Дисертації з теми "Rapid response systems"

Prevention of in-hospital cardiac arrest (IHCA) is critical to reducing morbidity and mortality as both the rates of return to pre-hospital functional status and overall survival after IHCAs are low. Early identification of patients at risk and prompt clinical intervention are vital patient safety strategies to reduce IHCA. One widespread strategy is the Rapid Response System (RRS), which incorporates early risk identification, expert consultation, and key clinical interventions to bedside nurses caring for patients in clinical deterioration. However, evidence of RRS effectiveness has been equivocal in the patient safety literature. This study utilized a holistic Realistic Evaluation (RE) framework to identify important clinical environment (context) and system triggers (mechanisms) to refine our understanding of an RRS to improve local patient emoutcomesem and develop a foundation for building the next level of evidence within RE research. The specific aims of the study are to describe a RRS through context, mechanism, and outcome variables; explore differences in RRS outcomes between medical and surgical settings, and identify relationships between RRS context and mechanism variables for patient outcomes. Study RRS data was collected retrospectively from a 397-bed community hospital in the Midwest; including all adult inpatient RRS events from May 2006 (2 weeks post-RRS implementation) through November 2013. RRS events were analyzed through descriptive, comparative, and proportional odds (ordinal) logistic regression analyses. The study found the majority of adult inpatient RRS events occurred in medical settings and most were activated by staff nurses. Significant differences were noted between RRS events in medical and surgical settings; including patient status changes in the preceding 12 hours, event trigger patterns, and immediate clinical outcomes. Finally, proportional odds logistic regression revealed significant relationships between context and mechanism factors with changes in the risk of increased clinical severity immediately following at RRS event. RE was utilized to structure a preliminary study to explore the complex variables and relationships surrounding RRSs and patient outcomes. Further exploration of settings, changes in clinical status, staffing and resource access, and the ways nurses use RRSs is necessary to promote the early identification of vulnerable patients and strengthen hospital patient safety strategies.

Thesis (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management; and, (S.M.)--Massachusetts Institute of Technology, Engineering Systems Division; in conjunction with the Leaders for Global Operations Program at MIT, 2013.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 91-92).
The motivation for multi-echelon supply chain management at Nike is to more cost-effectively accommodate customer-facing lead time reduction in the rapid-response replenishment business model. Multi-echelon inventory management, as opposed to a traditional finished-goods only philosophy, provides two clear benefits to a make-to-stock supply chain: first, it increases flexibility through staging calculated work-in-process inventory buffers at critical supply chain links and allowing postponed identification of finished goods; second, inventories held as work-in- process are typically carried at lower cost than finished goods. This thesis details the completion of a project intended to improve Nike's ability to determine optimal inventory levels by balancing cost and service level tradeoffs in a multi-echelon-enabled environment. The goal is to develop an inventory modeling methodology for Nike's supply chain data architecture specifically to evaluate the hypothesis that multi-echelon inventory management will present only limited opportunity for cost reduction in offshore, long lead time make-to-stock supply chains. To directly asses the hypothesis, Llamasoft's Supply Chain Guru optimization software will be deployed to create an inventory optimization model for a specific family of apparel products sold as part of Nike's replenishment offering in North America. The modeling results confirm the hypothesis that multi-echelon inventory management offers little value to the current offshore supply chain. Sensitivity and scenario analysis is utilized to identify significant inventory drivers, areas for substantial improvement, and profitable opportunities for multi-echelon inventory management.
by Robert Giacomantonio.
S.M.
M.B.A.

Rapid response systems (RRSs) have been developed and implemented with the aim of improving recognition of and response to deteriorating patients. However, there is little evidence to support the effectiveness of such systems. A recurring theme within the clinical literature is that these systems are not activated or used effectively by nursing staff and the reasons for this are not fully understood. The practices of nurses who used an RRS are explored in this thesis. Ward patients also appear to be more vulnerable to deterioration in the hosptial after-hours; in response to this, a number of patient safety initatives have been developed. One of these initiatives is an after-hours nurse-led RRS, a service run by Advanced Practice Nurses (APNs). To date, there has been limited exploration of the impact of this patient safety intiative on patient outcomes. Whether the introduction the APN after-hours service improved patient outcomes is also explored in this thesis. To develop in-depth knowledge and understanding of this contemporary and complex area of clinical practice, a single exploratory case study with two separate units of analysis was used. The context of the case was a large teaching hospital in Queensland; the case was the deteriorating ward patient. The first unit of analysis was nurse’s practices of using an RRS. The second unit of analysis was patient outcomes. In the first unit of analysis, 15 registered nurses who had cared for a deteriorating ward patient were interviewed about their practices of using an RRS and the resulting transcripts were thematically analysed. Four themes relating to participants experiences and perceptions of RRSs emerged from the data. These themes were: (1) sensing clinical deterioration; (2) resisting and hesitating; (3) pushing the button; and (4) reflecting on the Medical Emergency Team (MET).
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Nursing and Midwifery
Griffith Health
Full Text

Includes supplemental material.
Disaster relief operations, such as the 2005 Tsunami and Hurricane Katrina, and wartime operations, such as Operation Enduring Freedom and Operation Iraqi Freedom, have identified the need for a standardized command and control system interoperable among Joint, Coalition, and Interagency entities. The Systems Engineering Analysis Cohort 9 (SEA-9) Rapid Response Command and Control (R2C2) integrated project team completed a systems engineering (SE) process to address the military’s command and control capability gap. During the process, the R2C2 team conducted mission analysis, generated requirements, developed and modeled architectures, and analyzed and compared current operational systems versus the team’s R2C2 system. The R2C2 system provided a reachback capability to the Regional Combatant Commander’s (RCC) headquarters, a local communications network for situational assessments, and Internet access for civilian counterparts participating in Humanitarian Assistance/Disaster Relief operations. Because the team designed the R2C2 system to be modular, analysis concluded that the R2C2 system was the preferred method to provide the RCC with the required flexibility and scalability to deliver a rapidly deployable command and control capability to perform the range of military operations.

Thesis (M.Eng.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics, 1997.
Includes bibliographical references (p. 123-127).
The MIT/Draper Technology Development Partnership Project is a two year initiative between MIT's Department of Aeronautics and Astronautics and Draper Laboratory (the funding customer) to develop an innovative, first-of-a-kind system. Through in-depth market research. concept generation. and reviews with Draper. the Wide Area Surveillance Projectile (WASP) was chosen as the lead technology demonstration project. The WASP is a gun-launched projectile in the 5"/54 NAVY to 155 mm ARMY class of munitions that transforms into a powered flight vehicle after traveling a ballistic trajectory. Once transformed, the WASP performs visual imaging reconnaissance and relays field data to the user via a Satcom or UAV signal link. This thesis covers much of the work conducted in the first year of the program. and focuses on Ballistics and aerodeceleration. Structures, and Systems Interface Design of the WASP. Although the two year timeline for the program precludes building the complete system, a series of "long-poles" are being used to demonstrate the concept functionality and feasibility for possible prototype development. These long-poles include the development of high-g composite structures, deployable flight surfaces. and a two-stroke propulsion system. as well as a virtual ground station with sensors/communications subsystems. and finally a drop-test flyer that will perform the vehicles intended mission scenario.
by Cory R.A. Hallam.
M.Eng.

Fluvial adjustment to base level change has its roots in the fundamental concepts of geomorphology. This thesis explores the rate of erosion and sedimentation on the Colorado and Dirty Devil rivers and North Wash Creek under the current base level changes related to the drawdown conditions of Lake Powell. Through cross section and long profile resurveys, the current state of each system is captured and added to the historic record of sedimentation in Lake Powell. All three systems are generally forming narrow and deep incised channels driven by the rapid rate of base level fall. Cross sections that deviate from this are due to site-specific factors, such as channel armoring, the presence of local base levels, or bedrock canyon width in relation to active channel width. In all systems, sediment is being transported through the establishing fluvial regime and is deposited at or below the new base level. This has caused rapid downstream progradation of each delta front. The volume of sediment accumulation and erosion and rates through time are calculated for each system. Deposit volume is proportional to each systems drainage basin area, as are the rates and magnitudes of deposition and erosion. The percentage of sediment eroded versus deposited shows an inverse relationship, with North Wash eroding the greatest percentage of its delta. Field observations and repeat photography on the distribution, orientation, and activity of lateral slumping and mud cracks identify that thick beds of fine-grained and cohesive silts and clays are necessary for these features to form. These features act to destabilize sediment and, in the case of bank failure, deliver it directly to the channel.

Thesis (M.Eng.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics, 1997.
Includes bibliographical references (p. 69).
The Rapid-Response Surveillance System (also known as WASP or Wide Area Surveillance Projectile) was developed within the context of the MIT/Draper Technology Development Partnership Project, which had as its aims the development of a first-of-a-kind system within a time-frame of two years and the development of an entrepreneurial spirit in the participating engineering students at MIT. After some studies, the final concept consisted of a integrated shell-flier system, known as the Super-Shell. After being launched from a standard Army or Navy gun, the shell would deploy a parachute during the ballistic trajectory, to de-spin and slow down. Aerodynamic surfaces (wings and tails) would deploy out of the shell, and the flier would conduct a 15-minute surveillance mission, recording images with a visual sensor, and sending them back to a ground station. In the aerodynamic analysis and modeling, this report shows the trade studies performed in selecting the best aerodynamic configuration in terms of performance and stability. The propulsion system selection is an integral part of the aerodynamic performance, and a propeller driven by an electric motor was selected. In the static and dynamic stability analysis, the aerodynamic configuration was modeled and analyzed using existing software, to provide sufficient control for a flexible mission.
by David Iranzo-Greus.
M.Eng.

Akutsjuksköterskans roll är att tillhandahålla omedelbar vård till människor eller att utföra en omvårdnadsåtgärd som kan förhindra att en nödsituation uppstår. Akutsjuksköterskan ska leda, initiera och samordna patientvården. Faktorer som påverkar patientsäkerheten är ledarskapet, att arbeta i team, att arbeta evidensbaserat, kommunikation, utbildning och att arbeta patientcentrerat. Rapid response system (RRS) utvecklades för att förbättra patientsäkerheten inom akutsjukvården. Det finns fyra enheter som är grundläggande för systemet. Den afferenta komponenten som omfattar av sjuksköterskan som ansvarar för identifiering av varningssignaler för kritiskt sjuka patienter och aktivering av RRS. Till sin hjälp har sjuksköterskan ett track- and triggersystem som baseras på patientens vitalparametrar för att identifiera kritiskt sjuka patienter på avdelning. De vanligaste förekommande vitalparametrarna inom akutsjukvården är: respiration, temperatur, blodtryck, hjärtfrekvens, medvetandegrad samt urinproduktion. Den efferenta komponenten är den hjälpinsats som den afferenta komponenten tillkallar vid aktivering av RRS när avvikande vitalparametrar är observerade och genererar hög poängsumma i ett track- and triggersystem alternativt på inrådan av sjuksköterskans instinktiva känsla av att patientens tillstånd försämrats. Syftet var att belysa sjuksköterskans upplevelser av att arbeta utefter ett rapid response system och belysa dess påverkan på patientsäkerheten. Metoden som användes var litteraturöversikt. Databassökningar gjordes i PubMed, CINAHL och Web Of Science, vilket resulterade i att 16 artiklar inkluderades i studien. Inklusionskriterier som användes var att artikeln skulle vara publicerad på engelska, ’peer- reviewed’ och publicerade i vetenskapliga tidskrifter mellan år 2006–2016. En integrerad analysmetod användes för att finna likheter och skillnader i resultatet. I resultatet framkom det att RRS ökade identifieringen av kritiskt sjuka patienter och flertalet artiklar konstaterade att RRS minskade antalet hjärtstopp och oväntade dödsfall. I resultatet framkom svårigheter och begränsningar med att arbeta utefter RRS så som otillräcklig kompetens, hög arbetsbelastning och hierarki. Avvikande vitalparametrar togs mer på allvar jämfört med ”tysta” förändringar. Sjuksköterskorna aktiverade systemet på grund av oro relaterat till klinisk erfarenhet, trots att vitalparametrarna var normala RRS var till hjälp att hantera kritiskt sjuka patienter och fungerade som sjukhusets 112. Avdelningssjuksköterskorna upplevde att de mestadels fick stöttning av det medicinska akutvårdsteamet men tillfällen då sjuksköterskan upplevde otrevligt bemötande påverkade det beslutsfattandet av aktivering av RRS negativt framöver. Slutsatsen av denna litteraturöversikt tyder på att RRS främjar patientsäkerheten och hjälper sjuksköterskan i sitt dagliga arbete genom att främja säker vård. Sjuksköterskans upplevelser belyser gynnsamma omständigheter och upplevda svårigheter med RRS som kan användas till vidare forskning för att utveckla systemet.
The role of the emergency nurse is to provide immediate care to patients or to perform a nursing intervention that can prevent an emergency. They should lead, initiate and coordinate patient care. Factors that affect patient safety could be leadership, working in teams, evidence-based work, communication, training, or patient-centered work. Rapid response system (RRS) was developed to improve patient safety in emergency care. There are four units that are essential for the system to function. The afferent component includes the nurse who is responsible to identify warning signs if the patient is deteriorating and activate RRS. A track-and trigger system based on the patient’s vital signs is used to assist the nurse to identify deteriorating patients on wards. The most common vital signs in emergency care are: respiration, temperature, blood pressure, heart rate, consciousness and urine production. The efferent component is the relief effort that the afferent component calls for by activating RRS when abnormal vital signs are observed and generate a high score in the track-and trigger system. Alternatively, on the advice of the nurse's instinctive feeling that the patient's condition has deteriorated. The aim of this study was to highlight nurses' experiences of applying rapid response system in their work and illustrate its impact on patient safety. The method used was a literature review. Database searches were made in PubMed, CINAHL and Web of Science, which resulted in 16 articles being included in the study. Inclusion criteria used were English language, ’peer-reviewed’ and published in scientific journals between the years 2006-2016. An integrated analysis was used to find similarities and differences in the results. The result showed that RRS increased identification of critically ill patients, resulting in reduced number of cardiac arrests and unexpected deaths and led to more patients being moved to a higher level of care. Difficulties or limitations that emerged were inadequate skills, high workload and hierarchy. Abnormal vital signs were taken more seriously compared to "silent" changes. The nurses sometimes activated the system due to concerns based on their clinical experience, despite vital signs being normal. RRS was a help to manage critically ill patients and served as the hospital's Department 112. The emergency medical team mostly supported the nurses, but sometimes they experienced negative attitudes, which affected the future activations negatively. The conclusion of this literature review indicates that RRS for patient safety could help nurses in their daily work by promoting safe care. The nurse's experiences highlight the favorable circumstances and perceived difficulties with the RRS, which could be used for further research to develop the system.

Thesis (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management; and, (S.M.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science; in conjunction with the Leaders for Manufacturing Program at MIT, 2002.
"June 2002."
Includes bibliographical references (leaves 57-60).
by Randall Bauman.
S.M.
M.B.A.

Thesis (M.Eng.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics, 1997.
Includes bibliographical references (p. 145-146).
The MIT/Draper Technology Development Partnership Project was conceived as a collaborative design and development program between MIT and Draper Laboratory. The overall aims of the two year project were to strengthen ties between the two institutions, to provide students with an opportunity to develop a first-of-a-kind system, and to foster a sense of entrepreneurship in the students working on the project. This first design team consisted of a mix of Master of Engineering and Master of Science students, along with undergraduate research assistants. The team began its work by reviewing the needs of the nation and the capabilities possessed by MIT and Draper which could be leveraged to address those needs. Candidate projects were then developed, and several were further refined through brief market assessments. Based on these assessments, a final project was chosen. The selected project, the Wide Area Surveillance Projectile (WASP), called for the development of a small, unmanned aerial vehicle which could be launched from an artillery gun to provide a rapid-response, time-critical reconnaissance capability for small military units or selected civilian applications. This thesis reviews the first year of work completed on the project. A systems view is used throughout, describing the top-level trades which were made to develop a product which would meet all of the user's needs. Specific attention is given to the interactions between the various subsystems and how these interactions contributed to the design solution developed by the team. In addition to this chronological description of the project, management lessons learned from the author's experience as project manager are presented, along with recommended approaches for future projects of a similar nature. These lessons may also find applications in the broader realm of rapid-prototyping engineering projects, as well as future projects undertaken as part of the MIT/Draper Technology Development Partnership Project.
by Joshua I. Bernstein.
M.Eng.

Environmental stress conditions can drastically affect plant growth and productivity. In contrast to soil moisture or salinity that can gradually change over a period of days or weeks, changes in light intensity or temperature can occur very rapidly, sometimes over the course of minutes or seconds. So, in our study we have taken an metabolomics approach to identify the rapid response of plants to light stress. In the first part we have focused on the ultrafast (0-90 sec) metabolic response of local tissues to light stress and in the second part we analyzed the metabolic response associated with rapid systemic signaling (0-12 min). Analysis of the rapid response of Arabidopsis to light stress has revealed 111 metabolites that significantly alter in their level during the first 90 sec of light stress exposure. We further show that the levels of free and total glutathione accumulate rapidly during light stress in Arabidopsis and that the accumulation of total glutathione during light stress is dependent on an increase in nitric oxide (NO) levels. We further suggest that the increase in precursors for glutathione biosynthesis could be linked to alterations in photorespiration, and that phosphoenolpyruvate could represent a major energy and carbon source for rapid metabolic responses. Taken together, our analysis could be used as an initial road map for the identification of different pathways that could be used to augment the rapid response of plants to abiotic stress. In addition, it highlights the important role of glutathione in initial stage of light stress response. Light-induced rapid systemic signaling and systemic acquired acclimation (SAA) are thought to play an important role in the response of plants to different abiotic stresses. Although molecular and metabolic responses to light stress have been extensively studied in local leaves, and to a lesser degree in systemic leaves, very little is known about the metabolic responses that occur in the different tissues that connect the local to the systemic leaves. These could be important in defining the specificity of the systemic response as well as in supporting the propagation of different systemic signals, such as the reactive oxygen species (ROS) wave. Here we report that local application of light stress to one rosette leaf resulted in a metabolic response that encompassed local, systemic and transport tissues (tissues that connect the local and systemic tissues), demonstrating a high degree of physical and metabolic continuity between different tissues throughout the plant. We further show that the response of many of the systemically altered metabolites could be associated with the function of the ROS wave, and that the level of eight different metabolites is altered in a similar way in all tissues tested (local, systemic, and transport tissues). These compounds could define a core metabolic signature for light stress that propagates from the local to the systemic leaves. Taken together, our findings suggest that metabolic changes occurring in cells that connect the local and systemic tissues could play an important role in mediating rapid systemic signaling and systemic acquired acclimation to light stress.

The nursing culture of an inpatient pediatric unit was resistant to activating pediatric rapid response team (PRRT) alerts despite guidelines for activation. Nurses routinely assessed patients and assigned a pediatric early warning score (PEWS); however, the level of illness severity was not interpreted consistently among nurses and a PEWS action algorithm did not exist to guide nurses' minimal actions based on the PEWS score. Guided by 3 adult learning theories (Knowles, Kolb, and Bandura) and 1 evaluation model (Kirkpatrick), this staff education project sought to educate pediatric nurses on a PEWS action algorithm and determine whether this project improved nurses' knowledge, situational awareness, and attitude toward activating PRRT alerts. A convenience sample of 30 pediatric nurses completed a preeducation knowledge survey (EKS), attended an interactive PEWS education class, and completed a postEKS. After participating in the class, correct responses on the EKS increased from 43% to 82% and, using the Wilcoxon-signed rank test, a significant increase was noted in nurses' responses to questions related to self-efficacy, factual knowledge, and application. The overall increase in the nurses' self-efficacy and knowledge about the PEWS might enhance critical-thinking skills, foster identification of patients at risk for clinical deterioration, and empower nurses to follow the PEWS action algorithm including activation of PRRT alerts when indicated. This project has the potential to effect positive social change by supporting nurses' actions designed to improve pediatric patient outcomes.

Myelin and axonal debris are cleared very slowly after injury to the adult mammalian central nervous system (CNS). This process of degeneration distal to the site of axon injury, called Wallerian degeneration, can take several weeks to months to complete in the CNS, and is thought to be due to a slow immune cell response. However, rapid myelin phagocytosis can occur in the CNS under certain conditions such as during lysophosphatidylcholine (LPC)-induced demyelination.
To understand the factors that regulate and control the immune cell responses that lead to rapid myelin phagocytosis, I first studied the cellular and molecular changes that underlie LPC-mediated demyelination in the adult mouse spinal cord. I showed that LPC induced rapid recruitment of T cells, neutrophils and monocytes, and activation of macrophages that phagocytosed myelin by two days. A substantial degree of demyelination was established by 4 days. Recruitment of the immune cells was accompanied by significant increases in expression of the cell adhesion molecules VCAM-1 and ICAM-1 in blood vessels, as well as widespread disruption of the blood-brain barrier.
I then carried out studies to assess the involvement of chemokines and cytokines in mediating the rapid immune cell responses and demyelination induced by LPC. The expression of GM-CSF, MIP-1alpha, MCP-1, and TNF-alpha mRNA was found to be increased in the mouse spinal cord early after LPC injections. To provide more direct evidence for their involvement in the immune cell response, the activity of these molecules was blocked singly or in combination using neutralizing antibodies. All four molecules were found to play a role in promoting recruitment of T cells and neutrophils, and recruitment and activation of macrophages, as well as myelin phagocytosis. In addition, MCP-1 and MIP-1alpha together were found to contribute significantly to these effects.
I then compared the expression of these two chemokines in the hemisected mouse spinal cord and cut sciatic nerve, two regions of the nervous system that have differing rates of Wallerian degeneration. The expression of MCP-1 and MIP-1alpha mRNA was upregulated in the distal segments of the peripheral nerve. In contrast, there was little if any increase in expression in regions of the spinal cord undergoing Wallerian degeneration. Direct injections of recombinant MCP-1 and MIP-1alpha into the dorsal columns of the spinal cord undergoing Wallerian degeneration resulted in rapid phagocytosis of axonal and myelin debris.
These studies demonstrate that MCP-1 and MIP-1alpha play a significant role in mediating the immune cell changes needed for rapid phagocytosis and clearance of myelin from the injured adult mammalian CNS. This work will have implications for stimulating rapid Wallerian degeneration in the CNS, as well as understanding some of the factors that may be involved in inflammatory demyelinating diseases such as multiple sclerosis.

Background Rapid response system (RRS) is a safety tool designed for early detection and intervention of a deteriorating patient on the general floor in the hospital. Obstructive sleep apnea (OSA) has been associated with significant cardiovascular complications. We hypothesized that patients with high-risk of OSA have higher rate of RRS events and intervention with positive airway pressure therapy in these patients can mitigate the RRS events. Methods As part of a clinical pathway, during a 15 month period, patients with BMI >= 30 kg/m(2) in select medical services were screened with a validated sleep questionnaire. Patients were characterized as high or low risk based on the screening questionnaire. RRS rates were compared between the groups. Subsequently the impact of PAP therapy on RRS events was evaluated. Results Out of the 2,590 patients screened, 1,973 (76%) were identified as high-risk. RRS rates calculated per 1,000 admissions, were 43.60 in the High-Risk OSA group versus 25.91 in the Low-Risk OSA Group. The PAP therapy compliant group had significantly reduced RRS event rates compared to non-compliant group and group with no PAP therapy (16.99 vs. 53.40 vs. 56.21) (p < 0.01). Conclusion In a large cohort of patients at a tertiary care hospital, we show an association of increased rate of RRS events in high-risk OSA patients and reduction of the risk with PAP intervention in the compliant group.

Per contrastare gli attacchi informatici, ogni anno in aumento e di sempre maggiore impatto, è di primaria importanza la prevenzione, attraverso la corretta configurazione dei propri sistemi, l'installazione di soluzioni per la sicurezza come firewall e antivirus e l'educazione degli utenti, sensibilizzandoli alle problematiche di sicurezza. Questo non è però sufficiente, in quanto anche la migliore delle configurazioni rimane pur sempre esposta ad eventuali vulnerabilità non ancora note e, poiché le configurazioni necessitano dell'intervento umano, non è da escludere che si commettano errori. Tutelarsi adeguatamente richiede anche un continuo monitoraggio dei sistemi alla ricerca di eventuali attività malevole che non sono state bloccate. Qualora un attacco in corso venisse rilevato, è fondamentale agire in maniera tempestiva per terminarlo ed impedirne la propagazione: i danni potenziali prodotti da un attaccante aumentano direttamente con il tempo di persistenza all'interno del sistema. Nell’ambito di questa tesi ci si è focalizzati, attraverso l'automatizzazione dell'inserimento di regole di blocco all'interno dei prodotti per la sicurezza dei clienti, sulla progettazione e lo sviluppo di un sistema robusto ed estensibile in grado di ridurre notevolmente i tempi tra il rilevamento di un attacco in corso da parte degli analisti di un “Incident Response Team” e la sua terminazione.

El treball presentat en aquesta tesi doctoral te com objectiu principal la contribució en el camp de la microbiologia per entendre el biofilms i el possible control de desenvolupament mitjançant l’ús de mètodes i enfoc multidisciplinari. Els biofilms estan definits com comunitats de microorganismes que creixen envoltats en una matriu exopolisacárida i s’adhereixen a una superfície inert o teixit viu. La formació dels biofilms bacterians tenen un gran interès en microbiologia clínica degut al desenvolupament d’infeccions que son causades pel contacte directe o per colonització de dispositius mèdics implantats i pròtesis. Actualment es consideren causa de més del 60 % de les infeccions bacterianes. El problema dels biofilms bacterians a nivell clínic es que mostren millor resistència a antibiòtics arribant inclús a ser de 500 a 5000 cops més resistents a agents antimicrobians comparant amb la mateixa bactèria planctònica (bactèria en suspensió). Hi ha hagut moltes temptatives d’adaptar mètodes a laboratoris clínics on es reprodueixen les condicions pel desenvolupament de biofilms, però encara no s’ha arribat a obtenir òptims protocols estàndard per a aquest propòsit de monitoritzar la formació i toxicitat a temps real. Ha crescut l’interès en disseny, desenvolupament i utilització de dispositius de microfluídica que poden emular els fenòmens biològics que ocorren amb diferents geometries, dinàmica de fluids i restriccions de transport de biomassa en microambients fisiològics. La recerca descrita en aquesta tesis s’ha dut a terme amb diferents mètodes “label-free” basats en la variació acústica y/o propietats elèctriques per a la monitorització de biofilms. El treball presentat en la monografia descriu un dispositiu “custom-made” per a la utilització d’Espectroscòpia de impedància electroquímica com a eina útil per a l’obtenció d’informació d’adherència i formació de biofilms. El fet d’afegir nanopartícules com a segon biosensor permet la correlació de biofilm amb la seva toxicitat a temps real per a la detecció del punt òptim de tractament de biofilms. Finalment el disseny d’aquesta tecnologia s’utilitza per l’assaig de la resposta de biofilms a antibiòtics com a model in vitro d’infeccions causades per biofilms.
El trabajo presentado en esta tesis doctoral tiene como principal objetivo la contribución en el campo de la microbiología para entender los biofilms y el posible control de desarrollo mediante el uso de métodos y enfoque multidisciplinar. Los biofilms están definidos como comunidades de microorganismos que crecen embebidos en una matriz exopolisacárida y se adhieren a una superficie inerte o tejido vivo. La formación de los biofilms bacterianos tiene un gran interés en microbiología clínica debido al desarrollo de infecciones que son causadas por contacto directo o por colonización de dispositivos médicos implantados y prótesis. Actualmente se consideran la causa de más del 60 % de las infecciones bacterianas. El problema de los biofilms bacterianos a nivel clínico es que muestran mejor resistencia a antibióticos llegando incluso a ser de 500 a 5000 veces más resistentes a agentes antimicrobianos comparado a la misma bacteria planctónica (bacteria en suspensión). Ha habido muchas tentativas de adaptar métodos a laboratorios clínicos donde se reproducen las condiciones para el desarrollo de biofilms, pero aún no se ha llegado a obtener óptimos protocolos estándar para este propósito de monitorizar la formación y toxicidad en tiempo real. Ha crecido el interés en diseño, desarrollo y utilización de dispositivos de microfluídica que puedan emular los fenómenos biológicos que ocurren con diferentes geometrías, dinámica de fluidos y restricciones de transporte de biomasa en microambientes fisiológicos. La investigación descrita en esta tesis se lleva a cabo con diferentes métodos “label-free” basados en variación acústica y/o propiedades eléctricas para la monitorización de biofilms. El trabajo presentado en esta monografía describe un dispositivo “custom-made” para la utilización de Espectroscopia de impedancia electroquímica como herramienta útil para obtener información de adherencia y formación de biofilms. El hecho de añadir nanopartículas como segundo biosensor permite la correlación de biofilm con su toxicidad en tiempo real para la detección del punto óptimo del tratamiento de biofilms. Finalmente el diseño de esta tecnología es usada para el ensayo de la respuesta de biofilms a antibióticos como modelo in vitro de infecciones causadas por biofilms.
The work presented in this thesis has the main aim to contribute in the field of clinical microbiology to understand the biofilms and the possible of development through the use of methods with multidisciplinary approach. Biofilms are defined as communities of microorganisms that grow embedded in a matrix of exopolysaccharides and adhering to an inert surface or living tissue. The formation of bacterial biofilms has an interest in clinical microbiology with the development of infections that usually arise from either direct contact or the colonization of implanted medical devices and prostheses. Currently they are considered the cause of over 60% of bacterial infections. The problem of bacterial biofilms at clinical level is showing great resistance to antibiotics, so that the biofilm bacteria are 500 to 5000 times more resistant to antimicrobial agents that the same bacteria grown in planktonic cultures (bacteria in suspension). There have been attempts to adapt methods to clinical laboratories where they reproduce the conditions of biofilms, but have not yet adopted an optimal standard protocol for this purpose to follow-up the formation and toxicity in real-time. There has been a growing interest in design, development and utilization of microfluidic devices that can emulate biological phenomena that occur in different geometries, fluid dynamics and mass transport restrictions in physiological microenvironments. The research described in this thesis deals with different label-free methods based on variation of acoustic and electric properties for biofilm monitoring. The work presented in this monograph describe a custom-made device for using electrochemical impedance spectroscopy (EIS) as useful tool to obtain information of adherence and formation of biofilms. The addition of nanoparticles as toxicity biomarker allows the correlation of biofilm formation with its toxicity in real-time for detention of the optimal point for biofilm treatment. Finally the design of this technology is used for testing the biofilm response to antibiotic as in vitro model of biofilm-related infection.

The North American monsoon (NAM) is the principal driver of summer severe weather in the Southwest U.S. With sufficient atmospheric instability and moisture, monsoon convection initiates during daytime in the mountains and later may organize, principally into mesoscale convective systems (MCSs). Most monsoon-related severe weather occurs in association with organized convection, including microbursts, dust storms, flash flooding and lightning. The overarching theme of this dissertation research is to investigate simulation of monsoon severe weather due to organized convection within the use of regional atmospheric modeling. A commonly used cumulus parameterization scheme has been modified to better account for dynamic pressure effects, resulting in an improved representation of a simulated MCS during the North American monsoon experiment and the climatology of warm season precipitation in a long-term regional climate model simulation. The effect of urbanization on organized convection occurring in Phoenix is evaluated in model sensitivity experiments using an urban canopy model (UCM) and urban land cover compared to pre-settlement natural desert land cover. The presence of vegetation and irrigation makes Phoenix a "heat sink" in comparison to its surrounding desert, and as a result the modeled precipitation in response to urbanization decreases within the Phoenix urban area and increase on its periphery. Finally, analysis of how monsoon severe weather is changing in association with observed global climate change is considered within the context of a series of retrospectively simulated severe weather events during the period 1948-2010 in a numerical weather prediction paradigm. The individual severe weather events are identified by favorable thermodynamic conditions of instability and atmospheric moisture (precipitable water). Changes in precipitation extremes are evaluated with extreme value statistics. During the last several decades, there has been intensification of organized convective precipitation, but these events occur with less frequency. A more favorable thermodynamic environment for monsoon thunderstorms is the driver of these changes, which is consistent with the broader notion that anthropogenic climate change is presently intensifying weather extremes worldwide.

Incorporation of nanoparticles (NPs) into consumer products is on the rise and human exposure to NPs is unavoidable. Currently, there is insufficient data to assess the safety of nanoparticles. I conducted a series of five studies using the zebrafish model to determine which NP components (i.e., core material or surface functionalization) contribute to biological responses and how ionic strength influences these results. The first study employed a systematic, rapid embryonic zebrafish assay to identify specific responses to precisely engineered lead sulfide (PbS-NPs) and gold nanoparticles (AuNPs) functionalized with different surface ligands. Lead sulfide nanoparticles functionalized with either 3-mercaptopropanesulfane (MT) or sodium 2,3-dimercaptopropanesulfonate (DT) ligands with nearly identical core sizes caused differential responses at the same concentration. I determined that the different responses were because MT-functionalized NPs released more soluble lead ions than DT-functionalized NPs due to different decomposition and oxidation rates. The second study investigated the different biological responses of three NPs identified during toxicity screening of a gold nanoparticle library. AuNPs functionalized with 2-mercaptoethanesulfonic acid (MES), N,N,N-trimethylammoniumethanethiol (TMAT), or 2-(2-(2-mercaptoethoxy)ethoxy)ethanol (MEEE), induced differential biological responses in embryonic zebrafish at the same concentration. Exposure to MES-AuNPs induced sublethal effects, while TMAT-AuNPs were embryo-lethal and MEEE-AuNPs were benign. Gold tissue concentration was confirmed to be similar in exposed embryos using inductively coupled-mass spectrometry. Microarrays were used to gain insight to the causes of the different responses. This approach identified that MES- and TMAT-AuNPs perturbed inflammatory and immune responses. These differential biological responses may be due to misregulated transport mechanisms causing numerous downstream defects unique to each surface functional group‟s property. In the next study, I tested the long-term consequences of developmental exposure to TMAT-, MES, and MEEE-AuNPs, and showed that MES- and TMAT-AuNPs affected larval behavior that persisted into adulthood. During the course of these investigations, I found that high ion concentration in exposure solutions results in NP agglomeration, presenting a problem for NP testing in the zebrafish model. For the fourth study, I focused on solving this by determining that zebrafish can be raised in nearly ion-free media without adverse consequences. When 3-MPA-AuNPs were dispersed in this new low ionic media, I observed adverse responses in the embryonic zebrafish toxicity assay, but not when the NPs were suspended in high ionic media. Thus, I demonstrated that the media greatly influences both agglomeration rates and biological responses, but most importantly, that the zebrafish is insensitive to external ions. The fifth study focused on the adverse response observed when embryonic zebrafish were exposed to 3-MPA-AuNPs. Exposed larvae failed to respond to a touch in the caudal fin at 120 hours post fertilization (hpf). Addition of a neuromuscular stimulus, nicotine, revealed the exposed embryos were not paralyzed, but experienced a reduction in axonal projections. A global genomic analysis (RNA-seq) using embryos exposed to 3-MPA-AuNP and MEEE-AuNPs (non-toxic control) from 6 to 120 hpf suggested that neurophysiological and signal transduction processes were perturbed. Functional analysis of the data led to the hypothesis that the most elevated gene, early growth response 1 (EGR-1), impacts axonogenesis in the caudal fin, interfering with glutaminergic synapses and preventing the connection of sensory neurons and touch perception. Although MEEE-AuNPs did not cause morphological defects, the RNA-seq analysis identified that these NPs perturbed immune and inflammatory system processes. Collectively, these results suggest that surface functional groups drive the differential responses to nanomaterials. The five studies summarized here confirm that a systems toxicological approach using the zebrafish model enables the rapid identification of structure-activity relationships, which will facilitate the design of safer nano-containing products.
Graduation date: 2013

碩士
朝陽科技大學
資訊工程系碩士班
100
In this study, The traditional control system were replaced with our homemade control system for the equipment of manufactures. Recently, research and application of PID control are more and more mature, a lot of research literatures were reported by using the PID control algorithm, including fuzzy algorithm and neural algorithms, genetic algorithms, Gray algorithmand expert system. This paper also adopts the incremental digital PID control, compared with the traditional PID controller, the incremental PID controller has the advantages of faster settling time, less oscillation, etc. In the PID controller functions listed for sale must be added to the recording equipment before the record information, or using a memory card or network transport functions of the human-machine interface, on the other hand, our studied self-made PID control system already contains the recording and network transmissionfunction control interface witha larger degree flexibility in operating.The control part of this study using a microchip system, and its sampling time is microseconds grade, compared to the millisecond rating listed for sale, in the computation of the sensitivity of the reaction, as well as information, the ability of the controllerhave improved a lot. Another advantage of this study is user-friendly design and more convenient to use, the design model believe willbe the future trend of the heating control system.

This research examines the activation of the Rapid Response Team (RRT) through the Early Warning Score (EWS) model as a system of predicting adverse event outcomes. Modeling the input parameters of this system concluded that although conventional parameters associated with EWSs were predictive,the most predictive clinical and laboratory parameters are those of hematological and nephritic function, related to the model of multi-organ system decompensation. Upon examining different EWSs, the Modified Early Warning Score exhibited superior operating characteristics, however, it was not statistically different than other common EWSs from literature. Accounting for temporal features of the dataset shows that the International Normalized Ratio is the most predictive parameter, however, the hazard model exhibits poor discriminative ability. Therefore, clinically, parameters outside the EWS models are predictive of the outcomes in question, and their incorporation into future policy would serve to better inform the prevention of adverse events.

碩士
慈濟大學
護理學系碩士班
105
Abstract Background: Institute for healthcare improvement (IHI) proposed the Rapid Response System (RRS) in order to improve the quality of medical-treatment about inpatients in 2006. The past studies about the intervention of RRS are inconsistent, including improving inpatients transferring into ICU, lowering inpatient days, and reducing readmission. Besides, the study showed that maybe the intervention of RRS can increase the rate of signing the Do Not Resuscitate, accepting palliative care and hospice care. But it still lacked for related empirical data analysis. Purpose : The purpose of the study was to explore the effects on decision-making and medical- treatment about inpatients with rapid-response system (RRS) intervention. Methods : We explored the effects by using observation study by backtracking of medical history. The samples were selected from the medical wards with rapid-response system. Data were collected in a regional teaching hospital in Yi-lan from January 1st, 2012 to February 9th, 2017. Patients without RRS from January 1st, 2012 to February 9th, 2014 were selected to be case study group, and the ones with RRS intervention from February 10th, 2014 to February 9th, 2017 were participants of the contrast samples. Percentage, mean, and standard deviation were used to analyze age, gender, and the CCI index. T-test, Chi-square test, and Mann-Whitney U test were used to know the effects on decision-making care and medical-treatment about inpatients with RRS intervention. Results: In contrast to traditional emergency group, the Rapid Response System (RRS) can monitor patients’ endanger situation earlier, increase patients’ safety and improve medical treatment quality. RRS can alarm inpatients’ worsen situation in advanced time, and decrease the death rate in Intensive Care Unit (ICU). RRS effects of patients’ medical treatment are decreasing the hospitalizing rate in ICU, increasing inpatients days in ICU, decreasing the death rate in ICU, and increasing total hospitalizing days and survival to discharged rate. After intervention of RRS, the 14-day readmission rate of patients is 16.2%. On the other side about inpatients’ care decision-making, the effect of RRS is to improve the rate of accepting palliate care. The result of this research can be the reference for the different care decision- making among clinical care, patients and family members.

碩士
國立臺灣科技大學
材料科學與工程系
99
Area-forming rapid prototyping system is also referred to as Mask Projection Stereo-Lithography (MPSLA), in which each layer is cured through only one radiation. Because of the process parameters may influence the performance of the RP machine. Therefore, in order to obtain the more precise prototype in area-forming rapid prototyping system. First, this study used the fractional factorial design to find out the significant factors in the area-forming rapid prototyping system. Second, apply the response surface methodology based on the central composite design to evaluate the regression models aim at the response variables both of prototype’s precision and processing time. Finally, construct a desirability function for each individual response variables further to obtain the optimal process parameters.

碩士
國立高雄第一科技大學
環境與安全衛生工程研究所
101
Due to development of metropolitan area with rapid economic growth, ”Mass Rapid Transit System” has been focused by Government Communications Construction. However, several problems during operational phase exist. These problems wound deviate into three parts as incident of equipment, natural incident and miss operation. The difficult and necessary of transport emergency response, transport arrangement, and equipment maintenance are enhanced by the increased number of passenger, equipment aging, and natural event due to global warming. A transport emergency response plan will be important to prevent a minor incident from becoming a disaster, save lives, prevent injuries, and minimize damage to property and the environment. Emergency treatment can avoid accidents evolved into greater losses and disaster. However the effect of emergency response plan depends on plan, efficiency, and practice. The “Disaster emergency response procedures” usually have been set for several individual events. However, a natural disaster, electricity failure, or other events may produce multiple events one after another. The commander of emergency response center encounters too limited resource and time to make a right decision. The effect of emergency response may consequently fail. This study focuses on emergency response plan for multiple incidents. According to a in-depth interview with emergency management specialist, some disasters with high risk including uncontrolled fire, electricity failure, and impairment of major equipment were discussed. AHP (analytic hierarchy process) was used to analyze the data. The results of factors weight by AHP in this study provided excellent information for commanders.

碩士
國立高雄師範大學
英語學系
105
ABSTRACT This study aimed to investigate the responses to English signs and slogans at Kaohsiung Rapid Transportation System (KRTS) for Taiwanese’s and foreigners’ responses. To be specific, their responses to English signs and slogans were compared in four dimensions, including (a) the importance of English signs and slogans, (b) the function of English signs and slogans, (c) the style of English signs and slogans, and (d) the content of English signs and slogans for Taiwanese’s and foreigners’ responses. The subjects of the study included 51 Taiwanese and 51 foreigner passengers taking KRTS were recruited. A questionnaire and interview form about KRTS’s English signs and slogans were applied as instruments. Specifically, the subject responses to the questions in a five-point scale on the questionnaire were calculated and analyzed quantitatively by an independent samples t-test and descriptive analyses. In addition, the subject responses to open-ended questions were discussed qualitatively. Based on the data analysis, the major findings of the present study were summarized as follows: 1. There are four significant differences in the responses to the importance of English signs and slogans between the Taiwanese and the foreigners. In addition, the mean scores of the foreigners are higher than that of the Taiwanese. It shows that the foreigners’ passengers think that English signs and slogans provide more than Taiwanese’s passengers about the importance and usefulness of the English signs and slogans. Furthermore, foreigner passengers hold more positive responses to showing a friendly environment and helping improve the globalization of Kaohsiung City. 2. There are four significant differences in the responses to the function of English signs and slogans between the Taiwanese and the foreigners. In addition, the mean scores of the foreigners are higher than that of the Taiwanese. It shows that the foreigners’ passengers think more than the Taiwanese that English signs and slogans help them guide the directions and entrances and exits. Other mean scores show that the foreigner passengers have more positive responses to the name of stations of KRTS, showing the features of stations of KRTS, and showing the shuttle buses or other transportations connecting KRTS than the Taiwanese passengers. 3. There are five significant differences in the responses to the style of English signs and slogans between Taiwanese’s and foreigner’s responses. In addition, the mean scores of the foreigners are higher than that of the Taiwanese. It shows that the foreigners’ passengers show more positive responses to the layout of English signs and slogans than the Taiwanese passengers. Other higher mean scores indicate that the foreigner passengers have more positive responses to (a) the color, (b) the size, and (c) the image of English signs and slogans of KRTS than the Taiwanese passengers. 4. There is no significant difference in the responses to the content of English signs and slogans between Taiwanese’s and foreigner’s responses. However, the mean scores of the content of English signs and slogans at KRTS in Taiwanese’s and foreigners’ responses are more than 4.0 and it shows that Taiwanese and foreigners are satisfied with the signs and slogans at KRTS. On the basis of study findings, the designers of English signs and slogans or the staff of KRTS can take foreigners’ demands, the English signs’ and slogans’ functions, and practices into consideration. According to the findings, they can offer some suggestions. First of all, KRTS can confirm their efforts on the importance and function of the English signs and slogans at KRTS. In this study, both Taiwanese and foreigners’ passengers are satisfied with the English signs and slogans at KRTS. Second, art designers have to take many factors into consideration when designing the style of English signs and slogans at KRTS. In this study, both Taiwanese and foreigners’ passengers are much concerned about the style of English signs and slogans at KRTS, such as the layout, color, or image. Finally, native speakers can double check the expression and spelling of English signs and slogans at KRTS. The English expression can show the vision of Kaohsiung City. By the meaningful and powerful English language on the signs and slogans at KRTS, Kaohsiung City is promoted.

Web-based learning should move away from static transmission of instruction to dynamic pages for effective interactive learning. Furthermore, automated assessment of learning should move beyond rigid quizzes or multiple-choice questions. This study describes the design, development, implementation, testing and evaluation of two prototypes of an electronic assessment tool to enhance the effectiveness of automated assessment. The tool was developed in the context of a distance-learning organisation and was built according to a development research model entailing a cyclic design-intervention-outcomes process. The first variant, E-Grader, was developed to test an algorithm for assigning marks to open-ended textual responses. The second variant, Web-Grader, was an interactive web-based extension of E-Grader. It provided immediate interactive support to students as they responded textually to content-based questions. This multi-disciplinary study incorporates principles and techniques from software engineering, formal computer science, database development and instructional design in the quest towards electronic assessment of web-based textual inputs.
Computing
M.Sc. (Information Systems)