Intro/Aims: Differences in end-of-life decision-making among minorities have been well described. However, among Native Hawaiian and Other Pacific Islanders (NHOPIs), this has not been well studied. Aim 1: Determine if differences in time to withdrawal of life support (WOLS) exist between NHOPIs and non-Hispanic whites (NHWs). Aim 2: If differences in time to WOLS between races are found, examine factors that may contribute to these differences. Methods: A retrospective study was conducted on patients admitted to a primary stroke center in Honolulu with diagnosis of spontaneous intracerebral hemorrhage (ICH). Medical records were reviewed for occurrence of WOLS and time of WOLS. Unadjusted and multivariable logistic regression models were performed to determine associations between race and WOLS. Kaplan Meier analysis and Cox regression were performed to estimate survival time to WOLS and to compare these results between racial groups. Results: 396 patients with diagnosis of spontaneous ICH were studied. Mean time to WOLS after ICH was found to be similar between NHWs and NHOPIs (p = .925). Prevalence of WOLS was significantly lower in NHOPIs in univariate analysis (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.15, 0.80) and Kaplan Meier analysis predicted a significant difference in WOLS between NHOPI and NHWs within 30 days of ICH (p =<. 01). However, in multivariate analysis, race was no longer significant when adjusted for age (OR 0.59, 95% CI 0.25, 1.43) and when fully adjusted (OR 0.68, 95% CI 0.20, 2.39). NHOPIs were significantly younger at the time of ICH when compared to NHWs (p =<.001) although ICH severity and presentation such as initial Glasgow Coma Scale, presence of intraventricular hemorrhage and ICH volume were similar (p = .241; p = .604; p = .901, respectively). Conclusions: No difference in mean time to WOLS was noted between NHOPIs and NHW. However, secondary analysis showed WOLS was less prevalent after ICH in the NHOPI population compared to NHWs, although the significance of this finding was attenuated by age. NHOPIs in this population likely had a lower incidence of WOLS due to the fact that they presented with ICH at a significantly younger age, although small sample size also may have resulted in difficulty detecting variances between races.

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.

Intensive Care depends on sophisticated life support technology. Effective management of device-supported patients is complex, involving the interpretation of many variables, comparative evaluation of numerous therapy options, and control of various patient-management parameters. Raw data, when taken literally, can lead to the wrong interpretation of the patient. We propose a system which processes raw data in real-time for intelligent alarming and analyses historical data for summarisation and patient state assessment. This will utilise a temporal expert system which incorporates associational reasoning. Using continuous physiological data from monitors, patient history and times of therapy administration, our research consists of applying three consecutive processes: <I>filtering </I>which is used to remove noise in the physiological data; <I>interval identification </I>which generates temporal intervals from the filtered data points which have abstractions relating to their direction of change (i.e. increasing, decreasing and steady); and <I>interpretation</I> which performs summarisation and patient state-assessments from a historical point of view and intelligent alarming from a real-time point of view. Using the temporal intervals, interpretation involves differentiating between events which are clinically insignificant and events which are clinically significant. We need to identify and remove clinically insignificant events (e.g. line flushes, blood samples etc.). Similarly, we need to identify clinically significant events i.e. clinical conditions (e.g. hypovolaemia, pulmonary haemorrhage etc.) and the outcome of therapies - this will utilise the patient history and times of therapy administration. Inherent in this process is the <I>trend template </I>which is used to represent events. Trend templates support temporal reasoning, knowledge to differentiate between events and taxonomical knowledge. Algorithms which are analogous to the way clinicians identify events use these trend templates.

Objectives: To describe learning outcomes of undergraduate nursing students following an online basic life support course (BLS). Methods: An online BLS course was developed and administered to 94 nursing students. Pre- and post-tests were used to assess theoretical learning. Checklist simulations and feedback devices were used to assess the cardiopulmonary resuscitation (CPR) skills of the 62 students who completed the course. Results: A paired t-test revealed a significant increase in learning [pre-test (6.4 +/- 1.61), post-test (9.3 +/- 0.82), p < 0.001]. The increase in the average grade after taking the online course was significant (p < 0.001). No learning differences (p = 0.475) had been observed between 1st and 2nd year (9.20 +/- 1.60), and between 3rd and 4th year (9.67 +/- 0.61) students. A CPR simulation was performed after completing the course: students checked for a response (90%), exposed the chest (98%), checked for breathing (97%), called emergency services (76%), requested for a defibrillator (92%), checked for a pulse (77%), positioned their hands properly (87%), performed 30 compressions/cycle (95%), performed compressions of at least 5 cm depth (89%), released the chest (90%), applied two breaths (97%), used the automated external defibrillator (97%), and positioned the pads (100%). Conclusions: The online course was an effective method for teaching and learning key BLS skills wherein students were able to accurately apply BLS procedures during the CPR simulation. This short-term online training, which likely improves learning and self-efficacy in BLS providers, can be used for the continuing education of health professionals.

Deployable structures have made an immense impact in the engineering world. The concept of the deployable structure has been able to reduce costs and sizing limits across a variety of use cases. However, sizing and cost reduction are not the only reasons that deployable structures are prominent. There are unique propeller blades that have entered into the world of deployable structures, where the ability to be stowed away and deployed to a much larger diameter can increase launch flexibility, and the engine efficiencies of aircraft. Although, most of the deployable propeller blades that have been designed in studies have the usual hinge mechanism where the down side of a hinge is that it does not necessarily provide any stiffness nor does it change the diameter of the propeller blade when stowed away. However, an unique strategy, that uses the underlying principle of snap through buckling can help to negate the use of hinges. This principle allows the propeller blade itself to be folded and stowed away, where stored strain energy is used in order to self-deploy back into the original shape. This paper will present an overall approach to the structural architecture development, conceptual prototype fabrication, and computational analysis of a foldable propeller blade.

Lightweight aerospace structures have been sought after since humans took flight in 1903, making major strides in NASA's pursuit of the moon with the development of sandwich panel composites. Sandwich structures typically consist of two stiff phases (i.e., face sheets) separated by a lightweight phase (i.e., core), which are stacked together through adhesive layers. Such a structural arrangement provides a high stiffness-to-weight ratio and is often used in applications where weight saving is critical. Functionally Graded Materials (FGMs), refer to multifunctional materials, which contain a spatial variation of composition and/or microstructure for the specific purpose of altering thermal and structural properties. Recent advancements in Additive Manufacturing (AM), or 3D printing, drastically increased research capabilities. This thesis poses two novel concepts. First, sandwich beams manufactured as a single unit through additive manufacturing, eliminates the need for secondary bonding used in traditional sandwich structures. Second, with the introduction of a Functionally Graded (FG) core, sandwich structures offer enhanced flexural stiffness-to-weight ratio. To test these hypotheses, the design space of sandwich beams with FG cores is analytically explored by forming governing equations from existing methods and developing specific FG performance parameters. These equations are then exploited in MATLAB to map variation of the sandwich beam stiffness-to-weight ratio as a function of core relative density. Analytical estimations are verified for a particular design point of variable core density using the Finite Element (FE) models developed in the commercial FE program ABAQUS. Both the analytical and numerical results reveal a performance increase of approximately 31% of the stiffness-to-weight ratio for a variable core density. Finally, the selected design is additively manufactured using a poly-jet printer (Stratasys J55). The flexural modulus and strength of the additively manufactured sandwich beams are measured by the three-point bend test method. The experimental results clearly match the analytical and numerical estimations.

This study investigated the application of a polyelectrolyte (PE)-assisted metallic iron nanoparticle-integrated forward osmosis (FO) membrane to treat synthetic spacecraft wastewater comprising urea, ammonium carbonate, and linear alkylbenzene sulfonate (LAS). The draw solution (MgSO4) diluted via the FO operation was further treated using a nanofiltration (NF) membrane aimed at producing potable quality water by the FO-NF hybrid process. A cellulose triacetate FO membrane was functionalized by layer-by-layer deposition of polyallylamine hydrochloride (PAH) and polyacrylic acid (PAA) followed by incorporating zero valent iron nanoparticles (ZVINP) within the "bilayers". It required 14 bilayers to ensure a uniform coating as demonstrated via scanning electron microscopy image examination. The PE modification of the FO membrane counteracted the effects of membrane fouling and internal concentration polarization. Although the modified membrane appeared to accumulate slightly more foulants than the unmodified membrane, the modified membrane demonstrated higher water flux. After 10 hours of the FO operation, the water flux of the unmodified membrane observed a decreased while the modified membranes FS remained constant throughout. The reverse salt flux of the unmodified membrane was higher than the functionalized membrane. The RSF of the unmodified membrane increased while the modified membranes results remained constant throughout the process. The higher water flux of the functionalized membrane can be attributed to the deposition of PE-ZVINP that may have reduced the effects of ICP and RSF. The performance of the FO-NF hybrid process was evaluated by comparing the removal of nitrogen (TN) and total organic carbon (TOC) from the wastewater using a bench-scale setup. When using the modified FO membrane, the system removed 85.6% of TN and 86.2% TOC. This hybrid FO-NF system is expected to reduce the overall energy input and membrane operation cost when treating various wastewaters including the spacecraft wastewater.

ABSTRACT Nurses’ Cardiopulmonary resuscitation (CPR) competence has been a subject of many research studies. The need for nurses to be competent in CPR is not debatable, because nurses are expected to preserve and promote life. This study assessed and compared CPR competence between two groups of Advanced Student Nurses in a Kenyan Medical Training College. The study used a descriptive comparative design. The participants were assigned to two groups based on the CPR training they had received. Group I had Advanced Life Support (ALS) training n=23 (comprised ICU advanced nursing students) and group II had Basic Life Support (BLS) training n=48 (comprised Midwifery, Ophthalmic, Community and Psychiatric advanced nursing students). The study sample constituted 71 participants of whom 28.2% were males and 71.8 % were females. Out of the 71 students who took part in the study only five attained the competence score, the remaining 66 failed the competence test. The five who passed the competence score were from the ALS group. The null hypothesis tested in the study was subjected to paired t-test and a p-value of p= 0.0001 was obtained. The null hypothesis was thus rejected based on this finding. The study confirmed previous findings that nurses CPR competence is below the expectation and the difference in training for the two groups of Advanced Student Nurses.

No description available.

<p>Hjärtlungräddning (HLR) är en direkt livsavgörande kunskap och förväntningar på att sådan kunskap finns bland sjukhuspersonal är trolig. Syftet med studien var att kartlägga utbildning i och attityder till undervisning i HLR bland all personal som arbetar på ett mindre sjukhus i södra Sverige. En enkät bestående av fjorton frågor besvarades av 151 personer via sjukhusets intranät. Majoriteten av svaren kom från sjuksköterskor och undersköterskor, övriga yrkeskategorier fanns också representerade fast i mindre omfattning. Majoriteten var nöjd med nuvarande HLR utbildning och de flesta önskade regelbunden utbildning. Upplevelsen av att befintliga kunskaper var tillräckliga instämde endast hälften i och likaså att handlandet i samband med hjärtstopp kändes adekvat. Anledningen till ovanstående resultat kan bara spekuleras kring men tidigare forskning pekar på att faktorer som oerfarenhet, stress, etiska dilemman och bristande HLR utbildning kan bidra till sådana upplevelser. Slutsatsen kan dras att regelbunden HLR utbildning bör ske enligt gängse riktlinjer samt att all sjukhuspersonal erbjuds, även de som inte är direkt involverade i patientomvårdnaden. Åtgärder för att förbättra kunskap och handlande i samband med hjärtstopp kan t ex göras genom tillgång till enkla återupplivningsdockor med feedback möjlighet och erbjudande om debriefing efter hjärtstopp. Kommande forskning bör fokusera på personers upplevelse av kunskap och handlande i samband med hjärtstopp relaterat till HLR utbildning.</p>