The purpose of this study was to test several formats of end-of-life comfort instruments for patients and closely involved caregivers. Kolcaba's Comfort Theory was the theoretical framework utilized. Different response formats for two end-of-life (EOL) comfort questionnaires (for patients and caregivers, respectively), and horizontal and vertical visual analog scales for total comfort (TC) lines were compared in two phases. Evaluable data were collected from both members of 38 patient-caregiver dyads in each phase. Suitable dyads were recruited from two hospice agencies in northeastern Ohio. Cronbach's alpha for the EOL comfort questionnaire (six response Likert-type format) tested during phase I for patients was .98 and for caregivers was .97. Test-retest reliability for the vertical TC line tested during phase I for patients was .64 and for caregivers was .79. The implications of this study for nursing practice and research are derived from the American Nursing Association (ANA) position statement about EOL care, which states that comfort is the goal of nursing for this population. These instruments will be useful for assessing comfort in actively dying patients and comfort of their caregivers as well as for developing evidence-based practice for this population.

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Sandia National Laboratories and Idaho National Laboratory deployed state-of-the-art cybersecurity technologies within a virtualized, cyber-physical wind energy site to demonstrate their impact on security and resilience. This work was designed to better quantify cost-benefit tradeoffs and risk reductions when layering different security technologies on wind energy industrial control system, operational technology networks. Standardized step-by-step attack scenarios were drafted for adversaries with remote and local access to the wind network. Then, the team investigated the impact of encryption, access control, intrusion detection, security information and event management, and security, orchestration, automation, and response (SOAR) tools on multiple metrics, including physical impacts to the power system and termination of the adversary kill chain. We found, once programmed, the intrusion detection systems could detect attacks and the SOAR system was able to effectively and autonomously quarantine the adversary, prior to impacting the power system. Cyber and physical metrics indicated good network and endpoint visibility were essential to demonstrate the resilience of the system. In particular, certain hardening technologies, like encryption, reduced access to the adversaries, but recognition and response were able to ensure there was no impact to the operation of the wind site generators.INDEX TERMS wind turbine generation, cybersecurity, cyber-resilience, co-simulation, cyber-physical systems However, the control systems necessary to integrate renewable energy systems expand the attack surface by exposing

As the population ages, the elderly will account for a significant portion of surgical cases. These patients have age-related cardiovascular changes and can suffer from multiple chronic disease conditions. Congestive heart failure is a chronic condition that afflicts nearly five million Americans. It is the most common diagnosis among patients 65 years or older, with 8% to 10% of senior citizens having this chronic disease. A comprehensive understanding of the pathophysiology, assessment, and management strategies of congestive heart failure will give the orthopaedic nurse the knowledge needed to help minimize the morbidity and mortality associated with this disease.

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