O objetivo deste estudo foi desenvolver o conceito de morte digna da criança na Unidade de Terapia Intensiva pediátrica. O Modelo Híbrido de Desenvolvimento de Conceitos foi aplicado em suas três fases: Teórica, de Campo e Analítica Final. Na Fase Teórica, foram analisados 49 artigos nas áreas Médica e de Enfermagem que estudaram e focalizaram a morte digna da criança. A Fase de Campo foi conduzida através de entrevistas semi-estruturadas com nove enfermeiras e sete médicos que atuavam em UTI pediátrica. Os dados da Fase de Campo foram analisados utilizando-se os resultados da Fase Teórica como eixo teórico e a Análise de Conteúdo como referencial metodológico. Na Fase Analítica Final, os resultados da Fase Teórica e de Campo foram comparados, analisados e integrados. Os dados evidenciam que a MORTE DIGNA na UTI pediátrica é ter um tratamento clínico de excelência no final de vida, com honra aos benefícios da evolução natural da doença, respeito aos aspectos socioculturais, conforto físico e bem-estar. A morte digna ocorre em um contexto de veracidade e parceria entre a equipe e a família, no qual é possível expressar expectativas e receios. O resultado da morte digna é o alívio do sofrimento tanto da criança quanto da família. Os dados da Fase Teórica apontam os antecedentes, atributos e conseqüências da morte digna como situações protocolares, porém, na Fase de Campo foi possível identificar o componente experiencial que está por trás das condutas dos profissionais diante da criança em final de vida. Assim, pôde-se compreender como se dá a manifestação do conceito na prática clínica, possibilitando a ampliação dos dados identificados na Fase Teórica. Clarificar o conceito de morte digna na UTI pediátrica permite fortalecer teorias sobre os cuidados no final de vida à criança e à família, bem como possibilita aos profissionais que atuam na prática clínica refletirem sobre as motivações que pautam atitudes e decisões diante da criança fora de possibilidade de cura / The purpose of this research was to develop the concept of dignified death for children in the Pediatric Intensive Care Unit. The Hybrid Model of Concept Development was applied in its three phases: Theoretical, Fieldwork and Final Analytical. In the Theoretical Phase 49 papers in the Medical and Nursing fields were analyzed, which studied and focused on the dignified death for children. The Fieldwork was conducted through semi-structured interviews with nine doctors and seven registered nurses who worked in pediatric ICUs. The data from the Fieldwork Phase was analyzed having the results of Theoretical Phase as the theoretical axis and the Content Analysis as the methodology. In the Final Analytical Phase, the results from the Theoretical and Fieldwork Phases and were compared, analyzed and integrated. The data show that the DIGNIFIED DEATH for children in the pediatric ICU means having a clinical treatment of excellence at the end-of-life, honoring the benefits of the natural evolution of the disease, respecting the socio-cultural aspects, physical comfort and welfare. A dignified death occurs in a context of veracity and partnership between the team and the family, in which it is possible to express hopes and fears. The result of the dignified death is the relief of suffering from both the child and the family. Data from the Theoretical Phase suggests that the antecedents, attributes and consequences of dignified death as being protocol situations, however, in the Fieldwork it was possible to identify the component of the experience behind the conduct of the professionals when dealing with children at end-of-life. Thus, it was possible to understand how the manifestation of the concept occurs in clinical practice, allowing the expansion of the data identified in the Theoretical Phase. Clarifying the concept of dignified death in the pediatric ICU can strengthen theories about end-of-life care to children and families and makes it possible to professionals who work in clinical practice to reflect on the motivations that guide their attitudes and decisions when dealing with a child in life-sustaining condition

Submitted by Claudinei Pracidelli (cpracide@ipen.br) on 2016-11-11T12:57:29Z No. of bitstreams: 0 / Made available in DSpace on 2016-11-11T12:57:29Z (GMT). No. of bitstreams: 0 / Neste trabalho buscou-se conhecer as perspectivas de sustentabilidade socioambiental no contexto do desenvolvimento do turismo na cidade de Mateiros/Tocantins. Para tanto, foi avaliada a aplicabilidade em destino de pequeno porte dos indicadores de sustentabilidade: Índice de Qualidade de Vida (IQV), Indicadores de Sustentabilidade da Organização das Nações Unidas (ONU) e Pegada Ecológica do Turismo. Percebeu-se que houve um incremento no IQV da cidade de Mateiros de 32,82% após o estabelecimento do turismo, com destaque para as famílias que atuam na produção das peças de artesanato de capim dourado. A mudança, de 0,162 para 0,215, indica que apesar de ter havido uma elevação na qualidade de vida das famílias entrevistadas, o IQV permaneceu baixo, isto é, com valores entre zero e 0,499. Tal fato demonstra que a qualidade de vida das famílias não é satisfatória. Quanto à ferramenta da ONU, percebeu-se que não há sistematização de dados suficientes para que esta ferramenta possa ser utilizada pelos órgãos governamentais na captação de recursos e utilização destes para criar novas políticas públicas para a região. Tal fato demonstra uma ineficácia em destinos de pequeno porte que se assemelhem à cidade de Mateiros na forma em que foi utilizado nesse trabalho. Quanto à Pegada Ecológica do Turismo, de acordo com a metodologia proposta, são necessários 2.194,2263 hectares de terras para absorver o CO2 demandado pela atividade turística na região. A categoria com maior impacto foi terras de energia fóssil na subcategoria transporte terrestre. Conclui-se, então, que os indicadores de sustentabilidade Pegada Ecológica do Turismo e Índice de Qualidade de Vida mostraram-se ferramentas eficazes para se avaliar as perspectivas de sustentabilidade de destinos de pequeno porte. / Tese (Doutorado em Tecnologia Nuclear) / IPEN/T / Instituto de Pesquisas Energeticas e Nucleares - IPEN-CNEN/SP

Este estudo teve como objetivos: compreender como se dá o processo de o enfermeiro exercer sua autonomia nas decisões de final de vida vivenciadas em UTI adulto; identificar os significados que ele atribui à experiência de tomar decisões e de exercer sua autonomia nas situações de final de vida dos pacientes internados na UTI adulto; construir uma teoria substantiva sobre a compreensão de exercer a sua autonomia nas tomadas de decisão em situações de final de vida dos pacientes na UTI adulto. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico a Teoria Fundamentada em Dados. A análise comparativa dos dados possibilitou desvendar o significado de exercer autonomia do enfermeiro com pacientes em final de vida internados na UTI adulto. Foi possível serem identificados três fenômenos que compõem esta experiência. O primeiro,Trabalhando num ambiente de pressão, representa a etapa inicial da experiência do enfermeiro, agrega não somente o contexto que permeia o seu trabalho na UTI, mas também os aspectos clínicos do paciente, as interações com os outros profissionais e com a família nas tomadas de decisão de final de vida. O segundo,Buscando empoderar-se para poder decidir, mostra o movimento, no qual o enfermeiro cria estratégias para ampliar as oportunidades a fim de poder exercer autonomia. O terceiro,Revendo os espaços para exercer autonomia, reconsidera outros espaços onde possa atuar no processo de final de vida, em relação ao planejamento do cuidado ao paciente, no acolhimento das famílias nas tomadas de decisão ou, ainda, na interface com os membros da equipe e a instituição. A articulação destes fenômenos permitiu identificar a categoria central AMPLIANDO AS OPORTUNIDADES PARA EXERCER A AUTONOMIA, que representa o processo vivido pelo enfermeiro na busca de espaços de poder de decisão e de ação ao assumir seu papel nos cuidados no processo de final de vida. / The purpose of this study is to: understand the process of autonomy exercised by nurses when making decisions related to end-of-life situations they in the adult ICU; to identify the meanings that nurses attribute to the experience of making decisions and of exercising their autonomy in end-of-life situations of adult patients in ICU; to construct a theoretical model about the process of understanding the exercise of their autonomy in decision-making relating to end-of-life situations of adult patients in the ICU. The study used as a theoretical reference the Symbolic Interactionism, and as methodological reference, the Grounded theory. The comparative analysis of the data has permitted the understanding of the meaning of nurses experience in exercising autonomy relating to life-ending adult patients in the ICU. Three phenomena that compose this experience have been identified: The first, \"Working in an environment of pressure,\" represents the initial phase of nurses experience, adding not only the features that exist within the ICU where the work is done, but also the clinical aspects of patients interaction with other professionals and family in end of life decision-making. The second, \"Seeking to gain power in order to be allowed to make decisions,\" shows the movement in which nurses create strategies for expanding opportunities in order to exercise autonomy. The third phenomena, \"Reviewing the spaces to exercise autonomy,\" reconsiders other spaces where nurses can act in end-of-life situations regarding planning of patient care, supporting families on their decision making and interface with health team members and the institution. The articulation of these phenomena has permitted the identification of the central category EXPANDING-THE-OPPORTUNITIES-FOR-EXERCISE AUTONOMY, based on which it has been possible to propose a theoretical model that explains the experience. It represents the process experienced by nurses in seeking spaces of power regarding decision making and action to assume the care role in end-of-life process.

Introdução: No panorama mundial, as doenças cardiovasculares configuram-se como principal causa da parada cardiorrespiratória em adultos, cujas chances de sobrevivência são maiores, quando presenciada por pessoas aptas para prover o suporte básico de vida (SBV) na reanimação imediata. Objetivo: Desenvolver e avaliar o curso online Suporte Básico de Vida: aspectos essenciais no atendimento do adulto em parada cardiorrespiratória. Método: Em primeira etapa, trata de pesquisa aplicada, de produção tecnológica acerca do desenvolvimento do curso online sobre SBV, utilizando design instrucional baseado no modelo ADDIE (Analisys-Análise, Design-Desenho, Development-Desenvolvimento, Implementation-Implementação, Evaluation-Avaliação). Nessa perspectiva, foi avaliado por especialistas e estudantes. A segunda etapa configura-se em delineamento quase-experimental, do tipo antes-depois. O curso online foi aplicado aos estudantes da Escola de Enfermagem da Universidade de São Paulo, como intervenção educacional, em 2014-2015. Os estudantes foram avaliados mediante pré-teste, pós-teste e simulação em prática presencial com dispositivos de feedback. Resultados: O curso online foi implementado em ambiente virtual de aprendizagem; 94 (100%) estudantes aceitaram participar da pesquisa, 88 (94%) acessaram ambiente virtual, 67 (71%) finalizaram parte teórica, 62 (66%) concluíram o curso online. A maioria era do sexo feminino (90,4%), do 1º e 2º ano (65%), idade média 21,48 (DP 2,39). Adotando nível de significância 95%, a média das notas no pré-teste foi 6,4 (DP 1,61), pós-teste 9,3 (DP 0,82), p<0,001. ANOVA para medidas repetidas indicou diferenças significativas (p<0,001) entre médias das notas no pré-teste dos estudantes do 1º e 2º ano 6,2 (DP 1,59) e do 3º e 4º ano 7,2 (DP 0,83). Média das notas do pós-teste foi 9,2 (DP 1,60) nos dois primeiros anos e 9,7 (DP 0,61) nos dois últimos anos, p<0,475. Regressão linear múltipla com inclusão progressiva (forward stepwise) para variáveis associadas ao aprendizado mostrou-se significativa (p<0,015) com ano de curso no Bacharelado -0,542 (EP 0,215) e participação anterior em curso de emergência -0,903 (EP 0,437). Na prática simulada, a média das notas foi de 9,1 (DP 0,95). Registros do checklist indicaram que 98% dos estudantes realizaram exposição do tórax, 97% avaliaram respiração, 76% se lembraram de chamar serviço de emergência, 92% solicitaram desfibrilador, 77% verificaram pulso corretamente, 87% posicionaram as mãos no tórax corretamente, 95% efetuaram ciclo de 30 compressões adequadamente, 89% em profundidade mínima 5 cm, 90% liberaram tórax após compressão, 97% alternaram 2 ventilações corretamente, 97% usaram Desfibrilador Externo Automático, 100% posicionaram as pás corretamente. Registros do dispositivo de feedback indicaram percentual de desempenho equivalente a Reanimação Cardiopulmonar Básica 43,7 (DP 26,86), médias de duração ciclo compressões/seg 20,5 (DP 9,47), do número de compressões 167,2 (DP 57,06), da profundidade compressões/mm 48,1 (DP 10,49), do volume de ventilação 742,7 (DP 301,12), do percentual de fração de fluxo 40,3 (DP 10,03). O curso foi bem avaliado pelos estudantes e especialistas, com reações positivas quanto ao conteúdo, objetividade, clareza, didática, organização, acesso e navegação. Conclusão: Confirmou-se a plausibilidade da hipótese do estudo, corroborando a contribuição do curso online no aprendizado sobre SBV. Mostrando-se efetivo no suporte ao ensino em Enfermagem, o curso online permite integrar apresentações em diferentes disciplinas e capacitações, frente a necessidade de inovações tecnológicas e estratégias educacionais ativas, em ações para identificação precoce da parada cardiorrespiratória e sistematização do atendimento na reanimação cardiopulmonar. / Introduction: In the world scene, cardiovascular diseases constitute the main cause of cardiac arrest in adults, whose chances of survival are higher if witnessed by persons able to provide the basic life support (BLS) in immediate resuscitation. Objective: To develop and to evaluate the online course \"Basic Life Support: essential aspects in adult cardiac arrest. Method: In the first stage it refers to the applied research of production technology on the development of online course on BLS, with the instructional design ADDIE (Analisys, Design, Development, Implementation, Evaluation). In the second stage, in quasi-experimental, before and after design, the online course was applied to students of Escola de Enfermagem, Universidade de São Paulo, as an educational intervention in 2014-2015. Pre-test, post-test and simulation with feedback devices were applied. The online course was evaluated by specialists and students. Results: The course was implemented in the virtual environment and 94 (100%) students who agreed to participate of the research, 88 (94%) accessed the virtual environment, 67 (71%) completed the theoretical part and 62 (66%) completed the online course. The majority were women (90.4%), in the 1st and 2nd year (65%), mean age 21.48 (SD 2.39). With 95% significance level, the mean grade in the pre-test 6.4 (SD 1.61), in the post-test 9.3 (SD 0.82), p <0.001. ANOVA for repeated measures showed significant differences (p <0.001) between the average scores in the pre-tests of students in the 1st and 2nd years 6.2 (SD 1.59) and the 3rd and 4th years 7.2 (SD 0, 83). The averages note in the post-test 9.2 (SD 1.60) in the first two years and 9.7 (SD 0.61) in the last two years, p<0,475. In multiple linear regression with progressive inclusion (stepwise forward) for variables associated with learning, it was significant (p <0.015) for year course -0.542 (SE 0.215), previous participation in emergency course -0.903 (SE 0.437). In simulated practice the mean score was 9.1 (SD 0.95). The checklist records showed 98% students performed exposure of the chest, 97% observed the breathing, 76% remembered to call emergency services, 92% requested defibrillator, 77% checked the pulse correctly, 87% positioned their hands properly, 95% effected 30 compressions cycle properly, 89% in minimum depth 5 cm, 90% released after chest compression, 97% correctly applied 2 breaths, 97% used External Automatic Defibrillator, 100% positioned blades correctly. Feedback device records indicated equivalent percentage of performance Basic CPR 43.7 (SD 26.86), the averages of duration compressions cycle / second 20.5 (SD 9.47), compressions number 167.2 (SD 57.06) depth compressions/mm 48.1 (SD 10.49), ventilation volume 742.7 (SD 301.12), percentage flow fraction 40.3 (SD 10.03). The course was evaluated as good quality by participants, with positive reactions about the content, objectivity, clarity, teaching, organization, access and navigation. Conclusion: The plausibility of the hypothesis of this study was confirmed, corroborating the online courses contribution in the BLS learning. In support teaching in Nursing, it lets to compose presentations in different disciplines and training, arising from the need for technological innovations and active educational strategies in action for early identification of cardiac arrest and systematization of care in cardiopulmonary resuscitation.

Bakgrund: Amyotrofisk lateral skleros (ALS) är en ovanlig sjukdom vars sjukdomsförlopp kan gå mycket fort. Det är vanligt att patienter med ALS får livsuppehållande behandlingar för att förlänga livet och för att förbättra livskvaliteten. Olika typer av behandling används för denna patientgrupp. De som beskrivs är ventilationsbehandling och nutritionsbehandling med gastrostomi. Självbestämmande, hälsa och livskvalitet är komponenter av värde för att förstå patienters perspektiv. Syfte: Syftet var att beskriva hur det är att leva med livsförlängande behandling vid sjukdomen ALS. Metod: En litteraturöversikt utfördes med vetenskapliga artiklar inom kunskapsområdet för att belysa det aktuella kunskapsläget. Fribergs metodbeskrivning och analysmetod användes. Tolv vetenskapliga artiklar användes från flertal länder i resultatet. Resultat: Resultatet presenteras i huvudteman med tillhörande subteman. Tema ett: Att ta beslut till behandling innefattar Patientens roll i beslutsfattande och Sjukvårdens betydelse vid beslutsfattande. Tema två: Att acceptera behandling är en process. Tema tre: Att vara i nuet och leva vidare med behandling innefattar Att vara i nuet och Att leva vidare. Diskussion: Den teoretiska utgångspunkten som användes var Virginia Hendersons behovsteori i grundläggande sjukvård. Uppsatsen visar vad patienter uttrycker som betydelsefullt när de står inför beslut kring livsförlängande behandling. Att ha självbestämmande, att ha kontroll och att sjukvården ska vara förtroendeingivande är betydelsefullt. Acceptansprocessen, stöd och möjligheter till att leva vidare har betydelse för meningsfullheten hos patienter. / Background: Amyotrophic lateral sclerosis (ALS) is an unusual disease where the disease progress can be very fast. It is common for patients with ALS to receive life-sustaining treatments to prolong their lives and improve their quality of life. Different types of treatment are used for this group of patients, those described are ventilation and nutritional treatment with gastrostomy. Self-determination, health and quality of life are components of value to understand the patient's perspective. Aim: The aim was to describe how it is to live with life-prolonging treatment with the disease ALS. Method: A literature review was conducted with scientific articles to highlight the current state of knowledge in the field. Friberg's methodology and method of analysis were used. Twelve scientific articles were used from several countries in the result. Results: The results are presented in main themes with associated subthemes. Theme one: Decision making for treatment includes the role of the patient in decision making and the meaning of health care in decision making. Theme two: Accepting treatment is a process. Theme Three: Being in the present and continuing on with treatment includes being in the present and living on. Discussion: The theoretical basis used was Virginia Henderson and her theory of needs in the basic healthcare. This essay shows what patients express as important when they are faced with decisions about life-prolonged treatment. Having self-determination, having control and that the care must be trustworthy are important. The acceptance process, support and the opportunity to live on are important for the meaningfulness of patients.

Bakgrund. Specialistsjuksköterskor inom intensivvård och anestesisjukvård deltar i traumaomhändertagande på akutmottagningen. De utgör en viktig roll i traumateamet och ställs inför krävande utmaningar som kan framkalla känslor hos specialistsjuksköterskorna. Vilket påverkar deras upplevelser av att delta i traumaomhändertagandet. Syfte. Syftet var att beskriva upplevelser hos specialistsjuksköterskor inom intensivvård och anestesisjukvård av att arbeta med traumaomhändertagande vid nivå-1 traumalarm. Metod. Kvalitativ ansats med beskrivande design. Sju specialistsjuksköterskor inom intensivvård och fem specialistsjuksköterskor inom anestesisjukvård på tre mellanstora sjukhus i Mellansverige med erfarenhet av traumaomhändertagande inkluderades. Data samlades in genom semistrukturerade intervjuer och analyserades med hjälp av kvalitativ innehållsanalys. Huvudresultat. Det framkom ett övergripande tema: Traumaomhändertagandets innebörd, samt fyra huvudkategorier: Systematiskt omhändertagande, Att vara en del av traumateamet, Vårdmiljöns betydelse och Upplevda känslor och strategier genom traumaomhändertagandets förlopp. Specialistsjuksköterskorna beskrev att den givna strukturen och att de kände sig förtrogna med sin roll minskade osäkerheten. Tydlig kommunikation upplevdes förbättra samarbetet och patientsäkerheten. Begränsat utrymme och för mycket personal utöver traumateamet beskrevs komplicera traumaomhändertagandet. Traumaomhändertagandet beskrevs som en betydelsefull uppgift som skedde under positiv stress och med stort fokus. Det framfördes känslor av ovisshet inför vad de skulle mötas av. Erfarenhet, övning och utbildning ökade tryggheten. Debriefing underlättande bearbetningen. Slutsats. Specialistsjuksköterskorna har en betydelsefull roll i traumateamet och ställs inför utmanande och påfrestande situationer där vikten av övning, erfarenhet och utbildning är betydande. Att identifiera specialistsjuksköterskors upplevelser kring ämnet möjliggör uppkomsten av förbättringsområden inom traumaomhändertagande på akutmottagningen. / Background. Specialist nurses in intensive care unit and nurse anesthetist take part in trauma life support care in the emergency service. They have an important role of the trauma team. Specialist nurses face challenges that may produce feelings which affect their experiences of participating in trauma life support care. Aim. The aim was to describe the experiences of specialist nurses in intensive care unit and nurse anesthetist, in trauma life support care at first-level trauma. Method. A descriptive design with a qualitative approach was used. Seven specialist nurses in an intensive care unit and five nurse anesthetists worked with trauma life support care at mid-sized hospitals in middle of Sweden were included. Data were collected with semi-structured interviews and analysed with qualitative content analysis. Result. One theme emerged: The Significance of Trauma Life Support Care. Four main categories: Systematic Care, Being Part of the Trauma Team, Importance of Hospital Environment, and Feelings and Strategies Experienced in the Course of Trauma Life Support Care. Specialist nurses described that structures provided feeling of being secure. Communication improved cooperation and patient safety. Limited workspace, excessive personnel of trauma team complicated the trauma life support care. Trauma life support care was described meaningful under positive stress. Feelings of about what they would meet were experienced encounters. Experiences, clinical practice, and education increased feelings of safety. Debriefing made processing easier. Conclusion. Specialist nurses have an important role in the trauma team. The importance of clinical practice, experiences, and education are significant. Identifying experiences of specialist nurses enables to improve trauma life support care in emergency service.

Name: Effectivness of Basic Life Support in Children Provided by Wheelchair Users Objectives: The aim of this diploma thesis is to evaluate the effectiveness of elementary emergency resuscitation children under 1yr of age with three selected positions of resuscitation manikin in persons using a wheelchair for their movement. Based on the comparison of the results when positioning the manikin on a lap, on a mat and on the ground, aim is to evaluate the most suitable position for performing elementary emergency resuscitation. Method: The research group consisted of ten people with spinal cord injury (four with tetraplegia and six with paraplegia), who use wheelchair for their movement. Three methods of data collection were used in this work. A survey was used for the first method, which obtained anamnestic data of the research group. The second method of data collection was the observation of probands during first aid. The third selected method was a measurement using a SimPad SkillReporter and a Resusci Baby QCPR resuscitation manikin. The measurement was used to evaluate the effectiveness of elementary emergency resuscitation of children for five minutes in three selected positions. Results: Based on observations and measurements, it was found that all probands are able to lift and manipulate a...

In order to enhance accessibility to microgravity research, the design process for experiments on the ISS must be streamlined and accessible to all scientific disciplines, not just aerospace engineers. Thus, a general design and analysis toolbox with accompanying best practices manual for microgravity liquid containment is proposed. The work presented in this thesis improves the design process by introducing a modular liquid tank design which can be filled, drained, or act as a passive liquid-gas separation device. It can also be pressurized, and used for aerosol spray. This tank can be modified to meet the design requirements of various experimental setups and liquids. Furthermore, rough simulations of this tank are presented and available to the user for modification. The simulation and design methodology for other general cases is discussed as well. After reading this thesis, the user should have a basic understanding of how liquids behave in microgravity. She will be able to run simple simulations, design, build, test, and fly a liquid management device which has been modified to suit the requirements of her specific experiment. The general tank design can be manufactured using 3-D printing, traditional CNC milling, or a combination thereof. The design methodology and best practices presented here have been used to design tanks used in experiments on the International Space Station for Budweiser and Lambda Vision. Both tanks functioned nominally on orbit. While the specific data from these experiments cannot be presented due to proprietary restrictions, using this thesis as a design guide for new experiments should yield favorable results when applied to new tank designs. If the reader has any questions or would like an updated design process, the author’s preferred contact information can be found using the Orcid iD: 0000-0002-2617-2957 .

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 &amp; 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 &amp; 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.

Objetivo: Se buscó determinar el nivel de conocimientos adquiridos en el aula virtual por estudiantes de medicina de sexto año de tres universidades de Lambayeque, sobre soporte vital básico del adulto, 2022, y el nivel de dicho conocimiento según si recibieron un curso extracurricular sobre el mismo. Materiales y métodos: Se diseñó una investigación descriptiva transversal, la población estuvo constituida por los estudiantes de medicina de sexto año de la región Lambayeque 2022 procedentes de tres universidades. Se aplicó un muestreo no probabilístico, censal y estratificado por universidad. Resultados y discusión: El 75% de los estudiantes presentaron conocimientos inadecuado sobre soporte vital básico del adulto. De los estudiantes que llevaron un taller extracurricular sobre soporte vital básico, el 74% presento un nivel inadecuado de conocimiento. Así mismo, tampoco se hallaron diferencias del nivel de conocimiento según sexo, edad, ni universidad de procedencia. Conclusión: Los conocimientos adquiridos en el aula virtual sobre soporte vital básico del adulto son principalmente inadecuados. No teniendo impacto significativo entre los grupos que recibieron un taller extracurricular y entre aquellos que no lo recibieron. / Objective: To determine the level of knowledge acquired in the virtual classroom by sixth-year medical students from three Universities in Lambayeque, on basic adult vital support, 2022, and the level of knowledge depending if they received an extracurricular course on support basic adult life. Material and methods: A cross-sectional descriptive research were designed in sixth-year medical students from the Lambayeque region 2022 from three universities. Sample was non- probabilistic, census and stratified by university. Results and discussion: 75% of students presented inadequate knowledge about basic adult vital support. 74% of students had an inadequate level of knowledge having held a workshop on basic vital support. There were no difference in the level of knowledge according to sex, age, and university of origin. Conclusion: The knowledge acquired in the virtual classroom on basic adult vital support is mainly inadequate. There is no difference between the groups that received a workshop on basic vital support and between those that did not receive it.