End-of-life care in the critical care setting : nurses' practices and factors affecting these practices

Background: Critical care units are designed and resourced to save lives, yet the provision of end-of-life care is a significant component of nursing work in these settings. Limited research has investigated the actual practices of critical care nurses in the provision of end-of-life care, or the factors influencing these practices. To improve the care that patients at the end of life and their families receive, and to support nurses in the provision of this care, further research is needed. The purpose of this study was to identify critical care nurses' end-of-life care practices, the factors influencing the provision of end-of-life care and the factors associated with specific end-of-life care practices. Methods: A three-phase exploratory sequential mixed-methods design was utilised. Phase one used a qualitative approach involving interviews with a convenience sample of five intensive care nurses to identify their end-of-life care experiences and practices. In phase two, an online survey instrument was developed, based on a review of the literature and the findings of phase one. The survey instrument was reviewed by six content experts and pilot tested with a convenience sample of 28 critical care nurses (response rate 45%) enrolled in a postgraduate critical care nursing subject. The refined survey instrument was used in phase three of this study to conduct a national survey of critical care nurses. Descriptive analyses, exploratory factor analysis and univariate general linear modelling was undertaken on completed survey responses from 392 critical care nurses (response rate 25%). Results: Six end-of-life care practice areas were identified in this study: information sharing, environmental modification, emotional support, patient and family-centred decision making, symptom management and spiritual support. The items most frequently identified as always undertaken by critical care nurses in the provision of end-of-life care were from the information sharing and environmental modification practice areas. Items least frequently identified as always undertaken included items from the emotional support practice area. Eight factors influencing the provision of end-of-life care were identified: palliative values, patient and family preferences, knowledge, preparedness, organisational culture, resources, care planning, and emotional support for nurses. Strong agreement was noted with items reflecting values consistent with a palliative approach and inclusion of patient and family preferences. Variation was noted in agreement for items regarding opportunities for knowledge acquisition in the workplace and formal education, yet most respondents agreed that they felt adequately prepared. A context of nurse-led practice was identified, with variation in access to resources noted. Collegial support networks were identified as a source of emotional support for critical care nurses. Critical care nurses reporting values consistent with a palliative approach and/or those who scored higher on support for patient and family preferences were more likely to be engaged in end-of-life care practice areas identified in this study. Nurses who reported higher levels of preparedness and access to opportunities for knowledge acquisition were more likely to report engaging in interpersonal practices that supported patient and family centred decision making and emotional support of patients and their families. A negative relationship was identified between the explanatory variables of emotional support for nurses and death anxiety, and the patient and family centred decision making practice area. Contextual factors had a limited influence as explanatory variables of specific end-of-life care practice areas. Gender was identified as a significant explanatory variable in the emotional and spiritual support practice areas, with male gender associated with lower summated scores on these practice scales. Conclusions: Critical care nurses engage in practices to share control with and support inclusion of families experiencing death and dying. The most frequently identified end-of-life care practices were those that are easily implemented, practical strategies aimed at supporting the patient at the end of life and the patient's family. These practices arguably require less emotional engagement by the nurse. Critical care nurses' responses reflected values consistent with a palliative approach and a strong commitment to the inclusion of families in end-of-life care, and these factors were associated with engagement in all end-of-life care practice areas. Perceived preparedness or confidence with the provision of end-of-life care was associated with engagement in interpersonal caring practices. Critical care nurses autonomously engage in the provision of end-of-life care within the constraints of an environment designed for curative care and rely on their colleagues for emotional support. Critical care nurses must be adequately prepared and supported to provide comprehensive care in all areas of end-of-life care practice. The findings of this study raise important implications, and informed recommendations for practice, education and further research.

Superior piezoelectric composite films : taking advantage of carbon nanomaterials

Piezoelectric composites comprising an active phase of ferroelectric ceramic and a polymer matrix have recently attracted numerous sensory applications. However, it remains a major challenge to further improve their electromechanical response for advanced applications such as precision control and monitoring systems. We hereby investigated the incorporation of graphene platelets (GnPs) and multi-walled carbon nanotubes (MWNTs), each with various weight fractions, into PZT (lead zirconate titanate)/epoxy composites to produce three-phase nanocomposites. The nanocomposite films show markedly improved piezoelectric coefficients and electromechanical responses (50%) besides an enhancement of ~200% in stiffness. Carbon nanomaterials strengthened the impact of electric field on the PZT particles by appropriately raising the electrical conductivity of epoxy. GnPs have been proved far more promising in improving the poling behavior and dynamic response than MWNTs. The superior dynamic sensitivity of GnP-reinforced composite may be caused by GnPs’ high load transfer efficiency arising from their two-dimensional geometry and good compatibility with the matrix. Reduced acoustic impedance mismatch resulted from the improved thermal conductance may also contribute to the higher sensitivity of GnP-reinforced composite. This research pointed out the potential of employing GnPs to develop highly sensitive piezoelectric composites for sensing applications.

Predicting voltage unbalance impacts of plug-in electric vehicles penetration in residential low-voltage distribution networks

Plug-in electric vehicles will soon be connected to residential distribution networks in high quantities and will add to already overburdened residential feeders. However, as battery technology improves, plug-in electric vehicles will also be able to support networks as small distributed generation units by transferring the energy stored in their battery into the grid. Even though the increase in the plug-in electric vehicle connection is gradual, their connection points and charging/discharging levels are random. Therefore, such single-phase bidirectional power flows can have an adverse effect on the voltage unbalance of a three-phase distribution network. In this article, a voltage unbalance sensitivity analysis based on charging/discharging levels and the connection point of plug-in electric vehicles in a residential low-voltage distribution network is presented. Due to the many uncertainties in plug-in electric vehicle ratings and connection points and the network load, a Monte Carlo-based stochastic analysis is developed to predict voltage unbalance in the network in the presence of plug-in electric vehicles. A failure index is introduced to demonstrate the probability of non-standard voltage unbalance in the network due to plug-in electric vehicles.

Modelling for the electricity distribution network

Global awareness for cleaner and renewable energy is transforming the electricity sector at many levels. New technologies are being increasingly integrated into the electricity grid at high, medium and low voltage levels, new taxes on carbon emissions are being introduced and individuals can now produce electricity, mainly through rooftop photovoltaic (PV) systems. While leading to improvements, these changes also introduce challenges, and a question that often rises is ‘how can we manage this constantly evolving grid?’ The Queensland Government and Ergon Energy, one of the two Queensland distribution companies, have partnered with some Australian and German universities on a project to answer this question in a holistic manner. The project investigates the impact the integration of renewables and other new technologies has on the physical structure of the grid, and how this evolving system can be managed in a sustainable and economical manner. To aid understanding of what the future might bring, a software platform has been developed that integrates two modelling techniques: agent-based modelling (ABM) to capture the characteristics of the different system units accurately and dynamically, and particle swarm optimization (PSO) to find the most economical mix of network extension and integration of distributed generation over long periods of time. Using data from Ergon Energy, two types of networks (3 phase, and Single Wired Earth Return or SWER) have been modelled; three-phase networks are usually used in dense networks such as urban areas, while SWER networks are widely used in rural Queensland. Simulations can be performed on these networks to identify the required upgrades, following a three-step process: a) what is already in place and how it performs under current and future loads, b) what can be done to manage it and plan the future grid and c) how these upgrades/new installations will perform over time. The number of small-scale distributed generators, e.g. PV and battery, is now sufficient (and expected to increase) to impact the operation of the grid, which in turn needs to be considered by the distribution network manager when planning for upgrades and/or installations to stay within regulatory limits. Different scenarios can be simulated, with different levels of distributed generation, in-place as well as expected, so that a large number of options can be assessed (Step a). Once the location, sizing and timing of assets upgrade and/or installation are found using optimisation techniques (Step b), it is possible to assess the adequacy of their daily performance using agent-based modelling (Step c). One distinguishing feature of this software is that it is possible to analyse a whole area at once, while still having a tailored solution for each of the sub-areas. To illustrate this, using the impact of battery and PV can have on the two types of networks mentioned above, three design conditions can be identified (amongst others): · Urban conditions o Feeders that have a low take-up of solar generators, may benefit from adding solar panels o Feeders that need voltage support at specific times, may be assisted by installing batteries · Rural conditions - SWER network o Feeders that need voltage support as well as peak lopping may benefit from both battery and solar panel installations. This small example demonstrates that no single solution can be applied across all three areas, and there is a need to be selective in which one is applied to each branch of the network. This is currently the function of the engineer who can define various scenarios against a configuration, test them and iterate towards an appropriate solution. Future work will focus on increasing the level of automation in identifying areas where particular solutions are applicable.

Control, operation and power sharing among parallel converter-interfaced DERs in a microgrid in the presence of unbalanced and harmonic loads

This paper demonstrates power management and control of DERs in an autonomous MG. The paper focuses on the control and performance of converter-interfaced DERs in voltage controlled mode. Several case studies are considered for a MG based on the different types of loads supplied by the MG (i.e. balanced three-phase, unbalanced, single-phase and harmonic loads). DERs are controlled by adjusting the voltage magnitude and angle in their converter output through droop control, in a decentralized concept. Based on this control method, DERs can successfully share the total demand of the MG in the presence of any type of loads. This includes proper total power sharing, unbalanced power sharing as well as harmonic power sharing, depending on the load types. The efficacy of the proposed power control, sharing and management among DERs in a microgrid is validated through extensive simulation studies using PSCAD/EMTDC.

A SiC-based matrix converter topology for inductive power transfer system

Typical inductive power transfer (IPT) systems employ two power conversion stages to generate a high-frequency primary current from low-frequency utility supply. This paper proposes a matrix-converter-based IPT system, which employs high-speed SiC devices to facilitate the generation of high-frequency current through a single power conversion stage. The proposed matrix converter topology transforms a three-phase low-frequency voltage system to a high-frequency single-phase voltage, which, in turn, powers a series compensated IPT system. A comprehensive mathematical model is developed and power losses are evaluated to investigate the efficiency of the proposed converter topology. Theoretical results are presented with simulations, which are performed in MATLAB/Simulink, in comparison to a conventional two-stage converter. Experimental evident of a prototype IPT system is also presented to demonstrate the applicability of the proposed concept.

Modeling and position-sensorless control of a dual-airgap axial flux permanent magnet machine for flywheel energy storage systems

This paper presents the modeling and position-sensorless vector control of a dual-airgap axial flux permanent magnet (AFPM) machine optimized for use in flywheel energy storage system (FESS) applications. The proposed AFPM machine has two sets of three-phase stator windings but requires only a single power converter to control both the electromagnetic torque and the axial levitation force. The proper controllability of the latter is crucial as it can be utilized to minimize the vertical bearing stress to improve the efficiency of the FESS. The method for controlling both the speed and axial displacement of the machine is discussed. An inherent speed sensorless observer is also proposed for speed estimation. The proposed observer eliminates the rotary encoder, which in turn reduces the overall weight and cost of the system while improving its reliability. The effectiveness of the proposed control scheme has been verified by simulations and experiments on a prototype machine.

Modeling and analysis of a novel variable-speed cage induction generator

This paper introduces a novel cage induction generator and presents a mathematical model, through which its behavior can be accurately predicted. The proposed generator system employs a three-phase cage induction machine and generates single-phase and constant-frequency electricity at varying rotor speeds without an intermediate inverter stage. The technique uses any one of the three stator phases of the machine as the excitation winding and the remaining two phases, which are connected in series, as the power winding. The two-series-connected-and-one-isolated (TSCAOI) phase winding configuration magnetically decouples the two sets of windings, enabling independent control. Electricity is generated through the power winding at both sub- and super-synchronous speeds with appropriate excitation to the isolated single winding at any frequency of generation. A dynamic mathematical model, which accurately predicts the behavior of the proposed generator, is also presented and implemented in MATLAB/Simulink. Experimental results of a 2-kW prototype generator under various operating conditions are presented, together with theoretical results, to demonstrate the viability of the TSCAOI power generation. The proposed generator is simple and capable of both storage and retrieval of energy through its excitation winding and is expected to be suitable for applications, such as small wind turbines and microhydro systems.

Bit-stream-based space vector modulators

Bit-stream-based control, which uses one bit wide signals to control power electronics applications, is a new approach for controller design in power electronic systems. This study presents a novel family of three-phase space vector modulators, which are based on the bit-stream technique and suitable for three-phase inverter systems. Each of the proposed modulators simultaneously converts a two-phase reference to the three-phase domain and reduces switching frequencies to reasonable levels. The modulators do not require carrier oscillators, trigonometric functions or, in some cases, sector detectors. A complete three-phase modulator can be implemented in as few as 102 logic elements. The performance of the proposed modulators is compared through simulation and experimental testing of a 6 kW, three-phase DC-to-AC inverter. Subject to limits on the modulation index, the proposed modulators deliver spread-spectrum output currents with total harmonic distortion comparable to a standard carrier-based space vector pulse width modulator.

Doubly Fed Induction Generator for wind energy generation using nine-switch power converter

A Three-Phase Nine-Switch Converter (NSC) topology for Doubly Fed Induction Generator in wind energy generation is proposed in this paper. This converter topology was used in various applications such as Hybrid Electric Vehicles and Uninterruptable Power Supplies. In this paper, Nine-Switch Converter is introduced in Doubly Fed Induction Generator in renewable energy application for the first time. It replaces the conventional Back-to-Back Pulse Width Modulated voltage source converter (VSC) which composed of twelve switches in many DFIG applications. Reduction in number of switches is the most beneficial in terms of cost and power switching losses. The operation principle of Nine-Switch Converter using SPWM method is discussed. The resulting NSC performance of rotor side current control, active power and reactive control are compared with Back-to Back voltage source converter performance. DC link voltage regulation using front end converter is also presented. Finally the simulation results of DFIG performances using NSC and Back-to-Back VSC are analyzed and compared.

A Bit-Stream based space vector modulator

Bit-Stream based control, which uses one bit wide signals to control power electronics applications, is a new approach for controller design in power electronic systems. Bit-Stream signals are inherently high frequency in nature, and as such some form of down sampling or modulating is essential to avoid excessive switching losses. This paper presents a novel three-phase space vector modulator, which is based on the Bit-Stream technique and suitable for standard three-phase inverter systems. The proposed modulator simultaneously converts a two phase reference to the three-phase domain and reduces switching frequencies to reasonable levels. The modulator consumes relatively few logic elements and does not require sector detectors, carrier oscillators or trigonometric functions. The performance of the modulator was evaluated using ModelSim. Results indicate that, subject to limits on the modulation index, the proposed modulator delivers a spread-spectrum output with total harmonic distortion comparable to standard space vector pulse width modulation techniques.

Parents’ perception of their children’s participation in physical activity

This paper describes parents' survey and interview responses about their children's participation in physical activity which were collected for the second part of a three phase project funded by the Commonwealth Department of Health and Family Services: Health Advancement Project through the auspices of ACHPER. In the first phase of the project, an extensive data base was compiled on children's participation in physical activity; the second phase investigated parents' and teachers' perceptions of their children's and students' participation in physical activity. The third phase, which is now underway, will use the first two phases to develop a set of resources with which to advocate for policy, programs and educational strategies to serve the needs of young people in Australia most effectively in relation to physical activity.

The quality of life and caregiving burden among caregivers of people with dementia in Hanoi, Bac Ninh and Hai Phong, Vietnam

This three phase study aimed to describe dementia carer's quality of life (QoL) and perceived burden, and explore the associations between family carer characteristics, burden and perceived QoL in Vietnam. Dementia carers in the capital, Hanoi, in Phase 1 (N= 153) and from Hanoi, Hai Phong and Bac Ninh in Phase 2 (N=347) completed questionnaires. Survey results showed dementia carers reported low QoL, predicted by high perceived burden. Other carer characteristics including age, gender, family income and perceived experience were significantly associated with QoL. Filial piety contributed to only a single domain of QoL. Phase 3 employed qualitative methods to explore the specific issues faced by daughter carers. Findings suggested that filial gratitude and positive aspects of the role may influence the caring experience of daughter carers. Further investigation of the specific support needs of general dementia carers, and daughter carers in particular, in Vietnam is warranted.

Double star chopper cell converter for battery electric vehicles with inter-module SoC balancing and fault tolerant control

A modularized battery system with Double Star Chopper Cell (DSCC) based modular multilevel converter is proposed for a battery operated electric vehicle (EV). A design concept for the modularized battery micro-packs for DSCC is described. Multidimensional pulse width modulation (MD-PWM) with integrated inter-module SoC balancing and fault tolerant control is proposed and explained. The DSCC can be operated either as an inverter to drive the EV motor or as a synchronous rectifier connected to external three phase power supply equipment for charging the battery micro-packs. The methods of operation as inverter and synchronous rectifier with integrated inter-module SoC balancing and fault tolerant control are discussed. The proposed system operation as inverter and synchronous rectifier are verified through simulations and the results are presented.

Supporting quality timely PhD completions: Delivering research outcomes

The case study used a three-phase organising process to explain how design and implementation of an accessible and interactive electronic thesis submission form streamlined quality assurance of theses and their timely dissemination via an online thesis repository. The quality of the theses submitted is assured by key academics in their final sign off of the form. It describes the role of shared cultural value in ensuring ready acceptance of a change process within one university and highlights the value of communication in achieving positive change. Quality standards as defined by an external policy framework are shown to be interpreted at the local university level to enhance the PhD completion experience. It describes the impact of moving quality assurance processes to an online environment on research activities; considering the potential for quality assurance to improve universities’ teaching, learning and research activities by facilitating academic oversight of the quality assurance process and reducing the overheads associated with monitoring, measuring and reporting on quality assurance measures.