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published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

No description available.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Masters of Science in Physiotherapy. Johannesburg 2017 / Background: There is limited research available on the use of outcome measures in intensive care units (ICU) in a South African setting.The Chelsea Critical Care Physical Assessment tool (CPAx) is a measure of morbidity related to physical function and assesses respiratory function and functional abilities of critically ill patients. Objectives: The objectives of this study were to establish the effect of the use of the CPAx tool on ICU and hospital length of stay (LOS) in the care of critically ill patients; to establish the usefulness of the CPAx tool according to patient admission diagnosis; to determine if a relationship exists between CPAx scores and severity of illness or general morbidity during ICU admission; and to establish physiotherapists’ perceptions and views towards the use of the CPAx tool in their daily clinical practice in ICU. Design: The study consisted of two parts. Part one was a quasi-experimental design with a historical matched control group. Part two was a survey-based design. Methods: The study took place in a South African public sector hospital. Twenty six participants each were recruited into the experimental and control groups. Participants from the control group were matched with participants in the experimental group according to age, gender, diagnosis and acute physiology and chronic health evaluation (APACHE) II scores. CPAx scores and sequential organ failure assessment (SOFA) scores were calculated for participants in the experimental group on alternate weekdays during their ICU stay. Comparisons of ICU and hospital LOS between the study participants and historical control group were done using an independent t-test. Pearson’s correlation coefficient was used to determine if a relationship existed between CPAx scores, APACHE II scores or SOFA scores. A p-value ≤ 0.05 was deemed statistically significant. A questionnaire was developed and was completed by the research assistants who administered the CPAx tool to participants in the experimental group in order to determine their perceptions of the tool. Results: The mean age for the CPAx group was 37.88 (±13.37) years and for the control group was 37.81 (±12.21) years. The CPAx group consisted of 14 (53.8%) participants who underwent surgical procedures and 12 (46.2%) participants with traumatic orthopaedic injuries. The control group consisted of 14 (53.8%) participants who underwent surgical procedures and 12 (46.2%) participants with traumatic orthopaedic injuries. The mean initial SOFA score for the CPAx group was 2.42 (±1.79) and for the control group was 4.15 (±2.6). A p=0.03 indicates that there was a statistically significant difference between the two groups with regards to initial SOFA scores. The mean SOFA score at ICU discharge for the CPAx group was 1.80 (±0.42) and for the control group was 2.87 (±1.81). A p=0.05 indicates that there was a statistically significant difference between the two groups with regards to SOFA scores at ICU discharge. The mean initial CPAx score for the experimental group was 29.73 points (±14.81) and the mean CPAx score at ICU discharge was 36.15 (±8.33). The mean CPAx scores changed by 9.45 points between admission and discharge from ICU for participants who underwent surgical procedures and the mean CPAx scores changed by 3.9 points between admission and discharge from ICU for participants who sustained traumatic orthopaedic injuries. The mean ICU LOS for the CPAx group was 5.84 days (±7.43) and for the control group was 4.56 days (±5.25). The mean hospital LOS for the CPAx group was 17.43 (±16.68) days and for the control group was 19.31 days (±15.79); however, in both cases differences were not statistically significant. APACHE II scores had a very weak negative correlation with initial CPAx scores. APACHE II scores had a very weak positive correlation with CPAx scores at ICU discharge. There was a statistically significant difference between the two groups with regards to initial SOFA scores (p=0.05). Initial SOFA scores had a statistically significant moderate negative correlation with initial CPAx scores (r=-0.45, p=0.02). Initial SOFA scores had a weak negative correlation with CPAx scores at ICU discharge. Initial CPAx scores had a moderate positive correlation with SOFA scores at ICU discharge. CPAx scores at ICU discharge had a very strong statistically significant positive correlation with SOFA scores at ICU discharge (r=0.80, p=0.05).The CPAx tool proved to be more responsive in a surgical population than in a trauma population. Clinicians had positive perceptions of the CPAx tool in the management of critically ill patients. Discussion: Participants in the CPAx group were well matched with those in the historical control group with regards to age, gender, diagnoses and severity of illness. Those in the CPAx group had lower extent of organ dysfunction than those in the control group which might account for their shorter period of hospitalisation. Patients with a higher risk for mortality on admission into the ICU displayed lower functional abilities and, in turn, lower CPAx scores were measured. A greater change in CPAx scores was observed for participants recovering from surgical interventions compared to those recovering from traumatic orthopaedic injuries. Participants with low morbidity at the time of ICU admission seemed to have a greater ability to perform functional activities during their ICU stay. Limitations of the study included a small patient sample, a limited number of research assistants as well as lack of content validation of the questionnaire used. A multi-centre trial on the use of CPAx in ICU patient management could yield a wider perception of physiotherapists regarding the usefulness of the tool in daily clinical practice. Measuring the effect of the CPAx tool on participants’ length of mechanical ventilation could also be an interesting clinical outcome to consider. Conclusion: The data presented in this study show that the use of the CPAx tool does not have an influence on ICU and hospital LOS in a small sample of surgical and trauma participants. The tool appears to be more useful when used in the care of patients who are recovering from surgical procedures rather than those who sustained complex traumatic injuries. Physiotherapy clinicians that participated in the study supported the use of the CPAx tool in this single-centre trial and generally had positive perceptions towards the use of the tool. / MT2017

The use of neural networks in the field of development geology is in its infancy. In this study, a neural network will be used to identify flow units in Happy Spraberry Field, Garza County, Texas. A flow unit is the mappable portion of the total reservoir within which geological and petrophysical properties that affect the flow of fluids are consistent and predictably different from the properties of other reservoir rock volumes (Ebanks, 1987). Ahr and Hammel (1999) further state a highly "ranked" flow unit (i.e. a good flow unit) would have the highest combined values of porosity and permeability with the least resistance to fluid flow. A flow unit may also include nonreservoir features such as shales and cemented layers where combined porosity-permeability values are lower and resistance to fluid flow much higher (i.e. a poor flow unit) (Ebanks, 1987). Production from Happy Spraberry Field primarily comes from a 100 foot interval of grainstones and packstones, Leonardian in age, at an average depth of 4,900 feet. Happy Spraberry Field is unlike most fields in that the majority of the wells have been cored in the zone of interest. This fact more easily lends the Happy Spraberry Field to a study involving neural networks. A neural network model was developed using a data set of 409 points where X and Y location, depth, gamma ray, deep resistivity, density porosity, neutron porosity, lab porosity, lab permeability and electrofacies were known throughout Happy Spraberry Field. The model contained a training data set of 205 cases, a verification data set of 102 cases and a testing data set of 102 cases. Ultimately two neural network models were created to identify electrofacies and reservoir quality (i.e. flow units). The neural networks were able to outperform linear methods and have a correct classification rate of 0.87 for electrofacies identification and 0.75 for reservoir quality identification.

Thesis PlanA (M.S.)--University of Wisconsin--Stout, 2009. / Includes bibliographical references.

The purpose of this study was to determine whether ischemia would enhance muscle spindle responses to tendon tap and vibration during submaximal fatiguing contractions in the soleus muscle of able-bodied individuals. Nine healthy adults attended two experimental sessions approximately 48 hours apart. Both sessions were identical except that the fatigue task in one was performed with a pressure cuff placed above the knee and inflated to 180 mm Hg. Three 5s maximum voluntary contractions (MVCs) were performed prior to and after the fatigue task. Each participant held a target force of 20% MVC until endurance time (peak-to-peak tremor amplitude exceeded 5% MVC or target force dropped by 2% for 3s). Muscle spindle responses were evaluated using the peak-to-peak EMG amplitude of tendon taps (delivered by a custom-made tapper) and the Motor Unit Firing Rates (MUFR) during 15 s of vibration, recorded with fine-wire intramuscular electrodes. H reflex responses were measured before and after fatigue for each condition, to measure the net excitability of the spinal cord. There were no significant differences (p>0.05) in the P-P EMG of tendon taps or the MUFR across any conditions. The post-fatigue Maximal Voluntary Contraction forces were measured and were less than the pre-fatigue values under both conditions (and significantly different in the non-ischemic condition (p=0.01)). Absence of significant differences in the Hmax:Mmax ratios (p=0.94 in non-ischemic/fatigue and p=0.43 in ischemic condition) indicated that the spinal excitability was relatively unchanged across the conditions. Therefore, we could not conclude that ischemia enhanced the muscle spindle response. / text

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