Abstract Magnetic resonance imaging (MRI) has excellent soft tissue contrast, which can be enhanced by different contrast agents, multiplanar imaging capability and high temporal and spatial resolution. Even blood vessels can be easily visualised, and MRI parameters are sensitive to temperature. Therefore, MRI has the greatest potential for guiding and monitoring interventional and surgical procedures. The aim of this study was to design and evaluate new solutions for MR-guided procedures and surgery, to develop the technique and to assess the feasibility of MR-guided nerve root infiltration, bone biopsy and sacroiliac (SI) joint arthrography. The possibilities for versatile use of MR scanners were studied with a setup where an MR scanner with a 0,23 T open magnet was installed in a full-scale operating room (OR) to allow diagnostic MRI examinations, research, radiological interventions and neurosurgical operations to be performed in the same facility. All of the 144 MR-guided radiological interventions and neurosurgical operations performed in Oulu University Hospital between February 1999 and September 2000 were included in the study. The studied setup was a functionally feasible solution for combined neurosurgical and radiological use. To further improve MR-guided interventions, a new user interface was developed and preliminary tested with simulated clinical experiments. The new user interface seemed to be easily adobted by radiologists for interventional procedures. MR-guided nerve root infiltrations were studied by using MRI guidance on 34 consequent patients referred for first sacral root infiltration. Needle placement into the first sacral nerve root sheath was successful in 34 of the 35 (97%) cases, and the average duration of the procedure was 32 minutes. Bone biopsies were performed using a bone biopsy set designed in our institution to be connected to an optical tracking system. The feasibility of this new guiding system was evaluated with biopsies from five different anatomical areas. The bone biopsy system was successfully applied to all patients and provided a safe and accurate guidance method for all phases of the procedure. Twenty patients with low back pain suspected to arise from the SI joint underwent MR-guided SI joint arthrography. The procedure was successfully performed in all cases. The needle guiding with optical tracking inside the soft tissues proved to be accurate enough for successful procedures. In conclusion, versatile use of MR scanners for diagnostic imaging, radiological procedures and neurosurgery is feasible if planned properly. The prototype of a new user interface for MR-guided procedures allows radiologist to fully control the MR-scanner during the procedure. MRI is a suitable and accurate guidance method for musculoskeletal interventions.

The diploma thesis is divided into two parts. The first part deals with problems of development projects, individual phases of the project and their risks. It also describes different ways of financing and examines indicators for assessing the economic efficiency of investments. The second part is a feasibility study that solves a particular development project. The study is based on the theoretical part and examines the various options of the project solution - its financing, cash flow, economic indicators, schedule and budget of the project. The study defines the conditions under which the project is realizable. The data obtained from the feasibility study can therefore be used as a basis for a possible investment.

Please read the abstract in the section 00front of this document / Dissertation (MSc)--University of Pretoria, 2003. / Geology / Unrestricted

Background: Medication errors continue to be one of the most prevalent problems in healthcare related to patient safety, often resulting in injury or death, with higher incidences of error occurring with intravenous medications. The purpose of this study was to explore the use of deliberate practice (DP) with second-degree nursing students in developing and maintaining fundamental intravenous medication management practices required for safe practice. Method: This was a feasibility study using a two-arm, single-blind, randomized controlled trial design. Vygotsky’s Zone of Proximal Development model was used to explore the use of a DP teaching intervention to achieve competency in skills associated with safe IV medication management. A convenience sample of first-year, first-semester nursing students enrolled in an accelerated graduate program (N = 32) were invited to participate; 19 enrolled, and 12 completed the study. Students (n = 12) received three 30- minute one-on-one practice sessions at 2-week intervals with an expert nurse (the intervention group focused on IV skills and the control group on skills unrelated to IVs). Pre- and post-intervention instruments tested participants’ confidence with IV management and safety skills. The primary outcome was their ability to safely administer and monitor IV medications during a 20-minute videotaped medication administration scenario. Results: Low recruitment (19 of 32) and high attrition (37%) were observed. Participants completing the study (5 in the intervention group and 7 in the control group) reported that the time required to attend the sessions was not burdensome (91.7%); time allotted was adequate (100%); 100% reported positive experience; 91.7% found the DP sessions essential to learning. Change in confidence scores for IV skills were not significant (P = 0.210), but were higher in the intervention group (2.97–4.14 = 1.50 change) compared to the control group (2.71–3.77 = 1.04 change). Significant differences were found in overall medication administration skills between the control and intervention groups (t [-2.302], p = 0.044) in favor of the intervention group, particularly with medication preparation skills (p = 0.039). Overall raw scores were low in both groups; only 16–42 (26%–70%) of the total 60 steps required for safe practice were completed. Participants scored lowest in the evaluation phase, with all participants performing less than 50% of the 14 steps. Conclusion: Even though participant satisfaction was high, significant attrition occurred. Students reported the DP sessions to be beneficial and they felt more confident in performing skills, but three 30-minute sessions (90 minutes) were not adequate to develop, maintain, or refine all the IV-management skills associated with safe medication practices. Determining the length and duration of DP sessions as well as comparing the efficacy of DP sessions between individual and group sessions with varying doses and frequencies is needed to advance our understanding of using DP within nursing education.

Numerous studies in the hospitality field have focused on the importance of the convention industry to the economic well being of the local tourism industry. Because of intense competition between convention centers, destinations are practicing strategies of expanding their convention facilities and related infrastructure. Unfortunately, many of these expansions appear to have been based on feasibility studies that failed to present rigorous reviews and examinations regarding alleged claims of positive impacts and over-optimistic operational pro-forma statements. The main objective of this study is to propose an alternative framework for feasibility studies, which consists of an updated, rigorous methodology to calculate a more comprehensive picture, on what convention centers can deliver on public and private investment. Data from the Orange County Convention Center (OCCC) in Orlando, Florida were used for assessing this proposed framework.

Objectives: 1) To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety (PA) and its associated outcomes in children undergoing surgery; 2) To assess the psychometric properties of a new scale, the Children’s Perioperative Multidimensional Anxiety Scale (CPMAS); 3) To examine the feasibility and acceptability of a novel tablet-based intervention, Story-Telling Medicine (STM), for reducing children’s PA; 4) To examine the relation between temperament and PA in the surgical context. Methods: A systematic review of studies where the primary outcome was children’s PA was conducted (Study 1). A study of the reliability and validity of the CPMAS were assessed at preoperative assessment (T1), on the day of surgery (T2), and 1 month postoperatively (T3) was also undertaken (Study 2). The feasibility and acceptability of STM were then examined and compared its effect to Usual Care (UC) (Study 3). Finally, children’s temperament was examined using the Colorado Childhood Temperament Inventory at T1 along with the CPMAS assessed at T1 and T2 (Study 4). Results: Fourteen of the 18 studies led to reductions in children’s PA (Study 1). The CPMAS demonstrated good internal consistency, stability and convergent validity across all visits (Study 2). The participant recruitment and study procedures were shown to be feasible and children in the STM group demonstrated greater reductions in CPMAS compared to the UC group (Study 3). Shyness predicted lower PA at T1, while sociability predicted higher PA at T1 and T2 (Study 4). Conclusions: AV interventions appear useful but full-scale RCTs of these treatments are required to pinpoint those that are most effective. The CPMAS is a promising tool for evaluating children’s PA and preliminary evidence suggests that STM is a feasible intervention for reducing children's PA. Finally, our findings highlight the importance of considering individual differences in predicting anxiety in the surgical setting. / Thesis / Doctor of Philosophy (PhD) / Preoperative anxiety affects up to 5 million children in North America annually and is associated with many adverse psychological, behavioural, and health effects. These problems not only produce significant distress for children and families, but can have immediate and long-term effects on a child’s mental health and development. Current methods to reduce preoperative anxiety in children (e.g., medications and psychological preparation programs) are limited by their expense and/or time-intensive nature. In an attempt to reduce children’s preoperative anxiety and its associated negative outcomes, this work examined the usefulness of audiovisual interventions in reducing children’s preoperative anxiety, sought to develop a new instrument to measure children’s preoperative anxiety, tested a new tablet-based application to reduce children’s preoperative anxiety, and examined the relation between children’s temperament and preoperative anxiety. The goal is to improve the surgical experience for children and families, and to reduce psychological and physical problems in children undergoing surgery.

Yes / Heart failure affects 26 million people globally, and the optimal management of medicines is crucial for patients, particularly when their care is transferred between hospital and the community. Optimising clinical outcomes requires well-calibrated cross-organisational processes with staff and patients responding and adapting to medicines changes. The aim of this study was to assess the feasibility of implementing a complex intervention (the Medicines at Transitions Intervention; MaTI) co-designed by patients and healthcare staff. The purpose of the intervention was to optimise medicines management across the gaps between secondary and primary care when hospitals handover care. The study objectives were to (1) assess feasibility through meeting specified progression criteria to proceed to the trial, (2) assess if the intervention was acceptable to staff and patients, and (3) determine whether amendment or refinement would be needed to enhance the MaTI. The feasibility of the MaTI was tested in three healthcare areas in the North of England between July and October 2017. Feasibility was measured and assessed through four agreed progression to trial criteria: (1) patient recruitment, (2) patient receipt of a medicines toolkit, (3) transfer of discharge information to community pharmacy, and (4) offer of a community pharmacy medicines review/discussion or medicines reconciliation. From the cardiology wards at each of the three NHS Acute Trusts (sites), 10 patients (aged ≥ 18 years) were recruited and introduced to the 'My Medicines Toolkit' (MMT). Patients were asked to identify their usual community pharmacy or nominate a pharmacy. Discharge information was transferred to the community pharmacy; pharmacists were asked to reconcile medicines and invited patients for a medicines use review (MUR) or discussion. At 1 month following discharge, all patients were sent three questionnaire sets: quality-of-life, healthcare utilisation, and a patient experience survey. In a purposive sample, 20 patients were invited to participate in a semi-structured interview about their experiences of the MaTI. Staff from hospital and primary care settings involved in patients' care were invited to participate in a semi-structured interview. Patient and staff interviews were analysed using Framework Analysis. Questionnaire completion rates were recorded and data were descriptively analysed. Thirty-one patients were recruited across three sites. Eighteen staff and 18 patients took part in interviews, and 19 patients returned questionnaire sets. All four progression to trial criteria were met. We identified barriers to patient engagement with the intervention in hospital, which were compounded by patients' focus on returning home. Some patients described not engaging in discussions with staff about medicines and lacking motivation to do so because they were preoccupied with returning home. Some patients were unable or unwilling to attend a community pharmacy in person for a medicines review. Roles and responsibilities for delivering the MaTI were different in the three sites, and staff reported variations in time spent on MaTI activities. Staff reported some work pressures and staff absences that limited the time they could spend talking to patients about their medicines. Clinical teams reported that recording a target dose for heart failure medicines in patient-held documentation was difficult as they did not always know the ideal or tolerable dose. The majority of patients reported receiving the patient-held documentation. More than two-thirds reported being offered a MUR by their community pharmacists. Delivery of the Medicines at Transitions Intervention (MaTI) was feasible at all three sites, and progression to trial criteria were met. Refinements were found to be necessary to overcome identified barriers and strengthen delivery of all steps of the intervention. Necessary changes to the MaTI were identified along with amendments to the implementation plan for the subsequent trial. Future implementation needs to take into account the complexity of medicines management and adaptation to local context. / This study is funded by the National Institute for Health Research (NIHR) (Programme Grants for Applied Research (Grant Reference Number RP-PG-0514-20009)). The study is also supported by the NIHR Yorkshire and Humber Patient Safety Translational Research Centre.

Yes / Fidelity to the treatment protocol is key to successful trials but often problematic. This article reports the staff's views on delivering a complex rehabilitation intervention: patient-led therapy during inpatient stroke care. An exploratory qualitative study using focus groups with staff involved in a multicenter (n = 12) feasibility trial of patient-led therapy (the MAESTRO trial) was undertaken as part of the evaluation process. Purposive sampling ensured that participants represented all recruiting sites, relevant professions and levels of seniority. Data analysis used a Framework Approach. Five focus groups were held involving 30 participants. Five main themes emerged: the effect of the interventions, practical problems, patient-related factors, professional dilemmas, and skills. Staff felt the main effect of the therapies was on patients' autonomy and occupation; the main practical problems were the patients' difficulties in achieving the correct position and a lack of space. Staff clearly identified characteristics that made patient-led therapy unsuitable for some patients. Most staff experienced dilemmas over how to prioritize the trial interventions compared to their usual therapy and other clinical demands. Staff also lacked confidence about how to deliver the interventions, particularly when adapting the interventions to individual needs. For each barrier to implementation, possible solutions were identified. Of these, involving other people and establishing a routine were the most common. Delivering rehabilitation interventions within a trial is complex. Staff require time and support to develop the skills, strategies and confidence to identify suitable patients, deliver new treatments, adapt the new treatments to individuals' needs and balance the demands of delivering the trial intervention according to the treatment protocol with other clinical and professional priorities. TRIAL REGISTRATION: ISRCTN: ISRCTN29533052 . October 2011.

Thesis (MSc)--Stellenbosch University, 2009. / ENGLISH ABSTRACT: The Division of Aquaculture, Stellenbosch University (SU) was commissioned jointly by Namdeb Diamond Corporation (Pty) Ltd (Namdeb) and the Oranjemund Town Management Company Limited (OTMCo) to assess the aquaculture potential of the mining area at Oranjemund in Namibia. This document provides a proposal for the establishment of a marine finfish (yellowtail, Seriola lalandi) farm at Oranjemund. There appears to be considerable potential and as such this document provides a proposal for the establishment of a marine finfish (yellowtail, Seriola lalandi) farm at Oranjemund. A 5 000 metric ton (mt) yellowtail farm would have a turnover of about N$ 115 million per year and provides direct employment for about 200 people. Oranjemund is located immediately north of the Orange River at the most south-western corner of Namibia, approximately 1000 kilometers southwest of the capital, Windhoek. Namdeb currently operates an alluvial diamond mining operation along a 160 kilometer (km) stretch of the southern Namibia coastline, but is expected to downscale their activities significantly over the next 5 to 10 years. Aquaculture, the cultivation of fish, shellfish and aquatic plants, is the fastest growing food producing industry in the world and has considerable potential to contribute to the establishment of a vibrant post-mining economy in Oranjemund. The marine finfish industry is the most important and valuable aquaculture sector in many countries and is expected to grow significantly over the medium term, thereby also offering exciting opportunities for investment and business participation. The yellowtail farm venture is part of a greater plan to develop a vertically integrated aquaculture cluster at Oranjemund. The yellowtail development will be conducted in two phases, with Phase 1 the establishment of a pilot project to assess and confirm technical and financial feasibility. Phase 2 is the development of a 1 000 mt commercial farm. Other species being considered for development at Oranjemund include abalone (Haliotis midae), turbot (Psetta Maxima), rock lobster (Jasus lalandi) and oysters (Crassostria gigas). Several companies in South Africa are currently actively pursuing aquaculture expansion opportunities along both the west and east coasts of South Africa. Key amongst these is the development of abalone farms at Hondeklip Bay and Port Nolloth in the Northern Cape Province of South Africa by HIK Abalone Farm (Pty) Ltd (HIK) and NewFarmers Development Company Limited (NewF). The development of abalone and yellowtail farming at Oranjemund has been positioned as a further extension of the abovementioned initiative with HIK, NewF and a finfish fingerling supplier as potential operating, investment and development partners. The proposed business structure of the project provides investment opportunities for both institutional and Black Economic Empowerment (BEE) investors as well as employee equity instruments. Namibia’s economic prospects for the future are bright given its stable economic performance, good regulatory framework, and robust private sector. The country has experienced steady growth, moderate inflation, strong external surpluses and low indebtedness over the past several years as a result of generally prudent fiscal policies, a stable political environment, a fairly developed infrastructure, and a strong legal and regulatory environment. Economic growth since independence (1991) has averaged 4.3% per annum, and the World Bank’s Investment Climate Assessment Report currently notes that Namibia has a relatively attractive investment climate. The Government of Namibia has identified aquaculture as a prime priority development area. Both Vision 2030 and the NDP2 documents summon the country’s urgency to develop aquaculture and as such the Namibian Government has created an enabling environment for investment in aquaculture. / Namdeb Diamond Corporation (Pty) Ltd (Namdeb) and the Oranjemund Town Management Company Limited (OTMCo)

Approved for public release, distribution is unlimited / Optical fiber has been the preferred cabling technology for certain building and campus network LAN backbones. Until recently, however, the use of fiber as a cabling medium to the desktop has been confined to special environments that require the unique properties of optical fiber such as noise immunity, security, distance, high bandwidth demands (CAD/CAM, video conferencing), and immunity to electrical interference. However, choosing to use optical fiber in a network over other cabling options may present significant advantages in its inherent ability to handle data at higher speeds. Decreasing costs of optical fiber components compared to the increasing electronic costs of carrying Gigabit Ethernet over Cat 5 or Cat 5E UTP copper cabling has also accelerated the migration to optical fiber LAN. The thesis conducts a feasibility study of implementing a Fiber Optic Local Area Network in Software Metrics Laboratory in Ingersoll 158. / Major, Republic of Singapore Air Force