Thesis submitted in fulfillment of the requirements for the degree of Masters of Science in Nursing, Faculty of Community and Health Sciences, Department of Nursing Education, University of the Witwatersrand Johannesburg, 2012 / Studies generally agree the survival of the mechanically ventilated patient in the ICU is largely reliant upon the competence of the nurse undertaking this highly specialized role (Alphonso,Quinones,Mishra,et al. 2004; Burns 2005) However, an audit undertaken by the Critical Care Society of Southern Africa (2004) revealed that 75 % of nurses working in ICU are inexperienced and do not hold an ICU qualification, and as such are unlikely to have acquired the level of competency required to care for the mechanically ventilated patient (Binnekade 2004). A high index of suspicion exists around the competence levels of nurses‟ currently working in ICU in SA as revealed by local studies (Khoza & Ehlers 1998; Scribante & Bhagwanjee 2003; Moeti, van Niekerk, van Velden, 2004; Morolong & Chabeli 2005; Windsor 2005; Perrie & Schmollgruber 2010). The purpose of the study was to determine and describe the level of competence with regard to mechanical ventilation, of nurses working in ICU, who have varying years of experience and training backgrounds, using study specific designed clinical vignettes, in two tertiary healthcare institutions in Gauteng. A descriptive two phase design was utilized for the study. Phase one comprised the development and validation of three clinical vignettes to determine the level of competence of nurses working in ICU‟s with regard to mechanical ventilation. A modified Delphi technique technique using purposively sampled experts from medical technical and nursing backgrounds was used to validate the three clinical vignettes. Content validity was strengthened by computing CVI of the instrument. In Phase two consecutive sampling was used, and data collection comprised of participants (n=136) completing three validated clinical vignettes in the ICU‟s of two tertiary healthcare institutions in Gauteng. All nurses who participated in the study completed the same three clinical vignettes and demographic data. Nurses‟ perceptions regarding their own level of competence with regard to mechanical ventilation were quantified and compared with actual scores achieved in the clinical vignettes. Descriptive and inferential statistics were used to analyse the data. The level of significance was set at <0,05 and confidence levels at 95%. The competency indicator for the vignettes was set at 75% by the expert group, and nurses‟ level of competence was graded according to vignette score outcomes using a grading scale. Statistical assistance was obtained from a statistician from the Medical Research Council (MRC). Results: Results of the study showed that nurses regardless of training background, age, or experience showed a poor level of knowledge, the average score being 48% for ICU qualified nurses and 31% for non-ICU qualified nurses. There was a small significant difference between ICU qualified and non-ICU qualified nurses‟ competence levels in mechanical ventilation when analysed using a two tailed- t- test (p=0.039). Nurses also experienced a misperception regarding their own competence levels in mechanical ventilation when compared to their actual competence levels as determined by three clinical vignettes.

La navigation par système inertiel strapdown est aujourd’hui la plus répandue. L’architecture est bien connue et a été très largement améliorée au cours des dernières décennies. Néanmoins, le principe fondamental n’a subi de bouleversement et reste constitué d’une triplette d’accéléromètres et de gyromètres permettant de revenir aux informations d’attitude et de cap.La précision de l’estimation de position repose principalement sur la gamme de performance des capteurs utilisés. En particulier, des applications telles que des lanceurs spatiaux requièrent une très haute précision et des capteurs d’une technologie éprouvée sont utilisés. L’arrivée sur le marché de capteurs inertiels MEMS de haute précision ouvre une alternative à coût réduits couplée à une réduction de masse, volume et de consommation. Les moyens de production des MEMS ainsi qu’une meilleure connaissance des propriétés des matériaux ont permis l’arrivée d’accéléromètres MEMS pouvant rivaliser avec les technologies éprouvées de gamme tactique. Toutefois, les gyromètres de technologie MEMS existantes restent dans une gamme de performance de type industrielle.La présente étude vise à analyser la possibilité d’utiliser des accéléromètres de haute précision pour améliorer les performances gyrométriques, dans l’objectif de réaliser une solution tout MEMS d’unité de mesure inertielle. Une brève introduction sur les techniques de filtrage de Kalman pour la fusion de données est présentée, ainsi que son implémentation pour notre étude. L’analyse théorique se poursuit avec une présentation des résultats expérimentaux.L’étude conclut que l’utilisation d’une paire d’accéléromètres de haute performance et d’un gyroscope de type consommateur permet d’atteindre les performances d’un gyromètre tactique. Les contraintes de définition et de mesure pour l’implémentation du système sont présentées en détail.Cette étude est menée pour la mesure angulaire autour d’un axe unique de rotation, un complément d’étude est nécessaire à l’extrapolation de cette approche pour une mesure générique en 3D. / Strapdown inertial navigation units are the most popular systems used for navigation. The system architecture is well established and has been extensively improved over the past decades. However, the core idea remains same where a triad of accelerometers and gyroscopes provide the attitude and heading information.The accuracy of the position estimate depends on the performance grade of the sensors employed. For applications like space launchers requiring very high accuracy, high-grade devices using traditional technologies are used. The advent of accurate MEMS based sensors offer an exciting low-cost alternative with expected reduction in size and power consumption. MEMS fabrication technology, assisted by improved understanding of material properties have led to accelerometers that can compete with traditional devices for tactical applications. However, the MEMS based solutions currently available for gyroscopes can replace only industrial grade applications.This study attempts to investigate if the currently available high-grade accelerometers can be used to improve the gyroscope performance, towards the final goal of a complete MEMS based solution for inertial navigation units. The study begins with a literature review of current status of technology. A brief explanation of linear Kalman filtering technique for data fusion is presented, along with its implementation concerning this work. The theoretical discussion is then followed by presentation of experimental results.The study found that using a pair of high-grade accelerometers, a consumer grade gyroscope can have its performance upgraded for tactical applications. The design and sensing constraints for realizing this system are discussed in detail.Since this research work primarily concerns with angular rate estimation around a single axis of rotation, further research is recommended for extrapolating this approach for a more general 3-D sensing case.

Introdução: A hemodiálise é um procedimento invasivo, para pacientes em falência renal onde se realiza a filtração do sangue continuamente, utilizando-se circulação extracorpórea em um filtro hemodialisador. No Brasil, a prática do reuso de hemodialisadores atinge quase 100% nos serviços de diálise. Uma das justificativas para o reuso são os limitados recursos para a assistência à saúde. No entanto, esta prática, causa questionamentos relacionados à segurança. Erros técnicos no reprocessamento, qualidade da água e alteração da integridade da membrana do hemodiliasador podem afetar a qualidade do processamento expondo os pacientes ao risco de bacteriemia e sepse. Objetivo: Avaliar a contaminação microbiana dos hemodialisadores após o número máximo de reusos permitidos, comparando os resultados conforme tipo de processamento: manual e automatizado. Método: Esta pesquisa caracterizou-se como estudo de campo, transversal, de caráter exploratório comparativo em dois serviços de diálise. A composição da amostra foi por conveniência conforme a disponibilidade destas, pelas instituições doadoras, sendo os grupos experimentais compostos por 11 hemodialisadores processados pelo método automatizado e quatro hemodialisadores processados manualmente. As amostras foram coletadas após o processamento obedecendo ao número máximo de reusos permitidos pela RDC ANVISA nº 11/2014, sendo 12 reusos para processamento manual e 20 reusos para processamento automatizado. Em Cabine de Proteção Biológica a solução salina e dialisadora foram drenadas dos compartimentos de sangue e dialisato, respectivamente, e injetados 150 mL de meio de cultura Tioglicolato de Sódio Fluido em cada compartimento. As amostras foram incubadas em estufa microbiológica por 14 dias, a temperatura de 35 ºC ±2ºC. Após esse período alíquotas do meio de cultura foram semeadas em meios de ágar sangue, anaerinsol e sabouraud, capazes de recuperar a maioria dos microrganismos aeróbios, anaeróbios, bolores e leveduras. As placas foram incubadas por 48 horas a 35 ºC ±2ºC, e procedida a identificação de gênero dos micorganismos. Realizados controles positivos com hemodialisadores contaminados intencionalmente e controles negativos, com novos esterilizados. Resultados: Das amostras submetidas ao processamento automatizado três amostras (3/11-27,3%) apresentaram crescimento microbiano no compartimento de sangue, sendo identificados dois diferentes microrganismos: de Sphingomonas paucimobilis (66,67%) e de Penicillium sp. (33,33%). Todas as amostras 11/11 (100%) apresentaram crescimento microbiano no compartimento de dialisato, sendo identificados 5 diferentes microrganismos: Sphingomonas paucimobilis (43,75%), Strenotrophomonas maltophilia (25%), Pseudomonas aeruginosa (18,75%), Acinectobacter baumannii (6,25%) e Candida sp (6,25%). Dos quatro hemodialisadores submetidos ao processamento manual, uma amostra (25%) apresentou crescimento de bacilo Gram-positivo no compartimento de sangue e uma amostra (25%) apresentou crescimento no compartimento do dialisato contaminados por três microrganismos distintos: de Bacillus sp, Rhizobium radiobacter, Burkholderia sp. Comparando os resultados da contaminação microbiana segundo os dois métodos de processamento analisados não houve diferença estatisticamente significante (p=1) para o compartimento de sangue. Para o compartimento do dialisato o método automatizado apresentou maior número amostras positivas em relação ao manual (p=0,008791). Conclusão: Os resultados demonstraram que o reuso dos hemodialisadores não é uma prática recomendada, podendo causar bacteriemia e sepse em pacientes em tratamento hemodialítico. Ressalta-se que a pesquisa foi conduzida no pior cenário após o número máximo de reusos permitidos sem determinar em qual número de reusos a contaminação aconteceu. / Introduction: Hemodialysis is an invasive procedure for patients with kidney failure in which blood is continuously filtered using a dialyzer filter through extracorporeal blood flow. In Brazil dialyzers are nearly 100% reused in dialysis facilities. One of the main justifications to reuse dialyzers is economical. However, this practice often leads to concerns related to patient safety. Technical errors in reprocessing, water quality and the membrane dialyzer degradation may lead to different risks including bacteremia and sepsis. Objective: To evaluate dialyzers regarding microbiological contamination after maximal number of reuses, comparing results in accordance with the type of reprocessing: manual and automated. Method: This research was characterized as a transversal, exploratory and comparative in two dialysis facilities. The sample was composed as convenience according to the availability of the facilities which donated the samples. The experimental groups were composed of 11 automated reprocessed dialyzers and four manually reprocessed dialyzers. The samples were collected after reprocessing in dialysis facilities according to the maximal number of reuses permited by law (12 in manual reprocessing and 20 in automated reprocessing) and prepared in Biosafety Cabinets. Saline Solution and dialysate solution were drained from both the blood and the dialysate chambers, respectively, by applying suction and filled with 150 mL of culture medium sodium thioglicolato fluid in each chamber and they were incubated at a temperature of 35 º C + or -2 ° C for 14 days. After this period, the samples were cultured in medium adequate for the growth of aerobic and anaerobic organisms as well as fungi and yeasts.The samples were incubated for 48 hours at 35 º C + or -2 ° C and identification of microorganisms was carried. Results: The analyzed samples which were automated reprocessed, 3/11(27.3%) showed microbiological growth in the blood chamber, of this total, we identified two different microorganisms: S.paucimobilis (66,67%) and Penicillium sp. (33,33%). In the dialysate chamber 11/11 (100%) of microbiological growth was identified, of this total we identified five different microorganisms: S.paucimobilis (43,75%) , S. maltophilia (25%) , P. aeruginosa (18,75%) , A. baumannii (6,25%) and Candida sp. (6,25%). The four analyzed samples which were manually reprocessed, 1/4(25%) showed microbiological growth in the blood chamber. One sample with Gram-positive Bacillus was identified in the dialysate chamber and contaminated by Bacillus sp, R. Radiobacter and Burkholderia sp. Comparing the results related to microbiological growth according to the two methods in the blood chamber, we concluded that there was no statistically significant difference (p=1) and in the dialysate chamber, there was a higher number of positive samples among those which were automated reprocessed compared to manually reprocessed (p = 0.008791) Conclusion: The results showed that dialyzers reuse is not a recommended practice and may cause bacteremia and sepsis for patients with chronical kidney disease. We highlight that this study was carried out considering the worst case scenario ,i.e. after the maximal number of reuses permitted by law, without specifying in which number of reuses the contamination occurred.

Com crescimento da degradação ambiental, houve um grande investimento em unidades de conservação, que resultou no Sistema Nacional de Unidades de Conservação (SNUC). Embora o SNUC almeje regulamentar as unidades de conservação, muitas dessas tem dificuldade em proteger o meio ambiente, como é o caso da reserva biológica de São Donato, situada entre os municípios de Itaqui e Maçambará - RS, cujo objetivo é proteger o banhado São Donato, frente à expansão da agricultura e da pecuária. Assim, o objetivo da dissertação é contribuir para o estudo das unidades de paisagem da reserva biológica de São Donato, através da cartografia ambiental. Para isso, foram traçados objetivos específicos: (1) elaborar mapas temáticos - hipsométrico, clinográfico e uso do solo; (2) proceder uma análise multitemporal do uso do solo; (3) propor uma cartografia de unidades de paisagem da reserva biológica; (4) avaliar essas unidades de paisagem, quanto ao grau das intervenções antrópicas. Portanto, a partir do conceito de paisagem definido por Bertrand (1968) e da metodologia proposta por Martinelli; Pedrotti (2001) para a cartografia de unidades de paisagem foram identificadas dez unidades de paisagem na reserva biológica de São Donato, sendo que as unidades com maior interferência antrópica estão em expansão, enquanto que as unidades naturais encontram-se em dinâmica de retração, devido ao crescimento da atividade agropecuária no entorno da unidade de conservação, sobretudo do cultivo do arroz irrigado. / With growing environmental degradation, there was a large investment in protected areas, which resulted in the National System of Conservation Units (SNUC). Although this system aims to regulated conservation units, many of these have difficulty in protecting the environment, such as the biological reserve of São Donato, located between the towns of Itaqui and Maçambará - RS, in order to protect the São Donato wetland, given the expansion of agriculture and livestock. The objective of this research is to contribute to the study of landscape units of the biological reserve of São Donato, through the environmental cartography. For this, specific objectives were outlined: (1) elaborate thematic maps; (2) make a multitemporal analysis of land use, (3) propose a cartography of landscape units of biological reserves; (4) evaluate these landscape units, the degree of human interventions. Therefore, from the concept of landscape defined by Bertrand (1968) and the methodology proposed by Martinelli; Pedrotti (2001) for cartography of landscape units were identified ten scenic drives in the biological reserve of São Donato, and units with greater human interference are increasing, while the natural units are in dynamic retraction, due to the growth of farming in the surrounding conservation area, especially the cultivation of rice.

by Tsun Tak-on. / Chinese title: / Bibliography: leaves 111-113 / Thesis (M.Phil.)--Chinese University of Hong Kong, 1983

Title also in Chinese. / Thesis (M.Phil.)--Chinese University of Hong Kong. / Bibliography: leaves 159-161.

Acute medical patients constitute the single largest group of patients in hospitals. The processes by which they are cared for in the United Kingdom (UK) have changed over the past few decades and now the majority of acute medical care is delivered within acute medical units (AMUs). The AMU model is also increasingly being adopted outside of the UK, including in Ireland, Australasia and Europe. AMUs emerged as a result of local service innovations and there is evidence to suggest that care within AMUs varies across settings. Although there are published recommendations for care delivery, empirical evidence is lacking. In this thesis I aim to examine the concept of the AMU model with regard to the literature; its definition; its components; and how these components are delivered across Scottish sites. This is with the aim of informing service provision and contributing to the development of an evidence base relating to AMUs. Firstly, I undertook a systematic review of the evidence relating to the effectiveness of and variation in the AMU model. I found limited, observational and possibly confounded evidence that the AMU model was associated with reductions in hospital length of stay and mortality compared to other models of care in European and Australasian settings. I also found variation in the admission criteria, entry sources, functions and staff work patterns across the 12 AMUs described in the literature. Given this finding that AMUs do not operate in a uniform way, I undertook a second systematic review to assess the published evidence evaluating different methods of delivery of care within AMUs. I identified nine studies of ten interventions. From this I concluded that there was little discerning evidence pertaining to how best to deliver care in AMUs. This led me to undertake a qualitative descriptive study of all the AMUs in Scotland with the aim of further delineating the AMU model. During a visit to each AMU, I collected data through semi-structured interviews with healthcare professionals working in the units. This totalled 171 interviews of 275 participants across 29 sites. I used this data to provide a report detailing how care was delivered in each AMU. I then thematically analysed these reports using framework analysis. There were three principal findings from this qualitative study. Firstly, I found that acute medical care was delivered in acute medical services rather than single AMUs. Secondly, I identified a framework of 12 key components of AMU care that were integral to the functioning of the AMU irrespective of the setting. Examples include nurse staffing and the physical areas contained within the AMU. Lastly, I described how these components were delivered across Scottish AMUs and, where possible, identified distinct models of care delivery. For example, I identified 13 models of AMU functions and seven models of consultant work patterns. In summary, I found that care in Scottish AMUs is delivered variably. The reasons for the variation are unclear. The findings of this thesis are the first in-depth study into AMUs. They provide a useful foundation for discussions and onward planning of resources, capacity and standards of care at both a national and local level. These findings are also an impetus for further research to delineate how best to deliver care in AMUs, and form an essential precursor to such work.

Cartas al editor / Revisión por pares

Polymers were synthesised containing the methanoanthracene (MA), methanopentacene (MP) and benzomethanoanthracene (BzMA) units to investigate their properties as gas separation membranes. For each monomer type, polymers were successfully synthesised using Tröger’s base (TB) chemistry and cast as free standing films from low-boiling point solvents. Gas permeability tests revealed high selectivities for most of the technologically significant gas pairs. Most interestingly, MA/dimethylethanoanthracene co-polymer, MP-TB and BzMT-TB polymers all show a high degree of selectivity in the separation of a number of technologically significant gas pairs when compared to other state-of-the-art polymers. In particular MP-TB has very high selectivity for the N2/O2 gas pair. Synthetic routes to MP-TB and BzMA-TB involve fewer steps and are significantly cheaper to implement compared to other state of the art TB polymers and high performance PIMs that provide data above the Robeson upper bounds due to their high permeability and selectivity. Co-polymers of MA were synthesised in 1:1, 4:1 and 9:1 ratios. Gas permeability data demonstrated that properties correlate with the monomer composition. Results indicate that inclusion of methano-bridged units into the polymers increased the rigidity of polymer chains, leading to smaller pore widths and improved selectivities compared to polymers such made from more flexible structural units. The first chapter of this thesis introduces the concepts of microporosity, permeability and membrane separation, and describes a number of polymers that have demonstrated properties of interest for separating gas mixtures. Chapter two describes the synthesis and gas permeability data of MA-TB polymer and a series of copolymers incorporating MA. Chapter 3 describes the synthesis of polymers containing the MP structural unit and describes the performance of MP-TB as a membrane for gas separation. Chapter 4 describes a number of polymers synthesised using the BzMA structural unit and chapter 5 reports the synthesis of a number of larger units derived from BzMA including benzomethanotetracene, benzomethanopentacene and dibenzomethanopentacene. Permeability data for TB polymers synthesised from BzMA-type monomers is reported in these chapters.

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