Information transfer for multi-trauma patients on discharge from the emergency department : mixed-method narrative review

Aim. This paper is a report of a review conducted to identify (a) best practice in information transfer from the emergency department for multi-trauma patients; (b) conduits and barriers to information transfer in trauma care and related settings; and (c) interventions that have an impact on information communication at handover and beyond. Background. Information transfer is integral to effective trauma care, and communication breakdown results in important challenges to this. However, evidence of adequacy of structures and processes to ensure transfer of patient information through the acute phase of trauma care is limited. Data sources. Papers were sourced from a search of 12 online databases and scanning references from relevant papers for 1990–2009. Review methods. The review was conducted according to the University of York’s Centre for Reviews and Dissemination guidelines. Studies were included if they concerned issues that influenced information transfer for patients in healthcare settings. Results. Forty-five research papers, four literature reviews and one policy statement were found to be relevant to parts of the topic, but not all of it. The main issues emerging concerned the impact of communication breakdown in some form, and included communication issues within trauma team processes, lack of structure and clarity during handovers including missing, irrelevant and inaccurate information, distractions and poorly documented care. Conclusion. Many factors influence information transfer but are poorly identified in relation to trauma care. The measurement of information transfer, which is integral to patient handover, has not been the focus of research to date. Nonetheless, documented patient information is considered evidence of care and a resource that affects continuing care.

How long does it take for aquifer recharge or aquifer discharge processes to reach steady state?

Groundwater flow models are usually characterized as being either transient flow models or steady state flow models. Given that steady state groundwater flow conditions arise as a long time asymptotic limit of a particular transient response, it is natural for us to seek a finite estimate of the amount of time required for a particular transient flow problem to effectively reach steady state. Here, we introduce the concept of mean action time (MAT) to address a fundamental question: How long does it take for a groundwater recharge process or discharge processes to effectively reach steady state? This concept relies on identifying a cumulative distribution function, $F(t;x)$, which varies from $F(0;x)=0$ to $F(t;x) \to \infty$ as $t\to \infty$, thereby providing us with a measurement of the progress of the system towards steady state. The MAT corresponds to the mean of the associated probability density function $f(t;x) = \dfrac{dF}{dt}$, and we demonstrate that this framework provides useful analytical insight by explicitly showing how the MAT depends on the parameters in the model and the geometry of the problem. Additional theoretical results relating to the variance of $f(t;x)$, known as the variance of action time (VAT), are also presented. To test our theoretical predictions we include measurements from a laboratory–scale experiment describing flow through a homogeneous porous medium. The laboratory data confirms that the theoretical MAT predictions are in good agreement with measurements from the physical model.

Imaging of the asymmetric DC discharge: visualization to adjust plasma in the novel PECVD reactor

Normal asymmetric glow dc discharge in the thermal furnace converted into the efficient PECVD system was imaged to adjust the structure of the plasma column to the two possible localizations of the process zone. The visualization revealed the possibility to use short and long discharge configurations for the plasma-enabled growth and processing of various nanostructures in the modified setup. Images of the discharge in the two localizations are presented.

Discharge mode transitions in low-frequency inductively coupled plasmas with internal oscillating current sheets

Transitions between the two discharge modes in a low-frequency (∼460 kHz) inductively coupled plasma sustained by an internal oscillating radio frequency (rf) current sheet are studied. The unidirectional rf current sheet is generated by an internal antenna comprising two orthogonal sets of synphased rf currents driven in alternately reconnected copper litz wires. It is shown that in the low-to-intermediate pressure range the plasma source can be operated in the electrostatic (E) and electromagnetic (H) discharge modes. The brightness of the E -mode argon plasma glow is found remarkably higher than in inductively coupled plasmas with external flat spiral "pancake" coils. The cyclic variations of the input rf power result in pronounced hysteretic variations of the optical emission intensity and main circuit parameters of the plasma source. Under certain conditions, it appears possible to achieve a spontaneous E→H transition ("self-transition"). The observed phenomenon can be attributed to the thermal drift of the plasma parameters due to the overheating of the working gas. The discharge destabilizing factors due to the gas heating and step-wise ionization are also discussed. © 2005 American Vacuum Society.

Ions And Barriers in Electric Discharge

It is a well know that electrons and positive ions are responsible in the case of electric spark. Investigation have been undertaken in the high voltage laboratory to study the effect of injecting ions (both possitive and negative)into the spark gap.Also the effect of paper screens in blocking the ions being invetsigated.

Coplanar gas-discharge display

1. The electric field strength between coplanar electrodes is calculated employing "conformal transformations." The electron multiplication factor is then computed in the nonuniform field region. These calculations have been made for different gap lengths, voltages, and also for different gases and gas pressures. The configuration results in a curved discharge path. It is found that the electron multiplication is maximum along a particular flux line and the prebreakdown discharge is expected to follow this flux line. Experimental tubes incorporating several coplanar gaps have been fabricated. Breakdown voltages have been measured for various discharge gaps and also for various gases such as xenon, helium, neon, argon, and neon-argon mixture (99.5:0.5) at different filling pressures. The variation of breakdown voltage with pressure and gap length is discussed. The observed discharge paths are curved and this is in agreement with theoretical results. A few experimental single-digit coplanar gas-discharge displays (CGDD's) with digit height of 5 cm have been fabricated and dependence of their characteristics on various parameters, including spacing between top glass plate and bottom substrate, have been studied.

Surface Discharge Studies with Uniform Field Electrodes at Low Pressures

An investigation of power frequency (50 Hz) surface partial discharges in dry air, using 21r/3 Rogowski profile electrodes in the low pressure range of 0.067 to 91.333 kPa, shows that for the discharges occurring symmetrically around the electrodes and just outside the uniform field region, the breakdown voltages are 20 to 30% lower than those accounted for by the usual Paschen values. Emphasis, therefore, has been given to modified values of breakdown voltages for any useful calculations. The effect of reduced pressure on inception voltage has been discussed and an attempt has been made to explain the difference between the observed and calculated values on the basis of a pressure-dependent secondary ionization coefficient. It is shown that increasing the insulation thickness in a critical pressure range (0.067 to 0.400 kPa) does not allow any significant increase in the discharge free working stress of the insulation system. At higher pressures (>0.400 kPa) the increase in inception voltage with thickness and pressure follows an equation which is expected to hold for other insulating materials as well.

Experimental evidence of the cavity theory of sorption-desorption hysteresis by a study of the effect of electric discharge on entrapped water in silica gel

With the use of the quartz fiber spring balance, sorptions and desorptions of water on silica gel at 30°C were studied and the permanent and reproducible hysteresis loop was obtained. At different points on the desorption curve forming the loop, the gel was subjected to high tension glow electric discharge. As a result of the electric discharge, the gel at any point on the desorption curve shifts to a corresponding point on the sorption curve. This is due to the release from the cavities of gel of the entrapped water held in a metastable state. The electric discharge has no effect on the gel at different points on portions of the desorption curve which coincide with the sorption curve and also on the sorption curve itself, indicating the absence of entrapped water in the gel in these regions. The results afford direct experimental evidence of the reality of the cavity theory of sorption-desorption hysteresis.

Dielectric barrier discharge plasma interaction with the airflow over an airfoil

The effect of various parameters on the velocity of the induced jet produced by a dielectric barrier discharge (DBD) plasma was studied experimentally. The glow discharge was created at atmospheric conditions by using a high voltage RF power supply. Flow visualization and photographic studies of the plasma were performed. The parametric investigation of the characteristics of the plasma show that the width of the plasma in the uniform glow discharge regime was an indication of the velocity induced under stagnant conditions. It was observed that the spanwise overlap of the two electrodes, dielectric thickness, voltage and frequency of the applied voltage are the major parameters that govern the velocity and the extent of plasma in the streamwise direction.

Battery-Powered RF Pre-Ionization System for the Caltech Magnetohydrodynamically-Driven Jet Experiment: RF Discharge Properties and MHD-Driven Jet Dynamics

This thesis describes investigations of two classes of laboratory plasmas with rather different properties: partially ionized low pressure radiofrequency (RF) discharges, and fully ionized high density magnetohydrodynamically (MHD)-driven jets. An RF pre-ionization system was developed to enable neutral gas breakdown at lower pressures and create hotter, faster jets in the Caltech MHD-Driven Jet Experiment. The RF plasma source used a custom pulsed 3 kW 13.56 MHz RF power amplifier that was powered by AA batteries, allowing it to safely float at 4-6 kV with the cathode of the jet experiment. The argon RF discharge equilibrium and transport properties were analyzed, and novel jet dynamics were observed.

Although the RF plasma source was conceived as a wave-heated helicon source, scaling measurements and numerical modeling showed that inductive coupling was the dominant energy input mechanism. A one-dimensional time-dependent fluid model was developed to quantitatively explain the expansion of the pre-ionized plasma into the jet experiment chamber. The plasma transitioned from an ionizing phase with depressed neutral emission to a recombining phase with enhanced emission during the course of the experiment, causing fast camera images to be a poor indicator of the density distribution. Under certain conditions, the total visible and infrared brightness and the downstream ion density both increased after the RF power was turned off. The time-dependent emission patterns were used for an indirect measurement of the neutral gas pressure.

The low-mass jets formed with the aid of the pre-ionization system were extremely narrow and collimated near the electrodes, with peak density exceeding that of jets created without pre-ionization. The initial neutral gas distribution prior to plasma breakdown was found to be critical in determining the ultimate jet structure. The visible radius of the dense central jet column was several times narrower than the axial current channel radius, suggesting that the outer portion of the jet must have been force free, with the current parallel to the magnetic field. The studies of non-equilibrium flows and plasma self-organization being carried out at Caltech are relevant to astrophysical jets and fusion energy research.

Characterization of a high-density, direct-current reflex discharge plasma source operating in Ar and N-2

The characterization of a direct current, low-pressure, and high-density reflex discharge plasma source operating in argon and in nitrogen, over a range of pressures 1.0-10(-2) mbar, discharge currents 20-200 mA, and magnetic fields 0-120 G, and its parametric characterization is presented. Both external parameters, such as the breakdown potential and the discharge voltage-current characteristic, and internal parameters, like the charge carrier's temperature and density, plasma potential, floating potential, and electron energy distribution function, were measured. The electron energy distribution functions are bi-Maxwellian, but some structure is observed in these functions in nitrogen plasmas. There is experimental evidence for the existence of three groups of electrons within this reflex discharge plasma. Due to the enhanced hollow cathode effect by the magnetic trapping of electrons, the density of the cold group of electrons is as high as 10(18) m(-3), and the temperature is as low as a few tenths of an electron volt. The bulk plasma density scales with the dissipated power. Another important feature of this reflex plasma source is its high degree of uniformity, while the discharge bulk region is free of electric field. (C) 2002 American Institute of Physics.

Comparison of plasma transport theory with measurements in a H- discharge

This paper and its companion paper describe the comparison between a one-dimensional theoretical model of a hydrogen discharge in a magnetic multipole plasma source and experimental measurements of the plasma parameters. The discharge chamber, described here, has been designed to produce significant densities of H- ions by incorporating a weak transverse field through the discharge to obtain electron cooling so as to maximize H- production. Langmuir probes are used to monitor the plasma, determining the ion density, the electron density and temperature and the plasma potential. The negative density is measured by photo-detachment of the extra electron using an intense laser beam. The model, described in the companion paper, uses the presented source geometry to calculate these plasma quantities as a function of the major are parameters; namely the are current and voltage and gas pressure. Good agreement is obtained between theory and experiment as a function of position and arc parameters.

Bacterial sterilization by a dielectric barrier discharge (DBD) in air

Cold atmospheric plasma treatment of microorganisms and living tissues has become a popular topic in modern plasma physics and in medical science. The plasma is capable of bacterial inactivation and noninflammatory tissue modification, which makes it an attractive tool for treatment of skin diseases, open injuries and dental caries. Because of their enhanced plasma chemistry, Dielectric Barrier Discharges (DBDs) have been widely investigated for some emerging applications such as biological and chemical decontamination of media at ambient conditions. Despite the high breakdown voltage in air at atmospheric pressure, the average current of DBD discharges is low. Therefore, a DBD can be applied in direct contact with biological objects without causing any damage. In this work a 60 Hz DBD reactor, which generates cold atmospheric plasma inside Petri dishes with bacterial culture, is investigated. Samples of Staphylococcus aureus, a Gram-positive bacterium and Escherichia coil a Gram-negative bacterium were selected for this study. The bacterial suspensions were evenly spread on agar media planted in Petri dishes. The reactor electrodes were placed outside the Petri dish, thus eliminating the risk of samples microbial contamination. The covered Petri dish with agar medium in it serves as dielectric barrier during the treatment. The plasma processing was conducted at same discharge power (similar to 1.0 W) with different exposure time. Sterilization of E. coil and S. aureus was achieved for less than 20 min. Plasma induced structural damages of bacteria were investigated by Scanning Electron Microscopy. (C) 2010 Elsevier B.V. All rights reserved.

COMBUSTION INITIATION BY ELECTRICAL-DISCHARGE-INDUCED PLASMA IN LEAN AND DILUTE METHANE-AIR MIXTURE: EXPERIMENTAL AND MODELING INVESTIGATION

This dissertation represents experimental and numerical investigations of combustion initiation trigged by electrical-discharge-induced plasma within lean and dilute methane air mixture. This research topic is of interest due to its potential to further promote the understanding and prediction of spark ignition quality in high efficiency gasoline engines, which operate with lean and dilute fuel-air mixture. It is specified in this dissertation that the plasma to flame transition is the key process during the spark ignition event, yet it is also the most complicated and least understood procedure. Therefore the investigation is focused on the overlapped periods when plasma and flame both exists in the system. Experimental study is divided into two parts. Experiments in Part I focuses on the flame kernel resulting from the electrical discharge. A number of external factors are found to affect the growth of the flame kernel, resulting in complex correlations between discharge and flame kernel. Heat loss from the flame kernel to code ambient is found to be a dominant factor that quenches the flame kernel. Another experimental focus is on the plasma channel. Electrical discharges into gases induce intense and highly transient plasma. Detailed observation of the size and contents of the discharge-induced plasma channel is performed. Given the complex correlation and the multi-discipline physical/chemical processes involved in the plasma-flame transition, the modeling principle is taken to reproduce detailed transitions numerically with minimum analytical assumptions. Detailed measurement obtained from experimental work facilitates the more accurate description of initial reaction conditions. The novel and unique spark source considering both energy and species deposition is defined in a justified manner, which is the key feature of this Ignition by Plasma (IBP) model. The results of numerical simulation are intuitive and the potential of numerical simulation to better resolve the complex spark ignition mechanism is presented. Meanwhile, imperfections of the IBP model and numerical simulation have been specified and will address future attentions.