BACKGROUND: Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end-of-life (EOL). Providing high quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made over the last 17 years.OBJECTIVE: To determine the most common and current obstacles in EOL care as perceived by ICU nurses and then to evaluate whether or not meaningful changes have occurred since data were first gathered in 1998.METHODS: A quantitative-qualitative mixed methods design was used. A random, geographically dispersed sample of 2,000 members of the American Association of Critical-Care Nurses was surveyed.RESULTS: Five obstacle items increased in mean score and rank as compared to 1999 data including: (1) family not understanding what the phrase "life-saving measures" really means; (2) providing life-saving measures at families' requests despite patient's advance directive listing no such care; (3) family not accepting patient's poor prognosis; (4) family members fighting about use of life support; and, (5) not enough time to provide EOL care because the nurse is consumed with life-saving measures attempting to save the patient's life. Five obstacle items decreased in mean score and rank compared to 1999 data including (1) physicians differing in opinion about care of the patient; (2) family and friends who continually call the nurse rather than calling the designated family member; (3) physicians who are evasive and avoid families; (4) nurses having to deal with angry families; and, (5) nurses not knowing their patient's wishes regarding continuing with tests and treatments.CONCLUSIONS: Obstacles in EOL care, as perceived by critical care nurses, still exist. Family-related obstacles have increased over time and may not be easily overcome as each family, dealing with a dying family member in an ICU, likely has never experienced a similar situation. Based on the current top five obstacles, recommendations for possible areas of focus may include (1) improved nursing assessment regarding the health literacy of families followed with directed, appropriate, and specific EOL information, (2) improved care coordination between physicians and other health care providers to facilitate sharing care plans, (3) advanced directives that are followed as written by patients, (4) designated family contact communicating with family and friends regarding patient information, and, finally, (5) earlier, transparent discussions of patient prognoses as disease processes advance and patient conditions deteriorate.

La Belgique et la France ont notamment intégré en 2002 dans leurs systèmes législatifs respectifs une loi consacrée aux droits des patients qui met au centre du système de santé le patient et le devoir de respecter son autonomie. Partant de l’idée selon laquelle les concepts et principes ne peuvent être pensés indépendamment de la manière dont ils sont susceptibles de s’articuler au sein de la « vie ordinaire », j’ai adopté une démarche de philosophie empirique impliquant un terrain d’enquête au sein de laquelle j’ai choisi d’explorer une situation que l’on peut qualifier de limite, en portant mon attention sur la question du consentement aux soins des patients atteints de la maladie d’Alzheimer hospitalisés en gériatrie pour un événement de santé aigu. En effet, la maladie d’Alzheimer implique une diminution des capacités (notamment cognitives) des personnes qui en sont affectées, mettant ainsi l’autonomie du sujet à l’épreuve. Les spécificités liées à cette maladie, doublées du caractère aigu de la prise en charge des personnes qui en sont affectées, font de ce contexte un terrain extrêmement fécond pour examiner les significations et les limites de ce principe tel qu’il est actuellement valorisé dans le domaine des soins de santé. La réflexion proposée dans le cadre de cette thèse s’est ainsi élaborée autour d’éléments recueillis lors d’une enquête de terrain comparative (comprenant différents sites hospitaliers belges et français) spécifiquement mise en place pour les besoins de ce travail. Cette enquête s’est concentrée sur la relation entre les patients et les « soignants de proximité » (infirmières et aides-soignantes), étant donné que c’est dans le cadre de cette relation que la question de la capacité d’autonomie du sujet atteint de la maladie d’Alzheimer émerge principalement en contexte de soin à l’hôpital. En outre, cette enquête s’est en grande partie intéressée à la problématique du refus de soin des patients, ainsi qu’à celle du recours à la contrainte. En effet, c’est essentiellement dans ce type de situations que la question du respect de l’autonomie des patients et du recueil de leur consentement se pose avec le plus d’acuité dans le secteur qui nous occupe. La mise en place de ce terrain d’enquête doit être comprise comme un outil méthodologique et épistémologique ayant pour objectif de nourrir la réflexion conceptuelle, critique et normative liée à la problématique du respect de l’autonomie des patients atteints de la maladie d’Alzheimer. L’ensemble de ce travail m’a permis de développer une nouvelle conception de l’autonomie qui se distingue des réponses les plus fréquemment proposées au sein de la littérature médicale, juridique et philosophique. L’idée principale défendue ici consiste à penser que le problème relatif à la question du respect de la capacité d’autonomie des patients atteints de la maladie d’Alzheimer ne réside pas tant au niveau de la capacité propre des personnes, mais qu’elle dépend avant tout de ce que je présente comme un geste d’octroi, résultant d’un processus de co-construction collectif des professionnels de santé, marqués par des affects et des motivations qui leur sont propres / In 2002, Belgium and France implemented a law that places patients and their right to autonomy at the center of the healthcare system. Based on the assumption that concepts and principles cannot be perceived independently of the way they are likely to be implemented in “ordinary life”, I applied an empirical-philosophical approach to the research field by choosing to examine what can be described as a borderline situation, bringing my attention to the issue of consent to medical care of patients with Alzheimer’s disease hospitalized in geriatric units for an acute health issue. Indeed, Alzheimer’s disease involves a decline of the patient’s abilities (including cognitive skills), thereby jeopardizing his autonomy. The specific characteristics of the disease coupled with the acute medical care it requires single it out as the perfect ground to question the meaning and limitations of the principle and its current use in the healthcare system. The reflection proposed in this thesis is based on information gathered during a comparative field study (including various Belgian and French hospital sites) specifically set up for the purpose of this work. The research focused on the relationship between the patients and the “immediate caregivers” (nursing staff), where the capacity of autonomy of Alzheimer patients in a hospital setting is most frequently questioned. Moreover, the present study largely dealt with the issue of treatment refusal by patients as well as the use of coercion. It is indeed mainly in this type of situation that the problem of respecting patient’s autonomy and obtaining their consent is most vividly debated in the present field of study. The introduction of this research field must be seen as a methodological and epistemological tool that aims at providing further conceptual, critical and normative inputs to the issue of respect of autonomy for patients suffering from Alzheimer’s disease. This work allowed me to develop a new understanding of autonomy, which differs from the most frequently proposed responses that are to be found in medical, legal and philosophical literature. The main advocated idea here is that the question of respect of autonomy for Alzheimer patients does not lie so much in the person’s own capacity, but actually depends on what I consider a granting gesture that results from a collective construction process of health professionals, biased by their own affects and motivations

An algebra $A$ over a field $\K$ is said to be \textit{invertible} if it has a basis $\B$ consisting only of of units; if $\B^{-1}$ is again a basis, $A$ is \textit{invertible-2}, or \textit{I2}. The question of when an invertible algebra is necessarily I2 arises naturally. The study of these algebras was recently initiated by Lòpez-Permouth, Moore, Szabo, Pilewski \cite{lopezIJM}, \cite{lopez1}. In this work, we prove several positive results on this problem, answering also some questions and generalizing a few results from these papers. We show that every field is an I2 algebra over any subfield, and that any subalgebra of the rational functions field $K(x)$ that strictly contains $K[x]$, with $K$ an algebraically closed field, has a symmetric basis $\B=\B^{-1}$. Using this, we expand the class of examples of algebras known to be invertible or I2 with several classes, such as semiprimary rings over fields $K\neq \F_2$ satisfying some additional mild conditions. We also show that every commutative, finitely generated, invertible algebra without zero divisors is almost I2 in the sense that it becomes I2 after localization at a single element.

Accurate risk assessment tools and methods are necessary to understand the relationship between occupational exposure to physical risk factors and musculoskeletal disorders. Ergonomists typically consider direct measurement methods to be the most objective and accurate of the available tools. However, direct measurement methods are often not used due to cost, practicality, and worker/workplace disruption. Inertial measurement units (IMUs), a relatively new direct measurement technology used to assess worker kinematics, are attractive to ergonomists due to their small size, low cost, and ability to reliably capture information across full working shifts. IMUs are often touted as a field-capable alternative to optical motion capture systems (OMCs). The error magnitudes of IMUs, however, can vary significantly (>15°) both within and across studies. The overall goals of this thesis were to (i) provide knowledge about the capabilities and limitations of IMUs in order to explain the inconsistencies observed in previous studies that assessed IMU accuracy, and (ii) provide guidance for the ergonomics community to leverage this technology. All three studies in this dissertation systematically evaluated IMUs using a repetitive material transfer task performed by thirteen participants with varying movement speeds (15, 30, 45 cycles/minute) and magnetic disturbance (absent, present). An OMC system was used as the reference device. This first study systematically evaluated the effects of motion speed and magnetic disturbance on the spatial orientation accuracy of an inertial measurement unit (IMU) worn on the hand. Root-mean-square differences (RMSD) exceeded 20° when inclination measurements (pitch and roll) were calculated using the IMU’s accelerometer. A linear Kalman filter and a proprietary, embedded Kalman filter reduced inclination RMSD to < 3° across all movement speeds. The RMSD in the heading direction (i.e., about gravity) increased (from < 5° to 17°) under magnetic disturbance. The linear Kalman filter and the embedded Kalman filter reduced heading RMSD to < 12° and < 7°, respectively. This study indicated that the use of IMUs and Kalman filters can improve inclinometer measurement accuracy. However, magnetic disturbances continue to limit the accuracy of three-dimensional IMU motion capture. The goal of the second study was to understand the capability of IMU inclinometers to improve estimates of angular displacements and velocities of the upper arm. RMSD and peak displacement error exceeded 11° and 28° at the fastest transfer rate (45 cycles/min) when upper arm elevation was calculated using the IMU accelerometer. The implementation of a Kalman filter reduced RMS and peak errors to < 1.5° and < 2.3°, respectively. Similarly, the RMS and peak error for accelerometer-derived velocities exceeded 81°/s and 221.3°/s, respectively, at the fastest transfer rate. The Kalman filter reduced RMS and peak errors to < 9.2°/s and < 25.1°/s, respectively. The third study was conducted to evaluate the relationship between magnetic field strength variation and magnetic heading deviation. In this study, the presence of the metal plate increased magnetic heading deviations from < 12° (90th-10th percentile) to approximately 30°. As expected, the magnetic field strength standard deviation increased from 1.0uT to 2.4uT. While this relationship may differ across other sources of magnetic disturbance, the results reinforce the notion that local magnetic field disturbances should be minimized when using IMUs for human motion capture. Overall, the findings from this thesis contribute to the ergonomics community’s understanding of the current capabilities and limitations of IMUs. These studies suggest that while the touted capabilities of the IMUs (full-body motion capture in workplace settings) may be unattainable based on current sensor technology, these sensors are still significantly more accurate than the accelerometer-based inclinometers commonly used by ergonomists to measure motions of the upper arms.

The purpose of this study was to determine the accuracy of mapping of pachic and cumulic soils in Cache County. The soil maps that were used for this study as the basemap were the Atlas sheets of the published soil survey of Cache County. Five map units from Mendou, Nebeker, Avon, Hendricks and Winn which include almost 52 percent of the pachic and cumulic soils in the survey area were selected for this study. These five soils cover large areas when compared to other soil series and they are distributed throughout the county. All these map units were recognized as pachic and cumulic in the published soil survey report. The thickness of the epipedon was therefore selected as the principal criterion for determining the accuracy of the map units. About 400 samples from the major delineations were studied in the field and the necessary data were collected and interpreted statistically in order to find: (1) the accuracy of each map unit, (2) the inclusions, misclassified and not classified pedons and their proportions, and (3) the estimated thickness of the epipedons. Attempts were made to select the pedons on transects with appropriate interval, depending on landforms and continuity of soils. Statistical interpretations were conducted by using the chi-square method. The results for each map units are as follows: for Mendon map unit (MeA) 42-56 percent and for Hendricks map unit (HdD) only 30-60 percent of the samples have characteristics required for the named soil in these map units. These values are less than 75 percent which is the critical value for the map units by definition. It is concluded therefore that with the available data the Mendon and Hendricks series have been mapped incorrectly. For Nebeker map unit (NbE) 77-93 percent and from Avon map unit (ArA) 85-99 percent of the samples have the characteristics required for the named soil in the map units. These values are more than the critical value (75) so it is concluded that with available data the Nebeker and Avon series have been mapped correctly. For Winn map unit (Wn) 54-82 percent of the samples have the required characteristics of this series. The statistical analysis did not reveal strictly whether the pedons are mapped correctly or not and additional samples are required to adequately test the accuracy of the Winn map unit. It is concluded that in Cache County the influence of different geologic depositions and variations in topography are two major factors responsible for poor accuracy in mapping the Mendon and Hendricks series.

Fault location reveals the exact information needed for utility crews to timely and promptly perform maintenance and system restoration. Therefore, accurate fault location is a key function in reducing outage time and enhancing power system reliability. Modern power systems are witnessing a trend of integrating more distributed generations (DG) into the grid. DG power outputs may be intermittent and can no longer be treated as constants in fault location method development. DG modeling is also difficult for fault location purpose. Moreover, most existing fault location methods are not applicable to simultaneous faults. To solve the challenges, this dissertation proposes three impedance-based fault location algorithms to pinpoint simultaneous faults for power transmission systems and distribution systems with high penetration of DGs. The proposed fault location algorithms utilize the voltage and/or current phasors that are captured by phasor measurement units. Bus impedance matrix technique is harnessed to establish the relationship between the measurements and unknown simultaneous fault locations. The distinct features of the proposed algorithms are that no fault types and fault resistances are needed to determine the fault locations. In particular, Type I and Type III algorithms do not need the information of source impedances and prefault measurements to locate the faults. Moreover, the effects of shunt capacitance are fully considered to improve fault location accuracy. The proposed algorithms for distribution systems are validated by evaluation studies using Matlab and Simulink SimPowerSystems on a 21 bus distribution system and the modified IEEE 34 node test system. Type II fault location algorithm for transmission systems is applicable to untransposed lines and is validated by simulation studies using EMTP on a 27 bus transmission system. Fault area identification method is proposed to reduce the number of line segments to be examined for fault location. In addition, an optimal fault location method that can identify possible bad measurement is proposed for enhanced fault location estimate. Evaluation studies show that the optimal fault location method is accurate and effective. The proposed algorithms can be integrated into the existing energy management system for enhanced fault management capability for power systems.

Learning English as a second language is a key factor to promote globalization, because the language has spread widely. Furthermore, learning English vocabulary for the fast-paced global business environment is highly dependent on the imagined future of a business major; he or she must imagine in what context the business career will take place: what sphere of activity will be involved, in which scenarios of language usage, and what lexical items will be needed. Vocabulary learning has long been characterized by the use of decontextualized vocabulary academic word lists. As an alternative, this project researches the use of an integrated language thematic mode--the theme being business communication-with a focus on incorporating various linguistics aspects of learning English. This research will emphasize the integrated linguistics approach to the acquisition of academic vocabulary. Additionally, the project explores the use of an individual’s imagined community in setting vocabulary goals and second-language-acquisition strategies. The study took place at the English Language Program and College of Business and Public Administration (CBPA) at California State University, San Bernardino in the spring of 2016. International students were asked to participate in a survey; an interview questionnaire was designed to discover the students’ preferences strategies and in learning English with respect to their future career. The results varied based on students’ backgrounds, their specific majors, and their personalities and preferred ways of learning.

Energy efficient houses benefit communities not only to provide renewable energy shares and generating surplus electricity supporting local economic development. Also, residents in energy efficient houses have less energy usage that reduces household budget expenses. However, one of the obstacles of energy efficient technology installment of residential buildings is high investment cost, which can be solved with the usage of modular housing. In Europe, housing costs have a large share, especially for Sweden, housing expenses is a burden mostly for people who are at the risk of poverty. Also, high investment costs of energy efficient housing are combined with high construction prices leading a large share of budgets and effort to make houses affordable for low income groups. This study develops a scenario to find solutions for affordable housing problem in Sweden with a design proposal. The aim of this study is to investigate if there are ways of achieving socio-economic mix by the production of energy efficient affordable housing and urban gardening to develop a strategy for resource efficiency in Jakobsgårdarna. To achieve the aim, energy efficient affordable housing designed as modular units to achieve a local economic development. This study uses a design-based research method consisting of learning from background cases to transfer lesson learned in design phase of the sustainable neighborhood consisting of energy efficient technologies. Background cases were analyzed with literature review to define sustainable neighborhood, which was then used to develop a hypothesis. Findings of this thesis generates definition of sustainability tools consisting of a collaborative ownership; designing common kitchens; producing electricity and biogas from renewable energy sources; practicing urban agriculture; managing waste and storm and methods to cross subsidize energy efficient affordable housing production. The outcome of this research provides a sustainable neighborhood design proposal for Jacobsgårdarna, Borlänge.

Because of the rapid advancements being made in the field of knowledge, educators, as well as those in other fields, must periodically take inventory. Current practices, policies, and methods must be carefully scrutinized to determine if they are the most effective. The group or class method of instruction is one such area. The current philosophy of education held in many parts of the United States today places a great deal of importance upon the individual child. Numerous programs have been inaugurated to give the individual child as much attention as possible and still be able to have a class large enough to be practical financially. This task becomes increasingly difficult when the range of abilities within each classroom is so great. It isn't uncommon in the upper elementary and secondary classes to find a spread of from six to nine years difference in ability or achievement within one classroom. Not only do we have the problem of range within the classroom, but with the increasing school population of today, classes have grown to a prohibitive size. Add these and other problems that stem from the pressures of present day society together, and even with the best possible teacher, we get only average results.

This study integrated remotely sensed data, geographic information system (GIS), and classification tree-based modeling to delineate ecological units for the Ashley National Forest. Data points , provided by the Ashley National Forest, with a known location and dominant vegetation type, were related to data layers that were determined to be helpful in a landtype classification. These layers included elevation, slope, aspect, potential solar irradiation, precipitation, geology, basins, Landsat thematic mapper (TM) bands 3, 4, 5, and 6, and basic land cover. These points, with their related information, were then used to train the tree-based model for landtype classification. This resulted in a set of rules, in the form of a binary decision tree, that could be applied to the entire study area. After the landtype classification was obtained, it was cross-classified with geology to produce a landtype association layer. This resulting data layer was compared to an existing landtype association map and it was determined, by cross-tabulation, that the two classifications identified many of the same patterns.