A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Science in Medicine in Emergency Medicine. Johannesburg, 2015 / Aim: To determine any association between the lunar synodic or anomalistic months and the nature and volume of emergency department patient consultations and hospital admissions from the emergency department (ED). Design: A retrospective, descriptive study. Setting: All South African EDs of a private hospital group. Patients: All patients consulted from 01 January 2005 to 31 December 2010. Methods: Data was extracted from monthly records and statistically evaluated, controlling for calendric variables. Lunar variables were modelled with volumes of differing priority of hospital admissions and consultation categories including; trauma, medical, paediatric, work injuries, obstetrics and gynaecology, intentional self harm, sexual assault, dog bites and total ED consultations. Main Results: No significant differences were found in all anomalistic and most synodic models with the consultation categories. Small but significant increases were found with a small number of synodic models around full moon with some categories, P2 medical, total paediatric consultations and total admissions. Significant decreases in admissions, particulary total admissions, were found around perigee. The effect sizes of all significant lunar associations were smaller than those of the calendric variables. Conclusions: Most comparisons demonstrated no lunar association. Small but significant associations were demonstrated around full moon with some synodic models. A number of anomalistic admission models demonstrated small but significant decreases in admissions at perigee.

Thesis (M.Fam. Med.)--University of the Witwatersrand, Faculty of Health Sciences, 2013.

A research report presented to the Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand In partial fulfilment of the degree Master of Science in Medicine (Emergency Medicine) / Background: Private health care emergency departments (EDs) are vital components of health care systems and have become increasingly popular due to their accessibility, convenience and proficiency. This popularity has led to overcrowding which in turn has led to increased patient waiting times. Lengthy waiting times have been shown to be a common cause of patient dissatisfaction. Patients, however, often overestimate the passage of time which results in unwarranted dissatisfaction. Study objectives: The purpose of this study was to establish the actual waiting times experienced by patients from the time of triage to first doctor contact at the Dogwood Hospital Emergency Department. Design: A retrospective cross-sectional descriptive study was undertaken at the Dogwood Hospital Emergency Department from 1 st January 2009 to the 30th August 2009. All patients (adults and children) of all priority who sought medical attention at the Dogwood Hospital ED were included in the study. Main Results: Priority 3 patients waited the longest out of all patients, particularly on weekday mornings. Overall this study revealed that for 70% of patients the triage-to-doctor waiting time was less than 1 hour. Almost 24% of patients waited between one and two hours and about six percent waited more than two hours. Conclusions: Most patients in this study were seen by a doctor within the target times set by the South African Triage Group (SATG). Numerous studies suggest that patients believe that the acceptable triage-to-doctor waiting time is approximately one hour. In this study 30% of patients waited longer than one hour.

The number of devices connected to the Internet will increase exponentially by 2020, which is smoothly migrating the Internet from an Internet of people towards an Internet of Things (IoT). These devices can communicate with each other and exchange information forming a wide Wireless Sensor Network (WSN). WSNs are composed mainly of a large number of small devices that run on batteries, which makes the energy limited. Therefore, it is essential to use an energy efficient routing protocol for WSNs that are scalable and robust in terms of energy consumption and lifetime. Using routing protocols that are based on clustering can be used to solve energy problems. Cluster-based routing protocols provide an efficient approach to reduce the energy consumption of sensor nodes and maximize the network lifetime of WSNs. In this thesis, a single hop cluster-based network layer routing protocol, referred to as HRHP, is designed. It applies centralized and deterministic approaches for the selection of cluster heads, in relation to offer an improved network lifetime for large-scaled and dense WSN deployments. The deterministic approach for selecting CHs is based on the positive selection mechanism in the human thymus cells (T-cells). HRHP was tested over six different scenarios with BS position outer the sensing area, it achieved a maximum average of 78% in terms of life time. To further reduce energy consumption in WSN, a multi-hop algorithm, referred to as MLHP, is proposed for prolonging the lifetime of WSN. In this algorithm, the sensing area is divided into three levels to reduce the communication cost by reducing the transmission distances for both inter-cluster and intra-cluster communication. MLHP was tested over fourteen cases with different heterogeneity factors and area sizes and achieved a maximum of 80% improvement in terms of life time. Finally, a real-time and autonomous emergency evacuation approach is proposed, referred to as ARTC-WSN, which integrates cloud computing with WSN in order to improve evacuation accuracy and efficiency for smart buildings. The approach is designed to perform localized, autonomous navigation by calculating the best evacuation paths in a distributed manner using two types of sensor nodes (SNs), a sensing node and a decision node. ARTC-WSN was tested in five scenarios with different hazard intensity, occupation ratio and exit availability over three different areas of evacuation and achieved an average of 98% survival ratio for different cases.

Thesis (M. Med. (Family Medicine)) -- University of Limpopo (Medunsa Campus), 2010. / Title: Waiting time of patients who present at Saint Rita’s hospital Emergency Department (ED), Limpopo province, South Africa. Objective: To determine the waiting time for stable patients who present at Saint Rita’s hospital ED, to determine where the longest time is spent by patients in ED and to identify the area of inefficient patients flow. Methods: A descriptive cross-sectional study was conducted in the ED of Saint Rita’s Regional hospital in the province of Limpopo, South Africa. During a one week period, Monday to Friday in July 2010, a daily random sample of 30 patients was monitored. The time In and Out of each step in the process of care was recorded. Waiting time was defined as the time from arrival of the patient in the ED until the start of the consultation by the Medical Officer. Time elapsed was calculated for various steps in care. Demographic data, diagnosis and acuity based on the SATS were obtained from patient’s record. Data capturing was done in window excel and data analysis done using the statistical software SPSS 17. Results: The mean waiting time for stable patients was 252.3 minutes. The mean EDLOS was 360 minutes for stable patients. Result show that 80% of patient attending Saint Rita’s ED are non-urgent (SATS: Green) cases. There was fluctuation of waiting times from Monday to Friday; with Monday having the longest waiting time and Tuesday the shortest waiting time. The waiting time for unstable patients (SATS: Red or Orange) is Zero minute. Patients spent the longest time waiting for registration (60 minutes) and for triage (57 min waiting for vitals and 28 minutes waiting for history taking). Interestingly the extremity of age: the youngest and oldest had lowest waiting time in ED. Areas of inefficient patient flow were registration and triage. Conclusion: This study has determined the waiting time for stable patients attending Saint Rita’s Regional Hospital ED. It has shown that waiting time in ED fluctuates with the day of the week. It has also shown that waiting time in ED varies with age of the patient and volume of patients in ED. Registration and triage have been identified as areas of inefficiency patients flow and recommendations for improvement have been formulated. Sustainability of the performance requires regular follow up from the hospital management.

This thesis has several aims. The first was to identify how practicing emergency nurses developed themselves personally in educationally in preparation for triage practice. The second was to develop a triage educational program to prepare emergency nurses in triage practice. The third was to evaluate the effectiveness of the triage educational program in increasing participant’s triage knowledge, and the fourth was to develop triage standards for triage education and practice. The research programme was conducted in three stages. The first stage consisted of the development, distribution, analysis and evaluation of a needs analysis questionnaire designed to determine the issues related to a triage education. The second stage of the research applied the needs analysis findings to the development of a 40 hour Triage Educational Program. Stage three added a qualitative dimension to the thesis. The evaluative results supported the quantitative results obtained in the two preceding studies. The Triage Educational Program was not only an effective triage education resource but in addition it was evaluated as effective regardless of one’s previous experience level of triage expertise. / Doctor of Philosophy (PhD)

Thesis (D.P.A.)--University of Illinois at Springfield, 2006. / Vita: leaves 169-171. Includes bibliographical references (leaves 89-96).

Vår målsättning med detta examensarbete var att ta fram en nödbogseringsmanual till skolfartyget Calmare Nyckel. Denna skulle vara helt i enlighet med de regler och riktlinjer som fanns tillgängliga och underlätta beslutsfattandet för besättningen i situationer som kräver nödbogsering. Projektbeställare var Bengt Karlsson, befälhavare på Calmare Nyckel, och efter ett inledande möte sattes arbetet i gång då i form av ett projektarbete inom ramen för examensarbete. Vi har baserat manualen på i första hand aktuell lagstiftning och riktlinjer men också på andra fartygs nödbogseringsmanualer vi bedömde som bra.Arbetet förflöt enligt utsatt tidsplan och det slutgiltiga resultatet blev väl utfört enligt oss och projektbeställaren.Calmare Nyckel är nu utrustad med en fullt fungerande nödbogseringsmanual som vi med säkerhet kan säga uppfyller alla tillämpliga krav som ställs på en sådan. Vår förhoppning är att manualen aldrig kommer att behöva användas i skarpt läge, men däremot regelbundet fungera som underlag i övnings- och utbildningssyfte. / Our goal has been to develop an Emergency Towing Manual for the scholar ship M/S Calmare Nyckel. It would be in line with present rules and conventions and facilitate decision-making in situations requiring emergency towing. Our project client is Bengt Carlsson, Master on the Calmare Nyckel, and after intitial talks the work was set in motion taking form of a project.The Emergency Towing Manual is foremost based upon present legislation and guidelines but also on other ships ETM:s, which we have found succesfull.The project was carried out within our schedule and the resulting manual was well appreciated by us and the project client.M/S Calmare Nyckel is now equipped with a fully functioning Emergency Towing Manual which meets all applicable demands. Our hope is that the manual will never have to be used during real emergencies – however, regularly refered to in exercises as part of the onboard emergency prepardness.

Every time emergency responders respond to an incident, they enter an ambiguous situation that is an ill-defined problem space. As the responders engage with the incident, they discover, piece by piece, the unique interlocking problems and act quickly to put form and structure onto the potential solution. In order to quickly, effectively, and safely resolve an incident, emergency responders must have depth and breadth of knowledge across responder disciplines and domains. This knowledge is acquired through both formal training courses and informal training in the station house. The ability to quickly assess a situation, accurately identify the elements as they emerge and their significance, then decide on a course of action combining a variety of domains and skill sets speaks to the creative nature of emergency responders. This study uses naturalistic inquiry to explore what it is like to be an emergency responder, describe how creativity manifests itself in a field environment, and discuss what emergency responders want in their training. This study found that being an emergency responder is emotional, exciting, stressful, challenging, full of the unexpected, and rewarding. During an incident, emergency responders are dealing with the complex interactions of various emotions while resolving difficult and often sad situations. Being an emergency responder is synonymous with being a good problem solver; they are also highly emotionally resilient. The process of creativity within an emergency response environment is seen through preparation that is, training. The consistent review and development of skills makes the skills automatic. Responders also cross-train and, often, an individual responder will have expertise in multiple areas. The improvisational skills of emergency responders to events which are often emergent and creative in their own right, demonstrate a depth of creative force through the handling of complex, high-risk situations with persistence, endurance, and determination. Finally, this study found that emergency responders are passionate about their training. They know that what they learn and practice during training evolutions forms the foundation of their professionalism, provides opportunities to learn new skills or hone already established skills, reinforces safety considerations, and will save their lives and the lives of other people.

Thesis--PlanB (M.S.)--University of Wisconsin--Stout, 2002. / Includes bibliographical references.