradation hav~ ?een used wherever possible in each of the models contained in ITDM. This overcc:mes the deficiency of the traditional statistical track models which rely heavily on historical degradation data, which is generally not available in many railway systems. In addition statistical models lack the flexibility of incorporating future changes in traffic patterns or maintenance practices. The research starts with reviewing railway track related studies both in Australia and overseas to develop a comprehensive understanding of track performance under various traffic conditions. Existing railway related models are then examined for their suitability for track degradation analysis for Australian situations. The ITDM model is subsequently developed by modifying suitable existing models, and developing new models where necessary. The ITDM model contains four interrelated submodels for rails, sleepers, ballast and subgrade, and track modulus. The rail submodel is for rail wear analysis and is developed from a theoretical concept. The sleeper submodel is for timber sleepers damage prediction. The submodel is developed by modifying and extending an existing model developed elsewhere. The submodel has also incorporated an analysis for the likelihood of concrete sleeper cracking. The ballast and subgrade submodel is evolved from a concept developed in the USA. Substantial modifications and improvements have been made. The track modulus submodel is developed from a conceptual method. Corrections for more global track conditions have been made. The integration of these submodels into one comprehensive package has enabled the interaction between individual track components to be taken into account. This is done by calculating wheel load distribution with time and updating track conditions periodically in the process of track degradation simulation. A Windows-based computer program ~ssociated with ITDM has also been developed. The program enables the user to carry out analysis of degradation of individual track components and to investigate the inter relationships between these track components and their deterioration. The successful implementation of this research has provided essential information for prediction of increased maintenance as a consequence of railway trackdegradation. The model, having been presented at various conferences and seminars, has attracted wide interest. It is anticipated that the model will be put into practical use among Australian railways, enabling track maintenance planning to be optimized and potentially saving Australian railway systems millions of dollars in operating costs.