Made available in DSpace on 2014-10-09T12:36:09Z (GMT). No. of bitstreams: 0 / Made available in DSpace on 2014-10-09T13:59:22Z (GMT). No. of bitstreams: 1 01803.pdf: 1763975 bytes, checksum: 1d9670fc7ad262d61966c6814c757dc7 (MD5) / Dissertacao (Mestrado) / IPEN/D / Instituto de Pesquisas Energeticas e Nucleares - IPEN/CNEN-SP

Major advances in antiemetic therapy have been made over the past two decades. Despite these advances in antiemetic management, nausea and vomiting are still important problems in clinical practice, and approximately 50% of patients receiving chemotherapy still experience nausea and/or vomiting, highlighting the need for further developments in the field. Non-pharmacological interventions are suggested as possible adjuncts to standard anti-emetic therapy. A recently developed non-pharmacological intervention to alleviate nausea and vomiting is Nevasic, which may have potential to reduce CINV and improve management of these symptoms.This pilot trial was run to examine the feasibility of implementing and conducting a randomised controlled trial using Nevasic programme. In addition, the study aimed to evaluate the acceptability and potential effect of Nevasic on cancer patients undergoing chemotherapy. Ninety nine adult female breast cancer patients who had been prescribed a course of moderately high emetogenic chemotherapy were randomised to usual care (standard anti-emetics) plus one of (1) intervention group (using Nevasic), (2) attention group (listening to music), and (3) control group, receiving no additional intervention. Data were collected daily using the Rhodes Index of Nausea, Vomiting and Retching (INVR) and a structured diary questionnaire. The EORTC QLQ-C30 (and BR23) were used at baseline and day 6 post chemotherapy. Data were collected from cancer centres affiliated to Mashhad University of Medical Sciences in Mashhad, Iran.The findings from the trial highlight that conducting a non-pharmacological intervention using such an audio programme is feasible, although difficulties and limitations exist. This study did not detect any evidence for the effectiveness of Nevasic on CINV; however, the results show statistically significant less use of anti-emetics (post-chemotherapy) (p=0.03) and borderline non-significant (p=0.06) better global health status in Nevasic group. Further studies are required to investigate its implications from other perspectives such as use of anti-emetics - rather than looking only at the "level of nausea and/or vomiting" perspective.

To broadcast live media to the viewer, more known as streaming, has grown in popularity a tremendous amount the last few years. Despite the large viewerbase and people’s dreams to share their creation with the world it’s still quite difficult to get started as a streamer. How can we make it easier for people to start streaming? This project includes the thought and design process of the development of a new product linefor streamers. The product’s purpose is to offer the correct functions that makes it possible, but also easy for anyone to share their passion with the entire world. Letting anyone in the world not just watch you, but also be a part of the experience. The project resulted in a conceptual starter kit for streaming. The kit includes products that cooperate with each other, giving the user a personal and positive experience when starting out with streaming.

This master´s thesis provides an overview of diferences between conventional way to obtain ATPL licence and MPL course. Next focus is on the flight schools providing this courses and air carriers requirements to their future pilots.

Erroneous decisions made by pilots during encounters with adverse weather is often cited as a cause of General Aviation accidents. Pilot experience, which can be measured in several ways, is believed to play a role in the outcome of such encounters. However, it is unclear whether any of the elements of experience alone or in combinations affect the likelihood of General Aviation accidents during actual encounters with adverse weather, or how they do so. One barrier to conclusively determining such effects is the danger in extrapolating simulation results to the real world; nearly all work done to date has used simulators to identify accident risk. Therefore, the extent to which such results can be applied to actual flying is not clear.<div><br></div><div>In this work, two conceptual models for analyzing experience and its role inencounters with adverse weather during the cruise phase of General Aviation Part 91 fixed wing operations are presented. A novel method for evaluating accident risk, specifically the likelihood that an incident turns into an accident is also presented and then used to evaluate the experience profile of 595 pilots, detailed in actual accident and incident reports from the NTSB and ASRS databases. The effect of various elements of experience, alone and in combinations, on that risk is evaluated using regression modeling. The level of significance for each experience variable is first established, and then a series of discrete models is developed to progressively evaluate accident risk along a hypothetical experience continuum. This approach obviates commonly encountered challenges with research in the area and provides results that are ecologically valid.<br></div><div><br></div><div>The focus of this research work was on the role of cognitive aspects of experience in the outcome of flights during the cruise phase of General Aviation Part 91 fixed wing flights between January 1, 2005 and December 31, 2015. Only flights which encountered adverse weather during the cruise phase and for which experience and/or errors in decision making were determined to be a cause or factor in the outcome were included in the study. All flights during the period that involved takeoff and landing, equipment failure or student pilots were not considered for the study. The emphasis of the research was on the effect of experience on cognitive aspects of pilot performance during adverse weather encounters, rather than “stick and rudder” skills.<br></div><div><br></div><div>It was found that variables related to the breadth or variety of pilots’ experience are more predictive of the likelihood of adverse weather encounters turning into accidents compared to those related to the duration or length of experience. While several commonly used measures of experience provide some level of insulation against accidents, the relationship between elements that define the length or duration of experience and outcomes is not linear. Furthermore, this relationship is mediated by variables that define the breadth of experience, especially at their lower levels. These findings may be leveraged to design specifically targeted regulatory or training policies and interventions to expedite the transition from novice to expert pilots in General Aviation weather-related decision making.<br></div>

no / We co-designed and piloted ‘Festival in a Box’, an outreach programme to enable socially isolated people with dementia to engage with and enjoy cultural activities in their homes. It comprised 3–4 weekly home visits, each led by a professional artist to create art works using materials brought in ‘the box’. Activities included music, poetry, pottery, crafts and photography. We qualitatively interviewed 13 participants (6 people with dementia, 4 artists, 3 befrienders). Six participants with dementia completed, enjoyed and engaged with the planned visits. Main themes were: engagement, reflection on value of previous cultural activities, precariousness and isolation in current neighbourhood and the importance of a voice and being heard. Befrienders reported their preconceptions of what participants could do were challenged. Artists reported shifts in their preconceptions about dementia and the influence of the project on their professional practice. We propose that the ‘Festival in a Box’ pilot study suggests a means through which community arts festivals could work with socially isolated people with dementia to contribute to the creation of ‘Dementia Friendly Communities’. A larger-scale pilot study is now needed to develop this hypothesis.

Meeting patient expectations in relation to pain management is an essential component of palliative and end-of-life care. However, previous research has demonstrated that pain is highly prevalent, especially during the four months prior to death. Poorly controlled pain contributes to cognitive failure, depression and an inability to complete daily activities. Unfortunately, pain and symptom management are often inadequate for patients placed in hospice care. The purpose of this study is to evaluate the perspectives of hospice nurses on complementary and alternative therapies to determine if there is an educational need in order to aide in the management of chronic pain in older adults. A survey was developed in order to determine the nursing perceptions of complementary and alternative therapies. A total of 24 participants were recruited. The survey targeted 28 complementary and alternative therapies most commonly used as defined by National Institute for Complementary and Alternative Medicines (NCCAM). Each therapy was ranked on several aspects including perceptions, personal experience, and present knowledge and training. After completing the survey it was found that all participants were either eager or open to use some complementary and alternative therapies in their workplace, in spite of having an educational barrier on how to implement them, and wanted these therapies to become available to patients, families, and staff.

Patients with acute spinal cord injury (SCI) have a high risk of venous thromboembolism (VTE) despite receiving thromboprophylaxis. The current standard of care recommended by guidelines is to use low-molecular-weight heparin (LMWH) for thromboprophylaxis for 90 days. This entails once- or twice-daily subcutaneous injections of LMWH for this duration, which is inconvenient for the patients and only partially effective. There are uncertainties about risk factors and the true incidence of SCI-associated VTE, the optimal time to commence thromboprophylaxis, and the optimal duration of thromboprophylaxis. Furthermore, there are currently no studies on the use of direct oral anticoagulants (DOACs) for thromboprophylaxis in patients with SCI. The use of DOACs for prophylaxis in this group can eliminate the inconvenience associated with daily subcutaneous injections for 3 months. To examine the incidence and risk factors of SCI-associated VTE, we performed a retrospective chart review of consecutive adult patients with acute SCI admitted to Hamilton General hospital from 2009 to 2015. The incidence of symptomatic VTE despite the use of thromboprophylaxis was 11% within 90 days of acute SCI; age and presence of other sites of injuries (such as lower limb fractures or pelvic fractures) along with SCI were independent risk factors for symptomatic VTE. To determine the opinion of Canadian spine surgeons about the optimal timing of starting LMWH after acute SCI, a short 5-question electronic survey was sent to the Canadian Spine Society. Data from our survey showed that the understanding about thromboprophylaxis after acute SCI was variable and that most spine surgeons were comfortable with starting LMWH after consultation with the surgeon. Future studies should focus on educational strategies to improve the knowledge base in this area. We will perform a pilot study at the Hamilton General Hospital comparing apixaban versus LMWH for thromboprophylaxis in patients with acute SCI. The use of apixaban for this indication can contribute to cost savings for the healthcare system and increased convenience for the patient. The protocol for the pilot study as well as steps towards a multi-center randomized controlled trial will be detailed in this thesis. / Thesis / Master of Science (MSc)

The National Transportation Safety Board has cited deficiencies in judgement and decision-making as contributing factors in numerous general aviation accidents. Several studies have also indicated that some pilots exhibit <i>hazardous attitudes</i> in their decision-making processes. Although decision-making and judgment training is mentioned by the Federal Aviation Administration as areas that should be taught to aspiring pilots, there are relatively few current guidelines to assist flight or ground school instructors. This study centers on the decision-making characteristics of expert and novice pilots. Four expert and four novice pilots were selected by the researcher. All of the subjects were interviewed about their decision-making processes as they related to four aeronautical decision-making scenarios. Experts exhibited characteristics and themes that differed noticeably from that of the novices. One of the more pertinent differences involved what some writers have referred to as <i>cognitive maps</i>. These mental guides appeared to be used effectively by experts in attempting to cope with problems associated with the scenarios. Novices also appeared to make use of cognitive maps in their decision-making processes. Their maps, however, were primitive in comparison to the experts and resulted in difficulties when attempting to address specific scenarios. The findings regarding the decision-making thought processes of experts were consistent with previous studies (e.g., decisions were based on pertinent mental cues from their experiences). The findings related to novices revealed five themes that included: a. the quantity and quality of information acquired to assess risk was often deficient; b. the interpretation of the risks associated with each scenario reflected a lack of attention to pertinent issues related to the scenarios; c. decision-making was often based on recognition of familiar conditions with which novice subjects could relate; d. decision-making often reflected an emphasis on rules and procedures that novices had been taught or acquired through independent research and e. novices exhibited hazardous attitudes in their decision-making processes. The researcher reviewed significant findings and areas in need of further research. A brief conclusion and recommendations conclude the study. / Ph. D.

The development of large lightweight airframes has resulted in what used to be high frequency structural dynamics entering the low frequency range associated with an aircraft’s rigid body dynamics. This has led to the potential of adverse interactions between the aeroelastic effects and flight control, especially unwanted when incidents involving failures or extreme atmospheric disturbances occur. Moreover, the pilot’s response in such circumstances may not be reproducible in simulators and unique to the incident. The research described in this thesis describes the development of a pilot model suitable for the investigation of the effects of aeroelasticity on manual control and the study of the resulting airframe loads. After a review of the state-ofthe- art in pilot modelling an experimental approach involving desktop based pilot-in-the-loop simulation was adopted together with an optimal control based control-theoretic pilot model. The experiments allowed the investigation of manual control with a nonlinear flight control system and the derivation of parameter bounds for single-input-single-output pilot models. It was found that pilots could introduce variations of around 15 dB at the resonant frequency of the open loop pilot-vehicle-system. Sensory models suitable for the simulation of spatial disorientation effects were developed together with biomechanical models necessary to capture biodynamic feedthrough effects. A detailed derivation and method for the application of the modified optimal control pilot model, used to generate pilot control action, has also been shown in the contexts of pilot-model-in-the-loop simulations of scenarios involving an aileron failure and a gust encounter. It was found that manual control action particularly exacerbated horizontal tailplane internal loads relative to the limit loads envelope. Although comparisons with digital flight data recordings of an actual gust encounter showed a satisfactory reproduction and highlighted the adverse affects of fuselage flexibility on manual control, it also pointed towards the need for more incident data to validate such simulations.