Current Care Guidelines for Cardiopulmonary Resuscitation : Implementation, skills and attitudes

Background: The national resuscitation guidelines were published in Finland in 2002 and are based on international guidelines published in 2000. The main goal of the national guidelines, available on the Internet free of charge, is early defibrillation by nurses in an institutional setting. Aim: To study possible changes in cardiopulmonary resuscitation (CPR) practices, especially concerning early defibrillation, nurses and students attitudes of guideline implementation and nurses and students ability to implement the guideline recommendations in clinical practices after publication of the Current Care (CC) guidelines for CPR 2002. Material and methods: CPR practices in Finnish health centres; especially concerning rapid defibrillation programmes, as well as the implementation of CC guidelines for CPR was studied in a mail survey to chief physicians of every health centre in Finland (Study I). The CPR skills using an automated external defibrillator (AED) were compared in a study including Objective stuctured clinical examination (OSCE) of resuscitation skills of nurses and nursing students in Finnish and Swedish hospital and institution (Studies II, III). Attitudes towards CPR-D and CPR guidelines among medical and nursing students and secondary hospital nurses were studied in surveys (Studies IV, V). The nurses receiving different CPR training were compared in a randomized trial including OSCE of CPR skills of nurses in Finnish Hospital (Study VI). Results: Two years after the publication, 40.7% of Finnish health centres used national resuscitation guidelines. The proportion of health centres having at least one AED (66%) and principle of nurse-performed defibrillation without the presence of a physician (42%) had increased. The CPR-D training was estimated to be insufficient regarding basic life support and advanced life support in the majority of health centres (Study I). CPR-D skills of nurses and nursing students in two specific Swedish and Finnish hospitals and institutions (Study II and III) were generally inadequate. The nurses performed better than the students and the Swedish nurses surpassed the Finnish ones. Geriatric nurses receiving traditional CPR-D training performed better than those receiving an Internet-based course but both groups failed to defibrillate within 60 s. Thus, the performance was not satisfactory even two weeks after traditional training (Study VI). Unlike the medical students, the nursing students did not feel competent to perform procedures recommended in the cardiopulmonary resuscitation guidelines including the defibrillation. However, the majority of nursing students felt confident about their ability to perform basic life support. The perceived ability to defibrillate correlated significantly with a positive attitude towards nurse-performed defibrillation and negatively with fear of damaging the patient s heart by defibrillation (Study IV). After the educational intervention, the nurses found their level of CPR-D capability more sufficient than before and felt more confident about their ability to perform defibrillation themselves. A negative attitude toward defibrillation correlated with perceived negative organisational attitudes toward cardiopulmonary resuscitation guidelines. After CPR-D education in the hospital, the majority (64%) of nurses hesitated to perform defibrillation because of anxiety and 27 % hesitated because of fear of injuring the patient. Also a negative personal attitude towards guidelines increased markedly after education (Study V). Conclusions: Although a significant change had occurred in resuscitation practices in primary health care after publication of national cardiopulmonary resuscitation guidelines the participants CPR-D skills were not adequate according to the CPR guidelines. The current way of teaching is unlikely to result in participants being able to perform adequate and rapid CPR-D. More information and more frequent training are needed to diminish anxiety concerning defibrillation. Negative beliefs and attitudes toward defibrillation affect the nursing students and nurses attitudes toward cardiopulmonary resuscitation guidelines. CPR-D education increased the participants self-confidence concerning CPR-D skills but it did not reduce their anxiety. AEDs have replaced the manual defibrillators in most institutions, but in spite of the modern devices the anxiety still exists. Basic education does not provide nursing students with adequate CPR-D skills. Thus, frequent training in the workplace has vital importance. This multi-professional program supported by the administration might provide better CPR-D skills. Distance learning alone cannot substitute for traditional small-group learning, tutored hands-on training is needed to learn practical CPR-D skills. Standardized testing would probably help controlling the quality of learning. Training of group-working skills might improve CPR performance.

Phase change on transmission of microwaves through metal disc delay dielectrics

Expressions for the phase change Φ suffered by microwaves when transmitted through an artificial dielectric composed of metallic discs arranged in a three-dimensional array have been derived with different approaches as follows (i) molecular theory, (ii) electromagnetic theory and (iii) transmission line theory. The phase change depends on the distance t that the wave traverses inside the dielectric and also the spacing d between centre to centre of any two adjacent discs in the three principal directions. Molecular theory indicates Φ as an increasing function of t, whereas, the other two theories indicate Φ as an oscillatory function of t. The transmission line theory also exhibits Φ to be real or imaginary depending on t. Experimental values of Φ as a function of t have been obtained with the help of a microwave (3·2 cms wavelength) interferometer for two dielectrics having d as 1·91 cms and 2·22 cms respectively.

Psychosocial processes of health behaviour change in a lifestyle intervention : Influences of gender, socioeconomic status and personality

Background: The onset of many chronic diseases such as type 2 diabetes can be delayed or prevented by changes in diet, physical activity and obesity. Known predictors of successful behaviour change include psychosocial factors such as selfefficacy, action and coping planning, and social support. However, gender and socioeconomic differences in these psychosocial mechanisms underlying health behaviour change have not been examined, despite well-documented sociodemographic differences in lifestyle-related mortality and morbidity. Additionally, although stable personality traits (such as dispositional optimism or pessimism and gender-role orientation: agency and communion) are related to health and health behaviour, to date they have rarely been studied in the context of health behaviour interventions. These personality traits might contribute to health behaviour change independently of the more modifiable domain-specific psychosocial factors, or indirectly through them, or moderated by them. The aims were to examine in an intervention setting: (1) whether changes (during the three-month intervention) in psychological determinants (self-efficacy beliefs, action planning and coping planning) predict changes in exercise and diet behaviours over three months and 12 months, (2) the universality assumption of behaviour change theories, i.e. whether preintervention levels and changes in psychosocial determinants are similar among genders and socioeconomic groups, and whether they predict changes in behaviour in a similar way in these groups, (3) whether the personality traits optimism, pessimism, agency and communion predict changes in abdominal obesity, and the nature of their interplay with modifiable and domain-specific psychosocial factors (self-efficacy and social support). Methods: Finnish men and women (N = 385) aged 50 65 years who were at an increased risk for type 2 diabetes were recruited from health care centres to participate in the GOod Ageing in Lahti Region (GOAL) Lifestyle Implementation Trial. The programme aimed to improve participants lifestyle (physical activity, eating) and decrease their overweight. The measurements of self-efficacy, planning, social support and dispositional optimism/pessimism were conducted pre-intervention at baseline (T1) and after the intensive phase of the intervention at three months (T2), and the measurements of exercise at T1, T2 and 12 months (T3) and healthy eating at T1 and T3. Waist circumference, an indicator of abdominal obesity, was measured at T1 and at oneyear (T3) and three-year (T4) follow-ups. Agency and communion were measured at T4 with the Personal Attributes Questionnaire (PAQ). Results: (1) Increases in self-efficacy and planning were associated with three-month increases in exercise (Study I). Moreover, both the post-intervention level and three-month increases (during the intervention) in self-efficacy in dealing with barriers predicted the 12-month increase in exercise, and a high postintervention level of coping plans predicted the 12-month decrease in dietary fat (Study II). One- and three-year waist circumference reductions were predicted by the initial three-month increase in self-efficacy (Studies III, IV). (2) Post-intervention at three months, women had formed more action plans for changing their exercise routines and received less social support for behaviour change than men had. The effects of adoption self-efficacy were similar but change in planning played a less significant role among men (Study I). Examining the effects of socioeconomic status (SES), psychosocial determinants at baseline and their changes during the intervention yielded largely similar results. Exercise barriers self-efficacy was enhanced slightly less among those with low SES. Psychosocial determinants predicted behaviour similarly across all SES groups (Study II). (3) Dispositional optimism and pessimism were unrelated to waist circumference change, directly or indirectly, and they did not influence changes in self-efficacy (Study III). Agency predicted 12-month waist circumference reduction among women. High communion coupled with high social support was associated with waist circumference reduction. However, the only significant predictor of three-year waist circumference reduction was an increase in health-related self-efficacy during the intervention (Study IV). Conclusions: Interventions should focus on improving participants self-efficacy early on in the intervention as well as prompting action and coping planning for health behaviour change. Such changes are likely to be similarly effective among intervention participants regardless of gender and educational level. Agentic orientation may operate via helping women to be less affected by the demands of the self-sacrificing female role and enabling them to assertively focus on their own goals. The earlier mixed results regarding the role of social support in behaviour change may be in part explained by personality traits such as communion.

Open Access to Scientific Publications – An Analysis of the Barriers to Change?

One of the effects of the Internet is that the dissemination of scientific publications in a few years has migrated to electronic formats. The basic business practices between libraries and publishers for selling and buying the content, however, have not changed much. In protest against the high subscription prices of mainstream publishers, scientists have started Open Access (OA) journals and e-print repositories, which distribute scientific information freely. Despite widespread agreement among academics that OA would be the optimal distribution mode for publicly financed research results, such channels still constitute only a marginal phenomenon in the global scholarly communication system. This paper discusses, in view of the experiences of the last ten years, the many barriers hindering a rapid proliferation of Open Access. The discussion is structured according to the main OA channels; peer-reviewed journals for primary publishing, subject- specific and institutional repositories for secondary parallel publishing. It also discusses the types of barriers, which can be classified as consisting of the legal framework, the information technology infrastructure, business models, indexing services and standards, the academic reward system, marketing, and critical mass.

ICT and the Shaping of Society: Exploring Human -ICT Relationships in Everyday Life (summary section only)

This thesis explores the relationship between humans and ICTs (information and communication technologies). As ICTs are increasingly penetrating all spheres of social life, their role as mediators – between people, between people and information, and even between people and the natural world – is expanding, and they are increasingly shaping social life. Yet, we still know little of how our life is affected by their growing role. Our understanding of the actors and forces driving the accelerating adoption of new ICTs in all areas of life is also fairly limited. This thesis addresses these problems by interpretively exploring the link between ICTs and the shaping of society at home, in the office, and in the community. The thesis builds on empirical material gathered in three research projects, presented in four separate essays. The first project explores computerized office work through a case study. The second is a regional development project aiming at increasing ICT knowledge and use in 50 small-town families. In the third, the second project is compared to three other longitudinal development projects funded by the European Union. Using theories that consider the human-ICT relationship as intertwined, the thesis provides a multifaceted description of life with ICTs in contemporary information society. By oscillating between empirical and theoretical investigations and balancing between determinist and constructivist conceptualisations of the human-ICT relationship, I construct a dialectical theoretical framework that can be used for studying socio-technical contexts in society. This framework helps us see how societal change stems from the complex social processes that surround routine everyday actions. For example, interacting with and through ICTs may change individuals’ perceptions of time and space, social roles, and the proper ways to communicate – changes which at some point in time result in societal change in terms of, for example, new ways of acting and knowing things.

Climate change and forests in India: adaptation opportunities and challenges

Climate change is projected to lead to shift of forest types leading to irreversible damage to forests by rendering several species extinct and potentially affecting the livelihoods of local communities and the economy. Approximately 47% and 42% of tropical dry deciduous grids are projected to undergo shifts under A2 and B2 SRES scenarios respectively, as opposed to less than 16% grids comprising of tropical wet evergreen forests. Similarly, the tropical thorny scrub forest is projected to undergo shifts in majority of forested grids under A2 (more than 80%) as well as B2 scenarios (50% of grids). Thus the forest managers and policymakers need to adapt to the ecological as well as the socio-economic impacts of climate change. This requires formulation of effective forest management policies and practices, incorporating climate concerns into long-term forest policy and management plans. India has formulated a large number of innovative and progressive forest policies but a mechanism to ensure effective implementation of these policies is needed. Additional policies and practices may be needed to address the impacts of climate change. This paper discusses an approach and steps involved in the development of an adaptation framework as well as policies, strategies and practices needed for mainstreaming adaptation to cope with projected climate change. Further, the existing barriers which may affect proactive adaptation planning given the scale, accuracy and uncertainty associated with assessing climate change impacts are presented.

Optimizing Delay in Sequential Change Detection on Ad Hoc Wireless Sensor Networks

We consider the classical problem of sequential detection of change in a distribution (from hypothesis 0 to hypothesis 1), where the fusion centre receives vectors of periodic measurements, with the measurements being i.i.d. over time and across the vector components, under each of the two hypotheses. In our problem, the sensor devices ("motes") that generate the measurements constitute an ad hoc wireless network. The motes contend using a random access protocol (such as CSMA/CA) to transmit their measurement packets to the fusion centre. The fusion centre waits for vectors of measurements to accumulate before taking decisions. We formulate the optimal detection problem, taking into account the network delay experienced by the vectors of measurements, and find that, under periodic sampling, the detection delay decouples into network delay and decision delay. We obtain a lower bound on the network delay, and propose a censoring scheme, where lagging sensors drop their delayed observations in order to mitigate network delay. We show that this scheme can achieve the lower bound. This approach is explored via simulation. We also use numerical evaluation and simulation to study issues such as: the optimal sampling rate for a given number of sensors, and the optimal number of sensors for a given measurement rate

Improvement of power-system transient stability by phase-shift insertion

Computational studies of the transient stability of a synchronous machine connected to an infinite busbar by a double-circuit transmission line are used to illustrate the effect of relative phase-shift insertion between the machine and its associated power system. This method of obtaining a change in the effective rotor-excitation angle, and thereby the power transfer, is described, together with an outline of possible methods of implementation by a phase-shifting transformer in a power system.

Modern energy access to all in rural India: An integrated implementation strategy

Expanding energy access to the rural population of India presents a critical challenge for its government. The presence of 364 million people without access to electricity and 726 million who rely on biomass for cooking indicate both the failure of past policies and programs, and the need for a radical redesign of the current system. We propose an integrated implementation framework with recommendations for adopting business principles with innovative institutional, regulatory, financing and delivery mechanisms. The framework entails establishment of rural energy access authorities and energy access funds, both at the national and regional levels, to be empowered with enabling regulatory policies, capital resources and the support of multi-stakeholder partnership. These institutions are expected to design, lead, manage and monitor the rural energy interventions. At the other end, trained entrepreneurs would be expected to establish bioenergy-based micro-enterprises that will produce and distribute energy carriers to rural households at an affordable cost. The ESCOs will function as intermediaries between these enterprises and the international carbon market both in aggregating carbon credits and in trading them under CDM. If implemented, such a program could address the challenges of rural energy empowerment by creating access to modern energy carriers and climate change mitigation. (C) 2011 Elsevier Ltd. All rights reserved.

Foot-mounted INS for everybody - an open-source embedded implementation

We present an open-source, realtime, embedded implementation of a foot-mounted, zero-velocity-update-aided inertial navigation system. The implementation includes both hardware design and software, uses off-the-shelf components and assembly methods, and features a standard USB interface. The software is written in C and can easily be modified to run user implemented algorithms. The hardware design and the software are released under permissive open-source licenses and production files, source code, documentation, and further resources are available at www.openshoe.org. The reproduction cost for a single unit is below $800, with the inertial measurement unit making up the bulk ($700). The form factor of the implementation is small enough for it to be integrated in the sole of a shoe. A performance evaluation of the system shows a position errors for short trajectories (<;100 [m]) of ± 0.2-1% of the traveled distance, depending on the shape of trajectory.

Cognitive radio implementation for a frequency hopping primary signal

Frequency hopping communications, used in the military present significant opportunities for spectrum reuse via the cognitive radio technology. We propose a MAC which incorporates hop instant identification, and supports network discovery and formation, QOS Scheduling and secondary communications. The spectrum sensing algorithm is optimized to deal with the problem of spectral leakage. The algorithms are implemented in a SDR platform based test bed and measurement results are presented.

Asynchronous Measurement of Transient Phase-Shift Resulting From RF Receiver State-Change

In a wireless receiver, a down-converted RF signal undergoes a transient phase shift, when the gain state is changed to adjust for varying conditions in transmission and propagation. A method is developed, in which such phase shifts are detected asynchronously, and their undesirable effects on the bit error rate are corrected. The method was developed for and used in, the system-level characterization and calibration of a 65-nm CMOS UHF receiver. The phase-shifts associated with specific gain-state transitions were measured within a test framework, and used in the baseband signal processing blocks to compensate for errors, whenever the receiver anticipated a gain-state transition.

Implementation of throughput enhancing client-AP association scheme On a WLAN controller

In a typical enterprise WLAN, a station has a choice of multiple access points to associate with. The default association policy is based on metrics such as Re-ceived Signal Strength(RSS), and “link quality” to choose a particular access point among many. Such an approach can lead to unequal load sharing and diminished system performance. We consider the RAT (Rate And Throughput) policy [1] which leads to better system performance. The RAT policy has been implemented on home-grown centralized WLAN controller, ADWISER [2] and we demonstrate that the RAT policy indeed provides a better system performance.

Compositional dependence properties change in S40Se60-x,Sb-x alloys

Bulk samples of S40Se60,Sb-x (with x=10, 20, 30 and 40 at. %) were prepared from high purity chemicals by melt quenching technique. The samples compositions were confirmed by using energy dispersive analysis of X-rays. X-ray diffraction studies revealed that all the samples have poly-crystalline phase. The variation in optical properties with compositional has been investigated by X-ray photoelectron spectroscopy and Raman spectroscopy. The optical band gap of the thin films is found to be decreased with composition. Increasing Sb content was found to affect the structural and optical properties of bulk samples. The intensity of core level spectra changes with the addition of Sb clearly interprets the optical properties change due to compositional variation. The Raman shift and new peak formation in these samples clearly show the structural modifications due to Sb addition.