Training in and assessment of the procedural skills required to perform peripheral nerve blockade

The training and ongoing education of medical practitioners has undergone major changes in an incremental fashion over the past 15 years. These changes have been driven by patient safety, educational, economic and legislative/regulatory factors. In the near future, training in procedural skills will undergo a paradigm shift to proficiency based progression with associated requirements for competence-based programmes, valid, reliable assessment tools and simulation technology. Before training begins, the learning outcomes require clear definition; any form of assessment applied should include measurement of these outcomes. Currently training in a procedural skill often takes place on an ad hoc basis. The number of attempts necessary to attain a defined degree of proficiency varies from procedure to procedure. Convincing evidence exists that simulation training helps trainees to acquire skills more efficiently rather than relying on opportunities in their clinical practice. Simulation provides a safe, stress free environment for trainees for skill acquisition, generalization and transfer via deliberate practice. The work described in this thesis contributes to a greater understanding of how medical procedures can be performed more safely and effectively through education. The effect of feedback, provided to novices in a standardized setting on a bench model, based on knowledge of performance was associated with an increase in the speed of skill acquisition and a decrease in error rate during initial learning. The timing of feedback was also associated with effective learning of skill. A marked attrition of skills (independent of the type of feedback provided) was demonstrable 24 hrs after they have first been learned. Using the principles of feedback as described above, when studying the effect of an intense training program on novices of varied years of experience in anaesthesia (i.e. the present training programmes / courses of an intense training day for one or more procedures). There was a marked attrition of skill at 24 hours with a significant correlation with increasing years of experience; there also appeared to be an inverse relationship between years of experience in anaesthesia and performance. The greater the number of years of practice experience, the longer it required a learner to acquire a new skill. The findings of the studies described in this thesis may have important implications for the trainers, trainees and training bodies in the design and implementation of training courses and the formats of delivery of changing curricula. Both curricula and training modalities will need to take account of characteristics of individual learners and the dynamic nature of procedural healthcare.

Assessment of primary energy conversions of oscillating water columns. I. Hydrodynamic analysis

This is an investigation on the development of a numerical assessment method for the hydrodynamic performance of an oscillating water column (OWC) wave energy converter. In the research work, a systematic study has been carried out on how the hydrodynamic problem can be solved and represented reliably, focusing on the phenomena of the interactions of the wave-structure and the wave-internal water surface. These phenomena are extensively examined numerically to show how the hydrodynamic parameters can be reliably obtained and used for the OWC performance assessment. In studying the dynamic system, a two-body system is used for the OWC wave energy converter. The first body is the device itself, and the second body is an imaginary “piston,” which replaces part of the water at the internal water surface in the water column. One advantage of the two-body system for an OWC wave energy converter is its physical representations, and therefore, the relevant mathematical expressions and the numerical simulation can be straightforward. That is, the main hydrodynamic parameters can be assessed using the boundary element method of the potential flow in frequency domain, and the relevant parameters are transformed directly from frequency domain to time domain for the two-body system. However, as it is shown in the research, an appropriate representation of the “imaginary” piston is very important, especially when the relevant parameters have to be transformed from frequency-domain to time domain for a further analysis. The examples given in the research have shown that the correct parameters transformed from frequency domain to time domain can be a vital factor for a successful numerical simulation.

Assessment of primary energy conversions of oscillating water columns. II. Power take-off and validations

This is the second part of the assessment of primary energy conversions of oscillating water columns (OWCs) wave energy converters. In the first part of the research work, the hydrodynamic performance of OWC wave energy converter has been extensively examined, targeting on a reliable numerical assessment method. In this part of the research work, the application of the air turbine power take-off (PTO) to the OWC device leads to a coupled model of the hydrodynamics and thermodynamics of the OWC wave energy converters, in a manner that under the wave excitation, the varying air volume due to the internal water surface motion creates a reciprocating chamber pressure (alternative positive and negative chamber pressure), whilst the chamber pressure, in turn, modifies the motions of the device and the internal water surface. To do this, the thermodynamics of the air chamber is first examined and applied by including the air compressibility in the oscillating water columns for different types of the air turbine PTOs. The developed thermodynamics is then coupled with the hydrodynamics of the OWC wave energy converters. This proposed assessment method is then applied to two generic OWC wave energy converters (one bottom fixed and another floating), and the numerical results are compared to the experimental results. From the comparison to the model test data, it can be seen that this numerical method is capable of assessing the primary energy conversion for the oscillating water column wave energy converters.

An assessment of the influence of the industry distribution chain on the oxygen levels in commercial modified atmosphere packaged cheddar cheese using non-destructive oxygen sensor technology

The establishment and control of oxygen levels in packs of oxygen-sensitive food products such as cheese is imperative in order to maintain product quality over a determined shelf life. Oxygen sensors quantify oxygen concentrations within packaging using a reversible optical measurement process, and this non-destructive nature ensures the entire supply chain can be monitored and can assist in pinpointing negative issues pertaining to product packaging. This study was carried out in a commercial cheese packaging plant and involved the insertion of 768 sensors into 384 flow-wrapped cheese packs (two sensors per pack) that were flushed with 100% carbon dioxide prior to sealing. The cheese blocks were randomly assigned to two different storage groups to assess the effects of package quality, packaging process efficiency, and handling and distribution on package containment. Results demonstrated that oxygen levels increased in both experimental groups examined over the 30-day assessment period. The group subjected to a simulated industrial distribution route and handling procedures of commercial retailed cheese exhibited the highest level of oxygen detected on every day examined and experienced the highest rate of package failure. The study concluded that fluctuating storage conditions, product movement associated with distribution activities, and the possible presence of cheese-derived contaminants such as calcium lactate crystals were chief contributors to package failure.