Certificate Level Research Articles

PRACTICE REGARDING CARE OF ENDOTRACHEAL TUBE AMONG NURSES WORKING IN TEACHING HOSPITAL, BHARATPUR

Background: Endotracheal intubation is a most common procedure to maintain oxygenation and ventilation among the patients who admitted to critical care unit. So, meticulous care is necessary to maintain airway patency and prevent from complications. The objective of the study was to assess the practice regarding care of endotracheal tube among nurses working at teaching hospital, Bharatpur. Methods: A descriptive, cross- sectional study was conducted among 56 nurses working in critical care units of a teaching hospital, Chitwan. Sample was selected by using non probability, consecu­tive sampling technique. Data were collected through structured self-administered questionnaire to measure the socio-demographic and professional related information and observation checklist was used to measure the practice regarding care of endotracheal tube. Data were analyzed using descriptive and inferential statistics to find out the association between variables. Results: Majority (89.3%) of the nurses were above 20 years old, 71.4% of them were completed Proficiency Certificate Level, 60.7% had work experience of equal and less than one year in critical care unit and all of them participated in in-service education. Among 56 nurses, 57.1% had satis­factory level of practice regarding care of endotracheal tube. Nurses had highest mean practice score (79.55%) on suctioning and lowest score (19.22%) on cuff pressure management. Conclusions: It is concluded that nurses had marginally satisfactory level of practice regarding care of endotracheal tube. Hence, there is need to provide regular training for nurses regarding patient’s care with endotracheal tube.

Fuel Effects on Regulated and Unregulated Emissions from Three Light-Duty Euro 5 and Euro 6 Diesel Passenger Cars

<div class="section abstract"><div class="htmlview paragraph">Substantial advances in European road vehicle emissions have been achieved over the past 3 decades driven by strengthening revisions in emissions legislation and enabled by advances in fuel, vehicle engine and emissions control technologies. As both vehicle technology and emissions legislation in Europe continue to evolve, Concawe has conducted a study to examine the opportunities that fuels can provide to further reduce emissions from light-duty diesel passenger cars. Three European diesel cars spanning Euro 5, Euro 6b and Euro 6d-TEMP emissions certification levels have been tested over the cold-start WLTC (Worldwide harmonized Light-duty Test Cycle) with 6 fuels: an EN590-compliant B5 (petroleum diesel containing 5% biodiesel by volume), a bio-derived paraffinic diesel, a 50:50 blend of the aforementioned fuels, a low density petroleum-derived B5, a B30 and the same B30 additized with a high dose of cetane number improver. Results have shown that low density fuels with high hydrogen to carbon (H/C) ratio are capable of delivering benefits in tank-to-wheels CO<sub>2</sub> (carbon dioxide), CO (carbon monoxide), HC (hydrocarbons), other greenhouse gases and NO<sub>x</sub> (oxides of nitrogen), whereas no further benefits were measured in NH<sub>3</sub> (ammonia) or in PN (particle number) at the low baseline levels produced by the vehicles. Compared to B5, B30 gave a significant increase in NO<sub>x</sub> at the tailpipe from the Euro 5 car and engine-out from the Euro 6d-TEMP car but no tailpipe detriments in NOx were measurable in either of the Euro 6 cars, due to the good performance of their NOx aftertreatment devices. The latter results show that some fuel qualities previously important to control emissions such as PN or NOx have become less impactful with the latest engine technologies. The addition of cetane number improver to the B30 did not reduce NOx. The findings suggest that high H/C ratio diesel fuels could offer benefits to both emissions affecting local air quality and to greenhouse gas emissions on a tank-to-wheels basis. The addition of higher FAME (Fatty Acid Methyl Ester) levels to fuels can be used to increase renewable fuel contribution resulting in no penalty in NOx emissions from newer technology vehicles. Compatibility of these fuels with the existing vehicle fleet would require further specific consideration.</div></div>

Differentiation Strategies in the Adoption of Environmental Standards: LEED from 2000 to 2014

We study the role of vertical differentiation in the adoption of LEED (Leadership in Energy & Environmental Design), a multitier environmental building certification system. Our identification strategy relies on the timing of adoption and shows that builders seek to differentiate from each other by choosing a different certification level from previously certified buildings. A common concern in this framework is that mean-reverting behavior could be mistaken for differentiation. We develop a new method for establishing the importance of strategic interactions based on simulating from a model with independent choice and unobserved heterogeneity, and showing that such a model cannot generate the level of interaction that we observe. Finally, we estimate a model that incorporates both differentiation incentives and correlated market-level unobservables and use our estimates from this model to simulate the impact of reducing the number of LEED tiers from four to two. The simulations indicate that environmental investments depend on the location of the threshold between tiers. This paper was accepted by Bruno Cassiman, business strategy.

LEED CERTIFICATION AND PATIENT WELLBEING IN GREEN HEALTHCARE FACILITIES

ABSTRACTBeyond resource efficiencies, green buildings aim to create healthy indoor environments for building occupants. In terms of improving occupant well-being, a unique case emerges for healthcare facilities, whose patients may be at a vulnerable state. In the U.S., the Leadership in Energy and Environmental Design (LEED) rating system has become the most widely recognized certification system for green buildings, including green healthcare facilities and buildings. Hospitals with high total scores in the LEED rating system are green buildings but may not necessarily be the optimal green healthcare environment from a patient’s wellbeing perspective. Certified health-care facilities were analyzed in terms of their credit valuation to assess whether health-care facilities prioritize specific criteria that influence patient wellbeing and recovery time. Analysis of results indicate hospitals may be valuing the level of certification more than those credits that were deemed relevant for patient wellbeing and rate of recovery, either due to lack of information or due to economic constraints. To consolidate the previous results and to compare the performance of LEED certified green hospitals to the national average, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was analyzed for patients’ perspectives on the healthcare facility. Results indicate higher satisfaction in green hospitals’ overall patient care performance as well as a greater tendency to recommend green hospitals to others compared to the national average. No statistical significance was found for hospital cleanliness and quietness between green hospitals and the national average.HIGHLIGHTS

A Fraction of Recommended Practices: Implementation of the FIFA 11+ in NCAA Soccer Programs

Background and Objectives: National Collegiate Athletic Association (NCAA) soccer coaches implement numerous warm-up and flexibility strategies to prepare athletes for training and competition. The Fédération Internationale de Football Association (FIFA) developed the 11+ injury prevention program to reduce non-contact injuries. This study aimed to analyze the level of familiarity with and implementation of the evidence-based FIFA 11+ amongst NCAA Division I (DI) and Division III (DIII) men’s and women’s soccer coaches. Materials and Methods: NCAA soccer coaches in the United States received an Institutional Review Board—approved survey hyperlink. A total of 240 coaches completed the survey. The respondents represented 47.5% men’s and 52.5% women’s teams distributed within DI and DIII programs. Descriptive statistics are reported as frequency counts and mean ± standard deviation where applicable. Pearson’s chi-square tests were performed to assess potential differences with a significance level set at α < 0.05. Results: The results indicated that approximately 62% of the respondents reported being familiar with the FIFA 11+ program. Of those coaches familiar with the program, 15.0% reported full implementation, 57.5% reported partial implementation, and 27.5% reported no implementation. Chi-square analyses revealed significant differences in FIFA 11+ implementation based upon division level (χ2 = 4.56, p = 0.033) and coaching certification levels (χ2 = 13.11, p = 0.011). Conclusions: This study indicates that there is a gap between FIFA 11+ knowledge and actual implementation. To reduce the risk of non-contact injury, there is a need to educate coaches and athletic trainers on the purpose of the FIFA 11+ program and how to perform the exercises correctly.

The Importance of Professional Discourse for the Continual Advancement of Practice Standards: The RBT\xae as a Case in Point

The Behavior Analyst Certification Board (BACB®) created a third level of certification, the Registered Behavior Technician™ (RBT®) in 2014. The RBT® was created based upon the requests of stakeholders who wanted to credential those individuals who make direct contact with clients under the supervision of a Board Certified Behavior Analyst®. There has been tremendous growth in the number of RBTs® with over 60,000 individuals certified to date. The BACB® recently sent out a newsletter outlining changes to the RBT® certification, including the processes of training, supervising, and becoming an RBT®. These changes represent a number of potential concerns. The purpose of this paper is to highlight these concerns and to propose solutions to improve the RBT® certification.

Evaluating LEED commercial interior (LEED-CI) projects under the LEED transition from v3 to v4: the differences between China and the US

This study aims to assess the difference between projects from versions 3 (v3) and 4 (v4) of the Leadership in Energy and Environmental Design Commercial Interiors (LEED-CI) rating system in China and the US at the Silver and Gold certificate levels. Non-parametric statistics are used to estimate these differences. We analyze the Sustainable Sites (SS), Location and Transportation (LT), Water Efficiency (WE), Energy and Atmosphere (EA), Materials and Resources (MR), and Indoor Environmental Quality (EQ) categories for the LEED-CI Silver and Gold projects. The results show that the WE and EA categories in v3 and the WE, EA, LT, and MR categories in v4 are implemented differently in China and the US. For the LEED-CI Silver and Gold projects, the MR and EQ categories in v3 and the EQ category in v4 show similar implementation in China and the US. The LEED-CIv3 SS category shows a different result at the Gold level but the same at the Silver level when comparing China and the US. Thus, at the Silver and Gold levels of the LEED-CI projects, v4, rather than v3, provides more opportunities to highlight the environmental priorities of China and the US.

The Association of Death Notification and Related Training with Burnout among Emergency Medical Services Professionals

Introduction Death notification is a difficult task commonly encountered during prehospital care and may lead to burnout among EMS professionals. Lack of training could potentiate the relationship between death notification and burnout. The first objective of this study was to describe EMS professionals’ experience with death notification and related training. The secondary objective was to assess the associations between death notification delivery, training, and burnout. Methods: We administered an electronic questionnaire to a random sample of nationally-certified EMS professionals. Work-related burnout was measured using the validated Copenhagen Burnout Inventory. Analysis was stratified by certification level to basic life support (BLS) and advanced life support (ALS). The association between the number of adult (≥18 years) patient death notifications delivered in the prior 12 months and burnout was assessed using multivariable logistic regression to adjust for confounding variables. Multivariable logistic regression modeling was used to assess the adjusted association between training and burnout among those who reported delivering at least one death notification in the prior 12 months. Adjusted odds ratios (aOR) and 95% confidence intervals are reported (95% CI). Results: We received 2,333/19,330 (12%) responses and 1,514 were included in the analysis. Most ALS respondents (77%) and one-third of BLS respondents (33%) reported at least one adult death notification in the past year. Approximately half of respondents reported receiving death notification training as part of their initial EMS education program (51% BLS; 52% ALS) and fewer reported receiving continuing education (30% BLS; 44% ALS). Delivering a greater number of death notifications was associated with increased odds of burnout. Among those who delivered at least one death notification, continuing education was associated with reduced odds of burnout. Conclusion: Many EMS professionals reported delivering at least one death notification within the past year. Yet, fewer than half reported training related to death notification during initial EMS education and even fewer reported receiving continuing education. More of those who delivered death notifications experienced burnout, while continuing education was associated with reduced odds of burnout. Future work is needed to develop and evaluate death notification training specifically for EMS professionals.

Maintaining stability while boosting growth? The long-term impact of environmental accreditations on firms' financial risk and sales growth

PurposeIn this research, we examine the impact of ISO 14001, an international environmental management accreditation, on the long-term financial risk and sales growth of firms.Design/methodology/approachWe employ a quasi-experimental design and construct 682 treated and control firms that are matched using propensity score matching. We then test our hypotheses using the difference in difference model.FindingsWe find that, although ISO 14001 leads to lower financial risk, standard management systems such as ISO 14001 actually hinder the sales growth of firms, an unanticipated outcome. In particular, this trade-off worsens over time, becoming particularly more severe among firms that adopt ISO 14001 early and operate in less-polluting industries.Research limitations/implicationsWe present a hidden side of environmental accreditations, indicating a potential trade-off in the long-term efficacy of environmental standard management systems.Practical implicationsFirms must be cautious about adopting environmental management systems. Over time, a focus on environmental certification could potentially hinder firms' long-term growth. Firms should also be aware of certification timing and levels of industry pollution to resolve the tension in the trade-off.Originality/valueThis research is one of the first studies demonstrating that environmental accreditations result in a trade-off between reducing financial risk and improving sales growth.

An Overview of Nursing Education in Nepal

Nursing is the most valued public service leaning profession. The quality of nursing education and future of nurse remains a growing concern with international standards in Nepal. The perspective of nursing educationists reveals the scholastic, academic and practical sight to understanding of advancement in the nursing education. Nepal has been running nursing education in the Government as well as in private sectors throughout the country. Nursing education focused with changes as center of attention at the certificate level to highlight prospective functions in the public health and at the bachelor level to focus on advancement of leadership skills.&#x0D; There are many problems in the existing nursing education which need to be addressed by the concerned authority for quality nursing education in the country. Nepal Nursing Council Act has made a mandatory provision that prior to granting approval to establish and operate a nursing educational institution; the concerned body shall consult the council for establishing and operating any nursing educational institution. The continuous and routine supervision and monitoring is needed to be made from the university as well as from the Nepal Nursing Council, Ministry of Education.

LEED-CI V3 and V4 Silver and Gold Projects in China and the U.S.

Leadership in Energy and Environmental Design Commercial Interiors (LEED-CI) versions 4 (v4) and 3 (v3) Silver and Gold projects have been widely used in both the U.S. and China. This study aimed to compare the LEED-CI-Silver and LEED-CI-Gold v3 and v4 in China and the U.S. The design of the study comprised two stages: (1) to identify all LEED-CIv4 projects in China and the U.S. at the Silver and Gold levels for 2014–2019; and (2) to collect the same number of LEED-CIv3 projects for each certification level from the same cities of China and from the same states of the U.S. at the same times, if possible. Cliff’s δ or the log odds ratio effect size was used to evaluate the difference between the achieved and the possible points, and the difference between the Silver and Gold projects in China and the U.S. The results show that, in the Silver-to-Gold transition, in China, the water–energy–site–human health saving strategy was used, while in the U.S., only the water–energy saving strategy was used.

Application of Building Information Modeling in Data Center design

The constant increase in operating costs of data centers (DC) is the driving force behind innovations to increase their efficiency. Today, one of the newest ways to improve the design and functionality of data centers is the integration of building information modeling (BIM). The aim of the work is to analyze the possibilities of increasing the efficiency of the data center design stage based on the use of BIM-technologies, and the task is to design data center systems of all levels of certification of the Uptime Institute. The integration of the capabilities of BIM-technologies during design increases the efficiency of both the general design of the facility and special design indicators of data centers. This article sets out the basics of integrating BIM and data centers, a working mechanism for their interaction when designing the required level of functionality of the Uptime Institute with the design, as well as the possibility of using BIM-data from the design stage in the subsequent stages of installation and operation.

Practical issues of teaching discursive reading to foreign military personnel

The paper describes exercises for teaching discursive reading to foreign military personnel. A distinctive feature of the exercises is that they are aimed at forming cognitive strategies, metacognitive strategies and skills in discourse reading. Each group of exercises creates a certain order of actions aimed at developing persistent skills. The method of teaching discursive reading is revealed on the example of special exercises for the educational text The Russian Navy. The author has identified and justified the feasibility of using exercises in classes on Russian as a foreign language. The paper describes in detail the step-by-step work with the educational text, which involves performing a number of tasks aimed at developing all types of speech activity, as well as improving students vocabulary and grammar skills. The algorithm for working with text can be used with students of the first certification level and includes pre-text and post-text tasks for the development of discursive reading skills, as well as optimization of time spent on the acquisition of persistent skills. Special attention is paid to the ability to perceive the text from the position of a foreign language discourse, when the maximum result is determined by the culture of educational activity.

Association between green building certification level and post-occupancy performance: Database analysis of the National Australian Built Environment Rating System

This study aims to understand the improvement in building performance vis-à-vis a rise in green building certification levels. It investigated the National Australian Built Environment Rating System (NABERS), one of the few government initiatives that rates energy performance, emissions, water consumption, and indoor environment quality (IEQ) separately based on their corresponding post-occupancy data. A set of 2657 certified records of office buildings and their performance data acquired from the NABERS database were analysed. Performance indicators for the analysis were energy use intensity (EUI), emission intensity (EMI), water consumption intensity (WCI), and indoor environment quality score (IEQS). The results revealed a linear relationship between each indicator's performance data and certification level—a one-level rise reduced EUI, EMI, and WCI by 184.45 MJ/m2, 41.94 kgCO2-eq/m2, and 0.24 t/m2, respectively, per year on average. On the other hand, further rise in the level made the reduction less significant. The reduction also varied from the baseline, which is related to climatic and socioeconomic factors. This study also found that rise in IEQ and energy certification levels correspondingly raised the ratio of IEQS to EUI and EMI, indicating quality/load. Thus, compared with other major green building rating systems, NABERS could differentiate building performance more effectively using different certification levels. This study addresses the baseline issue as well and provides suggestions to improve NABERS and other green building rating systems.

Experimental and numerical methodology to obtain the probability of detection in eddy current NDT method

The scope of this paper is to define a methodology for building robust PoD curves from numerical modelling. First, an experimental database will be created in a laboratory scenario. A representative sample of inspectors with different certification levels in NDT method will be employed. Multiple inspections will be carried out to include the human influence in the MAPOD calculation. In addition, this study will take into account the impact of using different devices in the High Frequency Eddy Current method (HFEC). Then, a simulation model is created taking into consideration the main uncertainties due to human and device factors. These uncertainties are identified and quantified by the observation of experimental NDT inspection. Then, statistical distributions of these uncertainties are derived and used as inputs of the simulation model. Finally, the simulation PoD model will be compared and validated with the experimental results developed in the laboratory scenario. This comparison provided encouraging results to replace or complete experimental tests by simulation.

Comparing the Prevalence of Poor Sleep and Stress Metrics in Basic versus Advanced Life Support Emergency Medical Services Personnel

Background: Emergency medical services (EMS) personnel frequently encounter occupational factors that increase the risk of poor sleep and stress. The national prevalence of poor sleep and stress in EMS personnel is unclear, especially differences between personnel at the basic (BLS) versus advanced (ALS) life support levels. The objectives of this study were to: (1) estimate the prevalence of sleep and stress metrics in EMS personnel; and (2) compare these metrics between BLS and ALS-certified personnel. Methods: This study was a survey of recertifying nationally-certified EMS personnel working in civilian settings. Respondents completed an electronic questionnaire assessing their sleep quality; workday, non-workday, and average sleep duration; sleep debt; perceived stress; and chronic stress. Survey-weighted Poisson regression models were used to estimate adjusted prevalence ratios (PR) comparing BLS (emergency medical technician) to ALS (advanced emergency medical technician and paramedic) for each metric. Models were adjusted for age, sex, minority status, education level, EMS agency type, service type, EMS role, and significant interactions. Results: A total of 17,913 (response rate = 19%) responses were received with 17,522 included in the analysis. Adjusted PRs were significantly higher for ALS-certified personnel compared to BLS-certified for poor sleep quality (PR: 1.23, 95% CI: 1.20–1.27) and short (<7 hours) or long (≥9 hours) workday sleep duration (PR: 1.17, 95% CI: 1.15–1.19). Significant interactions were found between certification level and sex (average sleep duration) or age category (sleep debt, perceived stress, and chronic stress). The highest prevalence of short or long average sleep duration was among ALS men. Sleep debt, perceived stress, and chronic stress differed by age group between certification levels with higher PRs for ALS regardless of age group. Conclusions: There is a high prevalence of poor sleep and stress in EMS personnel, with evidence of the highest prevalence among ALS-certified personnel. Evidence of effect modification by age category and among BLS and ALS personnel suggests that interventions could target certain subgroups, such as older ALS personnel, to be most effective. Continued focus on sleep health and stress reduction is needed to improve the health and well-being of the EMS workforce.

Assessment of materials and resources credit achievements of LEED-certified buildings in Turkey based on certification levels

Assessment of materials and resources credit achievements of LEED-certified buildings in Turkey based on certification levels

Potential of Problem-Solving Flipped Classroom Instruction in teaching Internet of Things (IoT) at Community Colleges: A Needs Analysis

Flipped Classroom enables instructors to spend more time for hands-on problem-solving instruction compared to the traditional pedagogical model which involves lectures. The purpose of this study is to determine the need for a problem-solving flipped classroom module to be designed for the STM3023: Internet of Things (IoT) subject offered at the Certificate level at Malaysian Community Colleges. A structured interview was conducted with 16 lecturers from 14 Community Colleges offering the subject to obtain their views on current teaching practices along with the challenges faced in the teaching and learning of IoT to entry level students. Participants were also asked about their readiness towards the flipped classroom following an orientation session on Flipped Classroom approach. The findings showed that lecturers mostly used traditional pedagogical models in the TVET settings such as lectures. Students usually followed instructions and merely replicate the hands-on tasks as demonstrated by their lecturers in class. It was also found that students were struggling with the subject due to their lack of competency in programming and grasping electrical and electronics concepts. Students were also found to be weak in mathematics and reasoning skills, thus making it a challenge to teach IoT to them. Therefore, a myriad of media, materials and application of real-world concepts may be required to aid lecturers to improve students’ achievement in the subject. The flipped classroom approach for teaching which gives more time for hands-on problem-solving instruction may be appropriate to support lecturers to overcome the challenges in teaching IoT.

Demography of the National Emergency Medical Services Workforce: A Description of Those Providing Patient Care in the Prehospital Setting

Background The emergency medical services (EMS) workforce is a key component of healthcare in the U.S. Characteristics of active EMS professionals who are treating patients in the prehospital setting is unclear. The purpose of this study was to describe the roles and settings in which nationally certified EMS professionals are providing patient care and to evaluate similarities and differences of the demographics and practice settings of the three major certification levels. Methods We conducted a cross-sectional evaluation of all nationally certified EMS professionals in the U.S. that recertified between October 1, 2017 and March 31, 2018 and October 1, 2018 and March 31, 2019. Within the recertification application, EMS professionals completed an optional demographic profile. Those who were nationally certified, functioning as a patient care provider for at least one nonmilitary EMS organization, aged 18 to 85 years, and recertified at the EMT level or higher were included. Demographic, agency and job characteristics were assessed and descriptive statistics were calculated. Results In 2017-2018, 101,363 EMS professionals recertified and 87,471 (86%) completed the profile; in 2018-2019, 106,893 EMS professionals recertified and 92,640 (87%) completed the profile. Of the 142,751 EMS professionals who met inclusion criteria, the population was primarily male (76%) and age increased by certification level. By race/ethnicity, 85% were white, 5% were Hispanic/Latino, 5% were Black/African American, 2% were American Indian/Alaskan Native, 2% were Asian and 1% were Native Hawaiian/Pacific Islander. Paramedics had the highest proportion of associate degrees (EMT:16.0%; AEMT:16.6%; paramedic:28.5%); some college experience was common for all certification levels (EMT:34.7%; AEMT:37.2%; paramedic:31.6%). Most EMS professionals reported 3-7 years of experience, were working full-time (78%) and 28% were working for 2 or more agencies. Most were working for a fire department (48%) or private agency (21%) and providing 9-1-1 service (72%). No substantial differences were observed between the two recertification cycles. Conclusion This is the most comprehensive study evaluating the demographics of the national EMS workforce of active patient care providers. Understanding the characteristics of EMS professionals and the settings they practice in is important for educational and training initiatives, as well as protocols and policies.

Can buzzing bring business? Social interactions, network centrality and sales performance: An empirical study on business-to-business communities

Online business-to-business (B2B) help businesspeople to obtain heterogeneous work-related knowledge, develop social ties, and bring in business beyond the constraints of offline local contexts. However, knowledge of whether and how social interactions in B2B communities affect the business performance of community members is limited. The authors used social capital theory and social exchange theory to fill this gap in the research. Based on data from an online B2B community, the authors first examined how the characteristics of members’ social interactions influenced their online sales performance. The results showed that social interaction positively affected sales performance and that this relationship was mediated by the network centrality of the community members. The authors also found that the third-party certification level of the e-vendors represented by the community members positively moderated the influence of the members’ social interactions on their network centrality.