Recent reports in the field of medicine have recommended the use of teamwork training to reduce the number of injuries and fatalities from human error. Teamwork training in the field of medicine appears promising, but few empirical evaluations of such programs have confirmed their effectiveness. Existing teamwork training studies have tended to use a traditional, lecture approach to training, with positive but modest results upon teamwork attitudes and behaviors. The current study developed and evaluated a more active teamwork training protocol for trauma resuscitation teams. The training protocol supplemented several medical and non-medical role plays with a lecture and guided discussion for feedback. Forty-one residents participated in the training on one of two days (groups) and completed evaluation measures prior to and immediately following the training program. The training was evaluated with measures of trainee reactions, attitudes towards teamwork, and responses to a situational judgment test (SJT). Analyses compared item and scale scores between pre-training scores and post-training scores. T-tests generally found higher means for post-training behavioral responses than pre-training responses. However, mean comparisons with teamwork attitudes and learning goal orientation did not yield significant differences. An item analysis of the SJT responses (using chi-square) indicated significant response shifts in many items that correspond to the teamwork training content. In summary, results indicated that teamwork training on behavioral choices, but little effect on the self-reported attitudes of trainees.

A mass manufacturable impedance based, palladium doped porous silicon sensor, was fabricated for hydrogen detection. The sensor was built using electrochemical etching to produce mesoporous silicon. Four nanometers of palladium was defused directly into the porous silicon and another four nanometers of Pd was deposited on the defused surface to enhance sensing. The sensor was tested in a sealed chamber in which the impedance was measured while hydrogen in nitrogen was ranged from 0-2 percent. Unlike conventional hydrogen sensors this sensor responded at room temperature to changes in hydrogen concentration. The electrical impedance response due to adsorption and desorption of hydrogen reacted relatively quickly due to the nanoparticle nature of palladium diffusion in and Pd evaporation on porous silicon.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Bakgrund: Organdonation från avlidna är idag vanligt förekommande för att ge liv och hälsa åt svårt sjuka patienter. Operations- och intensivvårdssjuksköterskor är två av de yrkeskategorier som arbetar mest intimt med donatorvård, ett arbete som befunnits kunna ge såväl etiska som psykologiska efterverkningar. Syfte: Att sammanställa kunskap kring hur dessa yrkesgrupper upplever och hanterar arbetet med att vårda avlidna donatorer, med fokus på de strategier som används för att patienten ska behandlas med respekt och värdighet. Metod: Litteraturstudie med kvalitativ ansats. En litteratursökning i databaserna PubMed och CINAHL resulterande i 15 artiklar som inkluderades i resultatet. Resultat: Analysen genererade tre teman; ”Att vårda de döda” samlar utsagor och företeelser förknippade med denna vård. Här framkom synen på arbetet som stressigt och mentalt mycket tungt. Bristande förmåga att ta till sig hjärndödhetsbegreppet var vanligt och gjorde arbetet än svårare och mer etiskt utmanande. ”Att möjliggöra ett värdigt slut” beskriver en värdig behandling och strävan mot ett värdigt slut för donatorerna som de mest centrala förhållningssätten i vården av avlidna donatorer. I ”Att själv finna mening” beskrivs hur respondenterna, framför allt, genom att stötta varandra och genom vetskapen om det goda som kom ut av organdonation, både för de anhöriga och för organmottagarna. Ändå fann arbetet meningsfullt och givande. Slutsats: Denna studies resultat visar upp en bred problematik på en rad områden gällande vård av avlidna donatorer. Samtidigt som värdighet och respekt för de avlidna ansågs både viktigt och tillfredsställande. Att se sig själv och det goda som uppnåddes med arbetet, i ett större perspektiv gjorde arbetet positivt och tillfredsställande, trots de negativa aspekterna. / Background: Organ donation from deceased donors has become a common procedure that enables health and prolonged life for critically ill patients. Two of the professions most intimately involved with the care of the donors are operating room and intensive care nurses. This care has been found to cause adverse effects, ethical and psychological. Aim: To gather knowledge regarding how these two professions perceive, and cope with, the care of deceased donors. Focusing on strategies used to preserve and maintain respect and dignity for the donors. Method: Literature review with a qualitative approach. Results: Three themes emerged; ”Caring for the dead” collects statements and phenomena associated with the care. This was perceived as mentally exhausting and very stressful. Lack of understanding for the concept of brain death was common, which made the work harder and more ethically challenging. ”Facilitating a dignified end” established that very concept as the main purpose of the actions during donor care. ”To find a purpose” describes how the respondents, mainly, through support for each other and through the knowledge of the positive outcomes of organ donation, both for the donors’ families and for the organ recipients, still found meaningfulness and satisfaction in their work. Conclusion: This study displays a broad spectrum of adversities associated with donor care, in several areas. Dignity and respect for the deceased was deemed both highly important and personally satisfying. To see oneself and the good things achieved through ones labor, in a larger perspective, made donor care both positive and satisfying.

Introduktion: Omvårdnad är operationssjuksköterskans huvudområde. Operationssjuksköterskan ska förebygga skador och komplikationer som kan uppstå vid en operation. En sådan komplikation kan vara kompartmentsyndrom. Kompartmentsyndrom är en ovanlig komplikation men kan leda till allvarliga skador. Det är därför viktigt att operationssjuksköterskan beaktar det i sitt arbete. Syfte: Detta arbete syftar till att belysa operationssjuksköterskans erfarenheter av att arbeta med att förebygga kompartmentsyndrom i den perioperativa omvårdnaden. Metod: En kvalitativ ansats tillämpades och data samlades in via intervjuer. Insamlade data analyserades genom kvalitativ innehållsanalys. I arbetet deltog 11 operationssjuksköterskor, tio kvinnor och en man, som arbetade på fyra olika operationsavdelningar vid två olika sjukhus. Resultat: I den kvalitativa innehållsanalysen av texten framkom två kategorier, Att arbeta förebyggande samt Att handla på osäker grund. I den förstnämnda kategorin beskrevs hur operationssjuksköterskorna genomförde en individuell riskbedömning, var noggranna i positioneringen och utförde lägesändring samt massage av patientens ben för att förebygga kompartmentsyndrom. I den andra kategorin, Att handla på osäker grund, beskrevs en osäkerhet i den perioperativa omvårdnaden kring kompartmentsyndrom. Det belystes en osäkerhet runt ämnet, omvårdnadsinterventionerna ifrågasattes och en brist på vetenskaplig evidens framkom. Konklusion: Det fanns brister i riktlinjer och rutiner gällande omvårdnad kring kompartmentsyndrom. Det fanns även en brist i att implementera ny kunskap i operationssjuksköterskans omvårdnad för att kunna arbeta evidensbaserat. / Introduction: Nursing is the main area for the operating room (OR) nurse. The OR nurse will prevent injuries and complications that can occur during surgery. One such complication can be compartment syndrome. Compartment syndrome is a rare complication but can lead to serious injuries. It is therefore important that the OR nurse take this in consideration in their work. Aim: This essay aims to highlight the OR nurse's experiences of working with the prevention of compartment syndrome in the perioperative nursing. Method: A qualitative approach was applied and the data were collected through interviews. Collected data were analyzed by qualitative content analysis. The essay enrolled 11 OR nurses, ten women and one man, who worked in four different surgical wards at two different hospitals. Result: After a qualitative content analysis of the data were conducted two categories emerged, Preventive work and To act on uncertain foundations. The first category described how the OR nurse undertook an individual risk assessment, was accurate in positioning and performed a change in position and massage of the patient’s leg to prevent compartment syndrome. The second category, To act on uncertain foundations, described an uncertainty in the perioperative care regarding compartment syndrome. It highlighted an uncertainty around the topic, nursing interventions were questioned and a lack of scientific evidence emerged. Conclusion: There were a lack of guidelines and recommendations regarding care about compartment syndrome. There was also a lack of implementing new knowledge in nursing to provide an evidence-based practice.

Introduktion:  Operationssjuksköterskors  arbete  är  svårdefinierat  och  komplext  där  huvudansvaret  ligger  på patientens perioperativa omvårdnad, medicintekniska produkter och instrumentvård. Operationssjuksköterskor är skyldiga att utföra patientsäker vård i samråd med patienten. Preoperativa samtal kan vara ett redskap för att inhämta patientcentrerad information. Syfte: Att beskriva hur operationssjuksköterskor inhämtar information om patienten avseende säker vård samt undersöka operationssjuksköterskors erfarenheter av den perioperativa dialogen. Metod: En deskriptiv kvalitativ intervjustudie genomfördes. Semistrukturerade intervjuer genomfördes med tio operationssjuksköterskor från tre sjukhus. Intervjuerna transkriberades och texterna analyserades genom kvalitativ innehållsanalys med induktiv ansats. Resultat: Tre huvudkategorier framkom: ”Olika sätt att erhålla information”, ”Olika sätt att arbeta patientsäkert”, ”Möjligheter och hinder att genom den perioperativa dialogen erhålla information”. Operationssjuksköterskorna prioriterade inte samtal med patienten för att inhämta information. Tidsbrist, vårdorganisation och operationssjuksköterskornas attityder ansågs vara hinder för patientsamtal. De använde sig istället av operationsanmälan, journal och andrahandsinformation från kollegor. Operationssjuksköterskorna ansåg vården vara patientsäker även utan preoperativa samtal. Konklusion: Studien visar att operationssjuksköterskorna anser sig kunna utföra patientsäker vård och kan inhämta den information de behöver om sin patient utan att ha kommunicerat med patienten. Operationssjuksköterskorna har ett ansvar att hävda sin roll som patientens advokat för att kunna utföra en individanpassad vård. För att operationssjuksköterskan ska kunna utöva en mer patientcentrerad vård behövs kanske en förändring av operationssjuksköterskornas attityder och om så ska ske är det viktigt med ett organisatoriskt erkännande av hela deras arbetsfält.

The biological need for lighting by an individual differs from the merely visual purpose, such as viewing objects and doing work or movement. Lack of adequate daylight for biological stimulation can lead to health problems, for e.g. imbalanced circadian rhythm. The importance of daylight is vital for hospital patients who are mostly physically and/or psychologically stressed. As, many patients stay indoors for 24 hours, they might be vulnerable to the lack of daylight which is necessary for health reasons. Hence, for hospital patients, daylight can be a strong therapeutic environmental design element to ensure good health and accelerate clinical recovery. The complex relationship between daylight environment and individuals responses are not fully understood. Controversy results that are debated by the previous researchers, has made the implementation of daylighting strategies in the architectural design of hospital in-patient rooms critical, mainly for therapeutic purpose. Strong evidence needs to be established that can build confidence to both architects and policy makers to use daylight for therapeutic purpose and integration of therapeutic effect of daylight to in-patient room architecture is necessary as well. This thesis provides information to architects (with examples) for incorporation of therapeutic effect of daylight in the design of in-patient rooms to reduce patient length of stay (LoS) in hospitals. A triangulation research method was applied in this work, where theories were developed qualitatively and tested quantitatively. Literature review was carried out to establish the potential effect of daylight on patient health. Retrospective field investigations were conducted to establish the quantitative relationship between daylight intensity and patient LoS inside in-patient rooms by developing Multiple Linear Regression (MLR) models under a general hospital environment. Using the daylighting goal to enhance therapeutic benefit for hospital patients, referred from literature and verified from field investigation data, a daylight design concept (sky window configurations) was developed and evaluated by prospective simulation study, and found better compared to traditional standard hospital window configurations, in order to enhance therapeutic benefit for hospital patients. A dynamic annual Climate-Based Daylight Modelling (CBDM) method that uses RADIANCE (backward) raytracer combined with a daylight coefficient approach considering Perez all weather sky luminance model (i.e. DAYSIM), was used for simulation analysis. This thesis develops strategies for architects to incorporate therapeutic effect of daylight in the architectural design of hospital in-patient rooms, including guidelines to support architectural decisions in case of conflicting situations, and to identify the range of daylight intensities within which patient LoS is expected to be reduced. The strategies also consider the ultraviolet radiation (UVR) protections and discuss the challenges of climate change for daylight researchers for the incorporation of therapeutic effect of daylight in the design of hospital in-patient rooms. The thesis provides a contribution to knowledge by establishing strong evidence of quantitative relationship between daylight and LoS, and by presenting new architectural forms for hospital in-patient room design as one of the possible ways to incorporate therapeutic effect of daylight in the design of hospital in-patient rooms effectively. It is expected that the research will encourage and help architects and policy makers to incorporate therapeutic effect of daylight in the design of hospital in-patient rooms, efficiently.

Critical areas in a hospital, such as Intensive Care Units (ICUs) and isolation rooms, are designed to strict health standards. More often than not, these areas operate continuously to maintain designed indoor conditions in order to ensure the safety of patients, making them energy intensive areas. Several attempts have been made to design them to be more energy-efficient. However, cases have emerged in hot and humid countries like Malaysia where combination of poor design, operation and maintenance practices, exacerbated by the humid outdoor conditions especially during night time, have led to occurrences of mould growth in these critical areas. A question arise whether energy efficient design of a critical area can be achieved without incurring a risk of mould growth due to factors like moisture transfer, or continuous part load operation of HVAC systems. The objective of research in this thesis is to investigate the trade-off between optimizing the building and HVAC systems and minimizing the risk of mould growth in hospital buildings located in hot and humid climates. The problem formulation is a single zone isolation room with dimensions based from a real-life isolation room of a district hospital in Malaysia. The design variables, namely HVAC systems and the details of building constructions were selected as input files for energy performance evaluation using EnergyPlus. The output from the simulation will be compared with the selected existing mould growth model during post processing to determine the optimum solution. Simulation and the generation of solutions will be repeated until the most optimum solution is achieved. A binary-encoded Genetic Algorithm (GA) was used as an approach to the minimisation of hospital building energy use. The GA is proven to be effective in performing multi-objective optimisation, since the objective functions for this research are more than one; namely, the minimum annual energy use in the isolation room and the critical indoor surface conditions, such as temperature and relative humidity, below which there would be no mould growth. The research has shown that the normal practice of isolation room design for Malaysian hospitals does not work in minimising energy use and minimising the risk of mould growth and a new design guideline for isolation rooms in Malaysia is recommended. The principal originality of the research will be the application of optimisation methods to investigate the relationship, or trade-off between energy use and the risk of mould growth, particularly for hospital buildings in a hot and humid climate. In this respect, the new knowledge will be on the optimisation procedure and required modelling/analysis components. This combinatorial approach would serve as decision making tool for building and HVAC systems designers in designing more energy-efficient overall environment systems in hospitals, with particular attention to critical areas that are operating continuously.

Roof falls and accumulation of dangerous gasses are the most common hazards in any underground coal mine. Different mechanisms can jeopardize the stability of the roof in underground excavations and successful roof control can only be obtained if the failure mechanism is identified and understood properly. The presence of discontinuities, the inherent variability of the rock mass and discontinuity properties, and the uncertainties associated with directions and magnitudes of the in-situ stress makes the rock engineering problems challenging. The numerical modeling can assist the ground control engineers in designing and evaluating the stability of the underground excavations. If extensive geological and geotechnical data are available, then detailed predictions of deformation, stress and stability can be accomplished by performing numerical modeling. If not, still the numerical modeling can be used to perform parametric studies to gain insight into the possible ranges of responses of a system due to likely ranges of various parameters. The parametric studies can help to identify the key parameters and their impact on stability of underground excavations. The priorities of the material testing and site investigation can be set based on the selected key parameters from parametric studies. An underground coal mine in western Pennsylvania is selected as a case study mine to investigate the underlying causes of roof falls at this mine. The immediate roof at the case study mine consists of laminated silty shale, shale, or sandstone that changes from area to area, and the floor is shale or soft fireclay. This study was mainly focused in the stability analysis of the roofs with the laminated silty shale rock type, where the majority of roof falls had taken place in the roof with this type of roof material. Extensive laboratory tests were performed on the core samples obtained from the case study mine to estimate the intact rock and discontinuity properties of the materials that occur in large extent at the selected interest area of the case study mine. In this research, the three-dimensional distinct element method was used to investigate the stability of the roof in an underground room-and-pillar coal mine. The implemented technique was able to accurately capture the failure of the major discontinuities and rock masses which consist of intact rock and minor discontinuities. In order to accurately replicate the post failure behavior of the rock layers in the immediate roof area, the strain-softening material constitutive law was applied to this region. Extensive numerical parametric studies were conducted to investigate the effect of different parameters such as the variation of immediate roof rock mass strength properties, variation of discontinuity mechanical properties, orientations and magnitudes of the horizontal in-situ stresses, and the size of pillars and excavations on stability of the excavations. The distribution of post failure cohesion along with other measures such as accumulated plastic shear strain, distribution of Z-displacements at the roofline, failure state (joint slip and tensile failure) and displacement (normal and shear displacements) of discontinuities were used to accurately assess the roof stability in this case study. The research conducted in this dissertation showed that the bedding planes play an important role on the behavior of roof in underground excavations. Therefore, an appropriate numerical modeling technique which incorporates the effect of discontinuities should be employed to simulate the realistic behavior of the discontinuous rock masses such as the layered materials in roof strata of the underground coal mines. The three-dimensional distinct element method used in this research showed the clear superiority of this technique over the continuum based methods.

The main focus of this thesis is to analyse signals (signal-dependent analysis) and room responses (system-dependent analysis) from a statistical point of view, attempt to determine the underlying statistical relationships between the reverberant signals and the room responses and propose relevant statistical models. Based on such a statistical framework, this thesis aims to propose novel methodologies for the extraction of room acoustical information and parameters from reverberant signals. Schroeder's theory is experimentally evaluated for various Room Transfer Functions (RTFs) measured in many source/receiver positions in various enclosures and several related aspects are discussed. Using a statistical approach, the effects of reverberant energy on the histograms and statistical measures are discussed and models describing the relationship of statistical measures between the reverberant signal and the RTFs are extracted. Then, the statistical properties of Binaural Room Transfer Functions (BRTFs) and binaural cues are examined. The well-known property of the spectral standard deviation of the magnitude of RTFs, that is its convergence to 5.6 dB for diffuse fields, is examined for the case of BRTFs, using a similar approach and a generic model for the relationship of the spectral standard deviation of RTFs and BRTFs. This thesis is also concerned with the distance estimation problem from a perceptual and computational point of view. Two novel methods for the estimation of the source/receiver distance using speech signals are proposed. The first method is able to detect the distance between the speaker and the microphone in a room environment using single-channel signals. The distance-dependent variation of several temporal and spectral statistical features of single-channel signals is studied and a novel sound source distance detector, based on these features is developed. The second method estimates distance from binaural speech signals (two-channel signals). This method does not require a priori knowledge of the room impulse response, the reverberation time or any other acoustical parameter and relies on a set of novel features extracted from the reverberant binaural signals. For this method, a novel distance estimation feature is introduced exploiting the standard deviation of the difference of the magnitude spectra of the left and right binaural signals (termed here as Binaural Spectral Magnitude Difference Standard Deviation (BSMD STD)). Moreover, an extended and novel set of additional features based on the statistical properties of binaural cues (ILDs, ITDs, ICs) is extracted from an auditory front-end which models the peripheral processing of the human auditory system. Both methods rely on novel distance-dependent features, related to statistical parameters of speech signals. Finally, a novel method for the estimation of the direct-to-reverberant-ratio (DRR) from dual-channel microphone recordings without having knowledge of the source signal is presented. / Η παρούσα διατριβή ασχολείται με τη μελέτη και ανάλυση των στατιστικών χαρακτηριστικών ηχητικών σημάτων και των ακουστικών αποκρίσεων χώρου, έχοντας ως πρωταρχικό σκοπό να προτείνει σχέσεις που περιγράφουν τη συσχέτιση των στατιστικών χαρακτηριστικών των σημάτων με αντήχηση με τις ακουστικές αποκρίσεις χώρων. Βάσει ενός τέτοιου θεωρητικού πλαισίου, η διατριβή αυτή αποσκοπεί στο να προτείνει νέες μεθοδολογίες για την εξαγωγή πληροφορίας που σχετίζεται με τα ακουστικά χαρακτηριστικά των χώρων, κάνοντας χρήση ηχογραφημένων ηχητικών σημάτων (π.χ. σήματα ομιλίας) στους εκάστοτε κλειστούς χώρους. Το θεωρητικό υπόβαθρο αυτής της διατριβής βασίζεται σε υπάρχοντα θεωρητικά μοντέλα για το ηχητικό πεδίο μέσα σε ένα κλειστό χώρο, όπως, για παράδειγμα, το στατιστικό μοντέλο του Schroeder. Το μοντέλο του Schroeder επιβεβαιώνεται πειραματικά για ακουστικές αποκρίσεις που έχουν μετρηθεί σε διάφορες θέσεις, μέσα σε κλειστούς χώρους, οι οποίοι διαφέρουν στα ακουστικά χαρακτηριστικά τους. Βάσει στατιστικής ανάλυσης, εξάγονται στατιστικά μοντέλα, τα οποία περιγράφουν την επίδραση της αντήχησης στα ηχητικά σήματα, όταν αυτά αναπαραχθούν μέσα σε ένα κλειστό χώρο. Στη συνέχεια, λαμβάνοντας υπόψη αντιληπτικά μοντέλα ακοής, τα οποία προϋποθέτουν την ύπαρξη δυο ηχητικών σημάτων (δυο αυτιά, αμφιωτική ακοή) σε αυτή τη διατριβή, μελετώνται κάποιες παράμετροι οι οποίες εξάγονται από αμφιωτικές ακουστικές αποκρίσεις χώρου. Η ιδιότητα της φασματικής τυπικής απόκλισης συναρτήσεων μεταφοράς χώρων να συγκλίνει στην τιμή των 5.6~dB για διάχυτα ηχητικά πεδία, επεκτείνεται στην περίπτωση των αμφιωτικών αποκρίσεων χώρου και προτείνεται ένα γενικευμένο μοντέλο που συσχετίζει τη φασματική τυπική απόκλιση μονοφωνικών και αμφιωτικών συναρτήσεων μεταφοράς χώρου. Η διατριβή αυτή, επίσης, ασχολείται με το πρόβλημα της εκτίμησης της απόστασης μεταξύ πηγής και δέκτη. Προτείνονται δυο νέες μέθοδοι για την εκτίμηση της απόστασης μεταξύ πηγής και δέκτη, κάνοντας χρήση ηχητικών σημάτων ομιλίας. Η προτεινόμενη μέθοδος βασίζεται σε μια σειρά από στατιστικές παραμέτρους των οποίων οι τιμές μεταβάλλονται είτε στο πεδίο του χρόνου είτε στο πεδίο της συχνότητας. Η δεύτερη προτεινόμενη μέθοδος αφορά, επίσης, στην εκτίμηση της απόστασης πηγής/δέκτη, αλλά από αμφιωτικά σήματα. Η μέθοδος αυτή δεν προαπαιτεί γνώση της ακουστικής απόκρισης του χώρου, του χρόνου αντήχησης ή άλλης ακουστικής παραμέτρου και βασίζεται σε μια σειρά από νέες παραμέτρους, οι οποίες μπορούν να υπολογισθούν από τα αμφιωτικά σήματα με αντήχηση. Οι παράμετροι συνδυάζονται με δυο διαφορετικές τεχνικές αναγνώρισης προτύπων των οποίων τα μειονεκτήματα και πλεονεκτήματα συζητώνται. Στα πλαίσια αυτής της μεθόδου, προτείνεται μια νέα παράμετρος, η οποία βασίζεται στη διαφορά της φασματικής τυπικής απόκλισης του αριστερού και του δεξιού αμφιωτικού ηχητικού σήματος, η οποία αποδεικνύεται ότι σχετίζεται με τα στατιστικά της αντίστοιχης μονοφωνικής ακουστικής απόκρισης. Τέλος, προτείνεται μια σειρά από παραμέτρους οι οποίες βασίζονται στα στατιστικά χαρακτηριστικά αμφιωτικών παραμέτρων και σχετίζονται με το αντιληπτικό μοντέλο της ανθρώπινης ακοής. Τέλος, προτείνεται μια νέα μέθοδος για την εκτίμηση της στάθμης λόγου κατευθείαν προς ανακλώμενου ήχου από στερεοφωνικά σήματα.