The study of palliative care and its relationship with quality of life in patients with chronic heart failure. in 2014-2015

Background and aims: Chronic heart failure typically results in progressive debilitation, a deteriorating quality of life and distressing symptoms, especially at the end of life. The aim of this study was to investigate palliative care and its relationship with quality of life in patients with chronic heart failure. Methods: In this descriptive analytic study, 100 patients with chronic heart failure were selected from Imam Khomeini hospital of Jiroft in 2014-2015. They were entered in the study with written satisfaction. Biographic information questionnaire, Minnesota Living With Heart Failure Questionnaire (MLHFQ), and patients care questionnaire made by researcher were used that life quality questionnaire was filled in three stages(admission time in the hospital, discharge time and a month later) and palliative care questionnaire was filled in one stage (during discharge time and after receiving health team care). Data were analyzed using descriptive statistics, Pearson's correlations, Mann -Whitney, Kruskal-wallis, Friedman tests and SPSS software at significant level (P<0.05). Results: Findings showed that the mean score of quality of life in admission time was (77.41±15.08), discharge time (66.96±15.66) and a month later (42.87±22.08). The mean of palliative care hospitalized patients was 68.73±14.59. There was a significant and positive relationship between quality of life and palliative care in the patients. This relationship between quality of life a month later and palliative care was better and more meaningful (r=-0.39) (P=0.0001) than quality of life in discharge time and palliative care (P=0.098) (r=-0.16). However, it was not observed a significant relationship between quality of life in admission time and palliative care in the patients (P=0.191). Conclusion: Palliative care is delivered rather good based on hospitalized patients' viewpoints. It can be useful to improve quality of life in chronic heart failure patients over time, so that most of patients after discharge of hospital and receiving health team cares found considerable improvement in quality of life. So, applied and continuous palliative care programs are recommended in nursing care programs

effectiveness of their teaching skills to reduce stress job psychological empowerment of nursing staff in intensive care units in the center of Shiraz Shahid Rajaee 1392 .

Background and aims: Nurses of critical care wards are faced with a number of stressors that could also threaten the ability of those affected various aspects of health and undermine the quality of their performance. The role of psychological empowerment skills training to reduce stress among working nurses in intensive care wards is unknown. This research was aimed to determine the efficacy of psychological empowerment skills training to reduce stress among working nurses in intensive care wards in medical center of Shahid Rajaee in Shiraz was conducted in 2013. Methods: In this quasi-experimental study, 120 working nurses in intensive care wards randomly divided into interventional and control groups. Then, the workshop of self-empowerment skills training was performed for experimental group and a month after their training psychological empowerment, data were collectd using Osipow questionnaire in both groups. Data was analyzed using SPSS software and t-test, ANOVA, paired t-test, Chi-square and Mann-Whitney tests. Results: The mean score of job stress before training in the control group was 256.68±14.81 in intense level and after training) without training was 265.8±5.16 in severe level. Mean stress scores before training in the intervention group was 269.26±6.18 in intense level and after training was 251.70±17.97 in moderate level. There were significant differences between stress score mean before and after intervention (P=0.002). Conclusion: According to existing stress in the nursing profession; psychological empowerment can be effective to reduce stress and increase the quality of their nurses

Self-Directed Learning Outcomes and Facilitators in Virtual Training of Graduate Students of Medical Education

Background: Although virtual training has been considered an educational emergency during the coronavirus crisis, it is still discussed in universities as a capacity. Student learning is the concern of all professors. Self-direction is an efficiency indicator in electronic learning (e-learning) widely used in effective educational systems. Objectives: The present study aimed to determine self-directed learning outcomes and facilitators in virtual course students of medical education. Methods: The statistical population of this descriptive-analytical cross-sectional study included the graduate of virtual medical education in the universities of medical sciences in Tehran, Iran, in the academic year 2019. The research instrument was the Persian version of the Self-Directed Learning Readiness Scale. Data analysis was performed using SPSS software (version 16), the indicators of descriptive statistics (e.g., mean, frequency, percentage, and standard deviation), linear regression, and Pearson correlation coefficient. Results: Out of 201 individuals, 46 (22.9%) and 155 (77.1%) students were male and female, respectively. The mean age of the students was 39.93±8.25 years. The mean values of the scores of self-directed learning outcomes and facilitators were 71.8±9.4 (out of 95) and 70.4±10.6 (out of 125), respectively. There was a direct and significant relationship between self-directed learning outcomes and facilitators (P<0.001); accordingly, with the increase of the score of facilitators, the score of self-directed learning also increased. Additionally, the variables of outcomes and facilitators had significant relationships with academic achievement (P<0.001). Conclusion: According to the study results, by increasing self-directed learning facilitators, the outcomes of this type of learning, especially students’ academic achievement, increased. Therefore, it is recommended to increase students’ participation and consolidate self-directed activities. Furthermore, by the application of technology and program appropriate to the subject of the course, professors in virtual training should strengthen and nurture students’ self-direction skills and guide them to do various assignments and activities related to their lesson objectives. Keywords: Facilitators, Self-directed Learning, Students, Medical Education, Academic Achievemen

Effect of temperature on the flexural behavior of NSM CFRP strengthened RC beams under time-dependent loading and fatigue

There is a general trend towards rehabilitation and strengthening of existing reinforced concrete (RC) structures due to the costs associated with the replacement of the structural members and the environmental impact associated with the consumption of raw materials for new constructions. In this regard, fiber reinforced polymers (FRP) are presented to be an excellent solution for strengthening purposes, being the near-surface mounted (NSM) one of the main used techniques, because of the several advantages that it provides over the traditional plate bonding (i.e. externally bonded reinforcement (EBR)) technique. However, in spite of the advantages of NSM technique, premature debonding failure is still of concern. The effectiveness of a strengthening system relies on the capacity of the joint to allow the stress transfer during the loading process, which has been acknowledged to be partially governed by the mechanical properties of the bonding agent. In this sense, epoxy adhesives are usually chosen to be the bonding agent in NSM technique. However, due to their nature, performance of epoxy adhesives can be affected by temperature, as near or beyond their glass transition temperature (Tg) their mechanical properties may change, thus affecting the behavior of the NSM strengthened member. Besides, although NSM FRP strengthening has attracted an increasing amount of research, studies are still needed to fully understand their long-term performance, which partially depends on the material’s long-term properties. In this sense, creep and shrinkage of concrete and creep of epoxy adhesive, which are dependent on environmental conditions, are of high importance. Similar to long-term loading, attention should also be given to fatigue loading, where the stiffness of the system degrades due to progressive cracking and stress/strain accumulation in the material. This work aimed to experimentally and analytically study the flexural performance of NSM carbon FRP (CFRP)-strengthened RC beams subjected to short-term, long-term and fatigue loading under different high service temperatures. To this end, the first experimental program with 14 beams has been performed, where the effect of CFRP strengthening ratio, concrete strength and applied temperatures has been evaluated. The aim was to evaluate the effect of different parameters on the short-term behavior of the beams in order to easily design the long-term and fatigue experimental programs. Analytical simulations have also been performed to predict the load-deflection responses of the tested beams, where shrinkage effects have been accounted forHi ha una tendència cada vegada més generalitzada cap a la rehabilitació i el reforç de les estructures existents de formigó armat (FA) degut als costos associats a la seva substitució i a l’impacte ambiental derivat del consum de matèries primeres associat a la nova construcció. En aquest context, els polímers reforçats amb fibres (FRP, de l’anglès fiber reinforced polymer) es presenten com una solució excel·lent per al reforç estructural, sent la tècnica del reforç inserit en el recobriment del formigó (NSM, de l’anglès near surface mounted) una de les principals tècniques emprades degut als avantatges que aquesta ofereix enfront al reforç extern (EBR, de l’anglès externally bonded reinforcement). No obstant, malgrat els avantatges del reforç NSM, la fallada prematura per desenganxament continua sent una problemàtica. L’eficàcia de qualsevol sistema de reforç estructural depèn de la capacitat de transmissió d’esforços de la unió, que depèn parcialment de les propietats mecàniques del material adherent. En aquest sentit, les resines epoxídiques son el material adherent més utilitzat en la tècnica de reforç NSM. Ara bé, degut a la naturalesa d’aquests adhesius, el seu comportament es pot veure afectat per temperatures properes o superiors a la seva temperatura de transició vítria (Tg) i poden experimentar canvis en les seves propietats mecàniques. D’altra banda, encara que el reforç amb NSM FRP ha estat objecte d’un esforç creixent en recerca, es requereixen més estudis per entendre millor el seu comportament a llarg termini. En aquest sentit, la fluència i la retracció del formigó, així com la fluència de l’epoxy, prenen una gran importància, que és de gran rellevància si es té en compte que aquests fenòmens depenen de les condicions ambientals. D’altra banda, també és necessari estudiar el comportament d’aquests elements reforçats sota càrregues de fatiga. L’objectiu d’aquest treball és l’estudi experimental i analític del comportament de bigues de FA reforçades amb FRP a base de fibres de carboni (CFRP, de l’anglès carbon fiber reinforced polimers) mitjançant la tècnica NSM, que es troben sotmeses a temperatures de servei elevades. Aquest estudi inclou el comportament instantani, el comportament a llarg termini sota càrregues mantingudes i el comportament sota càrregues de fatiga. Amb aquesta finalitat, s’ha portat a terme un primer programa experimental per investigar el comportament instantani (càrrega monotònica fins a ruptura) a flexió que incloïa un total de 14 bigues. Els paràmetres de l’estudi han estat la quantia de reforç de CFRP, el tipus de formigó i la temperatura. Per complementar aquest primer programa experimental, s’han realitzat prediccions analítiques de la relació càrrega-fletxa de les bigues assajades, en les que s’ha tingut en compte l’efecte de la retracció del formigóPrograma de Doctorat en Tecnologi

Flexural Performance and End Debonding Prediction of NSM Carbon FRP-Strengthened Reinforced Concrete Beams under Different Service Temperatures

This paper aims to evaluate the influence of relatively high service temperatures (near or beyond the glass transition temperature (Tg) of epoxy adhesive) on the flexural performance and end debonding phenomenon in near-surface mounted (NSM) carbon fiber-reinforced polymer (CFRP)-strengthened, reinforced concrete (RC) beams. To this end, an experimental program consisting of 24 beams (divided into four groups) was performed, where different parameters was combined (i.e., service temperature, steel reinforcement ratio, CFRP ratio, and concrete compressive strength). In addition, the effect of the testing temperature on the end debonding phenomenon was investigated with an analytical procedure according to fib Bulletin 90, and the predictions were compared to experimental results. Taking specimens tested at 20 &deg;C as a reference, no considerable change was observed in the ultimate load of the specimens tested below 60 &deg;C (being in the range of epoxy Tg), and all specimens failed by FRP rupture. On the other hand, the increase in testing temperature up to 70 and 85 &deg;C was followed by a decrease in the capacity of the strengthened beams and a change in failure mode, moving from FRP rupture to end debonding and concrete crushing. The analytical procedure successfully predicted the occurrence of premature end debonding failure and demonstrated that the effect of temperature on the mechanical properties of materials can be a key factor when predicting the premature end debonding in a NSM joint

Flexural Performance and End Debonding Prediction of NSM Carbon FRP-Strengthened Reinforced Concrete Beams under Different Service Temperatures

This paper aims to evaluate the influence of relatively high service temperatures (near or beyond the glass transition temperature (Tg) of epoxy adhesive) on the flexural performance and end debonding phenomenon in near-surface mounted (NSM) carbon fiber-reinforced polymer (CFRP)-strengthened, reinforced concrete (RC) beams. To this end, an experimental program consisting of 24 beams (divided into four groups) was performed, where different parameters was combined (i.e., service temperature, steel reinforcement ratio, CFRP ratio, and concrete compressive strength). In addition, the effect of the testing temperature on the end debonding phenomenon was investigated with an analytical procedure according to fib Bulletin 90, and the predictions were compared to experimental results. Taking specimens tested at 20 °C as a reference, no considerable change was observed in the ultimate load of the specimens tested below 60 °C (being in the range of epoxy Tg), and all specimens failed by FRP rupture. On the other hand, the increase in testing temperature up to 70 and 85 °C was followed by a decrease in the capacity of the strengthened beams and a change in failure mode, moving from FRP rupture to end debonding and concrete crushing. The analytical procedure successfully predicted the occurrence of premature end debonding failure and demonstrated that the effect of temperature on the mechanical properties of materials can be a key factor when predicting the premature end debonding in a NSM joint

Effect of fatigue loading on flexural performance of NSM CFRP-strengthened RC beams under different service temperatures

This paper presents an experimental work to investigate the effect of fatigue loading and high service temperature on the flexural performance of near-surface mounted (NSM) carbon fiber reinforced polymer (CFRP)-strengthened reinforced concrete (RC) beams. The experimental program included 11 beams, where the effect of the strengthening (CFRP) ratio (0.06 % and 0.18 %), fatigue load level (R1 = 0.57 and R2 = 0.38) and applied temperature (20 °C and 70 °C) have been considered. Experimental results on fatigue tests showed that high service temperature resulted in an increase in deflections and reduction in the stiffness of the specimens along the test. Moreover, the application of fatigue cycles with larger amplitude resulted in the failure of the specimens (by steel rupture), whilst specimens submitted to lower fatigue amplitude survived to the fatigue cycles. The NSM CFRP-strengthening helped to postpone the final failure of strengthened RC beams after steel reinforcement rupture during the fatigue test. Besides, damage due to fatigue derived in lower residual yielding and ultimate load in the post-fatigue test.This research was supported by the Spanish Ministry of Science and Innovation (MCIN/ AEI) under project PID2020-119015GB-C22, the Generalitat de Catalunya under the grant number 2019FI_B 00054 and mobility grant from Universitat de Girona (MOB 2021)