Long Term Care: an Emotional Journey for Family Members, January 16, 2013

Many times, moving a loved one into a long-term care facility is a true act of love and unselfishness. If the caregiver and the care recipient cannot leave the house, you have both become very isolated. Imagine mom being able to go outside her door to find someone to talk with. There are activities, meals to be shared with friends, and a barrier free area where she can roam.

ANALYSIS OF FUNCTIONAL STATUS OF ELDERLY RESIDENTS IN LONG-TERM CARE INSTITUTIONS

Objective: To evaluate the functional status of elderly residents in long-term institutions. Methods: Exploratory-descriptive study, developed in two long-term care institutions for the elderly (LTC), in city of Fortaleza, Ceará. The instruments utilized were: 1) Sociodemographic form, 2) Functional Independence Measure (FIM), and 3) International Classification of Functioning (ICF). Data was descriptively analyzed through the calculation of frequency, mean and standard deviation. Results: There was a predominance of males (n=47; 59.49%), with mean age of 74.58 (± 8.89) years, 68.35% (n=54) have been or are married, and 49.37% (n=39) are illiterate. In reference to the FIM, it was observed that the elderly perform the activities in a complete or modified mode and 18.99% (n=15) have difficulty climbing stairs. As to the association between the FIM and the ICF, in relation to self-care, it was seen that 96.20% (n=76) have no difficulty in performing tasks; 92.40% (n=73) move around without difficulty; and 98.73% (n=78) have preserved the cognition. In relation to the capacity of maintaining and controlling social interactions, all exhibit this domain preserved. Conclusion: The surveyed elderly presented good cognitive status and little dependence in activities regarding personal care, mobility and communication. The use of the ICF allows the visualization of the functionality scenario among the elderly, what can facilitate more effective health promotion strategies for this population.

The impact of indoor air quality and contaminants on respiratory health of older people living in long-term care residences in Porto

Background: persons who are 65 years or older often spend an important part of their lives indoors thus adverse indoor climate might influence their health status. Objective: to evaluate the influence of indoor air quality and contaminants on older people’s respiratory health. Design: cross-sectional study. Setting: 21 long-term care residences (LTC) in the city of Porto, Portugal. Subjects: older people living in LTC with ≥65 years old. Methods: the Portuguese version of BOLD questionnaire was administered by an interviewer to older residents able to participate (n = 143). Indoor air contaminants (IAC) were measured twice, during winter and summer in 135 areas. Mixed effects logistic regression models were used to study the association between the health questionnaire results and the monitored IAC, adjusted for age, smoking habits, gender and number of years living in the LTC. Results: cough (23%) and sputum (12%) were the major respiratory symptoms, and allergic rhinitis (18%) the main selfreported illness. Overall particulate matter up to 2.5 micrometres in size median concentration was above the reference levels both in winter and summer seasons. Peak values of particulate matter up to 10 micrometres in size (PM10), total volatile organic compounds, carbon dioxide, bacteria and fungi exceeded the reference levels. Older people exposed to PM10 above the reference levels demonstrated higher odds of allergic rhinitis (OR = 2.9, 95% CI: 1.1–7.2). Conclusion: high levels of PM10 were associated with 3-fold odds of allergic rhinitis. No association was found between indoor air chemical and biological contaminants and respiratory symptoms.

Children with Special Health Care Needs: Comparison of the Effects of Home Care Setting, Prescribed Pediatric Extended Care Setting, and Long-Term Care Setting on Child and Family Health Outcomes and Health Care Service Use

Technological advances during the past 30 years have dramatically improved survival rates for children with life-threatening conditions (preterm births, congenital anomalies, disease, or injury) resulting in children with special health care needs (CSHCN), children who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who require health and related services beyond that required by children generally. There are approximately 10.2 million of these children in the United States or one in five households with a child with special health care needs. Care for these children is limited to home care, medical day care (Prescribed Pediatric Extended Care; P-PEC) or a long term care (LTC) facility. There is very limited research examining health outcomes of CSHCN and their families. The purpose of this research was to compare the effects of home care settings, P-PEC settings, and LTC settings on child health and functioning, family health and function, and health care service use of families with CSHCN. Eighty four CSHCN ages 2 to 21 years having a medically fragile or complex medical condition that required continual monitoring were enrolled with their parents/guardians. Interviews were conducted monthly for five months using the PedsQL TM Generic Core Module for child health and functioning, PedsQL TM Family Impact Module for family health and functioning, and Access to Care from the NS-CSHCN survey for health care services. Descriptive statistics, chi square, and ANCOVA were conducted to determine differences across care settings. Children in the P-PEC settings had a highest health care quality of life (HRQL) overall including physical and psychosocial functioning. Parents/guardians with CSHCN in LTC had the highest HRQL including having time and energy for a social life and employment. Parents/guardians with CSHCN in home care settings had the poorest HRQL including physical and psychosocial functioning with cognitive difficulties, difficulties with worry, communication, and daily activities. They had the fewest hours of employment and the most hours providing direct care for their children. Overall health care service use was the same across the care settings.

Development of Advanced Combustions using Cylinder Pressure Signal

Zero-carbon powertrains development has become one of the main challenges for automotive industries around the world. Following this guideline, several approaches such as powertrain electrification, advanced combustions, and hydrogen internal combustion engines have been aimed to achieve the goal. Low Temperature Combustions, characterized by a simultaneous reduction of fuel consumption and emissions, represent one of the most studied solutions moving towards a sustainable mobility. Previous research demonstrate that Gasoline partially premixed Compression Ignition combustion is one of the most promising LTC. Mainly characterized by the high-pressure direct-injection of gasoline and the spontaneous ignition of the premixed air-fuel mixture, GCI combustion has shown a good potential to achieve the high thermal efficiency and low pollutants in compression ignited engines required by future emission regulations. Despite its potential, GCI combustion might suffer from low combustion controllability and stability, because gasoline spontaneous ignition is significantly affected by slight variations of the local in-cylinder thermal conditions. Therefore, to properly control GCI combustion assuring the maximum performance, a deep knowledge of the combustion process, i.e., gasoline auto-ignition and the effect of the control parameters on the combustion and pollutants, is mandatory. This PhD dissertation focuses on the study of GCI combustion in a light-duty compression ignited engine. Starting from a standard 1.3L diesel engine, this work describes the activities made moving toward the full conversion of the engine. A preliminary study of the GCI combustion was conducted in a “Single-Cylinder” engine configuration highlighting combustion characteristics and dependencies on the control parameters. Then, the full engine conversion was performed, and a wide experimental campaign allowed to confirm the benefits of this advanced combustion methodologies in terms of pollutants and thermal efficiency. The analysis of the in-cylinder pressure signal allowed to study in depth the GCI combustion and develop control-oriented models aimed to improve the combustion stability.

Two stroke cycle, novel combustion concepts and electrification for a new generation of internal combustion engines

The pursuit of decarbonization and increased efficiency in internal combustion engines (ICE) is crucial for reducing pollution in the mobility sector. While electrification is a long-term goal, ICE still has a role to play if coupled with innovative technologies. This research project explores various solutions to enhance ICE efficiency and reduce emissions, including Low Temperature Combustion (LTC), Dual fuel combustion with diesel and natural gas, and hydrogen integration. LTC methods like Dual fuel and Reactivity Controlled Compression Ignition (RCCI) show promise in lowering emissions such as NOx, soot, and CO2. Dual fuel Diesel-Natural Gas with hydrogen addition demonstrates improved efficiency, especially at low loads. RCCI Diesel-Gasoline engines offer increased Brake Thermal Efficiency (BTE) compared to standard diesel engines while reducing specific NOx emissions. The study compares 2-Stroke and 4-Stroke engine layouts, optimizing scavenging systems for both aircraft and vehicle applications. CFD analysis enhances specific power output while addressing injection challenges to prevent exhaust short circuits. Additionally, piston bowl shape optimization in Diesel engines running on Dual fuel (Diesel-Biogas) aims to reduce NOx emissions and enhance thermal efficiency. Unconventional 2-Stroke architectures, such as reverse loop scavenged with valves for high-performance cars, opposed piston engines for electricity generation, and small loop scavenged engines for scooters, are also explored. These innovations, alongside ultra-lean hydrogen combustion, offer diverse pathways toward achieving climate neutrality in the transport sector.

Sviluppo di un modello matematico per il controllo della massa iniettata da un iniettore GDI benzina ad alta pressione

Una delle principali sfide odierne è la volontà di ridurre l’impatto ambientale, causato dalle attività umane, riducendo le emissioni inquinanti. Per questo motivo, negli ultimi anni, i requisiti di omologazione dei motori a combustione interna sono diventati sempre più selettivi, evidenziando la necessità di utilizzare nuove e più avanzate tecnologie. Tra le possibili alternative, le nuove tecnologie che forniscono i risultati più promettenti sono le cosiddette Low Temperature Combustions (LTC). Una di esse è la Gasoline Compression Ignition (GCI) che è caratterizzata da una combustione mediante il processo di auto-accensione di un carburante tipo benzina ed è in grado di ottenere un’elevata efficienza con ridotte emissioni inquinanti. Per poter controllare correttamente una combustione GCI, è necessario realizzare un pattern di iniezioni consecutive al fine di raggiungere le condizioni termodinamiche nel cilindro per garantire l’auto-accensione della benzina. I principali problemi dovuti alla realizzazione di un’iniezione multipla sono la generazione di onde di alta pressione nel condotto di iniezione e, nel caso di iniettori Gasoline Direct Injection (GDI) solenoidali, la magnetizzazione residua dei coil dello stesso. Sia le onde di pressione che la magnetizzazione residua comportano una variazione di massa iniettata rispetto al valore previsto. In questo elaborato è presentato un modello matematico realizzato per compensare le variazioni di massa che avvengono durante un pattern di due iniezioni consecutive in un iniettore GDI benzina ad alta pressione. Con tale modello, è possibile correggere i parametri che caratterizzano le iniezioni per introdurre il quantitativo desiderato di benzina indipendentemente dal pattern selezionato.