No description available.

No description available.

The aim of this study was to analyse the role of the registered nurse in the management of pro re nata (PRN) medication in a care home (nursing) for older people. Studying PRN medication provides insights into the role of the nurse in care homes (nursing) who act as assessor, decision maker and evaluator in residents' care. It also provides a lens by which to explore how residents and their carers interact and participate in day-to-day care decisions about residents' health. The case study draws on ethnography. It is a multi-method study, using documentary and medication reviews, observations and interviews to answer the research questions. Thirty-four residents were recruited to the study and 60 care home staff. Findings showed that 88.2% of residents (n=30) were prescribed PRN medication and that all residents were on a minimum of 1 and a maximum of 7 medication. During each 28-day MAR sheet period between 35 and 44 PRN prescriptions were written. They contributed 12.7% of all medication prescribed, accounting for between 1.2 and 1.5 medication per resident. Nurses were found to administer PRN medication, but a finding of this study was that this activity could be delegated to carers who were identifying resident needs. There was some evidence of resident engagement but this was often a three-way process between resident, GP and family or resident, carer and nurse. A percentage of medication that could have been PRN were routinely prescribed. Observations also identified that nurses would decide not to administer routine medication in certain circumstances and that this was directly related to their assessment of the resident. The process of medication management was dominated by the regulations and governance processes of the care home. Observations and interviews found that care home staff recognised and affirmed residents' pain but did not take action for analgesia to be administered. They were familiar with the use of pain assessment tools for older people living with dementia and had received training in dementia care. Many of the staff were also able to interpret signs and symptoms of a resident's distress. Nevertheless, their preoccupation with meeting internal and external regulator standards was a barrier to addressing residents' needs. This is the first study that has looked at an aspect of medication management to understand how nurses and care home staff work for and with residents to moderate and address their health care needs. It suggests that additional training in aspects of medication management and resident assessment may not be able to address deeper seated issues of autonomy and how the nursing role is understood and enacted in care home settings.

International Telemetering Conference Proceedings / October 25-28, 1999 / Riviera Hotel and Convention Center, Las Vegas, Nevada / L-3 Communications Telemetry & Instrumentation (L-3 T&I) has developed an advanced IBM PC-AT Telemetry, Tracking, and Commanding (TT&C) SATCOM system based on the utilization of Field Programmable Gate Array / Digital Signal Processing (FPGA/DSP) microprocessors. This system includes up-link, down-link, and range processing sections. Physically, the system consists of one IF Transceiver and two or more FPGA/DSP microprocessor boards called Advanced Processing Microprocessors (APMs). The form factor of these PWBs is compliant with full length, full height IBM PC PCI bus cards. This paper describes the features and functionality of an advanced Telemetry, Tracking, and Commanding Processing System (TT&CPS) based on the implementation of FPGA and DSP microprocessors. The high-level functional attributes of the TT&CPS are depicted in Figure 1. There are four main functional blocks: the IF Transceiver, the Down-Link Processing Section, the Up-Link Processing Section, and the Range Processor. The analog/IF circuitry in the IF Transceiver card interfaces between the 68–72 MHz (70 MHz, nominal) IF I/O signals and the Up-Link and Down-Link Processing Section's DSP equipment. The down-link portion of the IF Transceiver card has two user-selected input ports. From the selected input, the signal is processed through selectable bandwidth limiting, gain control, Doppler correction (optional), quadrature down-conversion to zero hertz (baseband), selectable baseband filtering, and precision Analog-to-Digital (A/D) conversion. The up-link portion of the IF Transceiver card takes I/Q digital data from the APM performing the up-link processing functions. This baseband I/Q digital data is Digital-to-Analog (D/A) converted, filtered, quadrature up-converted to 68–72 MHz, up-link Doppler corrected (optional), output level detected and level controlled, and sent to a two-position output selector switch. The down-link portion of the TT&CPS provides main carrier linear PM or BPSK or QPSK demodulation and can also, in composite linear PM demodulation mode, receive and demodulate FSK and/or BPSK subcarriers and ranging signals. The demodulators use symbol timing loops and bit decision circuits (matched filters) to perform the bit synchronization function. Several decoding algorithms, including differential, de-interleaving, Viterbi, and Reed-Solomon, are available for the down-link telemetry. Command format checking and CRC status is also available on FSK-demodulated data. Direct carrier BPSK/QPSK demodulation has decoding and frame synchronization capabilities. Because of the modular construction of the firmware and the use of FPGAs and DSPs, the system can be loaded with only the functions in use, lowering initial setup time while increasing overall system capability. To support a particular function, the card is downloaded with an “image,” which programs the FPGAs and DSPs at initialization. The user can change configurations by simply downloading a new set of instructions to the FPGA/DSP on the fly to keep the ground station running with minimal downtime. The flexibility of the design minimizes spare board costs, while achieving greater programmability at the end-user location.

In response to the unparalleled growth of demand for air traffic during the past few decades, the Federal Aviation Administration (FAA) launched the Next Generation Air Transportation (NextGen) program to restructure the National Airspace System (NAS). Among the research is the focus on direct, wind optimal routing using geodesic routes and flight operations that do not depend solely on ground based navigation aids (NAVAID) and a fixed airspace structure. While technologies, such as the Global Positioning System (GPS), exist to locate an aircraft at higher degrees of resolution with a larger coverage, the way in which this information is conveyed is long and cumbersome. Therefore, new ways to describe the airspace is desired. The thesis presents the results of an experimental investigation into three alternatives to fix/route and GPS methods. The first method is the Navigation Reference System (NRS) using an absolute grid based strategy that has been recently implemented in limited portions of the United States airspace. The second method, the Military Grid Reference System (MGRS), is also a grid based system, and it is used by NATO, but it has not been applied to the air traffic control context. The third alternative is Point Relation Navigation (PRN), which uses a single point of reference within each Air Route Traffic Center (ARTCC) airspace and acts as a hybrid of coordinate and radial fixes. 21 airline dispatchers from a single major U.S air carrier participated in an online assessment of the five methods above through specific tasks. Results indicate that most participants prefer the fix/route system over the others, followed closely by the PRN method. However, there were varying results across all of the methods in terms of speed and accuracy of completing the tasks. This study incites further interest in strategies to describe aircraft routes operating in a more flexible airspace.

L’acceptabilité d’un décès lors d’une simulation médicale reste débattue mais il existe peu de données sur la perspective des apprenants. Des médecins résidents ont effectué une pratique de code et ont rempli un questionnaire pré et post-simulation. Ils ont été exposés à deux scénarios où un bébé naissait sans signe de vie: 1. Nouveau-né ne répondant pas aux manœuvres de réanimation (DCD); 2. Nouveau-né s’améliorant avec une réanimation adéquate (REA). Les performances étaient évaluées à l’aide de la grille standardisée du Programme de Réanimation Néonatale. Le stress objectif (cortisol salivaire) et subjectif a été mesuré après le code. La rétroaction («feedback»), individuelle et en groupe, fut analysée à l’aide de méthodologies qualitatives. 59/62 apprenants ont répondu au questionnaire et 42 ont participé à la simulation. Tous les résidents trouvent les simulations bénéfiques et souhaitent y être exposés davantage. Le type et l’ordre des scénarios n’ont pas eu d’impact sur la performance. Un seul résident a interrompu les manœuvres de réanimation après 10 minutes d’asystolie, tel que recommandé, et 31% ont poursuivi après 20 minutes. Les participants trouvaient le scénario DCD plus stressant. Les niveaux de cortisol salivaire ont augmenté après les simulations (p<0.001) et ce, pour les deux scénarios. Cette augmentation était indépendante du scénario (p=0.06) et n’était pas associée à la performance. Les réponses à la question « Comment a été votre expérience? », ont permis d’identifier deux thèmes: 1. Le mannequin ne meurt pas en simulation médicale; 2. Le décès lors de la simulation signifie une réanimation inadéquate. Le décès lors d’une pratique de code est stressant, mais n’interfère pas avec la performance des soignants. Les apprenants trouvent cet exercice acceptable et bénéfique à leur pratique future. / The acceptability of simulated death has been debated by experts, but there is scarce information regarding trainees' perspective. Pediatric trainees were invited to perform medical simulation, including pre and post questionnaires. Participants were exposed to 2 mock codes of neonates born pulseless. In the RESUSC scenario, the manikin responded to adequate resuscitation; in the DEATH scenario, the manikin remained pulseless. Mock codes were evaluated using the Neonatal Resuscitation Program score sheet. Debriefing was analyzed using qualitative methodology. Salivary cortisol was collected from participants (objective stress). 59/62 trainees answered the questionnaire, and 42 performed mock codes. All trainees found mock codes beneficial and would appreciate being exposed to more. Scenario or order of scenario did not affect performance. Only one trainee stopped resuscitation after 10 minutes of asystole, as recommended by clinical guidelines of Neonatal Resuscitation Program (NRP), and 31% had not ceased resuscitation efforts by 20 minutes. Trainees found the DEATH scenario more stressful than RESUSC. Post-simulation salivary cortisol levels were significantly higher (p<0.001) than before simulation (for both scenario). This increase was not scenario dependent (p = 0.06) nor associated with performance scores. Trainees all answered the following question during debriefing: “How did this go for you?” Two themes were identified in their answers: 1. The manikin does not die; 2. Death equals inadequate resuscitation. The death of the manikin was stressful, but trainees thought this was acceptable and prepared them for their future. Having a mannequin die during simulation does not interfere with their performance.