Over 26 million Americans suffer from pulmonary disease, resulting in more than 150,000 deaths annually. Lung transplantation remains the only definitive treatment for many patients, but has meager survival rates and only approximately 1,700 of the 2,200 patients added to the lung transplant wait list each year are transplanted. Extracorporeal gas exchangers have been used as an alternative to mechanical ventilation in acute respiratory failure and as a bridge to transplantation in chronic respiratory failure. Current gas exchangers are limited by their high resistance and low biocompatibility that lead to patient complications and device clot formation. Therefore, there exists a dire need for improved devices that can act as destination therapy. To accomplish the goal of destination therapy, this dissertation discusses three studies that were performed to pave the way. First, I examined clot formation and failure patterns of two common clinical devices (Maquet’s CardioHelp (CH) and Quadrox (Qx)) to further our understanding of their limitations with respect to long-term support. Overall, it was demonstrated that the Qx devices fail earlier and more frequently than CH devices and result in a significantly greater reduction in platelet count, and that a four-inlet approach is beneficial. Next, I determined the optimal sweep gas nitric oxide (NO) concentration that minimizes platelet binding and activation while ensuring that blood methemoglobin (metHb) concentrations increase less than 5%. Miniature artificial lungs were attached to rabbits in a pumped veno-venous configuration and run for 4 h with NO added to the sweep gases in concentrations of 0, 100, 250, and 500 ppm (n=8 ea.). 100 ppm significantly reduced the amount of platelet consumption (p < 0.05), reduced platelet activation as measured by soluble p-selectin (p < 0.05), and had negligible increases in metHb and will thus be used in future experiments. Last, I tested the Pulmonary Assist Device (PAD) which was designed for long term use as a bridge to transplantation and destination therapy. Benchtop experiments were performed that confirmed that it meets our design and performance goals. From here, we are equipped to commence with 30-day PAD testing in sheep.

A parada cardiorrespiratória (PCR) é a principal causa de morte em países desenvolvidos e em desenvolvimentos, ocorrendo principalmente em ambientes extra hospitalares. Frente a esse panorama mundial considerado um problema de saúde pública atual, a capacitação de leigos no Suporte Básico de Vida (SBV) com uso da simulação clínica tem papel relevante para a melhoria das taxas de sobrevivência das vítimas de PCR. Estudo com objetivo de avaliar o conhecimento (teórico) e das habilidades (práticas) de leigos antes e após a sua participação no curso de SBV para leigos submetidos a estratégias de ensino-aprendizagem, aula expositivo-dialogada e atividade prática em laboratório de habilidades ou aula simulada no atendimento a PCR/RCP com SBV para leigos. Estudo com delineamento quase experimental, abordagem quantitativa com delineamento tempo-série. A população consistiu dos estudantes do primeiro ao quarto semestre de graduação da Faculdade de Enfermagem da Universidade Federal do Mato Grosso e a amostra de 104 estudantes que participaram do curso em SBV para leigos em duas etapas. Na etapa I todos os estudantes foram submetidos ao pré teste teórico, à aula expositivo-dialogada seguida de atividade prática em laboratório de habilidades com manequim de média fidelidade e uso do Desfibrilador Externo Automático (DEA), simulação clínica em laboratório utilizando o mesmo manequim e DEA e pós teste teórico imediato. A Etapa II ocorreu de 15 a 20 dias após a primeira e todos os estudantes foram submetidos à simulação clínica em laboratório utilizando o mesmo manequim de média fidelidade e DEA seguido de pós teste teórico mediato. Elaboraram-se os instrumentos de avaliação teórica, cenário de simulação e OSCE - avaliação clínica objetiva e estruturada no cenário de simulação com (checklist), validados em aparência e conteúdo por comitê de juízes. A estratégia de coleta de dados foi o curso de SBV para leigos. Foram avaliados as avaliações teóricas e OSCE (Exame Clínico Objetivo Estruturado) - avaliação clínica estruturada em Laboratório de Simulação, este último empregando como ferramenta o manequim de média-fidelidade e DEA. A atividade foi filmada e analisada por três avaliadores. Analisaram-se os desfechos nas etapas I e II do curso de SBV para leigos: desempenho teórico nos testes teóricos e práticos no OSCE, tempo de execução total e de cada domínio do OSCE e a qualidade das compressões torácicas externas (CTE) quanto a frequencia e profundidade em 120 segundos de reanimação cardiopulmonar (RCP). Resultados: 86 estudantes eram do sexo feminino e 18 do sexo masculino, a idade média 23,32±6,66 anos. No pré-teste a nota média foi de 3,52±2,03, e a mediana 3,0. No pós-teste imediato (pós 1) a nota média foi 8,01±1,19 (mediana 8,0) e no pós teste mediato (pós 2) foi de 7,41±2,68 (mediana 8,5). Comparando-se as médias obtidas no pré-teste, pós 1 e pós 2 há diferença estatisticamente significante (p<0,001) com retenção do conhecimento. Comparando as notas do pós 1 e pós 2 teóricos evidenciou diferença estatisticamente significante (p=0,019) com perda do conhecimento no pós 2. A média no OSCE na etapa I (pós 1) foi 3,63±0,30 e na etapa II (pós 2) de 3,63±0,31; comparou-se tais notas verificando-se que não há diferença estatisticamente significante (p=0,966). O tempo médio de execução do OSCE no pós 1 foi de 156,96±8,16s e no pós 2 foi de 138,68±43,58s, havendo diferença estatisticamente significante (p<0,001). O domínio de intervenção do OSCE \"Chegada em Cena\" apresentou média 20,78±6,20s no pós 1 e 16,46±4,56s no pós 2, o domínio \"Checar a responsividade\" média de 6,38±3,48s no pós 1 e 5,13±2,36s no pós 2, o domínio \"Usar o DEA\" média de 77,30±14,45s no pós 1 e 66,80±11,44s no pós 2, todos com diferença estatisticamente significante (p<0,001). Avaliando a qualidade das CTE a profundidade média atingida em milímetros (mm) apresentou média de 36,26±9,62 (mediana 35,00) no pós 1 e 39,36±10,96 (mediana 40,00) no pós 2. O nº de CTE média por minuto apresentou média de 116,01±21,72 (mediana 116,00) no pós 1 e 98,94±19,52 (mediana 100,00) no pós 2, o nº total de compressões (CTE) em 120 segundos apresentou média de 227,88±41,81 (mediana 226,00) no pós 1 e 197,31±30,42 (mediana 195,50) no pós 2, o nº de CTE muito superficiais média de 132,20±89,94 (mediana 146,50) no pós 1 e 74,96±75,76 (mediana 53,00) no pós 2, todos com diferenças estatisticamente significante (p<0,001). Já o nº de CTE incompletas apresentou média de 25,09±56,95 (mediana 0,00) no pós 1 e 14,51±35,45 (mediana 0,00) no pós 2 com diferença estatisticamente significante (p=0,012). No presente estudo, apesar de diferentes estratégias de ensino abordarem o SBV para leigos, os resultados demonstram que as mesmas foram eficazes e os objetivos de aprendizagem foram alcançados, pois houve incremento nas notas obtidas nos pós-testes e no OSCE tanto na etapa I quanto na etapa II em relação ao conhecimento prévio e habilidades, porém houve perda da retenção de conhecimento e habilidade de 15 a 20 dias após o curso de SBV para leigos o que reforça a necessidade da capacitação permanente / Cardiac arrest is the leading cause of death in developed and developing countries, and mainly occurs in non-hospital environments. With this global scenario, which is considered a present public health problem, training laypeople in Basic Life Support (BLS) with clinical simulation has an important role in improving survival rate of the cardiac arrest victims. This present study aims to evaluate the knowledge (theoretical) and skills (practical) of laypeople before and after the BLS training underwent to teaching and learning strategies, expository and dialogue class and practical activities in skills lab or simulation class in CPR/CPA. This study has an almost experimental, quantitative and time-series approach. The population study is composed of students from the first to fourth semester of Nursing at Federal University of Mato Grosso (UFMT) and the sample of 104 participants in BLS for laypeople in two steps. In Step 1, all the students had to undergo to the theoretical pretest, expository and dialogue class followed by practical activity in the skills lab with a mid-fidelity manikin and using automated external defibrillator (AED), clinical simulation in the lab using the same manikin and AED and immediate theoretical posttest. Step 2 occurred from the 15th to 20th days after the first one and all the students had to undergo to clinical simulation in the lab using the same mid-fidelity manikin and AED followed by immediate theoretical posttest. It was elaborated theoretical evaluation tools, simulation scenario and OSCE - objective structured clinical examination in the clinical scenario with checklist, validated in aspect and content by a judges committee. The data collection strategy was the BLS for laypeople. It was evaluated the theoretical tests and OSCE (objective structured clinical examination) - clinical examination structured in Simulation Lab, using as tool the mid-fidelity manikin and AED. The activity was filmed and analysed by three evaluators. The outcomes of Step 1 and 2 of BLS for laypeople were analysed: theoretical performance on theoretical and practical tests in OSCE, total execution time, each OSCE realm and the quality of external chest compression (ECC) such as frequency and deepness in 120 seconds of cardiopulmonary resuscitation (CPR). Outcomes: 86 female and 18 male students, median age 23.32±6.66. Median score in pretest was 3.52±2.03 and the average 3.0. At immediate posttest (post 1) the median was 8.01±1.19 (average = 8.0) and at immediate posttest (post 2) 7.41±2.68 (average = 8.5). Comparing the pretest averages and posttests 1 and 2, there is a statistically significant difference (p<0.001) of knowledge retention. Comparing theoretical posttests 1 and 2 revealed the statistically significant difference (p=0.019) with knowledge loss at posttest 2. Step 1 OSCE average (posttest 1) was 3.63±0.30 and Step 2 (posttest 2) 3.63±0.31; when compared, these scores demonstrated that there is not a statistically significant difference (p=0.966). The OSCE execution time average at posttest 1 was 156,96±8,16 seconds and at posttest 2 138.68±43.58 seconds, which demonstrated statistically significant difference (p<0.001). OSCE intervention realm \"Arrival on the scene\" showed posttest 1 20,78±6,20s and posttest 2 16,46±4,56s averages, the realm \"Check Responsiveness\" had averages of 6,38±3,48s in posttest 1 and 5,13±2,36s in posttest 2, the realm \"Using DEA\" averages of 77,30±14,45s in posttest 1 and posttest 2 of 66,80±11,44s, all of them with statistically significant difference (p<0,001). Evaluating the quality of ECT the reached deepness average in millimeters (mm) resulted 36.26±9.62 (average 35.00) in posttest 1 and 39.36±10.96 (average 40.00) in posttest 2. The number of ECC per minute showed 116.01±21.72 (average 116.00) in posttest 1 and 98.94±19.52 (average 100.00) in posttest 2, the total of compressions (ECC) in 120 seconds showed 227.88±41.81 (average 226.00) and 197.31±30.42 (average 195,50) in posttest 2, the number of surface ECC 132.20±89.94 (average 146.50) and 74.96±75.76 (average 53,00) in posttest 2, all of them with statistically significant difference (p<0,001). In the incomplete ECC showed 25.09±56.95 (average 0,00) in posttest 1 and 14.51±35.45 (average 0,00) in posttest 2 with statistically significant difference (p=0,012). In this present study, besides the different teaching strategies approaches for laypeople, the outcomes demonstrate that they were effective and the learning goals reached, since the posttests had higher scores in previous knowledge and skills of steps 1 and 2 of OSCE. However it showed a loss of knowledge and skills retention in 15 to 20 days after the BLS training for laypeople, what demonstrates the need of permanent training

No description available.

Fundamental to the future of space exploration is the development of advanced life support systems capable of maintaining crews for significant periods without re-supply from Earth. Bioregenerative life support systems harness natural ecosystem processes and employ plant photosynthesis and transpiration to produce food, supply oxygen, and regenerate water while consuming carbon dioxide. Proposed Lunar and Martian exploration has prompted interest into the effects of hypobaria on plant development. Reduced atmospheric pressure conditions will reduce the pressure gradient between the structure and the local environment thereby decreasing the engineering requirements, leakage and mass required to construct the growth facility. To establish the optimal conditions for reduced pressure plant growth structures it is essential to determine the atmospheric pressure limits required for plant development and growth. Due to its physiological importance, oxygen will compose a significant portion of this atmosphere. The effects of reduced atmospheric pressure and decreased oxygen partial pressures on plant germination, growth and development were assessed in the University of Guelph’s hypobaric plant growth chambers. Treatments included a range of total pressures from 10 to 98 kPa and oxygen partial pressures from 2 to 20 kPa. Results demonstrated that reduced atmospheric pressure had minimal effect on plant growth, net carbon exchange rate and transpiration if the physiologically important gases including carbon dioxide, oxygen and water vapour, were maintained above threshold levels. The reduction of oxygen partial pressures below 7 kPa had drastic consequences across all atmospheric pressures with poor germination, seedling establishment and growth. It is evident that the response of plants grown at reduced pressures from young seedlings differs from that of older plants that were established at ambient conditions and then subjected to the atmospheric adjustment. The young plant tissues adapt in response to the extreme conditions and maintain productivity despite the limited atmosphere. / Natural Science and Engineering Research Council, Canadian Space Agency, Ontario Graduate Student Program, Canadian Foundation for Innovation, Ontario Innovation Trust

Traditionally, the condition of hydroponic nutrient solutions used in controlled environment or greenhouse plant production is obtained by monitoring solution pH and electrical conductivity. These parameters provide greenhouse operators with an overall sense of the solution quality, but do not provide information on individual components of the fertilizer solution. Considering that plant nutrient uptake requirements vary with crop, growth phase and environment, real-time ion-selective measurements represent a significant technological advance in the management of recirculating nutrient solutions. The capacity for the monitoring and control of individual ions in the nutrient solution is the last remaining environment variable for which reliable feedback control does not exist in controlled environment plant production. This technology development study focussed on optical ion-selective sensors, termed ‘optrodes’, for potassium and calcium sensing within nutrient solution. Bulk optrode absorption-based sensors, tailored explicitly for nutrient ion activities within typical hydroponic solutions were theoretically modelled, fabricated and experimentally tested. Experimental data on sensor response time, measuring range, selectivity, repeatability, lifetime and influence of temperature were compiled. These ion-selective bulk optrode membranes were integrated into a custom instrument combining a light source, mini-spectrometer, optical fibres and other associated components. Monitoring and control software was written that collected and converted optical measurements into estimated nutrient ion activities for use in managing nutrient solution quality. Implemented spectral averaging, normalization and ratiometric computations and techniques resulted in sensors that offered the advantage of auto-calibration. The sensors met selectivity requirements in half strength Hoagland nutrient solution and provided repeatable measurements in solutions of different ion activity levels. Potassium and calcium selective membranes demonstrated lifetimes of 30 to 50 hours when constantly immersed in nutrient solution. Strategies for their operational implementation in plant growth systems based upon experimental testing are proposed as are suggestions for future study. The low mass, low volume, low cost and robust nature of these optrodes offer a promising technology for future space-based plant production systems and give them excellent terrestrial technology transfer potential.

Boendestöd är en framgångsfaktor i arbetet med att stötta utsatta grupper med att klara ett eget boende inte minst för missbrukare. Det här är en jämförande studie baserad på intervjuer med sex boendestödjare som arbetar med missbrukare och sex boendestödjare som arbetar med psykiskt funktionshindrade. Syftet är att undersöka boendestödjarnas uppfattningar om sitt arbete och deras upplevelser av vad arbetet innehåller. Varför är det vanligt med olika organisationer för missbruk och psykiskt funktionshinder? Vad är det som rättfärdigar indelningen i de två grupperna och vad blir konsekvenserna för brukarna och för de professionella som arbetar med boendestöd för grupperna? Resultatet är analyserat med tidigare forskning kring boende och stöd, forskning om professioner framväxt och teorier om socialkonstruktivism. Resultatet visar att kategoriseringen kan ha med vilket fokus boendestödet får och att boendestöd för missbrukare inriktas mot att missbrukaren skall klara sitt eget boende utan att vräkas. Dessutom finns det ett indirekt tvång inbyggt i boendestödet för missbrukare vilket inte återfinns i arbetet med de psykiskt funktionshindrade. Avslutningsvis är det möjligt att peka på att indelningen medför betydande konsekvenser för missbrukarna i jämförelse med övriga psykiskt funktionshindrade även om grunden för beslutet kring kategoriseringen är osäker. / Daily life support is a key success factor in efforts to support vulnerable groups in managing their own living and this is certainly true for addicts. This is a comparative study based on interviews with six daily supporters who work with addicts and six daily supporters who are working with mentally disabled clients. The purpose is to examine their experiences and their perceptions of what the work contains. What justifies the separation of the two groups and what are the consequences for the clients and for the professionals who work with daily life support for the two groups? The result is analyzed with earlier research in the area of daily life support, research concerning the development of professions and theories of social constructivism. The result shows that the categorization may has to do with the focus of the work with living support and that the daily living support for addicts often is directed towards the addicts ability to manage their own accommodation without risking the tenants to be evicted. In addition, the categorization implicates for addicts in terms of the existence of an indirect constraint embedded in the work of daily life support for addicts which is not found in the work of the mentally ill clients. Finally, it is possible to point to a significant difference in terms of consequences for the addicts in relation to the mentally ill group even if the base for the decision of categorization may be uncertain.

Withdrawal of life support therapy involves controlled removal of life support modalities including artificial respiration and circulation with intent to provide a comfortable death. Withdrawal of life support therapy is necessary prior to procedures such as organ donation after cardio-circulatory death, but remains poorly explored in current literature. To enhance the current evidence, we conducted a thorough structured review, an observational study, and a qualitative comparison of components comprising withdrawal of life support therapy in both donor and non-donor patient groups. At all stages, we considered how results impacted donation after cardio-circulatory death. Withdrawal of life support therapy processes vary between countries, hospitals, practitioners, and patients. Variability in practice impacts care and outcomes for both donor and non-donor patients. Improved definitions and consensus about the process of withdrawal of life support therapy may improve patient care, success of organ donation after cardio-circulatory death, and uptake of donation protocols.

Thesis (Ph. D.)--University of Washington, 1992. / Vita. Includes bibliographical references (leaves [157]-166).

Thesis (Ph. D. in Chemical Engineering)--Vanderbilt University, Dec. 2009. / Title from title screen. Includes bibliographical references.

Thesis (Ph. D.) University of Missouri-Columbia, 2006. / The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on August 2, 2007) Includes bibliographical references.