The purpose of this study was to determine the knowledge of nurses working in ICU with respect to pain management, glycaemic control and weaning from mechanical ventilation, care areas that are commonly guided by protocols. The effect of formal ICU training and years of ICU experience on this knowledge was elicited. A non-experimental, descriptive and contextual two-phase research design was used. The first phase of the study consisted of developing and validating a data collection instrument, using purposive sampling to select two groups of ICU nursing experts. The second phase of the study used the instrument developed in phase one to test the knowledge of nurses working in ICU. The knowledge of 136 ICU nurses (68 ICU trained and 68 non-ICU trained) from three (n=3) public sector and two (n=2) private sector hospitals in Gauteng was tested using the data collection instrument developed by the researcher and the two groups of ICU nursing experts. Knowledge of nurses, both ICU trained and non-ICU trained, working in the ICUs of three public and two private hospitals in Gauteng was found to be lacking in the three care areas tested in this study, namely pain management, glycaemic control and weaning from mechanical ventilation. The difference in knowledge between ICU trained and non-ICU trained nurses was statistically significant but relatively small. A weak correlation was found between level of knowledge and years of ICU experience. Recommendations to address this lack of knowledge of ICU nurses are given for clinical nursing practice, nursing management and nursing educators, as well as recommendations for further research in this area.

Les travaux effectués dans le cadre de cette thèse s'inscrivent dans la suite des travaux réalisés par l'INL (Institut des Nanotechnologies de Lyon) sur les résonateurs optiques à base de cristaux photoniques membranaires pour la réalisation de composants actifs ou passifs intégrés sur silicium. Ces travaux se concentrent particulièrement sur le contrôle des propriétés de propagation des modes et des résonances guidés s'établissant dans les cristaux photoniques membranaires. Ils s'appuient notamment sur la nature partiellement ou totalement guidée de ces modes, ainsi que des propriétés de symétrie des structures (ou au contraire de dissymétrie) afin de pouvoir générer des dispersions photoniques à la demande. En effet, le contrôle des propriétés spectro-spatiales est primordiale à la réalisation de composants photoniques efficients. Par exemple l'établissement d'un régime d'émission laser dans un cristal photonique membranaire passe par un contrôle minutieux des propriétés temporelles de la résonance (fort facteur de qualité) mais aussi spatiales (fort ralentissement de la lumière) afin de pouvoir générer des densités d'états photoniques suffisamment importantes. Ainsi, de nombreuses stratégies de contrôle ont été mises en place durant les années 2000, permettant l'établissement d'un régime laser dans des structures diverses. Néanmoins, si les méthodes de fabrication et la maîtrise dans la conception de ces structures se sont améliorées au fil de leur développement, ces dispositifs restent difficilement compétitifs face à d'autres technologies. Démontrer la versatilité de ces structures par l'ajout de fonctionnalités tels que le \emph{beam steering} ou d'autres capacités serait alors une véritable plus-value. Récemment, de nouvelles stratégies de contrôle de la lumière ont émergé. Ces stratégies se basent sur une approche totalement différente des procédés de contrôle habituels. Ainsi, on peut citer les nouveaux phénomènes de localisation de la lumière basés sur des procédés inédits de découplage de la lumière du continuum radiatif, ou des dispersions en cône de Dirac qui pourraient permettre la réalisation de composants originaux tels que des lasers mono-modes à grande surface active. Ces nouveaux phénomènes permettent d'envisager d'autres approches pour la réalisation de lasers à cristaux photoniques et pourraient apporter les nouvelles fonctionnalités recherchées. Parallèlement, l'utilisation de membranes photoniques multi-modes reste encore peu répandue dans la littérature. L'utilisation conjointe de modes d'ordres différents offre pourtant des possibilités supplémentaires dans le contrôle des propriétés de propagation de la lumière dans les cristaux photoniques membranaires. Ce contrôle supplémentaire peut se traduire par des capacités de ralentissement de la lumière accrues ou par la réalisation de dispersions plus exotiques. Le but de cette thèse est alors de mettre en place les briques conceptuelles nécessaires à la génération de ces dispersions particulières. Pour cela, un modèle théorique permettant d'appréhender les dynamiques de couplage opérant dans les cristaux photoniques membranaires étudiés est mis en place. Ce modèle est ensuite confronté aux résultats de simulation ainsi qu'aux caractérisations optiques des structures fabriquées. En parallèle, une étude prospective des applications possibles est menée pour chacune des dispersions générées. / Work carried out in this thesis is part of the overall work done at INL on optical resonators based on photonic crystals for the design of passive as well as active components integrated on silicon chips. These works especially focus on spectral properties and propagation control of guided modes and resonances settled in photonic crystal slabs. They rely partly on the guided nature of these modes as well as their symmetry properties to generate on-demand photonic dispersions. Indeed, control of the spectro-spatial properties is overriding for the design of efficient photonic components. For instance, obtaining a laser effect with a photonic crystal requires a precise control of both spectral properties (high quality factor) and spatial ones (high light slow-down) so that large photonic densities of states are achieved. Thereby, numerous strategies of control have been developed during the 2000s, allowing a laser effect to occur with various structures. Nonetheless, despite both manufacture and design qualities have been improved, these components still remain hardly competitive compared to other technologies. Demonstrating the versatility of these structures by achieving novel functionalities like beam steering or other capacities would be a real betterment. Recently, new strategies to control light using photonic crystals have been discovered. These strategies are based on completely new phenomena. For instance, new possibilities to localize light based on novel light decoupling processes from the continuum have arisen and Dirac cone dispersions could allow the formation of monomode larger-area photonic crystal lasers. These new phenomena enabled to consider new approaches to design photonic crystal laser that could lead to the novel functionalities sought. In parallel, the use of multimode photonic membranes still remains uncommon in the literature. The use of several guided orders gives additional possibilities to the control of light propagation within photonic crystal membrane thought. This additional control can lead to improved slowing-down capabilities or exotic dispersion generation. The goal of this thesis is to set up the fundamental blocks on which these particular dispersions are based on. In this purpose, a theoretical model allowing apprehending the coupling dynamic occurring in photonic crystal membranes is established. Then, this model is compared to simulation results and experimental characterizations of the manufactured structures.

Huang, Li. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 162-194). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

"This dissertation describes the development of a methodology for implementing robotic systems for interventional procedures under intraoperative Magnetic Resonance Imaging (MRI) guidance. MRI is an ideal imaging modality for surgical guidance of diagnostic and therapeutic procedures, thanks to its ability to perform high resolution, real-time, and high soft tissue contrast imaging without ionizing radiation. However, the strong magnetic field and sensitivity to radio frequency signals, as well as tightly confined scanner bore render great challenges to developing robotic systems within MRI environment. Discussed are potential solutions to address engineering topics related to development of MRI-compatible electro-mechanical systems and modeling of steerable needle interventions. A robotic framework is developed based on a modular design approach, supporting varying MRI-guided interventional procedures, with stereotactic neurosurgery and prostate cancer therapy as two driving exemplary applications. A piezoelectrically actuated electro-mechanical system is designed to provide precise needle placement in the bore of the scanner under interactive MRI-guidance, while overcoming the challenges inherent to MRI-guided procedures. This work presents the development of the robotic system in the aspects of requirements definition, clinical work flow development, mechanism optimization, control system design and experimental evaluation. A steerable needle is beneficial for interventional procedures with its capability to produce curved path, avoiding anatomical obstacles or compensating for needle placement errors. Two kinds of steerable needles are discussed, i.e. asymmetric-tip needle and concentric-tube cannula. A novel Gaussian-based ContinUous Rotation and Variable-curvature (CURV) model is proposed to steer asymmetric-tip needle, which enables variable curvature of the needle trajectory with independent control of needle rotation and insertion. While concentric-tube cannula is suitable for clinical applications where a curved trajectory is needed without relying on tissue interaction force. This dissertation addresses fundamental challenges in developing and deploying MRI-compatible robotic systems, and enables the technologies for MRI-guided needle-based interventions. This study applied and evaluated these techniques to a system for prostate biopsy that is currently in clinical trials, developed a neurosurgery robot prototype for interstitial thermal therapy of brain cancer under MRI guidance, and demonstrated needle steering using both asymmetric tip and pre-bent concentric-tube cannula approaches on a testbed."

Needle-based interventions are pervasive in Minimally Invasive Surgery (MIS), and are often used in a number of diagnostic and therapeutic procedures, including biopsy and brachytherapy seed placement. Magnetic Resonance Imaging (MRI) which can provide high quality, real time and high soft tissue contrast imaging, is an ideal guidance tool for image-guided therapy (IGT). Therefore, a MRI-guided needle-based surgical robot proves to have great potential in the application of percutaneous interventions. Presented here is the design of reconfigurable fiducial-integrated modular needle driver for MRI-guided percutaneous interventions. Further, an MRI-compatible hardware control system has been developed and enhanced to drive piezoelectric ultrasonic motors for a previously developed base robot designed to support the modular needle driver. A further contribution is the development of a fiber optic sensing system to detect robot position and joint limits. A transformer printed circuit board (PCB) and an interface board with integrated fiber optic limit sensing have been developed and tested to integrate the robot with the piezoelectric actuator control system designed by AIM Lab for closed loop control of ultrasonic Shinsei motors. A series of experiments were performed to evaluate the feasibility and accuracy of the modular needle driver. Bench top tests were conducted to validate the transformer board, fiber optic limit sensing and interface board in a lab environment. Finally, the whole robot control system was tested inside the MRI room to evaluate its MRI compatibility and stability.

Public school teachers face a great amount of stress, and that stress may lead to other adverse health outcomes. This study examined elementary public school teachers' stress levels before and after the use of guided imagery relaxation. Guided by the transactional model of stress and coping as the theoretical framework, the purpose of this research was to evaluate the use of guided imagery as an effective technique in the stress reduction of elementary public school teachers, thus enhancing the learning experience of students and creating healthier public school teachers. Eighty-one teachers (71 women, 10 men) participated in this study by completing the Classroom Appraisal of Resources and Demands Inventory Elementary Version. Several variables were examined including gender, years of experience, and adverse health as related to stress experiences. A repeated measures analysis of variance revealed that guided imagery relaxation was statistically significant in reducing stress levels of public school teachers. These results have implications for positive social change by illuminating the utility of a stress-reduction technique for public school teachers. School administrators and educators may find these results useful in their work to retain talented teachers.

The opioid epidemic in the United States continues to be a national health crisis affecting all populations. From 1999 to 2016, more than half a million people died from drug overdose. Nonpharmacological therapies are underused in nursing practice due to the gap in nurses' baseline knowledge and confidence related to nonpharmacological techniques for pain management. The purpose of this scholarly project was to develop and implement an expert-reviewed, evidence-based education program focused on nonpharmacological techniques for pain management. Participants included 18 registered nurses (RNs) from an orthopedic unit in a large academic medical center. A 45-minute educational session was conducted for RNs. A pre/postquestionnaire, including a 5-point Likert scale on nurses' self-perceived knowledge and confidence in using selected nonpharmacological techniques, was the method of data collection. Descriptive statistics were used to analyze the data. The results indicated an increase in nurses' self-perceived knowledge in all nonpharmacological techniques. The most significant increase in knowledge posteducation intervention was guided imagery with an increase of 72% in terms of the response Good. The data analysis indicates that the nurses self-perceived confidence posteducation intervention increased in terms of the response Good by 50 % and response Excellent by 33% demonstrating the efficacy of an evidence- based education program on nonpharmacological techniques. The implications of this project for social change include the empowerment of nurses to provide holistic patient-centered care, opioid sparing in keeping in alignment with patient safety, and the development of an evidence-based program that can be replicated in other settings.

The dual problem space model of writing (Scardamalia, Bereiter and Steinbach, 1984) shows how writers develop their knowledge and understanding of the world by reflecting on problems of substance and problems of presentation in planning a composition. Reflective thought is attributed to a two-way communication between a content problem space and a rhetorical problem space. The content space involves the development of ideas, while the rhetorical space is concerned with achieving various purposes in composition. This thesis reports an instructional experiment comparing alternative approaches to teaching the self-regulatory strategies required for the two-way process of reflection. The experiment compared the dialogue approach of current practice, which relies on the teacher to provide the linking operations between the two problem spaces, with two experimental approaches which promote development of self-regulatory strategies of reflection, so that students are able to sustain such a two-way process independently. The experimental approaches are described as a guided discovery approach proposed by Evans (1991) and an approach described as cognitive apprenticeship developed by Scardamalia, Bereiter and Steinbach (1984). Three instructional programs were prepared by the author to represent the three alternative approaches examined in the present study. The control program utilised the dialogue approach of current practice in which the dialectical process is carried on between teacher and student. The two experimental programs focused on promoting processes of self-questioning rather than questioning by an external agent such as a teacher. The guided discovery program consisted of activities which prompted self-questioning processes. The cognitive apprenticeship program employed scaffolding in the form of procedural facilitation cues to stimulate the self-questioning process. A pre-test and post-test control group design was used involving three groups, two experimental (guided discovery and cognitive apprenticeship) and one control (dialogue), with instructional method as the independent variable and rated reflectiveness of writing as the dependent variable. Instruction was concentrated on teaching the two-way problem formulating and problem solving strategies of the reflective process for opinion essays and factual exposition essays. The experiment compared the effectiveness of programs by measuring changes in overall reflectiveness of writing. Significant improvements were obtained for the experimental teaching methods withrespect to opinion essays. This research provided some support for the hypothesis that instruction which fosters self-regulation of the planning process through processes of reflection results in more reflective writing than instruction in which such regulation is prompted by the teacher.

The possibility and feasibility of experimental detection of localized defects in tubes using laser-induced ultrasonic wave approach through Thermo Acousto Photonic Non Destructive Evaluation (TAP-NDE) and Signal processing through wavelet transform is examined in this research. Guided waves in cylindrical surfaces provide solutions for detection of different defects in the material. Several experiments were conducted to this respect. Wave propagation in both axial and circumferential directions was studied. The dispersive wave propagation of ultrasonic waves in hollow cylinders has been investigated experimentally, primarily for use in non-contact and nondestructive inspections of pipes and tubes. The laser ultrasonic waves propagated in cylindrical waveguides are particularly attractive because of their unique characteristics in the applications of nondestructive evaluation (NDE). Contrary to studies making use of only axially symmetric guided waves in hollow cylinders, here are analyzed also nonaxisymmetric waves. The analysis of data is made by using the Gabor wavelet transform. The capability of modeling the guided wave dispersion in hollow cylinders is used in developing guided wave experimental techniques for flaw detection. Good agreement was obtained when comparing the dispersion spectra between theory and experimentation. Measurement of group velocities of guided waves, which are obtained directly from the wavelet transform coefficients, can be used to determine allocation and sizing of flaws.

To correct, improve, and maintain tissues, and their functions, are common denominators in tissue engineering and reconstructive plastic surgery. This can be achieved by using autolo-gous tissues as in flaps or transplants. However, often autologous tissue is not useable. This is one of the reasons for the increasing interest among plastic surgeons for tissue engineering, and it has led to fruitful cross-fertilizations between the fields. Tissue engineering is defined as an interdisciplinary field that applies the principles of engineering and life sciences for development of biologic substitutes designed to maintain, restore, or improve tissue functions. These methods have already dramatically improved the possibilities to treat a number of medical conditions, and can arbitrarily be divided into two main principles: > Methods where autologous cells are cultured in vitro and transplanted by means of a cell suspension, a graft, or in a 3-D biodegradable matrix as carrier. > Methods where the tissue of interest is stimulated and given the right prerequisites to regenerate the tissue in vivo/situ with the assistance of implantation of specially designed materials, or application of substances that regulate cell functions - guided tissue regeneration. We have shown that human mammary epithelial cells and adipocytes could be isolated from tissue biopsies and that the cells kept their proliferative ability. When co-cultured in a 3-D matrix, patterns of ductal structures of epithelial cells embedded in clusters of adipocytes, mimicking the in vivo architecture of human breast tissue, were seen. This indicated that human autologous breast tissue can be regenerated in vitro. The adipose tissue is also generally used to correct soft tissue defects e.g. by autologous fat transplantation. Alas 30-70% of the transplanted fat is commonly resorbed. Preadipocytes are believed to be hardier and also able to replicate, and hence, are probably more useful for fat transplantation. We showed that by using cell culture techniques, significantly more pre-adipocytes could survive and proliferate in vitro compared to two clinically used techniques of fat graft handling. Theoretically, a biopsy of fat could generate enough preadipocytes to seed a biodegradable matrix that is implanted to correct a defect. The cells in the matrix will replicate at a rate that parallels the vascular development, the matrix subsequently degrades and the cell-matrix complex is replaced by regenerated, vascularized adipose tissue. We further evaluated different biodegradable scaffolds usable for tissue engineering of soft tissues. A macroporous gelatin sphere showed several appealing characteristics. A number of primary human ecto- and mesodermal cells were proven to thrive on the gelatin spheres when cultured in spinner flasks. As the spheres are biodegradable, it follows that the cells can be cultured and expanded on the same substrate that functions as a transplantation vehicle and scaffold for tissue engineering of soft tissues. To evaluate the in vivo behavior of cells and gelatin spheres, an animal study was performed where human fibroblasts and preadipocytes were cultured on the spheres and injected intra-dermally. Cell-seeded spheres were compared with injections of empty spheres and cell suspensions. The pre-seeded spheres showed a near complete regeneration of the soft tissues with neoangiogenesis. Some tissue regeneration was seen also in the ‘naked’ spheres but no effect was shown by cell injections. In a human pilot-study, intradermally injected spheres were compared with hyaluronan. Volume-stability was inferior to hyaluronan but a near complete regeneration of the dermis was proven, indicating that the volume-effect is permanent in contrast to hyaluronan which eventually will be resorbed. Further studies are needed to fully evaluate the effect of the macroporous gelatin spheres, with or without cellular pre-seeding, as a matrix for guided tissue regeneration. However, we believe that the prospect to use these spheres as an injectable, 3D, biodegradable matrix will greatly enhance our possibilities to regenerate tissues through guided tissue regeneration. / On the day of the defence date the status of article V was In Press.