Dissertation submitted in fulfilment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2011. / South African Advanced Life Support (ALS) providers follow an autonomous practice model of care. This advanced role profile is characterized by clinical skill competence and autonomous decision making whilst demonstrating a high level of awareness of their own ethical attitudes, values and beliefs. It is through a professional commitment that ALS providers deliver an advanced evidence based practice that should be maintained constantly within a dynamic environment. Continuous Professional Development (CPD) is seen as an instrument for this. CPD should also serve as a means to acquire professional excellence and going beyond the boundaries of meeting the base level standard with the aim of providing the finest quality of care in the interest of patient safety. Purpose of the research The purpose of this research is to identify gaps in the professional development of out-of-hospital ALS providers trained in South Africa by assessing frequency of performance of ALS clinical skills, by determining perceived level of competence and predictors of confidence, and by sourcing information on attendance of CPD activities and training needs. vi Methodology This study used a quantitative non-experimental design. Data was attained from an e-mail based descriptive survey that was limited to a precise and concise questionnaire. The data from 140 (N) ALS providers was subjected to a descriptive statistical analysis using the PASW statistics version 18.0 to systematically show patterns and trends. Frequency distributions were generated to describe data categories. Bivariate analysis was conducted using Chi-square and Pearson correlation tests. Results Results indicated that ALS providers performed clinical skills infrequently. Of the total number of respondents 140 (N), the average ALS clinical skills performance was 6 (4.8%) daily. In the 2-6 times a week category 8 (6.4%) ALS clinical skills were performed. ALS clinical skills performance in the once a week category showed an average of 7 (5.6%) and the once a month category, an average of 17 (13.7%) ALS skills were performed. An average of 31 (25%) ALS skills were performed in the once in six months category whilst an average of 54 (43.5%) were performed in the greater than six months category. CPD activities that are appropriate to ensuring the maintenance of competence for these clinical skills were not adequately undertaken. Medical updates were mostly attended by ALS providers, 52 (42.9%) whilst CPD events that addressed clinical skills, was mostly limited vii to the ACLS course 42 (34.7%). The needs assessment for CPD showed that 56 (53%) of respondents expressed a need for paediatric and obstetric simulated skill sessions, whilst 43 (40.9%) requested clinical skills workshops and 39 (37.1%) expressed a need for clinical practice in theatre and coronary care units. Conclusions and recommendations This study shows that ALS clinical skill competence is maintained by frequent practice and appropriateness of CPD activities. The infrequent performance of ALS skills coupled with the lack of appropriate and diverse CPD activity attendance results in poor maintenance of competence. The loss of competence can be related to poor reported levels of confidence which consequently places patient safety at risk. To safeguard against medical error and ensure patient safety, it is strongly recommended that CPD audits be undertaken on all ALS providers for appropriate CPD compliance related to clinical skills performance. In addition to a clinical skills audit, it is recommended that a national clinical skills registry be established with the intention of facilitating clinical skill surveillance, to determine a notifiable, high risk skill set. To safeguard against knowledge and clinical skill attrition and loss of competence, the delivery of CPD activities should be assessed for effectiveness and appropriateness.

Extended missions to space have long been a goal of the National Aeronautics and Space Administration (NASA). Accomplishment of NASA's goal requires the development of systems and tools for sustaining human life for periods of several months to several years. This is the primary objective of NASA's Advanced Life Support (ALS) program. This work contributes directly to NASA efforts for ALS, particularly food production. The objective of this work is to develop a systematic methodology for analyzing and improving or modifying ALS technologies to increase their acceptability for implementation in long-duration space missions. By focusing primarily on the food production systems, it is an aim of this work to refine the procedure for developing and analyzing the ALS technologies. As a result of these efforts, researchers will have at their disposal, a powerful tool for establishing protocols for each technology as well as for modifying each technology to meet the standards for practical applications. To automate the developed methodology and associated calculations, a computer-aided tool has been developed. The following systematic procedures are interrelated and automatically integrated into the computer-aided tool: • Process configuration, with particular emphasis given to food production (e.g., syrup and flour from sweet potato, starch from sweet potato, breakfast cereal from sweet potato); • Modeling and analysis for mass and energy tracking and budgeting; • Mass and energy integration • Metrics evaluation (e.g., Equivalent System Mass (ESM)). Modeling and analysis is achieved by developing material- and energy-budgeting models. Various forms of mass and energy are tracked through fundamental as well as semiempirical models. Various system alternatives are synthesized and screened using ESM and other metrics. The results of mass, energy and ESM analyses collectively revealed the major consumers of time, equivalent mass, and energy, namely evaporation, condensation, dehydration, drying and extrusion. The targeted processes were subsequently targeted for modifications. In conclusion, this work provides a systematic methodology for transforming non-conventional problems into traditional engineering design problems, a significant contribution to ALS studies.

The gaseous plant hormone ethylene is a small molecule that regulates developmental change. Research was conducted in three areas: sensitivity, synthesis, and alterations to synthesis. Vegetative pea plants were more sensitive than radish plants to atmospheric ethylene. Light intensity did not affect ethylene sensitivity. Ethylene synthesis rates were measured for unstressed cotton, corn, soybean, and tomato plants. The per-plant ethylene synthesis rate ranged from 0.1-80 pmol plant-1 s-1. However, when normalized to net photosynthetic rate, this range was 1-4 µmol of ethylene synthesis per mol of CO2 uptake. Diurnal cycles in ethylene synthesis were present in all crops studied. These cycles were disrupted by drought stress and were attenuated when synthesis rates underwent large changes. Drought stress decreased synthesis in cotton. Flooded corn and soybean had increased synthesis. Blocked perception had no effect on ethylene synthesis or net photosynthetic rate in healthy unstressed plants.

The Water Recovery System (WRS) is one of the necessary subsystems in an Advanced Life Support program. It regenerates potable water by processing wastewater generated on a space shuttle or on a space station. The Biological Water Processor (BWP) is one of the complex subsections of WRS that involves processes described by continuous time as well as discrete event dynamics. Such systems can be modeled as hybrid dynamical systems in MATLAB/Stateflow. The following state variables of the BWP have been simulated in MATLAB: Pressure drop across Organic Carbon Oxidation Reactor (OCOR), Pressure drop across nitrification reactor, nitrifier flow rate, total flow to OCOR, Gas-liquid separator level, feed pump modes. The developed model of the BWP can be used for the simulation of the complete WRS and also for synthesis of a distributed control laws for the BWP subsection.

The foundation of modern-day emergency medical service (EMS) systems began in 1966, based on hospital medical care. Demand for evidence to support prehospital practices that have been in existence for the past half-century has continued to grow; yet, researchers have not adequately explored the relationship between the medical certification level of emergency first responders and the amount of time an ambulance spends on the scene. The purpose of this quantitative study was to examine and compare ambulance scene times for emergency responses when basic life support (BLS) certified first responders or advanced life support (ALS) first responders are first on the scene, and whether the level of first responder training reduces the time spent on the scene by a paramedic ambulance. A final research question dealt with whether there is a relationship between how long the first responder is on the scene and the amount of time an ambulance spends at the scene of an emergency. The publicly available archival data used for the study were from a community that had BLS and ALS first responders. Data analysis involved t-tests of the hypotheses for the first 2 research questions and a linear regression analysis of the hypotheses for the third research question. The findings showed that there is a clear difference in ambulance scene times based on the certification level of the first responders. Advanced life support first responders significantly reduced the scene time of ambulances when they arrived at the scene prior to the ambulance. Positive social change could result from this study if understanding the impact that ALS first responders have on ambulance scene times leads EMS planning managers to deploy resources more strategically, thus improving the efficiency of the public safety system and saving lives.

Dissertation submitted in fulfilment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2011. / South African Advanced Life Support (ALS) providers follow an autonomous practice model of care. This advanced role profile is characterized by clinical skill competence and autonomous decision making whilst demonstrating a high level of awareness of their own ethical attitudes, values and beliefs. It is through a professional commitment that ALS providers deliver an advanced evidence based practice that should be maintained constantly within a dynamic environment. Continuous Professional Development (CPD) is seen as an instrument for this. CPD should also serve as a means to acquire professional excellence and going beyond the boundaries of meeting the base level standard with the aim of providing the finest quality of care in the interest of patient safety. Purpose of the research The purpose of this research is to identify gaps in the professional development of out-of-hospital ALS providers trained in South Africa by assessing frequency of performance of ALS clinical skills, by determining perceived level of competence and predictors of confidence, and by sourcing information on attendance of CPD activities and training needs. vi Methodology This study used a quantitative non-experimental design. Data was attained from an e-mail based descriptive survey that was limited to a precise and concise questionnaire. The data from 140 (N) ALS providers was subjected to a descriptive statistical analysis using the PASW statistics version 18.0 to systematically show patterns and trends. Frequency distributions were generated to describe data categories. Bivariate analysis was conducted using Chi-square and Pearson correlation tests. Results Results indicated that ALS providers performed clinical skills infrequently. Of the total number of respondents 140 (N), the average ALS clinical skills performance was 6 (4.8%) daily. In the 2-6 times a week category 8 (6.4%) ALS clinical skills were performed. ALS clinical skills performance in the once a week category showed an average of 7 (5.6%) and the once a month category, an average of 17 (13.7%) ALS skills were performed. An average of 31 (25%) ALS skills were performed in the once in six months category whilst an average of 54 (43.5%) were performed in the greater than six months category. CPD activities that are appropriate to ensuring the maintenance of competence for these clinical skills were not adequately undertaken. Medical updates were mostly attended by ALS providers, 52 (42.9%) whilst CPD events that addressed clinical skills, was mostly limited vii to the ACLS course 42 (34.7%). The needs assessment for CPD showed that 56 (53%) of respondents expressed a need for paediatric and obstetric simulated skill sessions, whilst 43 (40.9%) requested clinical skills workshops and 39 (37.1%) expressed a need for clinical practice in theatre and coronary care units. Conclusions and recommendations This study shows that ALS clinical skill competence is maintained by frequent practice and appropriateness of CPD activities. The infrequent performance of ALS skills coupled with the lack of appropriate and diverse CPD activity attendance results in poor maintenance of competence. The loss of competence can be related to poor reported levels of confidence which consequently places patient safety at risk. To safeguard against medical error and ensure patient safety, it is strongly recommended that CPD audits be undertaken on all ALS providers for appropriate CPD compliance related to clinical skills performance. In addition to a clinical skills audit, it is recommended that a national clinical skills registry be established with the intention of facilitating clinical skill surveillance, to determine a notifiable, high risk skill set. To safeguard against knowledge and clinical skill attrition and loss of competence, the delivery of CPD activities should be assessed for effectiveness and appropriateness.

The development of a plant growth chamber capable of sustaining plant growth over multiple generations is a necessary step towards the attainment of a Controlled Ecological Life Support System (CELSS). The studies herein examine the effects of aeration abilities and rates on plants grown in three model nutrient delivery systems during germination and over the life-cycle of the plant. These studies are the first time a porous tube nutrient delivery system was compared to another active nutrient mist delivery system. During germination an indicator of hypoxic stress, alcohol dehydrogenase (ADH) activity, was measured and was more affected by aeration rate than mode of nutrient delivery. Over the life-cycle of the plant, however, plants grown in the porous tube system had the least ADH activity and the highest levels of shoot (leaf + stem), root and leaf biomass. None of the plants in any system, however, produced viable seed. This study highlights the need to optimize aeration capabilities in the root zone of enclosed chambers.

No description available.

In recent years international space agencies have become more and more explicit about long term lunar and Martian space missions. With the space program Terrae Novae, the European Space Agency puts forward a focus on the development of Human & Robotic Exploration technologies essential in enabling such long term missions. An integral component of this program is the focus on Advanced Life Support Systems. Life support systems are operated to provide astronauts with life necessities like oxygen, water and food. Currently, conventional Life Support System often have a linear supply design, relying on resources shipped from Earth, with limited onboard re-usage. However, for extended space missions, this linear supply model becomes impractical due to the constraints of dry mass during space travel. Given this need, the European Space Agency initiated the MELiSSA (Micro-Ecological Life Support System Alternative) project aimed at the development of a bioregenerative life support systems. In previous works, the MELiSSA Loop has been proposed: a system design inspired by terrestial ecosystems, that consists of multiple compartments that perform specific biological functions like nitrification and biosynthesis. Due to the complex interdependence of the individual compartments and general space system requirements, the control of such this cyber-physical system forms a significant challenge. This thesis proposes a previously undescribed architecture for the MELiSSA Loop controller design that coordinates the resource distribution between the compartments and establishes atmosphere revitalisation. The architecture meets control objectives specified at high level, and at the same time satisfies the physical and operational constraints. / Under de senaste åren har internationella rymdorganisationer blivit mer och mer tydliga om långsiktiga mån- och rymduppdrag på mars. Med rymdprogrammet Terrae Novae lägger Europeiska rymdorganisationen fram ett fokus på utvecklingen av Human & Robotic Exploration-teknik som är nödvändig för att möjliggöra sådana långsiktiga uppdrag. En integrerad del av detta program är fokus på Advanced Life Support Systems. Livsuppehållande system används för att förse astronauter med livsnödvändigheter som syre, vatten och mat. För närvarande har konventionella livsuppehållande system ofta en linjär försörjningsdesign som förlitar sig på resurser som skickas från jorden, med begränsad återanvändning ombord. Men för utökade rymduppdrag blir denna linjära försörjningsmodell opraktisk på grund av begränsningarna av torr massa under rymdresor. Med tanke på detta behov initierade Europeiska rymdorganisationen MELiSSA-projektet (MicroEcological Life Support System Alternative) som syftade till att utveckla ett bioregenerativt livsuppehållande system. I tidigare arbeten har MELiSSA Loop föreslagits: en systemdesign inspirerad av terrestiska ekosystem, som består av flera fack som utför specifika biologiska funktioner som nitrifikation och biosyntes. På grund av det komplexa ömsesidiga beroendet mellan de enskilda avdelningarna och allmänna krav på rymdsystem, utgör kontrollen av sådana detta cyberfysiska system en betydande utmaning. Denna avhandling föreslår en tidigare obeskriven arkitektur för MELiSSA Loopkontrollerdesignen som koordinerar resursfördelningen mellan avdelningarna och etablerar återupplivning av atmosfären. Arkitekturen uppfyller styrmål som anges på hög nivå, och uppfyller samtidigt de fysiska och operativa begränsningarna.

Thesis's Topic: The Activity Analysis of Rescue of Královehradecký kraj, station Trutnov 2006-2009 Aim of the thesis: To analyze the operation of the Emergeny Medical Service in Trutnov. Method: Research of available sources, data collection and the cooperation of the members of the Emergency Medical Service coming to the patient. Results: All here listed statistics data are base on intervetion documentation of Trutnov center. Therefore the presented results can't be taken, generalled to other centers and assumed that will be comparable. Keywords: Integrated Emergency Services, Emergency Medical Service, rapid response vehicle, advanced life support vehicle, calls for the crew of the Emergency Medical Service.