Development and feasibility testing of an education program to improve knowledge and self-care among Aboriginal and Torres Strait Islander patients with heart failure

Background/Aim There is a 70% higher age-adjusted incidence of heart failure (HF) amongst Aboriginal and Torres Strait Islander people, three times more hospitalisations and twice as many deaths than non-Aboriginal people. There is a need to develop holistic yet individualised approaches in accord with the values of Aboriginal community healthcare to support patient education and self-care. The aim of this study was to re-design an existing HF educational resource (Fluid Watchers-Pacific Rim©) to be culturally safe for Aboriginal and Torres Strait Islander peoples, working in collaboration with the local community, and to conduct feasibility testing. Methods This study was conducted in two phases and utilised a mixed methods approach (qualitative and quantitative). Phase 1 of this study used action research methods to develop a culturally safe electronic resource to be provided to Aboriginal HF patients via a tablet computer. A HF expert panel adapted the existing resource to ensure it was evidence-based and contained appropriate language and images that reflects Aboriginal culture. A stakeholder group (which included Aboriginal workers and HF patients, as well as researchers and clinicians) then reviewed the resources and changes were made accordingly. In Phase 2, the new resource was tested on a sample of Aboriginal HF patients to assess feasibility and acceptability. Patient knowledge, satisfaction and self-care behaviours were measured using a before and after design with validated questionnaires. As this was a pilot test to determine feasibility, no statistical comparisons were made. Results - Phase 1: Throughout the process of resource development, two main themes emerged from the stakeholder consultation. These were the importance of identity, meaning that it was important to ensure that the resource accurately reflected the local community, with the appropriate clothing, skin tone and voice. The resource was adapted to reflect this and of the local community voiced the recordings for the resource. The other theme was comprehension; images were important and all text was converted to the first person and used plain language. - Phase 2: Five Aboriginal participants, mean age 61.6 ± 10.0 years, with NYHA Class III and IV heart failure were enrolled. Participants reported a high level of satisfaction with the resource (83.0%). HF knowledge (percentage of correct responses) increased from 48.0 ± 6.7% to 58.0 ± 9.7%, a 20.8% increase and results of the self-care index indicated that the biggest change was in patient confidence for self-care with a 95% increase in confidence score (46.7 ± 16.0 to 91.1 ± 11.5). Changes in management and maintenance scores varied between9275 patients. Conclusion By working in collaboration with HF experts, Aboriginal researchers and patients, a culturally safe HF resource has been developed for Aboriginal and Torres Strait Islander patients. Engaging Aboriginal researchers, capacity-building, and being responsive to local systems and structures enabled this pilot study to be successfully completed with the Aboriginal community and positive participant feedback demonstrated that the methodology used in this study was appropriate and acceptable; participants were able to engage with willingness and confidence.

Causes and control of cracking in concrete reinforced with high-strength steel bars : a review of research /

Mode of access: Internet.

Coating and corrosion costs of highway structural steel report /

Mode of access: Internet.

Statistics of the American and foreign iron trades /

Vols. for 1879-84 have subtitle: Annual report of the Secretary; for 1885-1911: Annual statistical report of the American Iron and Steel Association; for 1912: Annual statistical report of the Bureau of Statistics of the American Iron and Steel Institute.

Rules for the classification and construction of steel ships.

At head of title: American bureau of shipping, incorporated by act of the legislature of the state of New York, 1862; united with the Great Lakes register in 1916.

Specifications for making and laying 54" wrought iron pipe, asphaltum coating for pipes, & for the manufacture of flange boiler iron.

Mode of access: Internet.

An introductory outline of the practice of ship-building, &c. &c. /

Bound with: Appendix I containing directions for the repairs of ships / by John Fincham. Portsea : Printed by W. Woodward, 1824.

Blast furnace and steel plant.

"The engineering authority of the steel industry."

History of the manufacture of iron in all ages, and particularly in the United States from colonial time to 1891. Also a short history of early coal mining in the United States ...

Mode of access: Internet.

The American steel worker; a twenty-five years' experience in the selection, annealing, working, hardening and tempering of various kinds and grades of steel,

Mode of access: Internet.

Effect of sample geometry on regression rate of the melting interface for carbon steel burned in oxygen

Promoted-ignition testing on carbon steel rods of varying cross-sectional area and shape was performed in high pressure oxygen to assess the effect of sample geometry on the regression rate of the melting interface. Cylindrical and rectangular geometries and three different cross sections were tested and the regression rates of the cylinders were compared to the regression rates of the rectangular samples at test pressures around 6.9 MPa. Tests were recorded and video analysis used to determine the regression rate of the melting interface by a new method based on a drop cycle which was found to provide a good basis for statistical analysis and provide excellent agreement to the standard averaging methods used. Both geometries tested showed the typical trend of decreasing regression rate of the melting interface with increasing cross-sectional area; however, it was shown that the effect of geometry is more significant as the sample's cross sections become larger. Discussion is provided regarding the use of 3.2-mm square rods rather than 3.2-mm cylindrical rods within the standard ASTM test and any effect this may have on the observed regression rate of the melting interface.

Experimental and Analytical Methodologies for Predicting Peak Loads on Building Envelopes and Roofing Systems

The performance of building envelopes and roofing systems significantly depends on accurate knowledge of wind loads and the response of envelope components under realistic wind conditions. Wind tunnel testing is a well-established practice to determine wind loads on structures. For small structures much larger model scales are needed than for large structures, to maintain modeling accuracy and minimize Reynolds number effects. In these circumstances the ability to obtain a large enough turbulence integral scale is usually compromised by the limited dimensions of the wind tunnel meaning that it is not possible to simulate the low frequency end of the turbulence spectrum. Such flows are called flows with Partial Turbulence Simulation. In this dissertation, the test procedure and scaling requirements for tests in partial turbulence simulation are discussed. A theoretical method is proposed for including the effects of low-frequency turbulences in the post-test analysis. In this theory the turbulence spectrum is divided into two distinct statistical processes, one at high frequencies which can be simulated in the wind tunnel, and one at low frequencies which can be treated in a quasi-steady manner. The joint probability of load resulting from the two processes is derived from which full-scale equivalent peak pressure coefficients can be obtained. The efficacy of the method is proved by comparing predicted data derived from tests on large-scale models of the Silsoe Cube and Texas-Tech University buildings in Wall of Wind facility at Florida International University with the available full-scale data. For multi-layer building envelopes such as rain-screen walls, roof pavers, and vented energy efficient walls not only peak wind loads but also their spatial gradients are important. Wind permeable roof claddings like roof pavers are not well dealt with in many existing building codes and standards. Large-scale experiments were carried out to investigate the wind loading on concrete pavers including wind blow-off tests and pressure measurements. Simplified guidelines were developed for design of loose-laid roof pavers against wind uplift. The guidelines are formatted so that use can be made of the existing information in codes and standards such as ASCE 7-10 on pressure coefficients on components and cladding.

GEOTECHNICAL AND ENVIRONMENTAL IMPACTS OF STEEL SLAG IN EMBANKMENTS

Steel slag is a byproduct of iron and steel production by the metallurgical industries. Annually, 21 million tons of steel slag is produced in the United States. Most of the slag is landfilled, which represents a significant economic loss and a waste of valuable land space. Steel slag has great potential for the construction of highway embankments; however, its use has been limited due to its high swelling potential and alkalinity. The swelling potential of steel slags may lead to deterioration of the structural stability of highways, and high alkalinity poses an environmental challenge as it affects the leaching behavior of trace metals. This study seeks a methodology that promotes the use of steel slag in highway embankments by minimizing these two main disadvantages. Accelerated swelling tests were conducted to evaluate the swelling behavior of pure steel slag and water treatment residual (WTR) treated steel slag, where WTR is an alum-rich by-product of drinking water treatment plants. Sequential batch tests and column leach tests, as well as two different numerical analyses, UMDSurf and WiscLEACH, were carried out to check the environmental suitability of the methods. Tests were conducted to study the effect of a common borrow fill material that encapsulated the slag in the embankment and the effects of two subgrade soils on the chemical properties of slag leachate. The results indicated that an increase in WTR content in the steel slag-WTR mixtures yields a decrease in pH and most of the leached metal concentrations, except aluminum. The change in the levels of pH, after passing through encapsulation and subgrade, depends on the natural pHs of materials.

Experimental and analytical methodologies for predicting peak loads on building envelopes and roofing systems

The performance of building envelopes and roofing systems significantly depends on accurate knowledge of wind loads and the response of envelope components under realistic wind conditions. Wind tunnel testing is a well-established practice to determine wind loads on structures. For small structures much larger model scales are needed than for large structures, to maintain modeling accuracy and minimize Reynolds number effects. In these circumstances the ability to obtain a large enough turbulence integral scale is usually compromised by the limited dimensions of the wind tunnel meaning that it is not possible to simulate the low frequency end of the turbulence spectrum. Such flows are called flows with Partial Turbulence Simulation.^ In this dissertation, the test procedure and scaling requirements for tests in partial turbulence simulation are discussed. A theoretical method is proposed for including the effects of low-frequency turbulences in the post-test analysis. In this theory the turbulence spectrum is divided into two distinct statistical processes, one at high frequencies which can be simulated in the wind tunnel, and one at low frequencies which can be treated in a quasi-steady manner. The joint probability of load resulting from the two processes is derived from which full-scale equivalent peak pressure coefficients can be obtained. The efficacy of the method is proved by comparing predicted data derived from tests on large-scale models of the Silsoe Cube and Texas-Tech University buildings in Wall of Wind facility at Florida International University with the available full-scale data.^ For multi-layer building envelopes such as rain-screen walls, roof pavers, and vented energy efficient walls not only peak wind loads but also their spatial gradients are important. Wind permeable roof claddings like roof pavers are not well dealt with in many existing building codes and standards. Large-scale experiments were carried out to investigate the wind loading on concrete pavers including wind blow-off tests and pressure measurements. Simplified guidelines were developed for design of loose-laid roof pavers against wind uplift. The guidelines are formatted so that use can be made of the existing information in codes and standards such as ASCE 7-10 on pressure coefficients on components and cladding.^