Sleeping on a problem: the impact of sleep disturbance on intensive care patients - a clinical review

Sleep disturbance is commonly encountered amongst intensive care patients and has significant psychophysiological effects, which protract recovery and increases mortality. Bio-physiological monitoring of intensive care patients reveal alterations in sleep architecture, with reduced sleep quality and continuity. The etiological causes of sleep disturbance are considered to be multifactorial, although environmental stressors namely, noise, light and clinical care interactions have been frequently cited in both subjective and objective studies. As a result, interventions are targeted towards modifiable factors to ameliorate their impact. This paper reviews normal sleep physiology and the impact that sleep disturbance has on patient psychophysiological recovery, and the contribution that the clinical environment has on intensive care patients' sleep

OPTIMIZATION OF LIGHTWEIGHT TORPEDO ALLOCATION

When making torpedo loadout decisions, planners must consider the capacities and capabilities of different ASW units, a limited budget, and diverse adversary submarine fleets. Currently, loadout decisions for the Mk-54 lightweight torpedo are made manually, and without a systematic approach to deal with threat uncertainty. The thesis seeks to inform these decisions by using stochastic optimization to determine the type and quantity of torpedoes to loadout to U.S. surface ships, fixed-wing aircraft, and helicopters in order to face an uncertain submarine threat with a desired probability of kill. We develop two formulations of the Torpedo Allocation Stochastic Optimization Model (TASOM): TASOM-1, which minimizes the number of missed submarines; and TASOM-2, which minimizes the deviation below the probability of kill threshold. To show the value of the stochastic programming approach over the typical deterministic planning, we present a notional case designed to represent an operation where ASW units are patrolling an area for adversary submarines. We randomly generate 100 threat scenarios where the number and class of submarines deployed to the area vary. The TASOM-2 loadout notably outperforms the deterministic average loadout. Our models combined with an accessible user interface provide planners with a decision aid tool to conduct sensitivity analysis to guide torpedo allocation and budget decisions under uncertainty.Outstanding ThesisLieutenant, United States NavyApproved for public release. Distribution is unlimited

Symptom Experience in Patients with Gynecological Cancers: The Development of Symptom Clusters through Patient Narratives

The vast majority of the increasing cancer literature on physical and psychological symptom clusters is quantitative, attempting either to model clusters through statistical techniques or to test priori clusters for their strength of relationship. Narrative symptom clusters can be particularly sensitive outcomes that can generate conceptually meaningful hypotheses for symptom cluster research. We conducted a study to explore the explanation of patients about the development and coexistence of symptoms and how patients attempted to self-manage them. We collected 12-month qualitative longitudinal data over four assessment points consisting of 39 interview data sets from 10 participants with gynecological cancer. Participants' experiences highlighted the presence of physical and psychological symptom clusters, complicating the patients' symptom experience that often lasted 1 year. While some complementary and self-management approaches were used to manage symptoms, few options and interventions were discussed. The cancer care team may be able to develop strategies for a more thorough patient assessment of symptoms reported as the most bothersome and patient-centered sensitive interventions that encompass the physiological, psychological, sociocultural, and behavioral components of the symptom experience essential for effective symptom management

Uso de las redes sociales y el rendimineto académico de los alumnos de cuarto y quinto de secundaria de la Institución Educativa Newton del distrito de San Martín de Porres, 2014

El presente trabajo tiene por objetivo determinar el uso de las redes sociales y el rendimiento académico de los estudiantes de cuarto y quinto de secundaria de la Institución Educativa Particular Newton del distrito de San Martín de Porres, 2014. El problema detectado afecta a los jóvenes que se encuentran inmersos en el uso de las redes sociales de internet, ya que no asumen responsabilidades con madurez lo que puede generar problemas en su rendimiento académico teniendo en cuenta que el rendimiento académico es el nivel de aprendizaje que el estudiante adquiere. A la vez se pude observar como las redes sociales de internet van tomando importancia en la actualidad y más aún en los adolescentes que a diario hacen uso de las mismas, generando desventajas cuando existe uso excesivo causando problemas en el campo educativo, que es donde afecta principalmente. Después de la investigación realizada se determinó que las redes sociales de internet inciden de manera negativa en el rendimiento académico ya que comienzan a dedicar mayor tiempo a estar conectados en la red social que en la realización de tareas escolares. Así mismo, la metodología empleada es no experimental, de diseño transversal de nivel descriptivo correlacional. La población de estudio estuvo constituida por 192 estudiantes del 4to.y 5to. año de educación secundaria de la Institución Educativa Newton de la Unidad de Gestión Educativa Local Nº 2 de San Martín de Porres de Lima. El total de esta población de estudio, estuvo conformado por el total de estudiantes (censal). En la investigación se formuló una hipótesis general y dos hipótesis específicas

Factores en el personal de salud que limitan al adolescente el acceso a los servicios de salud y reproducción para la prevención del embarazo en el Hospital Nacional Arzobispo Loayza octubre-diciembre 2016

Identifica los factores en el personal de salud que limitan el acceso de los adolescentes que acuden a los servicios de salud y de reproducción del Hospital Nacional Arzobispo Loayza, para la prevención del embarazo. La investigación es de carácter cualitativo y ha tomado instrumentos como las historias de vida, entrevistas a profundidad y observación participante para identificar qué limita al adolescente acceder a los servicios de salud reproductiva. El trabajo se completó con el método cuantitativo mediante la aplicación de encuestas.Tesi

Impact of endometriosis on women’s lives: a qualitative study

BACKGROUND This study aimed to explore women's experiences of the impact of endometriosis and whether there are differences across three age groups. METHODS A qualitative descriptive design was conducted using semi-structured focus group discussions with 35 Australian women with endometriosis, in three age groups. All tape-recorded discussions were transcribed verbatim and read line by line to extract meaningful codes and categories using NVivo 9 software through a thematic analysis approach. Categories were then clustered into meaningful themes. RESULTS Participants' ages ranged from 17 to 53 years and had a history of 2 to 40 years living with endometriosis, with an average delay time to diagnosis of 8.1 years. Two main themes emerged: (1) experiences of living with endometriosis, and (2) impact of endometriosis on women's lives, with 14 discrete categories. The results showed similarities and differences of the impact between the three age groups. The most highlighted impacts were on marital/sexual relationships, social life, and on physical and psychological aspects in all three age groups, but with different orders of priority. Education was the second most highlighted for the 16-24 years, life opportunities and employment for the 25-34 years; and financial impact for those 35 years and above. CONCLUSIONS Our findings show that endometriosis impacts negatively on different aspects of women's lives. A better understanding of these findings could help to decrease the negative impact of endometriosis by guiding service delivery and future research to meet more effectively the needs of women and teenagers with this condition

Patients\u27 satisfaction with mental health nursing interventions in the management of anxiety: Results of a questionnaire study

Objective: Patients’ satisfaction is a significant indicator of the quality of care provided in a health setting. The purpose ofthis study was to identify aspects of mental health nursing care that are most likely to influence satisfaction with patientswho are experiencing anxiety in two private mental health care setting.Method: Study design: A survey of a sample of patients in two private mental health hospitals in Sydney, Australia wherepatients were asked to evaluate their overall experience of this episode of care and to complete the Patients’ SatisfactionQuestionnaire on specific aspects of their care for anxiety. Two hundred (200) Questionnaires were left with theparticipants to be completed at discharge, and there were 189 (94%) questionnaires returned.Results: One hundred and eighty nine patients (189) completed the survey. Representing 94% of respondents theyindicated that they were satisfied with the mental health nurses intervention for their anxiety. There were no significantdifferences found between genders, age groups, marital status, number of admissions and duration of hospitalisations. Amultiple linear regression indicated that the major determinants of patient satisfaction were emotional support and respectfor patient preferences. The results of satisfaction scores demonstrated evidence of construct validity of total scale withtotal mean rating of all domain 3.70 (SD=0.67) and Reliability coefficients for the total scale were .93, however, meanrating for the 5 domains was 3.69 (SD = 0.66).Conclusions: The finding of this preliminary patients’ satisfaction study suggests that mental health nurses withappropriate education and supervision can provide an effective therapeutic approach to patients who are experiencinganxiety in these two private mental health settings