Physician, institutional and patient factors all contribute to self-discharge. Improving cultural safety may be the key to lowering self-discharge rates. WHAT IS KNOWN ABOUT THE TOPIC? Rates of self-discharge by Aboriginal adults in Central Australia are the highest reported worldwide. Previous studies have been retrospective and focussed on patient demographics without addressing the environmental and cultural contexts in which self-discharge occurs. WHAT DOES THIS PAPER ADD? In this acute care setting, we found a pervasive failure to communicate effectively with Aboriginal patients. Consequently, most patients were unaware of their diagnosis or length of stay. Self-discharge was a common practice; nearly half of all previously admitted patients had self-discharged in the past. We demonstrate that physician, hospital and patient factors all contribute to this practice. Prospectively determined risk factors included the treating medical team, the need for transfer outside Central Australia, and patient factors such as male gender and alcohol dependence. Self-discharge rates fell significantly with Aboriginal Liaison involvement. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Cross-cultural communication skills must be markedly improved among medical staff caring for this marginalised population. Critical to reducing rates of self-discharge are improvements in institutional cultural safety by involving Aboriginal Liaison Officers and family members. However, persistently high self-discharge rates suggest a need to redirect medical services to a more culturally appropriate community-based model of care.
The Thunder Horse offshore Field, located in the Gulf of Mexico, consists of multiple producing complex oil reservoirs. The producing zones have been developed with approximately 20 wells flowing, via 5 subsea flowline-and-riser systems, into a dual train production facility. The combination of risers, trains, and separation stages allows a wide range of routing flexibility and optimization opportunities for this production system. However, the complexity of the different combinations requires innovative system optimisation strategies to identify optimal configurations. An Integrated Asset Model (IAM) was built which achieves excellent fidelity and reliably predicts production improvements. One particular application of the IAM in 2015 informed the safe, reliable routing of a well directly to a second stage separation vessel resulting in the delivery of over 5 mbopd extra production. These techniques are now being applied to other BP assets with continued success. This paper describes some key elements of these models, the challenges in maintaining and calibrating these models, and a case study to showcase its value.
This paper investigates nozzle material candidates for use in a turbocharger turbine technology known as the active control turbocharger (ACT) which is a distinct technology to the Variable Geometry Turbine (VGT) for turbochargers, but broadly based on this technology. In this concept an actuated nozzle mechanism is oscillated to provide a continuous change of the turbine inlet area in response to the instantaneous exhaust gas flow pulsating characteristics to provide greater extraction of exhaust gas pulse energy. Careful materials selection is required for this application to overcome the creep, fatigue, oxidation and high temperature challenges associated with the diesel engine exhaust conditions to which the nozzle is exposed to. The investigation of materials suitability for this application was conducted for steady and transient flow conditions. It was found that the nozzle vane undergo cyclical loading at a maximum stress of 58 MPa for 10 9 cycles of operation at an inlet temperature of 800 o C and pressure of 240 kPa. The vane experiences maximum stresses in the closed position which occurs at a vane angle of 70 o . It has been found that the implementation of ACT technology is possible using currently available materials. A material selection process was developed to incorporate the specific application requirements of the ACT application. A weightinG decision process was applied to analyse the importance of various material properties to each application requirement and to the properties of individual materials. Nimonic 90 and IN X750/751 obtained the highest overall scores from the selection process and were shown to be capable of withstanding the creep requirements; a failure mechanism of primary concern in the high temperature application. Nimonic 80A, although receiving a final rating 8% lower than Nimonic 90, also showed promising potential to offer a solution, with superior corrosion properties to both Nimonic 90 and IN X750/751.
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