Effect of a video on developing skills in undergraduate nursing students for the management of totally implantable central venous access ports

Background: Handling Totally Implantable Access Ports (TIAP) is a nursing procedure that requires skill and knowledge to avoid adverse events. No studies addressing this procedure with undergraduate students were identified prior to this study. Communication technologies, such as videos, have been increasingly adopted in the teaching of nursing and have contributed to the acquisition of competencies for clinical performance. Objective: To evaluate the effect of a video on the puncture and heparinization of TIAP in the development of cognitive and technical competencies of undergraduate nursing students. Method: Quasi-experimental study with a pretest-posttest design. Results: 24 individuals participated in the study. Anxiety scores were kept at levels 1 and 2 in the pretest and posttest. In relation to cognitive knowledge concerning the procedure, the proportion of correct answers in the pretest was 0.14 (SD=0.12) and 0.90 in the posttest (SD=0.05). After watching the video, the average score obtained by the participants in the mock session was 27.20. Conclusion: The use of an educational video with a simulation of puncture and heparinization of TIAP proved to be a strategy that increased both cognitive and technical knowledge. This strategy is viable in the teaching-learning process and is useful as a support tool for professors and for the development of undergraduate nursing students. (C) 2011 Elsevier Ltd. All rights reserved.

Long-Term Follow-Up of Implantable Cardioverter-Defibrillator for Secondary Prevention in Chagas' Heart Disease

Assessing the efficacy of implantable cardioverter-defibrillators (ICD) in patients with Chagas' heart disease (ChHD) and identifying the clinical predictors of mortality and ICD shock during long-term follow-up. ChHD is associated with ventricular tachyarrhythmias and an increased risk of sudden cardiac death. Although ChHD is a common form of cardiomyopathy in Latin American ICD users, little is known about its efficacy in the treatment of this population. The study cohort included 116 consecutive patients with ChHD and an ICD implanted for secondary prevention. Of the 116 patients, 83 (72%) were men; the mean age was 54 +/- 10.7 years. Several clinical variables were tested in a multivariate Cox model for predicting long-term mortality. The average follow-up was 45 +/- 32 months. New York Heart Association class I-II developed in 83% of patients. The mean left ventricular ejection fraction was 42 +/- 16% at implantation. Of the 116 patients, 58 (50%) had appropriate shocks and 13 (11%) had inappropriate therapy. A total of 31 patients died (7.1% annual mortality rate). New York Heart Association class III (hazard ratio [HR] 3.09, 95% confidence interval 1.37 to 6.96, p = 0.0064) was a predictor of a worse prognosis. The left ventricular ejection fraction (HR 0.972, 95% confidence interval 0.94 to 0.99, p = 0.0442) and low cumulative right ventricular pacing (HR 0.23, 95% confidence interval 0.11 to 0.49, p = 0.0001) were predictors of better survival. The left ventricular diastolic diameter was an independent predictor of appropriate shock (I-ER 1.032, 95% confidence interval 1.004 to 1.060, p = 0.025). In conclusion, in a long-term follow-up, ICD efficacy for secondary sudden cardiac death prevention in patients with ChHD was marked by a favorable annual rate of all-cause mortality (7.1%); 50% of the cohort received appropriate shock therapy. New York Heart Association class III and left ventricular ejection fraction were independent predictors of worse prognosis, and low cumulative right ventricular pacing defined better survival. (C) 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:1040-1045)

Totally implantable venous catheters: insertion via internal jugular vein with pocket implantation in the arm is an alternative for diseased thoracic walls

Purpose: Insertion of totally implantable catheters via deep vessels that drain into the superior vena cava results in a lower incidence of venous thrombosis and infection as compared to catheters inserted into femoral and arm veins. Superior vena cava obstruction and inadequacy of the thoracic wall are conditions that prevent reservoir implantation in the chest wall. In this article, we describe a technical innovation that enables the pocket to be fixed in the arm while still allowing access to be achieved via the internal jugular vein. Method: The procedure reported maintains the use of the internal jugular vein for access even when the patient's chest is not suited for reservoir implantation, which is localized in the arm. Results: The procedure was successful and no complications occurred. The position of the catheter tip did not alter with arm movement. Conclusion: The implantation of a port reservoir in the arm following venous access via the internal jugular vein is both safe and convenient.

The influence of different indium-composition profiles on the electronic structure of lens-shaped InxGa1-xAs quantum dots

We present effective-mass calculations of the bound-state energy levels of electrons confined inside lens-shaped InxGa1-xAs quantum dots (QDs) embedded in a GaAs matrix, taking into account the strain as well as the In gradient inside the QDs due to the strong In segregation and In-Ga intermixing present in the InxGa1-xAs/GaAs system. In order to perform the calculations, we used a continuum model for the strain, and the QDs and wetting layer were divided into their constituting monolayers, each one with a different In concentration, to be able to produce a specific composition profile. Our results clearly show that the introduction of such effects is very important if one desires to correctly reproduce or predict the optoelectronic properties of these nanostructures.

Effect of aspherical and yellow tinted intraocular lens on blue-on-yellow perimetry

PURPOSE: To investigate the possible effect of aspherical or yellow tinted intraocular lens (IOL) on contrast sensitivity and blue-on-yellow perimetry. METHODS: This prospective randomized bilateral double-masked clinical study included 52 patients with visually significant bilateral cataracts divided in two groups; 25 patients (50 eyes) received aspherical intraocular lens in one eye and spherical intraocular lens in the fellow eye; and 27 patients (54 eyes) received ultraviolet and blue light filter (yellow tinted) IOL implantation in one eye and acrylic ultraviolet filter IOL in the fellow eye. The primary outcome measures were contrast sensitivity and blue-on-yellow perimetry values (mean deviation [MD] and pattern standard deviation [PSD]) investigated two years after surgery. The results were compared intra-individually. RESULTS: There was a statistically significant between-group (aspherical and spherical intraocular lens) difference in contrast sensitivity under photopic conditions at 12 cycles per degree and under mesopic conditions at all spatial frequencies. There were no between-group significant differences (yellow tinted and clear intraocular lens) under photopic or mesopic conditions. There was no statistically significant difference between all intraocular lens in MD or PSD. CONCLUSION: Contrast sensitivity was better under mesopic conditions with aspherical intraocular lens. Blue-on-yellow perimetry did not appear to be affected by aspherical or yellow tinted intraocular lens. Further studies with a larger sample should be carried out to confirm or not that hypotheses.

Luminescence quantum efficiency at 1.5 µm of Er3+- doped tellurite glass determined by thermal lens spectroscopy

Erbium doped tellurite glasses (TeO2 + Li2O + TiO2) were prepared by conventional melt-quenching method to study the influence of the Er3+ concentration on the luminescence quantum efficiency (η) at 1.5 µm. Absorption and luminescence data were used to characterize the samples, and the η parameter was measured using the well-known thermal lens spectroscopy. For low Er3+ concentration, the measured values are around 76%, and the concentration behavior of η shows Er-Er and Er-OH- interactions, which agreed with the measured lifetime values.

Law and Science through the Lens of Patent Law and Software Agents

In this investigation I look at patents and software agents as a way to study broader relation between law and science (the latter term broadly understood as inclusive of science and technology). The overall premise framing the entire discussion, my basic thesis, is that this relation, between law and science, cannot be understood without taking into account a number of intervening factors identifying which makes it necessary to approach the question from the standpoint of fields and disciplines other than law and science themselves.

Knots and links in lens spaces

The aim of this dissertation is to improve the knowledge of knots and links in lens spaces. If the lens space L(p,q) is defined as a 3-ball with suitable boundary identifications, then a link in L(p,q) can be represented by a disk diagram, i.e. a regular projection of the link on a disk. In this contest, we obtain a complete finite set of Reidemeister-type moves establishing equivalence, up to ambient isotopy. Moreover, the connections of this new diagram with both grid and band diagrams for links in lens spaces are shown. A Wirtinger-type presentation for the group of the link and a diagrammatic method giving the first homology group are described. A class of twisted Alexander polynomials for links in lens spaces is computed, showing its correlation with Reidemeister torsion. One of the most important geometric invariants of links in lens spaces is the lift in 3-sphere of a link L in L(p,q), that is the counterimage of L under the universal covering of L(p,q). Starting from the disk diagram of the link, we obtain a diagram of the lift in the 3-sphere. Using this construction it is possible to find different knots and links in L(p,q) having equivalent lifts, hence we cannot distinguish different links in lens spaces only from their lift. The two final chapters investigate whether several existing invariants for links in lens spaces are essential, i.e. whether they may assume different values on links with equivalent lift. Namely, we consider the fundamental quandle, the group of the link, the twisted Alexander polynomials, the Kauffman Bracket Skein Module and an HOMFLY-PT-type invariant.

Design and experimental characterization of antennas and wireless systems for innovative wearable and implantable ultra low–power applications

The present PhD thesis exploits the design skills I have been improving since my master thesis’ research. A brief description of the chapters’ content follows. Chapter 1: the simulation of a complete front–end is a very complex problem and, in particular, is the basis upon which the prediction of the overall performance of the system is possible. By means of a commercial EM simulation tool and a rigorous nonlinear/EM circuit co–simulation based on the Reciprocity Theorem, the above–mentioned prediction can be achieved and exploited for wireless links characterization. This will represent the theoretical basics of the entire present thesis and will be supported by two RF applications. Chapter 2: an extensive dissertation about Magneto–Dielectric (MD) materials will be presented, together with their peculiar characteristics as substrates for antenna miniaturization purposes. A designed and tested device for RF on–body applications will be described in detail. Finally, future research will be discussed. Chapter 3: this chapter will deal with the issue regarding the exploitation of renewable energy sources for low–energy consumption devices. Hence the problem related to the so–called energy harvesting will be tackled and a first attempt to deploy THz solar energy in an innovative way will be presented and discussed. Future research will be proposed as well. Chapter 4: graphene is a very promising material for devices to be exploited in the RF and THz frequency range for a wide range of engineering applications, including those ones marked as the main research goal of the present thesis. This chapter will present the results obtained during my research period at the National Institute for Research and Development in Microtechnologies (IMT) in Bucharest, Romania. It will concern the design and manufacturing of antennas and diodes made in graphene–based technology for detection/rectification purposes.

Radio follow-up of the gamma-ray flaring gravitational lens B0218+357

B0218+357 è un blazar soggetto al lensing che si trova a z=0.944. Questo sistema consiste in due componenti compatte (A e B) e un anello di Einstein. Recentemente è stato associato ad una sorgente gamma soggetta a burst osservata con il satellite Fermi-LAT. Questo blazar ha mostrato una forte variabilità in banda γ da agosto a settembre del 2012. Gli episodi di variabilità osservati hanno consentito di misurare per la prima volta in banda gamma il ritardo temporale previsto dalla teoria del lensing gravitazionale. Le osservazioni in banda gamma sono state seguite da un programma di monitoring con il Very Long Baseline Array (VLBA) in banda radio con lo scopo di verificare l’esistenza di una correlazione tra l’emissione nelle due bande. In questa Tesi tali osservazioni radio sono state analizzate con lo scopo di studiare la variabilità di B0218+357 e, quindi, attestare la connessione tra l’emissione alle alte energie e quella in banda radio. L’obiettivo principale di questo lavoro di Tesi è quello di studiare l’evoluzione della densità di flusso, dell’indice spettrale e della morfologia delle immagini A e B e delle loro sottocomponenti. I dati analizzati sono stati ottenuti con l’interferometro VLBA a tre frequenze di osser- vazione: 2.3, 8.4 GHz (4 epoche con osservazioni simultanee alle due frequenze) e 22 GHz (16 epoche). Le osservazioni hanno coperto un periodo di circa due mesi, subito successivo al flare in banda gamma. La riduzione dei dati è stata effettuata con il pacchetto AIPS. Dall’analisi delle immagini, nella componente B è possibile riconoscere la tipica struttura nucleo-getto chiaramente a tutte e tre le frequenze, invece nella componente A questa struttura è identificabile solo a 22 GHz. A 2.3 e 8.4 GHz la risoluzione non è sufficiente a risolvere nucleo e getto della componente A e l’emissione diffusa risulta dominante. Utilizzando il metodo dello stacking sulle immagini a 2.3 GHz, è stato possibile rivelare le parti più brillanti dell’Einstein ring associato a questa sorgente. Questo è stato possibile poiché la sorgente non ha mostrato alcun segno di variabilità significativa né di struttura né di flusso nelle componenti. Quindi dall’analisi delle curve di luce delle due componenti A e B non è emersa una variabilità significativa chiaramente associabile al flare osservato in banda gamma. Per verificare questo risultato, le curve di luce ottenute sono state confrontate con le osservazioni del radio telescopio OVRO (15 GHz) nel periodo corrispondente alle nostre osservazioni. La curva di luce OVRO è risultata in pieno accordo con le curve di luce ottenute durante questo lavoro di tesi e ha confermato che B0218+257 non ha mostrato un’importante attività radio nel periodo delle osservazioni VLBA. In definitiva, la mancanza di variabilità radio associata a quella osservata nei raggi gamma può essere dovuta al fatto che la regione in cui si è originato il flare gamma è otticamente spessa alle lunghezze d’onda radio, oppure non esiste una precisa correlazione tra le due emissioni, rimanendo quindi un problema aperto da investigare.

Fibered knots and links in lens spaces

La tesi propone alcuni esempi di link fibrati in spazi lenticolari. Sfruttando la compatibilità fra le mosse di chirurgia intera e la nozione di open book decomposition, si ricava un esempio di link fibrato prima in L(p,1), per poi generalizzarlo a L(p,q). Si conclude determinando una struttura di contatto equivalente alla open book relativa agli spazi del tipo L(p,1).

Development and in-vitro characterization of an implantable flow sensing transducer for hydrocephalus

An implantable transducer for monitoring the flow of Cerebrospinal fluid (CSF) for the treatment of hydrocephalus has been developed which is based on measuring the heat dissipation of a local thermal source. The transducer uses passive telemetry at 13.56 MHz for power supply and read out of the measured flow rate. The in vitro performance of the transducer has been characterized using artificial Cerebrospinal Fluid (CSF) with increased protein concentration and artificial CSF with 10\% fresh blood. After fresh blood was added to the artificial CSF a reduction of flow rate has been observed in case that the sensitive surface of the flow sensor is close to the sedimented erythrocytes. An increase of flow rate has been observed in case that the sensitive surface is in contact with the remaining plasma/artificial CSF mix above the sediment which can be explained by an asymmetric flow profile caused by the sedimentation of erythrocythes having increased viscosity compared to artificial CSF. After removal of blood from artificial CSF, no drift could be observed in the transducer measurement which could be associated to a deposition of proteins at the sensitive surface walls of the packaged flow transducer. The flow sensor specification requirement of +-10\% for a flow range between 2 ml/h and 40 ml/h. could be confirmed at test conditions of 37 degrees C.

Chronic posttraumatic stress and its predictors in patients living with an implantable cardioverter defibrillator

Patients with an implantable cardioverter defibrillator (ICD) show clinically relevant depression and anxiety, but little is known about their levels of posttraumatic stress. We assessed chronic posttraumatic stress attributable to a traumatic cardiac event and its predictors in patients at two time points after ICD placement.