Can course format influence the performance of students in an advanced cardiac life support (ACLS) program?

Advanced cardiac life support (ACLS) is a problem-based course that employs simulation techniques to teach the standard management techniques of cardiovascular emergencies. Its structure is periodically revised according to new versions of the American Heart Association guidelines. Since it was introduced in Brazil in 1996, the ACLS has been through two conceptual and structural changes. Detailed documented reports on the effect of these changes on student performance are limited. The objective of the present study was to evaluate the effect of conceptual and structural changes of the course on student ACLS performance at a Brazilian training center. This was a retrospective study of 3266 students divided into two groups according to the teaching model: Model 1 (N = 1181; 1999-2003) and Model 2 (N = 2085; 2003-2007). Model 2 increased practical skill activities to 75% of the total versus 60% in Model 1. Furthermore, the teaching material provided to the students before the course was more objective than that used for Model 1. Scores greater than 85% in the theoretical evaluation and approval in the evaluation of practice by the instructor were considered to be a positive outcome. Multiple logistic regression was used to adjust for potential confounders (specialty, residency, study time, opportunity to enhance practical skills during the course and location where the course was given). Compared to Model 1, Model 2 presented odds ratios (OR) indicating better performance in the theoretical (OR = 1.34; 95%CI = 1.10-1.64), practical (OR = 1.19; 95%CI = 0.90-1.57), and combined (OR = 1.38; 95%CI = 1.13-1.68) outcomes. Increasing the time devoted to practical skills did not improve the performance of ACLS students.

Basic life support knowledge of first-year university students from Brazil

We aimed to evaluate knowledge of first aid among new undergraduates and whether it is affected by their chosen course. A questionnaire was developed to assess knowledge of how to activate the Mobile Emergency Attendance Service - MEAS (Serviço de Atendimento Móvel de Urgência; SAMU), recognize a pre-hospital emergency situation and the first aid required for cardiac arrest. The students were also asked about enrolling in a first aid course. Responses were received from 1038 of 1365 (76.04%) new undergraduates. The questionnaires were completed in a 2-week period 1 month after the beginning of classes. Of the 1038 respondents (59.5% studying biological sciences, 11.6% physical sciences, and 28.6% humanities), 58.5% knew how to activate the MEAS/SAMU (54.3% non-biological vs 61.4% biological, P=0.02), with an odds ratio (OR)=1.39 (95%CI=1.07-1.81) regardless of age, sex, origin, having a previous degree or having a relative with cardiac disease. The majority could distinguish emergency from non-emergency situations. When faced with a possible cardiac arrest, 17.7% of the students would perform chest compressions (15.5% non-biological vs 19.1% biological first-year university students, P=0.16) and 65.2% would enroll in a first aid course (51.1% non-biological vs 74.7% biological, P<0.01), with an OR=2.61 (95%CI=1.98-3.44) adjusted for the same confounders. Even though a high percentage of the students recognized emergency situations, a significant proportion did not know the MEAS/SAMU number and only a minority had sufficient basic life support skills to help with cardiac arrest. A significant proportion would not enroll in a first aid course. Biological first-year university students were more prone to enroll in a basic life support course.

A Web-Based Environmental Toolkit to Support Small and Medium-Sized Enterprises in the Implementation of Their Own Environmental Management System

With small and medium sized-enterprises (SMEs) taking up the majority of the global businesses, it is important they act in an environmentally responsible manner. Environmental management systems (EMS) help companies evaluate and improve their environmental impact but they often require human, financial, and temporary resources that not all SMEs can provide. This research encompasses interviews with representatives of two small enterprises in Germany to provide insights into their understanding, and knowledge of an EMS and how they perceive their responsibility towards the environment. Furthermore, it presents a toolkit created especially for small and medium-sized enterprises that serves as a simplified version of an EMS based on the ISO 14001 standard and is evaluated by the representatives of the SMEs. Some of the findings are: while being open to the idea of improving their environmental impact, SMEs do not always feel it is their responsibility to do so; they seem to lack the means to fully implement an EMS. The developed toolkit is considered useful and usable and recommendations are drawn for its future enhancement.

Synthesis of Short Oligonucleotides on a Soluble Support by the Phosphoramidite Method

In the last decades, the chemical synthesis of short oligonucleotides has become an important aspect of study due to the discovery of new functions for nucleic acids such as antisense oligonucleotides (ASOs), aptamers, DNAzymes, microRNA (miRNA) and small interfering RNA (siRNA). The applications in modern therapies and fundamental medicine on the treatment of different cancer diseases, viral infections and genetic disorders has established the necessity to develop scalable methods for their cheaper and easier industrial manufacture. While small scale solid-phase oligonucleotide synthesis is the method of choice in the field, various challenges still remain associated with the production of short DNA and RNA-oligomers in very large quantities. On the other hand, solution phase synthesis of oligonucleotides offers a more predictable scaling-up of the synthesis and is amenable to standard industrial manufacture techniques. In the present thesis, various protocols for the synthesis of short DNA and RNA oligomers have been studied on a peracetylated and methylated β-cyclodextrin, and also on a pentaerythritol-derived support. On using the peracetylated and methylated β-cyclodextrin soluble supports, the coupling cycle was simplified by replacement of the typical 5′-O-(4,4′-dimethoxytrityl) protecting group with an acid-labile acetal-protected 5′-O-(1-methoxy-1-methylethyl) group, which upon acid-catalyzed methanolysis released easily removable volatile products. For this reason monomeric building blocks 5′-O-(1-methoxy-1-methylethyl) 3′-(2-cyano-ethyl-N,N-diisopropylphosphoramidite) were synthesized. Alternatively, on using the precipitative pentaerythritol support, novel 2´-O-(2-cyanoethyl)-5´-O-(1-methoxy-1-methylethyl) protected phosphoramidite building blocks for RNA synthesis have been prepared and their applicability by the synthesis of a pentamer was demonstrated. Similarly, a method for the preparation of short RNAs from commercially available 5´-O-(4,4´-dimethoxytrityl)-2´-O-(tert-butyldimethyl-silyl)ribonucleoside 3´-(2-cyanoethyl-N,N-diisopropylphosphoramidite) building blocks has been developed

Choosing the service support model after a merger: Case Are Ltd.

The meaning of information technology (IT) and information systems have increased during the last few years. This is mainly because business is nowadays seen more and more as a service business and IT is one of the key elements to support those business services. Since the meaning of IT services has increased also the meaning of IT service support should be a factor paid more attention to. Especially after a merger and acquisition (M&A) it is more important than ever to consider service support. The purpose of this study is to discover the best practices for choosing a suitable service support model. The research question is How to choose a service support organization model for the ERP service desk function after a merger? A qualitative method is selected as a research method. This thesis includes two parts: a literature review and a case study. Theoretical part compiles an integrated model of previous research on the topic. It consists a collection of academic articles, publications and reports. The empirical part focuses on the issues in the case organization. That part tries to answer the question: what would be the most suitable service support model for the case organization? The empirical part is conducted by interviewing the employees of the case organization. This study finds that even though there are many ways of selecting a service support model it is difficult to define an unambiguous guidelines. However, there are few main objectives that should be taken into account regardless the case. Especially by using ITIL processes it is possible to implement a comprehensive service support and raise overall awareness of the existing service support models. The main functions that need to be taken into account are nature, industry and size of the organization. Also the business strategy, goals and resources need to be considered. These are the same factors that are noticed in the case study as well. The suggestions for the case organization are presented based on the interviews and the literature review.