Cardiac rehabilitation at AUBMC : clinical protocols and the role of the advanced practice nurse -

First Reader: Dr. Samar Noureddine, Professor, Hariri School of Nursing, Faculty of Medicine ; Second Reader: Dr. Wael Al Jaroudi, Assistant professor, Internal Medicine Department, Division of Cardiology, Faculty of Medicine.Project. M.Sc. American University of Beirut. Hariri School of Nursing. Faculty of Medicine 2014. W 4 I861c 2014Includes bibliographical references (leaves 39-43)Coronary artery disease and heart failure are the two most common cardiac diseases, mandate changes in lifestyle, mainly diet, exercise, smoking cessation, in addition to taking prescribed medications in order to prevent recurrent exacerbations and to reduce cardiovascular risk. Cardiac rehabilitation programs provide the infra-structure that allows cardiac patients to change unhealthy behavior and improve their functional capacity.The history of cardiac rehabilitation started in the late 60s, since then cardiac rehabilitation is being delivered mainly by three international models: American, British, and Australian model. The evidences has shown many beneficial effects on the outcome of cardiovascular diseases patients including: reducing the risk of a future cardiac events by stabilizing, slowing, or even reversing the progression of cardiovascular diseases; improving the clinical outcomes of patients with various cardiovascular diseases; and significantly reducing the cardiovascular mortality, and hospital readmission.The aim of this project is to develop the clinical protocols and documentation forms of the cardiac rehabilitation program at American University of Beirut Medical Center (AUBMC), with an emphasis on the role of the advanced practice nurse. The proposed cardiac rehabilitation program is adapted from the three international cardiac rehabilitation models and aligned with latest guidelines of managing the risk factors of the cardiovascular diseases. The proposed cardiac rehabilitation program for AUBMC follows a clinical pathway consisting of six stages, which starts with patient presentation, then assessment and enrolling of the patient in the program, then the patient goes into in-hospital cardiac rehabilitation, after the discharge from the hospital, the patients are enrolled in out-patient rehabilitation program, the patients then are assessed at the end program, and discharged to a follow-up phase

Meat molecular detection: sensitivity of polymerase chain reaction-restriction fragment length polymorphism in species differentiation of meat from animal origin

Three restriction enzymes were used in Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) using the mitochondrial cytochrome b region to establish a differential diagnosis which detect and discriminate between three meat species: pork, cow and chicken. DNA was extracted from samples containing meat of a single animal such as raw pork (Sus scrofa domesticus), chicken (Gallus gallus) and cow (Bos taurus) as well as mixed samples of two species of animals in different ratios. The amplified 359 base pairs (bp) portion of the mitochondrial cyt b gene from pure or mixed samples in different ratios was cut using three different restriction enzymes resulting in species specific restriction fragment length polymorphism (RFLP). This technique proved to be extremely reliable in detecting the presence of low levels of target DNA obtained from a 0.25 mg component in a particular mixed meat sample. This revealed the cyt b region as highly conserved and consequently a good molecular marker for diagnostic studies. Thus, this technique can be applied to food authentication for the identification of different species of animals in food products

Optimisation opérationnelle, écologique et énergétique des groupes électrogènes diesel

RÉSUMÉ: Les générateurs diesel (GD) modernes deviennent de plus en plus complexes, et aussi sévèrement soumis à des normes internationales constamment mises à jour en termes de consommation et du respect de l'environnement. Le moindre défaut dans leurs moteurs peut engendrer une dégradation de ses performances ainsi qu'une augmentation de ses consommations et de ses émissions polluantes. Les GD sont la principale source d'énergie électrique qui alimente la plupart des régions éloignées et isolées dans le monde. Malheureusement, ces générateurs diesel posent encore d'énormes défis techniques, financiers et environnementaux. Au Canada, la majorité de la population bénéficie de l'électricité fiable, garantie et à prix abordable. Toutefois, sa production dans les communautés éloignées s'avère problématique du fait qu'ils ne sont pas connectés aux réseaux électriques nationaux. Dans ces communautés, disséminées dans tout le pays, vivent à peu près 211,000 personnes dont la plupart sont des populations autochtones (première nation, inuit et métis). Incontestablement, les GD figurent au premier rang parmi les fournisseurs. Plus précisément, 72% des communautés éloignées privilégient l'utilisation des générateurs à combustion fossile, plus particulièrement le diesel afin de s'auto-suffire en énergie électrique. En dépit de nombreux avantages qu'ils possèdent (fiabilité et stabilité), les GD présentent plusieurs inconvénients et leur usage pose de sérieux problèmes environnementaux, sociaux, économiques et techniques. En effet, dans un contexte de production d'électricité en régions éloignées, l'utilisation de GD, seuls ou en hybridation avec des sources d'énergies renouvelables fait face à des problématiques techniques bien connues. L'instabilité électrique qui caractérise souvent les réseaux isolés, qui est due au caractère fluctuant des ressources renouvelables et aux variations de la charge, induit un fonctionnement des GD en régime dynamique transitoire et/ou à faibles charges. De plus, un fonctionnement prolongé des GD à faibles niveaux de charges favorise la condensation des résidus de combustion sur les parois de cylindres de moteurs des GD ce qui, au bout d'un certain temps, augmente la friction, diminue leur rendement et accroît leur consommation en carburant et assure une usure prématurée. D'autre part, l'organisation maritime internationale (OMI) a adoptée des règles relatives aux polluants atmosphériques provenant des navires notamment des moteurs de propulsion et des GD, ainsi que des mesures obligatoires relatives au rendement énergétique ayant pour objectif de réduire les émissions de gaz à effet de serre (GES) d'au moins 50% d'ici 2050 par rapport à 2008. Des nouveaux plafonds mondiaux de la teneur en soufre du fuel-oil utilisé ainsi des limites d'émission pour les oxydes d'azotes (NOx) ont été récemment adopté poussant ainsi les manufacturiers à optimiser leurs moteurs et groupes électrogènes diesel par des technologies basées sur des solutions de prétraitement, traitement-internes et de post-traitement. Une réduction progressive des émissions a été adoptée et la création de zones de contrôle des émissions dans des zones maritimes désignées ont vu le jour.Cette thèse présente une analyse et une comparaison détaillées des différentes technologies et solutions permettant l'optimisation des performances opérationnelles, écologiques et énergétiques des GD d'un part, et les techniques les plus adaptables aux GD sans apporter de modifications majeures à l'architecture de leurs moteurs afin d'optimiser leurs performances et réduire leurs consommations de carburant, d'autre part. Elle expose également le fonctionnement des GD en sous-performances et la détection des indices de dégradation du rendement basée sur les analyses de gaz d'échappement. Elle expose de plus, une nouvelle technologie électrique brevetée au Canada, aux États-Unis et en Australie connue sous le nom de Genset-Synchro et qui n'a jamais fait l'objet d'une application commerciale ou d'un projet pilote. D'autre part, les résultats expérimentaux obtenus d ns cette thèse concernant la suralimentation d'un moteur diesel, ont démontré le grand potentiel du système hybride éolien-diesel-stockage d'air comprimé pour des applications à petite et à moyenne échelle surtout pour les communautés isolées et qui sont situées dans des régions possédant une ressource éolienne suffisante pour une exploitation commerciale. L'utilisation du jumelage éolien-diesel avec stockage d'air comprimé dans ces réseaux pourrait donc réduire les déficits d'exploitation. Finalement, pour le cas de l'industrie de transport maritime, un système de lavage de gaz a été choisi pour l'étude. De plus, une étude techno-économique a été réalisée sur les différentes technologies permettant l'optimisation écologique et énergétique des groupes électrogènes diesel marins et qui sont forcés à rencontrer les exigences relatives au contrôle des émissions des navires et la réglementation sur l'efficacité énergétique adoptés par l'OMI depuis 2015.Des simulations numériques, mathématiques, des bancs d'essais avec des tests pratiques et des analyses techno-économiques des systèmes sont de ce fait étudiés pour des applications d'électrification autonomes (hors réseau).Le contenu de la thèse est présenté sous forme de huit articles originaux publiés dans des journaux scientifiques avec comité de lecture. Chacun de ces articles fait, au moment de sa soumission, l'objet de l'état de l'avancement de l'étude, selon la méthodologie détaillée dans le chapitre I. -- Mot(s) clé(s) en français : Groupes électrogènes diesel, Optimisation, Performance, Faible charge, site isolé, Marpol Annexe VI, Alternateur Genset-Synchro, Système hybride éolien-diesel SHEDAC, Scrubber. -- ABSTRACT: Modern diesel generators are becoming more and more complex, and subject to strict international standards that are constantly updated in terms of consumption and respect for the environment. The slightest defect in their engines can lead to a deterioration in their performance as well as an increase in their consumption and pollutant emissions.Diesel generators (DGs) are the main source of electrical energy that supplies most remote and isolated areas of the world. Unfortunately, these diesel generators still pose enormous technical, financial and environmental challenges.In Canada, most of the population benefits from reliable, guaranteed and affordable electricity. However, its production in remote communities is problematic because they are not connected to the national electricity grids. Approximately 211,000 people live in these communities, spread across the country, most of whom are Aboriginal (First Nation, Inuit and Métis). There is no doubt that diesel generators are the leading supplier. More specifically, 72% of remote communities favor the use of fossil fuel generators, particularly diesel, to self-sufficient in electrical energy.Despite their many advantages (reliability and stability), DGs have several disadvantages and their use poses serious environmental, social, economic and technical problems. Indeed, in a context of electricity production in remote regions, the use of DG, alone or in hybridization with renewable energy sources, faces well-known technical problems. The electrical instability that often characterizes isolated networks, which is due to the fluctuating nature of renewable resources and load variations, induces the operation of DGs in a transient dynamic regime and/or at low loads. In addition, prolonged operation of low load DGs promotes the condensation of combustion residues on the walls of DG engine cylinders, which, over time, increases friction, reduces their efficiency and increases fuel consumption and ensures premature wear.On the other hand, the International Maritime Organization (IMO) has adopted rules on air pollutants from ships, including propulsion engines and DGs, as well as mandatory energy efficiency measures aimed at reducing greenhouse gas (GHG) emissions by at least 50% by 2050 compared to 2008. New global caps on the Sulphur content of fuel oil used and emission limits for nitrogen oxides (NOx) have recently been adopted, pushing manufacturers to optimize their diesel engines and generators with technologies based on pre-treatment, internal treatment and post-treatment solutions. A gradual reduction of emissions has been adopted and the creation of emission control areas in designated marine areas has been initiated.This thesis presents a detailed analysis and comparison of the different technologies and solutions allowing the optimization of the operational, ecological and energy performance of DGs on the one hand, and the techniques most adaptable to DGs without making major modifications to the architecture of their engines in order to optimize their performance and reduce their fuel consumption, on the other hand. It also discusses the operation of underperforming DGs, and the detection of performance degradation indices based on exhaust gas analyses. It also features a new electrical technology patented in Canada, the United States and Australia known as Genset-Synchro that has never been commercially applied or piloted before.On the other hand, the experimental results obtained in this thesis concerning the supercharging of a diesel engine, have demonstrated the great potential of the hybrid wind-diesel-compressed air storage system for small and medium scale applications, especially for communities that are located in regions with sufficient wind resources for commercial operation. The use of wind/diesel twinning with compressed air storage in these networks could therefore reduce operating deficits.Finally, in the case of the shipping industry, a gas washing system (closed-loop scrubber) was chosen for the study. In addition, a techno-economic s udy was carried out on the various technologies that allow the ecological and energy optimization of marine diesel generators and that are forced to meet the ship emission control requirements and the ship energy efficiency regulations adopted by the IMO and coming into force in 2015. Numerical and mathematical simulations, test benches with practical tests and techno-economic analyses of the systems are therefore studied for autonomous (off-grid) electrification applications.The content of the thesis is presented in the form of eight original articles published in peer-reviewed scientific journals. Each of these articles is, at the time of its submission, the subject of the study's progress report, according to the methodology detailed in Chapter I. -- Mot(s) clé(s) en anglais : Diesel generator sets, Optimization, Performance, Low charge, isolated site, Marpol Annex VI, Genset-Synchro alternator, SHEDAC-wind diesel hybrid system, Scrubber

Examining Factors in Preventing Foodborne Diseases among Food Handlers at Military Dining Hall

This study aims to determine Food Safety (FS) knowledge, practice in preventing Foodborne Disease (FBD), and risk perception related to food handling among food handlers at military bases. An Optimistic Bias (OB) in preventing FBD were examined based on the risk perception responses. A set of questionnaires was sent to an officer at each military base in Malaysia. Later, the officer would conveniently distribute the questionnaire to approximately half of the targeted respondents. A total of 284 data were gathered and were analysed using SPSS version 20. The findings revealed that food handlers had good FS knowledge scores and practice to prevent FBD. However, it was found that different risk perception levels were present, indicating OB. The existence of OB was observed in all comparisons and situations except for the question about sanitising utensils. Hence, a conclusion can be made that there is a tendency that food handlers tend to neglect and overlook FS procedures, and can contaminate foods due to the presence of OB. This study will contribute significantly to military foodservice establishments in Malaysia regarding food hygiene and safety awareness

THE JOINT EFFECTS OF CLIMATE CHANGE AND URBANIZATION ON THE DISTRIBUTION OF STREAMFLOW MAGNITUDES IN THE MARYLAND PIEDMONT REGION

This thesis examines the effect of climate and land use change on streamflow distributions in six urbanizing watersheds in the Maryland Piedmont region, and produces future predictions under three proposed scenarios of future climate and land use varying individually and then jointly. Future climate is modeled using precipitation and temperature predictions from the CCC and Hadley models. Two approaches are used to predict future streamflows: a regression model approach, and a continuous streamflow model approach. Trend tests at a 5% level of significance are used to statistically quantify emerging trends in the simulated climate and streamflow time series. Precipitation is the dominant factor and generally controls the directionality of trends in streamflows. Temperature has less influence on low flows and no apparent effect on peak flows. Land use change has caused low flows to be slightly smaller and peak flows slightly larger, but no significant trends were detected

Leadership Styles among the Administrative Heads of Departments at Irbid University College and its Relationship with Employees' Motivation Toward Work

The present study aimed to detect the type of leadership for heads of departments administrators in Irbid University College and its relationship with employees' motivation toward work, and to achieve these objectives administrated  leadership style scale, and motivation towards work scale on a sample of 123 workers in Irbid University College for the academic year 2015 / 2016, after its achieved validity and reliability, the results showed that (Democratic) style from the standpoint of workers in Irbid university College and the workers have high level of motivation towards work, and there is statistically significant negative relationship at the level of statistical (α = 0.05) between the leadership style (dictatorship) and motivation of workers in Irbid university College towards the work, and there is statistically significant positive relationship at the level of statistical (α = 0.05) between the leadership style (Democratic) and motivation of workers in Irbid university College towards the work. Keywords: leadership style, department heads, Irbid University College, motivation towards wor

PENGARUH PENGGUNAAN EKSTRAK KULIT KACANG TANAH DAN BAKTERI Bacillus cereus DAN Lactobacillus bulgaricus TERHADAP PENURUNAN AMONIA EKSKRETA AYAM KAMPUNG

Penelitian ini bertujuan untuk mengetahui pengaruh sinbiotik dari kombinasi Bacillus cereus dan Lactobacillus bulgaricus dengan ekstrak kulit kacang tanah untuk menurunkan kadar amonia, pH, dan kadar air ekskreta ayam kampung. Metode yang digunakan yaitu eksperimental rancangan acak lengkap (RAL) dengan 4 perlakuan dan 5 ulangan. Perlakuan penambahan sinbiotik terdiri dari konsentrasi 0% (P0) sebagai kontrol, 3% (P1), 6% (P2), 9% (P3). Parameter yang diukur meliputi kadar amonia, pH dan kadar air. Data yang diperoleh dianalisis menggunakan ANOVA dan dilanjutkan dengan uji Duncan Multiple Range Test. Hasil analisis menunjukkan bahwa terdapat pengaruh nyata konsentrasi sinbiotik dari kombinasi Bacillus cereus dan Lactobacillus bulgaricus dengan ekstrak kulit kacang tanah terhadap kadar amonia setelah inkubasi 12 jam, kadar pH setelah inkubasi 36 jam dan kadar air setelah inkubasi 36 jam. Perlakuan penambahan sinbiotik kurang efektif untuk menurunkan kadar amonia ekskreta ayam kampung diduga probiotik yang digunakan tidak mampu beradaptasi di dalam ekskreta sehingga mengganggu proses metabolisme primer dan sekunder