Background: The delivery of an aerosol via a tracheostomy tube has been previously described with both a tracheostomy collar and a T-piece, but not with a Wright mask, or aerosol mask. The primary purpose of this study was to quantify lung doses using different interfaces: tracheostomy collar, Wright mask, and aerosol mask. The secondary purposes were to compare albuterol delivery between an opened vs. a closed fenestration hole and also to determine the effect of inspiratory time:expiratory time (I:E) ratio on aerosol delivery. Methods: A teaching mannequin (Medical Plastic Labs, Gatesville, TX) with a tracheostomy opening was used. Two of the mannequin's bronchi were connected to a "Y" adaptor, which was attached to a collecting filter (Respirgard ™ II 303, Vital Signs, Englewood, CO), which was connected to a breathing simulator (Harvard Apparatus Dual Phase Control Respirator Pump, Holliston, MA) through a corrugated tube. Settings for spontaneous breathing were respiratory rate 20/min, and tidal volume 400 mL. The I:E ratios were adjusted in the first and second comparisons at 2:1 and 1:2, respectively. The nebulizer was operated by a flow meter (Timemeter, St. Louis, MO) at 8 L/min with 100% oxygen. In every condition, the flow was discontinued at the end of nebulization. The nebulizer was attached to the tracheostomy collar (AirLife™, Cardinal Health, McGaw Park, IL) in the first group, the Wright mask (Wright Solutions LLC, Marathon, FL) in the second group, and the aerosol mask (AirLife™, Cardinal Health, McGaw, IL) in the third group. Drug was eluted from the filter and analyzed by spectrophotometry (276 nm). Data Analysis: Paired t-test, one-way analysis of variance (ANOVA), repeated measures ANOVA, post-hoc and pairwise comparisons were performed at the significance level of .05, using PASW version 18.0. Results: Aerosol delivery was greater with the tracheostomy collar than the Wright mask and aerosol mask (p < .05). Closing the fenestration hole increased aerosol deposition significantly at 2:1 ratio (p = .04) compared to opening the fenestration at 1:2 ratio. I:E ratio and aerosol delivery were directly related. Increasing I:E ratio from 1:2 to 2:1 improved aerosol delivery significantly with tracheostomy collar-fenestration opened (p = .009), Wright mask (p = .02) and aerosol mask (p = .01). Conclusion: This study indicates that the use of a tracheostomy collar is the best method of delivering aerosol therapy among the three interfaces. The I:E ratio of 2:1 caused greater aerosol deposition than 1:2 ratio. The aerosol deposition was better when the fenestration hole was closed compared with opened fenestration.

This thesis investigates the activities of the Majlisul Islamil A`la Indonesia (MIAI), an Islamic federative organization of pre-independent Indonesia, elaborating in particular on the federation's socio-religious and political stance. Operating for only six years (1937--1943), the MIAI represented Muslim groups, as a counterpart to the "secularists," within the nationalist movement during both the final years of Dutch rule and the early stages of the Japanese occupation. The MIAI was established for the specific purpose of unifying the Islamic organizations---political and non-political, traditionalist and modernist alike---while at the same time reviving Muslim political and socio-religious strength after the decline of the Sarekat Islam, which had for almost fifteen years dominated the nationalist scene. / The mission of the MIAI was seen by Muslims as a response to the threat posed by external forces. It reacted in particular against Dutch policies considered discriminatory by Muslims concerning matters involving Islamic belief and practice, such as marriage and education. The federation also took a strong stand regarding Christian polemic aimed at Islam and took part in Indonesian Muslim response. That the establishment of the MIAI was favored by most Islamic organizations attested to the strong sentiment among Indonesian Muslims for a common front, regardless of their differences on socio-religious and political issues. Together with the GAPI (Gabungan Partai Politik Indonesia or the Federation of Indonesian Political Parties) and the PVPN (Persatuan Vakbonden Pegawai Negeri, or the Association of Government Employees), the MIAI took part in demanding political reform on behalf of Muslim groups. Indeed, notwithstanding its short life span, the MIAI was a pioneer for national unity in general and Indonesian Muslim unity in particular.

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